Severe or chronic disease in childhood predicts suicidality and links to anxiety in young adulthood.

PURPOSE: Suicide prevention needs measures, and further understanding of the role of adverse childhood experiences may elucidate the suicide process and ease the identification of suicide risk. MATERIALS AND METHODS: A random sample of adults, aged 18-28 years and representative of the general population living in Finland, participated in a nationwide health examination survey. Of them (n = 793) we analyzed whether severe or chronic disease in childhood before the age of 16 years contributed to suicidality (suicidal ideation and/or suicide attempts), and whether severe or chronic disease in childhood was associated with mental disorders, current psychological distress, current usage of prescription medicines, or current work capacity. RESULTS: Having severe or chronic disease in childhood contributed independently to suicidality, with the odds ratio of 5.41 (95% confidence interval of 2.98-9.82, p < .001), but the significance of this association was lost after controlling for mental disorders. Having severe or chronic disease during childhood, as compared not having such condition, was associated with having more frequently anxiety (p < .001), greater psychological distress (p < .001), more frequently usage of psychotropic medicines (p < .001), and poorer work capacity (p < .001). CONCLUSION: Having severe or chronic disease in childhood not only increased the odds for suicidality, but also associated with anxiety, current psychological distress, current usage of psychotropic medication, and current work capacity in young adulthood.

Being able to enjoy normal day to day activities separates suicidal ideation from attempted suicide in a nationwide population-based health examination study of adults aged 18 to 28 years.

PURPOSE: A higher total score on the General Health Questionnaire (GHQ-12) is associated with a higher likelihood of having suicidal ideation as well as having suicide attempt. The association of GHQ-12 with suicide attempts item by item has not been analyzed earlier. MATERIALS AND METHODS: In a population-based sample, aged 18 to 28 years, mental illness was assessed as self-reported during the interview. Participants were also asked to score on two specific questions concerning suicidal ideation as well as attempted suicide. The GHQ-12 total score and each of the 12 item scores of the GHQ-12 were analyzed with regression models to explain suicidality (n = 679). RESULTS: The total score of GHQ-12 differed by suicidality (Bonferroni-corrected p < 0.001). The item 6 (Felt that could not overcome difficulties) and the item 11 (Feeling oneself worthless) were associated with suicidal ideation (OR = 1.66, 95% CI = 1.12-2.47, p = 0.01 and OR = 1.58, 95% CI = 1.04-2.39, p = 0.03, respectively) as well as with suicide attempts (OR = 2.82, 95% CI = 1.54-5.16, p = 0.001 and OR = 3.10, 95% CI = 1.64-5.85, p < 0.001, respectively). The item 7 (Able to enjoy normal day to day activities) was associated with suicide attempts (OR = 0.28, 95% CI = 0.12-0.64, p = 0.003) and made the item-specific difference between those with suicidal ideation w/o suicide attempt (OR = 0.35, 95% CI = 0.14-0.89, p = 0.03). CONCLUSION: Being able to enjoy normal activities day to day made a difference between suicidal ideation and attempted suicide.

[Burn injuries and mental health]. / Palovammat ja mielenterveys.

Currently a large proportion of patients with severe burn injuries survive. This gives increasing challenges also for psychological recovery after the trauma. More than half of burn patients have mental disorders already before the burn injury but also patients who previously had no mental disorders may suffer from them. Some of the hospitalize burn patients have injuries due to suicidal attempts. Only a small proportion of burn patients receive appropriate psychiatric care although psychosocial interventions specifically planned for burn victims exist. More frequent screening of symtoms of mental disorders and psychiatric consultation, also after acute care in hospital, could lead to better management of post-burn psychiatric care as well as better management of the burn treatment and rehabilitation itself.

Childhood Bullying as a Predictor of Suicidality in Young Adults in a Nationwide Population-Based Health Examination Study.

OBJECTIVE: Having been bullied at school in childhood links to suicidality. We aimed at verifying earlier findings and delivering diverse data from a representative population-based sample of young adults to characterize the impacts beyond childhood. METHOD: A random sample of adults, aged 18-28 years and representative of the general population living in Finland, participated in a nationwide health examination study. Adverse childhood experiences before the age of 16 years were analyzed for 779 participants in relation to lifetime suicidality (suicidal ideation, suicide attempts), current suicidal thoughts (HSCL-25), mental disorders (self-reports for lifetime, M-CIDI for DSM-IV during the past 12 months), current usage of mental health services, current usage of prescription medicines (ATC codes), current psychological distress (GHQ-12), and current work capacity and work ability. RESULTS: Having been bullied in childhood contributed to greater suicidality (p < 0.001), more frequent current usage of antipsychotics (p < 0.001) as well as antidepressants (p < 0.001), greater current psychological distress (p < 0.001), and poorer current work capacity (p < 0.001) as well as work ability (p < 0.001). Of the self-reported mental disorders on lifetime basis, psychosis had the strongest association (p = 0.03) with having been bullied, whereas the interview-based diagnosis of mental disorders during the past 12 months had no significant association. CONCLUSIONS: Having been bullied at school before the age of 16 years was independently associated not only with suicidality, but also with the self-report of psychosis as well as a range of indicators of poorer mental health at the age of 18-28 years.

Having been bullied at school contributed to suicidality in young adults.Having been bullied linked to current use of antipsychotics and antidepressants.Having been bullied associated with poor work capacity and poor work ability.

Self-harm in burn patients: An analysis of Finnish patient records (2011-2020).

AIM: To collect data on self-harm burn patients at a national level in Finland and analyze patient characteristics. MATERIAL AND METHODS: First, we went through The National Care Register for Health Care (Hilmo) records from 2011 to 2015 to find all patients in Finland with both burn and self-harm ICD10 codes. Then we investigated the medical records of all patients treated at the National Burn Centre (NBC) in Helsinki in the period 2011-2020. Patients admitted to the hospital because of self-harm burn injuries were compared to those without self-harm injuries. Patients below 18 years old were excluded. RESULTS: The Hilmo register consisted of a total of 3391 adult burn patients admitted to any healthcare unit during the study period. Compared with non-self-harm patients, self-harm patients (N = 82) had lower mean age (41 years vs 54 years, p < 0.001) and longer hospitalization (18 days vs. 6 days, p < 0.05). Two-thirds of the self-harm patients (N = 38) admitted to the NBC in the period 2011-2020 had a pre-burn history of psychiatric care (66%) and one-third of them had a previous record of self-harm or suicide attempt. Men had more severe burns than women (mean TBSA 46% vs. 14%, p < 0.05), and seven of them died during the first 48 h of care, but this was not the case for any female patient. CONCLUSIONS: Self-harm burn patients were younger and had longer hospitalization at all care levels than other burn patients. Based on medical records of hospitalized self-harm burn patients, we found clear gender differences in the severity of the burn injury and in mortality, with men suffering more severe injuries, in some cases leading to death. Recognizing high-risk patients pre-burn could have a strong preventive impact.

Cynical hostility increases whereas sense of coherence decreases the odds for current suicidal thoughts: A cross-sectional study of the general adult population sample.

Background and Aims: Earlier, somatic diseases and mental disorders have been associated with cynical hostility as well as sense of coherence, but there is a gap of knowledge, whether they contribute to suicidality at population level. Methods: A random sample of adults, representative of the general population living in Finland, participated in a nationwide health examination study. For 4387 participants aged 18-97 years, we analyzed, after controlling for confounding factors, whether cynical hostility, as assessed with the 8-item Cook-Medley Hostility Scale, or sense of coherence, as assessed with the 13-item Sense of Coherence Scale, contributed to current suicidal thoughts during the past 7 days as scored on the 25-item Hopkins Symptom Checklist. Results: Suicidal thoughts (current thoughts of ending one's life) were associated significantly with cynical hostility (p < 0.001) as well as with sense of coherence (p < 0.001). Of the specific items of cynical hostility, the item "I am sure that most people do not have problems with lying for their own good" was associated most strongly with current suicidal thoughts (p < 0.001). Conclusion: Cynical hostility predicted current suicidal thoughts in a population-based sample of adults aged 18-97 years. Sense of coherence protected from current suicidal thoughts.

Seasonality contributes to depressive, anxiety and alcohol use disorders in the Finnish general adult population.

BACKGROUND: Earlier evidence suggests that the seasonal changes in mood and behavior are associated with mental disorders, especially with mood disorders. However, the extent of these associations has not been analyzed by using large samples of the general population. METHODS: A random sample of adults, aged 29 to 97 years and representative of the general population living in Finland, attended a nationwide health examination survey. Mental disorders were assessed with the Munich version of the Composite International Diagnostic Interview (M-CIDI, n = 4554). Of them, the seasonal variations in mood and behavior (seasonality) were assessed with the six items of the Global Seasonality Score (GSS, n = 4004) as well as with the experienced problem due to these variations. RESULTS: After adjusting for age, gender, level of education, and region of residence, the GSS was associated with depressive, anxiety and alcohol use disorders (all p < 0.001). Of the GSS items, mood was associated with depressive disorders (p < 0.001), anxiety disorders (p = 0.003) and alcohol use disorders (p = 0.008), whereas appetite was associated only with depressive disorders (p = 0.012), and energy level only with anxiety disorders (p = 0.025). LIMITATIONS: This cross-sectional study was based on self-reported data on the seasonal pattern. CONCLUSIONS: Seasonality had significant associations with depressive, anxiety and alcohol use disorders among the general adult population. This needs attention in clinical practice.

Seasonal changes in mood and behavior contribute to suicidality and worthlessness in a population-based study.

Limited evidence suggests that the seasonal changes in mood and behavior may associate with suicidality and the feelings of worthlessness, but these associations have not been analyzed in large population-based data. A random sample of adults (n = 4069), representative of the general population living in Finland, attended a nationwide health examination survey. Seasonal variations (seasonality) in mood and behavior were analyzed with the six items of global seasonality score (GSS) and the experienced problem due to these variations. Their impact on suicidality as well as on the feelings of worthlessness were analyzed using logistic regression models. After adjusting for age and gender, the GSS, each of its six items and the experienced problem due to the seasonal variations in mood and behavior all showed separately a significant association with suicidality as well as with worthlessness. After further adjustment for the education level and region of residence, the GSS, its mood item and the experienced problem remained significantly associated with both suicidality and worthlessness. Seasonal variations in mood and behavior have a significant association with both suicidality and worthlessness.

Suicidality in relation to depressive symptoms and psychological distress in adults aged 30 to 101 years in a population-based study in Finland.

BACKGROUND: Screening for suicidality has importance in terms of public health. We investigated which specific items of psychological distress best predicted suicidality in a population-based sample. METHODS: A random sample of adults aged 30-101 years, being representative of the general population living in Finland, attended a health examination survey (Health 2011). We analyzed (n = 4373) the total scores on the General Health Questionnaire (GHQ-12) and the Beck Depression Inventory (BDI-13), as well as alcohol use, depressive and anxiety disorders as assessed with the Munich-Composite International Diagnostic Interview (M-CIDI) among the participants. We assigned the participants having suicidality on the basis of the self-harm item on the BDI-13, and analyzed which of the items of the GHQ-12 were significant predictors of suicidality. RESULTS: After adjusting for background variables, five items of the GHQ-12 remained as significant predictors for suicidality: items 11, 9, 4, 6, and 5 in this descending order. LIMITATIONS: The definition of suicidality was based on only a single item of the BDI-13. CONCLUSIONS: Certain items of the GHQ-12 demonstrated strong associations with suicidality, and the GHQ-12 or a brief version of it might be used as a screening instrument for suicidality.

Suicidality and psychological distress in adults aged 18 to 29 years in a population-based study in Finland.

BACKGROUND: Suicidality is a major concern for young adults. We analyzed which specific items of psychological distress best predicted suicidality in a nationwide population-based sample of young adults. METHODS: A random sample (n=1995) of adults aged 18 to 29 years living in Finland, was recruited to a health examination survey (Health 2011). We analyzed the total scores on the General Health Questionnaire (GHQ-12) and the Beck Depression Inventory (BDI-13) among the participants (n=837). We assigned the participants having suicidality on the basis of two direct self-harm items on a survey questionnaire, and analyzed which of the items of the GHQ-12 were significant predictors of suicidality. RESULTS: The associations of the GHQ-12 items with suicidality were significant with the odds ratios ranging from 1.95 to 7.35. The strongest association of suicidality was with the item 11. In factor analysis, suicidality was loaded most strongly on the same factor together with the item 10. LIMITATIONS: The definition of suicidality was based on two self-reported items. CONCLUSIONS: Feeling oneself worthless was robustly associated with suicidality. It seems to be a strong predictor and could be used as a screening question for suicidality in clinical appointments.

Impulsiveness and burn patients.

OBJECTIVE: Impulsiveness is a tendency to act quickly based on a whim without reflection or consideration of consequences. We studied its correlations with burn variables and mental disorders among burn patients. METHODS: Consecutive acute burn patients (N=107) admitted to the Helsinki Burn Center were assessed with the Structured Clinical Interview for DSM-IV mental disorders (SCID) at baseline and at 6 months. All patients filled out the 30-item Barratt Impulsiveness Scale (BIS-11), the most commonly administered self-report measure and a standard point of reference in research on impulsiveness. RESULTS: The mean total score of BIS-11 was 64.5 (range 41.0-87.8, SD±6.9). There was not a significant correlation between impulsiveness and a range of characteristics of burn injury (all p-values>0.05). We found a significant correlation between some pre-burn mental disorders and impulsiveness, alcohol dependence and attentional impulsiveness (OR=1.22, p=0.022), any personality disorder and non-planning impulsiveness (OR=1.21, p=0.005), and antisocial personality disorder and motor impulsiveness (OR=1.35, p=0.043). Patients with high impulsiveness (total score >65) more often than those with low impulsiveness (≤65), had pre-burn mental disorders such as major depressive disorder (22.6% vs. 8.6%, p=0.046), alcohol dependence (46.9% vs. 25.9%, p=0.023), or other substance dependence (12.2% vs. 1.7%, p=0.028). CONCLUSION: Impulsiveness had a significant correlation with mental disorders but not with burn-related variables. Therefore the role of impulsiveness in burn injuries should not be investigated independently without first accounting for the role of mental disorders.

Alcohol use and smoking in burn patients at the Helsinki Burn Center.

OBJECTIVE: We investigated alcohol use and smoking at time of burn and their relationships with severity of burn and presence of mental disorders. METHODS: Consecutive acute burn patients (N=107) admitted to the Helsinki Burn Center were assessed with the structured clinical interview for mental disorders (SCID) at baseline and after 6 months. Information regarding being under the influence of alcohol and having smoking-related activity at burn as well as about hazardous drinking (Alcohol Use Disorders Identification Test) and heavy smoking before the burn was recorded. RESULTS: Around half (52%) of the acute burn patients were under the influence of alcohol and 19% had been both drinking and smoking at the time of the burn. Patients under the influence at the time of burn had significantly higher prevalence of lifetime mental disorders compared to those patients who were not under the influence of alcohol (73.2% vs. 45.1%, p=0.003), especially alcohol dependence (55.4% vs. 13.7%, p<0.001) and anxiety disorders (28.6% vs. 9.8%, p=0.015). Patients who had both alcohol use and smoking at burn had even more often at least one mental disorder (95.0% vs. 51.7%, p<0.001), in specific alcohol dependence (90.0% vs. 23.0%, p<0.001), or psychotic disorder (25.0% vs. 6.9%, p=0.016). The main characteristics of the burns themselves did not differ significantly between these groups. CONCLUSION: Half of the burn patients were under the influence of alcohol at the time of the burn in this study. In almost all patients where alcohol and smoking contributed to the burn a diagnosable alcohol use disorder was present. Interventions for those with alcohol use disorders and the associated risk behaviors are important for the prevention of burns.

Functioning, Disability, and Social Adaptation Six Months After Burn Injury.

Major injuries commonly cause long-standing functional impairment. The authors investigated the levels of and predictors for functioning, disability, and social adaptation 6 months after a burn injury. The overall level of functioning at 6 months postburn was assessed among 87 (81%) of the 107 consecutive acute adult burn patients (mean TBSA 9.7%) admitted to the Helsinki Burn Centre during an 18-month period. Social and Occupational Functioning Assessment Scale (SOFAS) was used to evaluate functioning overall, and Sheehan Disability Scale (SDS) to assess the domains of working capacity, social life, and family life. Social Adaptation Self-Evaluation Scale (SASS) was used to measure social adaptation. Structured clinical interview was used to assess mental disorders at baseline and 6 months after injury. The mean SOFAS score was 69.7 (SD = 20.8), indicating some impairment in social and occupational functioning. The strongest independent predictors of SOFAS were mental disorders during follow-up (P < .001), particularly major depressive disorder (P < .001) and delirium (P = .016), but also length of stay (P = .004) and hand burn (P = .012). Concerning disability (SDS), the authors found mild impairment in all three domains, the most in SDS work (mean 3.59, SD = 3.46). The strongest predictor of SDS was major depressive disorder during follow-up (P < .001) and of SASS personality disorders (P = .007). Six months after a burn injury, some difficulties in social and occupational functioning remained. Level of functioning was predicted strongly and consistently by mental disorders, particularly depression. Length of stay and hand burns also predicted functioning, more in a clinician's evaluation (SOFAS) than in self-reported measures (SDS and SASS).

Return to work six months after burn: a prospective study at the Helsinki Burn Center.

OBJECTIVE: Burn and other major injuries often impair survivors' capacity to work. We investigated predictors for not returning to work by six months after acute burn. Differences in demographic, clinical and psychiatric characteristics between burn patients returning to work and those not were examined. METHOD: All consecutive acute burn patients (N=107) admitted to the Helsinki Burn Center were assessed with a structured psychiatric diagnostic interview at baseline. Of the 60 patients working at baseline, 53 patients (88%) participated in the six-month follow-up interview. Variables predicting not returning to work were analyzed in binary logistic regression models. RESULTS: Two-thirds (70%, 37 of 53) of the cohort followed returned to work by six months. When compared to patients returning to work, those not returning to work had a higher mean percentage of total body surface area (TBSA) (16.3% vs. 6.2%, p=0.001), and hand burns were more common (75% vs. 41%). The presence of mental disorders during follow-up was also more common (81% vs. 30%, p=0.001), particularly major depressive disorder (MDD) (31% vs. 3%) or delirium (31% vs. 3%). In a multivariate analysis, proportion of total body surface area (%TBSA) burned (B=1.12, p=0.029) and presence of MDD (OR 55.3, p=0.007) or delirium (OR 19.2, p=0.046) significantly predicted not returning to work. CONCLUSION: Majority of the burn patients working at baseline returned to work by six months. Capacity to work after burn is predicted by both smaller %TBSA burned and lack of diagnosable mental disorders, particularly delirium or MDD, after burn.

Health-related quality of life 6 months after burns among hospitalized patients: Predictive importance of mental disorders and burn severity.

RATIONALE: Major burns are likely to have a strong impact on health-related quality of life (HRQoL). We investigated the level of and predictors for quality of life at 6 months after acute burn. METHODS: Consecutive acute adult burn patients (n=107) admitted to the Helsinki Burn Centre were examined with a structured diagnostic interview (SCID) at baseline, and 92 patients (86%) were re-examined at 6 months after injury. During follow-up 55% (51/92) suffered from at least one mental disorder. The mean %TBSA was 9. TBSA of men did not differ from that of women. Three validated instruments (RAND-36, EQ-5, 15D) were used to evaluate the quality of life at 6 months. RESULTS: All the measures (RAND-36, EQ-5, 15D) consistently indicated mostly normal HRQoL at 6 months after burn. In the multivariate linear regression model, %TBSA predicted HRQoL in one dimension (role limitations caused by physical health problems, p=0.039) of RAND-36. In contrast, mental disorders overall and particularly major depressive disorder (MDD) during follow-up (p-values of 0.001-0.002) predicted poor HRQoL in all dimensions of RAND-36. HRQoL of women was worse than that of men. CONCLUSION: Self-perceived HRQoL among acute burn patients at 6 months after injury seems to be mostly as good as in general population studies in Finland. The high standard of acute treatment and the inclusion of small burns (%TBSA<5) in the cohort may partly explain the weak effect of burn itself on HRQoL. Mental disorders strongly predicted HRQoL at 6 months.

Self-inflicted burns: an eight year retrospective study in Finland.

The aim of this study was to investigate differences in characteristics of burn patients who had attempted suicide, as compared with other burn patients admitted to the Helsinki Burn Centre during 1989-97. Burn patients were first drawn from a computerised register, after which a psychiatrist examined their medical records and ascertained the suicide attempters. Of the total of 811 burn patients, 46 (5.7%) had attempted suicide. The median total body surface area (TBSA) of suicide attempters (24.0%) was markedly higher than in the other patients (6.0%, P < 0.001). Flame was a much more common cause of burns among suicide attempters (82.1%) than among the remainder (44.5%, P < 0.001). Suicide attempters were also more often unemployed (28.2 versus 12.9%) or on disability pension (30.8 versus 7.1%) before the injury (P < 0.001). Although the proportion with self-inflicted burns among all burn patients was not high, the markedly higher severity of their burns makes them an important clinical subgroup for further study.

Mental disorders after burn injury: a prospective study.

OBJECTIVE: To prospectively investigate variations in prevalences of mental disorders after burn, and correlation between burn severity and mental disorders among hospitalized burn patients. METHOD: A cohort of 107 consecutive acute adult burn patients was examined with structured diagnostic interview (SCID-I) at baseline, and 92 patients (86%) at 6 months after injury. Prevalences of mental disorders for the whole 6-month follow-up period, plus 1-month point prevalences in acute care and in a second 6-month interview were assessed, and the two point prevalences were compared. Burn severity was estimate by %TBSA. RESULTS: During the 6-month follow-up 55% (51/92) of burn patients had at least one mental disorder, including 12% (11/92) with post-traumatic stress disorder (PTSD). In a multinomial regression, %TBSA exposure independently and strongly predicted risk for mental disorders, especially for anxiety disorders and delirium. The overall point prevalence of mental disorders decreased significantly (p=0.036) from acute care (45%) to 6 months (33%). CONCLUSIONS: After burn, more than half of the patients suffer from some type of mental disorder, but the prevalence declines over time after the acute phase. The disorders are not limited to depression and PTSD. A strong relationship likely exists between burn severity and some post-burn mental disorders.

Psychiatric consultation and care after acute burn injury: a 6-month naturalistic prospective study.

OBJECTIVE: To prospectively investigate proportions of burn patients receiving psychiatric consultation or care, and whether care actually received relates to estimated psychiatric need or burn severity. METHOD: Consecutive acute hospitalized adult burn patients were examined with the Structured Clinical Interview for DSM IV-TR (SCID-I) at baseline and six months after injury. During follow-up, 55% (51/92) suffered from some mental disorder. Estimated need for psychiatric care was classified as unequivocal, probable or nonexistent. The proportions of patients receiving psychiatric consultation and/or different levels of psychiatric care and specific psychiatric interventions during follow-up and predictors for care were investigated. RESULTS: During the follow-up, 21% of acute burn patients received psychiatric care, and 20%, psychiatric consultation. Of patients with unequivocal need, 48% (12/25) received psychiatric care, and 28%, psychiatric consultation; with probable need, 21% received psychiatric care, and 37%, consultation. Pre-burn psychiatric history (OR=7.54), severe burns (OR=6.76) and estimated need for psychiatric care (OR=6.23) significantly predicted psychiatric care. CONCLUSIONS: After hospitalized burn injury, only half of the patients with mental disorders and unequivocal need for psychiatric care actually received such care. Psychiatric consultations and care follow the course of acute burn treatment, not of later emerging mental disorders. Previous psychiatric history strongly influences care decisions.

Mental disorders among acute burn patients.

OBJECTIVE: To investigate mental disorders among acute hospitalized burn patients. METHOD: Consecutive acute adult burn patients (n=107) admitted to Helsinki Burn Centre were interviewed by an experienced psychiatrist with the Structured Clinical Interview for DSM-IV-TR for Axis I and II mental disorders assessed in three time frames (lifetime, the month prior to burn, and in acute care). Information on clinical features, psychiatric symptoms, personality traits, and burn severity (total body surface area, TBSA) was gathered. RESULTS: The mean TBSA was 9%. Most (61%) acute burn patients had at least one lifetime Axis I or II mental disorder. Prevalences of lifetime substance-related disorders (47%), psychotic disorders (10%), and Axis II personality disorders (23%) were high. The overall prevalence of Axis I mental disorders increased significantly (Q=6.40, df=1, p=0.011) from the month prior to burn (40%) to acute care (48%). The prevalence of delirium for this period was significantly higher (0.9% vs. 13%; Q=13.00, df=1, p<0.001) in acute care. CONCLUSIONS: Mental disorders, particularly substance use disorders, psychotic disorders, and personality disorders are common among acute burn patients before injury. These disorders may predispose to burns. Burn itself may also predispose to mental disorders, particularly delirium.