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. s. 1–7. doi: 10.1192/bjp.2025.22. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 8 forfattere av denne artikkelen] (2023). Levels of IL-6 are Associated with Lifetime Attempted Suicide in Alcohol Use Disorder Patients. Neuropsychiatric Disease and Treatment. ISSN 1176-6328. 19, s. 2141–2148. doi: 10.2147/NDT.S413101. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 1–9. doi: 10.1186/s13722-023-00415-9. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Myhre, Martin Øverlien; Astrup, Helene; Kildahl, Anine Therese; Bergsager, Dagfinn & Walby, Fredrik Andreas (2023). Suicide in services for mental health and substance use: A national hybrid registry surveillance system. Healthcare Informatics Research. ISSN 2093-3681. 29(1). doi: 10.1177/14604582231167439. Fulltekst i vitenarkiv Vis sammendrag

  Suicide is strongly associated with mental health and substance use disorders, which makes mental health- and substance misuse services important areas for suicide prevention. The aim of The Norwegian Surveillance System for Suicide in Mental Health and Substance Use Services is to describe all suicide deaths in Norway that occur within one year after contact with mental health and substance misuse services. The study uses a hybrid registry case series design. It consists of a yearly linkage between the Norwegian Cause of Death Registry and the Norwegian Patient Registry, which is linked with a questionnaire. The linkage is conducted by using a cryptographic hash function of the deceased’s personal id, thus ensuring that the project can link data across sources without the use of directly identifiable information. This indirect linkage ensures the deceased’s confidentiality. Moreover, the The Norwegian Surveillance System for Suicide shows how administratively collected data can be harnessed and used for surveillance. Both use of hybrid registry designs and linkage through cryptographic hash functions might contribute to the development of health informatics as well as quality improvement in health care.

• Tørmoen, Anita Johanna; Myhre, Martin Øverlien; Kildahl, Anine Therese; Walby, Fredrik A & Rossow, Ingeborg Margrete (2023). A nationwide study on time spent on social media and self-harm among adolescents. Scientific Reports. 13. doi: 10.1038/s41598-023-46370-y. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Self-harm among adolescents has increased in many countries, but few studies have examined possible explanations. One explanation could be the changes in the way adolescents socialize and use of social media. We explored the relationship between past year self-harm and time spent on social media, employing data from a nationwide cross-sectional survey among students in grades 8 through 11 in Norway (N = 37,268). The association was estimated in logistic regression models and we adjusted for identified confounders and stratified on gender, age group and depressive symptoms. A total of 16.1% of the study population reported to have self-harmed in the past year. This proportion was elevated among those spending more than 3 h daily on social media (unadjusted OR = 2.74 (CI 2.58.–2.90)). Adjustment for confounders modified the association (OR = 1.49 (CI 1.39–1.60)). In stratified analyses, adjusted OR did not differ significantly by gender or age The association between time spent on social media and self-harm was weaker among adolescents with severe depressive symptoms (adjusted OR = 1.38 (CI 1.22–1.55)), than among those with mild or no symptoms (adjusted OR = 1.70 (CI 1.56–1.86)). Risk of self-harm was elevated among those who spent 3 or more hours daily on social media, also after controlling for other factors. Further studies are needed to explore the nature and underlying mechanisms of this association. Strengthening the evidence will help informing the development of adequate measures to prevent self-harm.

• Larsen, Stian Slotnes; Tørmoen, Anita Johanna & Myhre, Martin Øverlien (2023). Behandling av selvskading- viktigheten av flere funksjonelle tilnærminger. Suicidologi. ISSN 1501-6994. doi: 10.5617/suicidologi.10545. Fulltekst i vitenarkiv Vis sammendrag

  Utbredelsen av selvskading er økende, har omfattende skadepotensial og medfører betydelige kostnader for enkeltpersoner og samfunnet. Unge ned i 13-årsalderen rapporterer om aktiv selvskading. Det er likevel få tilnærminger som adresserer selvskading direkte, selv om dette hevdes å være nødvendig for å oppnå bedring. Å forstå hvorfor enkelte påfører seg selv skade, er en viktig del av det å komme i posisjon til å redusere både hyppighet og alvorlighet av selvskading. Det er derfor viktig at det finnes effektive behandlinger som kan ta utgangspunkt i årsakene til denne atferden. En funksjonell forståelse, der man både ser på årsakene til at den enkelte påfører seg selv skade, og hvilke ferdigheter vedkommende mangler for å løse problemer på en mer akseptabel måte, mener forfatterne er en løsning. I den forbindelse trekkes det frem en tilnærming som baserer seg på en funksjonell forståelse av selvskading – Treatment of Self-Injurous Behavior (T-SIB). Hovedmomentene ved denne behandlingstilnærmingen presenteres og generelle prinsipper for atferdsendring drøftes. Dialektisk atferdsterapi (DBT) pekes også kort på i denne forbindelsen, da T-SIB bygger på prinsipper fra DBT.

• Pandey, Susmita; Bolstad, Ingeborg; Lien, Lars; Walby, Fredrik A; Myhre, Martin Øverlien & Bramness, Jørgen Gustav (2022). Sex-specific factors associated with lifetime suicide attempt among patients with alcohol use disorders. BJPsych Open. 8(4), s. 1–7. doi: 10.1192/bjo.2022.545. Fulltekst i vitenarkiv Vis sammendrag

  Background: Patients with alcohol use disorder (AUD) are at high risk for suicide attempts. Mental health problems along with AUD-related factors may contribute to this increased risk. Studies have shown sex differences in rates and correlates of suicide attempts. Aims: The purpose of the study was to examine mental-health-related and AUD-related factors associated with suicide attempt separately in female and male AUD patients. Method: We collected information about lifetime suicide attempt and mental-health- and AUD-related factors for AUD in-patients (n = 114; 32 females) receiving rehabilitative treatment. Results: The prevalence of lifetime suicide attempt was 27%, and the rate was similar in both sexes. Among females, current depressive symptoms and current post-traumatic stress disorder diagnosis were associated with suicide attempt. In male AUD patients, among the mental-health-related factors, lifetime major depression, panic disorder, social phobia, childhood sexual abuse and antisocial personality disorder were associated with suicide attempt. In addition, AUD-related factors including longer duration of drinking, history of delirium tremens, greater severity of AUD and lower levels of prolactin were associated with suicide attempt in males. Conclusions: Our results indicate that suicide attempts in female AUD patients were more mental-health-related, whereas those in males were also related to the severity of AUD. This suggests that a suicide prevention programme for AUD patients would benefit from a sex-based understanding of the risk factors.

• Aasland, Mia & Myhre, Martin Øverlien (2022). Sammenhengen mellom atferdsmønstre, responskontingent forsterkning og depressive symptomer hos studenter under Covid-19 pandemien. Suicidologi. ISSN 1501-6994. 27(2), s. 26–39. doi: 10.5617/suicidologi.10004. Fulltekst i vitenarkiv Vis sammendrag

  Covid-19-pandemien og tiltak for å begrense smitte har medført bekymring for økning av depressive symptomer. Nyere studier har funnet at depressive symptomer har økt under Covid-19-pandemien og det er viktig å finne forklaringer på denne økningen. Atferdsorienterte tilnærminger forklarer depresjon som et resultat av negativ forsterkning med påfølgende tap av responskontingent positiv forsterkning. I denne studien undersøkte vi om aktivitetsnivået fra en uke i mars 2021 er assosiert med begrenset tilgang på responskontingent positiv forsterkning og depressive symptomer. Studiens utvalg besto av 133 studenter bosatt i ulike deler av Norge. Resultatene viser at sammenhengen mellom aktivitetsnivå under pandemien og muligheten til å oppnå forsterkning målt med Reward Probability Index (RPI) er signifikant (p =.016). Endringer i atferdsmønstre kan bidra til å påvirke utviklingen av depresjon gjennom at tilgang på positiv forsterkning begrenses. Denne studien viser at det kan være viktig å opprette et høyt aktivitetsnivå som positivt forsterkende for å unngå utvikling av depresjon under pandemirelatert nedstenging.

• Walby, Fredrik Andreas; Myhre, Martin Øverlien & Mehlum, Lars (2022). Suicide among users of mental health and addiction services in the first 10 months of the COVID-19 pandemic: observational study using national registry data. BJPsych Open. 8(4). doi: 10.1192/bjo.2022.510. Fulltekst i vitenarkiv Vis sammendrag

  Summary Although many studies have reported no rise in suicides in the general population following the COVID-19 pandemic, little is known regarding mental health and substance misuse service patients, groups who have reportedly faced substantial reductions in their access to care during phases of lockdown. However, in this observational study using national registry data, during the first 10 months of the pandemic we found no evidence of an increased risk among people in recent (within 12 months) contact with secondary care. Both long-term and differential effects on subgroups remain to be studied.

• Myhre, Martin Øverlien; Walby, Fredrik Andreas; Bramness, Jørgen Gustav & Mehlum, Lars (2022). Trajectories of Service Contact before Suicide in People with Substance Use Disorders—A National Register Study. Archives of Suicide Research. ISSN 1381-1118. doi: 10.1080/13811118.2022.2151959. Fulltekst i vitenarkiv Vis sammendrag

  Objective: This study aimed to identify trajectories of service use during the last year before suicide death and the characteristics associated with the trajectories in patients with substance use disorders. Methods: This study used a national registry data linkage, which included all patients with substance use disorders who died by suicide in Norway between 2010 and 2018. In- and outpatient contacts with mental health or substance use services during the last year before suicide death was analyzed by week using Sequence State Analysis and cluster analysis to identify trajectories. Logistic regression was used to measure the association between the characteristics and the trajectories. Results: We identified four trajectories of service contact. A brief contact trajectory (n = 366) with a low proportion of weeks in contact (M weeks = 8.3), associated with less psychosis or bipolar disorder (aOR = 0.13 (0.08-0.22)) and higher age. A regular contact trajectory (n = 160), with a higher proportion of contact (M weeks = 47.9), associated with psychosis or bipolar disorder (aOR = 3.66 (2.10-6.47)) and depressive or anxiety disorder (aOR = 3.11 (1.93-5.13)). An intermittent contact trajectory (n = 195) with most contacts with outpatient substance use disorder services (M weeks = 9.7). A continuous contact trajectory (n = 109) with a high proportion of inpatient contact (M weeks = 44.5), strongly associated with psychosis or bipolar disorder (aOR = 6.08 (3.26-11.80)). Conclusion: Longitudinal descriptions of service use reveal different trajectories that are important to consider when developing policies or interventions to reduce the risk of suicide death in patients with substance use disorders. Keywords: Mental health services; state sequence analysis; substance use disorder services; substance use disorders; suicide. ß2022 The Author(s). Published with license by Taylor & Francis Group, LLC.This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License(http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium,provided the original work is properly cited, and is not altered, transformed, or built upon in any way.

• Myhre, Martin Øverlien & Løkke, Jon Arne (2022). Kognitiv atferdsterapi. I Haugland, Silje; Berge, Ulf; Gjermestad, Anita; Høium, Kari & Løkke, Jon Arne (Red.), Kunnskapsbasert miljøterapeutisk arbeid. Universitetsforlaget. ISSN 9788215053165. Fulltekst i vitenarkiv
• Astrup, Helene; Myhre, Martin Øverlien; Kildahl, Anine Therese & Walby, Fredrik Andreas (2022). Suicide After Contact With Child and Adolescent Mental Health Services—A National Registry Study. Frontiers in Psychiatry. 13. doi: 10.3389/fpsyt.2022.886070. Fulltekst i vitenarkiv Vis sammendrag

  Background Research has shown a strong association between suicide and mental disorders, and people in contact with services for mental health and substance use are known to be at high risk of suicide. Still, few studies have previously described suicide among young people in contact with Child and Adolescent Mental Health Services. Aim The aim of this study is to examine the prevalence of contact and suicide rates by gender and age groups, and to describe patient demographics and service utilization in secondary mental health services. Methods All young people in contact with Child and Adolescent Mental Health Services in the year prior to death in the period 2008–2018 were identified by linking the Norwegian Cause of Death Registry and the Norwegian Patient Registry. We estimated the prevalence of contact and suicide rates among those with and without contact, by gender and age groups. Characteristics of treatment contact were compared between boys and girls. Variables with significant differences were entered into a multivariate logistic regression model using gender as an outcome. Results More girls (39.7%) than boys (11.8%) had contact with Child and Adolescent Mental Health Services in the year prior to death. Among girls, suicide rates per 100,000 patients increased linearly in the age groups 10–13, 14–16, and 17–19 years: 5, 22, and 38 per 100,000 patients, respectively. Among boys, the suicide rate increased sharply from 7 per 100,000 patients in the age group 14–16 years to 40 per 100,000 patients in the 17–19-year-old group. In the age-adjusted multivariate model, boys were 4.07 (1.22–14.44, p = 0.024) times more likely to have terminated contact at the time of death. Conclusion This study shows gender differences in both suicide rates and service utilization among young people in contact with Child and Adolescent Mental Health Services before suicide, and future studies should focus on identifying the causes of these gender differences in service contact.

• Myhre, Martin Øverlien & Walby, Fredrik (2021). The Impact of a Widely Publicized Celebrity Suicide on Suicide-Related Internet Search Activity. Archives of Suicide Research. ISSN 1381-1118. doi: 10.1080/13811118.2021.1875942. Fulltekst i vitenarkiv Vis sammendrag

  Objective Media reporting of celebrities’ deaths by suicide are prone to suicide contagion effects. The aim of the current study is to examine whether the widely publicized celebrity suicide of Ari Behn in Norway was associated with changes in search activity of suicide-related terms. Method Search activity data for the terms “suicide,” “Ari Behn suicide,” “how to suicide,” and “suicide prevention” were retrieved from Google Trends. We analyzed data as an interrupted time series and used T-tests to compare means before and after the suicide. Crude linear models examining the association between searches for “suicide” over time and an adjusted model controlling for searches after “Ari Behn suicide” were built. The models were tested with structural change tests. Results A significant increase in search activity for “suicide” (p = < .001), “Ari Behn suicide” (p = .002), and “how to suicide” (p = .006) was found after the suicide. Searches for “suicide prevention” were not significant (p = .11). The structural change test was significant both for the model that did not control for explicit searches (p = <.001) and for the model controlled for explicit searches (p = <.001). Conclusions A recent widely publicized suicide in Norway was associated with increases in Google searches for suicide. No indications of the Papageno effect were found. The media should be cautious when reporting about the suicides of prominent public persons. Compliance with generally accepted media reporting guidelines may need more attention.

• Tørmoen, Anita Johanna; Myhre, Martin Øverlien; Walby, Fredrik A; Grøholt, Berit & Rossow, Ingeborg Margrete (2020). Change in prevalence of self-harm from 2002 to 2018 among Norwegian adolescents. European Journal of Public Health. ISSN 1101-1262. 30(4), s. 688–692. doi: 10.1093/eurpub/ckaa042. Fulltekst i vitenarkiv Vis sammendrag

  Self-harm is prevalent among adolescents and associated with mental health problems and negative life-events. Few studies have examined changes in its prevalence related to these factors. This study explored whether changes in prevalence of self-harm among adolescents had occurred, and to what extent changes in associated factors may have contributed. Two cross-sectional school-based surveys among adolescents (grades 8–10) in Norway were conducted in 2002 (N = 5842) and in 2017/18 (N = 29 063). Past year prevalence of self-harm and identical variables on risk factors was analyzed in hierarchical logistic regression to examine whether and to what extent changes in self-harm correlates could explain periodical change in prevalence of self-harm. An increase from 4.1% to 16.2% in self-harm prevalence was observed from 2002 to 2017/18. The increase was relatively larger among girls compared to boys and among 8th graders compared to 10th graders. Among the assessed risk factors for self-harm, depressive symptoms increased, while anti-social behavior, exposure to violent acts and drinking to intoxication decreased. The increase in depressive symptoms contributed to explain increase in self-harm. This contribution was outweighed by the decrease in other risk factors. Self-harm prevalence increased 4-fold among Norwegian adolescents over a 15-year period. While exposure to several risk factors for self-harm changed substantially in this period, these risk factors could in sum not explain any of the increase in self-harm.

• Myhre, Martin Øverlien; Kildahl, Anine Therese & Walby, Fredrik A (2020). Suicide after contact with substance misuse services: a national registry study. BJPsych Open. 6(3), s. 1–6. doi: 10.1192/bjo.2020.23. Fulltekst i vitenarkiv Vis sammendrag

  Background People with substance use disorders have a well-known increased risk for taking their own life. Previous research has mainly focused on suicide in mental health services, whereas there is limited knowledge regarding suicide after contact with substance misuse services. Aims The aim of the current study was to describe the utilisation of both mental health services and substance misuse services among people who have died by suicide within a year of contact with substance misuse services. Method We used an explanatory observational design, where all suicide deaths in the period from 2009 to 2016 were retrieved from the Norwegian Cause of Death Registry and linked with the Norwegian Patient Registry. The people who had been in contact with substance misuse services within a year before their death were included in the sample (n = 419). The analysis was stratified by gender, and variables with significant differences between men and women were entered into a multivariate logistic regression model. Results More women (73.5%) than men (60.6%) had contact with mental health services in their last year (P = 0.01). In the adjusted logistic regression model, poisoning was more common among women (adjusted odds ratio (AOR) = 1.81, 95% CI 1.09–3.02) and women were more likely to be diagnosed with a sedative, hypnotic or anxiolytic use disorder (F14) in their last year (AOR = 2.77, 95% CI 1.37–5.68). Conclusions This study highlights gender differences for suicide in substance misuse services, and the importance of collaboration and cooperation between substance misuse services and mental health services.

• Myhre, Martin Øverlien; Tørmoen, Anita Johanna; Strømgren, Børge & Walby, Fredrik A (2018). Tre generasjoner klinisk atferdsanalyse. Norsk Tidsskrift for Atferdsanalyse (NTA). ISSN 0809-781X. Fulltekst i vitenarkiv Vis sammendrag

  Atferdsanalyse i behandling av kliniske problemer – som angst eller depresjon – har de siste årene fått fornyet oppmerksomhet som ledd i videreutviklingen av mindfulness-basert atferdsterapi. Målet med artikkelen er å oppsummere den historiske utviklingen til klinisk atferdsanalyse, samt gi en kort aktuell oversikt over behandlingsformer i klinisk atferdsanalyse. Først presenteres den historiske utviklingen av klinisk atferdsanalyse gjennom tre generasjoner med atferdsterapi. Vi gir en kortfattet innføring i de mest sentrale behandlingsformene i tredje generasjons atferdsterapi med fokus på Dialektisk atferdsterapi, Atferdsaktivering, Aksept og forpliktelsesterapi og Funksjonell analytisk psykoterapi. Deretter vil tredje generasjons atferdsterapi oppsummeres i tre sentrale kjennetegn: Mindfulness, bruk av funksjonelle analyser sammen med pasienten, og etablering av verdi-baserte atferdsrepertoar. Avslutningsvis diskuterer vi behov for forskning som kan forbedre klinisk utforming og den empiriske støtten til klinisk atferdsanalyse i fremtiden.

• Myhre, Martin Øverlien; Strømgren, Børge; Arnesen, Eimund Fløisbonn & Veland, Martin Cornelius (2018). The feasibility of Brief Behavioral Activation Treatment for Depression in an acute inpatient ward psychiatric intensive care unit– a systematic replication. Journal of Psychiatric Intensive Care. ISSN 1742-6464. doi: 10.20299/jpi.2018.001. Fulltekst i vitenarkiv Vis sammendrag

  Behavioural treatments for depression have shown promising preliminary effects for depression in inpatient wards. However, more research is needed regarding their feasibility in psychiatric intensive care units (PICU). The aim of the current trial was to examine the feasibility of brief behavioural activation treatment for depression (BATD) in a PICU. ‘BATD added to standard care’ was compared to ‘standard care’ in a randomised controlled trial (RCT) with moderate to severely depressed inpatients. Between group differences on BDI-II (n = 19) was significant on post-test and gain-scores with strong effect sizes towards BATD, and response rates were significantly higher for participants who received BATD, with a strong effect size. Participants rated BATD as credible and acceptable in the setting. Treatment integrity was high and participant attrition was low for participants receiving BATD added to standard care. Preliminary support for BATD’s clinical significance, credibility and acceptability was found among inpatients. The main limitation was the large number of ineligible participants due to the inclusion criteria. The current study provides further support for BATD’s feasibility for treating depression among inpatients, including its administration by inpatient nursing staff.

• Walby, Fredrik A; Myhre, Martin Øverlien & Kildahl, Anine Therese (2018). Contact With Mental Health Services Prior to Suicide: A Systematic Review and Meta-Analysis. Psychiatric Services. ISSN 1075-2730. 69(7), s. 751–759. doi: 10.1176/appi.ps.201700475. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• 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. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien & Sjåfjell, Tommy Lunde (2026). Ikke glem alkoholen. doi: https:/www.dagensmedisin.no/alkohol-psykisk-helse-rus/ikke-glem-alkoholen/731071. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2025). Atferdsaktivering for depresjon: Workshop. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2025). Rus og selvskade. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2025). Personer med rusmiddelbrukslidelser: Den glemte risikogruppen? Fulltekst i vitenarkiv
• Walby, Fredrik A & Myhre, Martin Øverlien (2025). Selvmord, villet egenskade og selvmordstanker. I Gonzalez, Marianne Thorsen (Red.), Psykiske lidelser - faglig forståelse og terapeutisk tilnærming. Sykepleiefaglige og flerfaglige perspektiver.. Gyldendal Norsk Forlag A/S. ISSN 9788205590106. s. 211–224. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Walby, Fredrik Andreas; Myhre, Martin Øverlien & Astrup, Helene (2024). Selvmord under døgnopphold – forekomst og forebygging. Fulltekst i vitenarkiv
• Johannesen, Martin Knobloch; Myhre, Martin Øverlien; Seierstad, Andreas; Gardsjord, Erlend Strand & Walby, Fredrik A (2024). Suicide in psychosis. Fulltekst i vitenarkiv
• Astrup, Helene; Walby, Fredrik Andreas & Myhre, Martin Øverlien (2024). Implementation of the Norwegian Surveillance System for Suicide in Mental Health and Substance Misuse Services. Fulltekst i vitenarkiv
• Larsen, Stian Slotnes; Myhre, Martin Øverlien & Tørmoen, Anita Johanna (2023). Behandling av selvskading - viktigheten av flere funksjonelle tilnærminger. Suicidologi. ISSN 1501-6994. Fulltekst i vitenarkiv
• Walby, Fredrik Andreas; Myhre, Martin Øverlien & Giil, Ebba (2022). Selvmord i 2020 under Covid-19 pandemien - En drøfting av noen effekter i befolkningen og i risikogrupper. Suicidologi. ISSN 1501-6994. 27(2), s. 15–25. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2022). Bare atferd? Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2022). Kognitiv atferdsterapi og dialektisk atferdsterapi. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2022). Narkotikautløste dødsfall: Selvmord og overdoser. Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien & Mehlum, Lars (2022). No increase in Suicides among users of Mental Health and Addiction services in the first 10 months of the Covid-19 Pandemic. Fulltekst i vitenarkiv
• Viken, Kjetil & Myhre, Martin Øverlien (2022). Atferdsanalysens plass i psykisk helsearbeid. Fulltekst i vitenarkiv
• Walby, Fredrik Andreas; Myhre, Martin Øverlien & Astrup, Helene (2022). Ja takk til debatt om selvmord blant barn og unge. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien; Tørmoen, Anita Johanna & Løkke, Jon Arne (2022). Dialektisk Atferdsterapi. I Haugland, Silje; Berge, Ulf; Gjermestad, Anita; Høium, Kari & Løkke, Jon Arne (Red.), Kunnskapsbasert miljøterapeutisk arbeid. Universitetsforlaget. ISSN 9788215053165. Fulltekst i vitenarkiv
• Tørmoen, Anita Johanna; Myhre, Martin Øverlien; Kildahl, Anine Therese; Walby, Fredrik A & Rossow, Ingeborg Margrete (2022). Time spent on social media: a risk factor for self-harm in adolescence? A nationwide study. Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien; Astrup, Helene & Kildahl, Anine Therese (2022). Stressful life events before suicide before suicide in mental health patients: a national study. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien; Walby, Fredrik Andreas & Mehlum, Lars (2022). Systemperspektiver på selvmordsforebygging i psykisk helsevern. Suicidologi. ISSN 1501-6994. 27(3), s. 4–20. Fulltekst i vitenarkiv
• Walby, Fredrik Andreas; Astrup, Helene; Kildahl, Anine Therese; Giil, Ebba & Myhre, Martin Øverlien (2022). Nasjonalt kartleggingssystem for selvmord i psykisk helsevern og tverrfaglig spesialisert rusbehandling. Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien; Astrup, Helene; Kildahl, Anine Therese & Mehlum, Lars (2021). Suicides Among People Diagnosed with Personality Disorders in Contact with Mental Health Services: A National Registry Study 2008–2018. Fulltekst i vitenarkiv
• Astrup, Helene; Myhre, Martin Øverlien; Kildahl, Anine Therese & Walby, Fredrik A (2021). Suicide After Contact with Child and Adolescent Mental Health Services - A National Registry Study from Norway 2008–2018. Fulltekst i vitenarkiv
• Løkke, Jon Arne; Orm, Stian; Myhre, Martin Øverlien & Dechsling, Anders (2021). Autisme og selvmord: En systematisk litteraturgjennomgang. Fulltekst i vitenarkiv
• Tørmoen, Anita Johanna; Myhre, Martin Øverlien; Walby, Fredrik A; Rossow, Ingeborg Margrete & Kildahl, Anine Therese (2021). Time spent on social media: a risk factor for self-harm in adolescence? A nationwide cross-sectional study. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien; Walby, Fredrik A; Bramness, Jørgen Gustav & Mehlum, Lars (2021). Use of Health Services Last Year Before Suicide in People with Substance Use Disorders - A National Registry Study. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2021). Selvmordsforebyggende tiltak på gruppenivå. Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien & Astrup, Helene (2021). Suicides in people diagnosed with personality disorders in contact with mental health services. A national registry study 2008–2018. Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien; Tørmoen, Anita Johanna & Mehlum, Lars (2020). En korreksjon. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 57(6). Fulltekst i vitenarkiv
• Viken, Kjetil & Myhre, Martin Øverlien (2020). Atferdsanalyse og psykisk helsearbeid. I Bakken, Trine Lise (Red.), Håndbok i miljøterapi. Til barn og voksne med kognitiv funksjonshemming.. Fagbokforlaget. ISSN 9788245032673. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien; Kildahl, Anine Therese; Sjåfjell, Tommy Lunde & Walby, Fredrik A (2020). Liv kan reddes i rusbehandlingen. Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien; Tørmoen, Anita Johanna; Kildahl, Anine Therese & Mehlum, Lars (2020). Myter og fakta om selvmordsforebygging. 57(4), s. 295–297. Fulltekst i vitenarkiv
• Walby, Fredrik A & Myhre, Martin Øverlien (2020). Selvmord, villet egenskade og selvmordstanker. I Gonzalez, Marianne Thorsen (Red.), Psykiske lidelser - Faglig forståelse og terapeutisk tilnærming. Sykepleiefaglige og flerfaglige perspektiver. Gyldendal Akademisk. ISSN 9788205516700. s. 187–199. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien & Arnesen, Eimund Fløisbonn (2020). Vi er midt i en nasjonal krise. Dette er ikke tiden for profesjonskamp. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien; Kildahl, Anine Therese & Walby, Fredrik A (2019). Selvmord under og etter behandling i tverrfaglig spesialisert rusbehandling. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien & Veland, Martin Cornelius (2019). Selvmordsforebygging i døgnbehandling - Fokus på miljøpersonalets rolle. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien; Kildahl, Anine Therese & Walby, Fredrik A (2019). Suicide in Substance Abuse Services - The impact of Mental Health Service Contact. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien; Kildahl, Anine Therese; Bergsager, Dagfinn; Bjørn, Halvor; Jensberg, Heidi & Walby, Fredrik A (2019). The Norwegian Surveillance System for Suicide in Mental Health-and Substance Misuse Services -Combining Registry and Clinical Data. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien & Viken, Kjetil (2019). Funksjonelle analyser i tredje generasjons atferdsanalyse. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2019). Indirect (Functional) Assessment in Clinical Behavior Analysis. Fulltekst i vitenarkiv
• Tørmoen, Anita Johanna; Myhre, Martin Øverlien; Walby, Fredrik A; Grøholt, Berit & Rossow, Ingeborg Margrete (2019). Change in prevalence of Self-harm from 2002-2018 among Norwegian adolescents. Fulltekst i vitenarkiv
• Tørmoen, Anita Johanna; Myhre, Martin Øverlien; Walby, Fredrik A; Grøholt, Berit & Rossow, Ingeborg Margrete (2019). Trender i selvskading blang ungdom over en femtenårsperiode i Norge. Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien & Kildahl, Anine Therese (2019). Selvmord ved personlighetsforstyrrelse. Fulltekst i vitenarkiv
• Walby, Fredrik A; Kildahl, Anine Therese & Myhre, Martin Øverlien (2019). Some results form a national registry based study of all suicides in mental health care in Norway 2008-2015. Fulltekst i vitenarkiv
• Walby, Fredrik A; Kildahl, Anine Therese & Myhre, Martin Øverlien (2019). Short description of the newly established Norwegian Surveillance System for Suicide. Fulltekst i vitenarkiv
• Kildahl, Anine Therese; Myhre, Martin Øverlien & Walby, Fredrik A (2019). Suicide After Contact With Outpatient Mental Health Services - A Nationwide Registry Study from Norway. Fulltekst i vitenarkiv
• Walby, Fredrik A; Kildahl, Anine Therese & Myhre, Martin Øverlien (2019). Suicide Rates and Risk Ratios in Persons With or Without Contact With Secondary Mental Health Services in Norway. Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien & Kildahl, Anine Therese (2019). Vi trenger både høyrisiko- og befolkningsrettede strategier. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.19.0519. Fulltekst i vitenarkiv
• Arntzen, Erik; Kostewics, Douglas E.; Holden, Børge; Myhre, Martin Øverlien; Roulund, Alvdis & Viken, Kjetil [Vis alle 9 forfattere av denne artikkelen] (2019). Panel Discussion: "What are the limits of measurement". Fulltekst i vitenarkiv
• Walby, Fredrik A; Kildahl, Anine Therese & Myhre, Martin Øverlien (2019). Nasjonalt kartleggingssystem for selvmord i psykisk helsevern og tverrfaglig spesialisert rusbehandling (Kartleggingssystemet). Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien & Kildahl, Anine Therese (2019). Suicide rates and risk ratios in people with and without contact with mental health services in Norway. Fulltekst i vitenarkiv
• Tørmoen, Anita Johanna; Walby, Fredrik A & Myhre, Martin Øverlien (2019). Selvskading siste år hos elever i ungdoms- og videregående skole - Resultater fra Ungdata undersøkelsen 2017/2018. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien & Eilertsen, Jon Magnus (2018). Selvmordsatferd hos psykisk utviklingshemmede - Forekomst, utfordringer, og behandling. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien; Kildahl, Anine Therese & Walby, Fredrik A (2018). Suicide after contact with substance misuse services - A nationwide registry study. Fulltekst i vitenarkiv
• Walby, Fredrik A; Kildahl, Anine Therese & Myhre, Martin Øverlien (2018). Contact with different mental health services in the year before suicide; a nationwide registry-based study. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2018). Læringspsykologi for DBT terapeuter. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien & Eilertsen, Jon Magnus (2018). Selvmordsatferd hos psykisk utviklingshemmede - Forekomst, utfordringer, og behandling. Fulltekst i vitenarkiv
• Kildahl, Anine Therese; Myhre, Martin Øverlien & Walby, Fredrik A (2018). Contact with in- and outpatient mental health services preceding suicide - a nationwide registry study from Norway. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien; Walby, Fredrik A & Kildahl, Anine Therese (2017). Contact with mental health services prior to suicide - A systematic review and meta-analysis. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2017). Brief Behavioral Activation Treatment for Depression for deprimerte pasienter i akuttpsykiatrisk døgnbehandling. Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien; Kildahl, Anine Therese & Caruso, Giulia (2017). Nasjonalt Kartleggingssystem for Selvmord. Fulltekst i vitenarkiv
• Walby, Fredrik A; Kildahl, Anine Therese; Caruso, Giulia & Myhre, Martin Øverlien (2017). Nasjonalt kartleggingssystem for selvmord i psykisk helsevern og tverrfaglig spesialisert rusbehandling Bakgrunn, utviklingsprosess og formål. Suicidologi. ISSN 1501-6994. s. 28–33. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2017). Kontingensfeller. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2017). Atferdsaktivering for depresjon - En opplevelsesbasert workshop. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2017). Atferdsaktivering for depresjon. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 54(5). Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2017). Tre generasjoner klinisk atferdsanalyse. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2016). Atferdsaktivering for depresjon - En praktisk rettet workshop. Fulltekst i vitenarkiv
• Myhre, Martin Øverlien (2016). Verdier i klinisk endringsarbeid. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 11 forfattere av denne artikkelen] (2025). Utredning av hvordan mørketall ved selvmord kan reduseres. Folkehelseinstituttet. ISSN 9788284064970. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Walby, Fredrik Andreas; Astrup, Helene; Myhre, Martin Øverlien & Kildahl, Anine Therese (2022). Suicide among young people in contact with Child and Adolescent Mental Health Services in the year prior to death 2008-2018 - A national registry study. English Summary. Universitetet i Oslo. Fulltekst i vitenarkiv
• Walby, Fredrik Andreas; Astrup, Helene; Myhre, Martin Øverlien & Kildahl, Anine Therese (2022). Selvmord under og etter kontakt med psykisk helsevern for barn og unge 2008 til 2018 - en nasjonal registerstudie. Universitetet i Oslo. ISSN 9788269282702. Fulltekst i vitenarkiv
• Walby, Fredrik Andreas; Astrup, Helene; Myhre, Martin Øverlien & Kildahl, Anine Therese (2021). Norwegian Surveillance System for Suicide in Mental Health and Substance Misuse Services. English Summary of Annual Report 2018. Universitetet i Oslo. Fulltekst i vitenarkiv
• Walby, Fredrik A; Astrup, Helene; Myhre, Martin Øverlien & Kildahl, Anine Therese (2021). Nasjonalt kartleggingssystem for selvmord i psykisk helsevern og tverrfaglig spesialisert rusbehandling. Årsrapport 2018. Nasjonalt kartleggingssystem for selvmord i psykisk helsevern og tverrfaglig spesialisert rusbehandling. ISSN 9788299581684. Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien & Kildahl, Anine Therese (2020). Selvmord under og etter kontakt med tverrfaglig spesialisert rusbehandling 2009 til 2017 - En nasjonal registerstudie. Nasjonalt senter for selvmordsforskning og forebygging. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn Personer med ruslidelser har en betydelig forhøyet dødelighet, hvor selvmord er en av de viktigste årsakene. I Norge har vi har til nå manglet en oversikt over forekomsten av kontakt med tverrfaglig spesialisert rusbehandling (TSB) før selvmord, kjennetegn ved personene i kontakt og hvilken behandling de har mottatt før selvmordet. Denne rapporten presenterer resultatene fra den første nasjonale registerstudien av selvmord blant personer i kontakt med TSB siste år før dødsfallet i perioden 2009–2017. Registerstudien er utført som ledd i arbeidet med å etablere Nasjonalt kartleggingssystem for selvmord i psykisk helsevern og tverrfaglig spesialisert rusbehandling. Metode Rapporten er basert på en kobling av registerdata fra Dødsårsaksregisteret og Norsk pasientregister årene 2009–2017. Alle personer som døde i selvmord innen ett år etter kontakt med TSB i perioden 2009–2017 er inkludert i studien. Hovedfunn • 480 personer hadde kontakt med TSB siste år før de døde i selvmord. • Nesten hver tiende person (9,3 %) som dør i selvmord i Norge, har vært i kontakt med TSB siste leveår. • Selvmordsraten i TSB er 1,93 per 1000 pasienter, hvilket er sterkt forhøyet sammenlignet med selvmordsraten i befolkningen generelt. • Det er omtrent dobbelt så mange selvmord blant menn som kvinner i TSB, men andelen menn og kvinner i kontakt med TSB siste år før selvmord er tilnærmet lik. • Majoriteten (43 %) av personene i kontakt med TSB siste år før selvmord døde som følge av henging, kvelning eller strangulering, mens 23 % døde av forgiftning. I tillegg kan det være mørketall, særlig hva gjelder forgiftninger. • En betydelig andel (64 %) hadde også kontakt med psykisk helsevern (PHV) siste leveår. • Over 90 % av de som døde innen ett år etter kontakt med TSB hadde hatt poliklinisk kontakt siste år, men antall kontakter per pasient var relativt lavt med en median på 6 polikliniske kontakter i TSB siste år. • En stor andel (68 %) hadde hatt ett eller flere døgnopphold siste år: 40 % i TSB og 49 % i PHV. Innleggelsene var hovedsakelige kortvarige: I TSB var 30 % av innleggelsene under 7 dager, mens 50 % av innleggelsene i PHV var under 7 dager.• Majoriteten (91 %) var diagnostisert med en ruslidelse siste år. Av disse var alkoholbrukslidelse den vanligste diagnosen (45,6 %), etterfulgt av bruk av multiple stoffer (27,7 %) og opiatbrukslidelse (22,1 %). • En tredjedel (32,9 %) av mennene og nesten halvparten (46,9 %) av kvinnene i utvalget hadde siste år fått diagnostisert en depresjon eller angstlidelse i tillegg til en ruslidelse. • Få av selvmordene skjedde under døgnbehandling i TSB. • Det gikk lengre tid mellom siste kontakt og selvmord blant personer som kun hadde kontakt med TSB, sammenlignet med de som hadde hatt kontakt både med TSB og psykisk helsevern. Konklusjon Den høye andelen i kontakt med TSB viser nødvendigheten av fokus på forebygging av selvmord blant pasienter i TSB. Mange personer som dør i selvmord etter kontakt med TSB har sammensatte problemer som omfatter blant annet rusproblematikk og psykiske lidelser, og overlappende behandling i PHV er derfor vanlig. Det å sikre integrert behandling av rus og psykiske lidelser i både TSB og PHV, ha tilpassede og tilgjengelige tjenester, fokusere på tilbakefallsforebygging samt sikre oppfølging etter utskrivelse, fremstår som viktige prioriteringsområder i TSB. Tilgjengelige registerdata er godt egnet til å beskrive antall og andel i kontakt i de ulike tjenestene, men det mangler data i registrene vedrørende sosiale forhold, detaljer om behandlingen som ble gitt og tidligere selvmordsatferd. Data fra Kartleggingssystemet, som nå er implementert, vil bidra med mer kunnskap om selvmord i TSB.

• Walby, Fredrik A; Myhre, Martin Øverlien & Kildahl, Anine Therese (2018). 1910 døde pasienter - Selvmord i psykisk helsevern og tverrfaglig spesialisert rusbehandling 2008 til 2015 - en nasjonal registerstudie. Universitetet i Oslo. ISSN 9788299581646. Fulltekst i vitenarkiv

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