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.

Effectiveness of distant healing for patients with chronic fatigue syndrome: a randomised controlled partially blinded trial (EUHEALS).

BACKGROUND: Distant healing, a form of spiritual healing, is widely used for many conditions but little is known about its effectiveness. METHODS: In order to evaluate distant healing in patients with a stable chronic condition, we randomised 409 patients with chronic fatigue syndrome (CFS) from 14 private practices for environmental medicine in Germany and Austria in a two by two factorial design to immediate versus deferred (waiting for 6 months) distant healing. Half the patients were blinded and half knew their treatment allocation. Patients were treated for 6 months and allocated to groups of 3 healers from a pool of 462 healers in 21 European countries with different healing traditions. Change in Mental Health Component Summary (MHCS) score (SF-36) was the primary outcome and Physical Health Component Summary score (PHCS) the secondary outcome. RESULTS: This trial population had very low quality of life and symptom scores at entry. There were no differences over 6 months in post-treatment MHCS scores between the treated and untreated groups. There was a non-significant outcome (p = 0.11) for healing with PHCS (1.11; 95% CI -0.255 to 2.473 at 6 months) and a significant effect (p = 0.027) for blinding; patients who were unblinded became worse during the trial (-1.544; 95% CI -2.913 to -0.176). We found no relevant interaction for blinding among treated patients in MHCS and PHCS. Expectation of treatment and duration of CFS added significantly to the model. CONCLUSIONS: In patients with CFS, distant healing appears to have no statistically significant effect on mental and physical health but the expectation of improvement did improve outcome.

Epidemiology of psychotropic medication use: comparison of sales, prescriptions and survey data in Iceland.

Public health issues, medical and socio-demographics, related to use of psychotropic medications and to increasing sale of antidepressants and hypnotics need to be explored. The aim of this study was to investigate the use of antidepressants, tranquillizers and sedatives nationally and its connection with health and demographic factors, by comparing: 1) sales data and 2) prescription data for outpatients with 3) self-reported use of a random sample of the population aged 18-75 years. In 2001, the sales of psychopharmaca was 168.8 daily defined doses (DDD)/1000/day, thereof 46.6% were antidepressants mainly for outpatients; one-third of hypnotics and tranquillizers were used for inpatients; 134.2 DDD/1000/day were filled by outpatients. Almost 20% of the respondents in the survey had used one or more of these drugs for some time during the preceding 12 months. Treatment adherence for antidepressants was 56%, lower for women than men. The probability of psychotropic drug use for mental complaints is 52% when controlled for other covariates. Any observed gender difference in the community survey is related to differences in the covariates, e.g. women are more likely to seek a doctor than men. The age effect on self-reported use in the community survey is related to hypnotics. The use of psychotropic medicaments is primarily driven by mental health complaints, but not by gender or age, except the use of hypnotics, which increases with age. The difference between self-reported use and prescriptions filled may reflect compliance problems in psychiatric treatment.

Antidepressants and public health in Iceland. Time series analysis of national data.

BACKGROUND: Major depressive disorder is the second leading cause of disability-adjusted life-years in developed regions of the world and antidepressants are the third-ranking therapy class worldwide. AIMS: To test the public health impact of the escalating sales of antidepressants. METHOD: Nationwide data from Iceland are used as an example to study the effect of sales of antidepressants on suicide, disability, hospital admissions and out-patient visits. RESULTS: Sales of antidepressants increased from 8.4 daily defined doses per 1000 inhabitants per day in 1975 to 72.7 in 2000, which is a user prevalence of 8.7% for the adult population. Suicide rates fluctuated during 1950-2000 but did not show any definite trend. Rates for out-patient visits increased slightly over the period 1989-2000 and admission rates increased even more. The prevalence of disability due to depressive and anxiety disorders has not decreased over the past 25 years. CONCLUSIONS: The dramatic increase in the sales of antidepressants has not had any marked impact on the selected public health measures. Obviously, better treatment for depressive disorders is still needed in order to reduce the burden caused by them.

Definitions of bullying: a comparison of terms used, and age and gender differences, in a fourteen-country international comparison.

The study of school bullying has recently assumed an international dimension, but is faced with difficulties in finding terms in different languages to correspond to the English word bullying. To investigate the meanings given to various terms, a set of 25 stick-figure cartoons was devised, covering a range of social situations between peers. These cartoons were shown to samples of 8- and 14-year-old pupils (N = 1,245; n = 604 at 8 years, n = 641 at 14 years) in schools in 14 different countries, who judged whether various native terms cognate to bullying, applied to them. Terms from 10 Indo-European languages and three Asian languages were sampled. Multidimensional scaling showed that 8-year-olds primarily discriminated nonaggressive and aggressive cartoon situations; however, 14-year-olds discriminated fighting from physical bullying, and also discriminated verbal bullying and social exclusion. Gender differences were less appreciable than age differences. Based on the 14-year-old data, profiles of 67 words were then constructed across the five major cartoon clusters. The main types of terms used fell into six groups: bullying (of all kinds), verbal plus physical bullying, solely verbal bullying, social exclusion, solely physical aggression, and mainly physical aggression. The findings are discussed in relation to developmental trends in how children understand bullying, the inferences that can be made from cross-national studies, and the design of such studies.