Trajectories of Service Contact before Suicide in People with Substance Use Disorders—A National Register Study

Objective: This study aimed to identify trajectories of service use during the last year before suicide death and the characteristics associated with the trajectories in patients with substance use disorders. Methods: This study used a national registry data linkage, which included all patients with substance use disorders who died by suicide in Norway between 2010 and 2018. In- and outpatient contacts with mental health or substance use services during the last year before suicide death was analyzed by week using Sequence State Analysis and cluster analysis to identify trajectories. Logistic regression was used to measure the association between the characteristics and the trajectories. Results: We identified four trajectories of service contact. A brief contact trajectory (n ¼ 366) with a low proportion of weeks in contact (M weeks ¼ 8.3), associated with less psychosis or bipolar disorder (aOR ¼ 0.13 (0.08–0.22)) and higher age. A regular contact trajectory (n ¼ 160), with a higher proportion of contact (M weeks ¼ 47.9), associated with psychosis or bipolar disorder (aOR ¼ 3.66 (2.10–6.47)) and depressive or anxiety disorder (aOR ¼ 3.11 (1.93–5.13)). An intermittent contact trajectory (n ¼ 195) with most contacts with outpatient substance use disorder services (M weeks ¼ 9.7). A continuous contact trajectory (n ¼ 109) with a high proportion of inpatient contact (M weeks ¼ 44.5), strongly associated with psychosis or bipolar disorder (aOR ¼ 6.08 (3.26–11.80)). Conclusion: Longitudinal descriptions of service use reveal different trajectories that are important to consider when developing policies or interventions to reduce the risk of suicide death in patients with substance use disorders

Suicide among users of mental health and addiction services in the first 10 months of the COVID-19 pandemic: observational study using national registry data

Summary Although many studies have reported no rise in suicides in the general population following the COVID-19 pandemic, little is known regarding mental health and substance misuse service patients, groups who have reportedly faced substantial reductions in their access to care during phases of lockdown. However, in this observational study using national registry data, during the first 10 months of the pandemic we found no evidence of an increased risk among people in recent (within 12 months) contact with secondary care. Both long-term and differential effects on subgroups remain to be studied

Suicide After Contact With Child and Adolescent Mental Health Services—A National Registry Study

Background Research has shown a strong association between suicide and mental disorders, and people in contact with services for mental health and substance use are known to be at high risk of suicide. Still, few studies have previously described suicide among young people in contact with Child and Adolescent Mental Health Services. Aim The aim of this study is to examine the prevalence of contact and suicide rates by gender and age groups, and to describe patient demographics and service utilization in secondary mental health services. Methods All young people in contact with Child and Adolescent Mental Health Services in the year prior to death in the period 2008–2018 were identified by linking the Norwegian Cause of Death Registry and the Norwegian Patient Registry. We estimated the prevalence of contact and suicide rates among those with and without contact, by gender and age groups. Characteristics of treatment contact were compared between boys and girls. Variables with significant differences were entered into a multivariate logistic regression model using gender as an outcome. Results More girls (39.7%) than boys (11.8%) had contact with Child and Adolescent Mental Health Services in the year prior to death. Among girls, suicide rates per 100,000 patients increased linearly in the age groups 10–13, 14–16, and 17–19 years: 5, 22, and 38 per 100,000 patients, respectively. Among boys, the suicide rate increased sharply from 7 per 100,000 patients in the age group 14–16 years to 40 per 100,000 patients in the 17–19-year-old group. In the age-adjusted multivariate model, boys were 4.07 (1.22–14.44, p = 0.024) times more likely to have terminated contact at the time of death. Conclusion This study shows gender differences in both suicide rates and service utilization among young people in contact with Child and Adolescent Mental Health Services before suicide, and future studies should focus on identifying the causes of these gender differences in service contact

A nationwide study on time spent on social media and self-harm among adolescents

Abstract Self-harm among adolescents has increased in many countries, but few studies have examined possible explanations. One explanation could be the changes in the way adolescents socialize and use of social media. We explored the relationship between past year self-harm and time spent on social media, employing data from a nationwide cross-sectional survey among students in grades 8 through 11 in Norway (N = 37,268). The association was estimated in logistic regression models and we adjusted for identified confounders and stratified on gender, age group and depressive symptoms. A total of 16.1% of the study population reported to have self-harmed in the past year. This proportion was elevated among those spending more than 3 h daily on social media (unadjusted OR = 2.74 (CI 2.58.–2.90)). Adjustment for confounders modified the association (OR = 1.49 (CI 1.39–1.60)). In stratified analyses, adjusted OR did not differ significantly by gender or age The association between time spent on social media and self-harm was weaker among adolescents with severe depressive symptoms (adjusted OR = 1.38 (CI 1.22–1.55)), than among those with mild or no symptoms (adjusted OR = 1.70 (CI 1.56–1.86)). Risk of self-harm was elevated among those who spent 3 or more hours daily on social media, also after controlling for other factors. Further studies are needed to explore the nature and underlying mechanisms of this association. Strengthening the evidence will help informing the development of adequate measures to prevent self-harm

Clinical characteristics in schizophrenia patients with or without suicide attempts and non-suicidal self-harm - a cross-sectional study

Background: To investigate whether schizophrenia patients with both suicide attempts and non-suicidal self-harm have earlier age of onset of psychotic and depressive symptoms and higher levels of clinical symptoms compared to patients with only suicide attempts or without suicide attempt. Methods: Using a cross-sectional design, 251 patients (18–61 years old, 58% men) with schizophrenia treated at hospitals in Oslo and Innlandet Hospital Trust, Norway, were assessed with a comprehensive clinical research protocol and divided into three groups based on their history of suicide attempts and non-suicidal self-harm. Results: Suicide attempts were present in 88 patients (35%); 52 had suicide attempts only (29%) and 36 had both suicide attempts and non-suicidal self-harm (14%). When compared with nonattempters and those with suicide attempts without non-suicidal self-harm, patients with both suicide attempts and non-suicidal self-harm were more frequently women, younger at the onset of psychotic symptoms, had longer duration of untreated psychosis, and had higher levels of current impulsivity/aggression and depression. Patients with both suicide attempts and non-suicidal self-harm were more likely to repeat suicide attempts than patients with suicide attempts only. Conclusions: Patients with both suicide attempts and non-suicidal self-harm had different illness history and clinical characteristics compared to patients with only suicide attempts or patients without suicidal behavior. Our study suggests that patients with both suicide attempts and non-suicidal self-harm represent a distinct subgroup among patients with schizophrenia and suicidal behavior with their early onset of psychotic symptoms, high rate of repeated suicidal behavior and significant treatment delay