Suicidal behavior in depressive or bipolar disorders

A part of this thesis examined within the Helsinki University Psychiatric Consortium (HUPC) study explanatory factors for lifetime suicidal ideation or suicide attempts among patients with depressive or bipolar disorder in psychiatric care. Another part is a national register-based study investigating risk for suicide, its time trends and risk factors among first-hospitalized patients for depression. HUPC study is based on a random secondary-care sample of 287 patients with either depressive or bipolar disorder in the Helsinki metropolitan area. Lifetime principal clinical diagnoses were used. Patients were surveyed on multiple putative risk factors from multiple domains. Information on lifetime suicidal behavior was based on survey and patient record data. Of the HUPC cohort, 34% reported lifetime suicidal ideation and 45% had attempted suicide. Strongest explanatory factors for suicidal ideation without attempts were younger age, severe depressive disorder, type II bipolar disorder, and hopelessness. Strongest explanatory factors for suicide attempts were younger age, female sex, and severe depressive disorder with and without psychotic symptoms, type II bipolar disorder, alcohol dependence, and borderline personality disorder traits. In addition, childhood physical abuse independently explained lifetime suicidal ideation and suicide attempts. Borderline personality disorder traits mediated all of the total effect of childhood maltreatment on suicide attempts. A national cohort of 56 826 first-hospitalized patients for depression in 1991-2011 was followed on the registers up to the end of the year 2014 (maximum 24 years). The study linked individual level data from national registers. During the follow-up 2587 patients died by suicide. The cumulative risk for suicide was 8.6% in men and 4.1% in women. The risk for suicide was less than half among patients first hospitalized in 2006-2011 relative to patients first hospitalized in 1991-1995. The incidence rate was highest during the first year after discharge (2305 per 100 000 person-years in men, 973 per 100 000 person-years in women). Strongest predictors for suicide were male sex and previous suicide attempts. Among patients with previous suicide attempts, the cumulative probability for suicide was 15.4% in men and 8.5% in women. Other predictors were severe depression, psychotic depression, alcohol dependence, living alone, and higher socioeconomic status. Some gender differences in risk factors were found. Men died markedly more often than women by potentially more lethal methods. To conclude, risk factors for suicidal ideation and suicide attempts overlap, and may differ both qualitatively and quantitatively. Suicidal ideation is explained by depressive morbidity, hopelessness, and childhood physical abuse. Suicide attempters are characterized by more severe clinical characteristics and factors related to a predisposition to act on one’s thoughts. Borderline personality disorder traits may act as a major mediating factor between childhood maltreatment and suicide attempts. The cumulative risk of suicide in depression varies with time and contextual changes. The risk for suicide has declined substantially among former inpatients in Finland from 1991 to 2014. The first year after discharge forms a high-risk period. Clinical and sociodemographic characteristics predict long-term risk of suicide. Previous suicide attempters are at high-risk. Gender differences in risk factors are modest. The choice of potentially more lethal methods by men may explain men’s excess risk.Suomenkielinen tiivistelmä lähetetään erikseen

The effects of mandatory home quarantine on mental health in a community sample during the COVID-19 pandemic

Objective Major public and scientific interest exists on, whether quarantine as a containment measure, could have adverse effects on individual's mental health. We investigated psychic well-being and distress, symptoms of depression and anxiety among individuals imposed to home quarantine. Methods By total population sampling in a Finnish suburban city, a total of 57 quarantined cases (participation rate 97%) were identified and followed up for two weeks until expiration of the quarantine. A randomized control group (n = 53) was formed of people seeking laboratory testing for suspected Sars-CoV-2 infection. Primary outcome was the psychic well-being and distress experienced during quarantine measured by the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM). The cases were followed up by the Clinical Outcomes in Routine Evaluation-10 (CORE-10), Patient Health Questionnaire-9 (PHQ-9), and by the Overall Anxiety Severity and Impairment Scale (OASIS). Results The median CORE-OM score for the cases was 3.53 (95% CI: 2.23-4.66), and for the controls 3.24 (1.76-3.82), being mostly in the nonclinical to mild range. The difference between the groups was statistically nonsignificant (p = .19). Higher levels of psychic distress were explained by previous psychiatric disorders and living alone, but not having been quarantined. In comparison to controls, the quarantined participants experienced significantly, but slightly lower level of life functioning. At the follow-up, the quarantined participants rated further low on the CORE-10 (median 2.00; 95% CI: 1.00-3.00), the PHQ-9 (1.50; 0.00-3.00), and the OASIS (0.00; 0.00-0.00). Conclusions The distress associated with short-term home quarantine may not be to the degree of a mental disorder.Peer reviewe

Risk factors for suicide in depression in Finland : first-hospitalized patients followed up to 24 years

Objective To examine longitudinally risk factors for suicide in depression, and gender differences in risk factors and suicide methods. Method We linked data from (i) The Finnish Hospital Discharge Register, (ii) the Census Register of Statistics Finland, and (iii) Statistics Finland's register on causes of deaths. All 56 826 first-hospitalized patients (25 188 men, 31 638 women) in Finland in 1991-2011 with a principal diagnosis of depressive disorder were followed up until death (2587 suicides) or end of the year 2014 (maximum 24 years). Results Clinical characteristics (severe depression adjusted hazard ratio [AHR] 1.19 [95% CI 1.08-1.30]; psychotic depression AHR 1.45 [1.30-1.62]; and comorbid alcohol dependence AHR 1.26 [1.13-1.41]), male gender (AHR 2.07 [1.91-2.24]), higher socioeconomic status and living alone at first hospitalization were long-term predictors of suicide deaths. Highest risk was associated with previous suicide attempts (cumulative probability 15.4% [13.7-17.3%] in men, 8.5% [7.3-9.7%] in women). Gender differences in risk factors were modest, but in lethal methods prominent. Conclusion Sociodemographic and clinical characteristics at first hospitalization predict suicide in the long term. Inpatients with previous suicide attempts constitute a high-risk group. Despite some gender differences in risk factors, those in lethal methods may better explain gender disparity in risk.Peer reviewe

Kokkolan edustan merialueen sedimenttien toksisuus ja ekologinen riskinarviointi

Kokkolaan on keskittynyt Pohjoismaiden merkittävin metalli- ja kemian alan teollisuus. Kokkolan edustan merialuetta kuormittavat teollisuuden päästöt sekä Kokkolan kaupunki. Jätevedet sisältävät mm. raskasmetalleja sekä orgaanisia yhdisteitä. Myös Perhonjoen kautta huuhtoutuu merialueelle erityisesti ylivirtaamakausina metalleja, jotka ovat  seurausta valuma-alueen happamien sulfaattimaiden (HS-maat) kuivatuksista. Merialuetta on tarkkailtu yli 30 vuoden ajan. Teollisuuden metallipäästöt ovat tänä aikana pudonneet murto-osaan lähtötilanteesta. HS-maiden metallikuormien suhteellinen osuus on kasvanut. Eliöiden ja sedimenttien metallitasot ovat laskeneet, mutta ovat edelleen kohonneita. Pohjaeläinlajistossa on ollut viitteitä  toksisuudesta. Ympäristölainsäädäntö korostaa entistä painokkaammin tarvetta arvioida ihmisen toimista aiheutunutta ekologista haittaa. Tätä varten tulee selvittää missä määrin ekosysteemit ja niiden osat altistuvat haittatekijöille ja minkälaisia vaikutuksia altistumisesta seuraa. Tältä pohjalta voidaan arvioida riskien mittakaavaa ja merkitystä sekä suunnata ja kehittää tarkkailuohjelmia  ja ympäristönsuojelutoimenpiteitä. Osana Kokkolan edustan velvoitetarkkailuohjelmaa käynnistettiin ensimmäisen kerran vuonna 2005 ekotoksikologinen tutkimus ja ekologinen riskinarvio.   Tutkimuksessa tarkasteltiin Kokkolan edustan sedimenttien altistumista haitallisille aineille sekä niiden aiheuttamaa akuuttia ja kroonista toksisuutta. Kohteena olivat syvännepohjat, jotka käsittivät tehtaiden edustat ja ulommat kohteet  sekä Perhonjoen edustan (HS-maiden vaikutus).  Altistuksen indikaattorina olivat sedimenttien raskasmetallipitoisuudet, joita verrattiin saastuneiden maiden raja-arvoihin ja tavoitetasoihin. Akuutin toksisuuden testaukseen käytettiin valobakteeritestiä (SFS-EN ISO 11348). Kroonista toksisuutta arvioitiin surviaissääskien epämuodostumia hyödyntävällä tutkimuksella. Altistumis- ja vaikutusprofiilien yhteistarkastelun perustella laadittiin riskiarvio näyteasemittain. Uloimmassa kohteessa (n. 7 km päästölähteistä) riski oli alhainen, tehtaiden edustalla lievästi kohonnut – kohtalainen, Perhonjoen edustalla alhainen – kohtalainen. Riski oli korkea kohteessa mikä tulkittiin ruoppausmassojen vaikuttamaksi alueeksi. Tutkimus osoitti, että Kokkolan edustan merialueen sedimentissä haitallisten aineiden pitoisuudet ovat tasolla, joka aiheuttaa pohjaeläinyhteisölle paikoin merkittäviä toksisuushaittoja. Haittoja aiheuttavat sekä piste- että hajakuormitus. Haitta-aineita olivat mm. Hg, Cd, Zn ja As. Tämä tutkimus on tiettävästi ensimmäinen Suomessa tehty surviaissääskien epämuodostumista hyödyntävä tutkimus merialueelta. Määritysmenetelmä oli herkkä ja vaikutti soveltuvan myös velvoitetarkkailuna toteutettavaan haitallisten aineiden seurantaan  rannikkovesissä. Surviaissääskien keruu maastosta osoittautui kuitenkin työlääksi. Näytteistä saatujen yksilöiden pieni määrä ja epätasainen jakautuminen näyteasemien ja tutkittujen sukujen välille heikensivät tulosten luotettavuutta. Jatkossa sedimenttinäytteiden toksisuutta tulisi selvittää surviaissääskien morfologisiin häiriöihin perustuvina laboratoriotesteinä. Tällöin voidaan vakioida altistettavien eläinten määrä ja laji. Näin saadaan luotettavampi kuva toksisuushaittojen luonteesta, ajallisesta ja paikallisesta vaihtelusta ja haittojen kehityksestä. Tarkkailuja tulisi kehittää kokonainaisuutena, missä käyttö-, päästö- ja vaikutustarkkailu muodostavat ERA (Ekologinen riskianalyysi) -prosessia hyödyntävän kokonaisuuden. Painotusten tulisi vaihdella toisiaan tukien ja toksisuuden testauksen ja aineiden tunnistamisen edetä johdonmukaisesti

Whole-exome sequencing identifies novel candidate predisposition genes for familial polycythemia vera

Background: Polycythemia vera (PV), characterized by massive production of erythrocytes, is one of the myeloproliferative neoplasms. Most patients carry a somatic gain-of-function mutation in JAK2, c.1849G > T (p.Val617Phe), leading to constitutive activation of JAK-STAT signaling pathway. Familial clustering is also observed occasionally, but high-penetrance predisposition genes to PV have remained unidentified. Results: We studied the predisposition to PV by exome sequencing (three cases) in a Finnish PV family with four patients. The 12 shared variants (maximum allowed minor allele frequency G (p.Phe418Leu) in ZXDC, c.1931C > G (p.Pro644Arg) in ATN1, and c.701G > A (p.Arg234Gln) in LRRC3. We also observed a rare, predicted benign germline variant c.2912C > G (p.Ala971Gly) in BCORL1 in all four patients. Somatic mutations in BCORL1 have been reported in myeloid malignancies. We further screened the variants in eight PV patients in six other Finnish families, but no other carriers were found. Conclusions: Exome sequencing provides a powerful tool for the identification of novel variants, and understanding the familial predisposition of diseases. This is the first report on Finnish familial PV cases, and we identified three novel candidate variants that may predispose to the disease.Peer reviewe

Path-Following With LiDAR-Based Obstacle Avoidance of an Unmanned Surface Vehicle in Harbor Conditions

This article studies the design, modeling, and implementation challenges of a path-following with obstacle avoidance algorithms as guidance, navigation, and control (GNC) architecture of an unmanned surface vehicle (USV) in harbor conditions. First, an effective mathematical model is developed based on system identification, validating the USV model with field-test data. Then, a guidance system is addressed based on a line-of-sight algorithm, which uses a LiDAR as the main perception sensor for the obstacle avoidance algorithm. The GNC architecture uses a modular approach, including obstacle detection, path-following, and control in the USV platform. Finally, an implementation challenge in two control scenarios, simulation and field test, is addressed to validate the designed GNC architecture.acceptedVersionPeer reviewe

Features of borderline personality disorder as a mediator of the relation between childhood traumatic experiences and psychosis-like experiences in patients with mood disorder

Background: Psychosis-like experiences (PEs) are common in patients with non-psychotic disorders. Several factors predict reporting of PEs in mood disorders, including mood-associated cognitive biases, anxiety and features of borderline personality disorder (BPD). Childhood traumatic experiences (CEs), often reported by patients with BPD, are an important risk factor for mental disorders. We hypothesized that features of BPD may mediate the relationship between CEs and PEs. In this study, we investigated the relationships between self-reported PEs, CEs and features of BPD in patients with mood disorders. Methods: As part of the Helsinki University Psychiatric Consortium study, McLean Screening Instrument (MSI), Community Assessment of Psychic Experiences (CAPE-42) and Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n = 282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, multiple regression and mediation analyses were conducted. Results: Total scores of MSI correlated strongly with scores of the CAPE-42 dimension "frequency of positive symptoms" (rho = 0.56; p Conclusions: Self-reported cognitive-perceptual symptoms of BPD fully mediate, while affective, behavioural and interpersonal symptoms only partially mediate the relationships between CEs and PEs. Recognition of co-morbid features of BPD in patients with mood disorders reporting PEs is essential. (c) 2017 Elsevier Masson SAS. All rights reserved.Peer reviewe

Improvement and uncertainty evaluation of a 1 MV lightning impulse measurement system

publishedVersionPeer reviewe

Equations of State in Fighter Aircraft Oleo-pneumatic Shock Absorber Modelling

Most of all modern commercial and military aircraft have oleo-pneumatic shock absorbers in their landing gear. An oleo-pneumatic shock absorber consists of a gas charge and an oil fill. During the stroke oil is forced through orifices which provides damping, while the gas charge is compressed and acts as a spring by increasing the stiffness of the shock absorber. Typically, when the gas behaviour is modelled, the ideal gas law is used as the equation of state as this provides in most cases adequate fidelity with relatively light computational load. However, in a fighter aircraft, especially in naval service, the gas pressure inside a shock absorber raises too high during landing for the ideal gas assumption to be valid. Therefore, other well-established equations of state have been considered. These are Van der Waals, Redlich-Kwong-Soave, and Peng-Robinson equation of state. This paper presents a multi-physics simulation model of a two-chamber oleo-pneumatic shock absorber based on fundamental analytical equations. Using this model, the behaviour of the aforementioned equations of state are studied in two cases: quasi-static and dynamical compression. The simulation results are compared to laboratory measurements. This comparison verifies that the ideal gas law should not be used when modelling naval fighter aircraft shock absorbers.publishedVersionPeer reviewe

Proceedings of the 1st Annual SMACC Research Seminar 2016

The Annual SMACC Research Seminar is a new forum for researchers from VTT Technical Research Centre of Finland Ltd, Tampere University of Technology (TUT) and industry to present their research on the area of smart machines and manufacturing. The 1st seminar is held on 10th of October 2016 in Tampere, Finland. The objective of the seminar is to publish results of the research to wider audiences and to offer researchers a new forum for discussing methods, outcomes and research challenges of current research projects on SMACC themes and to find common research interests and new research ideas. Smart Machines and Manufacturing Competence Centre - SMACC is joint strategic alliance of VTT Ltd and TUT in the area of intelligent machines and manufacturing. SMACC offers unique services for SME`s in the field of machinery and manufacturing – key features are rapid solutions, cutting-edge research expertise and extensive partnership networks. SMACC is promoting digitalization in mechanical engineering and making scientific research with domestic and international partners in several different topics (www.smacc.fi)