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.

[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.

Polygenic risk scores for schizophrenia and bipolar disorder associate with addiction.

We use polygenic risk scores (PRSs) for schizophrenia (SCZ) and bipolar disorder (BPD) to predict smoking, and addiction to nicotine, alcohol or drugs in individuals not diagnosed with psychotic disorders. Using PRSs for 144 609 subjects, including 10 036 individuals admitted for in-patient addiction treatment and 35 754 smokers, we find that diagnoses of various substance use disorders and smoking associate strongly with PRSs for SCZ (P = 5.3 × 10-50 -1.4 × 10-6 ) and BPD (P = 1.7 × 10-9 -1.9 × 10-3 ), showing shared genetic etiology between psychosis and addiction. Using standardized scores for SCZ and BPD scaled to a unit increase doubling the risk of the corresponding disorder, the odds ratios for alcohol and substance use disorders range from 1.19 to 1.31 for the SCZ-PRS, and from 1.07 to 1.29 for the BPD-PRS. Furthermore, we show that as regular smoking becomes more stigmatized and less prevalent, these biological risk factors gain importance as determinants of the behavior.

Suicide mortality trends in the Nordic countries 1980-2009.

BACKGROUND AND AIM: The Nordic countries provide a suitable setting for comparing trends in suicide mortality. The aim of this report is to compare suicide trends by age, gender, region and methods in Denmark, Finland, Iceland, Norway and Sweden 1980-2009. METHODS: Suicide statistics 1980-2009 were analyzed for men and women aged 15 years and above and the age group 15-24 years. Regional suicide rates in 2009 were presented in maps. RESULTS: The suicide rates across the Nordic countries declined from 25-50 per 100,000 in 1980 to 20-36 in 2009 for men and from 9-26 in 1980 to 8-11 in 2009 for women. The rates in Finland were consistently higher than those of the other countries. A significant increase of suicides in young women in Finland and Norway and a lack of a decline among young women in Sweden were noted. The male- female ratio of suicide converged to approximately 3:1 across the region during the study period. Rural areas in Finland, Norway and Sweden saw the highest suicide rates, whereas the rates in the capital regions of Denmark, Norway and Sweden were lower than the respective national rates. CONCLUSIONS: We hold that the overall decline of suicide rates in the Nordic countries reflects the socio-economic development and stability of the region, including the well-functioning healthcare. The increasing rates in Finland and Norway and the unchanged rate in Sweden of suicide in young women are an alarming trend break that calls for continued monitoring.

Addictions and their familiality in Iceland.

Here, we provide an overview of previous family studies of addiction and present a new family study based on clinical data for more than 19,000 individuals who have been treated for addiction in Iceland over the last three decades. Coupled with the extensive Icelandic genealogy information, this population-based sample provides a unique opportunity for family studies. The relative risk (RR) was determined for up to fifth-degree relatives of probands diagnosed with alcohol, cannabis, sedative, and amphetamine dependence. We observe highly significant RR values for all substances ranging from 2.27 for alcohol to 7.3 for amphetamine, for first-degree relatives, and RRs significantly above 1 for distant relations, where the effect of shared environmental factors is minimized. The magnitude of risk in psychostimulant dependence is particularly striking. These findings emphasize the role of genetics in the etiology of addiction and highlight the importance of substance-specific effects.

Gender issues in suicide rates, trends and methods among youths aged 15-24 in 15 European countries.

BACKGROUND: No recent cross-country examinations for youth suicide trends and methods for Europe were found. AIM: The aim of the study is to specify differences in suicide rates, trends and methods used among 15-24 years olds by gender across 15 European countries. METHOD: Data for 14,738 suicide cases in the age group 15-24 in 2000-2004/5 were obtained and analysed. RESULTS: Suicide rates ranged 5.5-35.1 for males and 1.3-8.5 for females. Statistically significant decline since 2000 was observed in Germany, Scotland, Spain, and England for males and in Ireland for females. Hanging was most frequently used for both genders, followed by jumping and use of a moving object for males and jumping and poisoning by drugs for females. Male suicides had a higher risk than females of using firearms and hanging and lower risk of poisoning by drugs and jumping. There were large differences between single countries. LIMITATIONS: The limitations of the study are the small numbers of specific suicide methods in some countries as well as the re-categorisation of ICD-9 codes into ICD-10 in England, Ireland and Portugal. Further, the use of suicides (X60-X84) without events of undetermined deaths (Y10-Y34) continues to be problematic considering the possibility of "hidden suicides". CONCLUSIONS: The present study shows that suicide rates among young males are decreasing since 2000 in several European countries. Analysis of suicide methods confirms that there is a very high proportion of hanging in youths, which is extremely difficult to restrict. However, besides hanging there are also high rates of preventable suicide methods and reducing the availability of means should be one of the goals of suicide prevention.

A variant associated with nicotine dependence, lung cancer and peripheral arterial disease.

Smoking is a leading cause of preventable death, causing about 5 million premature deaths worldwide each year. Evidence for genetic influence on smoking behaviour and nicotine dependence (ND) has prompted a search for susceptibility genes. Furthermore, assessing the impact of sequence variants on smoking-related diseases is important to public health. Smoking is the major risk factor for lung cancer (LC) and is one of the main risk factors for peripheral arterial disease (PAD). Here we identify a common variant in the nicotinic acetylcholine receptor gene cluster on chromosome 15q24 with an effect on smoking quantity, ND and the risk of two smoking-related diseases in populations of European descent. The variant has an effect on the number of cigarettes smoked per day in our sample of smokers. The same variant was associated with ND in a previous genome-wide association study that used low-quantity smokers as controls, and with a similar approach we observe a highly significant association with ND. A comparison of cases of LC and PAD with population controls each showed that the variant confers risk of LC and PAD. The findings provide a case study of a gene-environment interaction, highlighting the role of nicotine addiction in the pathology of other serious diseases.

The 'European Alliance Against Depression (EAAD)': a multifaceted, community-based action programme against depression and suicidality.

Action programmes fostering partnerships and bringing together regional and national authorities to promote the care of depressed patients are urgently needed. In 2001 the 'Nuremberg Alliance Against Depression' was initiated as a community-based model project within the large-scale 'German Research Network on Depression and Suicidality' (Kompetenznetz 'Depression, Suizidalität'). The 'Nuremberg Alliance Against Depression' was an action programme, conducted in the city of Nuremberg (500,000 inhabitants) in 2001/2002, addressing four intervention levels (Hegerl et al. Psychol Med 2006;36:1225). Based on the positive results of the Nuremberg project (a significant reduction of suicidal behaviour by more than 20%) 18 international partners representing 16 different European countries established the 'European Alliance Against Depression' (EAAD) in 2004. Based on the four-level approach of the Nuremberg project, all regional partners initiated respective regional intervention programmes addressing depression and suicidality. Evaluation of the activities takes place on regional and international levels. This paper gives a brief overview of the background for and experiences with the EAAD. It describes the components of the programme, provides the rationale for the intervention and outlines the current status of the project. The aim of the paper is to disseminate information about the programme's potential to reduce suicidal behaviour and to provide examples of how European community-based 'best practice' models for improving the care of depressed patients and suicidal persons can be implemented using a bottom-up approach. EAAD is mentioned by the European commission as a best practice example within the Green Paper 'Improving the mental health of the population: Towards a strategy on mental health for the European Union' (European Commission 2005).

Anxiety with panic disorder linked to chromosome 9q in Iceland.

The results of a genomewide scan for genes conferring susceptibility to anxiety disorders in the Icelandic population are described. The aim of the study was to locate genes that predispose to anxiety by utilizing the extensive genealogical records and the relative homogeneity of the Icelandic population. Participants were recruited in two stages: (1) Initial case-identification by a population screening for anxiety disorders, using the Stamm Screening Questionnaire, was followed by aggregation into extended families, with the help of our genealogy database; and (2) those who fulfilled the diagnostic and family aggregation criteria underwent a more detailed diagnostic workup based on the Composite International Diagnostic Interview. Screening for anxiety in close relatives also identified additional affected members within the families. After genotyping was performed with 976 microsatellite markers, affected-only linkage analysis was done, and allele-sharing LOD scores were calculated using the program Allegro. Linkage analysis of 25 extended families, in each of which at least one affected individual had panic disorder (PD), resulted in a LOD score of 4.18 at D9S271, on chromosome 9q31. The intermarker distance was 4.4 cM on average, whereas it was 1.5 cM in the linked region as additional markers were added to increase the information content. The linkage results may be relevant not only to PD but also to anxiety in general, since our linkage study included patients with other forms of anxiety.