Viewing the body after bereavement due to suicide: a population-based survey in Sweden.

BACKGROUND: Research on the assumed, positive and negative, psychological effects of viewing the body after a suicide loss is sparse. We hypothesized that suicide-bereaved parents that viewed their childs body in a formal setting seldom regretted the experience, and that viewing the body was associated with lower levels of psychological morbidity two to five years after the loss. METHODS AND FINDINGS: We identified 915 suicide-bereaved parents by linkage of nationwide population-based registries and collected data by a questionnaire. The outcome measures included the Patient Health Questionnaire (PHQ-9). In total, 666 (73%) parents participated. Of the 460 parents (69%) that viewed the body, 96% answered that they did not regret the experience. The viewing was associated with a higher risk of reliving the child's death through nightmares (RR 1.61, 95% CI 1.13 to 2.32) and intrusive memories (RR 1.20, 95% CI 1.04 to 1.38), but not with anxiety (RR 1.02, 95% CI 0.74 to 1.40) and depression (RR 1.25, 95% CI 0.85 to 1.83). One limitation of our study is that we lack data on the informants' personality and coping strategies. CONCLUSIONS: In this Swedish population-based survey of suicide-bereaved parents, we found that by and large everyone that had viewed their deceased child in a formal setting did not report regretting the viewing when asked two to five years after the loss. Our findings suggest that most bereaved parents are capable of deciding if they want to view the body or not. Officials may assist by giving careful information about the child's appearance and other details concerning the viewing, thus facilitating mental preparation for the bereaved person. This is the first large-scale study on the effects of viewing the body after a suicide and additional studies are needed before clinical recommendations can be made

Psychological morbidity among suicide-bereaved and non-bereaved parents: a nationwide population survey.

OBJECTIVE: To determine how psychological premorbidity affects the risk of depression in parents who lost a child through suicide. DESIGN: Population-based survey. SETTING: Sweden, between 2009 and 2010. PARTICIPANTS: All parents who lost a child, age 15-30, through suicide between 2004 and 2007 according to National population registries. Non-bereaved parents matched for age, sex, living area, marital status, number of children. EXCLUSION CRITERIA: born outside a Nordic country, not Swedish speaking, contact details missing. Participants: 666 of 915 (73%) suicide-bereaved and 377 of 508 (74%) non-bereaved parents. MAIN OUTCOME MEASURES: Depression measured by the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) and study-specific questions to assess psychological premorbidity and experience of the child's presuicidal morbidity. RESULTS: In all, 94 (14%) suicide-bereaved and 51 (14%) non-bereaved parents (relative risk 1.0; 95% CI 0.8 to 1.4) had received their first treatment for psychological problems or had been given a psychiatric diagnosis more than 10 years earlier. The prevalence of moderate-to-severe depression was 115 (18%) in suicide-bereaved versus 28 (7%) in non-bereaved parents (RR 2.3; 95% CI 1.6 to 3.5). For those without psychological premorbidity, the relative risk was 2.3 (95% CI 1.4 to 3.6). 339 (51%) suicide-bereaved parents expressed worry over the child's psychological health during the month preceding the suicide and 259 (39%) had anticipated the suicide. CONCLUSIONS: In parents who lost a child through suicide in Sweden we did not find a higher prevalence of long-term psychological premorbidity than among parents who had not lost a child; the more than twofold risk of depression among the bereaved can probably be explained by the suicide and the stressful time preceding the suicide

Depression among Parents Two to Six Years Following the Loss of a Child by Suicide: A Novel Prediction Model.

BACKGROUND: Parents who lose a child by suicide have elevated risks of depression. No clinical prediction tools exist to identify which suicide-bereaved parents will be particularly vulnerable; we aimed to create a prediction model for long-term depression for this purpose. METHOD: During 2009 and 2010 we collected data using a nationwide study-specific questionnaire among parents in Sweden who had lost a child aged 15-30 by suicide in years 2004-2007. Current depression was assessed with the Patient Health Questionnaire (PHQ-9) and a single question on antidepressant use. We considered 26 potential predictors assumed clinically assessable at the time of loss, including socio-economics, relationship status, history of psychological stress and morbidity, and suicide-related circumstances. We developed a novel prediction model using logistic regression with all subsets selection and stratified cross-validation. The model was assessed for classification performance and calibration, overall and stratified by time since loss. RESULTS: In total 666/915 (73%) participated. The model showed acceptable classification performance (adjusted area under the curve [AUC] = 0.720, 95% confidence interval [CI] 0.673-0.766), but performed classification best for those at shortest time since loss. Agreement between model-predicted and observed risks was fair, but with a tendency for underestimation and overestimation for individuals with shortest and longest time since loss, respectively. The identified predictors include female sex (odds ratio [OR] = 1.84); sick-leave (OR = 2.81) or unemployment (OR = 1.64); psychological premorbidity debuting during the last 10 years, before loss (OR = 3.64), or more than 10 years ago (OR = 4.96); suicide in biological relatives (OR = 1.54); with non-legal guardianship during the child's upbringing (OR = 0.48); and non-biological parenthood (OR = 0.22) found as protective. CONCLUSIONS: Our prediction model shows promising internal validity, but should be externally validated before application. Psychological premorbidity seems to be a prominent predictor of long-term depression among suicide-bereaved parents, and thus important for healthcare providers to assess

Mortality and cancer incidence following cerebral angiography with thorotrast

Epidemiological studies are important tools in assessing radiation-related health effects in humans. The most common form of radiation exposure is low-dose alpha-radiation such as that from radon. However, the long-term health effects of low-dose radiation are incompletely known. Studies of patients exposed to Thorotrast provide valuable information, since the administration of this radioactive contrast medium resulted in lifelong exposure to alpha particles at a low dose rate. Thorotrast was used worldwide for visualization of vascular structures from about 1930 to the beginning of 1950. It proved to be one of the most carcinogenic substances ever utilized in medical practice, causing very high rates of liver cancer. In Sweden, 1,115 patients were exposed to Thorotrast through cerebral angiography performed between 1932-48. The principal objective of these studies was to evaluate associated health effects. Incident cancers (paper IV and V) and site-specific causes of death (paper I-II) compared to the general population were assessed through the Swedish Cancer and Cause of Death Registers (SCR and SCDR) for the exposed patients alive when these registers were started. A comparison group of 1,058 sex- and age-matched non-exposed patients admitted to the same medical departments during the same period of time was selected for Cox regression analyses of the influence of time and volume on mortality and cancer incidence (paper II and V). The influence of underlying diseases, gender, time since injection, volume of Thorotrast, occupation, and lifestyle factors were investigated (paper V). Cohorts of Thorotrast-exposed in Sweden, Denmark, and the United States were combined to perform a pooled analysis of mortality among 1,736 exposed patients (paper III). Patients exposed to Thorotrast had a significant three-fold increase in overall mortality compared to the general population (standardized mortality ratio=SMR 2.8), with similar excesses for men and women. The largest risks were observed for deaths from benign haematological diseases, cerebrovascular disorders, liver cirrhosis, and malignant and benign tumors. Trends with time and injected volume of Thorotrast suggested an effect of cumulative radiation exposure on tumor development, gastrointestinal diseases including liver cirrhosis, and circulatory diseases. A total of 170 cancers occurring in 152 individuals were reported, whereas only 57 cases were expected in the general population. The standardized incidence ratio (SIR) was increased three-fold for cancer at all sites, with the largest excesses noted for primary liver and gallbladder cancer (SIR 39.2). Significantly increased risks were also seen for liver cancer not specified as primary, and cancers of the small intestine, stomach, kidney, pancreas, as well as leukemia. The association with time and volume showed that cumulative radiation was directly related to carcinogenesis in the liver and gallbladder, and possibly to other solid tumors and leukemia. Reducing selection and information bias by comparing the Thorotrast-exposed patients with a selected control group resulted in a reduction of the excesses in non-malignant mortality. An association between continuous radiation exposure and leukemia, cancers of the liver and gallbladder, and liver cirrhosis remained. Gender, occupation, smoking, and alcohol consumption did not influence the results. Improving statistical power in the pooled analysis gave similar results with significantly elevated all-cause mortality (relative risk=RR 1.7). Cancer, benign blood, and digestive diseases showed the highest radiation-related increases. Our study stresses the importance of reducing the influence of bias by using a comparable control group when severely ill individuals like the Thorotrast-exposed are studied

Här finns problem att lösa!

När vi människor har det svårt tänker många av oss automatiskt pådöd och självmord. Det är normalt och ofta nyttig. Hos de flesta klingarsådanatankar av spontant och ersätts av mer konstruktiva problemlösningar.Hos personer som lider av ångest, depression, utmattning, enkänsla av utanförskap och annan psykisk smärta kan dock tankarna pådöden som en möjlig utväg bli mycket farliga. Situationen förvärras oftaav en svårighet att be om hjälp. I stället drar sig personen inom sig självoch utarbetar en självmordsplan. En ytterligare, ibland mycket ringa, påfrestningkan göra att planen sätts i verket. Den suicidala patienten kommertill psykiatern/behandlaren fylld av dessa svårigheter. Det är viktigtatt börja samtalet där hen är och följa upp med ett problemlösningsperspektiv.Tvåforskarsamtal är en bra modell för att bryta patientens känslaav isolering och möta de aktuella behoven. Frågan är om inte patologisksuicidalitet bör ses som ett eget psykiatriskt syndrom.Fortfarande dör ca 1.500 svenskar i suicid varje år. År 2013 var siffran1.606. Läget är således ständigt akut. Låt oss därför snabbt försökakomma fram till en någorlunda välfungerande modell för bemötandet avdessa personer!In severe trouble many people immediately and automatically associateto death and suicide. This is a normal and in fact often a rationalreaction. Usually such ideas spontaneously fade away and are substitutedby more constructive problem solving. For people suffering fromanxiety, depression, exhaustion, feelings of being an outsider and otherforms of mental pain the thoughts of death as a convenient rescue canbe very dangerous. The situation can be still worse if the person hasdifficulties to ask for help. Instead the person may draw him/herselfback and start to develop a suicidal plan. Sometimes new even trivialstrains can trigger the acting out of the plan. When the suicidal personat last try to get help and meets a psychiatrist or some other helper he/she is totally occupied by these mental problems. It is then importantto meet such persons in exactly that situation and applicate a problemsolving perspective. The model «Two researchers» is a valuable modelto counteract the patient’s feelings of loneliness and to meet his/herimmediate needs. Furthermore we need to discuss if not pathologicalsuicidality should be perceived as a psychiatric syndrome in its ownright.In Sweden still about 1.500 persons commit suicide every year. In2013 the number was 1606. The situation is thus acute. Let us thereforerapidly develop a well-functioning model for meeting these persons ina rational way!När vi människor har det svårt tänker många av oss automatiskt pådöd och självmord. Det är normalt och ofta nyttig. Hos de flesta klingarsådanatankar av spontant och ersätts av mer konstruktiva problemlösningar.Hos personer som lider av ångest, depression, utmattning, enkänsla av utanförskap och annan psykisk smärta kan dock tankarna pådöden som en möjlig utväg bli mycket farliga. Situationen förvärras oftaav en svårighet att be om hjälp. I stället drar sig personen inom sig självoch utarbetar en självmordsplan. En ytterligare, ibland mycket ringa, påfrestningkan göra att planen sätts i verket. Den suicidala patienten kommertill psykiatern/behandlaren fylld av dessa svårigheter. Det är viktigtatt börja samtalet där hen är och följa upp med ett problemlösningsperspektiv.Tvåforskarsamtal är en bra modell för att bryta patientens känslaav isolering och möta de aktuella behoven. Frågan är om inte patologisksuicidalitet bör ses som ett eget psykiatriskt syndrom.Fortfarande dör ca 1.500 svenskar i suicid varje år. År 2013 var siffran1.606. Läget är således ständigt akut. Låt oss därför snabbt försökakomma fram till en någorlunda välfungerande modell för bemötandet avdessa personer

Självet och suicidaliteten

SAMMANFATTNINGDen psykiatriska sjukdomsmodellen är inte någon bra modell föratt förstå suicidalitet. I denna uppsats prövar vi möjligheten av att istället se självmord som ett mord på självet. Självets utveckling, dess forsvarsmekanismer och revir skisseras. Det moderna västerländska samhället är på många sätt felkonstruerat, vilket ständigt producerar lidande. Personer med suicidalitet skall ej i första hand uppfattas som offer utan som tappra hjältar och nödvändiga informatörer. Deras erfarenheter kan öka vår medvetenhet och bidra till att denna jord blir en något bättre plats att leva på.ENGELSK ABSTRACTThe model of mental disorders is not adequate in understandingsuicidality. In this paper we investigate the possibility to perceivesuicide as a murder of the self. We describe the development of theself, its defense mechanisms and its territories. The modern westernsociety is in many respects constructed in a deficient way, whichcontinuously results in suffering for its members. Suicidal personsshall not be comprehended as sacrifices but as brave heroes andimportant informants. Their experience can increase our awarenessand contribute to the efforts making this earth a somewhat betterplace to live in.SAMMANFATTNINGDen psykiatriska sjukdomsmodellen är inte någon bra modell föratt förstå suicidalitet. I denna uppsats prövar vi möjligheten av att istället se självmord som ett mord på självet. Självets utveckling, dess forsvarsmekanismer och revir skisseras. Det moderna västerländska samhället är på många sätt felkonstruerat, vilket ständigt producerar lidande. Personer med suicidalitet skall ej i första hand uppfattas som offer utan som tappra hjältar och nödvändiga informatörer. Deras erfarenheter kan öka vår medvetenhet och bidra till att denna jord blir en något bättre plats att leva på.ENGELSK ABSTRACTThe model of mental disorders is not adequate in understandingsuicidality. In this paper we investigate the possibility to perceivesuicide as a murder of the self. We describe the development of theself, its defense mechanisms and its territories. The modern westernsociety is in many respects constructed in a deficient way, whichcontinuously results in suffering for its members. Suicidal personsshall not be comprehended as sacrifices but as brave heroes andimportant informants. Their experience can increase our awarenessand contribute to the efforts making this earth a somewhat betterplace to live in

Suicidalitet ur evolutionärt och neurofysiologiskt perspektiv

SAMMANFATTNINGUnder de fyra miljarder år som livet funnits på jorden har det visat enenorm anpassnings- och utvecklingskapacitet. Framväxandet av detmoderna samhället under de senaste 250 åren har emellertid lett tillsåväl fysiska som psykosociala felkonstruktioner, som kan vara svåraatt hantera. Neurofysiologiskt ligger problemen på flera olika nivåersåsom svårigheter att differentiera mellan sexualitet och behovetav sensuell kontakt, det synnerligen snabba arousalsystemet ochtill detta knutna kroppsliga reaktioner samt svårigheter i samspeletmellan system 1 och 2 i den mänskliga storhjärnan.ABSTRACTIn a first article (Suicidologi nr 1 2015), the authors suggested thatit is necessary to meet suicidal persons in their present painfulsituation from a problem-oriented perspective. In a second article(Suicidologi nr 2 2015), they suggested that the goal of the destructivedrive is to kill their own perceived incapable self, or perhapsthe contrary, to find ways to resist this drive and thus survive. In thisthird article, the evolutionary and neurophysiological backgroundas well as inherent weaknesses of importance for problem-solvingand suicidality is described. The construction of the modern societyduring the last 250 years has created both physical and psychosocialrisks leading to injuries and deaths. Concerning neurophysiologythere are problems on different levels, which may be of importancefor suicidality, such as difficulties to differentiate between sexualityand sensuality and difficulties to control the sometimes very rapidarousal systemSAMMANFATTNINGUnder de fyra miljarder år som livet funnits på jorden har det visat enenorm anpassnings- och utvecklingskapacitet. Framväxandet av detmoderna samhället under de senaste 250 åren har emellertid lett tillsåväl fysiska som psykosociala felkonstruktioner, som kan vara svåraatt hantera. Neurofysiologiskt ligger problemen på flera olika nivåersåsom svårigheter att differentiera mellan sexualitet och behovetav sensuell kontakt, det synnerligen snabba arousalsystemet ochtill detta knutna kroppsliga reaktioner samt svårigheter i samspeletmellan system 1 och 2 i den mänskliga storhjärnan.ABSTRACTIn a first article (Suicidologi nr 1 2015), the authors suggested thatit is necessary to meet suicidal persons in their present painfulsituation from a problem-oriented perspective. In a second article(Suicidologi nr 2 2015), they suggested that the goal of the destructivedrive is to kill their own perceived incapable self, or perhapsthe contrary, to find ways to resist this drive and thus survive. In thisthird article, the evolutionary and neurophysiological backgroundas well as inherent weaknesses of importance for problem-solvingand suicidality is described. The construction of the modern societyduring the last 250 years has created both physical and psychosocialrisks leading to injuries and deaths. Concerning neurophysiologythere are problems on different levels, which may be of importancefor suicidality, such as difficulties to differentiate between sexualityand sensuality and difficulties to control the sometimes very rapidarousal system

Absorbing Information about a Child's Incurable Cancer

To assess parents' ability to absorb information that their child's cancer was incurable and to identify factors associated with parents' ability to absorb this information

Suicide-bereaved parents experience of viewing the body at formal settings.

<p>^* “Emergency department or ward”, “Hospital church”, “Department of forensic medicine”, and “Funeral parlour”. Viewing also includes viewing the contour of the body or part of the body.</p>†<p>The most unfavourable value ranging from “No”; “Yes, a little”; “Yes, moderate”; “Yes, much” at any of the formal settings.</p