Læknablaðið : fylgirit - 01.08.2003, Blaðsíða 38

I ABSTRACTS / 27TH NORDIC PSYCHIATRIC CONGRESS
S-XIII/2 Friday 15/8,11:00-12:30
Suicide trends during the period 1981-1997 in patients
with affective disorders
Eyd H. Hoyer, MD, PhD, National Centre of Register-based Research, University of
Aarhus, Tásingegagde 1, 8000 Aarhus, Denmark. Thomas Larsen, Esben Agerbo, Ping
Qin, Merete Nordentoft, Preben B. Mortensen.
ehh@ncrr.dk
Introduction: In the general population in Denmark the risk of sui-
cide has been decreasing since 1980. Patients who have been ad-
mitted to a psychiatric hospital or department constitute more than
40% of all suicides in Denmark and the largest single diagnostic
group is affective disorder.
Aims: To study if the risk of suicide decreased during the period
1980-1997 among patients with affective disorders.
Mcthod: A nested case-control design was used. Included were all
suicides in Denmark during the study period 1981-1997, and all
patients with affective disorder who had been admitted to a
psychiatric hospital. Each case was matched with 20 controls.
Kcsults: The risk of suicide in patients hospitalised because of affec-
tive disorder decreased significantly during the time period from
212 in 1981 to 85 in 1997. The suicide risk declined at higher rate
than the suicide risk in persons who had never had contact with the
mental health system.
Condusion: The reduction in the number of suicides in affective
disorders could be because of better treatment of depression and of
more attention on depression as a treatable disease, and also be-
cause of factors shared with the general population such as less
access to lethal suicidal means.
S-XIII/3 Friday 15/8,11:00-12:30
Relationship between suicidality and comorbid
psychiatric disorders
Högni Ósknrsson, Psychiatrist, Therapeia, Suöurgata 12, 101 Reykjavík, lceland. H
Kolbeinsson, E Líndal, Þ Þorgcirsson, Gulcher J, K Stefánsson, JG Stefánsson.
Aims: To clarify the interrelationship between symptoms of
suicidality and comorbid lifetime psychiatric illness.
Method: The original sample was based on a population-wide
screening for anxiety and depression in Iceland, followed by diag-
nostics with the Composite International Diagnostic Interview
(CIDI). The four suicide-related items in the CIDI were given a
severity rating (Thoughts of Death=l, Wish to Die=2; Suicida!
Thoughts=5, Suicide Attempt=10; the first three with a time frame
of at least two weeks). Four groups were created, with accumulated
suicidal severity of 0 (I), 1-4 (II), 5-9 (III) and 9-18 (IV). The anxiety
mean was based on eight lifetime disorders, depression on two, and
alcohol/substance abuse/dependence on two disorders.
Rcsults: 2.236 individuals underwent the CIDI; 1.274 with an
anxiety disorder, 1.053 with depression, with much overlap. 1.260
scored 1-18 on the suicidality item score; f/m ratio = 2.2:1; 976
scored zero, f/m ratio 1.7:1. There were 976 in group 1,567 in group
II, 518 in group III and 166 in group IV. The mean rate of anxiety
disorders increased according to suicidal severity from 0.8 to 2.2;
that of depressive disorders from 0.3 to 1.1; and that of alcohol/
substance abuse from 0.2 to 0.6. These increases are highly signifi-
cant (P<0.001) across categories and disorders.
Conclusion: These results show a significant linear relationship
between the severity of lifetime morbidity of anxiety, depressive
disorders and substance abuse/dependence, and suicide risk.
S-XIII/4 Friday 15/8,11:00-12:30
Can suicide rates be reduced by antidepressants?
Göran Isacsson, Associate Professor, Karolinska Institute, Neurotec, Division of
Psychiatry, Huddinge University Hospital, S-141 86 Stockholm, Sweden
Goran. Isacsson@neurotec. ki.se
Method: Review of evidence and new toxicological data.
Kesult: Several reports give evidence for that lithium prevents sui-
cide in bipolar patients (1). A long-term study of a cohort in Zurich
found that the amount of received antidepressants was the best
predictor for not having committed suicide at foliow-up (2). It has
been shown that only a minority of individuals committing suicide
have received adequate antidepressant treatment. Based on epi-
demiological studies until 1991, it was estimated that treatment with
antidepressants reduced suicide rates by 50% in depressed indivi-
duals. Less than l-in-5 of depressed individuals was treated, how-
ever, leading to a very subtle reduction of suicide - in Sweden 5%
during 1978-1991. It was therefore predicted that a 5-fold increase
in the use of antidepressants would lower suicide rates by 25%. Ten
years later, the use of antidepressants in Sweden was five times
higher than in 1990 and the suicide rate was 31% lower (3). The
proportion of suicides found positive for antidepressants in forensic
toxicology had increased from 16% to 23%.Conclusion. Although
definitive conclusions cannot be drawn, the increased use of anti-
depressants is the most probable cause of the decrease in suicide.
References
1. Tondo L, Isacsson G, Baldcssarini RJ. Suicidal behaviour in bipolar disorder.
Risk and prevention. CNS Drugs 2003; in press.
2. Angst F, Stassen HH, Clayton P, Angst J. Mortality of patients with mood
disorders: follow-up over 34-38 years. J Affect Disord 2002; 68:167-81.
3. Isacsson G. Suicide prevention-a medical breakthrough? Acta Psychiatr Scand
2000; 102:113-7.
S-XIII/5 Friday 15/8,11:00-12:30
Rational elder suicide - when the clock cannot be turned
back
Mira J. Sheerin, 1050 George Street, apt. 8N - New Brunswick, NJ 08901, USA
sheeriiwij@aol.com
Background: There is an increasing awareness of elder suicide.
Since I am approaching the stage in life when irreversible mental
and physical decline cannot be stopped, the thought of achieving a
dignified death is increasingly with me.
Aims: Written by a nonprofessional, the paper examines reasons
for rational suicide and the importance of physician assistance.
Method: Discussions with peers, reading of studies by physicians
and social workers, and, most importantly, personal feelings, are the
basis of this paper. Consideration is given to causes of suicide, ad-
38 Læknablaðið / FYLOIRIT 48 2003/89