Lower suicide intention in patients with personality disorders admitted for deliberate self-poisoning than in patients with other diagnoses.

BACKGROUND: People with deliberate self-poisoning and personality disorders are in increased risk for suicide. Intention and psychiatric features are important factors in a psychiatric evaluation and for planning aftercare. METHODS: Patients admitted to medical departments after deliberate self-poisoning were studied (n = 117). Patients with personality disorder according to (ICD-10, F.60-69) were compared to patients with affective disorders, substance use disorders, and unknown psychiatric diagnosis on Beck Suicide Intention Scale (SIS), Beck Suicide Ideation Scale (BSI), Beck Hopelessness Scale (BHS), and Beck Depression Inventory (BDI). RESULTS: The mean suicide intention score (SIS) was significantly lower among patients with personality disorders compared with patients with other psychiatric diagnoses 10.2 (95% CI 8.1-12.4) vs. 14.6 (95% CI 12.7-16.4) (p = 0.040). The hopelessness scores (BHS) were significantly higher among patients with personality disorders 13.0 (95% CI 10.9-15.2) compared with patients with affective disorders 8.2 (95% CI 6.1-10.3) and substance use disorders 9.9 (95% CI 5.2-14.6) (p = 0.0014) and unknown psychiatric diagnoses 10.6 (95% CI 9.1-12.2). There were no significant differences between the groups on suicide ideation (BSI) and depression (BDI). CONCLUSIONS: Although patients with personality disorders had lower suicide intention compared to patients with other psychiatric diagnoses, they reported significantly more hopelessness. This distinction is an important implication in the clinical assessment and planning of further treatment of DSP patients.

Structured follow-up by general practitioners after deliberate self-poisoning: a randomised controlled trial.

BACKGROUND: General Practitioners (GPs) play an important role in the follow-up of patients after deliberate self-poisoning (DSP). The aim was to examine whether structured follow-up by GPs increased the content of, adherence to, and satisfaction with treatment after discharge from emergency departments. METHODS: This was a multicentre, randomised trial with blinded assignment. Five emergency departments and general practices in the catchment area participated. 202 patients discharged from emergency departments after DSP were assigned. The intervention was structured follow-up by the GP over a 6-month period with a minimum of five consultations, accompanied by written guidelines for the GPs with suggestions for motivating patients to follow treatment, assessing personal problems and suicidal ideation, and availability in the case of suicidal crisis. Outcome measures were data retrieved from the Register for the control and payment of reimbursements to health service providers (KUHR) and by questionnaires mailed to patients and GPs. After 3 and 6 months, the frequency and content of GP contact, and adherence to GP consultations and treatment in general were registered. Satisfaction with general treatment received and with the GP was measured by the EUROPEP scale. RESULTS: Patients in the intervention group received significantly more consultations than the control group (mean 6.7 vs. 4.5 (p = 0.004)). The intervention group was significantly more satisfied with the time their GP took to listen to their personal problems (93.1% vs. 59.4% (p = 0.002)) and with the fact that the GP included them in medical decisions (87.5% vs. 54. 8% (p = 0.009)). The intervention group was significantly more satisfied with the treatment in general than the control group (79% vs. 51% (p = 0.026)). CONCLUSIONS: Guidelines and structured, enhanced follow-up by the GP after the discharge of the DSP patient increased the number of consultations and satisfaction with aftercare in general practice. Consistently with previous research, there is still a need for interventional studies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01342809. Registered 18 April 2011.

Adolescents' adverse experiences and mental health in a prospective perspective.

AIMS: The aim of this study is to examine the possible changes in depressive symptoms related to various adverse experiences, based on a three-year follow-up among adolescents. METHODS: All 10(th) graders invited to enter the youth section of the Oslo Health Study 2001 (n = 3,811) constituted a baseline of a longitudinal study. A high level of mental distress (Hscl-10 score ≥ 1.85) according to the different life experiences was compared, at baseline (15 years) and follow-up (18 years). RESULTS: All adverse experiences were associated with a high Hscl-10 score except parents not living together and death of a close person at 15 and 18 years for boys, and death of a close person at 18 years of age for girls. A development from high Hscl-10 score at baseline to low score at follow up was defined as recovery from mental distress. The proportion of the youth that had a high Hscl-10 score related to reporting adverse life experiences at age 15, followed by a low Hscl-10 score three years later proved to be between 44% and 89% among boys and between 16% and 31% among girls. CONCLUSIONS: From a three year longitudinal perspective the recovery from mental distress is substantial and higher among boys than among girls. However, mental distress seems to persist in a considerable proportion of the adolescents. Consequently, it is insufficient to brush aside traumas and hurt and rely on a time healing process only.

[Are life experiences of children significant for the development of somatic disease? A literature review]. / Er barns livserfaringer av betydning for somatisk sykdomsutvikling? En litteraturoversikt.

This review presents the relationship between serious life events, chronic family difficulties and illness, and focuses on how healthy children cope. Hospitalised children had experienced about twice as many serious life events as children in healthy environments. Known diseases related to stress are eczema, upper respiratory tract infections, asthma, ulcerative colitis, heart disease in adults, juvenile rheumatoid arthritis, fibromyalgia and juvenile diabetes. Research on healthy children at risk (resiliences) has revealed a number of social and interpersonal protective factors. A modified biopsychosocial model, for the purpose of understanding the health status and care of children at high risk, is presented. More research is needed to understand these multietiological diseases in order to develop strategies for the promotion of good health.

Illness and exposure to negative life experiences in adolescence: two sides of the same coin? A study of 15-year-olds in Oslo, Norway.

AIM: To investigate associations between negative life experiences and common illnesses among adolescents. METHODS: Cross-sectional questionnaire study carried out at all lower secondary schools (10 grade) in Oslo. Norway, during 2000 and 2001 (n = 8316 pupils). Different negative life experiences and illnesses were addressed. RESULTS: The participation rate was 88%. Among reported negative life experiences last year were a pressure felt to succeed (62%), death of a close person (26%), exposure to physical violence (22%), bullying at school (15%) and sexual violation (4%). A large number of the pupils had some chronic illness: hay fever (38%), eczema (29%) and asthma (13%). Reported illnesses the previous 12 month were: headache (56%), painful neck or shoulders (35%), sore throat at least three times (15%), lower respiratory tract infection (9%) and mental problems for which help was sought (7%). During the week prior to the survey, 26% of all girls had symptoms of a depressive disorder, while this applied to 10% of all boys. Fifty-three percent of the boys (29% of the girls) who had depressive symptoms had been exposed to physical violence. Sexually violated boys had a high probability for seeking help for mental problems (OR = 4.9) and for frequent episodes of sore throat (OR = 2.5). Corresponding odds ratios for girls were 1.7 and 2.5, respectively. CONCLUSION: Common illnesses in adolescence are significantly associated with negative life experiences. In clinical encounters with adolescents not only should the presenting complaints be addressed, but also other common illnesses and relevant background factors such as negative life events.