Nordic region suicide trends 2000-2018; sex and age groups.

BACKGROUND AND AIM: Overall, suicide rates in the Nordic region, Denmark, Finland, Iceland, Norway and Sweden, have declined in the past 40 years. The aim of this study was to determine trends in suicide mortality from 2000 to 2018. METHODS: Data were obtained from official suicide statistics for men and women, 15 years and older. Gender and age groups in four calendar periods were analyzed using Joinpoint Estimated Regression Coefficient. RESULTS: The crude regional suicide rate was 17.1, 2000-2004, decreased to 14.1 per 100,000 inhabitants in 2015-2018. Age-standardized rates are 13.6-11.3. The crude rate decreased by 19.5% (16.3% age-standardized), 19.3% for males and 20.5% for females. The largest decrease was found in Finland (34.9%), the smallest in Norway (1.4%). In males, the exception was an increased suicide rate among all Icelandic except 15-24-year olds, and in 45-64 year-old Norwegians. Among females, an increase was seen among 15-24-year olds in all countries except Iceland, in all age groups in Norway, and in 25-44-year olds in Sweden. In males, a decline of the suicide rated lower than 10% was noted in 25-44 olds in Norway and in 15-64 year-olds in Sweden. DISCUSSION: A robust decrease was observed in the overall regional suicide rate in recent years. Exceptions are rising rates in Icelandic males, in Norwegian females, and the youngest female groups in all except Iceland. The small decline among middle-aged males in Norway and Sweden is of concern.

Suicide Rates in Nordic Prisons 2000-2016.

OBJECTIVE: To compare suicide rates of people in prison and the general population in the Nordic countries. METHODS: Data on deaths by suicide and person-years for people in prison and the general population were obtained for the Nordic countries during 2000-2016. Age-standardized rate ratios were calculated. RESULTS: The suicide rate in the Nordic countries overall was 110.1 (95% CI = 98.1, 122.2) per 100,000 person-years for people in prison. A significant decline was noted for the suicide rate of people in prison between 2000 and 2016 (p < 0.0001). The age-standardized mortality ratio was 7.4 (95% CI = 5.9-8.2) for males and 17.8 (95% CI = 7.3-33.2) for females in Denmark, Iceland, and Norway. CONCLUSION: Despite a decreasing trend over time, excess suicide mortality was noted for people in prison.

[Economic crises and incidence of suicide in Iceland 1911-2017]. / Efnahagskreppur og tíðni sjálfsvíga á Íslandi 1911-2017

INTRODUCTION: Suicides are number 16 as a cause of death worldwide. Causes are not always known, often associated with depression or trauma. Suicide incidence has decreased world- wide in the past three decades. The economic crisis of 2008 led to an increase in many countries. Many confounding factors make comparisons between countries difficult. This study assesses the possible impact of economic crises in Iceland on suicide incidence. MATERIAL AND METHODS: The work is based on suicide data from 1911 to 2017 and six economic crises from 1918 to 2008. The incidence is calculated five and ten years before and after the index year of each crisis. Possible crisis impact was assessed by applying a quasi-Poisson model to the data. Variance can be greater than model shows, so overdispersion was assessed. The evolution over time is assessed by inspection of cumulative sum of squared -residuals (CUSUMSQ). RESULTS: Suicide incidence increased from 1930, beginning to decline around 1990. Given a small population size there are wide upwards incidence fluctuations, within and outside the crisis -periods. The crises of 1931 and 1948 showed an increase, wheras in the others there is no change or a decrease. The sizes of deviations from expected value are, for the whole period, in compliance with the quasi-poisson model for counts. CONCLUSION: There is no statistical correlation between the six economic crises and suicide incidence in the Icelandic data. The study is based on population incidence and does not preclude a negative impact of economic crises on individuals.

[Eating Disorder Treatment in Iceland - Treatment adherence, psychiatric co-morbidities and factors influencing drop-out]. / Átröskunarmedferd á Íslandi - sjúkdómsmnd, medferdarheldni og forspárpættir brofalls.

OBJECTIVE: Treatment adherence in patients with eating disorders (ED) in Iceland is unknown. The aim of the study was to investigate treatment drop-out and explore factors that influence premature termination of treatment in a specialized ED treatment unit, at the University Hospital of Iceland, during the period of September 1, 2008 - May 1, 2012. MATERIAL AND METHODS: The study is retrospective and naturalistic. Hospital records of referred patients were examined. Those meeting the ICD 10 criteria of anorexia nervosa (AN) (F50.0, F50.1), bulimia nervosa (BN) (F50.2, F50.3) and eating disorder not otherwise specified (EDNOS) (F50.9) were included. The total sample was 260 and 182 patients met inclusion criteria. No-shows were 7%. Drop-out was defined as premature termination of treatment without formal discharge. RESULTS: The sample consisted of 176 women and 6 men, mean age 26.3 years. BN was diagnosed in 52.7% of patients, EDNOS in 36.8% AN in 10.4%. 74.7% had one or more co-morbid psychiatric diagnosis. Anxiety- and/or depression were diagnosed in 72.5%, Attention hyperactivity deficiency disorder in 15.4% and personality disorders in 8.2%. Lifetime prevalence of substance use disorders (SUDs) was 30.8%. Drop-out from treatment occurred in 54.4% of cases (with approximately 1/3 returning to treatment), 27.5% finished treatment and 18.1% were still in treatment at the end of the follow up period. Treatment adherence was significantly higher in patients who had a university degree, in those who had themselves taken the initiative to seek ED treatment and in those with higher anxiety scores at assessment. AN patients did better than other ED patients while patients with SUDs showed a tendency for higher drop-out (p=0.079). CONCLUSION: The drop-out rates were similar to what has been reported from other western countries. Follow-up time was longer and AN patient did better than expected. Higher education, initiative in seeking treatment and higher anxiety scores on questionnaires were protective.

Validity of Gotland Male Depression Scale for male depression in a community study: the Sudurnesjamenn study.

BACKGROUND: Several studies suggest a "male depressive syndrome", where not only the standard symptoms of major depressive disorder (MDD) but also symptoms of anxiety, anger, irritability and antisocial behaviour are prominent. METHOD: In a community study, 534 males were screened for possible depression by the Gotland Male Depression Scale (GMDS) and Beck's Depression Inventory (BDI). For comparison psychiatrists examined a sub-sample of healthy and depressive males (n=137). The validity of the GMDS was compared both with the BDI and MDD diagnosis according to DSM-IV. RESULTS: GMDS was as good as BDI for screening males. ROC-curve analysis gave AUC 0.945 (95% CI 0.923-0.968) for GMDS when tested against BDI. Second, when both scales were tested by ROC-curves against DSM-IV, the GMDS had AUC=0.861 (95% CI 0.800-0.921) and BDI had AUC=0.822 (95% CI 0.751-0.893). The estimated prevalence was 14-15%. LIMITATIONS: Low participation rate (25%) in the screening phase. CONCLUSION: GMDS is a valid screening tool for detecting male depression (MDD). Furthermore it is a short self-rating scale, easy to use in daily practice to screen for depression. Our results support recent reports of high prevalence of depressions in the community which supports active screening of males in clinical practice.

Saliva testosterone and cortisol in male depressive syndrome, a community study. The Sudurnesjamenn Study.

INTRODUCTION: The association between testosterone levels and depression is unclear. The relationship has been described as complex, i.e. more U (J)-shaped than linear in some previous studies. AIM: The primary aim of this study was to examine the relationship between saliva testosterone level variations and different levels of male depressive symptoms in a community sample. The secondary aim was to investigate whether simultaneous testing of evening cortisol and testosterone improved the detection of depression. METHODS: In a community study, 534 males were screened, using the Beck Depression Inventory (BDI), the Gotland Male Depression Scale (GMDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS). Those with signs of depression (n = 65) and randomly selected controls (n = 69) had psychiatric evaluation for depressive disorder. In a sub-sample (n = 51) saliva testosterone was measured twice on a single day. RESULTS: Testosterone morning values were significantly higher than evening values (236 vs. 145 pg/ml, P = 0.009). Evening testosterone was significantly higher in depressive males, according to both MADRS (P = 0.028) and BDI (P = 0.036). Having depression increased the likelihood of being in the highest third of testosterone levels (BDI P = 0.021; MADRS P = 0.018). Positive correlation was between total BDI score and elevated evening testosterone with and without psychotropics (P = 0.017; P = 0.002). Correlation was between elevated evening cortisol and evening testosterone levels (P = 0.021) though simultaneous testing did not increase specificity of detecting depression. CONCLUSION: Evening saliva testosterone measurements seem the most informative, as they correlate with male depressive syndrome. Simultaneous testing for evening cortisol and evening testosterone levels did not increase specificity for clinical diagnosis of depressive disorder.

Saliva cortisol and male depressive syndrome in a community study. The Sudurnesjamenn study.

BACKGROUND: The degree and direction of hypothalamic-pituitary-adrenal (HPA) dysfunction to male mental health is unclear. AIMS: The aim of the study was to investigate the relationship between cortisol and male mental health. METHODS: In this community study, 534 males were screened, using the Beck Depression Inventory (BDI), Gotland Male Depression Scale (GMDS) and a general health questionnaire. Those with signs of depression (n = 65) and controls (n = 69) were evaluated in a psychiatric examination according to the DSM-IV criteria for depressive disorder (DD). In a sub-sample (n = 51) saliva cortisol was measured five times on a single day. RESULTS: Evening cortisol was significantly higher in untreated individuals with DD. Significantly higher evening cortisol (at 22 h) correlated also with a history of physical disorder, a history of any mental disorder and MADRS score ≥ 20 (Montgomery-Åsberg Depression Rating Scale). High cortisol, measured as AUC (area under curve), correlated with a high MADRS score but not with any other health variable tested. Morning cortisol did not correlate with any health variable; however, cortisol awakening response (CAR) could not be investigated. The BDI and GMDS scores did not correlate with cortisol measurements. CONCLUSION: Evening saliva cortisol measurement seems most informative, as it correlates with male depressive syndrome in our study but replications with larger studies are needed.

Revision of deposition and weathering parameters for the ingestion dose module (ECOSYS) of the ARGOS and RODOS decision support systems.

The ECOSYS model is the ingestion dose model integrated in the ARGOS and RODOS decision support systems for nuclear emergency management. The parameters used in this model have however not been updated in recent years, where the level of knowledge on various environmental processes has increased considerably. A Nordic work group has carried out a series of evaluations of the general validity of current ECOSYS default parameters. This paper specifically discusses the parameter revisions required with respect to the modelling of deposition and natural weathering of contaminants on agricultural crops, to enable the trustworthy prognostic modelling that is essential to ensure justification and optimisation of countermeasure strategies. New modelling approaches are outlined, since it was found that current ECOSYS approaches for deposition and natural weathering could lead to large prognostic errors.

Depression in Swedish women: relationship to factors at birth.

Depression is a common and serious disorder that may have developmental origins. Birth-related factors have been related to childhood and adult occurrence of somatic as well as psychiatric disorders, but studies on the relationship between birth-related factors and depression are few and show mixed results. In addition, varying methods have been used to assess depression. Standardized clinical criteria to diagnose depression, combined with birth data collected from midwife records have not been used in most studies. Participants in the Prospective Population Study of Women in Sweden (803 women), born 1914, 1918, 1922 and 1930, provide information on birth factors and depression. Women participated from 1968 at mid-life ages of 38-60 years, to 2000, when they were age 78-92 years. Original birth records containing birth weight, length, head circumference, and gestational time, as well as social factors were obtained. Lifetime depression was diagnosed via multiple information sources. Symptoms were assessed using the Comprehensive Psychopathological Rating Scale and diagnoses were based on DSM-III-R criteria. Over their lifetime, 44.6% of women in this sample experienced depression. Birth weights ≤ 3500 g [odds ratio (OR), age-adjusted = 1.72; 95% CI 1.29-2.28, P < 0.001] and shorter gestational time (OR, age-adjusted = 1.13; 95% CI 1.04-1.24, P = 0.005) were independently associated with a higher odds of lifetime depression in a logistic regression model adjusted for age. Lower than median birth weights and shorter gestational time were related to lifetime depression in women. Both neurodevelopmental and environmental contributions to lifetime depression may be considered.

[Anorexia nervosa in psychiatric units in Iceland 1983-2008, incidence of admissions, psychiatric comorbidities and mortality]. / Lystarstol 1938-2008 - innlagnir, sjukdomsmynd og lifun.

OBJECTIVE: Information is scarce concerning the incidence of anorexia nervosa (AN) in psychiatric facilities in Iceland. The aim of this study was to describe the incidence of admissions, comorbidity and mortality of patients who were admitted to psychiatric units in Iceland, diagnosed with AN in 1983-2008. MATERIAL AND METHODS: The study is retrospective. 140 medical records with an AN or atypical eating disorder diagnosis according to the ICD-9 and ICD-10 were reviewed. Final sample was 84 patients with confirmed AN diagnosis. RESULTS: Five men and 79 women were admitted to a psychiatric inpatient ward for the first time diagnosed with AN. Average age was 18.7 years. Incidence of admissions for both sexes in the first part of the study period (1983-1995) was 1.43/100.000 persons/year, 11-46 years old, but in the second part (1996-2008) 2.91. The increase was statistically significant (RR=2.03 95% CI 1.28-3.22) and can mainly be explained by an increased incidence of admissions to the children- and adolescent psychiatric wards (CAW). Mortality of women was 2/79 (2.5%) and standard mortality rate 6.25. The average length of stay was 97 days, 67.3 days in adult units and 129.7 days in CAW (p<0.05). In the study period 51 patients (60.7%) were only admitted once. One patient had compulsory admission on his first admission but ten (11.9%) had at some point compulsory admission. The body mass index increased in average from admission to discharge from 15.3 to 17.5 kg/m2. A correlation was found between self harm and suicide attempts and compulsory admissions. CONCLUSION: The study revealed an increased incidence between periods. This might reflect a real increase of AN in the society. Mortality rate was lower than expected.

[Clinical aspects and follow up of suicide attempts treated in a general intensive care unit at Landspitali University Hospital in Iceland 2000-2004]. / Sjálfsvígstilraunir medhöndladar á gjörgaesludeildum Landspítala árin 2000-2004.

OBJECTIVE: To gather information on patients admitted to an intensive care unit (ICU) after a serious suicide attempt (SA). METHODS: Retrospective analysis and follow up of admittances to ICUs of Landspitali University Hospital after SA years 2000-2004. RESULTS: Admittances because of SA were 251 (4% of ICU admissions, 61% females, 39% males, mean age 36 yr +/- 14 ). Ten percent were admitted more than once and 61% had prior history of SA. Drug intoxication was the most prevalent type of SA (91%) and the most frequent complication was pneumonia. Following ICU stay 36% of the patients were admitted to psychiatric wards and 80% received psychiatric follow up. The main psychiatric diagnosis was addiction (43%). Majority of patients were divorced or single and the rate of unemployment was high. Mortality during ICU stay was 3%. During 3-7 year follow up 21 patients died (10 %), majority due to suicide. In a survival analysis only the number of tablets taken, APACHE II score and number of somatic diseases predicted risk of death. CONCLUSION: The patient group is young (36 yr), majority are women (61%), repeated attempts are frequent, social circumstances are poor and death rate after discharge from hospital is high (10%) even though the vast majority (80%) receives psychiatric follow up.This raises the question if the offered treatment is effective enough. Key words: Suicide attempt, suicide, drug poisoning, intensive care, mental health care.

The relationship between cerebrospinal fluid biomarkers and depression in elderly women.

OBJECTIVE: Cerebrospinal fluid (CSF) biomarkers including the 42 amino-acid form of beta-amyloid (Abeta42), total tau protein (T-tau), and the CSF/serum albumin ratio are markers of brain pathology and metabolism. Abeta42 and T-tau are sometimes used to discriminate geriatric depression from mild forms of Alzheimer disease (AD) in clinical studies. However, studies focusing on the relationship between these CSF biomarkers and geriatric depression are lacking. METHODS: This was a cross-sectional study with a population-based sample of 84 nondemented elderly women in Sweden. Measurements included neuropsychiatric, physical, and lumbar puncture examinations, with Diagnostic and Statistical Manual of Mental Disorders, Third Revision-based depression diagnoses and measurement of CSF levels of Abeta42, T-tau, albumin, and serum albumin. RESULTS: Fourteen women (mean age: 72.6 years) had any depression (11 with major depressive disorder [MDD]). Compared to women without depression, women with MDD had higher levels of Abeta42 and the CSF/serum albumin ratio. The CSF/serum albumin ratio was also higher in women with any depression. No differences in T-tau were observed; however, T-tau increased with age. CONCLUSION: Higher levels of CSF Abeta42 were observed among elderly depressed women, in contrast to lower levels usually observed in AD, indicating potential neuropathological differences between the two disorders. Higher CSF/serum albumin ratios observed in depressed women point to potential vascular processes.