Psychiatric diagnoses, trauma, and suicidiality

BACKGROUND: This study aimed to examine the associations between psychiatric diagnoses, trauma and suicidiality in psychiatric patients at intake. METHODS: During two months, all consecutive patients (n = 139) in a psychiatric hospital in Western Norway were interviewed (response rate 72%). RESULTS: Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma for longer periods of time. Only 7% acquired a PTSD diagnosis. The comorbidity of PTSD and other psychiatric diagnoses were 78%. A number of diagnoses were associated with specific traumas. Sixty-seven percent of the patients reported suicidal thoughts in the month prior to intake; thirty-one percent had attempted suicide in the preceding week. Suicidal ideation, self-harming behaviour, and suicide attempts were associated with specific traumas. CONCLUSION: Traumatised patients appear to be under- or misdiagnosed which could have an impact on the efficiency of treatment

Number of addictive substances used related to increased risk of unnatural death: A combined medico-legal and case-record study

<p>Abstract</p> <p>Background</p> <p>Substance use disorders have repeatedly been found to lead to premature death, i.e. drug-related death by disease, fatal intoxications, or trauma (accidents, suicide, undetermined suicide, and homicide). The present study examined the relationship between multi-drug substance use and natural and unnatural death.</p> <p>Methods</p> <p>All consecutive, autopsied patients who had been in contact with the Addiction Centre in Malmö University Hospital from 1993 to 1997 inclusive were investigated. Drug abuse was investigated blindly in the case records and related to the cause of death in 387 subjects.</p> <p>Results</p> <p>Every substance apart from alcohol used previously in life added to the risk of unnatural death in a linear way. There were independent increased risks of fatal heroin overdoses or undetermined suicide. Death by suicide and violent death were unrelated to additional abuse.</p> <p>Conclusion</p> <p>The number of drugs used was related to an increased risk of unnatural death by undetermined suicide (mainly fatal intoxications) and heroin overdose.</p

Suicidal Behavior and Alcohol Abuse

Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide. We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases. Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns. Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence. People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality. Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns

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Post-traumatic stress disorder and suicidal behaviour in immigrants to Sweden

The aim of the investigation was to study definite & undetermined suicides in immigrants toSweden, as well as aspects of suicidal behaviour associated with Post-traumatic stress disorder(PTSD) among immigrants/refugees. We have also inquired in which modality immigrantsuicide victims had been in contact with psychiatric care. Likewise, psychosocial andsocioeconomic factors were studied with respect to differences in the suicide rate betweenimmigrants and native Swedes. The problem of the high number of undetermined forensicdiagnoses on suicide (UMSA) in Sweden, was also investigated. We tested the hypothesis thatUMSA and definite suicides may differ in positive blood alcohol analysis at autopsy (BAC)or in patho-anatomic autopsy findings associated with chronic alcohol consumption, beingthis possible difference ethnically-culturally related. Another aim was the study of suicidalbehaviour among refugees with post-traumatic stress disorder, PTSD (the study hypothesisbeing that the nature of certain trauma stressors, such as torture methods, would be reflectedin the content of post-traumatic self-destructive ideation). We also investigated whethercultural bias is determinant in the suicidal behaviour among refugees with PTSD. Immigrants were overrepresented in the Swedish suicide statistics (X2= 45.4, p = 0.0001) 15countries (60% of immigrant pop.) manifested more observed than expected cases. Thisoverrepresentation was statistically significant among immigrants from Russia, Finland,Germany, Denmark and Norway. The risk for an immigrant to die of a cause related tosuicide is 1.8 times higher than for a native Swede. Further, the increased suicide ratesobserved among the immigrant groups in Sweden, was found to be higher than in therespective countries of origin in 90% of the nationalities investigated (paired t-Test t = -3.8; p= 0.01), the rank order being generally the same in both the countries of origin and inSweden (Spearman rank correlation 0.74; p = 0.01). On the other hand, a covariationbetween suicide and immigrant status, unfavourable socioeconomic conditions and lack ofpsychiatric care was found. Immigrants are poorly represented in the psychiatric care ascompared with the native Swedish suicide victims; the proportion of psychiatric consultationsresulting in admissions was significantly lower among immigrants than among native Swedes(X2= 7, p = 0.008). These reports may thus be interrelated with the separate finding thatimmigrants are overrepresented in the suicide statistics for low income areas. With respect toforensic-diagnostics, non-Swedish nationality in the victim and high BAC/signs of alcoholabuse at autopsy did show to convey difficulties for the forensic pathologist to establish themode of death with optimal certainty Among suicide and UMSA cases, BAC differedsignificantly among the different ethnic groups (ANOVA, F = 3.50, p < .03). Comparison ofmean levels using the Fisher PLSD test showed significantly higher alcohol concentrations inFinnish immigrants than in either native Swedes or in immigrants from other groups. Thestudy has also suggested the identification of a new epidemiological subgroup in suicidalbehaviour, metasuicide. PTSD was found to prevail in 78% of all refugee cases with a history of trauma. Theprevalence of suicidal behaviour was significantly greater among refugees with PTSDdiagnoses than among the remainder no-PTSD cases (p = 0.04). The high frequency ofaffective symptoms found in our PTSD sample suggest that the increased suicidal behaviourmay be related also to depressive states. Among PTSD patients with a history of torture, arelationship appeared to exist between the torture methods that the victim had been exposedto, and the suicide method used in fantasies or attempts. The majority (78%) among thePTSD refugees with increased suicidal behaviour did not regard religious proscription asdeterrent of suicidal behaviour. Another noteworthy finding in the present study was thatsuicidal behaviour did not differ significantly between asylum applicants and refugeesgranted residence permits. The findings in this study indicate that immigrant status should be considered a potential suicide risk factor in Sweden.Key words: transcultural psychiatry, suicide, metasuicide,immigrants, refugees, post-traumatic stress disorder ISBN 91-628-1984-