Ping Qin

• Hughes, Carla Louise & Qin, Ping (2027). Suicide risk in relation to socioeconomic and occupational disadvantage in middle- and old-aged men – A national register-based study. Journal of Affective Disorders. ISSN 0165-0327. 416, p. 122564–122564. doi: 10.1016/j.jad.2026.122564. Full text in Research Archive
• Pirkis, Jane; Shin, Sangsoo; Roberts, Leo; Arya, Vikas; Agrest, Martin & Aguilar, Pablo Analuisa [Show all 106 contributors for this article] (2026). The Cost-Of-Living Crisis and Suicide Rates: Time Series Analysis of Data From 54 Countries. Crisis. ISSN 0227-5910. doi: 10.1027/0227-5910/a001077. Full text in Research Archive Show summary

  Abstract: Background: The cost-of-living crisis may be contributing to suicide rates, but this has not been adequately tested. Aims: We aimed to determine whether the cost-of-living crisis is associated with suicide rates in multiple countries and areas-within-countries. Method: We sourced country- and area-within-country-level monthly suicide data at a minimum from January 1, 2019, to December 31, 2022 (and at a maximum from January 1, 2016, to June 30, 2023), and population denominator and monthly headline consumer price index (CPI) data. We calculated the yearly change in inflation as the percentage change in CPI for one month versus the equivalent month in the previous year. We estimated associations between yearly change in inflation (lagged by one month) and suicide rates for each country and area-within-country, using autoregressive negative binomial regression. We summarized results using weighted means. Results: We obtained data on 1,372,994 suicides from 54 countries. At the country-level, for every 1.0% increase in yearly inflation in the previous month, there was an average 0.2% increase in suicide rates. The association was strongest in those aged 30–49 and 50–69; for every 1.0% increase in yearly inflation in the previous month, there were 0.3% and 0.6% increases in suicide rates for these age-groups, respectively. This pattern held for males in these age-groups, with increases of the same magnitude, and for females aged 50–69, with a 0.8% increase. At the area-within-country-level, the picture was even starker. Limitations: Study limitations include: the ecological design; the single measure of inflation; potential variations in suicide data quality; lack of representation by low-and-middle-income countries (LMICS); lack of availability of sex, age and sex/age breakdowns for some countries and areas-within-countries; and potential issues with multiple testing. Conclusions: There is an association between the cost-of-living crisis and suicide rates internationally. Public and social policies that improve people’s circumstances are critical.

• Flygare, Oskar; Diest, Ana Portillo Van; Dymbe, Kine Johansen; Siqveland, Johan; Bhargav, Madhav & Fernández, Montserrat López [Show all 13 contributors for this article] (2026). A systematic review of clinical practice guidelines for suicide and self-harm prevention in adults. Psychiatry Research. ISSN 0165-1781. 366, p. 117465–117465. doi: 10.1016/j.psychres.2026.117465. Full text in Research Archive
• Wang, Jiang-Yan; Qin, Ping; Wang, Jia-Ning; Jia, Xiao-Yu; Liu, Chang & Hu, Wei [Show all 12 contributors for this article] (2026). Adverse childhood experiences and suicide attempts in rural China: Case–control study on roles of negative life events and psychological factors. Healthcare and Rehabilitation. 2(3), p. 100097–100097. doi: 10.1016/j.hcr.2026.100097. Full text in Research Archive
• Solberg, Amalie Christine; Ottesen, Akiah Astral; Barrett, Elizabeth Ann; Mork, Erlend; Qin, Ping & Melle, Ingrid (2026). Characteristics of self-harm in patients with first episode psychosis. Psychiatry Research. ISSN 0165-1781. 364, p. 117278–117278. doi: 10.1016/j.psychres.2026.117278. Full text in Research Archive
• Skei-Larssen, Emma; Grimholt, Tine Kristin & Qin, Ping (2025). Risk of deliberate self-harm and suicide in children bereaved from parental death by specific natural and external causes – A national study. Journal of Affective Disorders. ISSN 0165-0327. 397. doi: 10.1016/j.jad.2025.120984. Full text in Research Archive Show summary

  Objective Losing a parent in childhood can significantly impact the child, yet little research examines how cause of parental death may affect children differently. This study aims to investigate risks of deliberate self-harm (DSH) and suicide in bereaved children by parental cause of death. Method Data from Norwegian population registers were interlinked to investigate exposure to parental death from specific causes and risks of DSH and suicide via a nested case-control design. Children under the age of 35 who were treated for DSH (n = 20,180) or died by suicide (n = 5039) constituted the cases and were compared with population controls of 20 per case matched by gender and age. Conditional logistic regression models were used to assess the risk. Results In the study population, 9.7 % of the DSH cases and 13.1 % of the suicide cases lost a parent. The risk of DSH was increased for bereaved children [OR = 1.54, 95 %CI 1.46–1.62], with the highest risk associated with parental death caused by mental diseases [2.84, 2.34–3.44], followed by accidental poisoning and suicide. The risk of suicide was significantly increased for bereaved children after parental death [1.28, 1.17–1.40], with the highest risk associated with parental death caused by homicide [4.68, 2.18–10.02], followed by suicide and accidental poisoning. No gender interactions or gender-of-deceased interactions was detected. Conclusion Parental-bereaved children are at significantly increased risk of DSH and suicide in early life, but the risk differ by parental cause of death. This underscores the importance of psychosocial and familial support for children following a parental loss.

• Hughes, Carla Louise; Liu, Baopeng & Qin, Ping (2025). Socioeconomic, demographic, and occupational risk factors for suicide amongst males: a systematic review and meta-analysis. Journal of Affective Disorders. ISSN 0165-0327. 391. doi: 10.1016/j.jad.2025.119986. Full text in Research Archive Show summary

  Background Suicide mortality remains a serious public health issue amongst adult males, yet there is a lack of comprehensive reviews addressing suicide risk with occupation and socioeconomic status in this selected population. This systematic review and meta-analysis synthesises data drawn from multiple countries, with the purpose of highlighting how these societal factors contribute to male suicide. Methods Using PRISMA reporting guidelines, a systematic search was conducted across MEDLINE, Embase, PsycINFO, Scopus, and Web of Science for English-language studies published 1993 to 2023. Studies reporting individual-level data on employment, income, education, marital status and occupation associated with suicide of male adults were included. A total of 53 studies with data from 23 countries met the inclusion criteria. Results Meta-analyses revealed the pooled prevalence of key risk factors in male suicide decedents were often unemployed (18.4 %), had a low education (40.5 %), never married (33.7 %), divorced (13.4 %), or widowed (7.3 %). The associated pooled risk ratios demonstrated elevated risks for suicide: 1.84 (95 % CI: 1.44–2.36) for unemployment, 2.27 (1.84–2.81) for being separated/divorced, and 2.69 (1.52–4.77) for low income. Occupational classifications revealed increased risks for suicide amongst males in skilled agricultural work (RR 1.90, 1.59–2.17) and craft and related trades workers (RR 1.56, 1.16–2.10). Meanwhile, being managers and clerical support workers presented to be protective against suicide in males. Conclusion Male suicide is closely linked to personal socioeconomic status and type of occupation. These findings highlight the importance of informed social policies and suicide prevention initiatives targeting males with socioeconomic and occupational disadvantages.

• Solberg, Amalie; Ottesen, Akiah; Barrett, Elizabeth Ann; Kristiansen, Ida; Mork, Erlend & Qin, Ping [Show all 7 contributors for this article] (2025). Trajectories of suicidal behavior and their clinical correlates in the early phases of schizophrenia spectrum disorders. Psychiatry Research. ISSN 0165-1781. 347. doi: 10.1016/j.psychres.2025.116409. Full text in Research Archive Show summary

  Background Many risk factors for suicidal behavior (SB) in schizophrenia spectrum disorders (SSD) are present before the onset of psychosis or are associated with specific phases of illness. We aim to investigate the trajectories of SB from before the onset of psychosis until the first start of treatment in patients with first-episode psychosis (FEP). Method A total of 252 patients with first-episode SSD were recruited, out of which 224 had complete SB data. They participated in clinical interviews and self-report questionnaires during their first treatment. We assessed SB in three time periods: Before the onset of psychosis, during untreated psychosis, and at treatment start (study baseline). We used K-mean cluster analyses to identify trajectories of SB over these periods. Results Four trajectories of SB were identified: persistent low/no SB (n = 114, 51 % of 224), increasing mild/moderate SB (n = 54, 24 %), severe SB during untreated psychosis (n = 25, 11 %), severe persistent SB (n = 31, 14 %). With “persistent low/no SB” as a reference group, all other groups had significantly more depressive symptoms at baseline. The duration of untreated psychosis was significantly longer in the group with “severe SB during untreated psychosis”. Clinical insight subscale scores differed between the trajectory groups. Also, the “severe persistent SB” group reported more emotional abuse and total childhood trauma than the “increasing mild/moderate SB” group. Conclusion Our findings suggest the presence of different pathways to SB in FEP. More knowledge about these pathways can support the development of tailored preventive strategies in this patient group.

• Krishnamoorthy, Sadhvi; Armstrong, Gregory; Ross, Victoria; Reifels, Lennart; Purdon, Hayley & Francis, Jillian [Show all 51 contributors for this article] (2025). Towards development of guidelines for harnessing implementation science for suicide prevention: an international Delphi expert consensus study. BMJ Public Health. 3(1). doi: 10.1136/bmjph-2024-001206. Full text in Research Archive Show summary

  Objectives Suicide research and prevention are complex. Many practical, methodological and ethical challenges must be overcome to implement effective suicide prevention interventions. Implementation science can offer insights into what works, why and in what context. Yet, there are limited real-world examples of the application of implementation science in suicide prevention. This study aimed to identify approaches to employ principles of implementation science to tackle important challenges in suicide prevention. Methods A questionnaire about promoting implementation science for suicide prevention was developed through thematic analysis of stakeholder narratives. Statements were categorised into six domains: research priorities, practical considerations, approach to intervention design and delivery, lived experience engagement, dissemination and the way forward. The questionnaire (n=52 statements—round 1; n=44 statements—round 2; n=9 statements—round 3) was administered electronically to a panel (n=62—round 1, n=48—round 2; n=45—round 3) of international experts (suicide researchers, leaders, project team members, lived experience advocates). Statements were rated on a Likert scale based on an understanding of importance and priority of each item. Statements endorsed by at least 85% of the panel would be included in the final guidelines. Results Eighty-two of the 90 statements were endorsed. Recommendations included broadening research inquiries to understand overall programme impact; accounting for resources in the translation of evidence into practice; embedding implementation science in intervention delivery and design; meaningfully engaging lived experience; considering channels for dissemination of implementation-related findings and focusing on next steps needed to routinely harness the strengths of implementation science in suicide prevention research, practice and training. Conclusion An interdisciplinary panel of suicide prevention experts reached a consensus on optimal strategies for using implementation science to enhance the effectiveness of policies and programmes aimed at reducing suicide.

• Lunde, Ketil Berge; Mehlum, Lars; Melle, Ingrid & Qin, Ping (2024). Psychiatric follow-up and repeated hospital presentation of DSH: A national study on young adults. Journal of Affective Disorders. ISSN 0165-0327. 368, p. 383–389. doi: 10.1016/j.jad.2024.09.086. Full text in Research Archive Show summary

  Introduction Psychiatric care following discharge from general hospital treatment of deliberate self-harm (DSH) is important to reduce patients´ risk of relapse. Whether such follow-up is associated with DSH repetition in young adults is not sufficiently understood. This study examined the association between psychiatric service attendance within seven days of discharge and repeated hospital-presented DSH within 3, 6, and 12 months in patients aged 18–35 years. Methods Incident episodes of hospital-presented DSH from 2010 to 2017 were identified from the Norwegian Patient Register. Those already psychiatrically admitted or who died during the general hospital or in the seven days after discharge were excluded. Psychiatric service attendance was categorized as ‘no attendance’, ‘outpatient attendance’, and ‘inpatient admissions.’ The association between psychiatric service attendance and subsequent DSH repetition was examined with an Inverse Probability of Treatment Weighted logistic regression model. Results Of the 11,308 patients identified, 17.3 % had a psychiatric outpatient attendance, and 19.9 % had an inpatient admission. Outpatient attendance was not associated with a reduced risk of repeated DSH and inpatient admissions were associated with an increased risk in certain subgroups, notably patients: aged 18–24 years; without a recorded mood disorder diagnosis; or no history of hospital-treated DSH. Limitations Our data did not contain all relevant confounders. Unmeasured confounding is therefore likely to influence the results. Conclusion Although no conclusions regarding treatment effectiveness can be drawn from these findings, the study highlights that patients with the most severe psychiatric symptoms and at the highest risk of DSH relapse received follow-up.

• Goldman-Mellor, Sidra & Qin, Ping (2024). Psychiatric disorder before and after exposure to violent injury: A nationwide Norwegian register-based cohort study. Journal of Psychiatric Research. ISSN 0022-3956. 180, p. 154–162. doi: 10.1016/j.jpsychires.2024.09.053. Full text in Research Archive Show summary

  Interpersonal violent injury is associated with increased risk of subsequent psychological problems, but pre-existing psychopathology may complicate this association in ways that are poorly understood. Using nationwide longitudinal registry data from Norway, we tested how psychiatric history modified the association between violent injury exposure and subsequent psychiatric disorder, and examined disorder continuity before vs. after violent injury. We identified all individuals presenting to emergency services in 2010–2018 with a violent injury, along with sex- and age-matched comparison individuals from the general population. The primary outcome was subsequent psychiatric disorder, observed through December 31, 2018, with secondary analyses examining psychiatric diagnoses pre- vs. post-injury. Of the 28,276 violence-injured patients, 20% had a history of psychiatric disorder, vs. 6% of the 282,760 comparison individuals. In Cox regression models, violence-injured patients had substantially higher rates of any subsequent psychiatric disorder when compared to matched peers (HRadj: 2.36; 95% CI: 2.29, 2.42), but this association was confounded and modified by psychiatric history. Continuity of psychiatric diagnosis before and after injury was high among violence-injured patients, but they were also more likely than the comparison group to receive a new diagnosis, potentially indicating incident onset of new psychiatric disorder associated with violence exposure. Violence-injured patients face substantial burden of psychiatric disorder, especially for substance use and mood/anxiety disorders; clinical and public health strategies are needed to address this burden, which precedes violent injury in some cases but is likely provoked by it in others.

• Larsen, Kim Sverre; Stangeland, Tormod & Qin, Ping (2024). Reaksjoner på møter med selvmordshandlinger blant ansatte i psykisk helsevern og rusbehandling. Suicidologi. ISSN 1501-6994. 29(2), p. 12–33. doi: 10.5617/suicidologi.11797. Full text in Research Archive Show summary

  Artikkelen presenterer resultatene fra en spørreundersøkelse av ansattegruppen ved en klinikk for psykisk helsevern og rusbehandling (N=382) av helsepersonells opplevelse og særlig reaksjoner etter selvmordsforsøk og selvmord hos pasienter. Dette er tidligere blitt undersøkt hovedsakelig gjennom kvalitative intervjuer. 82 % av deltakerne oppga å ha erfart selvmord eller selvmordsforsøk hos pasienter. Reaksjoner i etterkant av selvmord eller selvmordsforsøk er svært utbredt blant deltakerne, særlig i form av symptomer på belastning (66.1 %) og økt fokus på formelle sider av arbeidet med risiko (51.2 %). 31.9 % av deltakerne rapporterer om skyldfølelse etter en slik hendelse, og 84 % oppgir at de har tenkt over om de egner seg til å jobbe med problematikken. Samtidig oppgir 14 % at arbeidet med selvmordsatferd også har forandret synet deres på livet i positive retninger. Leger og psykologer opplever erfaringene som gjennomgående mer belastende enn de andre yrkesgruppene. Personell som kun har erfaringer med selvmordsforsøk hos pasienter oppgir like omfattende reaksjoner som de som har erfart pasientselvmord, men de opplever mindre grad av støtte fra ledelse og kolleger. Dette funnet har åpenbare implikasjoner for oppfølging av personalet. Undersøkelsen gir støtte til at tidligere kvalitative undersøkelser av enkeltpersoner er representative for bredere grupper av helsepersonell innen psykisk helsevern og rusbehandling.

• Mortier, Philippe; Conde, Susana; Alayo, Itxaso; Amigo, Franco; Ballester, Laura & Amell, Roser Cirici [Show all 23 contributors for this article] (2024). Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge. JAMA Network Open. 7(6). doi: 10.1001/jamanetworkopen.2024.17131. Full text in Research Archive Show summary

  Importance There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. Objective To compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization. Design, Setting, and Participants This retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024. Exposures Socioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Main Outcomes and Measures Postdischarge premature death (ie, all-cause death before age 70 years) and suicide (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted. Results A total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males). Conclusions and Relevance In this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.

• Mortier, Philippe; Amigo, Franco; Bhargav, Madhav; Conde, Susana; Ferrer, Montse & Flygare, Oskar [Show all 21 contributors for this article] (2024). Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-05659-6. Full text in Research Archive Show summary

  Background Self-harm presents a significant public health challenge. Emergency departments (EDs) are crucial healthcare settings in managing self-harm, but clinician uncertainty in risk assessment may contribute to ineffective care. Clinical Decision Support Systems (CDSSs) show promise in enhancing care processes, but their effective implementation in self-harm management remains unexplored. Methods PERMANENS comprises a combination of methodologies and study designs aimed at developing a CDSS prototype that assists clinicians in the personalized assessment and management of ED patients presenting with self-harm. Ensemble prediction models will be constructed by applying machine learning techniques on electronic registry data from four sites, i.e., Catalonia (Spain), Ireland, Norway, and Sweden. These models will predict key adverse outcomes including self-harm repetition, suicide, premature death, and lack of post-discharge care. Available registry data include routinely collected electronic health record data, mortality data, and administrative data, and will be harmonized using the OMOP Common Data Model, ensuring consistency in terminologies, vocabularies and coding schemes. A clinical knowledge base of effective suicide prevention interventions will be developed rooted in a systematic review of clinical practice guidelines, including quality assessment of guidelines using the AGREE II tool. The CDSS software prototype will include a backend that integrates the prediction models and the clinical knowledge base to enable accurate patient risk stratification and subsequent intervention allocation. The CDSS frontend will enable personalized risk assessment and will provide tailored treatment plans, following a tiered evidence-based approach. Implementation research will ensure the CDSS’ practical functionality and feasibility, and will include periodic meetings with user-advisory groups, mixed-methods research to identify currently unmet needs in self-harm risk assessment, and small-scale usability testing of the CDSS prototype software. Discussion Through the development of the proposed CDSS software prototype, PERMANENS aims to standardize care, enhance clinician confidence, improve patient satisfaction, and increase treatment compliance. The routine integration of CDSS for self-harm risk assessment within healthcare systems holds significant potential in effectively reducing suicide mortality rates by facilitating personalized and timely delivery of effective interventions on a large scale for individuals at risk of suicide.

• Fardzadeh, Haghish Ebad; Czajkowski, Nikolai Olavi; Walby, Fredrik Andreas; Qin, Ping & Laeng, Bruno (2024). Suicide attempt risk predicts inconsistent self-reported suicide attempts: A machine learning approach using longitudinal data. Journal of Affective Disorders. ISSN 0165-0327. 355, p. 495–504. doi: 10.1016/j.jad.2024.03.133. Full text in Research Archive Show summary

  Introduction Inconsistent self-reports of lifetime suicide attempts (LSAs) are a major obstacle for accurate assessment of suicidal behavior. This study is the first to posit that adolescents at higher risk report LSAs more consistently than those at lower risk, revealing a link between suicide attempt risk and consistent reporting. Methods A machine learning model was trained with 70 % of the baseline assessment data of a longitudinal sample of Norwegian adolescents (n = 10,739). The model was used to estimate the LSA risk score for the remaining 30 % of the testing dataset. The relationship between these baseline risk scores and the consistency of reporting LSAs was assessed using a 2-year follow-up reassessment of the testing dataset. Results Internalizing problems, optimism about the future, conduct problems, substance use, and disordered eating were important factors associated with suicide attempt risk. Of the participants, 63.41 % had inconsistent self-reports at the two-year follow-up. Adolescents who consistently reported LSAs had significantly higher scores of suicide attempt risk at baseline. Two logistic regression analyses confirmed an association between suicide attempt risk and inconsistent self-reported LSAs and showed that sex (being male), and lower levels of depression and conduct problems significantly predicted such inconsistencies. Those who inconsistently reported LSAs were more likely than the others to be classified by the model as false negatives at the baseline risk assessment due to their lower estimated risk scores. Limitations Suicide attempts were measured with a single item in this study. Conclusion These risk factors support the theory of adolescent suicidality (TAS) and could improve suicide attempt risk assessment. Inconsistent self-reported LSAs signal lower suicide attempt risk.

• Goldman-Mellor, Sidra & Qin, Ping (2024). Interpersonal violent injury and subsequent risk of suicide and deliberate self-harm: a register-based national cohort study from Norway, 2010–2018. EClinicalMedicine. 68. doi: 10.1016/j.eclinm.2024.102442. Full text in Research Archive Show summary

  Background Interpersonal violence is a leading cause of morbidity, with potentially severe adverse consequences for the mental health of the injured persons. The extent to which violent injury is associated with subsequent suicidal behavior, however, remains unclear. This study aimed to examine how violent injury was associated with subsequent deliberate self-harm and death by suicide. Methods This retrospective cohort study used nationwide longitudinal registry data from Norway to identify all individuals presenting to emergency services in 2010–2018 with a violence-related injury, along with sex- and age-matched control individuals from the general population. The primary outcomes were any emergency visit for deliberate self-harm (DSH) and suicide death, observed through 31 December 2018. Rates of each outcome were compared between violence-injured patients and comparison individuals using stratified multivariable Cox regression models, controlling for sociodemographic characteristics as well as history of psychiatric treatment and DSH. Secondary analyses tested for moderation by sex, age, and prior psychiatric treatment. Findings Violence-injured patients (n = 28,276) had substantially higher rates of DSH (946.7 per 100,000 person-years) and suicide death (74.5 per 100,000) when compared to controls (n = 282,760; 90.0 and 15.2 per 100,000, respectively). The hazard ratios (HRs) remained significantly higher even after accounting for covariates (HRadj for DSH: 5.11; 95% CI: 4.62, 5.66; HRadj for suicide: 2.40; 95% CI: 1.78, 3.24). Sex differences in this association were negligible, but the association between violence injury and DSH increased with age. Violence-injured patients with prior psychiatric treatment had the highest risk of suicidal behavior. Interpretation Violence-injured patients experience significantly excess rates of suicidal behavior, a finding with potential to inform both clinical intervention and population-level suicide prevention strategies.

• Fardzadeh, Haghish Ebad; Nes, Ragnhild Bang; Obaidi, Milan; Qin, Ping; Stänicke, Line Indrevoll & Bekkhus, Mona [Show all 8 contributors for this article] (2023). Unveiling Adolescent Suicidality: Holistic Analysis of Protective and Risk Factors Using Multiple Machine Learning Algorithms. Journal of Youth and Adolescence. ISSN 0047-2891. 53, p. 507–525. doi: 10.1007/s10964-023-01892-6. Full text in Research Archive Show summary

  Abstract Adolescent suicide attempts are on the rise, presenting a significant public health concern. Recent research aimed at improving risk assessment for adolescent suicide attempts has turned to machine learning. But no studies to date have examined the performance of stacked ensemble algorithms, which are more suitable for low-prevalence conditions. The existing machine learning-based research also lacks population-representative samples, overlooks protective factors and their interplay with risk factors, and neglects established theories on suicidal behavior in favor of purely algorithmic risk estimation. The present study overcomes these shortcomings by comparing the performance of a stacked ensemble algorithm with a diverse set of algorithms, performing a holistic item analysis to identify both risk and protective factors on a comprehensive data, and addressing the compatibility of these factors with two competing theories of suicide, namely, The Interpersonal Theory of Suicide and The Strain Theory of Suicide. A population-representative dataset of 173,664 Norwegian adolescents aged 13 to 18 years (mean = 15.14, SD = 1.58, 50.5% female) with a 4.65% rate of reported suicide attempt during the past 12 months was analyzed. Five machine learning algorithms were trained for suicide attempt risk assessment. The stacked ensemble model significantly outperformed other algorithms, achieving equal sensitivity and a specificity of 90.1%, AUC of 96.4%, and AUCPR of 67.5%. All algorithms found recent self-harm to be the most important indicator of adolescent suicide attempt. Exploratory factor analysis suggested five additional risk domains, which we labeled internalizing problems, sleep disturbance, disordered eating, lack of optimism regarding future education and career, and victimization. The identified factors provided stronger support for The Interpersonal Theory of Suicide than for The Strain Theory of Suicide. An enhancement to The Interpersonal Theory based on the risk and protective factors identified by holistic item analysis is presented.

• Erlangsen, Annette; Khan, Murad; Su, Wen; Alateeq, Khawlah; Charfi, Fatma & Madsen, Trine [Show all 13 contributors for this article] (2023). Situation Analysis of Suicide and Self-Harm in the WHO Eastern Mediterranean Region. Archives of Suicide Research. ISSN 1381-1118. doi: 10.1080/13811118.2023.2262532. Full text in Research Archive
• Bøe, Anne Seljenes; Mehlum, Lars; Melle, Ingrid & Qin, Ping (2023). Psychiatric disorders among adult deliberate self-harm patients and subsequent risk of dying by suicide, mental and behavioural disorders and other external causes. Journal of Psychiatric Research. ISSN 0022-3956. 165, p. 83–90. doi: 10.1016/j.jpsychires.2023.07.011. Full text in Research Archive Show summary

  Introduction Deliberate self-harm (DSH) treated in general hospital is a well-established risk factor for suicide and other cause mortality. However, few studies have used population data to investigate the differential impact of specific psychiatric disorders on the risk of subsequent suicide, by sex and age of the patient in the context of previous DSH episodes. Method All patients aged 18 and older treated for DSH in general hospitals during the period 2008–2018 were identified through national registers. Cox proportional hazards regression was used to ascertain the associated risk of death by suicide, mental and behavioural disorder and other external causes. Results The cohort consisted of 39 479 patients of which 878 died by suicide, 461 by mental and behavioural disorders and 1037 by other external causes. Overall, schizophrenia spectrum disorders, affective disorders and personality disorders increased the risk of suicide. Large gender and age differences were identified in the risk of suicide associated with personality disorders and affective disorders. Alcohol use disorders and dementia increased the risk of dying by mental and behavioural disorders and alcohol use disorders and other substance use disorders increased the risk of death by external causes. Conclusion Schizophrenia spectrum disorders, affective disorders and personality disorders increased the risk of suicide among DSH patients, but the effect varied by gender, age and history of previous DSH. Psychiatric evaluation of all DSH patients and treatment tailored to the patient's specific needs is essential to reduce the risk of premature death.

• Erlangsen, Annette; Qin, Ping; Madsen, Trine; Hawton, Keith; Osler, Merete & Hjorthøj, Carsten [Show all 12 contributors for this article] (2023). Association between SARS-CoV-2 infection and self-harm: Danish nationwide register-based cohort study. British Journal of Psychiatry. ISSN 0007-1250. 222(4), p. 167–174. doi: 10.1192/bjp.2022.194. Full text in Research Archive Show summary

  Background Case studies have linked SARS-CoV-2 infection to suicidal behaviour. However, conclusive evidence is lacking. Aims To examine whether a history of SARS-CoV-2 infection or SARS-CoV-2-related hospital admission was associated with self-harm in the general population and in high-risk groups. Method A cohort design was applied to nationwide data on all people aged ≥15 years and living in Denmark between 27 February 2020 and 15 October 2021. Exposure was identified as having had a positive SARS-CoV-2 PCR test, and further assessed as SARS-CoV-2-related hospital admission. Rates of probable self-harm were examined using adjusted incidence rate ratios (aIRRs). The following subgroups were identified: (a) lower educational level, (b) chronic medical conditions, (c) disability pension, (d) mental disorders, (e) substance use disorders, and history of (f) homelessness and (g) imprisonment. Results Among 4 412 248 included individuals, 260 663 (5.9%) had tested positive for SARS-CoV-2. Out of 5453 individuals presenting with self-harm, 131 (2.4%) had been infected. Individuals with a history of a positive SARS-CoV-2 test result had an aIRR for self-harm of 0.86 (95% CI 0.72–1.03) compared with those without. High rates were found after a SARS-CoV-2-related hospital admission (aIRR = 7.68; 95% CI 5.61–10.51) or a non-SARS-CoV-2-related admission (aIRR = 10.27; 95% CI 9.65–10.93) versus non-infected and not admitted. In sensitivity analyses with a more restrictive definition of self-harm, a positive PCR test was associated with lower rates of self-harm. Conclusions Individuals with a PCR-confirmed SARS-CoV-2 infection did not have higher rates of self-harm than those without. Hospital admission in general, rather than being SARS-CoV-2 positive. seemed to be linked to elevated rates of self-harm.

• Bøe, Anne Seljenes; Mehlum, Lars; Melle, Ingrid & Qin, Ping (2022). Psychiatric disorders among adults treated for deliberate self-harm in general hospital: A national register study. Journal of Affective Disorders. ISSN 0165-0327. 319, p. 490–496. doi: 10.1016/j.jad.2022.09.066. Full text in Research Archive Show summary

  Background Psychiatric disorders are common among individuals treated for deliberate self-harm (DSH) in general hospitals. However, few large-scale studies have explicitly addressed psychiatric disorders among adult DSH patients. Aim To examine the presence of psychiatric disorders among adults presenting to general hospitals following DSH, and further to establish clinical and sociodemographic determinants of being diagnosed with a psychiatric disorder in this patient population. Method Data from several national registers were interlinked to identify all individuals aged 18 and older presenting to general hospital for DSH during the period 2008–2018. Logistic regression was used to examine the association between psychiatric disorders (ICD-10) and clinical and sociodemographic characteristics of the DSH patients. Results Altogether 39,534 subjects with 63,622 episodes of DSH were included in the study with a gender ratio (F:M) of 1.48. The majority were unmarried and had low income and education. Psychiatric disorders were present in 58.5 % of all episodes and in 54.3 % of the index episodes. Affective disorders displayed the highest prevalence (18.3 %), followed by alcohol use disorder (16.4 %). Personality disorders were highly prevalent among young females with multiple DSH episodes. Middle-aged individuals had the highest prevalence of psychiatric disorders. Presence of psychiatric disorders was significantly associated with DSH repetition. Limitations Data was restricted to variables available in the registers. Conclusions Psychiatric disorders were common among DSH patients in the present cohort, but distributed differently between the genders. DSH repetition and middle-age was associated with being diagnosed with a psychiatric disorder.

• Goldman-Mellor, Sidra; Kaplan, Mark S. & Qin, Ping (2022). Mortality Risk Following Nonfatal Injuries With Alcohol Use Disorder Involvement: AOne-Year Follow-Up of Emergency Department Patients Using Linked Administrative Data. Journal of Studies on Alcohol and Drugs. ISSN 1937-1888. 83(6), p. 879–887. doi: 10.15288/jsad.21-00444. Full text in Research Archive
• Liu, Bao-Peng; Qin, Ping; Zhang, Jie; Hennessy, Dwight A.; Chu, Jie & Wang, Xin-Ting [Show all 8 contributors for this article] (2022). Suicide and non-suicide mortality and associated risk factors among suicide attempters: A 10-year follow-up of a large cohort in rural China. Journal of Psychiatric Research. ISSN 0022-3956. 150, p. 71–78. doi: 10.1016/j.jpsychires.2022.03.034. Full text in Research Archive
• Bøe, Anne Seljenes; Mehlum, Lars; Melle, Ingrid & Qin, Ping (2022). Clinical determinants of hospital treated deliberate self-harm repetition: A time to recurrent event analysis. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 146(6), p. 557–567. doi: 10.1111/acps.13503. Full text in Research Archive Show summary

  Introduction Psychiatric disorders are strongly associated with hospital treated deliberate self-harm (DSH). However, the effect of specific disorders on risk for DSH repetition in sex-age-subgroups is understudied. The present study aims to assess the influence of various specific psychiatric disorders on risk for subsequent DSH repetition by way of time to recurrent event analysis on a national cohort of DSH patients. Material and Methods Individuals aged 18 and older presenting to somatic hospital for DSH during the period 2008–2018 was identified through national registers. A parametric shared frailty survival analysis was used to investigate the impact of various psychiatric disorders on risk of DSH repetition. Results The cohort consisted of 39,508 individuals of which 8634 (21.8%) presented with 24,028 repeated episodes of hospital treated DSH. Borderline personality disorder increased the risk of DSH repetition in females (adjusted HR 1.49, CI 1.41–1.57), while alcohol use disorder (HR 1.12, CI 1.04–1.19) and substance use disorders (adjusted HR 1.22, CI 1.14–1.32) increased the risk of repetition in males. The strongest impact of psychiatric disorder on risk of repetition was found among the elderly. Previous history of DSH was associated with the highest increased risk of repetition. Conclusion Prior history of DSH was strongly associated with DSH repetition, but the influence of psychiatric disorder varied significantly by specific diagnoses and by sex and age of the patients. Efforts to prevent DSH repetition should be age and gender specific and designed to meet the needs of people with different specific psychiatric disorders.

• Qin, Ping; Sadia, Syeda; Canetto, Silvia S; Arya, Vikas; Liu, Baopeng & Menon, Vikas [Show all 10 contributors for this article] (2022). Midlife suicide: A systematic review and meta-analysis of socioeconomic, psychiatric and physical health risk factors. Journal of Psychiatric Research. ISSN 0022-3956. 154, p. 233–241. doi: 10.1016/j.jpsychires.2022.07.037. Full text in Research Archive Show summary

  Suicide is an increasing contributing cause of mortality in middle-aged adults; however, knowledge to guide prevention is limited. This first systematic review and meta-analysis of studies on midlife suicide has provided an overview of published research on this issue and synthesized the evidence on socioeconomic and physical and mental health factors associated with this mortality. Using PRISMA guidelines MEDLINE, Embase, PsycINFO, Scopus and Web of Science were searched for English-language publications that involved persons aged 35 to 65, used individual-level data, and reported prevalence of exposure(s) or relative risks. The search identified 62 studies on midlife suicides and associated factors (28 for SES, 22 for psychiatric disorder and 23 for physical illness). All studies were from high income countries, and most (80.6%) used data from population registries. Meta-analyses showed that the pooled prevalence of exposure in suicide decedents was 57.8% for psychiatric disorder, 56.3% for low income, 43.2% for unemployment, and 27.3% for physical illness. The associated pooled risk ratio was 11.68 (95% confidence intervals: 5.82–23.47) for psychiatric illness of any type, 12.59 (8.29–19.12) for mood disorders, 3.91 (2.72–5.59) for unemployment, 3.18 (2.72–3.72) for being separated or divorced, 2.64 (2.26–3.10) for cancer, 2.50 (0.96–6.38) for central nervous system illness, and 2.26 (1.16–4.41) for low income. In conclusion, midlife suicide is strongly associated with socioeconomic difficulties and physical and psychiatric illnesses that are common in this age population. Future investigations should consider the interactions between risk factors, the intersectionality of sex and ethnicity, and include data from low- and middle-income countries.

• Pirkis, Jane; Gunnell, David; Qin, Ping; Shin, Sangsoo; Pozo-Banos, Marcos Del & Arya, Vikas [Show all 50 contributors for this article] (2022). Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries. EClinicalMedicine. 51. doi: 10.1016/j.eclinm.2022.101573. Full text in Research Archive Show summary

  Background Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries’ COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries’ income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue.

• Lunde, Ketil Berge; Mehlum, Lars; Melle, Ingrid & Qin, Ping (2022). Psychiatric admissions after hospital presented deliberate self-harm in the young: A national study. Journal of Psychiatric Research. ISSN 0022-3956. 151, p. 575–582. doi: 10.1016/j.jpsychires.2022.05.020. Full text in Research Archive Show summary

  Follow-up psychiatric care is crucial for young adults presenting to hospitals because of deliberate self-harm (DSH). However, who receives such care is not sufficiently understood. We therefore investigated the clinical and sociodemographic correlates of admissions to psychiatric inpatient treatment immediately following general hospital treatment of DSH in this age band. All episodes of hospital presented DSH among patients aged 18–35 years during the period 2008–2018 were identified from the Norwegian Patient Register. The outcome was admissions to psychiatric inpatient treatment immediately after discharge from the general hospital. The correlates of such admissions were calculated using binomial generalized estimating equation. Of 26.166 identified DSH episodes, 21.4% were admitted to psychiatric inpatient treatment. Admissions were most common for patients with a history of psychiatric treatment and a recorded diagnosis of psychosis-, mood- or personality disorders. Adjusted for other psychiatric factors, alcohol- or substance misuse diagnoses and repeated presentations of DSH were inversely associated with admissions to psychiatric inpatient treatment. Young adults admitted to psychiatric inpatient treatment following DSH have a high burden of psychiatric morbidity and risk factors for suicide. However, the inverse association seen for two important risk factors for suicide, alcohol- or substance misuse and repeated DSH, warrants further attention.

• Liu, Baopeng; Jia, Cunxian; Qin, Ping; Zhang, Yingying; Yu, Yaokun & Luo, Xiao [Show all 7 contributors for this article] (2022). Associating factors of suicide and repetition following self-harm: A systematic review and meta-analysis of longitudinal studies. EClinicalMedicine. 49. doi: 10.1016/j.eclinm.2022.101461. Full text in Research Archive Show summary

  Background Longitudinal evidence for sociodemographic and clinic factors deviating risk for suicide and repetition following SH (self-harm) varied greatly. Methods A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted from January 1st, 2010 to April 5th, 2022. Longitudinal studies focusing on examining associating factors for suicide and repetition following SH were included. PROSPERO registration CRD42021248695. Findings The present meta-analysis synthesized data from 62 studies published from Jan. 1st, 2010. The associating factors of SH repetition included female gender (RR, 95%CI: 1.11, 1.04–1.18, I2=82.8%), the elderly (compared with adolescents and young adults, RR, 95%CI: 0.67, 0.52–0.87, I2=86.3%), multiple episodes of SH (RR, 95%CI: 1.97, 1.51–2.57, I2=94.3%), diagnosis (RR, 95%CI: 1.60, 1.27–2.02, I2=92.7%) and treatment (RR, 95%CI: 1.59, 1.40–1.80, I2=93.3%) of psychiatric disorder. Male gender (RR, 95%CI: 2.03, 1.80–2.28, I2=83.8%), middle-aged adults (compared with adolescents and young adults, RR, 95%CI: 2.40, 1.87–3.08, I2=74.4%), the elderly (compared with adolescents and young adults, RR, 95%CI: 4.38, 2.98–6.44, I2=76.8%), physical illness (RR, 95%CI: 1.95, 1.56–2.43, I2=0), multiple episodes of SH (RR, 95%CI: 2.02, 1.58–2.58, I2=87.4%), diagnosis (RR, 95%CI: 2.13, 1.67–2.71, I2=90.9%) and treatment (RR, 95%CI: 1.36, 1.16–1.58, I2=58.6%) of psychiatric disorder were associated with increased risk of suicide following SH. Interpretation Due to the substantial heterogeneity for clinic factors of suicide and repetition following SH, these results need to be interpreted with caution. Clinics should pay more attention to the cases with SH repetition, especially with poor physical and psychiatric conditions.

• Qin, Ping; Stanley, Barbara; Melle, Ingrid & Mehlum, Lars (2022). Association of Psychiatric Services Referral and Attendance Following Treatment for Deliberate Self-harm with Prospective Mortality in Norwegian Patients. JAMA psychiatry. ISSN 2168-6238. 79(7), p. 651–658. doi: 10.1001/jamapsychiatry.2022.1124. Full text in Research Archive
• Stene-Larsen, Kim; Raknes, Guttorm; Engdahl, Bo Lars; Qin, Ping; Mehlum, Lars & Strøm, Marianne Sørlie [Show all 7 contributors for this article] (2022). Suicide trends in Norway during the first year of the COVID-19 pandemic: A register-based cohort study. European psychiatry. ISSN 0924-9338. 65(1), p. 1–8. doi: 10.1192/j.eurpsy.2022.17. Full text in Research Archive Show summary

  Background There 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. Methods This 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. Results In 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). Conclusion There is no indication that the COVID-19 pandemic led to an increase in suicide rates in Norway in 2020.

• Qin, Ping & Larsen, Kim (2021). Formal requirements for suicide risk assessment in mental healthcare services: Self-reported familiarity and perceptions among clinicians. International Journal of Healthcare Management. ISSN 2047-9700. p. 1–7. doi: 10.1080/20479700.2020.1870350. Full text in Research Archive Show summary

  Background Standardized routines and procedures are crucial in clinical practice, however, these may also restrict clinical autonomy. This study aims to assess clinicians’ familiarity with and perceptions of established formal requirements for suicide risk assessment in mental healthcare services. Methods Clinical staff in the psychiatric section at a large hospital trust in Norway were invited to take part in an online survey designated for the study. Responses were measured on a Likert scale. 503 clinicians participated in the survey and data from 396 respondents whose tasks at work involved asking and recording patientś suicidal behavior were included in the analysis. Results Participants reported high levels of familiarity with the formal requirements for suicide risk assessment, i.e., routines in their own work section, procedures in the hospital’s electronic quality management system, current legislation, and national guidelines. However, there are notable differences by clinical background with higher levels of familiarity being found among doctors and psychiatrists and among staff frequently seeing suicidal patients. The perceived benefits of these formal requirements are clear goal setting and confidence to do what is relevant, whilst the perceived drawbacks are that these routines and procedures are time consuming and have an overly legalistic focus. These perceptions exhibited a high level of internal consistency and were not associated with respondents’ familiarity with the requirements. Conclusion Clinicians reported good familiarity with formal requirements and possessed ambivalent perceptions of required routines and procedures in practice. There is a need to enhance the understanding of the multi-purpose of implementing standardized procedures for suicide risk assessment in health services.

• Erlangsen, Annette; Qin, Ping & Mittendorfer-Rutz, Ellenor (2021). Data linkage and studies of suicidal behavior. In Kölves, Kairi; Sisask, Merike; Värnik, Peeter; Värnik, Airi & Leo, Diego De (Ed.), Advancing Suicide Research. Hogrefe & Huber Publishers. ISSN 9780889375598. p. 115–127. Full text in Research Archive
• Qin, Ping & Mehlum, Lars (2021). National observation of death by suicide in the first 3 months under COVID-19 pandemic. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 143(1), p. 92–93. doi: 10.1111/acps.13246. Full text in Research Archive
• Qin, Ping (2021). Kommentar: Selvmord i Norge i 2020. Suicidologi. ISSN 1501-6994. 26(1), p. 62–63. doi: 10.5617/suicidologi.8933. Full text in Research Archive
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Psykososiale vansker etter tap av foreldre i barn-dom og ungdomstid. Suicidologi. ISSN 1501-6994. 26(3), p. 4–25. doi: 10.5617/suicidologi.9321. Full text in Research Archive Show summary

  At en forelder dør grunnet ytre årsaker slik som selvmord, ulykker og drap er en av de mest traumatiske hendelser et barn eller ungdom kan oppleve. Tidligere forskning har vist at de som har opplevd slikt tap har økt risiko for psykososiale vanskersammenlignet med de som ikke har opplevd slikt tap. Det er derimot mye vi fortsatt ikke vet omsammenhengen mellom tap av foreldre og psykososiale vansker. Denne artikkelen sammenfatter en rekke studier vi har gjort for å kartlegge hvorvidt personer som har mistet en forelder grunnet ytre dødsårsaker i barndom eller ungdomstid har øktlangvarig risiko for å få lavere utdannelse, psykiske lidelser, psykiatrisk komorbiditet, sykehusbehandlet villet egenskade, selvmord eller flere av disse problemene samtidig. Vi ønsket også å identifisere viktige faktorer ved dødsfallet som kan påvirkeetterlattes risiko. For å gjennomføre disse studiene ekstraherte vi data på individnivå fra fire norske longitudinelle registre, og gjennomførte flere studier med store, representative populasjonsutvalg. Studiene som sammenfattes her utgjør den mestomfattende undersøkelsen av psykososiale vansker hos etterlatte barn i Norge.
 Tap av foreldre grunnet ytre årsaker var assosiert med en signifikant høyere risiko for å ikke fullføre utdannelse på alle utdanningsnivåer, bli diagnostisert med en psykisk lidelse, motta sykehusbehandling for villet egenskade og dø iselvmord. Etterlatte hadde også en signifikant høyere sannsynlighet for psykiatrisk komorbiditet og å ha flere psykososiale problemer samtidig. I kombinasjon viste resultatene at tap grunnet selvmord var assosiert med den høyeste risikoen. Somde første innen forskningsfeltet viste også studiene at etterlatte etter fall- og forgiftningsulykker harstørre risiko for psykiske lidelser og sykehusbehandlet villet egenskade enn etterlatte etter transportulykker. Det var derimot små forskjeller knyttet til kjønnet til den avdøde forelderen, barnas alder ved dødsfallet og kjønnet til det etterlatte barnet. Ilys av disse resultatene anbefaler vi at alle etterlatte barn og ungdommer rutinemessig tilbys oppfølgingi primærhelsetjenesten og skolesystemet, og at etterlatte ved selvmord rutinemessig tilbys tettereoppfølging innen psykisk helsevern for barn og unge. De omfattende og langvarige psykososialeproblemene som etterfølger tap av foreldre fremhever viktigheten av en mangefasettert, omfattendeog langvarig oppfølging av denne sårbare gruppen.

• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Parental death by external causes during childhood and risk of psychiatric disorders in bereaved offspring. Child and Adolescent Mental Health. ISSN 1475-357X. doi: 10.1111/camh.12470. Full text in Research Archive Show summary

  Background Previous studies have reported increased risks of psychiatric disorders in offspring who have lost a parent, but knowledge is lacking on the risks of several specific disorders and comorbidity. The present study investigated the influence of parental death by external causes during childhood and adolescence on risk of a range of psychiatric disorders and comorbidity. Method The study cohort comprised 655,477 individuals born 1970–2012 with a link to both parents. Data on deceased parent’s cause and date of death between 1970 and 2012 and offspring’s psychiatric disorders between 2008 and 2012 were retrieved from four longitudinal Norwegian registers. Data were analyzed with Cox regression. Results Compared to nonexposed offspring, offspring exposed to parental death by external causes had a significantly increased risk of depressive disorders, reactions to stress, anxiety disorders, substance use disorders, developmental disorders, childhood behavioral and emotional disorders, psychotic disorders, bipolar disorder, personality disorders, and psychiatric comorbidity, but not eating disorders. These increased risks were especially evident following parental suicide and accidental falls and poisoning. No differences were evident depending on gender of the deceased or age at bereavement, and generally no significant interactions with gender of the bereaved offspring were evident. Conclusions The improved insight into several different psychiatric disorders and psychiatric comorbidity should guide postvention measures aimed at children and adolescents at greatest risk of future sequelae.

• Pirkis, Jane; John, Ann; Shin, Sangsoo; DelPozo-Banos, Marcos; Arya, Vikas & Analuisa-Aguilar, Pablo [Show all 55 contributors for this article] (2021). Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries. The Lancet Psychiatry. ISSN 2215-0374. 8(7), p. 579–588. doi: 10.1016/S2215-0366(21)00091-2. Full text in Research Archive
• Næss, Erik Oftedahl; Mehlum, Lars & Qin, Ping (2021). Marital status and suicide risk: Temporal effect of marital breakdown and contextual difference by socioeconomic status. SSM - Population Health. ISSN 2352-8273. 15(5). doi: 10.1016/j.ssmph.2021.100853. Full text in Research Archive Show summary

  Research has shown that people who have never been married, divorced, or widowed are at an increased risk of suicide compared with those who are married, but we have little knowledge as to how this elevated risk is modified by socioeconomic factors, and little research has studied the risk among persons enduring a marital separation. This study addressed these issues with individual-level data from Norwegian national registers. All suicide cases in people above 18 years that took place in the period 1992–2012 (n = 11 051) were compared with living controls (185 685) matched on sex and age via a nested case control design, and suicide risk associated with marital status was assessed with conditional logistic regression. The results showed that, compared with a status of being married, suicide risk was highly associated with a status of being never married, separated, divorced, or widowed, even after adjustment for income-level, educational attainment, centrality of residence, and immigration status. The strongest effect was seen for a separated status; compared to the married, separated persons were fully 6.06 times more apt to die by suicide, and the effect was strongest in the 30 days following a separation. The observed significant associations remained but differed in strength by sex and age, and there were significant deviations by personal socioeconomic status. Most notably, the increased risk was higher for never-married persons with low educational attainment or income. However, most interaction effects (10/16) did not yield significant results. In conclusion, suicide risk is strongly associated with a single status of any form with the highest risk during a marital separation, but the increased risk varies in strength according to individual-level factors. The stress and loss of support induced by marital dissolution are important contributing risk factors for suicide, and persons with low income may be especially vulnerable.

• Amin, Ridwan; Rahman, Syed; Helgesson, Magnus; Björkenstam, Emma; Runeson, Bo & Tinghög, Petter [Show all 9 contributors for this article] (2021). Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals: a cohort study. International Journal for Equity in Health. doi: 10.1186/s12939-021-01460-z. Full text in Research Archive Show summary

  Background To identify key information regarding potential treatment differences in refugees and the host population, we aimed to investigate patterns (trajectories) of antidepressant use during 3 years before and after a suicide attempt in refugees, compared with Swedish-born. Association of the identified trajectory groups with individual characteristics were also investigated. Methods All 20–64-years-old refugees and Swedish-born individuals having specialised healthcare for suicide attempt during 2009–2015 (n = 62,442, 5.6% refugees) were followed 3 years before and after the index attempt. Trajectories of annual defined daily doses (DDDs) of antidepressants were analysed using group-based trajectory models. Associations between the identified trajectory groups and different covariates were estimated by chi2-tests and multinomial logistic regression. Results Among the four identified trajectory groups, antidepressant use was constantly low (≤15 DDDs) for 64.9% of refugees. A ‘low increasing’ group comprised 5.9% of refugees (60–260 annual DDDs before and 510–685 DDDs after index attempt). Two other trajectory groups had constant use at medium (110–190 DDDs) and high (630–765 DDDs) levels (22.5 and 6.6% of refugees, respectively). Method of suicide attempt and any use of psychotropic drugs during the year before index attempt discriminated between refugees’ trajectory groups. The patterns and composition of the trajectory groups and their association, discriminated with different covariates, were fairly similar among refugees and Swedish-born, with the exception of previous hypnotic and sedative drug use being more important in refugees. Conclusions Despite previous reports on refugees being undertreated regarding psychiatric healthcare, no major differences in antidepressant treatment between refugees and Swedish-born suicide attempters were found.

• Amin, R.; Mittendorfer-Rutz, Ellenor; Mehlum, L.; Runeson, B.; Helgesson, Magnus & Tinghög, P. [Show all 9 contributors for this article] (2021). Does country of resettlement influence the risk of suicide in refugees? A case-control study in Sweden and Norway. Epidemiology and Psychiatric Sciences (EPS). ISSN 2045-7960. 30. doi: 10.1017/S2045796021000512. Full text in Research Archive Show summary

  Aims Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature. We aimed to investigate (1) the risk of suicide in refugees resident in Sweden and Norway, in general, and according to their sex, age, region/country of birth and duration of residence, compared with the risk of suicide in the respective majority host population; (2) if factors related to socio-demographics, labour market marginalisation (LMM) and healthcare use might explain the risk of suicide in refugees differently in host countries. Methods Using a nested case-control design, each case who died by suicide between the age of 18 and 64 years during 1998 and 2018 (17 572 and 9443 cases in Sweden and Norway, respectively) was matched with up to 20 controls from the general population, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide. Separate models were controlled for factors related to socio-demographics, previous LMM and healthcare use. Analyses were also stratified by sex and age groups, by refugees' region/country of birth and duration of residence in the host country. Results The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI 0.5–0.6) and 0.3 (95% CI 0.3–0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI 0.7–1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age except for younger refugees aged 18–24 who did not have a statistically significant relative difference in suicide risk than their respective host country peers. Factors related to socio-demographics, LMM and healthcare use had only a marginal influence on the studied associations in both countries. Conclusions Refugees in Sweden and Norway had almost similar suicide mortality advantages compared with the Swedish-born and Norwegian-born population, respectively. These findings may suggest that resiliency and culture/religion-bound attitudes towards suicidal behaviour in refugees could be more influential for their suicide risk after resettlement than other post-migration environmental and structural factors in the host country.

• Liu, Bao-Peng; Lunde, Ketil Berge; Jia, Cun-Xian & Qin, Ping (2020). The short-term rate of non-fatal and fatal repetition of deliberate self-harm: A systematic review and meta-analysis of longitudinal studies. Journal of Affective Disorders. ISSN 0165-0327. 273, p. 597–603. doi: 10.1016/j.jad.2020.05.072. Full text in Research Archive
• Mittendorfer-Rutz, Ellenor; Amin, Ridwanul; Niederkrotenthaler, Thomas; Björkenstam, Emma; Helgesson, Magnus & Qin, Ping [Show all 9 contributors for this article] (2020). Mental ill-health and suicidal behaviour in asylum seekers and refugees during the COVID-19 pandemic. Suicidologi. ISSN 1501-6994. 25(1), p. 31–33. doi: 10.5617/suicidologi.8276. Full text in Research Archive Show summary

  WITHOUT DOUBT, THE COVID-19 PANDEMICis the greatest Public Health challenge of ourtime. Naturally, incidence rates of COVID-19-related morbidity and mortality as well asdiscussions on the most suitable strategies tolower them, have dominated media and scientific reporting. Increasingly, though, attentionhas also been given to the possible mentalhealth consequences of the pandemic. Here,asylum seekers and refugees are a particularrisk group as levels of mental ill-health havebeen already high before the COVID-19 outbreak. Specifically, there are several reasonsto expect suicide rates in asylum seekers/refugees to increase in the wake of the pandemic.Here we raise key points of concern andsuggest priorities for research and preventioninitiatives.

• Lunde, Ketil Berge; Mehlum, Lars; Melle, Ingrid & Qin, Ping (2020). Deliberate self-harm and associated risk factors in young adults: the importance of education attainment and sick leave. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. doi: 10.1007/s00127-020-01893-x. Full text in Research Archive Show summary

  Abstract Purpose The prevalence of deliberate self-harm (DSH) is high in young adults. However, few studies have examined risk in this specific age group. We, therefore, examined the relative influence and interactive nature of a wide range of potential sociodemographic and sick leave related risk factors in young adults, aged 18–35 years, using Norwegian register data. Methods All subjects with at least one episode of hospital presentation for DSH registered in the Norwegian Patient Register during the period 2008–2013 were compared with age, gender and date matched population controls using a nested case–control design. The relative influence of factors and their interactions were assessed using conditional logistic regression and recursive partitioning models. Results 9 873 study cases were compared to 186 092 controls. Socioeconomic status, marital status, sick leave and several demographic factors influenced risk for DSH. Specifically, low education (OR 7.44, 95% CI 6.82–8.12), current sick leave due to psychiatric disorders (OR 18.25, 95% CI 14.97–22.25) and being previously married (OR 3.83, 95% CI 3.37–4.36) showed the highest effect sizes. Importantly, there was an interaction between education and sick leave, where those with either low education and no sick leave (OR 13.33, 95% CI 11.66–15.23) or high education and sick leave (OR 18. 87, 95% CI 17.41–24.21) were the subgroups at highest risk. Conclusion DSH in young adults is associated with multiple sociodemographic and health disadvantages. Importantly, the two high-risk subgroups imply different pathways of risk and a need for differentiated preventative efforts.

• Skisland, Anders & Qin, Ping (2020). Barn og unges selvmordsytringer: Kartlegging og analyse av barn og unges selvmordsytringer i samtaler med en nettbasert hjelpelinje. Suicidologi. ISSN 1501-6994. 25(2), p. 18–27. doi: 10.5617/suicidologi.8548. Full text in Research Archive Show summary

  Et økende antall barn og unge kontakter Røde Kors sitt nettsamtaletilbud «Kors på halsen», for å snakke om selvmordstanker. Gjennom analyse av 200 chat-samtaler med Kors på halsen fra barn og unge mellom 11 og 20 år, har denne studien som mål å gi kunnskap om hva som særligkjennetegner ytringene til barn og unge som eksplisitt forteller at de har selvmordstanker. Basert på utsagn ellerord brukt i chat-samtalene ble det kodet 59 variabler om aktuelle begreper og ytringer og videre analysert for åfinne sammenheng med uttrykte selvmordstanker. Av 200 samtaler var 125 (62,5 %) ungdommer tydelige på at selvmordstanker var den primære grunnen til at de kontaktet Kors på halsen. Selvskading, depresjon og angst var de vanligste plagene, mens ensomhet, mobbing, vold ogovergrep, samt manglende støtte, var vanlig. Videre fortalte mange om dårlig relasjon til foresatte (19,5 %), dårlig trivselhjemme eller på skole. Når det gjaldt hjelpesøkeratferd så fortalte mange at det var vanskelig å forklare, eller at deikke visste hva de skulle si når de skulle oppsøke hjelp (30 %), og de var redd for at foresatte skulle bli skuffet (20,5%). Mange fortalte også at de ønsket hjelp nå (17,0 %), men at de vegret seg for å oppsøke hjelp (18,0 %). Detble funnet 14 aktuelle begreper og ytringer med en positiv sammenheng med selvmordstanker som den primæregrunnen til kontakt (p<0,5). Enkeltvis var «depresjon» en av de variablene med høyest odds (OR=10,88) etterfulgtav selvskading, mobbing, tidligere eller nylige selvmordsforsøk, ønsker ikke å fortelle det til andre, føler at ting ertungt, og ønsker hjelp nå. Studien gir en ny type innsikt i barn og unges utfordringer, tanker og uttrykk om egneselvmordstanker. Ut ifra resultatene er det viktig å starte selvmordsforebyggende arbeid tidlig, og tiltak bør værebrede i omfang for å imøtekomme den store variasjonen i barn og unges hverdag.

• Niederkrotenthaler, Thomas; Gunnell, David; Arensman, Ella; Pirkis, Jane; Appleby, Louis & Hawton, Keith [Show all 14 contributors for this article] (2020). Suicide Research, Prevention, and COVID-19. Crisis. ISSN 0227-5910. 41(5), p. 321–330. doi: 10.1027/0227-5910/a000731. Full text in Research Archive
• Qin, Ping; Burrell, Lisa Victoria; Bøe, Anne Seljenes & Mehlum, Lars (2020). Forekomst av villet egenskade estimert ved data fra Norsk pasientregister. Suicidologi. ISSN 1501-6994. 25(3), p. 32–43. doi: 10.5617/suicidologi.8536. Full text in Research Archive Show summary

  Pasientregistre er verdifulle kilder til å identifisere villet egenskade på befolkningsnivå, men vi mangler innsikt i hvordan vi best benytter denne komplekse datakilden. I denne studien har vi benyttet data fra Norsk pasientregister for å identifisere tilfeller og estimere forekomsten av medisinsk behandlet villet egenskade ved hjelp av kombinasjoner av diagnostiske koder. Dataene av alle akutt behandlingskontakter grunnet ytre årsaker ved somatiske sykehus 2008–2013 ble satt sammen og videre prosessert gjennom en flertrinns analytisk strategi. Gjennom en grundig undersøkelse av 13533 registrerte tilfellene av villet egenskade utarbeidet vi et system av diagnosekodekombinasjoner for å identifisere alle sannsynlige tilfeller av villet egenskade. Denne prosessen resulterte i totalt 38433 tilfeller (justerte tilfeller) – et tall som er 2,84 ganger høyere enn det registrerte antallet tilfeller av villet egenskade i studieperioden. Disse justerte tilfellene tilsvarer rundt 6400 tilfeller hos 5100 personer per år, hvilket svarer til en årlig kumulativ insidensrate på 121,0 per 100000 personer eldre enn 10 år. Studien viser at villet egenskade behandlet ved norske sykehus sannsynligvis er et vesentlig mer omfattende problem enn antatt og at data fra Norsk pasientregister er en viktig kilde for innhenting av kunnskap om karakteristikker av slike skader og om utviklingen av forekomst over tid.

• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2020). Educational attainment in offspring bereaved by sudden parental death from external causes: A national cohort study from birth and throughout adulthood. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. doi: 10.1007/s00127-020-01846-4. Full text in Research Archive Show summary

  Purpose Previous research has linked loss of a parent during childhood to reduced educational aspirations, school performance, and educational attainment later in life. The potential effect of maternal and paternal bereavement on attainment at all educational levels is, however, unknown. The present study aimed to investigate the potential influence of parental death by external causes on completion of compulsory education, high school, vocational education, and University or College education. Methods The study was based on data from three national longitudinal registers in Norway. The study population comprised 373,104 individuals born between January 1st 1970 and December 31st 1994. Information concerning deceased parents’ cause and date of death and offspring’s education and sociodemographic data were retrieved. Data were analysed with Cox regression. Results Children who had experienced parental death by external causes had a significantly reduced hazard ratio (HR) of completing all educational levels compared to children who did not have such experiences. The largest effects were evident for completion of high school (HR 0.68, 95% CI 0.65–0.71) and University or College education (HR 0.75, 95% CI 0.70–0.80). No differences were evident for different causes of death, genders of deceased or ages at bereavement, and generally no significant interactions between gender of the bereaved offspring and predictor variables were evident for completion of all educational levels. Conclusion Parental death by external causes has vast and long-lasting impacts on offspring’s educational attainment at all levels. Health care interventions aimed at supporting bereaved children and adolescents should focus on challenges related to educational progress.

• Mortier, Philippe; Vilagut, Gemma; Gracia, Beatriz Puértolas; Trujillo, Ana De Inés; Bueno, Itxaso Alayo & Coma, Laura Ballester [Show all 22 contributors for this article] (2020). Catalonia Suicide Risk Code Epidemiology (CSRC-Epi) study: protocol for a population-representative nested case-control study of suicide attempts in Catalonia, Spain. BMJ Open. 10(7), p. 1–9. doi: 10.1136/bmjopen-2020-037365. Full text in Research Archive Show summary

  Introduction Suicide attempts represent an important public health burden. Centralised electronic health record (EHR) systems have high potential to provide suicide attempt surveillance, to inform public health action aimed at reducing risk for suicide attempt in the population, and to provide data-driven clinical decision support for suicide risk assessment across healthcare settings. To exploit this potential, we designed the Catalonia Suicide Risk Code Epidemiology (CSRC-Epi) study. Using centralised EHR data from the entire public healthcare system of Catalonia, Spain, the CSRC-Epi study aims to estimate reliable suicide attempt incidence rates, identify suicide attempt risk factors and develop validated suicide attempt risk prediction tools. Methods and analysis The CSRC-Epi study is registry-based study, specifically, a two-stage exposure-enriched nested case–control study of suicide attempts during the period 2014–2019 in Catalonia, Spain. The primary study outcome consists of first and repeat attempts during the observation period. Cases will come from a case register linked to a suicide attempt surveillance programme, which offers in-depth psychiatric evaluations to all Catalan residents who present to clinical care with any suspected risk for suicide. Predictor variables will come from centralised EHR systems representing all relevant healthcare settings. The study’s sampling frame will be constructed using population-representative administrative lists of Catalan residents. Inverse probability weights will restore representativeness of the original population. Analysis will include the calculation of age-standardised and sex-standardised suicide attempt incidence rates. Logistic regression will identify suicide attempt risk factors on the individual level (ie, relative risk) and the population level (ie, population attributable risk proportions). Machine learning techniques will be used to develop suicide attempt risk prediction tools. Ethics and dissemination This protocol is approved by the Parc de Salut Mar Clinical Research Ethics Committee (2017/7431/I). Dissemination will include peer-reviewed scientific publications, scientific reports for hospital and government authorities, and updated clinical guidelines.

• Qin, Ping & Mehlum, Lars (2020). Deliberate self-harm: Case identification and incidence estimate upon data from national patient registry. PLOS ONE. 15(4). doi: 10.1371/journal.pone.0231885. Full text in Research Archive Show summary

  Background Patient registry is a valuable source for identification of deliberate self-harm (DSH) incidents on a population basis; however, little research has provided sufficient details that could inform best utilization of this complicated data source for DSH research and statistics. In this study we want to use data from the Norwegian Patient Register to delineate a diagnostic coding system to identify medically treated DSH incidents, to profile general characteristics of these incidents, and to estimate incidence rate of DSHs in the national population of Norway. Methods We obtained all records of patient contacts to somatic hospitals and emergency centers due to external causes from 2008 through 2013. For each contact, we retrieved clinical data on primary and comorbid diagnoses, urgency of contact, etc., alongside with personal general information. After careful mining, the data were further processed following a multi-step analytic strategy. Descriptive analysis was used to profile DSH incidents and to estimate incidence rates and corresponding 95% confidence intervals. Findings From 1 459 384 eligible incident contacts for emergency injury treatment, we identified 13 533 incidents that had a recorded diagnosis of DSH, i.e., with a supplemental code of X6n. Upon delineation of these recorded DSHs, we devised a diagnostic coding system to identify all possible DSH incidents. This yielded a total of 38 433 incidents to be considered as likely incidents of DSH (adjusted incidents)–a number that is 2.84 times higher than that of the recorded DSH incidents during the study period. While the proposed diagnostic system captured more incidents by males and old adults, the adjusted DSHs remained more common in females than males, and occurred most frequently within young people of 18–21 years. These incidents imply about 6400 DSH incidents from 5100 persons per year and correspond to a yearly cumulative incidence rate of 121.0 (95% CI: 113.4–128.2) per 100000 population over 10 years old with particularly high rates in teenage girls of 15–19 years old (296.1/100000) and females and males of 20–24 years old (282.5 and 178.8/100000, respectively). Conclusion The insightful details of data processing and the rich findings from this study underscore the importance of patient registry in studying and reporting DSH incidents on a population level.

• Amin, Ridwanul; Rahman, Syed; Tinghög, Petter; Helgesson, Magnus; Runeson, Bo & Björkenstam, Emma [Show all 10 contributors for this article] (2020). Healthcare use before and after suicide attempt in refugees and Swedish-born individuals. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. doi: 10.1007/s00127-020-01902-z. Full text in Research Archive Show summary

  Purpose There is a lack of research on whether healthcare use before and after a suicide attempt differs between refugees and the host population. We aimed to investigate if the patterns of specialised (inpatient and specialised outpatient) psychiatric and somatic healthcare use, 3 years before and after a suicide attempt, differ between refugees and the Swedish-born individuals in Sweden. Additionally, we aimed to explore if specialised healthcare use differed among refugee suicide attempters according to their sex, age, education or receipt of disability pension. Methods All refugees and Swedish-born individuals, 20–64 years of age, treated for suicide attempt in specialised healthcare during 2004–2013 (n = 85,771 suicide attempters, of which 4.5% refugees) were followed 3 years before and after (Y − 3 to Y + 3) the index suicide attempt (t0) regarding their specialised healthcare use. Annual adjusted prevalence with 95% confidence intervals (CIs) of specialised healthcare use were assessed by generalized estimating equations (GEE). Additionally, in analyses among the refugees, GEE models were stratified by sex, age, educational level and disability pension. Results Compared to Swedish-born, refugees had lower prevalence rates of psychiatric and somatic healthcare use during the observation period. During Y + 1, 25% (95% CI 23–28%) refugees and 30% (95% CI 29–30%) Swedish-born used inpatient psychiatric healthcare. Among refugees, a higher specialised healthcare use was observed in disability pension recipients than non-recipients. Conclusion Refugees used less specialised healthcare, before and after a suicide attempt, relative to the Swedish-born. Strengthened cultural competence among healthcare professionals and better health literacy among the refugees may improve healthcare access in refugees.

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• Erlangsen, Annette; Madsen, Trine; Reuter, Britt Morthorst; Høier, Nikolaj Kjær; Nordentoft, Merete & Wang, August G. [Show all 20 contributors for this article] (2024). Prevention of suicide and suicide attempts in the Nordic countries. Norden Co-operation. ISBN 9789289377911. 112 p. Full text in Research Archive

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• Skei-Larssen, Emma; Grimholt, Tine Kristin & Qin, Ping (2025). Risk of deliberate self-harm and suicide in young offspring bereaved from parental death by specific natural and external causes – a national study. Full text in Research Archive
• Larsen, Kim Sverre; Stangeland, Tormod & Qin, Ping (2025). Submitted Staff Reactions to Suicidal Acts of Patients in Mental Health Services. Full text in Research Archive
• Qin, Ping (2025). Suicide and other cause-specific mortality following non-fatal self-harm: a national cohort study. Full text in Research Archive
• Kizilaslan, Busenur & Qin, Ping (2025). Beyond the Surface: Understanding Self-Harm Subgroups through Latent Class Analysis of Hospital-treated Patients and Their Prospective Health Outcomes. Full text in Research Archive
• Qin, Ping (2025). Suicide risk in bereaved children and parents – findings from Norwegian registries. Full text in Research Archive
• Qin, Ping (2025). Understanding high-risk groups for suicide and suicidal behavior. Full text in Research Archive
• Qin, Ping (2025). Suicide and associated factors following hospital presentation for non-fatal deliberate self-harm: a national cohort study. Full text in Research Archive
• Hughes, Carla Louise & Qin, Ping (2025). Suicide risk in relation to socioeconomic disadvantage and related occupational stressors in males of middle- and old age - a contextual effect. Full text in Research Archive
• Qin, Ping (2025). Risk Factors for Suicidal Behavior and Prevention Challenges. Full text in Research Archive
• Qin, Ping (2025). Recent methodological developments in epidemiological suicide research. Full text in Research Archive
• Qin, Ping (2025). Follow-up Care and Support For Self-Harming Patients in the Real World. Full text in Research Archive
• Hughes, Carla Louise; Qin, Ping & Liu, Baopeng (2024). Socioeconomic, demographic and occupational risk factors for suicide amongst adult males: a systematic review and Meta-analysis. Full text in Research Archive
• Qin, Ping (2024). Deliberate self-harm and suicide in people with immigrant background: how can reason for immigration and country of origin differentiate the risks? Full text in Research Archive
• Qin, Ping (2024). Experience of violent injury and subsequent risks for psychiatric illness, deliberate self-harm and suicide: evidence from longitudinal registries. Full text in Research Archive
• Qin, Ping (2024). Deliberate self-harm and suicide in people with immigration background. Full text in Research Archive
• Qin, Ping (2024). Prospective mortality in patients with non-fatal deliberate self-harm: a national cohort study. Full text in Research Archive
• Qin, Ping (2024). Challenge of translating national suicide prevention strategies into effective implementation, with special reference to the experience in Norway. Full text in Research Archive
• Qin, Ping (2023). Large scale national registries from across the Nordic countries: combining different registers and utilizing suicide related data with innovative research approaches. Full text in Research Archive
• Qin, Ping (2023). Hva har det skjedd etterpå med pasientene behandlet for villet egenskade på somatisk sykehus? Full text in Research Archive
• Qin, Ping (2023). Follow-up Support And Intervention For Self-Harming Patients in the Real World. Full text in Research Archive
• Qin, Ping (2023). Follow up Psychiatric Care after Deliberate Self-harm. Full text in Research Archive
• Liu, Baopeng; Jia, Cunxian & Qin, Ping (2023). Temporal risk of repeat deliberate self-harm and associated risk factors: a national cohort of all patients treated in specialist health services in Norway. Full text in Research Archive
• Qin, Ping (2023). Selvmord i Norge: kommentar til selvmordsstatistikken for 2022. Suicidologi. ISSN 1501-6994. p. 46–47. Full text in Research Archive
• Israel, Pravin; Mehlum, Lars & Qin, Ping (2023). The Relative Risk of Parent Mortality Following a Child ́s Death: A National Cohort Study. Full text in Research Archive
• Qin, Ping (2022). Follow-up Care and Support after Suicide Attempt ⎯ What do we know from real world data? Full text in Research Archive
• Qin, Ping (2022). Suicide Prevention Research: Searching evidence from real-life data in routine registers. Full text in Research Archive
• Qin, Ping (2022). Suicide Prevention Research with data from routine registers. Full text in Research Archive
• Bøe, Anne Seljenes; Mehlum, Lars & Qin, Ping (2022). Psychiatric disorders among individuals treated for DSH in general hospital: A national register study. Full text in Research Archive
• Mellbye, Alex & Qin, Ping (2022). Machine learning to predict deliberate self-harm in patient registry data: a validation study. Full text in Research Archive
• Syeda, Sadia; Mehlum, Lars & Qin, Ping (2022). Utilization of mental healthcare services prior to and after deliberate-self-harm by immigrants under 40 years of age in Norway. Full text in Research Archive
• Qin, Ping (2022). Implementation of a 'mature' suicide prevention strategy in Norway: challenges and achievements. Full text in Research Archive
• Qin, Ping (2022). How to Impact Middle-Aged Population by Implementing a Workplace Suicide Prevention Strategy: International Perspectives. Full text in Research Archive
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2022). Etterlatte barn og unge. Full text in Research Archive
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2022). Etterlatte barn og unge. Full text in Research Archive
• Qin, Ping (2021). Effectiveness of mental healthcare following deliberate self-harm: Searching evidence from real-life data in routine registers. Full text in Research Archive
• Qin, Ping (2021). Selected treatment and intervention for self-harming patients in secondary healthcare system in Norway. Full text in Research Archive
• Qin, Ping (2021). Self-harm Repetition and Mortality Risk Following Non-Fatal Self-harm. Full text in Research Archive
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Barn som etterlatte: Psykososiale vansker etter brått tap av en forelder. Full text in Research Archive
• Qin, Ping (2021). Mental healthcare following hospital treatment of deliberate self-harm. Full text in Research Archive
• Qin, Ping (2021). Cause-specific mortality following hospital presentation for non-fatal deliberate self-harm: a national cohort study. Full text in Research Archive
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Barn som etterlatte: Psykososiale vansker etter brått tap av en forelder. Full text in Research Archive
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Etterlatte barn og unge. Full text in Research Archive
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Barn som etterlatte: Psykososiale vansker etter brått tap av en forelder. Full text in Research Archive
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Etterlatte barn og unge. Full text in Research Archive
• Qin, Ping; Legard, Ingunn; Walby, Fredrik A; Tørmoen, Anita Johanna & Mehlum, Lars (2020). Selvmordsrisiko og -forebygging under covid-19-pandemien og etterpå. 25(1), p. 14–19. doi: 10.5617/suicidologi.8271. Full text in Research Archive Show summary

  Covid-19-pandemien vil trolig ha omfattende og langvarigeeffekter på psykisk helse i befolkningen, og en økning iforekomst av selvmord og villet egenskade kan bli enkonsekvens. Det er behov for økt oppmerksomhet rettetmot selvmordsforebygging.

• Qin, Ping (2020). Suicide in middle-aged adults – what do we know from the East to the West? Full text in Research Archive
• Qin, Ping (2020). Physical illness and induced mental health problems: Searching insights from population registers. Full text in Research Archive
• Gunnell, David; Appleby, L; Arensman, Ella; Hawton, Keith; John, A & Kapur, Nav [Show all 12 contributors for this article] (2020). Suicide risk and prevention during the COVID-19 pandemic. The Lancet Psychiatry. ISSN 2215-0374. 7(6), p. 468-471–468-471. doi: 10.1016/S2215-0366(20)30171-1. Full text in Research Archive
• Lunde, Ketil Berge; Qin, Ping; Mehlum, Lars & Melle, Ingrid (2025). Deliberate Self-Harm (DSH) in Young Adults: Patient Characteristics, Follow-Up Psychiatric Care, and Repetition Risk in Norwegian Public Healthcare. Universitetet i Oslo. Full text in Research Archive Show summary

  Deliberate self-harm (DSH), defined as intentional self-injury or poisoning regardless of intent, is a severe consequence of psychological distress and/or mental illness. It is associated with a range of adverse outcomes; most prominently, suicide. A large proportion of patients who present to hospitals with DSH are young adults 18–35 years old. Efforts to improve followup care for these patients are crucial and should be informed by a solid understanding of patient’s characteristics, current treatment provision, and prospective outcomes. Young adults with hospital-presented DSH represent a highly heterogeneous group. Therefore, it is important to enhance our understanding of the heterogeneity of risk factors in this population as well as how clinical factors such as specific psychiatric morbidities and previous DSH influence both treatment provision and prospective outcomes. Accordingly, the aims of this thesis were: 1) to explore independent and interactive associations of a broad range of sociodemographic and health-related factors with hospitalpresented DSH; 2) to investigate rates of, and factors associated with, direct transferal to psychiatric inpatient services following somatic treatment of DSH; and 3) to describe followup psychiatric care within the first week of discharge from general hospital management of DSH, and its association with DSH relapse within three, six, and 12 months. The thesis comprises three self-contained studies and uses data from national longitudinal registers. Acute somatic treatments of DSH in young adults aged 18–35 years were identified in the Norwegian Patient Registry (NPR). Individual-level data on socioeconomic background and medical treatment were interlinked across registers via an encrypted personal identifier. Paper I was a nested case-control study examining socioeconomic and sick-leaverelated risk factors for DSH. Study cases were young adults with an index episode of hospitalpresented DSH within the study period of 2008–2013. These study cases were compared with age- and gender-matched controls derived from a 25% random sample of all Norwegian residents with no record of hospital-presented DSH at the time. We found that low education, current sick leave due to psychiatric disorders, and being divorced had the greatest effects. Subgroup analyses revealed an association between education and sick leave in which the two subgroups with the highest risk were young adults with low education and young adults with high education and recorded sick leave. Paper II used a retrospective cohort design to examine clinical and sociodemographic correlates of admissions to a psychiatric inpatient unit on the same day of discharge from the general hospital. The cohort included all episodes of hospital-treated DSH in young adult patients within the study period of 2008–2018. We found that 21.4% of these episode patients were directly transferred to psychiatric inpatient services after discharge from a general hospital. Prominent correlates of such transferal or admission were a history of psychiatric treatment and recorded diagnoses of psychotic, mood or personality disorders at a general hospital when DSH occurred. When adjusted for other factors, previous DSH presentations were inversely associated with psychiatric inpatient admissions. Paper III also used a retrospective cohort design, which included all young adults with a hospital-presented DSH within the study period of 2010–2017. The status of follow-up psychiatric care within seven days after discharge from a general hospital was categorized as no follow-up, outpatient attendance, or inpatient admission. The outcome of the study was repetition of hospital-presented DSH within three, six, and 12 months; and observed confounders were adjusted using inverse probability of treatment weighting. We found that 37.2% of these patients received follow-up psychiatric care within seven days of discharge from DSH somatic treatment (17.3% psychiatric outpatient attendance; 19.9% inpatient admissions). Those who received psychiatric follow-up were more likely to have a recorded psychiatric morbidity and were also shown to have a high crude risk of repeated DSH. When adjusting for observed psychiatric confounders and sociodemographic status, this risk was attenuated but remained significant for inpatient admissions. Additional analyses indicated that the increased risks associated with inpatient admissions were confined to certain subgroups: those aged 18– 24 years, those without a recorded mood disorder, and first-time DSH presenters. Overall, this thesis has shown that young adults with hospital-presented DSH often had low education or a history of sick leave. Furthermore, follow-up psychiatric care was most likely provided to those with the most complex and severe psychiatric symptoms and with a high risk of relapse. This was especially prominent among those who were psychiatrically hospitalized, which likely explains the high risk of repeated DSH associated with psychiatric inpatient admissions. Interestingly, although young adults with previous DSH had high psychiatric admission rates, the association between previous DSH and psychiatric inpatient admission reversed in adjusted analyses. Moreover, the increased risk associated with psychiatric inpatient admission was largely confined to certain subgroups of patients with no or limited prior contact with psychiatric services, namely those aged 18–24 years, those without a recorded mood disorder, and first-time DSH presenters. As we were less likely to capture differences in the baseline risk of DSH in these subgroups, this indicates that unmeasured confounders largely explained the risk of DSH relapse associated with inpatient admissions. Finally, young adults who presented to a hospital with DSH faced a multitude of adversities in addition to psychiatric morbidity, including socioeconomic disadvantage and sick leave from work. Although distinct risk factor configurations were found, difficulties in the occupational domain were prominent risk factors for DSH, underscoring the importance of coordinated follow-up from both healthcare services and social services in the DSH aftermath.

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