Fredrik A. Walby

• Furnes, Desire; Mehlum, Lars; Walby, Fredrik Andreas; Fredriksen, Kristin J; Ødegaard, Ketil Joachim & Gjestad, Rolf (2026). Predicting suicide in patients who have received acute psychiatric inpatient treatment - the longitudinal and prospective SIPEA study. Journal of Psychiatric Research. ISSN 0022-3956. 195, s. 257–263. doi: 10.1016/j.jpsychires.2026.01.053. Fulltekst i vitenarkiv Vis sammendrag

  Suicidality (suicidal ideation and -plans (SI) and deliberate self-harm (DSH)), has been extensively studied in different patient populations. Fewer studies have examined predictors of suicide within an extensive longitudinal frame, which is problematic since findings from studies including participants with non-lethal suicidal behavior are not easily generalizable to patients that complete suicide. We aimed to address this gap by examining demographic and clinical factors as predictors of suicide in a longitudinal prospective cohort study of 7,000 consecutively admitted patients. Mean observation time was 4.1 years. Male gender, more frequent admissions during the follow-up period, and having SI, DSH and substance-induced psychosis at the final admission before suicide, directly predicted shorter time to suicide. Shorter time to suicide was indirectly predicted by borderline personality disorder (BPD) via DSH and by psychotic depression and neurotic disorders via SI. In contrast, longer time to suicide was indirectly predicted by substance-induced psychosis and psychotic disorders via reduced probability of SI and DSH at the final admission. Patients diagnosed with BPD had more frequent admissions and higher levels of SI and DSH across admissions, which predicted shorter time to suicide via increased risk of DSH at the final admission. Similarly, patients diagnosed with neurotic disorders had a higher level of SI and DSH across admissions, with shorter time to suicide via SI and DSH at the final admission. Findings suggest different pathways to suicide for different clinical subgroups, and this is discussed in relation to current theoretical models that emphasize suicide as a transdiagnostic phenomenon.

• Walby, Fredrik A & Tørmoen, Anita Johanna (2025). Selvmordsproblematikk og selvskading hos barn og ungdom. Psykisk oppvekst Rådet for psykisk helse. doi: https:/psykiskhelse.no/psykiskoppvekst/utviklingsarenaer-og-overganger/selvmordsproblematikk-og-selvskading-hos-barn-og-ungdom/. Fulltekst i vitenarkiv
• Melby, Linde; Høyen, Karina Sagmo; Prestmo, Astrid; Vaaler, Arne Einar; Kvithyld, Tuva Prestmo & Galynker, Igor [Vis alle 9 forfattere av denne artikkelen] (2025). Symptoms of the suicide crisis syndrome and associated risk factors in an acute psychiatric population, a cross-sectional study. European psychiatry. ISSN 0924-9338. 68(1). doi: 10.1192/j.eurpsy.2025.10030. Fulltekst i vitenarkiv
• 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.

• 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, s. 495–504. doi: 10.1016/j.jad.2024.03.133. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Langjord, Tuva; Pedersen, Geir Arild Feigum; Bovim, Tone Helene; Bremer, Kjetil; Christensen, Tore Buer & Hove, Oddbjørn [Vis alle 20 forfattere av denne artikkelen] (2024). Evaluation of health services and treatment alliance among extensively hospitalized patients due to severe self-harm – results from the Extreme Challenges project. Nordic Journal of Psychiatry. ISSN 0803-9488. 78(7), s. 591–602. doi: 10.1080/08039488.2024.2376162. Fulltekst i vitenarkiv Vis sammendrag

  Background - Extensive psychiatric hospitalization due to repeated severe self-harm (SH), is a poorly researched area, but a challenge within health services (HS). Recent studies have demonstrated high levels of involuntary treatment among patients with severe personality disorder (PD) and complex comorbidity. Keeping focus on extensively hospitalized SH patients, this study aimed to investigate patients’ and clinicians’ evaluation of HS and treatment alliance. Method - A cross-sectional study with an inpatient sample (age >18 years) with frequent (>5) or long (>4 weeks) psychiatric hospital admissions last year due to SH or SA recruited from 12 hospitals across health regions (N = 42). Evaluation included patient and clinician report. Results - A minority of the patients (14%) were satisfied with HS before the current admission, 45% (patients) and 20% (clinicians) found the current admission helpful, and 46% (patients) and 14% (clinicians) worried about discharge. Treatment complaints were received in 38% of the cases. Outpatient mental HS were available after discharge for 68% and a majority of clinicians indicated satisfactory contact across HS. More intensive or specialized formats were unusual (structured outpatient treatment 35%, day treatment 21%, ambulatory services 32%, planned inpatient services 31%). Mutual problem understanding, aims, and confidence in therapists during the hospital stay were limited (patient-rated satisfactory mutual problem understanding: 39%, aims of stay: 50%, confidence: 50%). Patient and therapist alliance-ratings were in concordance for the majority. Conclusion - The study highlights poor HS satisfaction, poor patient–therapist coherence, limited treatment alliance and limited follow-up in structured treatments addressing SH or intermediary supportive ambulatory/day/inpatient services.

• Hunsager, Anita; Walby, Fredrik A; Midtbø, Vivian; Morken, Tone; Baste, Valborg & Johansen, Ingrid H. (2024). Self-injurious thoughts and behaviours as the reason for contact to Norwegian emergency primary care centres: an observational study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2024.2400668. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To describe and compare contacts regarding self-injurious thoughts and behaviours to other contacts to emergency primary care. Design: Observational study. Setting: A sentinel network of seven emergency primary care centres throughout Norway. Subjects: Initial contacts regarding patients 10 years and older during 12 consecutive months (11/2021–10/2022). Main outcome measures: Contacts due to self-injurious thoughts and behaviours. Results: Self-injurious thoughts and behaviours were the reason for contact for 0.6% (n = 478) of initial contacts for patients aged 10 years or older (n = 77 344). When compared to other contacts, self-injurious thoughts and behaviours were associated with female gender, younger age, occurrence during evening and nighttime, higher urgency, and more physician consultations and call-outs. Of contacts about self-injurious thoughts and behaviours, 58.2% were regarding thoughts and 41.8% about behaviours, and in 75.0% a history of similar contacts was recorded. Contacts regarding thoughts often concerned threats (30.6%) and were more often handled by telephone advice than contacts regarding behaviours. Contacts regarding behaviours with suicidal intent were associated with higher urgency and more physician call-outs than contacts regarding non-suicidal behaviours. Conclusion: Self-injurious thoughts and behaviours are rare reasons for contact to emergency primary care but are assessed as more urgent than other contact reasons and trigger more extensive medical help. Many of the patients are known to the service through a history of similar contacts. Implications: The infrequency and severity of these encounters might necessitate training, decision support and procedures to compensate for the health care personnel’s limited exposure.

• 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.

• Langjord, Tuva; Pedersen, Geir Arild Feigum; Bovim, Tone Helene; Christensen, Tore Buer; Eikenæs, Ingeborg Helene Ulltveit-Moe & Hove, Oddbjørn [Vis alle 21 forfattere av denne artikkelen] (2023). Mental health disorders, functioning and health-related quality of life among extensively hospitalized patients due to severe self-harm – results from the Extreme Challenges project. Frontiers in Psychiatry. 14. doi: 10.3389/fpsyt.2023.1258025. Fulltekst i vitenarkiv Vis sammendrag

  Background: Severe self-harm leading to extensive hospitalization generates extreme challenges for patients, families, and health services. Controversies regarding diagnoses and health care often follow. Most evidence-based treatments targeting self-harm are designed for borderline personality disorder (BPD). However, current knowledge about mental health status among individuals with severe self-harm is limited. Objectives: To investigate psychopathology among patients extensively hospitalized due to severe or frequent self-harming behaviors. Method: A cross sectional study (period 2019–2021) targeting psychiatric inpatients (>18 years) with frequent (>5) or long (>4 weeks) admissions last year due to self-harm. The target sample (N = 42, from 12 hospitals across all Norwegian health regions) was compared to individuals admitted to outpatient personality disorder (PD) treatment within specialist mental health services in the same period (N = 389). Clinicians performed interviews on self-harm and psychopathology, supplemented by self-report. Results: The target sample were young adults, mainly female, with considerable hospitalization and self-harming behaviors, both significantly more extensive than the comparison group. The majority in both groups reported self-harm onset <18 years. The target sample reported increasing severity of self-harm acts and suicidal intention over time. Both samples had high levels of childhood trauma, impaired personality functioning, and a majority fulfilled criteria for PD. In the target sample, comorbid depression, PTSD, anxiety disorders, and substance use occurred more frequently and in 50%, psychosis/dissociative disorder/autism spectrum disorder/ADHD was reported (outpatient comparison sample: 9%). 35% in the target sample screened over cut-off for possible intellectual disability. The target sample reported poor psychosocial functioning and health-related quality of life – greater impairment than the outpatient comparison sample. Conclusion: The study reveals that severe self-harm inpatients have complex psychopathology and highlights the importance of individualized and thorough assessment among patients with severe and/or repetitive self-harm.

• 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.

• 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.

• 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.

• Berg, Siv Hilde; Rørtveit, Kristine; Walby, Fredrik A & Aase, Karina (2022). Shared understanding of resilient practices in the context of inpatient suicide prevention: a narrative synthesis. BMC Health Services Research. 22:967, s. 1–13. doi: 10.1186/s12913-022-08282-x. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background The prevailing patient safety strategies in suicide prevention are suicide risk assessments and retrospective reviews, with emphasis on minimising risk and preventing adverse events. Resilient healthcare focuses on how everyday clinical practice succeeds and emphasises learning from practice, not from adverse events. Yet, little is known about resilient practices for suicidal inpatients. The aim of the study is to draw upon the perspectives of patients and healthcare professionals to inform the conceptual development of resilient practices in inpatient suicide prevention. Methods A narrative synthesis was conducted of findings across patients and healthcare professionals derived from a qualitative case study based on interviews with patients and healthcare professionals in addition to a systematic literature review. Results Three sub-themes categorise resilient practices for healthcare professionals and for patients hospitalised with suicidal behaviour: 1) interactions capturing non-verbal cues; 2) protection through dignity and watchfulness; and 3) personalised approaches to alleviate emotional pressure. The main theme, the establishment of relationships of trust in resilient practices for patients in suicidal crisis, is the foundation of their communication and caring. Conclusion Clinical practice for patients hospitalised with suicidal behaviour has characteristics of complex adaptive systems in terms of dynamic interactions, decision-making under uncertainty, tensions between goals solved through trade-offs, and adaptations to patient variability and interpersonal needs. To improve the safety of patients hospitalised with suicidal behaviour, variability in clinical practice should be embraced.

• Fredriksen, Kristin J; Gjestad, Rolf; Walby, Fredrik A; Anda, Liss; Ødegaard, Ketil Joachim & Schøyen, Helle Kristine (2022). High Scores on the Montgomery-Åsberg Depression Rating Scale and Psychotic Symptoms Predict Suicide: A Prospective Cohort Study of Psychiatric Acute Ward Patients. Journal of Clinical Psychiatry. ISSN 0160-6689. 83(5). doi: 10.4088/JCP.21m14018. Fulltekst i vitenarkiv
• 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.

• Fredriksen, Kristin Jørstad; Bartz-Johannessen, Christoffer; Schøyen, Helle Kristine; Vaaler, Arne; Walby, Fredrik A & Hegelstad, Wenche (2022). Imminent and Short-Term Risk of Death by Suicide in 7,000 Acutely Admitted Psychiatric Inpatients. Journal of Clinical Psychiatry. ISSN 0160-6689. 84(1). doi: 10.4088/JCP.22m14460. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To prospectively investigate the predictive value of diagnosis, suicidal behavior, and subjectively experienced depressed mood for imminent risk of suicide death. Methods: This prospective study included a representative and diagnostically mixed sample of 7,000 acutely hospitalized psychiatric patients between May 2005 and July 2014 in a Norwegian catchment area of 400,000 inhabitants. Suicide deaths were registered at 1 and 2 weeks and at 1, 6, and 12 months following admission. Survival and hazard functions were estimated, and Cox regression was used to estimate the predictive values of suicidal ideation, suicide attempts, a diagnosis of depressive disorder, and severely depressed mood. Assessments were conducted at admission and included ICD-10 diagnosis, clinical interview in the form of the Health of the Nation Outcome Scales, and qualitative assessments of suicidal ideation and suicide attempts during the past week. Results: During 1-year follow-up, 101 patients (1.4%) died by suicide, of whom almost 70% were men. Only severely depressed mood, including inappropriate self-blame and guilt, predicted suicide within the first week after admission (hazard ratio [HR] = 7.3; 95% confidence interval [CI], 1.4–37.1; P = .01). Suicidal ideation predicted death by suicide at 2 weeks (HR = 3.8; 95% CI, 1.2–12.8; P = .02) and all follow-up time points after, whereas a recent suicide attempt predicted suicide from the 1-month follow-up (HR = 7.3; 95% CI, 2.2–23.7; P < .001) onward. Conclusions: We recommend thoroughly examining severity of depressed mood during assessment of imminent suicide risk.

• 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.

• Berg, Siv Hilde; Rørtveit, Kristine; Walby, Fredrik A & Aase, Karina (2020). Safe clinical practice for patients hospitalised in mental health wards during a suicidal crisis: qualitative study of patient experiences. BMJ Open. 10:e040088(11), s. 1–11. doi: 10.1136/bmjopen-2020-040088. Fulltekst i vitenarkiv Vis sammendrag

  Aim: The aim of this study was to explore suicidal patients' experiences of safe clinical practice during hospitalisation in mental health wards. The study was guided by the following research question: How do suicidal patients experience safe clinical practice during hospitalisation in mental health wards? Design, setting and participants: A qualitative design with semistructured individual interviews was applied. Eighteen patients hospitalised with suicidal behaviour in specialised mental health wards for adults at a Norwegian hospital participated in the study. Data were analysed thematically and inductively using qualitative content analysis. Results: Patients in a suicidal crisis experienced safe clinical care in mental health wards characterised by the following three themes: (1) being recognised as suicidal, (2) receiving tailor-made treatment and (3) being protected by adaptive practice. Conclusion: This study illuminates the experiences of safe clinical practice for patients in a suicidal crisis. The patient group was multifaceted, with variable experiences of how safe clinical practice affected their subjective experience of safety and suicidal behaviour. The finding highlights the importance of embracing personalised activities in all parts of safe clinical practice and to recognise rather than efface patients' variability in patient safety efforts.

• Berg, Siv Hilde; Rørtveit, Kristine; Walby, Fredrik A & Aase, Karina (2020). Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study. BMC Psychiatry. 20(1), s. 1–12. doi: 10.1186/s12888-020-02689-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Safe clinical practice for patients hospitalised in mental health care during a suicidal crisis is situated within a dynamic, non-linear and uncertain context. Under such complex conditions, the adaptive capacity is considered vital to handling challenges and changes in clinical care. This study aimed to explore safe clinical practice for suicidal patients hospitalised in mental health wards through understanding healthcare professionals’ (HCPs’) capacities to adapt to challenges and changes in clinical care. Methods This study applied a qualitative design with focus group and individual interviews. Twenty-five HCPs participated in the focus groups, and 18 participated in individual interviews. The study was conducted in open and locked wards in a university hospital in Norway providing specialised mental health services for patients with mental illness. Results HCPs described their adaptive capacities for clinical practice relative to three themes. 1) HCPs used expertise to make sense of suicidal behaviour to support complex decision making. Their strategies included setting aside forms and checklists to prioritise trust and making judgements based on more than just patients’ spoken words. They improved their understanding by seeking others’ perspectives through collaborative sense-making processes involving the healthcare team and patient. 2) HCPs individualised the therapeutic milieu to address the diversity of patients with suicidal behaviour by creating individual clinical pathways, making trade-offs between under- and over-protection and adjusting observations. 3) HCPs described managing uncertainty as necessary for providing safe clinical practice. They managed uncertainty as a team by developing mutual collegial trust and support and creating a shared understanding. Conclusion HCPs’ adaptive capacities are vital to the complex set of practices involved in safe clinical practice for patients hospitalised during a suicidal crisis. By using expertise, individualising the therapeutic milieu, and managing uncertainty, HCPs individually and collectively develop their capacities to adapt to challenges and changes in clinical care. HCPs cannot easily ensure safe clinical practice by following standards; safe clinical practice depends on HCPs’ adaptations. Ward systems that ensure collegial trust and support, as well as arenas that foster shared understanding and situational awareness, are needed.

• Fredriksen, Kristin J; Schaufel, Margrethe Aase; Johannessen, Jan Olav; Walby, Fredrik A; Davidson, Larry & Schøyen, Helle Kristine (2019). Preventing Suicide among Psychiatric Inpatients with Psychotic Depression. Psychiatric quarterly. ISSN 0033-2720. doi: 10.1007/s11126-019-09677-6. Fulltekst i vitenarkiv
• 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.

• Holth, Fredrik; Walby, Fredrik A; Røstbakken, Thea; Lunde, Ingeborg; Ringen, Petter Andreas & Ramleth, Ruth-Kari [Vis alle 11 forfattere av denne artikkelen] (2018). Extreme challenges: psychiatric inpatients with severe self-harming behavior in Norway: a national screening investigation. Nordic Journal of Psychiatry. ISSN 0803-9488. 72(8), s. 605–612. doi: 10.1080/08039488.2018.1511751. Fulltekst i vitenarkiv
• 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
• Walby, Fredrik A (2026). Lessons learned from The Norwegian Surveillance System for Suicide in Mental Health and Substance Misuse Services and implications for the revised national guidelines for suicide prevention. doi: https:/www.iasp.info/wp-content/uploads/2025-IASP-Abstract-Book-Vienna.pdf. Fulltekst i vitenarkiv Vis sammendrag

  The Norwegian Surveillance System for Suicide in Mental Health and Substance Misuse Services (NoSS) systematically collects data regarding suicide among people who have been in contact with secondary mental health and substance misuse services in the 12 months preceding death. The NoSS is based on The National Confidential Inquiry into Suicide and Safety in Mental Health in the UK and adapted for Norway using a hybrid registry design. The aim of this presentation is 1) to describe the design of the NoSS including information security issues, 2) to provide an overview of main findings and 3) to discuss how available data has been used in the newly revised national preventive guidelines in Norway. The NoSS is well received among clinicians and authorities and has a coverage of above 92 % of all suicides in connection with care. Findings for the years 2010 – 2023 show that 46% of all people who died by suicide had contact with secondary mental health- and substance misuse services in the year preceding death, 38% had contact in the last 90 days. In adult mental health suicide rates were 111 (females) and 245 (males) per 100 000, and further increased 3.7 times among those with at least one inpatient admission. Post-discharge clustering was significant. More than half had a psychiatric history lasting more than 5 years, about half had a history of substance misuse and 66% of females and 48% of males had a history of deliberate self-harm. Recent adverse life events were known in about 40 % and only 25 % were employed. 46 % had depressive symptoms at last contact but only 25 % had known suicidal ideation. Both immediate and long-term suicide risk were generally rated as low. In substance misuse services the suicide rates were 190 (females) and 202 (males) per 100 / 100 000. Trajectory analyses show that most suicides had short and fragmented contact with any service during the 12 months before death. The findings from the NoSS have informed Norwegian practice guidelines including a deemphasis on the focus of suicide risk assessments and specific recommendations for post discharge follow up. Future research-based developments in health services aim at quality improvement as well as early interventions to target social difficulties and functioning seems necessary. Learning objective: Understand how systematic surveillance of suicides in large health-care organizations can assist in strengthening system-level approaches to suicide prevention in high-risk groups

• 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 (2024). Høy risiko og mye bekymring for selvmord i Psykisk helsevern. Hvordan forebygge mer effektivt basert på funn fra Kartleggingssytemet? Fulltekst i vitenarkiv
• Walby, Fredrik Andreas; Myhre, Martin Øverlien & Astrup, Helene (2024). Selvmord under døgnopphold – forekomst og forebygging. Fulltekst i vitenarkiv
• Walby, Fredrik Andreas (2024). Nasjonalt kartleggingssystem for selvmord: sentrale funn og implikasjoner for forebygging i tjenestene. 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
• 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
• 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
• Walby, Fredrik Andreas; Myhre, Martin Øverlien & Astrup, Helene (2022). Ja takk til debatt om selvmord blant barn og unge. 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
• 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
• Berg, Siv Hilde & Walby, Fredrik A (2021). Nullvisjon for selvmord. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 59(1), s. 30–35. Fulltekst i vitenarkiv Vis sammendrag

  Fagessay. Selvmordsfeltet kan lære av nullvisjonen i veitrafikken. Det krever samtidig en betydelig satsning og en tilpasning til sikkerhetens egenart i psykisk helsefeltet.

• 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
• 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
• Kvarstein, Elfrida H; Langjord, Tuva; Pedersen, Geir; Eikenæs, Ingeborg Helene Ulltveit-Moe; Urnes, Øyvind & Walby, Fredrik (2020). Ekstrem selvskading ; Nasjonal kartlegging av pasienter med omfattende behandling i døgninstitusjon grunnet høy selvmordsfare. 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
• Qin, Ping; Legard, Ingunn; Walby, Fredrik A; Tørmoen, Anita Johanna & Mehlum, Lars (2020). Selvmordsrisiko og -forebygging under covid-19-pandemien og etterpå. 25(1), s. 14–19. doi: 10.5617/suicidologi.8271. Fulltekst i vitenarkiv Vis sammendrag

  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.

• 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; Kildahl, Anine Therese & Walby, Fredrik A (2019). Selvmord under og etter behandling i tverrfaglig spesialisert rusbehandling. 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
• 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 (2019). Hva kan vi lære av 2000 selvmord? Fulltekst i vitenarkiv
• Walby, Fredrik A; Myhre, Martin Øverlien & Kildahl, Anine Therese (2019). Selvmord ved personlighetsforstyrrelse. Fulltekst i vitenarkiv
• Walby, Fredrik A (2019). Nasjonalt kartleggingssystem for selvmord. Fulltekst i vitenarkiv
• Walby, Fredrik A (2019). Some thoughts / ideas towards a possible clinical trial of suicide prevention intervention(s) in psychiatric patients. Fulltekst i vitenarkiv
• Walby, Fredrik A (2019). Hvorfor trenger vi nye retningslinjer for selvmordsforebygging? 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
• Kvarstein, Elfrida H; Walby, Fredrik A & Holst, Andrea (2019). "Extreme challenges" - Nasjonal kartlegging av pasienter med svært alvorlig selvskading og omfattende behandling i døgninstitusjon. Fulltekst i vitenarkiv
• Walby, Fredrik A (2019). Selvmordsforebygging og selvmordsrisikovurdering. Fulltekst i vitenarkiv
• Walby, Fredrik A (2019). Nytt kartleggingssystem for selvmord i PHV og TSB. 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
• Fredriksen, Kristin J; Schøyen, Helle Kristine; Walby, Fredrik A & Mellesdal, Liv Solrunn (2019). Psychiatric acute admission in depressive episodes: Can psychotic symptoms and suicidal behavior predict future suicide? Fulltekst i vitenarkiv
• Walby, Fredrik A (2019). Hva vet vi om ekstrem selvskading? Fulltekst i vitenarkiv
• Walby, Fredrik A (2019). Selvmordsforebyggende strategier. 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
• 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; 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
• Walby, Fredrik A (2018). Selvmordsrisikovurderinger: Hvor vanskelig er det? Kunnskapsstatus og utfordringer. Fulltekst i vitenarkiv
• Walby, Fredrik A (2018). Selvmord i psykisk helsevern og tverrfaglig spesialisert behandling 2008-2015. Historiske data fra Nasjonalt kartleggingssystem for selvmord. 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
• Walby, Fredrik A (2018). Hvorfor bør Nasjonale retningslinjer for selvmordsforebygging i psykisk helsevern revideres nå? :. 23(3), s. 23–25. doi: 10.5617/suicidologi.6767. 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
• 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.

• 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
• Schøyen, Helle Kristine; Walby, Fredrik A; Schaufel, Margrethe Aase & Fredriksen, Kristin J (2022). Psychotic depression and suicide risk - a mixed methods study. Universitetet i Stavanger. ISSN 9788284391069. Fulltekst i vitenarkiv Vis sammendrag

  Background The reasons behind suicide are multifactorial, complex, and poorly understood. Despite decades of research, suicide rates remain elevated both during hospitalization as well as shortly after discharge. Clinically relevant knowledge and tools for suicide risk assessments to guide decision-making processes in acute settings are needed. Objectives The thesis objective was to examine and improve understanding of the complex relationship between psychotic depression and suicide behaviour. We also examined risk factors of clinical relevance in hospital settings, both during treatment, and after discharge. Methods This research project used a sequential exploratory strategy, commencing with a qualitative part (paper 1-2), followed by a quantitative part (paper 3-4). In paper 1 and 2, we conducted qualitative interviews with nine patients diagnosed with psychotic depression as part of uni- or bipolar disorder. Papers 3 and 4 used data from the naturalistic prospective cohort study Suicidality in Psychiatric Emergency Admissions. In paper 3, we included all patients with depression (N= 1846) in a representative sample to identify risk factors for suicide using a cox regression analysis. Paper 4 investigated a mixed diagnostic sample of 7000 acutely admitted inpatients to identify imminent- and short-term risk factors for suicide. The findings from all four papers were combined into a secondary analysis, where we thematically synthesized the perspectives of patients’ experiences with the main findings from the prospective cohort study based on clinical assessment. Results thematic summarized Our main finding was that psychotic symptoms in depression are associated with increased suicide risk, both short- and long-term (Paper 3). A possible mechanism to explain this association is the combination of intense emotional suffering and cognitive impairment which may motivate impulsive behaviour in psychotic depression (Papers 1 and 2). Depressed mood including overvalued ideas and delusions of self-blame and guilt predicted suicide the first following week after admission (Paper 4). The association of intense affective states with both imminent and long-term suicide risk factors was supported by patient experiences of sleeplessness and intense anxiety as warning signs for suicidal behaviour (Paper 1 and 2). In further support of this, depression severity assessed by the Health of the Nation Scale item 7 predicted suicide the first following week after admission (Paper 4). We found higher short-term suicide rates in patients diagnosed with psychotic depression as compared to those without psychotic symptoms at all follow-up points (Paper 3). A diagnosis of psychotic depression and depression severity assessed by MADRS depression scale as independent predictors of suicide provided knowledge on the long-term perspective (median 5.5 years follow-up). Also of clinical importance is our finding that self-report of suicidal ideation is not a good measure of imminent, short- or long-term suicide risk. Our qualitative findings indicate that shame, psychotically motivated paranoid ideation and impulsivity motivated underreporting of both suicidal ideation and psychotic symptoms in themselves. This may partly explain why, despite reporting less suicidal ideation/planning on admission, the suicide rate was higher for patients with psychotic symptoms on admission than for those without such symptoms (Paper 3). Although reported suicidal ideation was less relevant for clinical risk assessment, paper 3 and 4 identified male gender and recent suicide attempt as significant risk factors for completed suicide. The last main finding was that patients found both security measures and a treatment approach focusing on modifying psychotic experiences, intense anxiety and sleeplessness was helpful during hospitalization. Taking the time to talk to establish good patient relations is essential for optimal treatment conditions. Conclusions The periods of acute inpatient treatment and immediately post- discharge are associated with the highest suicide risk. High symptom load as well as a diagnosis of psychotic depression, especially the presence of overvalued ideas and delusions of self-blame and guilt, appear to indicate especially high suicide risk regardless of time horizon. Identifying delusions and other psychotic symptoms is thus of the utmost importance. Psychosis- and depression-focused interventions and treatment approaches aiming specifically to reduce both psychotic and affective symptom load may act as a suicide prevention strategy for psychotic depressed patients. We found self-report of suicidal ideation of limited relevance when assessing suicide risk. Such assessments should thus always be combined with thorough clinical assessment by trained staff. This is especially true when assessing patients with psychotic depression, but especially given the frequent underreporting of psychotic symptoms, it remains important with any patient admitted for a depressive episode. Structured depression rating scales for clinician use may meaningfully contribute to suicide risk assessments. When assessing acute admission patients, we recommend paying particularly close attention to males, and patients with prior and recent suicide attempts.

• 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
• Berg, Siv Hilde; Aase, Karina; Rørtveit, Kristine & Walby, Fredrik A (2020). Safe clinical practice for patients hospitalised in mental healthcare during a suicidal crisis. Universitetet i Stavanger. ISSN 9788276449495. Fulltekst i vitenarkiv Vis sammendrag

  Preventing suicides is a major issue for patient safety in mental health wards. Safety is assumed to be achieved for suicidal inpatients in clinical practice when procedures are well implemented, without any gaps between practice guidelines and work as done in clinical practice. The approach to implementing safety practices assumes linear causality in which the implementation of a safety measure will yield predictable outcomes in clinical practice. While this approach can provide successful outcomes in systems that are well understood, well tested and well-behaved, it has some limitations when applied to complex and dynamic practices in which the risk is not completely understood, i.e., involving patients hospitalised during a suicidal crisis. Suicidal patients are characterised by aetiological heterogeneity, and each patient needs to be understood and approached differently. Deviations from standards may be necessary to maintain safe clinical practice for patients due to their complexity. However, knowledge of the complexity of safe clinical practice for patients hospitalised during a suicidal crisis is lacking. Patients and healthcare professionals are valuable sources of information about everyday clinical practice in this setting. Still, no studies have explored how suicidal patients experience safe clinical practice, and the knowledge of healthcare professionals’ experiences with safe clinical practice is limited. There is a need to understand the idiosyncrasy of safety within this context and acknowledge its complexity. The overall aim of this thesis was therefore to gain a deeper understanding of the complexity of safe clinical practice for patients hospitalised in mental health wards during a suicidal crisis, as experienced by patients and healthcare professionals. Objectives • To synthesise and describe the qualitative literature regarding suicidal patients’ experiences of safety during hospitalisation in mental healthcare. • To explore suicidal patients’ experiences of safe clinical practice during hospitalisation in mental healthcare. • To explore HCPs’ experiences with safe clinical practice for patients hospitalised during a suicidal crisis. • To synthesise the characteristics of the complexity of safe clinical practice for patients hospitalised during a suicidal crisis. Methods A qualitative case study design utilised multiple methods and data sources, including a systematic review of qualitative literature, individual interviews with patients, and a multi-method approach comprising individual interviews and focus group interviews with healthcare professionals. The complexity of safe clinical practice for suicidal patients was defined as the case, and mental health wards were defined as its context. Results Safe clinical practice as experienced by suicidal patients appears to be related to more than the absence of suicide risk and the need for physical protection. Safe clinical practice for the suicidal patient is highly dependent on patients’ perceptions of their connections with healthcare professionals, the fulfilment of their needs during care and their psychological safety (article I). Furthermore, suicidal patients are multifaceted, showing fluctuating suicidal behaviour, which highlights the importance of embracing personalised activities for safe clinical practice. Patients experience safe clinical practice during hospitalisation in mental health wards during a suicidal crisis, when they are being detected by mindful healthcare professionals, being protected by an adaptive practice and receiving tailor-made treatment (article II). Healthcare professionals experience safe clinical practice for patients hospitalised during a suicidal crisis as dependent on using expertise to make sense of suicidal behaviour, individualising the therapeutic milieu and managing uncertainty (article III). These are examples of capacities that enable healthcare professionals to adapt to challenges and changes in clinical care, and they are vital to the complex dynamic work practices involved in safe clinical practice in this setting. Through synthesising across suicidal patients’ and healthcare professionals’ experiences, the safe clinical practice involves a set of complex characteristics: collaborative detection, adaptive protection and individualised control which all depend on systems of trust. These characteristics demonstrate how nonlinearity and uncertainty characterise the complexity in this context. Additionally, the complexity in safe clinical practice is characterised by establishing psychological and relational safety, which is only created through personalised and trusted relationships. Conclusion This thesis offers a deeper understanding of the complexity of safe clinical practices for patients hospitalised during a suicidal crisis by considering the experiences of patients and HCPs. The inherent complexity of safe clinical practice for patients hospitalised during a suicidal crisis implies that there are unpredictable consequences of top-down safety interventions and that outcomes change over time and for each patient. Thus, safe clinical practice cannot be ensured just by following standards; it also depends on adaptations. To improve safe clinical practices, efforts should be made to embrace rather than efface variability in clinical care. This includes supporting adaptive capacities that enable HCPs to cope with challenges and changes in clinical care. Strategies should be directed toward strengthening expertise development, feedback systems, and systems ensuring support and predictability.

• 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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