Suicidal behaviour in children and adolescents in Sweden and some European countries : epidemiological and clinical aspects
Author: Hultén, Agnes
Date: 2000-09-01
Location: Rydbergska rummet, Karolinska sjukhuset
Time: 10.15
Department: Institutionen för kvinnors och barns hälsa / Department of Women's and Children's Health
Abstract
The starting point for this thesis is the empirical observation that in
Sweden, as in many other European countries, suicide is the leading cause
of death among men aged 15-34 and ranks second for young females.
Attempted suicide also constitutes a major public-health problem both in
Sweden and in the rest of Europe.
The purpose of the study was to analyse suicide trends in Sweden, the
relationship between suicide and attempted suicide, suicide-attempt
repetition patterns, recommendations for care in some European centres
after attempted suicide, and the quality of care in Sweden for young
people who subsequently committed suicide.
The material utilised in the study comprises 5,893 certain and 1,739
undetermined suicides among people aged 10-29 in Sweden during the period
1974-97, and also medical records of suicide attempters in the 15-24 age
group. The data were collected within the framework of the VHO/EURO
Multicentre Study on Suicidal Behaviour. This study was commenced in 1989
in 15 European centres (including two in Sweden) with an aggregate
catchment area of approximately 5,6 million inhabitants.
Regression analysis of suicides, broken down by gender and five-year age
group, shows no decrease in juvenile suicide rates in Sweden during the
period. For the females' part, the prevalent suicide method changed from
drug intoxication during the 1970s to violent methods in the '80s and
'90s. Males consistently use more violent suicide methods.
Attempted-suicide rates in 1989-92 found by the 15 monitoring centres
among people aged 15-24 (n=3,551) covary positively (Spearman rank order)
with both sexes' suicide rates in the centres' areas and countries of
location. For males, this correlation attained statistical significance
(p<0.02).
A longitudinal follow-up (mean: 204 weeks) of adolescents aged 15-19
(n=1,264) in seven centres revealed that more than 10% repeated their
suicide attempts within a year of the index attempt. Life-table analysis
indicated that 24% of the individuals who had attempted suicide before
the index suicide attempt tried again within a year, compared with 6.8%
of those with no such history. Stepwise Cox regression analysis showed
that the most significant predictor of repetition was a history of
attempted suicide.
Analysis of 1,540 suicide-attempt events recorded at nine centres showed
that adolescents aged 15-19 with a history of one or more suicide
attempts were - with no significant gender difference -recommended care
after attempting suicide to a significantly higher degree than those with
no such history (OR 2.0, 95% CI 1.5-2.6). Care was, moreover, recommended
significantly more often for those who used violent methods than for
those who did not (OR 1.7, 95% CI 1.5-1.96). Analysis of individual
centres showed large disparities in care recommendations, indicating that
no uniform criteria for recommending care for young suicide attempters
were in use.
A qualitative retrospective study of medical records relating to 34
psychiatric inpatients aged 15-24 before their deaths from suicide showed
a striking discontinuity - especially in adult psychiatric care - in
terms of contacts with doctors, therapists and other staff (with three to
30 different doctors involved during the period of care). This
discontinuity may have contributed to the fatal outcome. Suicide-risk
analyses were lacking, although two-thirds of the patients were known to
have attempted suicide previously and 75% were in situations of acute
stress. In most European countries, expert follow-up and care of juvenile
suicide attempters, and also scientifically based clinical guidelines for
diagnostics and treatment, are therefore urgently needed.
List of papers:
I. Hultén A, Wasserman D (1992). "Suicide among young people aged 10-29 in Sweden" Scand J Soc Med 20(2): 65-72
Pubmed
II. Hultén A, Wasserman D (1998). "Lack of continuity--a problem in the care of young suicides" Acta Psychiatr Scand 97(5): 326-333
Pubmed
III. Hawton K, Arensman E, Wasserman D, Hultén A, Bille-Brahe U, Bjerke T, Crepet P, Deisenhammer E, Kerkhof A, De Leo D, Michel K, Ostamo A, Philippe A, Querejeta I, Salander-Renberg E, Schmidtke A, Temesváry B (1998). "Relation between attempted suicide and suicide rates among young people in Europe" J Epidemiol Community Health 52(3): 191-194
Pubmed
IV. Hultén A, Jiang GX, Wasserman D, Hawton K, Hjelmeland H, De Leo D, Ostamo A, Salander-Renberg E, Schmidtke A (2000). "Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors" (Manuscript)
V. Hultén A, Wasserman D, Hawton K, Jiang GX, Salander-Renberg E, Schmidtke A, Bille-Brahe U, Bjerke T, Kerkhkof A, Michel K, Querejeta I (2000). "Recommended care for young people (15-19 years) after suicide attempts in certain European countries" Eur Child Adolesc Psychiatry 9(2): 100-108
Pubmed
I. Hultén A, Wasserman D (1992). "Suicide among young people aged 10-29 in Sweden" Scand J Soc Med 20(2): 65-72
Pubmed
II. Hultén A, Wasserman D (1998). "Lack of continuity--a problem in the care of young suicides" Acta Psychiatr Scand 97(5): 326-333
Pubmed
III. Hawton K, Arensman E, Wasserman D, Hultén A, Bille-Brahe U, Bjerke T, Crepet P, Deisenhammer E, Kerkhof A, De Leo D, Michel K, Ostamo A, Philippe A, Querejeta I, Salander-Renberg E, Schmidtke A, Temesváry B (1998). "Relation between attempted suicide and suicide rates among young people in Europe" J Epidemiol Community Health 52(3): 191-194
Pubmed
IV. Hultén A, Jiang GX, Wasserman D, Hawton K, Hjelmeland H, De Leo D, Ostamo A, Salander-Renberg E, Schmidtke A (2000). "Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors" (Manuscript)
V. Hultén A, Wasserman D, Hawton K, Jiang GX, Salander-Renberg E, Schmidtke A, Bille-Brahe U, Bjerke T, Kerkhkof A, Michel K, Querejeta I (2000). "Recommended care for young people (15-19 years) after suicide attempts in certain European countries" Eur Child Adolesc Psychiatry 9(2): 100-108
Pubmed
Issue date: 2000-08-11
Publication year: 2000
ISBN: 91-628-4254-4
Statistics
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Suicidal ...(legacy) | 579 |
Suicidal ... | 51 |
Total Visits Per Month
August 2020 | September 2020 | October 2020 | November 2020 | December 2020 | January 2021 | February 2021 | |
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Suicidal ... | 1 | 2 | 6 | 0 | 4 | 1 | 3 |
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