Suicide In Norway Research Articles

Trajectories of Service Contact before Suicide in People with Substance Use Disorders—A National Register Study

Objective This study aimed to identify trajectories of service use during the last year before suicide death and the characteristics associated with the trajectories in patients with substance use disorders. Methods This study used a national registry data linkage, which included all patients with substance use disorders who died by suicide in Norway between 2010 and 2018. In- and outpatient contacts with mental health or substance use services during the last year before suicide death was analyzed by week using Sequence State Analysis and cluster analysis to identify trajectories. Logistic regression was used to measure the association between the characteristics and the trajectories. Results We identified four trajectories of service contact. A brief contact trajectory (n = 366) with a low proportion of weeks in contact (M weeks = 8.3), associated with less psychosis or bipolar disorder (aOR = 0.13 (0.08–0.22)) and higher age. A regular contact trajectory (n = 160), with a higher proportion of contact (M weeks = 47.9), associated with psychosis or bipolar disorder (aOR = 3.66 (2.10–6.47)) and depressive or anxiety disorder (aOR = 3.11 (1.93–5.13)). An intermittent contact trajectory (n = 195) with most contacts with outpatient substance use disorder services (M weeks = 9.7). A continuous contact trajectory (n = 109) with a high proportion of inpatient contact (M weeks = 44.5), strongly associated with psychosis or bipolar disorder (aOR = 6.08 (3.26–11.80)). Conclusion Longitudinal descriptions of service use reveal different trajectories that are important to consider when developing policies or interventions to reduce the risk of suicide death in patients with substance use disorders.

Suicide trends in Norway during the first year of the Covid-19 pandemic. A register-based cohort study.

AbstractBackgroundThere is a concern that the COVID-19 pandemic will lead to an increase in suicides. Several reports from the first months of the pandemic showed no increase in suicide rates while studies with longer observation times report contrasting results. In this study, we explore the suicide rates in Norway during the first year of the pandemic for the total population as well as for relevant subgroups such as sex, age, geographical areas, and pandemic phases.MethodsThis is a cohort study covering the entire Norwegian population between 2010 and 2020. The main outcome was age-standardized suicide rates (per 100,000 inhabitants) in 2020 according to the Norwegian Cause of Death Registry. This was compared with 95% prediction intervals (95% PI) based on the suicide rates between 2010 and 2019.ResultsIn 2020, there were 639 suicides in Norway corresponding to a rate of 12.1 per 100,000 (95% PI 10.2–14.4). There were no significant deviations from the predicted values for suicides in 2020 when analyzing age, sex, pandemic phase, or geographical area separately. We observed a trend toward a lower than predicted suicide rate among females (6.5, 95% PI 6.0–9.2), and during the two COVID-19 outbreak phases in 2020 (2.8, 95% PI 2.3–4.3 and 2.8, 95% CI 2.3–4.3).ConclusionThere is no indication that the COVID-19 pandemic led to an increase in suicide rates in Norway in 2020.

Use of primary healthcare services prior to suicide in Norway: a descriptive comparison of immigrants and the majority population

BackgroundThere is an increase in studies investigating the use of healthcare services prior to suicide. Although studies generally report high usage, there are no previous studies comparing immigrants’ use of primary healthcare (PHC) prior to suicide with that of majority populations. There is a strong influx of immigrants in Europe, and thus a growing demand for filling this knowledge gap and exploiting unused potential for suicide prevention.MethodBy linking three national registers, we examine contact with PHC prior to suicide in all suicide cases in Norway from 2007 to 2014 among individuals aged 15 years and over (N = 4341). We report the percentage of individuals in personal contact within the last 6 months, 1 month and 1 week prior to suicide, and use the chi square-test for association.ResultsOverall, immigrants have less contact with PHC prior to suicide. We find significantly lower rates of contact among immigrants, both 6 months and 1 month prior to suicide, for both sexes. The trend is similar in the last week prior to suicide, but less pronounced. The largest variance in contact with PHC prior to suicide is amongst 30–44 year olds. Young, male immigrant suicide victims have the lowest rates of contact with PHC prior to suicide. Contact rates increase with age for all men and women in the majority population, but not for female immigrant suicide victims.ConclusionsThere is a clear difference in rates of contact with PHC prior to suicide between the majority and immigrant populations. The rates are especially low among young males, and measures should be made to lower their threshold for consulting PHC for young males in general and young male immigrants in particular. The difference in contact due to immigrant status appears to be of equal importance as the difference due to sex, although, with few significant results, a conclusion is hard to draw.

Use of prescription medication prior to suicide in Norway

BackgroundThe use of psychotropic medications in relation to mental disorders is considered central to preventing suicide. However, few studies have addressed prescription patterns at different time points within the last year prior to suicide and compared these with those of the general population.MethodsWe use data covering the period from 2010 to 2011 from the Norwegian Cause of Death Registry and the Norwegian Prescription Database to examine dispensing patterns of prescription medication within 12 months and within 30 days of suicide. Our data includes all registered suicides in Norway among individuals aged 15 years and older in 2011 (n = 594), 434 men and 160 women. Dispensing of prescription medication in the general population (n ≈ 4 million) are used for comparison.ResultsDispensing of any prescription medication were high and varied from 95.6% for females and 83.2% for males within 12 months of suicide, to 64.4% for females and 47.2% for males within 30 days of suicide, respectively. The percentages with dispensed prescription medication increased with age. A similar sex and age pattern was observed for the dispensing of psychotropic medications. Within the last 30 days, close to one in two were dispensed psychotropic medications. The dispensing of antidepressants, hypnotics and sedatives was more common than the dispensing of other categories of psychotropics. The percentages with dispensed prescription medication among the population controls were considerably lower, in particular the dispensing of psychotropics.ConclusionDispensing of prescription medications, including psychotropic medications, is common prior to suicide. The percentage with dispensed prescription medication increases with age and are higher for females than for males.

A 12-year National Study of Suicide by Jumping From Bridges in Norway

Studies from several countries suggest that erecting fences on bridges more commonly used for suicide by jumping may be an effective way of reducing the risk of suicide by jumping from these bridges. Distribution of suicides by jumping off bridges has not yet been studied on a national level in any country. This study included all suicides by jumping from high places registered in the Norwegian Cause of Death Registry (COD) in the period 1999–2010 (n = 319). Combining data from the COD registry and information from police records, 71 cases of suicide by jumping off a bridge were identified involving 36 bridges. This form of suicide constituted approximately 1% of all suicides in Norway in the period 1999–2010. Almost half of these suicides were registered at only 6 bridges. Three Norwegian bridges were secured during the observation period of this study. Two bridges had barriers installed on the full length of the bridge with 11 suicides registered before barriers were installed, and none after. On the 1 bridge that was only partially secured, no change in numbers of suicides was observed after barriers were installed. One-third of jumps from bridges occurred over land. We found that although suicide by jumping off bridges was a relatively rare event, there is a potential for saving lives by installing physical barriers on bridges that are more commonly used for suicide by jumping.

Differences between children and adolescents who commit suicide and their peers: A psychological autopsy of suicide victims compared to accident victims and a community sample

BackgroundThe purpose of this study was to gain knowledge about the circumstances related to suicide among children and adolescents 15 years and younger.MethodsWe conducted a psychological autopsy, collecting information from parents, hospital records and police reports on persons below the age of 16 who had committed suicide in Norway during a 12-year period (1993-2004) (n = 41). Those who committed suicide were compared with children and adolescents who were killed in accidents during the same time period (n = 43) and with a community sample. Results: Among the suicides 25% met the criteria for a psychiatric diagnosis and 30% had depressive symptoms at the time of death. Furthermore, 60% of the parents of the suicide victims reported the child experienced some kind of stressful conflict prior to death, whereas only 12% of the parents of the accident victims reported such conflicts.ConclusionOne in four suicide victims fulfilled the criteria for a psychiatric diagnosis. The level of sub-threshold depression and of stressful conflict experienced by youths who committed suicide did not appear to differ substantially from that of their peers, and therefore did not raise sufficient concern for referral to professional help.

The Important Role of the School following Suicide in Norway. What Support Do Young People Wish That School Could Provide?

Little knowledge has been documented on the experiences of young suicide survivors, how they are coping with schooling and what kind of support they think they need. Thirty-two adolescents who had lost a close family member or friend by suicide participated in a research project by filling in questionnaires and participating in focus group interviews. The article explores the young people's experiences with and wishes for help from the school, including teachers and school nurses. The results show that the young people struggle with concentration and learning new material. Although many are satisfied with care and support while at school, the young bereaved do not receive all the assistance they wish for and need. In order to adequately support young suicide survivors to continue schooling, it is worth listening to their opinions about how they may be approached.

Monthly variation in prevalence rates of comorbid depression and anxiety in the general population at 63–65° North: The HUNT study

Background To investigate monthly variation in depression, anxiety and their comorbidity (COM) in an epidemiologic study and their association to monthly variation in suicide rates. Methods 60,995 participants of the Health Study of Nord-Trøndelag County in 1995–97 rated themselves on the Hospital Anxiety and Depression Scale (HADS) in all months except July. All 10,670 male and 3833 female suicides in Norway from 1969 through 1996 were included. Results The prevalence of comorbid anxiety and depression was highest in spring (April, May) and in October ( p < 0.01). There was a correlation between the monthly variation in the national suicide rate and monthly variation in comorbid anxiety and depression ( r = 0.72, df = 11, p = 0.01) and for male alone ( r = 0.67, df = 11, p = 0.03). There was also a significant monthly variation in the prevalence of depression ( p < 0.001) and no monthly variation in the prevalence of anxiety. Limitations Limited information about the third of the population who did not take part in the HUNT-2 Study. HADS based depression and anxiety cover psychological symptoms, not somatic and social ones. In relation to DSM-IV and ICD-10 defined anxiety disorders and depressions, the sensitivity and specificity of HADS caseness, give a considerable number of false-positive cases. Conclusions Increased prevalence of comorbid depression and anxiety in males during spring, and its association with suicidality should have clinical importance, as identification and treatment could influence suicide rates.

The sales of antidepressants and suicide rates in Norway and its counties 1980–2004

Background Suicide is a major public health problem and depression is among the most important risk factors for suicide. Treatment of depression might prevent suicide. To study this hypothesis further we conducted an ecological study. Methods An ecological study using sales data for antidepressants and numbers of suicides in Norway and Norwegian counties 1980–2004 was performed. Data on alcohol consumption and unemployment rates were registered and taken into account. Data were analyzed using Cochrane-Orcutt time series for the country as a whole. The county specific data were analyzed with a random coefficient model with county as subject and intercept and time (slope) as random variables using an unstructured covariance matrix. Results Sales of non-tricyclic antidepressants (non-TCAs) and suicide were clearly negatively related, even when controlling for alcohol and unemployment (adjusted r 2: 0.57). There was an effect modification between time and level of sales of non-TCAs. Studying the relationship between the sales of non-TCAs and the suicide rate, we found that it was significant and stronger for the low sales figures, but non-existent for the high sales figures. Limitations Ecological studies cannot infer causality. Conclusions The fall in suicide rates in Norway and its counties was related to the increased sales of non-TCAs. The effect was mostly a result of a sales increase in the lower sales segment, indicating that a change from the more toxic TCAs, or heightened awareness of depression and its treatment, could explain the relationship found between sales of newer antidepressants and a decrease in suicide rate.

Seasonal variation in suicides and in admissions to hospital for mania and depression

Background: The influence of seasons on mood disorders is controversial. Objective: To examine monthly variations in admissions for mania and depressions including variations with sex and age and correlations with frequencies of suicides. Methods: All admissions for mania or depression ( N=4341) in a population of 1,800,000 with 35,285 admissions in the years 1992–1996 were analysed. All 14,503 suicides in Norway the years 1969–1996 were also analysed. Results: Admissions for depression had a significant monthly variation for women ( χ 2=29.78, df=11, P<0.005) with the highest peak in November and for men ( χ 2=19.69, df=11, P<0.05) with the highest peak in April. Among women increasing age correlated negatively with the range of monthly observed/expected ratios ( r s=−0.943, N=6, P<0.01) and with a of maximal monthly observed/expected ratio ( r s=−0.943, N=6, P<0.01). Among men suicides correlated with admissions for depression ( r=0.647, N=12, P<0.05) and mania ( r=0.678, N=12, P<0.05). Limitations: The time of admission to hospital are not identical to onset of affective episode. The study was done retrospectively. No sociocultural or physical environmental data were investigated. Conclusion: A hypothesis of an influence of seasons on mood disorders is supported. Younger women seem to be especially vulnerable.

Epidemiological trends of youth suicide in Norway

Norway, traditionally a country with low suicide rates, has experienced a strong increase in youth suicide over the last two decades. From 1973 to 1994 suicide rates roughly doubled both in 15–19 and 20–24 year old males, whereas there were only minor changes in the female rate. Over the same time span suicide remained very rare in children below the age of 15. Suicide accounted for 7% of all deaths in 10–24 year olds in 1973 and 24% in 1994. An increasing proportion of suicides in males and females is being committed by the use of fire-arms and hanging. In municipalities with less than 50 000 inhabitants or a low level of centrality there has been a strong increase in suicide rates over the time period under study, whereas highly urbanised municipalities had no increase. Possible etiological factors linked to these epidemiological changes are discussed in the light of contemporary psychiatric and sociological research.

Epidemiological trends of youth suicide in Norway

Norway, traditionally a country with low suicide rates, has experienced a strong increase in youth suicide over the last two decades. From 1973 to 1994 suicide rates roughly doubled both in 15--19 and 20--24 year old males, whereas there were only minor changes in the female rate. Over the same time span suicide remained very rare in children below the age of 15. Suicide accounted for 7% of all deaths in 10--24 year olds in 1973 and 24% in 1994. An increasing proportion of suicides in males and females is being committed by the use of fire-arms and hanging. In municipalities with less than 50 000 inhabitants or a low level of centrality there has been a strong increase in suicide rates over the time period under study, whereas highly urbanised municipalities had no increase. Possible etiological factors linked to these epidemiological changes are discussed in the light of contemporary psychiatric and sociological research.

Regional analyses of alcohol and suicide in Norway: some empirical considerations.

The association between alcohol consumption and suicide was analyzed on aggregate-level data from Norway, applying regional units in the analyses. Thereby two purposes could be served: to validate previous estimates derived from time series analyses, and to assess an empirical indication of alcohol and suicide as alternative solutions. The effect of alcohol consumption on suicide rates tended to be higher for women than for men, which is contrary to results from time series analyses and what might generally be expected. The results are discussed with reference to causal mechanisms and alcohol and suicide as alternative choices of action, and methodological considerations are outlined.

Norwegian data on death due to overdose of antidepressants.

The number of suicides in Norway has doubled during the last two decades, as has also the number of suicides by intoxication. Data are presented which demonstrate that while barbiturates make out a strongly decreasing percentage of the intoxications, the antidepressants make out a definite increasing percentage. The tricyclic antidepressants make out the bulk. There is a strong need for effective antidepressants with less toxicity than the commonly used tricyclic antidepressants.

The Impact of Divorce on Suicide in Norway, 1951-1980

The present study does a comparative analysis of a well-substantiated relationship based principally on American-based research: that between marital integration and suicide....Specifically it tests the generalizability of the divorce-suicide relationship in Norway using data for the period 1951-1980. Despite institutional and cultural buffers in Norway thought to account for a historically low suicide rate the author finds the recent rise in the suicide rate to be related to destabilizing trends in family life. Data are from the World Health Organization and other official sources. (EXCERPT)