Martin Øverlien Myhre

• Myhre, Martin Øverlien; Walby, Fredrik Andreas; Klungsøyr, Ole; Bramness, Jørgen Gustav & Mehlum, Lars (2025). Factors associated with self-harm in patients with substance use disorders who died by suicide: national hybrid questionnaire registry study. British Journal of Psychiatry. ISSN 0007-1250. p. 1–7. doi: 10.1192/bjp.2025.22. Full text in Research Archive Show summary

  Background - Self-harm, self-poisoning or self-injury, irrespective of the motivation, is a central risk factor for suicide. Still, there is limited knowledge of self-harm among patients with substance use disorders (SUDs) who die by suicide. <p> <p>Aims We aimed to describe the prevalence of a history of self-harm and identify the factors associated with self-harm, comparing individuals who died by suicide with and without SUDs. <p> <p>Method - We used data from the Norwegian Surveillance System for Suicide in Mental Health and Substance Use Services, which is based on a national linkage between the Norwegian Cause of Death Registry and the Norwegian Patient Registry, to identify individuals who died by suicide within 1 year after last contact with mental health or substance use services (n=1140). A questionnaire was retrieved for 1041 (91.3%) of these individuals. We used least absolute shrinkage and selection operator (LASSO) regression to select variables and compared patients with and without SUDs. Conditional selective inference was used to improve 90% confidence intervals and p-values. <p> <p>Results - The prevalence of self-harm was 55% in patients with SUDs and 52.6% in patients without SUDs. Suicidal ideation (odds ratio 2.98 (95% CI 1.74–5.10)) emerged as a factor shared with patients without SUDs, while personality disorders (odds ratio 1.96 (1.12–3.40)) and a history of violence (odds ratio 1.86 (1.20–2.87)) were unique factors for patients with SUDs. <p> <p>Conclusions - Ahistory of self-harm is prevalent in patients with SUDs who die by suicide and is associated with suicidal ideation, a history of violence and personality disorders in patients with SUDs.

• Myhre, Martin Øverlien; Rognli, Eline B.; Walby, Fredrik A; Bramness, Jørgen Gustav & Mehlum, Lars (2024). The annual trend of suicide rates from 2010 to 2021 in patients with cannabis use disorder – a national registry study. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. doi: 10.1007/s00127-024-02781-4. Full text in Research Archive Show summary

  Purpose - The temporal trend of suicide in patients with cannabis use disorder (CUD) is important to investigate, considering the recent increases in THC concentration in cannabis products. This study describes the annual suicide rates in patients with CUD from 2010 to 2021. To investigate if any change in suicide rate was specific to CUD, we compared these suicide rates with corresponding data for patients with alcohol use disorders (AUD) and other substance use disorders (SUDs).<p> <p>Method - The study used a time series design. We used a national registry linkage between the Norwegian Cause of Death Registry and the Norwegian Patient Registry from 2010 to 2021, including patients with CUD (ICD-10 code F12), AUD (F10), or other SUDs (F11; F13-F16; F18-F19) who died by suicide, supplemented with the total number of patients treated with specific disorders to estimate the suicide rates. The trend was analyzed by comparing the annual suicide rate to 2010 and using Poisson regression, adjusting for gender, age, and mental disorders.<p> <p>Results - We found increased annual incidence rate ratios for patients with CUD in 2018 (IRR = 2.14 (95% CI 1.14–3.99)) and onwards and an increasing time trend over the study period (IRR = 1.08 (1.05–1.12)). No increases in trends were found for AUD or other SUDs. The time trend for CUD was attenuated when adjusting for depressive or anxiety disorders (aIRR = 1.00 (0.92–1.08)) or other SUDs (aIRR = 0.96 (0.87–1.06)).<p> <p>Conclusions - Increasing suicide rates were found in patients with CUD. Comorbid anxiety and depression or other SUDs, but not other mental disorders, could partly explain these results.

• Bramness, Jørgen Gustav; Pandey, Susmita; Moe, Jenny Skumsnes; Toft, Helge; Lien, Lars & Walby, Fredrik A [Show all 8 contributors for this article] (2023). Levels of IL-6 are Associated with Lifetime Attempted Suicide in Alcohol Use Disorder Patients. Neuropsychiatric Disease and Treatment. ISSN 1176-6328. 19, p. 2141–2148. doi: 10.2147/NDT.S413101. Full text in Research Archive Show summary

  Background: Patients with alcohol use disorder (AUD) have an increased risk of suicide. Neuroimmunological measures, such as cytokines, are shown to deviate in people with attempted suicide. Few studies have investigated this among AUD patients. Patients and Methods: One-hundred and fourteen patients undergoing residential treatment for AUD were interviewed on lifetime suicide attempts (SA) along with several other background variables and clinical characteristics. Serum blood samples were drawn for analysis of cytokines. Results: Thirty-one patients (27%) reported at least one SA. These patients had more symptoms of current affective disorders and more severe dependence. In bivariate analysis only IL-6 and IL-10 appeared to be associated with lifetime SA but without reaching statistical significance. In multivariate linear regression, adjusting for sex, nicotine use, somatic illness, and the use of anti- inflammatory drugs, IL-6 was associated to SA (p = 0.033). Conclusion: The cytokine IL-6 has repeatedly been found to be associated with suicidality. The present study concurs with this role of IL-6 in a naturalistic observational study of AUD patients.

• Myhre, Martin Øverlien; Walby, Fredrik A; Bramness, Jørgen Gustav & Mehlum, Lars (2023). The temporal association between suicide and comorbid mental disorders in people treated for substance use disorders: a National registry study. Addiction science & clinical practice. ISSN 1940-0632. 18(1), p. 1–9. doi: 10.1186/s13722-023-00415-9. Full text in Research Archive Show summary

  Background The time after contact with specialized health services for mental health and substance use is associated with an increased risk of suicide, where temporal aspects of suicide and comorbid mental disorders in patients with substance use disorders could be associated. This study aimed to examine the temporal association between time from last treatment contact to suicide and comorbid mental disorders in patients with substance use disorders.<p> <p>Methods This study is a historical prospective case series using nationwide registry data. It included 946 individuals registered the year before suicide with a substance use disorder (F10-F19) in Norway’s specialized health services for treating substance use and mental health disorders between 2010 and 2020. The outcome was the number of weeks from the last contact with services to suicide. The exposure was comorbid mental disorders divided into ’no comorbid mental disorder’; ‘psychosis or bipolar disorders’ (F20−F31), ‘depressive or anxiety disorders’ (F32−F49); and ’personality disorders’ (F60-F69). Covariates included gender, age, last diagnosed substance use disorder, registered deliberate self-harm last year, and the number of in- and outpatient contacts the previous year. <p>Results The number of weeks from last service contact to suicide difered (p= <0.001) between patients with no comorbid mental disorders (Median=7; IQR 2–23), psychosis or bipolar disorders (Median=2; IQR=1–7), depressive or anxiety disorders (Median=3; IQR=1–11) and personality disorders (Median=1; IQR=1–5.5). Signifcantly decreased adjusted incidence rate ratios (aIRR) were found for psychosis or bipolar disorders [aIRR=0.67 (95% CI 0.53–0.85)] and personality disorders [aIRR=0.56 (0.42–0.77)] compared to no comorbid mental disorder when adjusted for individual characteristics and service contact. For depressive and anxiety disorders compared to no comorbid mental disorder, the association was signifcant when adjusted for individual characteristics [aIRR=0.55 (0.46–0.66)]. <p>Conclusions While patients with substance use disorders generally died by suicide a short time after contact with services, patients with comorbid mental disorders died an even shorter time after such contact and signifcantly shorter than patients without such comorbidities.

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• Myhre, Martin Øverlien; Walby, Fredrik A; Sjåfjell, Tommy Lunde; Bramness, Jørgen Gustav & Mehlum, Lars (2026). Preliminary Service Recommendations to Prevent Suicide in Patients with Substance Use Disorders. Full text in Research Archive
• Myhre, Martin Øverlien & Sjåfjell, Tommy Lunde (2026). Ikke glem alkoholen. doi: https:/www.dagensmedisin.no/alkohol-psykisk-helse-rus/ikke-glem-alkoholen/731071. Full text in Research Archive
• Myhre, Martin Øverlien (2025). Atferdsaktivering for depresjon: Workshop. Full text in Research Archive
• Myhre, Martin Øverlien (2025). Rus og selvskade. Full text in Research Archive
• Myhre, Martin Øverlien (2025). Personer med rusmiddelbrukslidelser: Den glemte risikogruppen? Full text in Research Archive
• Walby, Fredrik A & Myhre, Martin Øverlien (2025). Selvmord, villet egenskade og selvmordstanker. In Gonzalez, Marianne Thorsen (Eds.), Psykiske lidelser - faglig forståelse og terapeutisk tilnærming. Sykepleiefaglige og flerfaglige perspektiver.. Gyldendal Norsk Forlag A/S. ISSN 9788205590106. p. 211–224. Full text in Research Archive
• Myhre, Martin Øverlien; Walby, Fredrik A; Bramness, Jørgen Gustav & Mehlum, Lars (2024). Suicide rates and population attributable fraction in different substance use disorders – A national registry study. Full text in Research Archive
• Walby, Fredrik Andreas; Myhre, Martin Øverlien & Astrup, Helene (2024). Selvmord under døgnopphold – forekomst og forebygging. Full text in Research Archive
• Johannesen, Martin Knobloch; Myhre, Martin Øverlien; Seierstad, Andreas; Gardsjord, Erlend Strand & Walby, Fredrik A (2024). Suicide in psychosis. Full text in Research Archive
• Astrup, Helene; Walby, Fredrik Andreas & Myhre, Martin Øverlien (2024). Implementation of the Norwegian Surveillance System for Suicide in Mental Health and Substance Misuse Services. Full text in Research Archive
• Larsen, Stian Slotnes; Myhre, Martin Øverlien & Tørmoen, Anita Johanna (2023). Behandling av selvskading - viktigheten av flere funksjonelle tilnærminger. Suicidologi. ISSN 1501-6994. Full text in Research Archive
• Walby, Fredrik A; Astrup, Helene; Myhre, Martin Øverlien & Belanger, Sissel Marguerite (2025). Nasjonalt kartleggingssystem for selvmord i psykisk helsevern og tverrfaglig spesialisert rusbehandling: Selvmord under Covid-19-pandemien. Universitetet i Oslo. Full text in Research Archive
• Myhre, Martin Øverlien; Mehlum, Lars; Walby, Fredrik A & Bramness, Jørgen Gustav (2025). Service Utilisation and Clinical Characteristics of People with Substance Use Disorders Who Died by Suicide. A National Consecutive Case Series. Universitetet i Oslo. ISSN 9788234806759. Full text in Research Archive Show summary

  Substance use disorders are a well-known risk factor for suicide. Still, we have limited knowledge to guide prevention strategies within services. The aim of this thesis was to describe the clinical characteristics and service utilisation of patients with substance use disorders (SUD) who died by suicide within one year after contact with services for substance use or mental health. Materials from the Norwegian Surveillance System for Suicide (NoSS) were used. Paper I and II used a national registry linkage including all people who died by suicide or undetermined intent from the Norwegian Cause of Death Registry, who were registered with contact in substance use or mental health services in the Norwegian Patient Registry. Paper III included in addition nationally representative data from a clinical questionnaire filled in by clinicians who were in direct contact with patients during their last treatment contact before their death; these data were linked with the mentioned registry linkage. The studies included all patients within the NoSS who were registered with a SUD diagnosis in the NPR in the last year before their suicide. In the study reported in Paper I, we examined past-year service contact trajectories, identifying brief contact trajectories as the most prevalent. In the study reported in Paper II, we analysed the association between the number of weeks from the last contact to suicide and comorbid mental disorders, finding that patients with comorbid psychosis or bipolar disorder, or personality disorders died fewer weeks after their last contact with services. In the study reported in Paper III, we reported on the prevalence of a history of previous self-harm and examined the factors associated with such a history. A history of self-harm was present in 53 % of patients who later died by suicide, and such a history was associated with suicidal ideation at the last contact, personality disorder, a history of violent behavior and more than two admissions in the last year. These findings can inform clinical care and service development that are better adapted common characteristics, which in turn could contribute to improving patient safety and potentially saving lives.

• Graff, Ingvild Eide; Ellingsen, Christian Lycke; Gravensteen, Ida Kathrine; Johansen, Ingrid Hjulstad; Kirkhorn, Kari & Lexander, Hågen Vatshelle [Show all 11 contributors for this article] (2025). Utredning av hvordan mørketall ved selvmord kan reduseres. Folkehelseinstituttet. ISSN 9788284064970. Full text in Research Archive Show summary

  Ekspertgruppen har evaluert dagens praksis for hvordan informasjon om dødsårsak og dødsmåte blir formidlet til Dødsårsaksregisteret (DÅR) etter en persons død. Dette inkluderer opplysninger fra dødsmeldingen, dialog med lege, og fra obduksjonsrapport når det er aktuelt. Målet for ekspertgruppen har vært å identifisere og vurdere tiltak som kan bedre forekomsttallene for selvmord. Gruppens mandat har vært å foreslå endringer i dagens system slik at kvaliteten på informasjon om selvmord bedres, og at graden av mørketallene når det gjelder antall selvmord i Norge, kan reduseres. Dette er en del av arbeidet med å forebygge selvmord og er i tråd med regjeringens handlingsplan for 2020-2025. Overgangen fra dødsmelding på papir til digital dødsmelding startet i 2018, og fra 01.01.2022 ble det obligatorisk for leger å melde inn dødsfall elektronisk. I løpet av 2022 kom 98 % av dødsmeldingene digitalt inn til DÅR. Dette ga raskere tilgang til opplysninger om dødsårsak, bedre lesbarhet og tryggere lagring av data. Det virker som om dette systemet fungerer godt, og det rapporteres ikke om tekniske vanskeligheter fra leger som benytter systemene. Dødsmeldingen sendes automatisk til relevante myndigheter. Det er likevel en utfordring at det for de fleste leger går lang tid mellom hver gang de fyller ut en dødsmelding, og at de svært sjeldent er i befatning med selvmord. Ved dødsfall utenfor institusjon har legen ofte lite informasjon tilgjengelig i vurderingen av dødsårsak og dødsmåte. Det er derfor en risiko for at dødsfallet kodes feil. Hvert år publiseres statistikk over dødsårsaker, inkludert selvmord, fra året før. Det er flere feilkilder ved innmelding av et dødsfall som kan påvirke forekomsttallene av selvmord. Dødsmeldinger kan være dårlig eller mangelfullt utfylt, slik at det ikke kommer frem at det er et selvmord. Legen kan oppgi en feil, men plausibel dødsårsak på dødsmeldingen, eller det kan være oppgitt korrekt skadediagnose, men feil dødsmåte. Noen ganger benyttes koder for dødsårsak og dødsmåte som gir lite informasjon om den underliggende dødsårsaken. I Norge er omtrent 29 % av dødsfallene kodet med en slik lite informativ kode (såkalt skrotkode), og det er sannsynlig at en del av mørketallene for selvmord befinner seg blant disse skrotkodene. Ekspertgruppen har derfor foreslått tiltak som gruppen mener vil bedre kvaliteten på kodene for dødsårsak og dødsmåte i Norge, og dermed bidra til å ta ned mørketallene ved selvmord. Ekspertgruppens ti foreslåtte tiltak for å ta ned mørketallene ved selvmord er: • Automatisk involvering av fastlege når en dødsmelding er sendt inn til DÅR • Elektronisk kommunikasjon mellom DÅR og fastlegen når DÅR skal innhente tilleggsopplysninger • Inkludering av unaturlige dødsfall og rusrelaterte dødsfall i en lignende prosess som for dødsfall i veitrafikken (2020) • Betydelig økning i kapasitet og kompetanse i de rettspatologiske fagmiljøene • Gjennomføring av et forsknings- og utviklingsprosjekt for å undersøke andelen selvmord blant eldre • Forbedring av det digitale skjemaet for dødsmeldingen • Honorering for arbeid med dødsmelding, innhenting av tilleggsopplysninger, og rekvirering av obduksjon (HELFO sats) • Arrangering av årlige møter mellom rettsmedisinere, andre leger og kodere i DÅR • Påminnelse til rettspatologiavdelingene om å sette rettsmedisinsk kommisjon og DÅR som kopimottakere når de oppretter sak • Revurdering av finansieringsordningen for obduksjoner Ekspertgruppen har også anbefalt ytterligere syv tiltak, og har vurdert ni tiltak som er omtalt, men som gruppen ikke anbefaler. Ekspertgruppen anbefaler ikke at det igangsettes en utredning av coroner eller medical examiner ordning etter modell fra England i denne omgang. Ekspertgruppen oppfordrer til at tiltakene iverksettes noenlunde samlet dersom det er mulig. Det vil lette evalueringen av om tiltakene samlet sett har virket.

• Walby, Fredrik Andreas; Astrup, Helene; Giil, Ebba & Myhre, Martin Øverlien (2024). Nasjonalt kartleggingssystem for selvmord i psykisk helsevern og tverrfaglig spesialisert rusbehandling. Årsrapport 2021 - Selvmord etter kontakt med avtalespesialister innen psykisk hele og rus. Universitetet i Oslo. Full text in Research Archive
• Walby, Fredrik Andreas; Astrup, Helene; Giil, Ebba & Myhre, Martin Øverlien (2023). Nasjonalt kartleggingssystem for selvmord i psykisk helsevern og tverrfaglig spesialisert rusbehandling. Årsrapport 2019–2020 – Selvmord under døgnopphold. Universitetet i Oslo. ISSN 9788269282788. Full text in Research Archive

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