Lars Mehlum

• Flygare, Oskar; Diest, Ana Portillo Van; Dymbe, Kine Johansen; Siqveland, Johan; Bhargav, Madhav & Fernández, Montserrat López [Vis alle 13 forfattere av denne artikkelen] (2026). A systematic review of clinical practice guidelines for suicide and self-harm prevention in adults. Psychiatry Research. ISSN 0165-1781. 366, s. 117465–117465. doi: 10.1016/j.psychres.2026.117465. Fulltekst i vitenarkiv
• Bukten, Anne; Mehlum, Lars; Fazel, Seena; Lokdam, Nicoline Toresen; Tverborgvik, Torill & Skurtveit, Svetlana Ondrasova [Vis alle 12 forfattere av denne artikkelen] (2026). Sociodemographic, Criminological and Clinical Determinants in Suicide After Release From Prison: A 23‐Year National Cohort Study. Acta Psychiatrica Scandinavica. ISSN 0001-690X. doi: 10.1111/acps.70148. Fulltekst i vitenarkiv Vis sammendrag

  ABSTRACT Background Suicide risk is elevated after prison release, but population‐level evidence on temporal risk patterns and associated factors remains limited. We aimed to describe characteristics of individuals who die by suicide after release from Norwegian prisons, compare their suicide mortality with the general population, and examine risk factors over time. Material and Methods Data from the Norwegian Prison Release Study (nPRIS), including all people in prison in Norway (2000–2022), were linked to the Norwegian Cause of Death Registry, the Norwegian Prison Registry, the Norwegian Patient Registry, and Statistics Norway. We calculated crude mortality rates (CMR) per 100,000 person‐years, standardized mortality ratios (SMR), annual age‐standardized years of life lost rate (ASYR), and Cox proportional hazards models. Results From 2000 to 2022, 1183 suicides (9.1% of all deaths; CMR 81; 95% CI 76–85) occurred after release (90% male). The SMR was higher in women (SMR 8.64; 95% CI 7.17–10.34) than men (SMR 3.98; 95% CI 3.76–4.22). In multivariable models (2009–2022; n  = 57,034; 516 suicides), strong independent associations with suicide 6 months post‐release included self‐harm (adjusted HR [aHR] 4.76; 95% CI 2.60–8.72), severe mental illness (aHR 1.95; 95% CI 1.16–3.27), release from high‐security prisons (aHR 1.93; 95% CI 1.12–3.33), and pretrial detention (aHR 1.82; 95% CI 1.06–3.13). Conclusions Suicide risk is substantially and persistently elevated relative to the general population, peaks immediately after release, and is concentrated among people with prior self‐harm, severe mental illness, and those released from high‐security settings.

• Mohn, Christine; Haga, Egil; Nilsson, Hanne Sofie Wernø & Mehlum, Lars (2026). Who notices suicide prevention media campaigns? Demographic characteristics and attitudes to suicide and help-seeking. Psychiatry Research Communications. 6(4). doi: 10.1016/j.psycom.2026.100285. Fulltekst i vitenarkiv Vis sammendrag

  Public media campaigns have the potential to reach large numbers of people with suicide prevention messages. However, relatively few individuals among the exposed population report being aware of the campaigns when they occur. Those who notice these campaigns may differ from those who do not in key variables relevant for suicide prevention interventions. In this study, we compare the demographic characteristics and attitudes to suicide and help-seeking in these two groups. In 2022 and 2023, three regional uniform suicide prevention media campaigns were carried out in Mid-, West- and South-Norway. Before and after each campaign, sex- and age-representative samples of the population completed surveys of demographic variables and attitudes to suicide and help-seeking. Among the 3234 participants, n = 644 (20%) reported having noticed the campaign, and n = 2590 (80%) did not. In the campaign awareness group, there were significantly fewer members in the 30-39 age bracket and more members in the 70-79 age bracket than among the non-aware group. Moreover, the campaign awareness group had a higher proportion of people with MA level education, in retirement, and who had family members or friends who had died by suicide or attempted suicide. In this group, there was also slightly higher preparedness to help a suicidal person. The effect sizes were small. Logistic regression analyses revealed not belonging to the 30-39 age bracket and having family/friends with suicidal behaviour as significant predictors of campaign awareness.

• Dibaj, Iselin Solerød; Galfalvy, Hanga; Tørmoen, Anita Johanna; Haga, Egil & Mehlum, Lars (2026). Does Dialectical Behaviour Therapy for adolescents affect suicidal ideation and use of coping skills in adulthood? A 12.4-years follow-up study of a Randomized Trial using Ecological Momentary Assessment. Behaviour Research and Therapy. ISSN 0005-7967. 203. doi: 10.1016/j.brat.2026.105091. Fulltekst i vitenarkiv
• Bukten, Anne; Mehlum, Lars; Lokdam, Nicoline Toresen; Tverborgvik, Torill & Stavseth, Marianne Riksheim (2026). Rates, Timing and Correlates of Suicide in Norwegian Prisons: A 23-Year National Cohort Study. Archives of Suicide Research. ISSN 1381-1118. doi: 10.1080/13811118.2026.2680205. Fulltekst i vitenarkiv
• 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.

• Mehlum, Lars; Dibaj, Iselin Solerød; Haga, Egil; Helle, Sofie Egidius; Morken, Katharina Teresa Enehaug & Klungsøyr, Ole [Vis alle 7 forfattere av denne artikkelen] (2026). Adult life outcomes for adolescents 12.4 years after dialectical behavior therapy - a randomized clinical trial. European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-025-02856-w. Fulltekst i vitenarkiv Vis sammendrag

  Adolescents with suicidal and self-harming behavior run significant risk for suicide. Outcomes in adult life after specialized treatment for this population are unknown. We examined adult life outcomes in adolescents with recurrent suicidal and self-harming behavior and borderline features having participated in a randomized trial of dialectical behavior therapy (DBT-A) or enhanced usual care (EUC). Of the original 77 study participants, 61 (79%) were followed-up at a mean age of 28 years, an average of 12.4 years post-baseline. Primary outcomes were frequency of self-harm episodes and levels of suicidal ideation and depressive symptoms over the follow-up intervals. Secondary outcomes were borderline symptoms, psychiatric morbidity, occupational and psychosocial functioning. Self-harm frequency was consistently lower throughout the 12.4 year follow-up period in participants who had received DBT-A, although differences were not statistically significant at the final follow-up. Whereas suicide attempts were infrequent in both groups, self-harm episodes were more than twice as common in the EUC group compared to the DBT-A group with a mean difference of 90 episodes per person from baseline to 12.4 years follow-up. DBT-A was associated with significantly stronger reductions in suicidal ideation, depressive and borderline symptoms at end of treatment but differences tapered off until not statistically significant at the final follow-up. There were no significant trend differences in current psychiatric morbidity, self-reported depressive symptoms and global functioning. This first study of adult life outcomes of specialized psychosocial interventions for adolescents with recurrent suicidal and self-harming behavior and borderline features suggests that adolescents may have a realistic hope of sustained recovery as adults.

• Mohn, Christine; Haga, Egil; Nilsson, Hanne Sofie Wenø & Mehlum, Lars (2026). Changes in Attitudes After Suicide Prevention Media Campaigns in Three Norwegian Regions. Archives of Suicide Research. ISSN 1381-1118. doi: 10.1080/13811118.2026.2624605. Fulltekst i vitenarkiv
• Dibaj, Iselin Solerød; Tørmoen, Anita Johanna; Klungsøyr, Ole; Morken, Katharina Teresa Enehaug; Haga, Egil & Dymbe, Kine Johansen [Vis alle 7 forfattere av denne artikkelen] (2025). Early remission of deliberate self-harm predicts emotion regulation capacity in adulthood: 12.4 years follow-up of a randomized controlled trial of adolescents with repeated self-harm and borderline features. European Child and Adolescent Psychiatry. ISSN 1018-8827. s. 1–12. doi: 10.1007/s00787-024-02602-8. Fulltekst i vitenarkiv Vis sammendrag

  Emotion regulation capacity, critical for adult functioning and mental health, develops strongly during adolescence in healthy individuals. Deficits in emotion regulation is often referred to as emotion dysregulation [ED] and is associated with various mental health problems, including repeated deliberate self-harm [DSH] which peaks in adolescence. Dialectical Behaviour Therapy for adolescents [DBT-A] systematically targets ED through strategies such as changing coping behaviours and has previously been shown to effectively induce DSH remission in adolescents. However, whether such remission is associated with improved emotion regulation capacity in adulthood, and whether this effect is mediated by changes in use of coping strategies has not been previously studied. Prospective long-term follow-up study of an RCT comparing DBT-A with enhanced usual care [EUC] for adolescents presenting to community child and adolescent psychiatric outpatient clinics with borderline personality features and repeated self-harm. Assessments included both structured interviews and self-report at baseline and 1.6, 3.1 and 12.4 years follow-up. In the final follow-up, adult ED was measured and data were collected for 61 (80%) of the original 77 participants. DSH remission was assessed at 1.6 years follow-up, and use of coping strategies at 3.1 and 12.4 years follow-ups. A mediation analysis was conducted within a causal inference framework. Both treatment groups increased their use of functional coping skills from adolescence to adulthood, while only DBT-A was associated with decreases in dysfunctional coping. There was a direct effect of DSH remission 1 year after treatment on adult ED, particularly for participants who did not receive DBT-A. There was a negative association between reductions in dysfunctional coping and adult ED, however this did not mediate the effect of DSH remission. This is the first study to report that early DSH remission in adolescence predicted lower ED in adulthood. These results highlight the importance of early DSH remission and provides new insight into the long-term relationship between DSH and ED. Clinical trial registration information: “Treatment for Adolescents with Deliberate Self-harm”; http://ClinicalTrials.gov/;NCT00675129

• Dibaj, Iselin Solerød; Neupane, Sudan Prasad & Mehlum, Lars (2025). Brief, pragmatic measure of emotion dysregulation in young people – a preliminary validation of the BER-5. Borderline Personality Disorder and Emotion Dysregulation. 12. doi: 10.1186/s40479-025-00285-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Emotion dysregulation is a transdiagnostic construct associated with mental health problems, including self-harm and borderline personality disorder (BPD). Although often targeted in clinical practice, the majority of psychometric assessment instruments of emotion dysregulation are developed for research purposes, and there is a need for an adapted version to be used in a clinical screening setting. The main aim of this study was to examine psychometric properties of a brief, pragmatic measure of emotion dysregulation, the Brief Emotion Regulation Scale − 5 items (BER-5). Methods The sample consisted of 60 young adults (mean age 28.1 years) who participated in a 12.4 years follow-up study of an RCT of Dialectical Behaviour Therapy’s long-term effect. Cronbach’s alpha was used to calculate internal consistency. Concurrent and convergent validity were examined using Spearman’s correlation in comparison with other measures, and logistic regression as well as area under the curve to examine its ability in terms of differentiating between BPD diagnosis and trait levels. Optimal cut-off points were explored using Receiver Operating Curves. Results Our results indicated adequate internal consistency both in adolescence and in young adulthood, as well as high convergence with a gold-standard measure of emotion dysregulation, and moderate convergence with symptom measures of anxiety and depression. BER-5 was able to differentiate between participants with no BPD from subthreshold or full BPD diagnosis in adulthood, and a cut-off score of 5 was found optimal in terms of sensitivity and specificity in identifying individuals with BPD. Conclusions The BER-5 is a brief, pragmatic measure of emotion dysregulation with good psychometric properties and is potentially a useful screening tool for clinicians working in specialized health care settings.

• 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.

• Mohn, Hanne Christine; Haga, Egil; Nilsson, Hanne Sofie Wernø; Pirkis, Jane & Mehlum, Lars (2025). Predictors of not wanting to seek help or information for suicide thoughts. BMC Psychiatry. 25. doi: 10.1186/s12888-025-06985-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Approximately half of all individuals who die by suicide in Norway do not seek contact with specialist mental health services during the year before death. Here we aim to report the demographic characteristics and attitudes to suicide, mental ill health, and help-seeking in people who do not wish to seek help or information for suicide thoughts. Moreover, we identify the strongest predictors of non-help-seeking intentions. Methods A population sample (N = 3251) from the Mid- and West- Norway regions participated in an online survey of attitudes to suicide and help-seeking for mental ill health. The sample was recruited from the regional population that later was exposed to a media suicide prevention campaign. Of these, 167 individuals stated that they would not seek help or information if they were to get suicide thoughts. Results The group of people who would not seek help or information for suicide thoughts, were more likely to be male, aged between 40 and 49 years, not being retired, or having experienced suicide or suicide attempts among family or friends, compared to the group that stated their help-seeking intentions. Moreover, they were more likely to report more negative attitudes to suicide (e.g., believing it can’t be prevented, or that it should not be talked about), mental illness (e.g., wanting to hide depression, or wanting to sort out problems on their own), and help-seeking (e.g., feeling inferior if seeking professional help, or not being confident in getting help) as well as lower levels of support from family or friends. Stepwise logistic regression analyses identified male sex, not being confident in getting professional help for suicide thoughts, not being able to talk to family or friends about problems, and not wanting to disclose having depression, as the statistically significant predictors of not wanting to seek help or information, explaining 28% of the variance. Conclusions We conclude that these factors should be targeted in future suicide prevention efforts in Norway. In particular, the strongest predictor (Not being confident in getting professional care for suicide thoughts), should be addressed.

• Lunde, Ketil Berge; Mehlum, Lars; Melle, Ingrid & Qin, Ping (2024). Psychiatric follow-up and repeated hospital presentation of DSH: A national study on young adults. Journal of Affective Disorders. ISSN 0165-0327. 368, s. 383–389. doi: 10.1016/j.jad.2024.09.086. Fulltekst i vitenarkiv Vis sammendrag

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

• 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.

• Strømme, Maria Fagerbakke; Bartz-Johannessen, Christoffer; Kjelby, Eirik; Mehlum, Lars; Mykletun, Arnstein & Kroken, Rune Andreas [Vis alle 8 forfattere av denne artikkelen] (2024). Risk factors for mortality in patients admitted to a psychiatric acute ward: A prospective cohort study. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 149(3), s. 244–255. doi: 10.1111/acps.13657. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Associations between psychiatric disorders and mortality have been extensively studied, but limited evidence exists regarding influence of clinical characteristics on mortality risk, at the time of acute psychiatric hospitalization. Methods: A prospective total-cohort study included all patients consecutively admitted to Haukeland University Hospital's psychiatric acute ward in Bergen, Norway between 2005 and 2014 (n = 6125). Clinical interviews were conducted at the first admission within the study period, and patients were subsequently followed for up to 15 years in the Norwegian Cause of Death Registry. Competing risks regression models were used to investigate associations between clinical characteristics at first admission and the risk of natural and unnatural death during follow-up. Results: The mean age at first admission and at time of death was 42.5 and 62.8 years, respectively, and the proportion of women in the sample was 47.2%. A total of 1381 deaths were registered during follow-up, of which 65.5% had natural, 30.4% unnatural, and 4.1% unknown causes. Higher age, male sex, unemployment, cognitive deficits, and physical illness were associated with increased risk of natural death. Male sex, having no partner, physical illness, suicide attempts, and excessive use of alcohol and illicit substances were associated with increased risk of unnatural death. Conclusion: Psychiatric symptoms, except suicide attempts, were unrelated to increased mortality risk. In the endeavor to reduce the increased mortality risk in people with mental disorders, focus should be on addressing modifiable risk factors linked to physical health and excessive use of alcohol and illicit substances.

• Mehlum, Lars; Asarnow, Joan; Neupane, Sudan Prasad; Santamarina-Perez, Pilar; Primé-Tous, Mireia & Carlson, Gabrielle A. (2024). Psychotropic medication use among adolescents participating in three randomized trials of DBT. Borderline Personality Disorder and Emotion Dysregulation. 11(1). doi: 10.1186/s40479-024-00249-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Frequently presenting with symptoms of mood or anxiety disorders, substance abuse or borderline personality disorder, suicidal and self-harming adolescents often are prescribed psychotropic medication. Though such treatment may be warranted, recurrent suicidal and self-harming behaviour is often linked to emotion dysregulation where pharmacological treatment has weak empirical support. There is a need for more clinical research into the frequency, type and rationale for pharmacological treatment in this group. In this secondary analysis of three randomized clinical trials of dialectical behaviour therapy for adolescents, we report on psychotropic medication use in the respective samples at the time of recruitment, compare use of psychotropic medication across trials and describe sample characteristics that may be associated with possible differences in psychotropic medication. Findings Trials were conducted in Norway, the US and Spain (labelled the Oslo, US and Barcelona samples). At baseline, 86% of the Barcelona sample, 67% of the US sample and 12% of the Oslo sample were taking at least one psychotropic medication with antidepressants as the most frequent, followed by antipsychotics (72%, 22% and 1.3% respectively) and mood stabilizers (14.2%, 16.2% and 0%). In the Oslo sample there was a significant association between receiving a diagnosis of major depression and the likelihood of receiving antidepressants, but no such association was found in the Barcelona and US samples. The overall 7–8 times higher proportion of participants in the US and Barcelona samples treated with psychotropic medication could only partially be explained by differences between the samples in diagnostic profiles, symptom severity or level of dysfunction. Conclusions Highly prevalent in use among suicidal and self-harming adolescents with borderline features, psychotropic medication was still very unevenly prescribed across trials, differences not explained by differences in sample characteristics suggesting that current treatment practices are not fully empirically supported. We call for continued medical education and increased availability of evidence-based psychosocial interventions.

• Rodante, Demián; Bolotti, M; Boscolo, M; Cremades, C; Melone, M & Gagliesi, P [Vis alle 7 forfattere av denne artikkelen] (2024). Safety Planning Intervention Training Among Early Career Mental Health Professionals: Perception of Self-Efficacy, Usefulness and Feasibility. Archives of Suicide Research. ISSN 1381-1118. doi: 10.1080/13811118.2024.2335956. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: In 2021, in Argentina there were 3,639 deaths by sui-cide, equivalent to one death every three hours. Evidence indicates that brief suicide preventive interventions in emergency services, such as the Safety Planning Intervention (SPI), effectively reduce future suicidal ideation and attempts in both adults and adolescents.Objective: To evaluate the perception of self-efficacy, and the feasi-bility and usefulness of a training in SPI in early career mental health professionals.Method: Sixty-nine early career mental health professionals from Buenos Aires participated in a 3-hour SPI training. Through an online survey, measurements were taken in three times: before and after the training and 8–10weeks after the training.Results: All participants completed the pre- and post-training meas-ures, and 43 of them completed the follow-up survey. Post-training measures showed an increase in self-efficacy, maintaining the effect at 8–10weeks. The SPI was found useful and feasible to be imple-mented in clinical care. More than half of the participants reported having used the SPI during follow-up.Conclusion: Results suggest that training in SPI is associated with an increased perception of self-efficacy of early career mental health professionals; this is maintained after 2months post-training. In add-ition, the intervention is perceived as feasible, acceptable and useful for professionals in training.

• Mortier, Philippe; Conde, Susana; Alayo, Itxaso; Amigo, Franco; Ballester, Laura & Amell, Roser Cirici [Vis alle 23 forfattere av denne artikkelen] (2024). Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge. JAMA Network Open. 7(6). doi: 10.1001/jamanetworkopen.2024.17131. Fulltekst i vitenarkiv Vis sammendrag

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

• Øverland, Klara; Milde, Anne Marita & Mehlum, Lars (2024). Beredskapsplan for selvmord og selvmordsfare i skolen. Selvmordsforebygging i skolen. Universitetsforlaget. ISSN 9788215060224. Fulltekst i vitenarkiv
• Strømme, Maria Fagerbakke; Augustsson, Mina Thue; Bartz-Johannessen, Christoffer; Stautland, Andrea; Mykletun, Arnstein & Kroken, Rune Andreas [Vis alle 9 forfattere av denne artikkelen] (2024). Suicidality and use of psychotropic medications in patients with schizophrenia: A prospective cohort study. Psychological Medicine. ISSN 0033-2917. 54(16). doi: 10.1017/S0033291724002873. Fulltekst i vitenarkiv Vis sammendrag

  Background The lifetime prevalence of suicide is around 5% in patients with schizophrenia. Non-adherence to antipsychotic medication is an important risk factor, but prospective studies investigating joint effects of antipsychotic drugs, antidepressants, and benzodiazepines on suicidality are scarce. We aimed to investigate how use and non-use of psychotropic medications are associated with suicidality in schizophrenia. Methods An open cohort study followed all patients consecutively admitted to a psychiatric acute unit during a 10-year period with a diagnosis of schizophrenia (n = 696). Cox multiple regression analyses were conducted with use of antipsychotics, antidepressants, and benzodiazepines as time-dependent variables. Adjustments were made for age, gender, depressive mood, agitated behavior, and use of alcohol and illicit substances. Results A total of 32 (4.6%) suicide events were registered during follow-up. Of these, 9 (28%) were completed suicides and 23 (72%) were attempted suicides. A total of 59 (8.5%) patients were readmitted with suicidal plans during the follow-up. Compared to non-use, use of antipsychotics was associated with 70% lower risk of attempted or completed suicide (adjusted hazard ratio [AHR] = 0.30, p < 0.01, CI 0.14–0.65) and 69% reduced risk of readmission with suicidal plans (AHR = 0.31, p < 0.01, CI 0.18–0.55). Use of prescribed benzodiazepines was associated with 126% increased risk of readmission with suicidal plans (AHR = 2.26, p = 0.01, CI 1.24–4.13). Conclusions Adherence to antipsychotic medication is strongly associated with reduced suicidal risk in schizophrenia. The use of prescribed benzodiazepines was identified as a significant risk factor for being readmitted with suicidal plans.

• Mortier, Philippe; Amigo, Franco; Bhargav, Madhav; Conde, Susana; Ferrer, Montse & Flygare, Oskar [Vis alle 21 forfattere av denne artikkelen] (2024). Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-05659-6. Fulltekst i vitenarkiv Vis sammendrag

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

• Mohn, Hanne Christine; Haga, Egil; Nilsson, Hanne Sofie Wernø; Pirkis, Jane & Mehlum, Lars (2024). Change in attitudes after a suicide prevention media campaign in the Mid-Norway region. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-05905-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Suicide prevention media campaigns are one way of reaching people at increased suicide risk who would otherwise not seek help. This is the first study of a Norwegian campaign directed both at individuals at risk for suicide and at their social network. Methods We evaluated a media campaign consisting of outdoor posters, feature articles, film clips, and online banners in print, digital, and social media spread across the Mid-Norway region in late autumn 2022. This campaign material consisted of information about how to seek help for suicide thoughts and mental health problems and how to help a friend in similar situations. Before and after this campaign, 1149 adult individuals living in Mid-Norway participated in a survey on attitudes to suicide, mental ill health, and help-seeking. Results There were only marginal changes in attitudes and help-seeking literacy after the campaign. This result was sustained when controlling for age, sex, and campaign visibility. For males, there were a few changes in the negative direction, i.e. lack of willingness to seek help from family and friends, after the campaign. Conclusion We conclude that the campaign did not seem to have the desired effect and suggest ways of improving future regional Norwegian media campaigns.

• Dibaj, Iselin Solerød; Tørmoen, Anita Johanna; Klungsøyr, Ole; Haga, Egil & Mehlum, Lars (2023). Trajectories and Predictors of Change in Emotion Dysregulation and Deliberate Self-Harm Amongst Adolescents with Borderline Features. Clinical Child Psychology and Psychiatry. ISSN 1359-1045. 29(2), s. 407–423. doi: 10.1177/13591045231177374. Fulltekst i vitenarkiv Vis sammendrag

  Background Deliberate self-harm (DSH) and emotion dysregulation (ED) peaks in adolescence, and is associated with an increased risk of psychopathology, suicide and lower functioning in adulthood. DBT-A has been established as an effective treatment for reducing DSH, however less is known about changes in emotion dysregulation. This study aimed to identify baseline predictors of treatment response in outcome trajectories of DSH and emotion dysregulation. Methods Response trajectories of DSH and ED were investigated using Latent Class Analysis on RCT data comparing DBT-A and EUC for 77 adolescents treated for deliberate self-harm and borderline traits. Logistic regression analysis was used to examine baseline predictors. Results Two-class solutions were selected for both indicators, distinguishing between early and late responders in DSH, and responders and non-responders in ED. Higher levels of depression, shorter DSH histories and not receiving DBT-A predicted less favourable response in DSH, while DBT-A was the only predictor of treatment response in ED. Conclusions DBT-A was associated with a significantly faster reduction of deliberate self-harm in the short-term and improved emotion regulation in the long-term.

• Bøe, Anne Seljenes; Mehlum, Lars; Melle, Ingrid & Qin, Ping (2023). Psychiatric disorders among adult deliberate self-harm patients and subsequent risk of dying by suicide, mental and behavioural disorders and other external causes. Journal of Psychiatric Research. ISSN 0022-3956. 165, s. 83–90. doi: 10.1016/j.jpsychires.2023.07.011. Fulltekst i vitenarkiv Vis sammendrag

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

• Brager-Larsen, Anne Trana; Zeiner, Pål & Mehlum, Lars (2023). Sub-threshold or full-syndrome borderline personality disorder in adolescents with recurrent self-harm – distinctly or dimensionally different? Borderline Personality Disorder and Emotion Dysregulation. 10(1). doi: 10.1186/s40479-023-00234-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Borderline personality disorder (BPD) is a severe mental disorder frequently seen in individuals with recurrent self-harm behaviour. To what extent there are distinguishing characteristics between self-harming adolescents who meet the criteria for a full diagnosis of BPD, a sub-threshold number of BPD criteria and those who don’t have BPD, with respect to clinical characteristics, is still uncertain and could have important clinical implications. Methods Data from 103 adolescents with recurrent self-harm behaviour recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports. Bivariate analyses comparing participants with or without a diagnosis of BPD were performed. Group differences based on the number of BPD criteria fulfilled (few-if-any BPD: 0–2 criteria, sub-threshold BPD: 3–4 criteria, full-syndrome BPD: 5 or more criteria) were tested and regression analyses performed. Results Adolescents with a diagnosis of BPD (28.2%) had significantly higher numbers of co-morbid DSM-5 disorders, suicide attempts and self-harm methods. They also reported significantly higher levels of suicidal ideation, depression, anxiety and impulsivity, compared with adolescents without BPD. Adolescents with sub-threshold BPD (20.4%) place themselves in the intermediate position between participants with full-syndrome BPD and participants with few-if-any BPD, in terms of these symptoms. Higher levels of emotional regulation difficulties and a lower level of global functioning were significantly associated with fulfilling a higher number of BPD criteria. Conclusion Adolescents with recurrent self-harm who meet diagnostic criteria for a full-syndrome BPD or sub-threshold BPD seem to have difficulties within the same spectrum. They seem dimensionally, but not categorically, different with respect to the severity of their difficulties. These adolescents need interventions aimed at their dysfunctional self-harm behaviour, emotional regulation difficulties and BPD symptoms at an earlier, rather than at a later stage of symptom development.

• 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.

• Oskarsson, Högni; Mehlum, Lars; Titelman, David; Isometsä, Erkki; Erlangsen, Annette & Nordentoft, Merete [Vis alle 10 forfattere av denne artikkelen] (2023). Nordic region suicide trends 2000–2018; sex and age groups. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2023.2231918. Fulltekst i vitenarkiv
• Dymbe, Kine Johansen; Siqveland, Johan & Mehlum, Lars (2023). En litteraturgjennomgang og vurdering av retningslinjer for behandling av villet egenskade. Suicidologi. ISSN 1501-6994. doi: 10.5617/suicidologi.10546. Fulltekst i vitenarkiv Vis sammendrag

  Faglige retningslinjer er viktige slik at helsetjenestene blir mer evidensbaserte, oppdaterte og konsistente, og bedre i stand til å redusere risiko for uønskede hendelser og forbedre pasientsikkerheten. Videre vil slike retningslinjer kunne forbedre klinikeres evne til å vurdere og tilby behandling av høy kvalitet.&#x0D; Vårt mål var å vurdere kliniske retningslinjer for vurdering og behandling av selvmordsrisiko og villet egenskade. Vi gjennomførte systematisk søk i databaser etter slike retningslinjer. Fjorten retningslinjer ble vurdert ved bruk av AGREE II-instrumentet for kvalitetsvurdering av retningslinjer. Retningslinjene skåret høyest på domenene «avgrensning og formål», «involvering av interessenter» og «klarhet og presentasjon», mens de skåret lavest på domenene «metodisk nøyaktighet», «anvendbarhet» og «redaksjonell uavhengighet». Tre av de 14 retningslinjene ble vurdert som av god kvalitet. Flere retningslinjer baseres på konsensus og veldig få solide studier. Dessuten er det i flere retningslinjer manglende redegjørelse for utviklingen av retningslinjen og dens evidensgrunnlag. Dermed ser man viktigheten av mer forskning, spesielt randomiserte kontrollerte studier, for å danne grunnlag for fremtidige retningslinjer. I Norge er det spesielt behov for oppdaterte retningslinjer for sykehusbehandling av villet egenskade, ettersom dagens retningslinjer er utdaterte.

• Brager-Larsen, Anne Trana; Zeiner, Pål & Mehlum, Lars (2023). DSM-5 Non-Suicidal Self-Injury Disorder in a Clinical Sample of Adolescents with Recurrent Self-Harm Behavior. Archives of Suicide Research. ISSN 1381-1118. doi: 10.1080/13811118.2023.2192767. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Non-suicidal self-injury disorder (NSSID) is a new diagnosis proposed in DSM-5 with a need of further study, especially in adolescent clinical populations where non-suicidal self-injury (NSSI) is particularly prevalent. We aimed to study characteristics of NSSID and estimate an optimal cutoff frequency level of NSSI behavior. Methods Data were collected from 103 outpatient adolescents (ages 12–18) with recurrent self-harm behavior. Results Adolescents with NSSID reported significantly more frequent NSSI behavior and suicide attempts than adolescents without NSSID. Frequency of NSSI, global functioning, depressive symptoms, number of self-harm methods and anxiety symptoms best discriminated between adolescents with and without NSSID. An optimal cutoff level for a diagnosis of NSSID was found to be ≥15 days with NSSI during the last year, which led to a reduction in the rate of adolescents diagnosed with NSSID from 54% to 46%. Conclusion This study shows that NSSID is a highly impairing disorder characterized by high risk of multiple NSSI and suicide attempts, decreased functioning and other associated psychiatric disorders. Clinical awareness of these risks are important to ensure early detection and treatment. Future prospective longitudinal studies are needed to further validate the characteristics of the NSSID diagnosis and its clinical utility.

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

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

• Neupane, Sudan Prasad & Mehlum, Lars (2022). Adolescents With Non-Suicidal Self-Harm—Who Among Them Has Attempted Suicide? Archives of Suicide Research. ISSN 1381-1118. doi: 10.1080/13811118.2022.2072254. Fulltekst i vitenarkiv
• 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.

• Nilsson, Hanne Sofie Wernø; Haga, Egil & Mehlum, Lars (2022). Psykiske plager under COVID-19-pandemien i Norge: Kjønns-, alders- og sosioøkonomiske forskjeller. Suicidologi. ISSN 1501-6994. Fulltekst i vitenarkiv Vis sammendrag

  Siden starten av pandemien har det vært stor bekymring for hvordan den kom til å påvirke den generelle psykiske helsen i befolkningen. Denne studiens mål var å undersøke hvordan befolkningen rapporterer subjektiv økning av vanlige psykiske plager under pandemien, opplevde positive konsekvenser av pandemien, om det foreligger gruppeforskjeller i svarene i henhold til kjønn, alder og sosioøkonomisk status, samt om det er forskjeller i hvordan folk har svart på de to undersøkelsene i 2020 og 2021. Forskningsdesignet var en befolkningssurvey på to ulike tidspunkt (2020 og 2021) under pandemien hvor prevalens og gruppeforskjeller ble undersøkt. Spørreundersøkelsen ble besvart av 4012 personer i 2020 og 4007 personer i 2021. Resultatene fra 2020 viste at 45,5 % av deltakerne rapporterte at de opplevde økt bekymring, 38,5 % økt ensomhet og 33,4 % økt nedstemthet etter at pandemien startet. De yngre aldersgruppene (18–35 år og 35–55 år) og de med lav sosioøkonomisk status rapporterte i størst grad at de opplevde negative konsekvenser av pandemien på sin psykiske helse. Kvinner rapporterte i større grad enn menn at de opplevde økt bekymring. Det var ikke betydningsfulle forskjeller mellom 2020 og 2021 i noen av de undersøkte forholdene. Studien viser at en betydelig andel av befolkningen både i 2020 og 2021 rapporterte en opplevd økning i vanlige psykiske plager under pandemien. Samtidig tyder mye på at pandemien rammet skjevt i befolkningen slik at unge voksne og de med lav sosioøkonomisk status rapporterte om større innvirkninger på sin psykiske helse.

• Brager-Larsen, Anne Trana; Zeiner, Pål; Klungsøyr, Ole & Mehlum, Lars (2022). Is age of self-harm onset associated with increased frequency of non-suicidal self-injury and suicide attempts in adolescent outpatients? BMC Psychiatry. 22(1). doi: 10.1186/s12888-022-03712-w. Fulltekst i vitenarkiv Vis sammendrag

  Background Self-harm in adolescents is an increasing public health concern and an important risk factor for suicide. We aimed to examine how age of self-harm onset in adolescents was associated with frequency of subsequent suicidal and non-suicidal self-harm (NSSI) episodes, and how age of onset and duration of self-harm may influence the frequency of self-harm. Methods Data from 103 adolescents with recurrent self-harm recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports, and analysed with negative binomial and hurdle models. Results A lower age of self-harm onset and a longer duration of self-harm were both significantly associated with increased frequency of subsequent episodes of NSSI and risk of a first suicide attempt. There was an increase in repeated suicide attempts when the age of onset of self-harm decreased and the duration increased, and dramatically more for long duration of NSSI before first suicide attempt. Conclusion Initiating self-harm behaviour at the youngest age had the highest risk of increased frequency of NSSI and suicide attempts. Longer duration of self-harm behaviour increased this risk. This underlines the importance of early identification of self-harm behaviour in adolescents, and the use of effective interventions.

• Strømme, Maria Fagerbakke; Mellesdal, Liv Solrunn; Bartz-Johannessen, Christoffer; Kroken, Rune Andreas; Krogenes, Marianne Leiknes & Mehlum, Lars [Vis alle 7 forfattere av denne artikkelen] (2022). Use of Benzodiazepines and Antipsychotic Drugs Are Inversely Associated with Acute Readmission Risk in Schizophrenia. Journal of Clinical Psychopharmacology. ISSN 0271-0749. 42(1), s. 37–42. doi: 10.1097/JCP.0000000000001497. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Little is known about the impact of different psychotropic drugs on acute readmission risk, when used concomitantly in a real-life setting. We aimed to investigate the association between acute readmission risk and use of antipsychotic drugs, antidepressants, mood stabilizers, and benzodiazepines in patients with schizophrenia. Methods: A cohort study included all patients diagnosed with schizophrenia admitted to a psychiatric acute unit at Haukeland University Hospital in Bergen, Norway, during a 10-year period (N = 663). Patients were followed from discharge until first readmission or censoring. Cox multiple regression analyses were conducted using antipsychotic drugs, antidepressants, mood stabilizers, and benzodiazepines as time-dependent variables, and periods of use and nonuse were compared within individual patients. Adjustments were made for sex, age at index admission, and excessive use of alcohol and illicit substances. Results: A total of 410 patients (61.8%) were readmitted during follow-up, and the mean and median times in days to readmission were 709 and 575, respectively. Compared with nonuse, the use of antipsychotic drugs was associated with reduced risk of readmission (adjusted hazards ratio, 0.20; P < 0.01; confidence interval, 0.16–0.24), and the use of benzodiazepines was associated with increased risk of readmission (adjusted hazards ratio, 1.51; P < 0.01; confidence interval, 1.13–2.02). However, no relation to readmission risk was found for the use of antidepressants and mood stabilizers. Conclusions: We found that use of benzodiazepines and antipsychotic drugs are inversely associated with acute readmission risk in schizophrenia.

• Waraan, Luxsiya; Siqveland, Johan; Hanssen-Bauer, Ketil; Czajkowski, Nikolai Olavi; Axelsdottir, Brynhildur & Mehlum, Lars [Vis alle 7 forfattere av denne artikkelen] (2022). Family therapy for adolescents with depression and suicidal ideation: A systematic review and meta–analysis. Clinical Child Psychology and Psychiatry. ISSN 1359-1045. s. 1–19. doi: 10.1177/13591045221125005. Fulltekst i vitenarkiv Vis sammendrag

  Objective To systematically review and meta-analyze the effectiveness of family therapy compared to other active treatments for adolescents with depressive disorders or suicidal ideation. Method We conducted a systematic search of The Cochrane Central Register of Controlled Trials, Medline, Embase, PsycINFO, AMED, CINAHL and Web of Science and performed two meta-analyses of outcomes for depressive symptoms and suicidal ideation. Results We screened 5,940 records and identified 10 randomized controlled studies of family therapy for depressive disorder or suicidal ideation in adolescents with an active treatment comparison group. Nine studies reported outcome measures of depressive symptoms and four reported outcome measures of suicidal ideation. The meta-analysis showed no significant difference between family therapy and active comparison treatments for end-of-treatment levels of depression. For suicidal ideation our meta-analysis showed a significant effect in favour of family therapy over comparison treatments for suicidal ideation. Conclusions Based on the current body of research, we found that family therapy is not superior to other psychotherapies in the treatment of depressive disorder. However, family therapy leads to significantly improved outcomes for suicidal ideation, compared to other psychotherapies. The evidence for the treatment of depression is of low quality needs more research.

• Bøe, Anne Seljenes; Mehlum, Lars; Melle, Ingrid & Qin, Ping (2022). Clinical determinants of hospital treated deliberate self-harm repetition: A time to recurrent event analysis. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 146(6), s. 557–567. doi: 10.1111/acps.13503. Fulltekst i vitenarkiv Vis sammendrag

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

• Strømme, Maria Fagerbakke; Bartz-Johannessen, Christoffer; Kroken, Rune Andreas; Mehlum, Lars & Johnsen, Erik (2022). Overactive, aggressive, disruptive and agitated behavior associated with the use of psychotropic medications in schizophrenia. Schizophrenia Research. ISSN 0920-9964. 248, s. 35–41. doi: 10.1016/j.schres.2022.07.014. Fulltekst i vitenarkiv Vis sammendrag

  Background: Evidence is limited for the associations between use of psychotropic medications and overactive, aggressive, disruptive or agitated behavior (OADA)1 in clinical practice. Aims: To investigate the associations between risk of readmission with OADA and use of antipsychotics, antidepressants, mood stabilizers and benzodiazepines in patients with schizophrenia. Method: A consecutive total cohort diagnosed with schizophrenia (N = 663) after admission to the Haukeland University Hospital psychiatric acute unit in Bergen, Norway, was followed from discharge over a 10-year period. At every following readmission, the level of OADA was assessed using the first item of the Health of the Nation Outcome Scale (HoNOS). Periods of use versus non-use of antipsychotics, antidepressants, mood stabilizers and benzodiazepines were recorded as time-dependent variables in each patient and compared using Cox multiple regression analyses. Results: A total of 161 (24.3 %) patients were readmitted with OADA, and the mean (SD) and median times in years to readmission with OADA were 2.8 (2.6) and 2.1, respectively. We found that the risk of readmission with OADA was negatively associated with use of antipsychotics (adjusted hazard ratio (AHR) = 0.33, p < 0.01, CI: 0.24–0.46) and antidepressants (AHR = 0.57, p = 0.03, CI: 0.34–0.95), positively associated with use of benzodiazepines (AHR = 1.95, p < 0.01, CI: 1.31–2.90) and not significantly associated with use of mood stabilizers. Conclusions: Use of antipsychotics and antidepressants is associated with reduced risk of readmission with OADA whereas benzodiazepines are associated with an increased risk of readmission with OADA in patients with schizophrenia.

• Kramer, Ueli; Eubanks, Catherine F.; Bertsch, Katja; Herpertz, Sabine C.; McMain, Shelley & Mehlum, Lars [Vis alle 8 forfattere av denne artikkelen] (2022). Future Challenges in Psychotherapy Research for Personality Disorders. Current Psychiatry Reports. ISSN 1523-3812. 24(11), s. 613–622. doi: 10.1007/s11920-022-01379-4. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Purpose of Review Individuals with personality disorders are frequently seen in mental health settings. Their symptoms typically reflect a high level of suffering and burden of disease, with potentially harmful societal consequences, including costs related to absenteeism at work, high use of health services, ineffective or harmful parenting, substance use, suicidal and non-suicidal self-harming behavior, and aggressiveness with legal consequences. Psychotherapy is currently the first-line treatment for patients with personality disorders, but the study of psychotherapy in the domain of personality disorders faces specific challenges. Recent Findings Challenges include knowing what works for whom, identifying which putative mechanisms of change explain therapeutic effects, and including the social interaction context of patients with a personality disorder. By following a dimensional approach, psychotherapy research on personality disorders may serve as a model for the development and study of innovative psychotherapeutic interventions. Summary We recommend developing the following: (a) an evidence base to make treatment decisions based on individual features; (b) a data-driven approach to predictors, moderators, and mechanisms of change in psychotherapy; (c) methods for studying the interaction between social context and psychotherapy.

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

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

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

  Background There is a concern that the COVID-19 pandemic will lead to an increase in suicides. Several reports from the first months of the pandemic showed no increase in suicide rates while studies with longer observation times report contrasting results. In this study, we explore the suicide rates in Norway during the first year of the pandemic for the total population as well as for relevant subgroups such as sex, age, geographical areas, and pandemic phases. Methods This is a cohort study covering the entire Norwegian population between 2010 and 2020. The main outcome was age-standardized suicide rates (per 100,000 inhabitants) in 2020 according to the Norwegian Cause of Death Registry. This was compared with 95% prediction intervals (95% PI) based on the suicide rates between 2010 and 2019. Results In 2020, there were 639 suicides in Norway corresponding to a rate of 12.1 per 100,000 (95% PI 10.2–14.4). There were no significant deviations from the predicted values for suicides in 2020 when analyzing age, sex, pandemic phase, or geographical area separately. We observed a trend toward a lower than predicted suicide rate among females (6.5, 95% PI 6.0–9.2), and during the two COVID-19 outbreak phases in 2020 (2.8, 95% PI 2.3–4.3 and 2.8, 95% CI 2.3–4.3). Conclusion There is no indication that the COVID-19 pandemic led to an increase in suicide rates in Norway in 2020.

• Furnes, Desire; Gjestad, Rolf; Mehlum, Lars; Hodgekins, Joanne; Kroken, Rune Andreas & Ødegaard, Ketil Joachim [Vis alle 7 forfattere av denne artikkelen] (2021). Borderline Personality Disorder: What Predicts Acute Psychiatric Readmissions? Journal of Personality Disorders. ISSN 0885-579X. 35(4), s. 481–493. doi: 10.1521/pedi_2019_33_459. Fulltekst i vitenarkiv
• Grosselli, Luna; Herzog, Kristina; Aseltine, Robert H.; Balazs, Judit; Carli, Vladimir & Ciffone, Jerry [Vis alle 20 forfattere av denne artikkelen] (2021). Dos and Don'ts in Designing School-Based Awareness Programs for Suicide Prevention: Results of a Three-Stage Delphi Survey. Crisis. ISSN 0227-5910. 43(4), s. 270–277. doi: 10.1027/0227-5910/a000783. Fulltekst i vitenarkiv Vis sammendrag

  Abstract. Background: Despite the promising evidence for the effectiveness of school-based awareness programs in decreasing the rates of suicidal thoughts and suicide attempts in young people, no guidelines on the targets and methods of safe and effective awareness programs exist. Aims: This study intends to distill recommendations for school-based suicide awareness and prevention programs from experts. Method: A three-stage Delphi survey was administered to an expert panel between November 2018 and March 2019. A total of 214 items obtained from open-ended questions and the literature were rated in two rounds. Consensus and stability were used as assessment criteria. Results: The panel consisted of 19 participants in the first and 13 in the third stage. Recommended targets included the reduction of suicide attempts, the enhancement of help-seeking and peer support, as well as the promotion of mental health literacy and life skills. Program evaluation, facilitating access to healthcare, and long-term action plans across multiple levels were among the best strategies for the prevention of adverse effects. Limitations: The study is based on opinions of a rather small number of experts. Conclusion: The promotion of help-seeking and peer support as well as facilitating access to mental health-care utilities appear pivotal for the success of school-based awareness programs.

• Qin, Ping & Mehlum, Lars (2021). National observation of death by suicide in the first 3 months under COVID-19 pandemic. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 143(1), s. 92–93. doi: 10.1111/acps.13246. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Psykososiale vansker etter tap av foreldre i barn-dom og ungdomstid. Suicidologi. ISSN 1501-6994. 26(3), s. 4–25. doi: 10.5617/suicidologi.9321. Fulltekst i vitenarkiv Vis sammendrag

  At en forelder dør grunnet ytre årsaker slik som selvmord, ulykker og drap er en av de mest traumatiske hendelser et barn eller ungdom kan oppleve. Tidligere forskning har vist at de som har opplevd slikt tap har økt risiko for psykososiale vanskersammenlignet med de som ikke har opplevd slikt tap. Det er derimot mye vi fortsatt ikke vet omsammenhengen mellom tap av foreldre og psykososiale vansker. Denne artikkelen sammenfatter en rekke studier vi har gjort for å kartlegge hvorvidt personer som har mistet en forelder grunnet ytre dødsårsaker i barndom eller ungdomstid har øktlangvarig risiko for å få lavere utdannelse, psykiske lidelser, psykiatrisk komorbiditet, sykehusbehandlet villet egenskade, selvmord eller flere av disse problemene samtidig. Vi ønsket også å identifisere viktige faktorer ved dødsfallet som kan påvirkeetterlattes risiko. For å gjennomføre disse studiene ekstraherte vi data på individnivå fra fire norske longitudinelle registre, og gjennomførte flere studier med store, representative populasjonsutvalg. Studiene som sammenfattes her utgjør den mestomfattende undersøkelsen av psykososiale vansker hos etterlatte barn i Norge.&#x0D; Tap av foreldre grunnet ytre årsaker var assosiert med en signifikant høyere risiko for å ikke fullføre utdannelse på alle utdanningsnivåer, bli diagnostisert med en psykisk lidelse, motta sykehusbehandling for villet egenskade og dø iselvmord. Etterlatte hadde også en signifikant høyere sannsynlighet for psykiatrisk komorbiditet og å ha flere psykososiale problemer samtidig. I kombinasjon viste resultatene at tap grunnet selvmord var assosiert med den høyeste risikoen. Somde første innen forskningsfeltet viste også studiene at etterlatte etter fall- og forgiftningsulykker harstørre risiko for psykiske lidelser og sykehusbehandlet villet egenskade enn etterlatte etter transportulykker. Det var derimot små forskjeller knyttet til kjønnet til den avdøde forelderen, barnas alder ved dødsfallet og kjønnet til det etterlatte barnet. Ilys av disse resultatene anbefaler vi at alle etterlatte barn og ungdommer rutinemessig tilbys oppfølgingi primærhelsetjenesten og skolesystemet, og at etterlatte ved selvmord rutinemessig tilbys tettereoppfølging innen psykisk helsevern for barn og unge. De omfattende og langvarige psykososialeproblemene som etterfølger tap av foreldre fremhever viktigheten av en mangefasettert, omfattendeog langvarig oppfølging av denne sårbare gruppen.

• Waraan, Luxsiya; Mehlum, Lars; Rognli, Erling W.; Czajkowski, Nikolai Olavi & Villabø, Marianne (2021). Associations between insecure attachment styles to parents and suicidal ideation in adolescents with depression. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology. 9, s. 41–51. doi: 10.21307/sjcapp-2021-006. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Suicidal ideation and depressive symptoms are often interrelated in clinical settings. Insecure attachment may be a risk factor for suicidal ideation in depressed adolescents. To our knowledge, this study is the first to examine the association between self-reported insecure attachment styles to both parents and suicidal ideation in a clinical sample of adolescents with depression. Methods: Fifty clinically depressed adolescents (13-17 years, 84% girls) completed self-reported measures of suicidal ideation, depressive symptoms, and attachment style to parents. Results: There was a statistically significant bivariate association between higher levels of attachment anxiety in relation to mothers and fathers and higher levels of suicidal ideation. When attachments to both parents were included in the same multivariate model, only attachment anxiety to the mother was significantly associated with the level of suicidal ideation. Self-reported depressive symptoms remained significantly associated with the level of suicidal ideation in all analyses. Younger adolescents with attachment anxiety reported higher levels of suicidal ideation than older adolescents. Conclusion: Conclusions about directionality and causality of associations between insecure attachment and suicidal ideation are limited due to the cross-sectional design. Our findings suggest that attachment anxiety in relation to the mother and father is associated with increased levels of suicidal ideation. Implication of these findings for treatment selection is discussed.

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

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

• Næss, Erik Oftedahl; Mehlum, Lars & Qin, Ping (2021). Marital status and suicide risk: Temporal effect of marital breakdown and contextual difference by socioeconomic status. SSM - Population Health. ISSN 2352-8273. 15(5). doi: 10.1016/j.ssmph.2021.100853. Fulltekst i vitenarkiv Vis sammendrag

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

• Amin, Ridwan; Rahman, Syed; Helgesson, Magnus; Björkenstam, Emma; Runeson, Bo & Tinghög, Petter [Vis alle 9 forfattere av denne artikkelen] (2021). Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals: a cohort study. International Journal for Equity in Health. doi: 10.1186/s12939-021-01460-z. Fulltekst i vitenarkiv Vis sammendrag

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

• Waraan, Luxsiya; Rognli, Erling W.; Czajkowski, Nikolai Olavi; Villabø, Marianne & Mehlum, Lars (2021). Effectiveness of attachment-based family therapy compared to treatment as usual for depressed adolescents in community mental health clinics. Child and Adolescent Psychiatry and Mental Health (CAPMH). 15, s. 1–14. doi: 10.1186/s13034-021-00361-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent–child relationship. Objective To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. Method Sixty adolescents (86.7% girls), aged 13–18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles. Results At post-treatment, clinician-rated remission rates on the HAMD (5% in ABFT and 3.33% in TAU, p = 1, OR = 1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X2[2, N = 60] = 0.06, p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3%) of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study’s small sample size, missing data, and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted. Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial registration Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013

• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Co-occurrence of psychosocial sequelae in bereaved offspring. Journal of Affective Disorders. ISSN 0165-0327. 283, s. 325–328. doi: 10.1016/j.jad.2021.01.044. Fulltekst i vitenarkiv Vis sammendrag

  Background : Previous studies have found that people who have lost a parent to external causes of death during childhood and adolescence have increased risks of psychosocial sequelae. However, we lack information on the potential co-occurrence of these problems. This study aims to investigate the co-occurrence of psychiatric disorders, deliberate self-harm (DSH) hospitalization, and high school non-completion in people who have lost a parent to external causes of death during childhood and adolescence compared to people who have not experienced such loss. Methods : The study cohort comprised 655 477 individuals born 1970-2012 with a link to both parents. Data on psychiatric disorders, DSH hospitalization, high school completion and parental death were retrieved from four longitudinal Norwegian registers. Chi-square tests of independence investigated potential differences in co-occurrence between bereaved and non-bereaved people. Results : Altogether, 4756 people had experienced the death of a parent due to external causes of death before their 18th birthday. These bereaved offspring had a significantly higher likelihood of having one, two and three adverse outcomes compared to people who had not experienced such loss. Specifically, bereaved offspring had a significantly higher co-occurrence of psychiatric disorders and high school non-completion, but not significantly higher co-occurrences of DSH hospitalization and high school non-completion or DSH hospitalization and psychiatric disorders. Limitations : Information concerning DSH hospitalization and psychiatric disorders was only available from 2008 onwards Conclusions : The significantly higher co-occurrence in bereaved offspring suggests that the relatively small group of people suffering from extensive sequelae should be particularly targeted for postvention measures.

• Legard, Ingunn; Mehlum, Lars & Haga, Egil (2021). Folkeopplysning som ledd i en selvmordsforebyggende flernivåintervensjon. Suicidologi. ISSN 1501-6994. 26(3), s. 64–75. doi: 10.5617/suicidologi.9327. Fulltekst i vitenarkiv Vis sammendrag

  Etter mange år med stabile selvmordsrater er det behov for økt fokus på tiltak som når lengre ut i befolkningen. Målet er å gi kunnskap som kan øke evnen til å søke støtte og hjelp ved selvmordsfare og psykiske vansker som øker selvmordsfaren. Studier viser at folkeopplysningskampanjer kan ha effekt på bevissthet og kunnskap om og holdninger til selvmord og psykiske lidelser. Effekten av opplysningskampan-jer på hjelpsøking eller forekomst av selvmord og selvmordsforsøk ser ut til å være sterkest når kam-panjen inngår som del av flere tiltak som iverksettes på samme tid, en såkalt flernivåintervensjon. I denne artikkelen presenteres prosjektet «Folkeopplysning mot selvmord» som bygger på kunnskap om folkeopp-lysningskampanjer som ledd i selvmordsforebyggende flernivåintervensjoner.

• Strømme, Maria Fagerbakke; Mellesdal, Liv Solrunn; Bartz-Johannessen, Christoffer; Kroken, Rune Andreas; Krogenes, Marianne Leiknes & Mehlum, Lars [Vis alle 7 forfattere av denne artikkelen] (2021). Mortality and non-use of antipsychotic drugs after acute admission in schizophrenia: A prospective total-cohort study. Schizophrenia Research. ISSN 0920-9964. 235, s. 29–35. doi: 10.1016/j.schres.2021.07.009. Fulltekst i vitenarkiv Vis sammendrag

  Background: In society at large, it is debated whether use of antipsychotic drugs is associated with increased or decreased mortality among patients with schizophrenia. Large register studies have demonstrated an increased mortality risk associated with non-use of antipsychotic drugs, but prospective studies are missing. Aims: To investigate the association between mortality and non-use of antipsychotics in patients with schizophrenia. Method: An open cohort study included and followed all patients with a discharge-diagnosis of schizophrenia consecutively admitted to a psychiatric acute unit at Haukeland University Hospital, Bergen, Norway during a 10 year period (n = 696). Cox multiple regression analyses were conducted with use of antipsychotic drugs as a time dependent variable, and periods of use and non-use were compared within individual patients. Adjustments were made for gender, age at index admission, number of acute psychiatric hospital admissions, excessive use of alcohol and illicit substances and use of benzodiazepines and antidepressants. Results: A total of 68 (9.8%) deaths were registered during follow-up. Of these, 40 (59%) had natural causes, whereas 26 (38%) had unnatural causes. Non-use of antipsychotics was associated with 2.15 (p = .01, CI: 1.24–3.72) times higher mortality risk compared to use of antipsychotics. The difference in mortality risk between use and non-use of antipsychotic drugs was age dependent, with the largest risk difference in young patients. Conclusions: Non-use of antipsychotic drugs was associated with twofold increased mortality risk in patients with schizophrenia.

• Ose, Solveig Osborg; Tveit, Tone & Mehlum, Lars (2021). Non-suicidal self-injury (NSSI) in adult psychiatric outpatients – A nationwide study. Journal of Psychiatric Research. ISSN 0022-3956. 133. doi: 10.1016/j.jpsychires.2020.11.031. Fulltekst i vitenarkiv Vis sammendrag

  Background: Non-suicidal self-injury (NSSI) is a highly prevalent behavioural problem among people with mental illness, yet many fundamental aspects of NSSI remain unknown. We studied the prevalence of NSSI, and its relationship with suicide ideation (SI) and suicide attempts (SA) among adult psychiatric outpatients, with a special focus on patients with personality disorders compared with patients with other disorders. Method: During a 14-day period, data were collected on all available patients in all outpatient psychiatric clinics in Norway. This national clinical unselected cross-sectional dataset from 23,124 outpatients was used to generate proportional Venn diagrams of the prevalence of NSSI, SI and SA and their co-occurrence over the last four weeks. Differences in the risk for these behaviours across diagnoses were tested, both with and without adjustments for demographic and socio-demographic characteristics. Results: Over the previous four-week period, 8.1% of the patients had experienced at least one episode of NSSI, 17.3% had SI and 0.6% had made at least one SA. Among patients with NSSI, 27.8% had co-occurring SI, and among patients with SI, 13% had co-occurring NSSI. The prevalence of SA was more than seven times higher among patients with NSSI behaviour than among patients without NSSI behaviour. Patients with a diagnosis of personality disorder had a significantly higher prevalence of SI, NSSI, and NSSI with co-occurring SI, than all other diagnostic groups; however, they were not systematically different from patients with other diagnoses in their prevalence of NSSI without co-occurring SI. These findings remained statistically significant even when controlling for socio-demographic variables. Conclusions: The prevalence of recent NSSI is high in patients receiving outpatient psychiatric treatment in Norway. NSSI is significantly more prevalent in patients with personality disorders than in patients with other diagnoses, mainly due to the significantly higher prevalence of NSSI with co-occurring SI in patients with personality disorders. The co-occurrence of NSSI and SI is also prevalent in all diagnostic groups, but both NSSI and SI appear alone more often than together. The strong association between NSSI and SA calls for a more proactive focus on NSSI behaviour in mental health clinical settings as an important suicide preventive measure.

• Amin, R.; Mittendorfer-Rutz, Ellenor; Mehlum, L.; Runeson, B.; Helgesson, Magnus & Tinghög, P. [Vis alle 9 forfattere av denne artikkelen] (2021). Does country of resettlement influence the risk of suicide in refugees? A case-control study in Sweden and Norway. Epidemiology and Psychiatric Sciences (EPS). ISSN 2045-7960. 30. doi: 10.1017/S2045796021000512. Fulltekst i vitenarkiv Vis sammendrag

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

• Zalsman, Gil; Barbara, Stanley; Szanto, Katalin; Carli, Vladimir & Mehlum, Lars (2020). Suicide in the Time of COVID-19: Review and Recommendations. Archives of Suicide Research. ISSN 1381-1118. doi: 10.1080/13811118.2020.1830242. Fulltekst i vitenarkiv
• Lund-Heimark, Hallvard Teigen; Kjelby, Eirik; Mehlum, Lars; Gjestad, Rolf; Selbæk, Geir & Kroken, Rune Andreas [Vis alle 9 forfattere av denne artikkelen] (2020). Elderly Patients With No Previous Psychiatric History: Suicidality and Other Factors Relating to Psychiatric Acute Admissions. BJPsych Open. 6(4). doi: 10.1192/bjo.2020.45. Fulltekst i vitenarkiv Vis sammendrag

  Background: The common recommendation that adults with onset of mental illness after the age of 65 should receive specialised psychogeriatric treatment is based on limited evidence. Aims: To compare factors related to psychiatric acute admission in older adults who have no previous psychiatric history (NPH) with that of those who have a previous psychiatric history (PPH). Method: Cross-sectional cohort study of 918 patients aged ≥65 years consecutively admitted to a general adult psychiatric acute unit from 2005 to 2014. Results: Patients in the NPH group (n = 526) were significantly older than those in the PPH group (n = 391) (77.6 v. 70.9 years P < 0.001), more likely to be men, married or widowed and admitted involuntarily. Diagnostic prevalence in the NPH and PPH groups were 49.0% v. 8.4% (P < 0.001) for organic mental disorders, 14.6% v. 30.4% (P < 0.001) for psychotic disorders, 30.2% v. 55.5% (P < 0.001) for affective disorders and 20.7% v. 13.3% (P = 0.003) for somatic disorders. The NPH group scored significantly higher on the Health of the Nation Outcome Scale (HoNOS) items agitated behaviour; cognitive problems; physical illness or disability and problems with activities of daily living, whereas those in the PPH group scored significantly higher on depressed mood. Although the PPH group were more likely to report suicidal ideation, those in the NPH group were more likely to have made a suicide attempt before the admission. Conclusions: Among psychiatric patients >65 years, the subgroup with NPH were characterised by more physical frailty, somatic comorbidity and functional and cognitive impairment as well as higher rates of preadmission suicide attempts. Admitting facilities should be appropriately suited to manage their needs.

• Morthorst, Brit; Mehlum, Lars; Palsson, S; Muhlmann, Charlotte; Hammerlin, Yngve & Madsen, Trine [Vis alle 8 forfattere av denne artikkelen] (2020). Suicide Rates in Nordic Prisons 2000-2016. Archives of Suicide Research. ISSN 1381-1118. doi: 10.1080/13811118.2020.1746943. Fulltekst i vitenarkiv
• Mehlum, Lars (2020). Mechanisms of change in dialectical behaviour therapy for people with borderline personality disorder. Current Opinion in Psychology. ISSN 2352-250X. doi: 10.1016/j.copsyc.2020.08.017. Fulltekst i vitenarkiv Vis sammendrag

  This paper reviews current knowledge on mechanisms of change targeted in dialectical behaviour therapy for people with borderline personality disorder. Improvements in emotion regulation capacity and the use of coping skills or mindfulness skills helping patients to downregulate emotional reactions and to cope with stressful situations seem to play important roles. In addition, strong therapeutic relationships, where therapists use high levels of validation, seem equally beneficial for treatment outcomes. When therapists actively install hope in their patients and foster the capacity of hopeful thinking in other ways, long-term outcomes seem to improve. A growing body of evidence shows us how neurobiological and epigenetic change in brain regions important to emotion regulation and behaviour control correspond with more favourable treatment outcomes.

• Mittendorfer-Rutz, Ellenor; Amin, Ridwanul; Niederkrotenthaler, Thomas; Björkenstam, Emma; Helgesson, Magnus & Qin, Ping [Vis alle 9 forfattere av denne artikkelen] (2020). Mental ill-health and suicidal behaviour in asylum seekers and refugees during the COVID-19 pandemic. Suicidologi. ISSN 1501-6994. 25(1), s. 31–33. doi: 10.5617/suicidologi.8276. Fulltekst i vitenarkiv Vis sammendrag

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

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

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

• Niederkrotenthaler, Thomas; Gunnell, David; Arensman, Ella; Pirkis, Jane; Appleby, Louis & Hawton, Keith [Vis alle 14 forfattere av denne artikkelen] (2020). Suicide Research, Prevention, and COVID-19. Crisis. ISSN 0227-5910. 41(5), s. 321–330. doi: 10.1027/0227-5910/a000731. Fulltekst i vitenarkiv
• Qin, Ping; Burrell, Lisa Victoria; Bøe, Anne Seljenes & Mehlum, Lars (2020). Forekomst av villet egenskade estimert ved data fra Norsk pasientregister. Suicidologi. ISSN 1501-6994. 25(3), s. 32–43. doi: 10.5617/suicidologi.8536. Fulltekst i vitenarkiv Vis sammendrag

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

• Mehlum, Lars; Schmahl, Christian; Berens, Ann; Doering, Stephan; Hutsebaut, Joost & Kaera, Andres [Vis alle 14 forfattere av denne artikkelen] (2020). Euthanasia and assisted suicide in patients with personality disorders: A review of current practice and challenges. Borderline Personality Disorder and Emotion Dysregulation. 7(1). doi: 10.1186/s40479-020-00131-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice. Methods Narrative review of the literature combined with the authors’ collective experience and knowledge of personality disorders. Results In six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients’ suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient’s illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time. Conclusions In light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual’s potential for having a life worth living.

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

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

• Mortier, Philippe; Vilagut, Gemma; Gracia, Beatriz Puértolas; Trujillo, Ana De Inés; Bueno, Itxaso Alayo & Coma, Laura Ballester [Vis alle 22 forfattere av denne artikkelen] (2020). Catalonia Suicide Risk Code Epidemiology (CSRC-Epi) study: protocol for a population-representative nested case-control study of suicide attempts in Catalonia, Spain. BMJ Open. 10(7), s. 1–9. doi: 10.1136/bmjopen-2020-037365. Fulltekst i vitenarkiv Vis sammendrag

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

• Qin, Ping & Mehlum, Lars (2020). Deliberate self-harm: Case identification and incidence estimate upon data from national patient registry. PLOS ONE. 15(4). doi: 10.1371/journal.pone.0231885. Fulltekst i vitenarkiv Vis sammendrag

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

• Amin, Ridwanul; Rahman, Syed; Tinghög, Petter; Helgesson, Magnus; Runeson, Bo & Björkenstam, Emma [Vis alle 10 forfattere av denne artikkelen] (2020). Healthcare use before and after suicide attempt in refugees and Swedish-born individuals. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. doi: 10.1007/s00127-020-01902-z. Fulltekst i vitenarkiv Vis sammendrag

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

• Niederkrotenthaler, Thomas; Mittendorfer-Rutz, Ellenor; Mehlum, Lars; Qin, Ping & Björkenstam, Emma (2020). Previous suicide attempt and subsequent risk of re-attempt and suicide: Are there differences in immigrant subgroups compared to Swedish-born individuals? Journal of Affective Disorders. ISSN 0165-0327. 15(265), s. 263–271. doi: 10.1016/j.jad.2020.01.013. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2020). Parental death by external causes and risk of hospital treated deliberate self-harm in bereaved offspring. European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-020-01534-3. Fulltekst i vitenarkiv Vis sammendrag

  Previous studies have reported an increased risk of hospital-treated deliberate self-harm (DSH) in offspring who have lost a parent, but inconclusive findings regarding differences between loss from suicide and accidents. The present study aimed to investigate the association between parental death by external causes before age 18 and hospital-treated DSH, and potential differences between different accidents and suicide. This nested-case–control study was based on data from longitudinal Norwegian registers. Subjects comprised 12,526 people born between 1970 and 2003 who received acute somatic treatment because of DSH at hospitals and associated services between 2008 and 2013 (cases), and 222,362 controls matched for gender and date of birth with no recorded DSH treatment. Information concerning deceased parent’s death and offspring’s DSH treatment and socioeconomic data was merged. Data were analysed with conditional logistic regression. Results indicated that offspring who had lost a parent to suicide (OR 2.32, 95% CI 1.92–2.80) and death by accidents such as falls, poisoning, and drowning (OR 1.79, 95% CI 1.38–2.33) had a significantly increased risk of hospital-treated DSH compared to offspring who had not experienced such loss. Parental bereavement from transport accidents and other external causes were not associated with significantly increased risks. No differences were evident for different genders of deceased, ages at bereavement, or genders of bereaved. The improved identification of bereaved offspring at particular risk of hospital-treated DSH should be utilized to implement effective prevention and treatment programs in specialist healthcare aimed at the individuals at highest risk.

• Waraan, Luxsiya; Rognli, Erling W.; Czajkowski, Nikolai Olavi; Mehlum, Lars & Villabø, Marianne (2020). Efficacy of attachment-based family therapy compared to treatment as usual for suicidal ideation in adolescents with MDD. Clinical Child Psychology and Psychiatry. ISSN 1359-1045. doi: 10.1177/1359104520980776. Fulltekst i vitenarkiv Vis sammendrag

  Attachment-Based Family Therapy (ABFT) is the only empirically supported family therapy model designed to treat adolescent depression, including those at risk for suicide, and their families. ABFT aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. To study the effectiveness of ABFT compared with Treatment as Usual (TAU) in reducing suicidal ideation in clinically depressed adolescents. Sixty adolescents (86.7% girls), aged 13 to 18 years ( M = 14.9), with major depressive disorder referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions according to the treatment manual. Suicidal ideation was measured with the Suicidal Ideation Questionnaire-Junior at 4, 6, 8, 10, 12, 14, and 16 weeks. Linear mixed models were fitted to test our hypothesis, time was the only factor to have a significant effect on suicidal ideation t(31.05) = −3.32, p &lt; .01. Participants in both treatment groups reported significantly reduced suicidal ideation, but the majority were still in the clinical range after 16 weeks of treatment. ABFT was not associated with more favorable outcomes than TAU. Findings must be interpreted with caution given the study limitations.

• Furnes, Desire; Gjestad, Rolf; Rypdal, Knut; Mehlum, Lars; Hart, Stephen D. & Ødegaard, Ketil Joachim [Vis alle 7 forfattere av denne artikkelen] (2020). Suicidal and violent ideation in acute psychiatric inpatients: prevalence, co-occurrence, and associated characteristics. Suicide and Life-Threatening Behaviour. ISSN 0363-0234. s. 1–12. doi: 10.1111/sltb.12726. Fulltekst i vitenarkiv
• Tang, Fang; Mehlum, Lars; Mehlum, Ingrid Sivesind & Qin, Ping (2019). Physical illness leading to absence from work and the risk of subsequent suicide. A national register-based study. European Journal of Public Health. ISSN 1101-1262. 29(6), s. 1073–1078. doi: 10.1093/eurpub/ckz101. Fulltekst i vitenarkiv Vis sammendrag

  Background: Studies have shown that people with physical illness are at increased risk of suicide, but knowledge on the association between absence from work due to specific physical health problems and suicide risk is limited. This study aimed to examine the relationship between suicide risk and physical illness requiring leave from work across a range of specific physical diagnoses, and to study the interactions of mental illness and socioeconomic factors on this relationship. Methods: Using a nested case-control design, 9313 suicide cases and 169 235 matched controls were retrieved and interlinked from Norwegian national registries. Data on sick leave and related physical illness were derived from claims for sickness benefit and analyzed using conditional logistic regression. Results: For males, the risk of suicide increased progressively with the number of previous physical illness-related absences and the duration of recent physical illness-related absences. Absences related to digestive, musculoskeletal and neurological disorders as well as cancer and accidents/injuries were associated with a significantly increased risk of suicide. In contrast, females with a history of physical illness-related absence and a diagnosis of most organ or system specific illnesses were at a relatively reduced risk of suicide. In both genders, the suicide risk associated with physical illness resulting in absence from work differentiated significantly by history of sickness absence due to mental illness, and by education and income levels. Conclusions: The risk of suicide associated with physical illness requiring leave from work varied significantly by gender and by education and income status.

• Amin, Ridwan; Helgesson, Magnus; Runeson, Bo; Tinghög, Petter; Mehlum, Lars & Qin, Ping [Vis alle 8 forfattere av denne artikkelen] (2019). Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study. Psychological Medicine. ISSN 0033-2917. s. 1–10. doi: 10.1017/S0033291719003167. Fulltekst i vitenarkiv
• Puzo, Quirino; Mehlum, Lars & Qin, Ping (2019). Insights into rates, risks and characteristics of suicide by immigration background in Norway. Suicidologi. ISSN 1501-6994. doi: 10.5617/suicidologi.7027. Fulltekst i vitenarkiv Vis sammendrag

  Although most immigrants seem to successfully manage the challenges their immigration process entails, suicide mortality of minority groups has become an important public concern, particularly in countries with growing segments of immigrant populations such as Norway. The present article aimed to summarize insights into suicide among various immigrant populations, obtained by three Norwegian studies we recently conducted utilizing the unique possibilities of national population registers. First-generation immigrants had a relatively lower risk of suicide than native Norwegians, whereas the risks for people with mixed Norwegian and immigrant background were significantly higher. Suicide risk was associated with a range of socio-economic disadvantages in all populations, but the strength of the association differed by specific immigration background, with a generally weaker association in first-generation-immigrants than natives. In the meantime, there were notable differences in characteristics of suicide by immigration background with respect to method of suicide, month of the year when suicide occurred, and time to suicide since immigration. All these insights underscore the importance of treating immigrants as a very heterogeneous group, and differences in suicides by specific immigration background should be considered when planning public health policies and prevention measures in order to more effectively tailor these measures to at-risk immigrant populations.

• Mehlum, Lars; Ramleth, Ruth-Kari; Tørmoen, Anita Johanna; Haga, Egil; Diep, Lien My & Stanley, Barbara [Vis alle 10 forfattere av denne artikkelen] (2019). Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self-harming and suicidal behavior. Journal of Child Psychology and Psychiatry. ISSN 0021-9630. 60(10), s. 1112–1122. doi: 10.1111/jcpp.13077. Fulltekst i vitenarkiv Vis sammendrag

  Background Knowledge is lacking on the long‐term outcomes of treatment for adolescents with repetitive suicidal and self‐harming behavior. Furthermore, the pathways through which treatment effects may operate are poorly understood. Our aims were to investigate enduring treatment effects of dialectical behavior therapy adapted for adolescents (DBT‐A) compared to enhanced usual care (EUC) through a prospective 3‐year follow‐up and to analyze possible mediators of treatment effects. Methods Interview and self‐report data covering the follow‐up interval were collected from 92% of the adolescents who participated in the original randomized trial. Trial registration number: NCT01593202 (www.ClinicalTrials.gov). Results At the 3‐year follow‐up DBT‐A remained superior to EUC in reducing the frequency of self‐harm, whereas for suicidal ideation, hopelessness and depressive and borderline symptoms and global level of functioning there were no inter‐group differences, with no sign of symptom relapse in either of the participant groups. A substantial proportion (70.8%) of the effect of DBT‐A on self‐harm frequency over the long‐term was mediated through a reduction in participants’ experience of hopelessness during the trial treatment phase. Receiving more than 3 months follow‐up treatment after completion of the trial treatment was associated with further enhanced outcomes in patients who had received DBT‐A. Conclusions There were on average no between‐group differences at the 3‐year follow‐up in clinical outcomes such as suicidal ideation, hopelessness, depressive and borderline symptoms. The significantly and consistently larger long‐term reduction in self‐harm behavior for adolescents having received DBT‐A compared with enhanced usual care, however, suggests that DBT‐A may be a favorable treatment alternative for adolescents with repetitive self‐harming behavior.

• Asarnow, Joan Rosenbaum & Mehlum, Lars (2019). Practitioner Review: Treatment for suicidal and self-harming adolescents - advances in suicide prevention care. Journal of Child Psychology and Psychiatry. ISSN 0021-9630. 60(10), s. 1046–1054. doi: 10.1111/jcpp.13130. Fulltekst i vitenarkiv
• Simonsen, Sebastian; Bateman, Anthony; Bohus, Martin; Dalewijk, Henk-Jan; Doering, Stephan. & Kaera, Andres [Vis alle 12 forfattere av denne artikkelen] (2019). European guidelines for personality disorders: past, present and future. Borderline Personality Disorder and Emotion Dysregulation. doi: 10.1186/s40479-019-0106-3. Fulltekst i vitenarkiv Vis sammendrag

  Personality disorders (PD) are common and burdensome mental disorders. The treatment of individuals with PD represents one of the more challenging areas in the field of mental health and health care providers need evidence-based recommendations to best support patients with PDs. Clinical guidelines serve this purpose and are formulated by expert consensus and/or systematic reviews of the current evidence. In this review, European guidelines for the treatment of PDs are summarized and evaluated. To date, eight countries in Europe have developed and published guidelines that differ in quality with regard to recency and completeness, transparency of methods, combination of expert knowledge with empirical data, and patient/service user involvement. Five of the guidelines are about Borderline personality disorder (BPD), one is about antisocial personality disorder and three concern PD in general. After evaluating the methodological quality of the nine European guidelines from eight countries, results in the domains of diagnosis, psychotherapy and pharmacological treatment of PD are discussed. Our comparison of guidelines reveals important contradictions between recommendations in relation to diagnosis, length and setting of treatment, as well as the use of pharmacological treatment. All the guidelines recommend psychotherapy as the treatment of first choice. Future guidelines should rigorously follow internationally accepted methodology and should more systematically include the views of patients and users.

• Mehlum, Lars; Bateman, Anthony; Dalewijk, Henk-Jan; Doering, Stephan.; Kaera, Andres & Moran, Paul [Vis alle 11 forfattere av denne artikkelen] (2018). Building a strong European alliance for personality disorder research and intervention. Borderline Personality Disorder and Emotion Dysregulation. doi: 10.1186/s40479-018-0082-z. Fulltekst i vitenarkiv
• Qin, Ping; Shihua, Sun; Bøe, Anne Seljenes; Stanley, Barbara & Mehlum, Lars (2018). Injuries prior and subsequent to index poisoning with medication among adolescents: a national study based on Norwegian patient registry. BMC Psychiatry. 18. doi: 10.1186/s12888-018-1778-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Adolescents treated for self-poisoning with medication have a high prevalence of mental health problems and constitute a high-risk population for self-harm repetition. However, little is known about whether this population is also prone to injuries of other forms. Methods Data were extracted from the Norwegian Patient Registry to include all incidents of treated injuries in adolescents aged 10–19 years who were treated for self-poisoning with medication during 2008–2011. This longitudinal approach allowed for the inclusion of injuries of various forms both before and after the index poisoning with medication. Gender differences and associations of injuries with recorded deliberate self-harm or psychiatric comorbidity at index poisoning were analysed. Forms of injury and psychiatric illnesses were coded according to the ICD-10 system. Results 1497 adolescents treated for self-poisoning with medication were identified from the source database, including 1144 (76.4%) girls and 353 (23.6%) boys. For these 1497 adolescents a total of 2545 injury incidents were recorded in addition to the index poisoning incidents, consisting of 778 injury incidents taking place before the index poisoning and 1767 incidents taking place subsequently. Altogether 830 subjects (55.4%) had an injury treated either before or after the index poisoning. Injuries to the hand and wrist as well as injuries to the head, neck and throat were predominant in males. Females were more likely to repeat poisoning with medication, particularly those with psychiatric disorders. Conclusion Adolescents treated for poisoning with medication represent a high-risk population prone to both prior and subsequent injuries of other forms, and should be assessed for suicidal intent and psychiatric illness.

• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2018). Sudden Parental Death from External Causes and Risk of Suicide in the Bereaved Offspring: A National Study. Journal of Psychiatric Research. ISSN 0022-3956. 96, s. 49–56. doi: 10.1016/j.jpsychires.2017.09.023. Fulltekst i vitenarkiv Vis sammendrag

  Previous research has revealed an association between parental bereavement from external causes and risk of suicide in offspring. Few studies have however provided insights into specific influences of cause of death, gender of the deceased and bereaved, age at bereavement and suicide, and time since bereavement. The present nested case-control study was based on data from three longitudinal registers. Subjects comprised 19 015 persons who died from suicide at an age of 11–64 years during 1969–2012 (cases), and 332 046 live comparison individuals matched for gender and date of birth. Information about deceased parents’ cause and date of death, and sociodemographic data was retrieved and merged. Data were analysed with conditional logistic regression. Losing a parent to suicide, transport accidents and other external causes of death was associated with an increased suicide risk in offspring. Parental suicide was associated with a substantially higher suicide risk than transport accidents and other external causes. These effects were equally strong for daughters and sons, and for the loss of a mother, father or both parents. Suicide risk was highest in younger bereaved offspring, and bereavement had both short and long-term impacts on suicide risk. In conclusion, all offspring exposed to parental death by external causes have an increased suicide risk, independent of factors related to the exposure. The consequences are long lasting, and offspring should be offered follow-up in primary healthcare. Younger offspring bereaved by parental suicide have the highest risk and may be targeted for prevention and intervention programs in specialist healthcare.

• Mehlum, Lars (2018). Dialektisk atferdsterapi i behandling av suicidal og selvskadende atferd. Suicidologi. ISSN 1501-6994. 23(1), s. 10–21. doi: 10.5617/suicidologi.6197. Fulltekst i vitenarkiv Vis sammendrag

  Dialektisk Atferdsterapi (DBT) ble utviklet for å behandle suicidal og selvskadende atferd hos pasienter med emosjonelt ustabil personlighetsforstyrrelse – en pasientgruppe som mange klinikere opplever som svært utfordrende å hjelpe. I denne artikkelen skal vi se nærmere på hva utfordringene består i, og hvilke strategier DBT bruker som krisetiltak og i langsiktig håndtering av suicidal og selvskadende atferd. Vi skal også gi en kort oversikt over forskningslitteraturen om behandlingsresultater og effekter av DBT når det gjelder å redusere de mange problemene som knytter seg til gjentatt suicidal og selvskadende atferd. Dernest skal vi diskutere hvilke av de mange terapeutiske strategiene i DBT som sannsynligvis har størst betydning som endringsmekanismer i forbindelse med å redusere denne typen atferd.

• Puzo, Quirino; Mehlum, Lars & Qin, Ping (2018). Socio-economic status and risk for suicide by immigration background in Norway: A register-based national study. Journal of Psychiatric Research. ISSN 0022-3956. 100, s. 99–106. doi: 10.1016/j.jpsychires.2018.02.019. Fulltekst i vitenarkiv Vis sammendrag

  The relative importance of socio-economic factors on risk for suicide in the immigrant population may differ from that for the native population; however, few studies have addressed this issue on a national basis. With a nested case-control design and data from Norwegian population registers we identified 11,409 suicide cases in the years 1992–2012 and 191,785 sex-birthdate-matched controls. The influence of socio-economic factors on the risk for completed suicide was assessed through conditional logistic regression. Among 11,409 suicides, 1139 (10%) were individuals with an immigration background of either themselves or their parent(s). Suicide cases, as well as the controls, with an immigration background differed in several aspects of their socio-economic status from those without such a background. Being single or separated, divorced or widowed, was, however, associated with an increased risk of suicide regardless to the subjects’ immigration background. Low level of education and low annual income significantly increased the risk for suicide in almost all the study subgroups. Living in the capital area was associated with a reduced risk of suicide in first-generation immigrants but an increased risk in native Norwegians. In conclusion, persons with an immigration background, as well as native Norwegians, shared most common risk factors for suicide, but the strength of associations between socio-economic factors and risk for suicide can differ by immigration background.

• Haga, Egil; Aas, Eline; Grøholt, Berit; Tørmoen, Anita Johanna & Mehlum, Lars (2018). Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm. Child and Adolescent Psychiatry and Mental Health (CAPMH). 12(1). doi: 10.1186/s13034-018-0227-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Studies have shown that dialectical behaviour therapy (DBT) is effective in reducing self-harm in adults and adolescents. Aims To evaluate the cost-effectiveness of DBT for adolescents (DBT-A) compared to enhanced usual care (EUC). Methods In a randomised study, 77 adolescents with repeated self-harm were allocated to 19 weeks of outpatient treatment, either DBT-A (n = 39) or EUC (n = 38). Cost-effective analyses, including estimation of incremental cost-effectiveness ratios, were conducted with self-harm and global functioning (CGAS) as health outcomes. Results Using self-harm as effect outcome measure, the probability of DBT being cost-effective compared to EUC increased with increasing willingness to pay up to a ceiling of 99.5% (threshold of € 1400), while with CGAS as effect outcome measure, this ceiling was 94.9% (threshold of € 1600). Conclusions Given the data, DBT-A had a high probability of being a cost-effective treatment.

• Puzo, Quirino; Mehlum, Lars & Qin, Ping (2018). Rates and characteristics of suicide by immigration background in Norway. PLOS ONE. 13(9). doi: 10.1371/journal.pone.0205035. Fulltekst i vitenarkiv Vis sammendrag

  Suicide mortality among immigrant groups is an important health issue, particularly in countries with growing segments of immigrant populations such as Norway. Through linkage of Norwegian national registers we wanted to estimate suicide rates (per 100,000 population) in immigrant groups and to profile characteristics of suicide by immigration background with respect to sex, age, method and seasonality of suicide as well as time since immigrating to Norway. Among all 11,409 suicides during 1992–2012, 1,139 (10%) were individuals with an immigration background. Suicide rate was lower in first-generation immigrants (foreign-born persons to two foreign-born parents) than native Norwegians (9.53 vs 12.22, P < 0.01), with a significant difference confined to male rates only. Foreign-born persons with at least one Norwegian-born parent had significantly higher suicide rates than natives in both sexes (22.42 vs 18.03 in males, 11.67 vs 6.54 in females, P < 0.01). The most frequently used suicide method in all the population groups was hanging; this method accounted for 44.0% of all suicides of first-generation immigrants, 45.2% of all suicides of foreign-born persons with at least one Norwegian-born parent, and 35.4% of all suicides of natives. Suicide by firearms accounted for a much smaller proportion of cases of first-generation immigrants (6.7%) and foreign-born persons with at least one Norwegian-born parent (6.8%) than cases of native Norwegians (20.7%). In terms of monthly distribution, suicides of first-generation immigrants displayed two peaks, in May and in November (P = 0.01). More than 25% of all first-generation immigrant suicides occurred in the first five years after immigration; but differences in time since immigration were observed by sex and country group of origin, in particular among those aged 35 years or less when moving to Norway. In conclusion, there are notable differences in characteristics of suicides by immigration background. Knowledge of immigrant mortality according to suicide method, seasonality of suicide, and time since immigration may be useful when planning suicide preventive measures.

• Herpertz, Sabine; Huprich, Steven; Bohus, Martin; Chanen, Andrew; Goodman, Marianne & Mehlum, Lars [Vis alle 10 forfattere av denne artikkelen] (2017). The Challenge of Transforming the Diagnostic System of Personality Disorders. Journal of Personality Disorders. ISSN 0885-579X. 31(5), s. 577–589. doi: 10.1521/pedi_2017_31_338. Fulltekst i vitenarkiv
• Puzo, Quirino; Mehlum, Lars & Qin, Ping (2017). Suicide among immigrant population in Norway: A national register-based study. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 135(6), s. 584–592. doi: 10.1111/acps.12732. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To investigate differences in suicide risk among immigrant population in Norway compared with native Norwegians, with respect to associated country group of origin. Methods: Based on the entire national population, a nested case-control design was adopted using Norwegian national longitudinal registers to obtain 23 073 suicide cases having occurred in 1969–2012 and 373 178 controls. Odds ratios (ORs) for suicide were estimated using conditional logistic regression analysis adjusting for socio-economic factors. Results: Compared with native Norwegians, suicide risk was significantly lower in first- and second-generation immigrants but higher in Norwegian-born with one foreign-born parent and foreign-born individuals with at least one Norwegian-born parent. When stratifying data by country group of origin, first-generation immigrants had lower ORs in most of the strata. Subjects born in Asia and in Central and South America with at least one Norwegian-born parent had a significantly higher risk of suicide. The observed results remained mostly unchanged in the analyses controlled for socio-economic status. Conclusions: Suicide risk is lower in first- and second-generation immigrants but higher in subjects born in Norway with one foreign-born parent and those born abroad with at least one Norwegian-born parent, with notable differences by country group of origin.

• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2017). Risk Factors for Suicide in Offspring Bereaved by Sudden Parental Death from External Causes. Journal of Affective Disorders. ISSN 0165-0327. 222, s. 71–78. doi: 10.1016/j.jad.2017.06.064. Fulltekst i vitenarkiv Vis sammendrag

  Background: Parentally bereaved offspring have an increased suicide risk as a group, but the ability to identify specific individuals at risk on the basis of risk and protective factors is limited. The present study aimed to investigate to what degree different risk factors influence suicide risk in offspring bereaved by parental death from external causes. Methods: Based on Norwegian registers, individual-level data were retrieved for 375 parentally bereaved suicide cases and 7500 parentally bereaved gender- and age-matched living controls. Data were analysed with conditional logistic regression. Results: Bereaved offspring with low social support, indicated by offspring's single status and repeated changes in marital status and residence, had a significantly increased suicide risk compared to bereaved offspring with high social support. Moreover, low socioeconomic status, having an immigration background, having lost both parents and loss due to suicide significantly increased suicide risk. Limitations: Several variables relevant to bereavement outcome, such as coping mechanisms and the quality of the parent-offspring relationship are impossible to examine by utilizing population registers. Moreover, the availability of data did not enable the measurement of marital stability and residence stability across the entire lifespan for older individuals. Conclusions: Healthcare professionals should be aware of the additional risk posed by the identified risk factors and incorporate this knowledge into existing practice and risk assessment in order to identify individuals at risk and effectively target bereaved family and friends for prevention and intervention programs. Ideal follow-up for bereaved families should include a specific focus on mobilizing social support.

• Ramleth, Ruth-Kari; Grøholt, Berit; Diep, Lien My; Walby, Fredrik A & Mehlum, Lars (2017). The impact of borderline personality disorder and sub-threshold borderline personality disorder on the course of self-reported and clinician-rated depression in self-harming adolescents. Borderline Personality Disorder and Emotion Dysregulation. 4. doi: 10.1186/s40479-017-0073-5. Fulltekst i vitenarkiv Vis sammendrag

  Background Studies on adults suggest that the presence of comorbid depression and Borderline Personality Disorder (BPD) is associated with an elevated risk of self-harming behaviours and that self-harming behaviours, when present, will have higher severity. This comorbidity, furthermore, complicates clinical assessments, which may be an obstacle to early identification and proper intervention. Adolescents who self-harm frequently report high levels of depressive symptoms, but this is often not reflected in the clinicians’ assessment. BPD is still a controversial diagnosis in young people, and less is known about the clinical significance of comorbid BPD in adolescent populations. The purpose of the present study was to examine the impact of BPD on the assessment and course of self-reported and clinician-rated depression in self-harming adolescents before and after a treatment period of 19 weeks. We hypothesized that, compared to adolescents without BPD, adolescents with BPD would self-report higher levels of depression at baseline, and that they would have less reduction in depressive symptoms. Methods A total of 39 adolescents with depressive disorders and BPD-traits participating in a randomised controlled trial on treatment of self-harm with Dialectical Behaviour Therapy adapted for Adolescents or enhanced usual care were included. Adolescents with full-syndrome BPD (n = 10) were compared with adolescents with sub-threshold BPD (n = 29) with respect to their self-reported and clinician-rated depressive symptoms, suicidal ideation and global level of functioning at baseline, and after 19 weeks of treatment (end of trial period). Results At baseline, adolescents with full-syndrome BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation compared to adolescents with sub-threshold BPD, whereas the two groups were rated as equally depressed by the clinicians. At trial completion, all participants had a significant reduction in suicidal ideation, however, adolescents with BPD had a poorer treatment outcome in terms of significantly higher levels of clinician-rated and self-reported depressive symptoms and significantly lower levels of global functioning. At baseline as well as at trial completion, self-reported and clinician-rated levels of depressive symptoms were not significantly correlated in adolescents with BPD. In a multiple linear regression analysis, a diagnosis of BPD and a high baseline level of clinician-rated depressive symptoms predicted higher levels of depressive symptoms at trial completion, whereas receiving Dialectical Behaviour Therapy predicted lower levels of depressive symptoms. Conclusion Our findings suggest that a diagnosis of BPD may have a strong impact on the assessment and course of depressive symptoms in self-harming adolescents. Although rated as equally depressed, adolescents with BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation at baseline, and showed a poorer outcome in terms of higher levels of depressive symptoms and lower levels of global functioning at trial completion compared to adolescents with sub-threshold BPD. Our findings suggest that receiving Dialectical Behaviour Therapy could lead to a greater reduction in depressive symptoms, although firm conclusions cannot be drawn given the limited sample size. Clinicians should be aware of the possibility of underestimating the severity of depression in the context of emotional and behavioral dysregulation. Providing BPD specific treatments seems to be important to achieve sufficient treatment response with regard to depressive symptoms in adolescents with BPD-traits. Trial registration Treatment for Adolescents With Deliberate Self Harm; NCT00675129 , registered May 2008.

• Burrell, Lisa Victoria; Puzo, Quirino; Qin, Ping & Mehlum, Lars (2017). Betydningen av sosiale forhold for mental helse og selvmordsatferd. Suicidologi. ISSN 1501-6994. 22(3), s. 4–11. doi: 10.5617/suicidologi.5876. Fulltekst i vitenarkiv Vis sammendrag

  Lav sosioøkonomisk status og lite sosial støtte er risikofaktorer for dårlig fysisk og mental helse, selvmord og selvskading. Denne robuste sammenhengen kan enten skyldes at dårlige sosiale forhold forårsaker dårlig helse, eller at psykiske lidelser forringer individers sosiale forhold. Negative eller manglende sosiale forhold kan på sin side forårsake psykisk uhelse gjennom konstante og direkte effekter eller gjennom indirekte buffereffekter der gunstige sosiale forhold reduserer påvirkningen av negative livshendelser. Inngående kunnskap om sosiale forhold er uansett viktig for effektiv forebygging av psykiske lidelser og selvmordsatferd, og denne artikkelen vil derfor belyse betydningen av sosiale forhold for mental helse og selvmordsatferd gjennom å rette søkelyset mot noen overordnede teorier. Vi vil også benytte eksempler fra egne empiriske studier for å illustrere hvordan sosiale forhold kan ha betydning for forekomsten av selvmord i nordiske befolkningsutvalg.

• Chanen, Andrew; Sharp, Carla; Aguirre, Blaise; Andersen, R; Barkauskiene, R & Bateman, Anthony [Vis alle 69 forfattere av denne artikkelen] (2017). Prevention and early intervention for borderline personality disorder: a novel public health priority. World Psychiatry. ISSN 1723-8617. 16(2), s. 215–216. doi: 10.1002/wps.20429. Fulltekst i vitenarkiv
• Puzo, Quirino; Qin, Ping & Mehlum, Lars (2016). Long-term trends of suicide by choice of method in Norway: A joinpoint regression analysis of data from 1969 to 2012. BMC Public Health. 16(1). doi: 10.1186/s12889-016-2919-y. Fulltekst i vitenarkiv Vis sammendrag

  Background: Suicide mortality and the rates by specific methods in a population may change over time in response to concurrent changes in relevant factors in society. This study aimed to identify significant changing points in method-specific suicide mortality from 1969 to 2012 in Norway. Method: Data on suicide mortality by specific methods and by sex and age were retrieved from the Norwegian Cause-of-Death Register. Long-term trends in age-standardized rates of suicide mortality were analyzed by using joinpoint regression analysis. Results: The most frequently used suicide method in the total population was hanging, followed by poisoning and firearms. Men chose suicide by firearms more often than women, whereas poisoning and drowning were more frequently used by women. The joinpoint analysis revealed that the overall trend of suicide mortality significantly changed twice along the period of 1969 to 2012 for both sexes. The male age-standardized suicide rate increased by 3.1 % per year until 1989, and decreased by 1.2 % per year between 1994 and 2012. Among females the long-term suicide rate increased by 4.0 % per year until 1988, decreased by 5.5 % through 1995, and then stabilized. Both sexes experienced an upward trend for suicide by hanging during the 44-year observation period, with a particularly significant increase in 15–24 year old males. The most distinct change among men was seen for firearms after 1988 with a significant decrease through 2012 of around 5 % per year. For women, significant reductions since 1985–88 were observed for suicide by drowning and poisoning. Conclusions: The present study demonstrates different time trends for different suicide methods with significant reductions in suicide by firearms, drowning and poisoning after the peak in the suicide rate in the late 1980s. Suicide by means of hanging continuously increased, but did not fully compensate for the reduced use of other methods. This lends some support for the effectiveness of method-specific suicide preventive measures, such as restrictions to the access to firearms, which had been implemented in Norway during the relevant time period.

• Sæheim, Aleksandra; Hestetun, Ingebjørg; Mork, Erlend; Nrugham, Latha & Mehlum, Lars (2016). A 12-year National Study of Suicide by Jumping From Bridges in Norway. Archives of Suicide Research. ISSN 1381-1118. 21(4), s. 568–576. doi: 10.1080/13811118.2016.1199988. Fulltekst i vitenarkiv Vis sammendrag

  Studies from several countries suggest that erecting fences on bridges more commonly used for suicide by jumping may be an effective way of reducing the risk of suicide by jumping from these bridges. Distribution of suicides by jumping off bridges has not yet been studied on a national level in any country. This study included all suicides by jumping from high places registered in the Norwegian Cause of Death Registry (COD) in the period 1999–2010 (n = 319). Combining data from the COD registry and information from police records, 71 cases of suicide by jumping off a bridge were identified involving 36 bridges. This form of suicide constituted approximately 1% of all suicides in Norway in the period 1999–2010. Almost half of these suicides were registered at only 6 bridges. Three Norwegian bridges were secured during the observation period of this study. Two bridges had barriers installed on the full length of the bridge with 11 suicides registered before barriers were installed, and none after. On the 1 bridge that was only partially secured, no change in numbers of suicides was observed after barriers were installed. One-third of jumps from bridges occurred over land. We found that although suicide by jumping off bridges was a relatively rare event, there is a potential for saving lives by installing physical barriers on bridges that are more commonly used for suicide by jumping. This is an Accepted Manuscript of an article published by Taylor & Francis.

• Mehlum, Lars; Ramberg, Maria; Tørmoen, Anita Johanna; Haga, Egil; Diep, Lien My & Stanley, Barbara [Vis alle 9 forfattere av denne artikkelen] (2016). Dialectical behavior therapy compared with enhanced usual care for adolescents with repeated suicidal and self-harming behavior: outcomes over a one-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry. ISSN 0890-8567. 55(4), s. 295–300. doi: 10.1016/j.jaac.2016.01.005. Fulltekst i vitenarkiv
• Mellesdal, Liv Solrunn; Gjestad, Rolf; Johnsen, Erik; Jørgensen, Hugo A; Ødegaard, Ketil Joachim & Kroken, Rune Andreas [Vis alle 7 forfattere av denne artikkelen] (2015). Borderline personality disorder and posttraumatic stress disorder at psychiatric discharge predict general hospital admission for self-harm. Journal of Traumatic Stress. ISSN 0894-9867. 28(6), s. 556–562. doi: 10.1002/jts.22053. Fulltekst i vitenarkiv
• Ramberg, Maria; Stanley, Barbara; Ystgaard, Mette & Mehlum, Lars (2015). Depressed Suicide Attempters with Posttraumatic Stress Disorder. Archives of Suicide Research. ISSN 1381-1118. 19(1), s. 48–59. doi: 10.1080/13811118.2014.915777. Fulltekst i vitenarkiv
• Mehlum, Lars; Tørmoen, Anita Johanna; Ramberg, Maria; Haga, Egil; Diep, Lien My & Sund, Anne Mari [Vis alle 7 forfattere av denne artikkelen] (2014). Dialektisk atferdsterapi for ungdommer med gjentatt suicidal og selvskadende adferd : en randomisert kontrollert undersøkelse. Suicidologi. ISSN 1501-6994. 19(3), s. 15–23. doi: 10.5617/suicidologi.2268. Fulltekst i vitenarkiv
• Tørmoen, Anita Johanna; Grøholt, Berit; Haga, Egil; Brager-Larsen, Anne Trana; Miller, Alec L & Walby, Fredrik A [Vis alle 8 forfattere av denne artikkelen] (2014). Feasibility of dialectical behavior therapy with suicidal and self-harming adolescents with multi-problems: training, adherence and retention. Archives of Suicide Research. ISSN 1381-1118. 18(4), s. 432–444. doi: 10.1080/13811118.2013.826156. Fulltekst i vitenarkiv
• Grøholt, Berit; Haga, Egil; Tørmoen, Anita Johanna; Ramberg, Maria & Mehlum, Lars (2014). Screening for selvksading i barne- og ungdomspsykiatriske poliklinikker - erfaringer fra rekruttering til en randomisert kontrollert studie. Suicidologi. ISSN 1501-6994. 19(3), s. 24–29. doi: 10.5617/suicidologi.2269. Fulltekst i vitenarkiv
• Mehlum, Lars & Tørmoen, Anita Johanna (2014). Hva er dialektisk atferdsterapi? En kort oversikt. Suicidologi. ISSN 1501-6994. 3. doi: 10.5617/suicidologi.2266. Fulltekst i vitenarkiv
• Haga, Egil; Grøholt, Berit; Tørmoen, Anita Johanna; Aas, Eline & Mehlum, Lars (2014). Økonomisk evaluering av behandling for ungdom med villet egenskade - hvorfor og hvordan? Suicidologi. ISSN 1501-6994. 19(3), s. 30–35. doi: 10.5617/suicidologi.2270. Fulltekst i vitenarkiv
• Tørmoen, Anita Johanna; Rossow, Ingeborg; Mork, Erlend & Mehlum, Lars (2014). Contact with child and adolescent psychiatric services among self-harming and suicidal adolescents in the general population: A cross sectional study. Child and Adolescent Psychiatry and Mental Health (CAPMH). 8(13). doi: 10.1186/1753-2000-8-13. Fulltekst i vitenarkiv Vis sammendrag

  Studies have shown that adolescents with a history of both suicide attempts and non-suicidal self-harm report more mental health problems and other psychosocial problems than adolescents who report only one or none of these types of self-harm. The current study aimed to examine the use of child and adolescent psychiatric services by adolescents with both suicide attempts and non-suicidal self-harm, compared to other adolescents, and to assess the psychosocial variables that characterize adolescents with both suicide attempts and non-suicidal self-harm who report contact. Data on lifetime self-harm, contact with child and adolescent psychiatric services, and various psychosocial risk factors were collected in a cross-sectional sample (response rate = 92.7%) of 11,440 adolescents aged 14–17 years who participated in a school survey in Oslo, Norway. Adolescents who reported any self-harm were more likely than other adolescents to have used child and adolescent psychiatric services, with a particularly elevated likelihood among those with both suicide attempts and non-suicidal self-harm (OR = 9.3). This finding remained significant even when controlling for psychosocial variables. In adolescents with both suicide attempts and non–suicidal self-harm, symptoms of depression, eating problems, and the use of illicit drugs were associated with a higher likelihood of contact with child and adolescent psychiatric services, whereas a non-Western immigrant background was associated with a lower likelihood. In this study, adolescents who reported self-harm were significantly more likely than other adolescents to have used child and adolescent psychiatric services, and adolescents who reported a history of both suicide attempts and non-suicidal self-harm were more likely to have used such services, even after controlling for other psychosocial risk factors. In this high-risk subsample, various psychosocial problems increased the probability of contact with child and adolescent psychiatric services, naturally reflecting the core tasks of the services, confirming that they represents an important area for interventions that aim to reduce self-harming behaviour. Such interventions should include systematic screening for early recognition of self-harming behaviours, and treatment programmes tailored to the needs of teenagers with a positive screen. Possible barriers to receive mental health services for adolescents with immigrant backgrounds should be further explored.

• Mehlum, Lars; Tørmoen, Anita Johanna; Ramberg, Maria; Haga, Egil; Diep, Lien My & Laberg, Stine [Vis alle 11 forfattere av denne artikkelen] (2014). Dialectical Behavior Therapy for Adolescents With Repeated Suicidal and Self-harming Behavior: A Randomized Trial. Journal of the American Academy of Child and Adolescent Psychiatry. ISSN 0890-8567. 53(10), s. 1082–1091. doi: 10.1016/j.jaac.2014.07.003. Fulltekst i vitenarkiv
• Fadum, Elin Anita; Stanley, Barbara; Qin, Ping; Diep, Lien My & Mehlum, Lars (2014). Self-poisoning with medications in adolescents: a national register study of hospital admissions and readmissions. General Hospital Psychiatry. ISSN 0163-8343. 36(6), s. 709–715. doi: 10.1016/j.genhosppsych.2014.09.004. Fulltekst i vitenarkiv
• Mellesdal, Liv; Kroken, Rune; Lutro, Olav; Wentzel-Larsen, Tore; Kjelby, Eirik & Ødegaard, Kjetil [Vis alle 8 forfattere av denne artikkelen] (2014). Self-harm induced somatic admission after discharge from psychiatric hospital - a prospective cohort study. European psychiatry. ISSN 0924-9338. 29(4), s. 246–252. doi: 10.1016/j.eurpsy.2013.06.006. Fulltekst i vitenarkiv
• Mork, Erlend; Walby, Fredrik A; Harkavy-Friedman, Jill M.; Barrett, Elizabeth Ann; Steen, Nils Eiel & Lorentzen, Steinar [Vis alle 9 forfattere av denne artikkelen] (2013). Clinical characteristics in schizophrenia patients with or without suicide attempts and non-suicidal self-harm - a cross-sectional study. BMC Psychiatry. 13. doi: 10.1186/1471-244X-13-255. Fulltekst i vitenarkiv Vis sammendrag

  Background: To investigate whether schizophrenia patients with both suicide attempts and non-suicidal self-harm have earlier age of onset of psychotic and depressive symptoms and higher levels of clinical symptoms compared to patients with only suicide attempts or without suicide attempt. Methods: Using a cross-sectional design, 251 patients (18–61 years old, 58% men) with schizophrenia treated at hospitals in Oslo and Innlandet Hospital Trust, Norway, were assessed with a comprehensive clinical research protocol and divided into three groups based on their history of suicide attempts and non-suicidal self-harm. Results: Suicide attempts were present in 88 patients (35%); 52 had suicide attempts only (29%) and 36 had both suicide attempts and non-suicidal self-harm (14%). When compared with nonattempters and those with suicide attempts without non-suicidal self-harm, patients with both suicide attempts and non-suicidal self-harm were more frequently women, younger at the onset of psychotic symptoms, had longer duration of untreated psychosis, and had higher levels of current impulsivity/aggression and depression. Patients with both suicide attempts and non-suicidal self-harm were more likely to repeat suicide attempts than patients with suicide attempts only. Conclusions: Patients with both suicide attempts and non-suicidal self-harm had different illness history and clinical characteristics compared to patients with only suicide attempts or patients without suicidal behavior. Our study suggests that patients with both suicide attempts and non-suicidal self-harm represent a distinct subgroup among patients with schizophrenia and suicidal behavior with their early onset of psychotic symptoms, high rate of repeated suicidal behavior and significant treatment delay.

• Fadum, Elin Anita; Stanley, Barbara; Rossow, Ingeborg; Mork, Erlend; Tørmoen, Anita Johanna & Mehlum, Lars (2013). Use of health services following self-harm in urban versus suburban and rural areas: a national cross-sectional study. BMJ Open. 3(7:e002570). doi: 10.1136/bmjopen-2013-002570. Fulltekst i vitenarkiv Vis sammendrag

  OBJECTIVES: This study examines whether there is a difference between urban versus suburban and rural adolescents in their use of health services following two types of self-harm distinguished as self-harm with or without suicide intent. SETTING: A nationwide cross-sectional school survey of 11 406 Norwegian adolescents aged 13-19 years in 73 Norwegian junior and senior high schools. PARTICIPANTS: Adolescents who reported self-harm and provided valid responses to a follow-up question about having received subsequent help or treatment (n=959) were included in the study. Adolescents were divided into urban versus suburban and rural depending on: (1) the location of municipalities where they attended school and (2) the place of residence. Associations between urban versus suburban and rural areas and the use of health services following self-harm were assessed in those who self-harmed with and without suicide intent. PRIMARY OUTCOME MEASURE: Use of health services following self-harm. RESULTS: 1 in 4 adolescents reported using health services following self-harm. Adolescents reporting self-harm with suicide intent were more likely to use health services than those who self-harmed without suicide intent. Following self-harm without suicide intent, adolescents in urban areas were four times more likely to use health services than adolescents in suburban and rural areas. There was no statistically significant area difference in the use of health services following self-harm with suicide intent. CONCLUSIONS: This study found a geographical variation in the use of health services following self-harm without suicide intent, but not following self-harm with suicide intent. Differences in perception of self-harm and help-seeking behaviour between areas and different accessibility to services are suggested as possible explanations. There is a need to better understand how the interplay between individual characteristics and accessibility to services influences adolescents' use of health services following self-harm. We suggest that multilevel models are a valuable approach to achieve this goal.

• Titleman, David; Oskarsson, Høgni; Wahlbeck, K; Nordentoft, Merete; Mehlum, Lars & Jiang, G X [Vis alle 9 forfattere av denne artikkelen] (2013). Suicide mortality trends in the Nordic countries 1980-2009. Nordic Journal of Psychiatry. ISSN 0803-9488. 67(6), s. 414–423. doi: 10.3109/08039488.2012.752036. Fulltekst i vitenarkiv
• Koldsland, Bjørn Odd; Mehlum, Lars; Mellesdal, Liv; Walby, Fredrik A & Diep, Lien My (2012). The suicide assessment scale: Psychometric properties of a Norwegian language version. BMC Research Notes. 5, s. 417–417. doi: 10.1186/1756-0500-5-417. Fulltekst i vitenarkiv
• Mehlum, Lars (2012). Traumatisk stress og suicidal atferd :. Suicidologi. ISSN 1501-6994. 17(3), s. 3–10. doi: 10.5617/suicidologi.2169. Fulltekst i vitenarkiv
• Jia, Chen-Xi; Mehlum, Lars & Qin, Ping (2012). AIDS/HIV Infection, Comorbid Psychiatric Illness, and Risk for Subsequent Suicide: A Nationwide Register Linkage Study. Journal of Clinical Psychiatry. ISSN 0160-6689. 73(10), s. 1315–1321. doi: 10.4088/JCP.12m07814. Fulltekst i vitenarkiv
• Mork, Erlend; Mehlum, Lars; Barrett, Elisabeth Ann; Agartz, Ingrid; Harkavy-Friedman, Jill M. & Lorentzen, Steinar [Vis alle 9 forfattere av denne artikkelen] (2012). Self-Harm in Patients with Schizophrenia Spectrum Disorders. Archives of Suicide Research. ISSN 1381-1118. 16(2), s. 111–123. doi: 10.1080/13811118.2012.667328. Fulltekst i vitenarkiv
• Tørmoen, Anita Johanna; Rossow, Ingeborg; Larsson, Bo Sture & Mehlum, Lars (2012). Nonsuicidal self-harm and suicide attempts in adolescents: differences in kind or in degree? Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. 48(9), s. 1447–1455. doi: 10.1007/s00127-012-0646-y. Fulltekst i vitenarkiv
• Barrett, Elisabeth Ann; Sundet, Kjetil Søren; Simonsen, Carmen Elisabeth; Agartz, Ingrid; Lorentzen, Steinar & Mehlum, Lars [Vis alle 9 forfattere av denne artikkelen] (2011). Neurocognitive functioning and suicidality in schizophrenia spectrum disorders. Comprehensive Psychiatry. ISSN 0010-440X. 52(2), s. 156–163. doi: 10.1016/j.comppsych.2010.06.001. Fulltekst i vitenarkiv
• Mehlum, Lars; Mork, Erlend; Reinholdt, Nils Petter; Fadum, Elin Anita & Rossow, Ingeborg (2010). Quality of Psychosocial Care of Suicide Attempters at General Hospitals in Norway : A Longitudinal Nationwide Study. Archives of Suicide Research. ISSN 1381-1118. 14(2), s. 146–157. doi: 10.1080/13811111003704753. Fulltekst i vitenarkiv
• Mehlum, Lars; Jørgensen, Trond; Diep, Lien My & Nrugham, Latha (2010). Is Organizational Change Associated With Increased Rates of Readmission to General Hospital in Suicide Attempters? A 10-Year Prospective Catchment Area Study. Archives of Suicide Research. ISSN 1381-1118. 14(2), s. 171–181. doi: 10.1080/13811111003704811. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2010). Det norske dødsårsaksregisteret: en kommentar til datakvaliteten. Suicidologi. ISSN 1501-6994. 15(2), s. 8–11. Fulltekst i vitenarkiv
• Gravseth, Hans Magne Ulrik; Mehlum, Lars; Bjerkedal, Tor & Kristensen, Petter (2010). Suicide in young Norwegians in a life course perspective: population-based cohort study. Journal of Epidemiology and Community Health. ISSN 0143-005X. 64(5), s. 407–412. doi: 10.1136/jech.2008.083485. Fulltekst i vitenarkiv Vis sammendrag

  Background: Suicide is a leading cause of death in young adults. Several risk factors are well known, especially those related to adult mental health. However, some risk factors may have their origin in the very beginning of life. This study examines suicide in the general Norwegian population in a life course perspective, with a main focus on early life factors. Methods: In this study, several national registers were linked, supplying personal data on biological and social variables from childhood to young adult age. Participants were all Norwegians live born during the period 1967–1976, followed up through 2004. Persons who died or emigrated before the year of their 19th birthday, at which age follow-up started, were excluded. Thus, the study population comprised 610 359 persons, and the study outcome was completed suicide. Results: 1406 suicides (0.23%) were recorded, the risk being four times higher in men than in women. Suicide risk factors included not being firstborn (adjusted HR in men and women (95% CIs): 1.19 (1.05 to 1.36) and 1.42 (1.08 to 1.88)), instability of maternal marital status during childhood, parental suicide (mainly in women), low body mass index (only investigated in men), low education and indications of severe mental illness. Conclusions: Suicide in young adults may be rooted in early childhood, and the effect is likely to act through several mechanisms, some of which may be linked to the composition and stability of the parental home. A life course perspective may add to our understanding of suicide.

• Mellesdal, Liv Solrunn; Mehlum, Lars Ivar; Wentzel-Larsen, Tore; Kroken, Rune & Jørgensen, Hugo A (2010). Suicide risk and acute psychiatric readmissions: A prospective cohort study. Psychiatric Services. ISSN 1075-2730. 61(1), s. 25–31. Fulltekst i vitenarkiv
• Nrugham, Latha; Herrestad, Henning & Mehlum, Lars (2010). Suicidality among Norwegian youth: Review of research on risk factors and interventions. Nordic Journal of Psychiatry. ISSN 0803-9488. 64(5), s. 317–326. doi: 10.3109/08039481003628364. Fulltekst i vitenarkiv
• Mork, Erlend; Mehlum, Lars & Walby, Fredrik A (2009). Selvmord ved psykotisk depresjon og bipolar lidelse: Forekomst og risikofaktorer. Suicidologi. ISSN 1501-6994. 14(2), s. 8–12. Fulltekst i vitenarkiv
• Mehlum, Lars (2009). Clinical challenges in the assessment and management of suicidal behaviour in patients with borderline personality disorder. Epidemiologia e Psichiatria Sociale. ISSN 1121-189X. 18(3), s. 184–190. Fulltekst i vitenarkiv
• Mehlum, Lars & Holseth, Kristin (2009). Selvskading - hva gjør vi? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 129(8), s. 759–762. Fulltekst i vitenarkiv
• Mehlum, Lars & Nrugham, Latha (2009). The suicidal soldier. I Mandal, Manas K & Kumar, Updesh (Red.), Suicidal Behaviour Assessment of People-at-Risk. Sage Publications. ISSN 9788132102991. s. 297–323. Fulltekst i vitenarkiv
• Rossow, Ingeborg; Mehlum, Lars; Gjertsen, Finn & Møller, Bjørn (2009). Chain of care for patients with intentional self-harm: An effective strategy to reduce suicide rates? Suicide and Life-Threatening Behaviour. ISSN 0363-0234. 39(6), s. 614–622. doi: 10.1521/suli.2009.39.6.614. Fulltekst i vitenarkiv Vis sammendrag

  Er behandlingskjede for pasienter med villet egenskade en effektiv strategi for å redusere selvmordsratene? Det å etablere en behandlingskjede for pasienter innlagt i sykehus etter selvmordsforsøk eller annen villet egenskade har vært en viktig strategi i den norske handlingsplanen for forebygging av selvmord. En behandlingskjede innebærer at pasienten følges opp av en eller flere behandlingsinstanser i inntil ett år etter sykehusoppholdet. Individrettet strategi Studien gir ingen belegg for at en slik individrettet risikostrategi er effektiv for å redusere selvmordsratene i befolkningen. SIRUS-forsker Ingeborg Rossow står sammen med Lars Mehlum, Finn Gjertsen og Bjørn Møller bak studien, som er publisert i tidsskriftet Suicide and Life-Threatening Behavior. Om studien Forskerne har beregnet hvor stor den potensielle effekten av behandlingskjeder vil kunne være under ulike betingelser, og sammenliknet endringer i selvmordsrater i befolkningen i områder som har og ikke har innført behandlingskjede. Liten effekt Beregningene av potensielle effekter viste at selv under urealistisk gunstige betingelser ville den forventete effekten på selvmordsrater være veldig liten. I tråd med dette viste også sammenlikningene av observerte selvmordsrater over tid at det ikke var noen forskjeller i endringene i selvmordsrater i områder som har og ikke har innført behandlingskjede.

• Rossow, Ingeborg; Mehlum, Lars; Gjertsen, Finn & Møller, Bjørn (2009). On the potential of effects of chains of care for patients with intentional self-harm on reducing suicide rates. Suicide and Life-Threatening Behaviour. ISSN 0363-0234. 39(6), s. 14–22. Fulltekst i vitenarkiv
• Michel, P. O.; Thoresen, Siri; Sareen, J.; Belik, S. H. & Mehlum, Lars (2009). Suicidal Behavior Among Peacekeepers: An International Perspective. I Sher, L & Vilens, A (Red.), Suicide in the Military. Nova Biomedical Books. ISSN 9781616685409. s. 1–15. Fulltekst i vitenarkiv
• Mehlum, Lars (2009). Networking in suicide prevention. The International Association for Suicide Prevention. I Wasserman, Danuta & Wasserman, Camilla (Red.), Oxford Textbook of Suicidology and Suicide Prevention. A Global Perspective. Oxford University Press. ISSN 9780198570059. s. 729–732. Fulltekst i vitenarkiv
• Rozanov, Vsevolod; Mehlum, Lars & Stiliha, Richard (2009). Suicide in the military settings: combattants and veterans. I Wasserman, Danuta & Wasserman, Camilla (Red.), Oxford Textbook of Suicidology and Suicide Prevention. A Global Perspective. Oxford University Press. ISSN 9780198570059. s. 257–266. Fulltekst i vitenarkiv
• Mehlum, Lars (2009). Treatment and prevention of suicide attempts and suicide in psychiatric care. I Wasserman, Danuta & Wasserman, Camilla (Red.), Oxford Textbook of Suicidology and Suicide Prevention. A Global Perspective. Oxford University Press. ISSN 9780198570059. s. 471–476. Fulltekst i vitenarkiv
• Mehlum, Lars (2008). Nils Retterstøl til minne. Suicidologi. ISSN 1501-6994. 11(1), s. 3–3. Fulltekst i vitenarkiv
• Mehlum, Lars (2008). Nils Retterstøl in memoriam. IASP Newsletter. March. Fulltekst i vitenarkiv
• Mork, Erlend; Mehlum, Lars & Walby, Fredrik A. (2008). Selvmord ved psykoselidelser. Impuls : Tidsskrift for psykologi. ISSN 0801-2911. s. 118–129. Fulltekst i vitenarkiv
• Thoresen, Siri & Mehlum, Lars (2008). Traumatic stress and suicidal ideation in Norwegian male peacekeepers. Journal of Nervous and Mental Disease. ISSN 0022-3018. 196(11), s. 814–821. doi: 10.1097/NMD.0b013e31818b6a92. Fulltekst i vitenarkiv
• Thoresen, Siri & Mehlum, Lars (2006). Suicide in peacekeepers: Risk factors for suicide versus accidental death. Suicide and Life-Threatening Behaviour. ISSN 0363-0234. 36, s. 432–442. Fulltekst i vitenarkiv
• Mehlum, Lars; Koldsland, BO & Loeb, ME (2006). Risk factors for long-term posttraumatic stress reactions in unarmed UN military observers - A four-year follow-up study. Journal of Nervous and Mental Disease. ISSN 0022-3018. 194, s. 800–804. Fulltekst i vitenarkiv
• Walby, Fredrik A.; Ødegaard, Erik & Mehlum, Lars (2006). Psychiatric comorbidity may not predict suicide during and after hospitalization. A nested case–control study with blinded raters. Journal of Affective Disorders. ISSN 0165-0327. 92, s. 253–260. Fulltekst i vitenarkiv
• Mehlum, Lars; Dieserud, Gudrun; Ekeberg, Øivind; Grøholt, Berit; Mellesdal, Liv & Walby, Fredrik A. [Vis alle 7 forfattere av denne artikkelen] (2006). Forebygging av selvmord. Del 1. Psykoterapi, medikamentelle intervensjoner og elektrokonvulsiv terapi. Systematisk kunnskapsoppsummering. Rapport fra Kunnskapssenteret. Fulltekst i vitenarkiv
• Mehlum, Lars & Jensen, Anne Irene (2006). Suicidal atferd ved ustabil personlighetsforstyrrelse. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 126(22), s. 2946–2949. Fulltekst i vitenarkiv
• Thoresen, Siri; Mehlum, Lars; Røysamb, Espen & Tønnessen, Arnfinn (2006). Risk factors for completed suicide in veterans of peacekeeping: Repatriation, negative life events and marital status. Archives of Suicide Research. ISSN 1381-1118. 10(4), s. 353–363. doi: 10.1080/13811110600791106. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). Om motiver og intensjoner ved selvmordshandlinger. I Herrestad, Henning & Mehlum, Lars (Red.), Uutholdelige liv - Om selvmord, eutanasi og behandling av døende. Gyldendal Akademisk. ISSN 9788205335035. s. 29–42. Fulltekst i vitenarkiv
• Herrestad, Henning & Mehlum, Lars (2005). Samfunnets tre store samtaler om de uutholdelige liv. I Herrestad, Henning & Mehlum, Lars (Red.), Uutholdelige liv - Om selvmord, eutanasi og behandling av døende. Gyldendal Akademisk. ISSN 9788205335035. s. 13–21. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). Selvmordsforebygging angår alle. Leve Nytt. Fulltekst i vitenarkiv
• Mann, JJ; Apter, A; Bertolote, J; Beautrais, A; Currier, D & Haas, A [Vis alle 23 forfattere av denne artikkelen] (2005). Review of National Suicide Prevention Strategies. Journal of the American Medical Association (JAMA). ISSN 0098-7484. 294(16), s. 2064–2074. Fulltekst i vitenarkiv
• Mann, JJ; Apter, A; Bertolote, J; Beautrais, A; Currier, D & Haas, A [Vis alle 23 forfattere av denne artikkelen] (2005). Suicide prevention strategies: a systematic review. Journal of the American Medical Association (JAMA). ISSN 0098-7484. 294(16), s. 2064–2074. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). Traumatic stress and suicidal behaviour. An important target for treatment and prevention. I Hawton, Keith (Red.), Prevention and treatment of suicidal behaviours - From Science to Practice. Oxford University Press. ISSN 9780198529750. s. 121–138. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). Forebygging gjennom begrensning av tilgangen til selvmordsmidler. Suicidologi. ISSN 1501-6994. 10(2), s. 3–7. Fulltekst i vitenarkiv
• Thoresen, Siri & Mehlum, Lars (2004). Risk factors for fatal accidents and suicides in peacekeepers: is there an overlap? Military medicine. ISSN 0026-4075. 169, s. 988–993. Fulltekst i vitenarkiv
• Lilleng, Peer Kåre; Mehlum, Lars Ivar; Bachs, Liliana & Morild, Inge (2004). Deaths after intravenous misuse of transdermal fentanyl. Journal of Forensic Sciences. ISSN 0022-1198. 49(6), s. 1364–1366. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Developing and implementing a national strategy for suicide prevention - the Norwegian experience. Acta Suicidologica Slovenica. ISSN 1581-7504. 2(1-2), s. 24–29. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). A Suicide prevention strategy for England. Crisis. ISSN 0227-5910. 25, s. 69–73. Fulltekst i vitenarkiv
• Ystgaard, Mette; Hestetun, Ingebjørg & Mehlum, Lars (2004). Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior? International Journal of Child Abuse & Neglect. ISSN 0145-2134. 28, s. 863–875. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Studies show that childhood sexual and physical abuse predict repeated suicide attempts and self-mutilation. Little is known about the importance of sexual and physical abuse when compared to other severe childhood adversities with respect to chronic suicidal behaviour. Method: Seventy-four subjects, 65% of whom were women, consecutively admitted to a general hospital after having made a suicide attempt, were interviewed as part of the intake interview about prior suicide attempts and self-mutilation and received DSM-IV diagnoses. Sexual abuse, physical abuse, neglect, antipathy from parents, loss of parents, and severe discord in the family before the age of 18, were covered by the Childhood Experience of Care and Abuse (CECA) interview schedule. Results: The prevalence of severe sexual abuse was 35%, severe physical abuse 18%, neglect 27%, antipathy 34%, loss of caregiver 37% and exposure to family violence 31%. Physical and sexual abuse were independently associated with repeated suicide attempts when controlling for the effects of the other childhood adverse factors. No other childhood adversity was related to chronic suicidal behaviour. The odds ratio of exposure to sexual or physical abuse was highest among those who both repeated suicide attempts and self-mutilated. Conclusion: Physical and sexual abuse are significantly and independently associated with repeated suicidal behaviour.

• Thoresen, Siri; Mehlum, Lars & Møller, Bjørn (2003). Suicide in peacekeepers. A cohort study of mortality from suicide in 22,275 Norwegian veterans from international peacekeeping operations. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. 38(11), s. 605–610. Fulltekst i vitenarkiv Vis sammendrag

  OBJECTIVE: Several studies have investigated post-traumatic stress reactions and other psychosocial problems in former peacekeepers. The question has also been raised as to whether such veterans might be at increased risk of suicide. This study investigated the suicide mortality in Norwegian former peacekeepers. METHODS: Cause-specific mortality was identified in the population of Norwegian peacekeepers having participated in army missions in the years 1978-95. General population data were used for comparison. Standardized Mortality Ratios (SMRs) were calculated for different suicide methods and certain peacekeeping-related variables. Marital status was available for each year and controlled for by using separate suicide rates for unmarried, married and divorced. RESULTS: A moderately, but significantly, increased SMR of 1.4 for suicide was found among the former peacekeepers (95% confidence interval = 1.1-1.8). After adjusting for marital status, the SMR was reduced to insignificance (SMR = 1.1, 95% confidence interval = 0.9-1.4). There was a significant increase in suicide by means of firearms and carbon monoxide poisoning. CONCLUSIONS: The increased risk of suicide in former peacekeepers was related to the peace-keepers' lower marriage rate compared to the general population. This finding may indicate that the personnel were characterized by certain vulnerability factors before entering peacekeeping service, resulting in a reduced ability to enter into and remain in stable love relations. However, it cannot be excluded that stress reactions following peacekeeping may have contributed to possible strains on interpersonal relationships. Preventative work should, thus, include improved personnel selection routines and preferably also psychosocial support for veterans and their families. The increased number of suicides by use of firearms indicates that gun control might be an important prevention measure in this group.

• Mehlum, Lars (2003). Selvmordsforebyggende strategi for England. Suicidologi. ISSN 1501-6994. 8(1), s. 16–19. Fulltekst i vitenarkiv
• Ystgaard, Mette; Reinholdt, Nils Petter; Husby, Jorulf & Mehlum, Lars (2003). Villet egenskade blant ungdom. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 123(16), s. 2241–2286. Fulltekst i vitenarkiv
• Mehlum, Lars & Weisæth, Lars (2002). Predictors of posttraumatic stress reactions in Norwegian U.N.peacekeepers 7 years after service. Journal of Traumatic Stress. ISSN 0894-9867. 15(1), s. 17–26. Fulltekst i vitenarkiv Vis sammendrag

  A sample of 1,624 Norwegian veterans from the UNIFIL (United Nations Interim Force in Lebanon) was investigated on average 6.6 years after service, completing a questionnaire focusing on stress exposure and posttraumatic stress reactions. The prevalence of posttraumatic stress disorder (measured by the Posttraumatic Symptom Scale [PTSS-10]) was 5% overall, but 16% in the subgroup of personnel having been prematurely repatriated from UNIFIL. Multiple regression analyses showed that the following variables made separate and significant contributions to the explained variance of the PTSS-10: Service stress exposure, perceived lack of meaningfulness with respect to the military mission, and stressful life-events in life after service. These factors explained 25% (overall sample) and 37% (repatriated sample) of the variation in the posttraumatic symptom score.

• Andreassen, Anne Lie; Thoresen, Siri & Mehlum, Lars (2002). Veterans from peacekeeping: Evaluation of a follow-up programme. Prehospital and Disaster Medicine. ISSN 1049-023X. 17. Fulltekst i vitenarkiv
• Retterstøl, Nils & Mehlum, Lars (2001). Attempted suicide as a risk factor for suicide: treatment and follow-up. I Wasserman, Danuta (Red.), Suicide - an unnecessary death. Martin Dunitz. ISSN 9781853178221. s. 125–132. Fulltekst i vitenarkiv
• Mork, Erlend; Ekeid, Gunnar; Ystgaard, Mette; Mehlum, Lars & Holte, Arne (2001). Psykososial oppfølging etter parasuicid ved medisinske sykehusavdelinger i Norge (Psychosocial follow-up after parasuicide in Norwegian general hospitals). Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 121, s. 1038–1043. Fulltekst i vitenarkiv
• Mehlum, Lars (2001). Handlingsplan mot selvmord i Norge. I Amundsen, Kirsti; Mehlum, Lars & Schjelderup, Georg (Red.), Humanistisk-medisinske perspektiver på selvmord og forebygging. Universitetet i Oslo. ISSN 9788299581608. s. 99–107. Fulltekst i vitenarkiv
• Mehlum, Lars (2001). Vincent van Gogh ¿ suicidal prosess og suicidale motiver. I Amundsen, Kirsti; Mehlum, Lars & Schjelderup, Georg (Red.), Humanistisk-medisinske perspektiver på selvmord og forebygging. Universitetet i Oslo. ISSN 9788299581608. s. 49–62. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Mehlum, Lars; Milde, Anne Marita & Norevik, Annie (2024). Selvmordsforebygging i skolen. Universitetsforlaget. ISBN 9788215060224. Fulltekst i vitenarkiv
• Erlangsen, Annette; Madsen, Trine; Reuter, Britt Morthorst; Høier, Nikolaj Kjær; Nordentoft, Merete & Wang, August G. [Vis alle 20 forfattere av denne artikkelen] (2024). Prevention of suicide and suicide attempts in the Nordic countries. Norden Co-operation. ISBN 9789289377911. 112 s. Fulltekst i vitenarkiv
• Mehlum, Lars & Mork, Erlend (2016). After the Suicide Attempt—The Need for Continuity and Quality of Care. Chapter in: The International Handbook of Suicide Prevention, 2nd Edition. Wiley-Blackwell. ISBN 9781118903278. 16 s. Fulltekst i vitenarkiv
• Ribe, Kristin & Mehlum, Lars (2015). Ut av selvskading. Veier til forståelse. Fagbokforlaget. ISBN 9788245014594. 150 s. Fulltekst i vitenarkiv
• Herrestad, Henning & Mehlum, Lars (2005). Uutholdelige liv - Om selvmord, eutanasi og behandling av døende. Gyldendal Akademisk. ISBN 9788205335035. 268 s. Fulltekst i vitenarkiv
• Retterstøl, Nils & Mehlum, Lars (2003). Attempted suicide as a risk factor for suicide: Treatment and follow-up. In: Wasserman D (ed). Suicide � an unnecessary death. Martin Dunitz. 12 s. Fulltekst i vitenarkiv
• Mehlum, Lars (2003). National strategies for suicide prevention. Educational aspects. In: Vijayakumar L (ed): Suicide Prevention. Meeting the challenge together. Orient BlackSwan. 6 s. Fulltekst i vitenarkiv
• Mehlum, Lars (2003). Strategies for early intervention after trauma adopted by the Norwegian Armed Forces. I: R.Orner & U. Schnyder (eds). Reconstructing Early Intervention after Trauma � Innovations in the Care of Survivors. Oxford University Press. 9 s. Fulltekst i vitenarkiv
• Retterstøl, Nils; Ekeberg, Øivind & Mehlum, Lars (2002). Selvmord: et personlig og samfunnsmessig problem. Gyldendal Akademisk. -1 s. Fulltekst i vitenarkiv
• Amundsen, Kirsti; Mehlum, Lars & Schjelderup, Georg (2001). Humanistisk-medisinske perspektiver på selvmord og forebygging. Seksjon for selvmordsfoskning og -forebygging. ISBN 9788299581608. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Mohn, Christine; Haga, Egil; Nilsson, Hanne Sofie Wernø; Silviken, Anne & Mehlum, Lars (2026). Post-media campaign changes in attitudes to suicide and help-seeking in the indigenous Sami and majority Norwegian population in North-Norway. Fulltekst i vitenarkiv
• 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
• Mehlum, Lars & Dibaj, Iselin Solerød (2026). Effective Treatment of Adolescents With Suicidal and Self-Harming Behaviors: What Are the Knowledge Gaps? Journal of the American Academy of Child and Adolescent Psychiatry. ISSN 0890-8567. doi: 10.1016/j.jaac.2026.04.010. Fulltekst i vitenarkiv
• Bukten, Anne; Mehlum, Lars; Fazel, Seena; Lokdam, Nicoline Toresen; Skurtveit, Svetlana Ondrasova & Ericson, Øystein Bruun [Vis alle 11 forfattere av denne artikkelen] (2026). Risikofaktorer for selvmord under fengsling og etter løslatelse. Fulltekst i vitenarkiv
• Bukten, Anne; Mehlum, Lars; Fazel, Seena; Lokdam, Nicoline Toresen; Tverborgvik, Torill & Skurtveit, Svetlana Ondrasova [Vis alle 12 forfattere av denne artikkelen] (2026). Psykisk helse i fengsel. Risikofaktorer for selvmord under fengsling og etter løslatelse. doi: https:/www.fagligforum.no/event/rus-og-psykisk-helse-2026/. Fulltekst i vitenarkiv
• Bukten, Anne; Mehlum, Lars; Lokdam, Nicoline Toresen; Fazel, Seena; Tverborgvik, Torill & Skurtveit, Svetlana Ondrasova [Vis alle 12 forfattere av denne artikkelen] (2025). Suicides among people in prison. Fulltekst i vitenarkiv
• Tørmoen, Anita Johanna; Mehlum, Lars; Ødegård, Kristoffer Bele; Stornes, Marthe & Kvalstad, Gjertrud (2025). The fairy tale of DBT in Norway - from a clinical trail to a large-scale training program. Fulltekst i vitenarkiv
• Dibaj, Iselin Solerød; Tørmoen, Anita Johanna; Klungsøyr, Ole; Haga, Egil; Morken, Katharina Teresa Enehaug & Dymbe, Kine Johansen [Vis alle 7 forfattere av denne artikkelen] (2025). Remisjon av selvskading hos ungdommer predikerte bedre emosjonsregulering i voksen alder. Suicidologi. ISSN 1501-6994. 30(1). doi: 10.5617/suicidologi.12350. Fulltekst i vitenarkiv Vis sammendrag

  Emotion regulation capacity, which is critical for adult functioning and mental health, develops strongly during adolescence in healthy individuals, whereas deficits in emotion regulation is often referred to as emotion dysregulation [ED] and is associated with various mental health problems, including repeated deliberate self-harm [DSH], which peaks in adolescence. Dialectical behaviour therapy for adolescents [DBT-A] has previously been shown to effectively induce DSH remission in adolescents. The present study aimed to investigate whether such remission was associated with reduced ED in adulthood, and whether this effect was mediated by reductions in dysfunctional coping. The design was a prospective longterm follow-up study of an RCT comparing DBT-A with enhanced usual care [EUC] for adolescents with borderline personality features and repeated self-harm. The original sample consisted of 77 adolescents, of which 61 were assessed in adulthood, 12.4 years later. The results showed that there was a direct effect of DSH remission one year after treatment on adult ED, although this effect was not mediated by changes in coping. This is the first study to report that early DSH remission in adolescence predicted lower ED in adulthood, and highlights the importance of early DSH remission and provides new insight into the long-term relationship between DSH and ED.

• Isham, Aleksandra Eriksen; Watson, Lynn Ann; Bohn, Annette; Jørgensen, Carsten René & Mehlum, Lars (2025). Narrativ identitet og BPD-trekk, selvskade og suicidalitet i ungdomsårene. Fulltekst i vitenarkiv
• Isham, Aleksandra Eriksen; Watson, Lynn Ann; Sørensen, Alexander Leonard Birk; Bohn, Annette; Jørgensen, Carsten René & Mehlum, Lars (2025). Disruptions in narrative identity and vulnerability for BPD, self-harm, and suicidality during adolescence: are they associated? Fulltekst i vitenarkiv
• Isham, Aleksandra Eriksen; Sørensen, Alexander Leonard Birk; Mehlum, Lars; Bohn, Annette; Jørgensen, Carsten René & Watson, Lynn Ann (2025). Involuntary autobiographical memories: are they linked to BPD, self-harm, and suicide vulnerability in adolescents? Fulltekst i vitenarkiv
• Isham, Aleksandra Eriksen; Watson, Lynn Ann; Bohn, Annette; Jørgensen, Carsten René & Mehlum, Lars (2025). Involuntary autobiographical memories: a potential vulnerability factor for the emergence of BPD during adolescence? Fulltekst i vitenarkiv
• Helle, Sofie Egidius; Neupane, Sudan Prasad & Mehlum, Lars (2025). Pharmacotherapy in Randomized Controlled Studies of Psychotherapy for Adolescents With Borderline Personality Pathology: A Systematic Scoping Review. Fulltekst i vitenarkiv
• Neupane, Sudan Prasad; Helle, Sofie Egidius & Mehlum, Lars (2025). Psychopharmacotherapy for adolescents with self-harming behavior in the absence of documented effect. doi: 10.1007/s00787-025-02659-z. Fulltekst i vitenarkiv
• Haga, Egil; Mohn, Hanne Christine; Nilsson, Hanne Sofie Wernø & Mehlum, Lars (2025). Increasing intention to seek help for suicidal ideation and depression through a media campaign. Fulltekst i vitenarkiv
• Mohn, Hanne Christine; Haga, Egil; Nilsson, Hanne Sofie Wernø & Mehlum, Lars (2025). Who notices suicide prevention media campaigns? A study from three Norwegian regions. Fulltekst i vitenarkiv
• Øverland, Klara; Milde, Anne Marita & Mehlum, Lars (2024). Beredskapsplan for selvmord og selvmordsfare i skolen, Selvmordsforebygging i skolen. Universitetsforlaget. ISSN 9788215060224. Fulltekst i vitenarkiv
• Norevik, Annie; Milde, Anne Marita & Mehlum, Lars (2024). Hva sier erfarne lærere selv om hvordan de arbeider med barn og unge i forebygging av selvmord? Selvmordsforebygging i skolen. Universitetsforlaget. ISSN 9788215060224. Fulltekst i vitenarkiv
• Mehlum, Lars (2024). Selvmordsadferd og selvskading blant barn og unge – hvor stort er problemet? Selvmordsforebygging i skolen. Universitetsforlaget. ISSN 9788215060224. Fulltekst i vitenarkiv
• Milde, Anne Marita; Mehlum, Lars & Norevik, Annie (2024). Forebyggingstiltak og andre nyttige ressurser for skolen, Selvmordsforebygging i skolen. Universitetsforlaget. ISSN 9788215060224. Fulltekst i vitenarkiv
• Mehlum, Lars & Larsen, Kim Sverre (2024). Ulike perspektiver på selvmord – en grunnlagsforståelse, Selvmordsforebygging i skolen. Universitetsforlaget. ISSN 9788215060224. Fulltekst i vitenarkiv
• Mehlum, Lars & Helle, Sofie Egidius (2024). Barn og unge med emosjonelle reguleringsvansker – hvilke hjelpetiltak er effektive? Selvmordsforebygging i skolen. Universitetsforlaget. ISSN 9788215060224. 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
• Mehlum, Lars (2024). Dialectical behaviour therapy adapted for adolescents. Fulltekst i vitenarkiv
• Mehlum, Lars & Tørmoen, Anita Johanna (2024). Hvordan går det med ungdommene når de blir voksne? Kvantitative og kvalitative resultater fra en langtidsoppfølging etter DBT. Fulltekst i vitenarkiv
• Tørmoen, Anita Johanna; Røssberg, Jan Ivar; Aasland, Line & Mehlum, Lars (2024). SINCERITY WITH A CATCH: YOUNG ADULTS EARLIER TREATED FOR SELF-HARM LOOKING BACK AT THEIR SOCIAL MEDIA EXPERIENCES. Fulltekst i vitenarkiv
• Neupane, Sudan Prasad; Mehlum, Lars; Thorvik, Arne & Larsen, Kim Sverre (2024). Selvmordsforsker? Det må da være fryktelig trist! Suicidologi. ISSN 1501-6994. 29(2). doi: 10.5617/suicidologi.11806. Fulltekst i vitenarkiv
• Mehlum, Lars (2024). Suicidal and non-suicidal self-harm behaviours among adolescents - An update on prevalence, risk factors and effective interventions. Fulltekst i vitenarkiv
• Mehlum, Lars (2024). Asking for and granting access to assisted dying for people with mental health disorders. Fulltekst i vitenarkiv
• Mehlum, Lars (2024). The Norwegian National Strategy for Suicide Prevention 2020-2025 - Some Lessons Learned. Fulltekst i vitenarkiv
• Mehlum, Lars (2024). Treatment of self-harm in adolescents. Fulltekst i vitenarkiv
• Mehlum, Lars; Dibaj, Iselin Solerød & Haga, Egil (2024). Skills use and emotion regulation capacity as mechanisms of long-term change after DBT for suicidal and self-harming behaviour. Fulltekst i vitenarkiv
• Dibaj, Iselin Solerød; Tørmoen, Anita; Klungsøyr, Ole; Haga, Egil; Morken, Katharina Teresa Enehaug & Dymbe, Kine Johansen [Vis alle 7 forfattere av denne artikkelen] (2024). Behaviour Matters: The Significance of Early Remission of Deliberate Self-Harm in adolescents. Results from a follow-up study of a Randomized Controlled Trial comparing Dialectical Behaviour Therapy for Adolescents with Enhanced Usual Care. Fulltekst i vitenarkiv
• Dibaj, Iselin Solerød; Mehlum, Lars; Tørmoen, Anita Johanna; Klungsøyr, Ole & Haga, Egil (2024). Behaviour matters: The significance of early remission of deliberate self-harm in adolescents. Fulltekst i vitenarkiv
• Mehlum, Lars (2024). Hvordan går det med ungdommene når de blir voksne? Langtidsoppfølging etter DBT-A. Fulltekst i vitenarkiv
• Haga, Egil; Nilsson, Hanne Sofie Wernø; Mohn, Hanne Christine & Mehlum, Lars (2024). Changing negative attitudes towards help-seeking for suicidal ideation and depression through a media campaign. Fulltekst i vitenarkiv
• Mohn, Hanne Christine; Haga, Egil; Nilsson, Hanne Sofie Wernø & Mehlum, Lars (2024). Predictors of non-help-seeking for suicide thoughts. Fulltekst i vitenarkiv
• Mohn, Hanne Christine; Haga, Egil; Nilsson, Hanne Sofie Wernø; Pirkis, Jane & Mehlum, Lars (2024). Effectiveness of suicide prevention media campaigns in three Norwegian regions. Fulltekst i vitenarkiv
• Haga, Egil; Nilsson, Hanne Sofie Wernø; Mohn, Hanne Christine & Mehlum, Lars (2024). Effektive og trygge budskap i folkeopplysning mot selvmord. Suicidologi. ISSN 1501-6994. Fulltekst i vitenarkiv
• Haga, Egil; Wernø-Nilsson, Hanne Sofie & Mehlum, Lars (2023). Folkeopplysning for å redusere stigma til hjelpsøking. Fulltekst i vitenarkiv
• Mehlum, Lars (2023). Dialectical behaviour therapy - the evidence for its effectiveness. Fulltekst i vitenarkiv
• Israel, Pravin; Mehlum, Lars & Qin, Ping (2023). The Relative Risk of Parent Mortality Following a Child ́s Death: A National Cohort Study. Fulltekst i vitenarkiv
• Mehlum, Lars; Asarnow, Joan Rosenbaum; Santamarina-Perez, Pilar; Carlsson, Gabrielle & Neupane, Sudan Prasad (2023). Use of psychotropic medication in the treatment of suicidal and self-harming adolescents - a cross-national comparison between three treatment trials. Fulltekst i vitenarkiv
• Mehlum, Lars (2023). Promises of DBT in Preventing Suicide and Self-Harm. 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
• Bøe, Anne Seljenes; Mehlum, Lars & Qin, Ping (2022). Psychiatric disorders among individuals treated for DSH in general hospital: A national register study. Fulltekst i vitenarkiv
• Syeda, Sadia; Mehlum, Lars & Qin, Ping (2022). Utilization of mental healthcare services prior to and after deliberate-self-harm by immigrants under 40 years of age in Norway. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2022). Etterlatte barn og unge. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2022). Etterlatte barn og unge. Fulltekst i vitenarkiv
• Mehlum, Lars (2022). Dialectical behaviour therapy adapted for adolescents. Fulltekst i vitenarkiv
• Mehlum, Lars (2022). Strengthening clinical research on suicidal and self-harming behaviour – some practical considerations. Fulltekst i vitenarkiv
• Mehlum, Lars (2022). Suicidal og selvskadende atferd hos ungdom med personlighetsforstyrrelser - betydningen av tidlig intervensjon og behandling. Fulltekst i vitenarkiv
• Mehlum, Lars (2022). Dialektisk atferdsterapi - hvilke aktive strategier brukes for å redusere suicidal og selvskadende atferd? Fulltekst i vitenarkiv
• Mehlum, Lars (2022). DBT as a Suicide Preventive Intervention – Evidence from Research and Clinical Practice. Fulltekst i vitenarkiv
• Mehlum, Lars (2022). Selvmordsproblematikk og selvskading blant ungdom og unge voksne. Fulltekst i vitenarkiv
• Mehlum, Lars (2022). New approaches to suicide prevention – experiences from the Norwegian national strategy for suicide prevention. Fulltekst i vitenarkiv
• Mehlum, Lars (2022). Nyere utvikling i DBT i et internasjonalt perspektiv. Fulltekst i vitenarkiv
• Mehlum, Lars; Haga, Egil; Mellbye, Alex; Schønning, Thea; Dymbe, Kine Johansen & Siqveland, Johan (2022). Predictors of treatment non-response in adolescents receiving DBT-A. Fulltekst i vitenarkiv
• Mehlum, Lars (2022). Self-harm in adolescents – what are effective interventions? Fulltekst i vitenarkiv
• Mehlum, Lars (2022). Forlenget sorgforstyrrelse er blitt en diagnose, hva kjennetegner behandlingen? Fulltekst i vitenarkiv
• Mehlum, Lars (2022). Dialectical behaviour therapy in the treatment of suicidal and self-harming people – what have we learnt? Fulltekst i vitenarkiv
• Mehlum, Lars (2022). From prediction of suicide to therapeutic assessment. Fulltekst i vitenarkiv
• Mehlum, Lars (2022). Youth suicide prevention – which clinical approaches are effective? Fulltekst i vitenarkiv
• Mehlum, Lars (2022). Cost of self-harm to society is high and increasing: A call for evidence-based and systematic treatment approaches. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 145(4), s. 317–318. doi: 10.1111/acps.13402. 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
• Mehlum, Lars (2022). Lessons learned from suicide prevention in clients with Borderline Personality Disorder. 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
• Mehlum, Lars & Larsen, Kim Sverre (2021). Ulike forskningstradisjoner innen selvmordsforebygging, Nye perspektiver på selvmord. Sorgstøtte og forebygging hånd i hånd. Cappelen Damm Akademisk. ISSN 9788202669195. s. 32–53. Fulltekst i vitenarkiv
• Mehlum, Lars (2021). Suicide and Suicide Prevention and National Suicide Prevention Strategies in the Nordic Countries post-COVID-19. Fulltekst i vitenarkiv
• Mehlum, Lars (2021). Innvandrere og selvmordsrisiko – myter og fakta med basis i norske studier i nyere tid. Fulltekst i vitenarkiv
• Mehlum, Lars (2021). How can we transform research and care for people with complex emotional needs? Fulltekst i vitenarkiv
• Mehlum, Lars (2021). Treatment of self-harm behaviours in adolescents – what works? Fulltekst i vitenarkiv
• Mehlum, Lars; Haga, Egil & Dymbe, Kine Johansen (2021). Association between insecure attachment and self-harm in adolescents with borderline features – a longitudinal study. Fulltekst i vitenarkiv
• Mehlum, Lars (2021). European Society for the Study of Personality Disorders Summer School. Fulltekst i vitenarkiv
• Mehlum, Lars (2021). New approaches to suicide prevention – the Norwegian national strategy for suicide prevention. Fulltekst i vitenarkiv
• Mehlum, Lars (2021). Promises of DBT in Preventing Suicide and Self-Harm. Fulltekst i vitenarkiv
• Mehlum, Lars (2021). Transactional aspects of asking for and granting EAS in patients with personality disorders. 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
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Barn som etterlatte: Psykososiale vansker etter brått tap av en forelder. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Barn som etterlatte: Psykososiale vansker etter brått tap av en forelder. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Etterlatte barn og unge. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Barn som etterlatte: Psykososiale vansker etter brått tap av en forelder. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2021). Etterlatte barn og unge. Fulltekst i vitenarkiv
• Bekkevold-Jernberg, Ina; Pedersen, Geir Arild Feigum; Kvarstein, Elfrida Hartveit & Mehlum, Lars (2021). Avoidant Personality Disorder and Deliberate Self-Harm. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Deliberate self-harm (DSH) is frequent among patients with Borderline personality disorder (BPD), whereas the prevalence of this behaviour and its associations with psychosocial distress and impairment among patients with other PDs is less known. The purpose of this study was to determine the prevalence of DSH among 959 outpatients with Avoidant PD (AvPD), and to examine the association between DSH and psychological distress, impairment in work and social functioning, and the number of fulfilled BPD-criteria within this group of patients. Methods: Data on all patients with AvPD (but no comorbid BPD) were retrieved from 20 outpatient treatment units on a specialist mental health service level within the Norwegian Network for Personality Disorders. Logistic Regression was used to explore associations between selected variables and last year history of DSH. Results: Almost 1 in 4 patients (24%) with AvPD had a last year history of DSH and DSH was strongly associated with high levels of psychosocial distress (OR 2.04; p=<.010), depression (OR 4.19; p=<.010), anxiety (OR 2.16; p=<.010), work impairment (OR 2.07; p=<.050) and number of fulfilled BPD criteria (OR 1.52; p=<.010). Conclusion: DSH is highly prevalent among clients with AvPD in outpatient treatment settings and strongly associated with depression and psychosocial and work impairment. DSH was also significantly linked to clinical features captured by diagnostic criteria for BPD. The latter may imply that treatment interventions originally developed for patients with BPD could also be an effective treatment for self-harming patients with AvPD.

• 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.

• Gunnell, David; Appleby, L; Arensman, Ella; Hawton, Keith; John, A & Kapur, Nav [Vis alle 12 forfattere av denne artikkelen] (2020). Suicide risk and prevention during the COVID-19 pandemic. The Lancet Psychiatry. ISSN 2215-0374. 7(6), s. 468-471–468-471. doi: 10.1016/S2215-0366(20)30171-1. 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
• Mellesdal, Liv Solrunn; Gjestad, Rolf; Ødegaard, Ketil Joachim; Walby, Fredrik A. & Mehlum, Lars (2019). Factors related to future suicide in patients admitted to a psychiatric acute ward. Fulltekst i vitenarkiv
• Waraan, Luxsiya; Rognli, Erling W.; Mehlum, Lars; Czajkowski, Nikolai Olavi & Villabø, Marianne (2019). The efficacy of psychotherapy for suicidal ideation in youth. Fulltekst i vitenarkiv
• Boe, Anne Seljenes; Mehlum, Lars; Stanley, Barbara; Melle, Ingrid & Qin, Ping (2019). Psychiatric comorbidity in adult deliberate self-harm patients: a literature review and Norwegian observation. Fulltekst i vitenarkiv
• Bøe, Anne Seljenes; Mehlum, Lars; Melle, Ingrid & Qin, Ping (2019). Comorbid psychiatric disorder in adult DSH patients: A Norwegian observation. Fulltekst i vitenarkiv
• Qin, Ping & Mehlum, Lars (2019). Deliberate self-harm and follow-up care: insights from the secondary health care services in Norway. Fulltekst i vitenarkiv
• Mehlum, Ingrid Sivesind; Hanvold, Therese Nordberg; Mehlum, Lars; Hasting, Rachel Louise; Merkus, Suzanne & Kristensen, Petter (2019). Are psychosocial working conditions associated with suicide and intentional self-harm? A register-based study of 420,895 Norwegians. Occupational and Environmental Medicine. ISSN 1351-0711. 76, s. A63–A63. doi: 10.1136/OEM-2019-EPI.A63. Fulltekst i vitenarkiv
• Mehlum, Lars (2019). Treatment of self-harming behaviour in adolescents – what works? Fulltekst i vitenarkiv
• Mehlum, Lars (2019). Effective treatment of suicidal people in the emergency context and beyond. Fulltekst i vitenarkiv
• Mehlum, Lars (2019). Treatment of self-harming adolescents with Borderline Personality Disorder. Fulltekst i vitenarkiv
• Mehlum, Lars (2019). Designing clinical studies in personality disorder research. Fulltekst i vitenarkiv
• Mehlum, Lars (2019). How I began working on PD research. Fulltekst i vitenarkiv
• Mehlum, Lars (2019). Clinical Interventions for high risk behaviours and situations. Prevention of Suicide. Fulltekst i vitenarkiv
• Mehlum, Lars (2019). Comorbidities and differential diagnosis in assessment of Prolonged Grief Disorder. Fulltekst i vitenarkiv
• Mehlum, Lars (2019). Effective prevention of suicidal behaviours in adolescents – from targeted treatments to fire arms restriction. Fulltekst i vitenarkiv
• Mehlum, Lars (2019). Prevention and treatment of suicidal behaviours. Fulltekst i vitenarkiv
• Mehlum, Lars (2019). Treating Adolescents with Suicidal and Non-Suicidal Self-Injury - What Works? Fulltekst i vitenarkiv
• Mehlum, Lars (2019). Nordic Experience in Suicide Pevention. An update on developments from Norway. Invited lecture. Fulltekst i vitenarkiv
• Mehlum, Lars (2019). Implementation of Dialectical Behaviour Therapy for Suicidal and Self-harming Adolescents in a National Context. Fulltekst i vitenarkiv
• Mehlum, Lars; Haga, Egil; Thomassen, Hilde & Mork, Erlend (2018). Bedre behandling av depresjon i primærhelsetjenesten – et viktig selvmordsforebyggende tiltak. Utposten. ISSN 0800-5680. s. 12–14. Fulltekst i vitenarkiv
• Mehlum, Lars (2018). Langtidseffekter av DBT for ungdom. Fulltekst i vitenarkiv
• Huprich, SK; Herpertz, Sabine; Bohus, Martin; Chanen, Andrew; Goodman, Marianne & Mehlum, Lars [Vis alle 10 forfattere av denne artikkelen] (2018). Comment on Hopwood et al., "the time has come for dimensional personality disorder diagnosis". Personality and Mental Health. ISSN 1932-8621. s. 87–88. doi: 10.1002/pmh.1407. Fulltekst i vitenarkiv
• Mehlum, Lars (2018). Treating chronic suicidal and self-harming patients - Challenges and solutions. Fulltekst i vitenarkiv
• Mehlum, Lars (2018). Clinical Suicide Risk Assessment and Management. Fulltekst i vitenarkiv
• Mehlum, Lars (2018). Treatment of patients with chronic suicidal and self-harming behaviour. Fulltekst i vitenarkiv
• Mehlum, Lars (2018). Prevention of self-harm in young people. Fulltekst i vitenarkiv
• Mehlum, Lars (2018). Vi vet at DBT virker, men hva er endringsmekanismene ved virksom behandling? Fulltekst i vitenarkiv
• Mehlum, Lars (2018). Challenges and solutions in suicide prevention – an update. Fulltekst i vitenarkiv
• Mehlum, Lars (2018). Mechanisms of change during dialectical behaviour therapy (DBT) in suicidal and self-harming adolescents with borderline features. Fulltekst i vitenarkiv
• Mehlum, Lars & Haga, Egil (2018). Cost-effectiveness of dialectical behaviour therapy in self- harming adolescents with Borderline Personality Disorder features. Fulltekst i vitenarkiv
• Waraan, Luxsiya; Rognli, Erling W.; Mehlum, Lars; Czajkowski, Nikolai Olavi & Villabø, Marianne (2018). The association between Attachment Style to Father and Suicidal Ideation in Adolescents with Depression. Fulltekst i vitenarkiv
• Bøe, Anne Seljenes; Mehlum, Lars & Qin, Ping (2018). Influence of socioeconomic status and health condition on risk for suicide among the middle-aged in Norway. Fulltekst i vitenarkiv
• Lunde, Ketil Berge; Mehlum, Lars; Stanley, Barbara; Melle, Ingrid & Qin, Ping (2018). The influence of sick leave and sociodemographic factors on risk for deliberate self-harm: A national study. Fulltekst i vitenarkiv
• Puzo, Quirino; Mehlum, Lars & Qin, Ping (2018). Socio-economic status and risk for suicide by immigration background in Norway: A registerbased national study. Fulltekst i vitenarkiv
• Næss, Erik Oftedahl; Mehlum, Lars & Qin, Ping (2018). Suicide in relation to marital status – A national study. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2018). Educational attainment in offspring bereaved by sudden parental death from external causes: A national cohort study from birth and throughout adulthood. Fulltekst i vitenarkiv
• Puzo, Quirino; Mehlum, Lars & Qin, Ping (2018). Rates and characteristics of suicides by immigration background in Norway: A register-based analysis over two decades. Fulltekst i vitenarkiv
• Qin, Ping & Mehlum, Lars (2018). Future challenges and possibilities in register-based research on patients treated for self-harm. Fulltekst i vitenarkiv
• Bekkevold-Jernberg, Ina Marie; Pedersen, Geir Feigum & Mehlum, Lars (2018). Age and Gender Differences in Self-Harm Behaviours Among Patients with Borderline Personality Disorder. Fulltekst i vitenarkiv Vis sammendrag

  Age and Gender Differences in Self-Harm Behaviours Among Patients with Borderline Personality Disorder Bekkevold-Jernberg I.1, Pedersen, Geir.2,3, Mehlum L. 1, 1National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway; 2 Oslo University Hospital, Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo, Norway; 3 NORMENT, KG Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway. Introduction and aim: Suicidal and non-suicidal self-harm (NSSI) are common behaviours in patients with borderline personality disorder (BPD) and represent important challenges to patient safety and treatment implementation. We used data collected from a large clinical cohort of adult patients with BPD treated at units in the Norwegian Network of Personality Focused Treatment Programmes (DN) to explore age and gender differences in past and current self-harming behaviours and associated symptoms. Methods: Interview and self-report data from DN was analysed, counting 603 patients diagnosed with BPD, wherein 79 men (13.1 %) and 524 women (86.9 %), from 16 outpatient units between 2009 and 2015. Conditional Logistic Regression was used to explore associations. Results: Opposite of what we expected, there was no significant gender difference related to NSSI (OR 1.21, p = .426). The differences related to age, however, were notable; the younger patients (<25 years) had a much higher prevalence of and association with NSSI than the older patients (>25 years): (71.4% vs 40.9% and OR 3.61, p < .001 vs OR 0.28, p <.001). Regardless of age, the associations were strong between NSSI and recent suicidal ideation (2.64, p <.001), and especially recent suicidal ideation with concrete plans (15.14, p <.001). Conclusion: These results imply that gender is not an important factor for NSSI among patients with BPD. Young adulthood is, however, a period of strongly increased risk of NSSI in patients with BPD which should be reflected in treatment programmes targeting patients with BPD. Finally, high levels of suicidal ideation with concrete plans have a strong association with recent NSSI in patients with BPD, a fact that needs to be taken into consideration when strategies to increase patient safety are implemented.

• Bekkevold-Jernberg, Ina Marie; Pedersen, Geir Feigum & Mehlum, Lars (2018). Borderline Personality Disorder and Self-Harm Behaviours: Gender and Age Differences. Fulltekst i vitenarkiv
• Puzo, Quirino; Mehlum, Lars & Qin, Ping (2017). Suicide among immigrant population in Norway: what is the risk difference and how socio-economic factors influence the risk. Fulltekst i vitenarkiv
• Qin, Ping & Mehlum, Lars (2017). National plan for suicide prevention: Norwegian experience. Fulltekst i vitenarkiv
• Puzo, Quirino; Mehlum, Lars & Qin, Ping (2017). Suicide among immigrant population in Norway: A national register-based study. Fulltekst i vitenarkiv
• Puzo, Quirino; Mehlum, Lars & Qin, Ping (2017). The effect of socio-economic factors on suicide risk among immigrant population in Norway. Fulltekst i vitenarkiv
• Mehlum, Lars (2017). DBT as a Suicide and Self-harm Treatment: Assessing and Treating Suicidal Behaviours. I Swales, Michaela (Red.), The Oxford Handbook of Dialectical Behaviour Therapy. Oxford University Press. ISSN 9780198758723. doi: 10.1093/oxfordhb/9780198758723.001.0001. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2017). Sudden Parental Death from External Causes and Risk of Suicide in the Bereaved Offspring: A National Study. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2017). Sudden Parental Death from External Causes and Risk of Suicide in the Bereaved Offspring. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2017). Risk Factors for Suicide in Offspring Bereaved by Sudden Parental Death from External Causes. Fulltekst i vitenarkiv
• Mehlum, Lars (2017). Suicidale og selvskadende ungdommer. Nye forskningsresultater om behandling og oppfølging. Fulltekst i vitenarkiv
• Mehlum, Lars (2017). Regulering av følelser – hvilken relevans har det for å forstå og behandle suicidalitet og selvskading? Fulltekst i vitenarkiv
• Oftedahl, Næss Erik; Mehlum, Lars & Qin, Ping (2017). Suicide risk in relation to marital status: a national study. Fulltekst i vitenarkiv
• Mehlum, Lars (2017). Developing new interventions to prevent suicide in the US national trauma network for children. Fulltekst i vitenarkiv
• Mehlum, Lars (2017). Dialectical Behaviour Therapy for Adolescents with Repeated Suicidal and Self-harming Behaviour: Randomized Trials and Beyond. Fulltekst i vitenarkiv
• Mehlum, Lars (2017). Effective strategies for suicide prevention and Support for bereaved after suicide. Fulltekst i vitenarkiv
• Mehlum, Lars (2017). Implementation of Dialectical Behaviour Therapy within a Nordic Health Care System. Fulltekst i vitenarkiv
• Mehlum, Lars (2017). Screening for self-harm in Child and Adolescent Psychiatric Outpatient Setting. Fulltekst i vitenarkiv
• Mehlum, Lars (2017). Dialectical Behaviour Therapy for Suicidal Adolescents. Fulltekst i vitenarkiv
• Mehlum, Lars (2017). Adopting a Dialectical Stance in Psychotherapy - Why and How? Fulltekst i vitenarkiv
• Puzo, Quirino; Mehlum, Lars & Qin, Ping (2017). Suicide among immigrant population in Norway: A national register-based study. Fulltekst i vitenarkiv
• Tang, Fang; Mehlum, Lars; Mehlum, Ingrid Sivesind & Qin, Ping (2017). Suicide risk and physical illness leading to leave from work: a national study of people in Norwegian labor force. Fulltekst i vitenarkiv
• Qin, Ping & Mehlum, Lars (2017). Who receives a diagnosis of DSH in clinics? – Insight from Norwegian national patient registration. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2017). Sudden Parental Death from External Causes and Risk of Suicide in the Bereaved Offspring: A National Study. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Mehlum, Lars & Qin, Ping (2016). Sudden Parental Death from External Causes and Risk of Suicide in the Bereaved Offspring: A National Study. Fulltekst i vitenarkiv
• Mehlum, Lars (2016). Long-term outcomes in Self-harming Adolescents with Borderline Personality Features Having Received Dialectical Behaviour Therapy or Enhanced Usual Care. Fulltekst i vitenarkiv
• Mehlum, Lars (2016). Treating Self-harming Adolescents with Borderline Personality Disorder Features with DBT vs Enhanced Usual Care Long-term Efficacy, Mechanisms of Change and Cost Effectiveness. Fulltekst i vitenarkiv
• Mehlum, Lars (2016). Skills use, Hopelessness and Self-esteem and Reduction in Self-harm in Adolescents with Borderline Personality Disorder Features - Follow-up Two years After Treatment. Fulltekst i vitenarkiv
• Mehlum, Lars (2016). The role of family involvement in treating teenagers. Clinical round table discussion. Fulltekst i vitenarkiv
• Mehlum, Lars (2016). Mediators of Long-term Reduction in Self-harm in Adolescents with Borderline Personality Disorder Features. Fulltekst i vitenarkiv
• Mehlum, Lars (2016). Implementation of DBT in a publicly funded mental health context – Some lessons learned in Norway. Fulltekst i vitenarkiv
• Mehlum, Lars (2016). Epidemiological studies on mental health and suicidal behaviours in children and adolescents in Norway – why do they matter? Fulltekst i vitenarkiv
• Mehlum, Lars (2015). Suicide risk assessment for general practitioners in Portugal. Fulltekst i vitenarkiv
• Mehlum, Lars (2015). Challenges and achievements in suicide prevention in Norway. Fulltekst i vitenarkiv
• Mehlum, Lars (2015). Dialectical Behaviour Therapy. Fulltekst i vitenarkiv
• Ramleth, Ruth-Kari; Grøholt, Berit; Diep, Lien My & Mehlum, Lars (2015). Depressive symptoms in self-harming adolescents with Borderline personality disorder. Fulltekst i vitenarkiv
• Morthorst, Brit; Mehlum, Lars; Pálsson, Sigurdur Emil; Muhlmann, Charlotte; Hammerlin, Yngve & Madsen, Trine [Vis alle 8 forfattere av denne artikkelen] (2015). Suicide in Danish, Icelandic, and Norwegian prisons, 1999 – 2011. A Nordic collaboration. Fulltekst i vitenarkiv
• Mehlum, Lars (2015). Dialectical Behavior Therapy for Adolescents with Repeated Suicidal and Self-Harming Behavior – A RCT. Fulltekst i vitenarkiv
• Mehlum, Lars (2015). Adressing suicidal behaviour in adolescents. Fulltekst i vitenarkiv
• Mehlum, Lars (2015). Psychotherapeutic Interventions for Suicidal and Self-harming Behavior in Adolescents. Fulltekst i vitenarkiv
• Mehlum, Lars; Ramberg, Maria; Tørmoen, Anita Johanna; Haga, Egil; Diep, Lien My & Stanley, Barbara [Vis alle 9 forfattere av denne artikkelen] (2015). Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents with Repeated Suicidal and Self-harming Behavior: Outcomes over a 1-year Follow-Up. Fulltekst i vitenarkiv
• Mehlum, Lars (2015). Treatment of Self-Harm in Adolescents – What Works? Fulltekst i vitenarkiv
• Mehlum, Lars (2015). Dialectical Behaviour Therapy adapted for Adolescents. Fulltekst i vitenarkiv
• Mehlum, Lars; Ramberg, Maria; Tørmoen, Anita Johanna; Haga, Egil; Diep, Lien My & Stanley, Barbara [Vis alle 9 forfattere av denne artikkelen] (2015). One year follow-up of Dialectical Behavior Therapy vs. Enhanced Usual Care for Self-harming Adolescents. Fulltekst i vitenarkiv
• Mehlum, Lars (2015). Mental Health Services and Care Organization in Norway Primary Care, Specialized Care and the School Setting. Fulltekst i vitenarkiv
• Mehlum, Lars (2015). Implementing DBT in a publicly funded mental health context - lessons learned from Norway. Fulltekst i vitenarkiv
• Mellesdal, Liv Solrunn; Kroken, Rune Andreas; Lutro, Olav; Wentzel-Larsen, Tore; Kjelby, Eirik & Ødegaard, Ketil Joachim [Vis alle 8 forfattere av denne artikkelen] (2015). Predictors of severe self-harm in patients discharged from psychiatric hospital. A prospective cohort study. Fulltekst i vitenarkiv
• Qin, Ping & Mehlum, Lars (2015). Who receives a diagnosis of DSH in clinics? – An investigation of the national patient data from Norway. Fulltekst i vitenarkiv
• Qin, Ping & Mehlum, Lars (2015). Self-poisoning with medication — a nationwide investigation on the incidents, comorbidities and repetitions in Norway. Fulltekst i vitenarkiv
• Qin, Ping & Mehlum, Lars (2015). Self-poisoning with medication — a nationwide investigation on the incidents, comorbidities and repetitions in Norway. Fulltekst i vitenarkiv
• Lindkvist, Karoline & Mehlum, Lars (2015). Komplisert sorg og behandling. Fulltekst i vitenarkiv
• Mehlum, Lars (2015). Prevention of suicidal behaviour in a clinical context. What is best practice? Fulltekst i vitenarkiv
• Haga, Egil; Tørmoen, Anita Johanna; Aas, Eline; Mehlum, Lars & Grøholt, Berit (2015). Cost-effectiveness of Dialectical Behaviour Therapy (DBT) vs Enhanced Usual care in the treatment of adolescents With self-harm. Fulltekst i vitenarkiv
• Fadum, Elin Anita; Stanley, Barbara; Qin, Ping; Diep, Lien My & Mehlum, Lars (2014). Acute medication poisoning in adolescents: A national register study of hospital admissions and readmissions. Fulltekst i vitenarkiv
• Fadum, Elin Anita; Stanley, Barbara; Qin, Ping; Diep, Lien My & Mehlum, Lars (2014). Acute medication poisoning in adolescents: A national register study of hospital admissions and readmissions. Norsk Epidemiologi, Supplement. ISSN 0803-4206. Fulltekst i vitenarkiv
• Mehlum, Lars; Ness, Ewa & Walby, Fredrik A (2014). Re: Overdreven tro på selvmordsrisikovurderinger? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(6), s. 593–593. doi: 10.4045/tidsskr.14.0283. Fulltekst i vitenarkiv
• Mellesdal, Liv; Gjestad, Rolf; Johnsen, Erik; Jørgensen, Hugo arild; Kroken, Rune andreas & Oedegaard, Ketil joachim [Vis alle 7 forfattere av denne artikkelen] (2013). Prospective self-harm predicted by Borderline Personality Disorder and -criteria, and PTSD Diagnosis in patients admitted to a psychiatric acute ward. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: A large proportion of admissions to psychiatric acute wards are suicide risk related. Many of these patients continue to engage in suicidal behavior over longer time periods; this is particularly true for subjects with Borderline Personality Disorder (BPD) and patients with Posttraumatic Stress Disorder (PTSD). The comorbidity between BPD and PTSD is well-known, but how the borderline and PTSD syndrome in combination influence the risk of further self-harm is less studied. Aim: We wanted to study what borderline characteristics are associated with prospective self-harm when adjusted for a diagnosis of PTSD. Methods: Altogether 308 non-psychotic patients were randomly selected from all patients admitted to a psychiatric acute ward due to suicide risk. The patients were interviewed at baseline (during acute admission) and at six months follow-up (response rate =91%). Baseline assessments included the M.I.N.I. International Neuropsychiatric Interview for DSM-IV Axis I disorders and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Additionally to assessing the diagnosis BPD, the presence of all BPD criteria was scored and rated on a 5 point Likert scale. Data on hospital referred self-harm (HSH) were retrieved through register linkage covering the six months follow-up period. Separate Mplus Two-part regression models were used to predict a binary part describing whether HSH occurred or not, and a continuous part describing the frequencies. Results: The diagnosis of BPD predicted HSH during the follow-up both when analysed separately and in combination with PTSD. The single BPD criteria 'suicidality', 'affective instability' and 'impulsivity' predicted HSH during follow-up even after adjusting for a diagnosis of PTSD. The strongest association, however, was between PTSD and HSH. Conclusion: Using structured diagnostic tools that include assessment of the BPD criteria is recommended for all patients with suicide risk related admissions to psychiatric acute wards. Because PTSD was an even stronger predictor of prospective self-harm than the diagnosis of BPD, it is also important to ensure that PTSD is assessed. Treatment targeted towards problems related to affective instability, impulsivity and PTSD symptoms may reduce the risk of suicidal behavior in these patients.

• Nrugham, Latha; Lien, My Diep & Mehlum, Lars (2013). Firearms - Means Restriction As Suicide Prevention Intervention In Norway. Fulltekst i vitenarkiv
• Qin, Ping; Fadum, Elin Anita & Mehlum, Lars (2013). Hospital Registration of Self-harm and Suicide Attempt: Norwegian Observation. Fulltekst i vitenarkiv
• Fadum, Elin Anita; Stanley, Barbara; Qin, Ping & Mehlum, Lars (2013). Risk of Repetition Among Hospital Treated Patients with Medicinal Poisoning 2008 – 2011. Suicidologi. ISSN 1501-6994. 18, s. 415–415. Fulltekst i vitenarkiv
• Fadum, Elin Anita; Stanley, Barbara; Qin, Ping & Mehlum, Lars (2013). Risk of Repetition Among Hospital Treated Patients with Medicinal Poisoning 2008 – 2011. Fulltekst i vitenarkiv
• Mehlum, Lars & Nrugham, Latha (2012). Kartlegger selvmordene. [Journal]. Fredrikstad Blad. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2012). Ethnic minorities and suicide: Review of rates and risk factors. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2011). Suicide among ethnic minorities: Rates and risk factors. Fulltekst i vitenarkiv
• Nrugham, Latha; Mehlum, Lars; Herrestad, Henning & Diep, Lien My (2011). Suicide rates and the Human Development Index (HDI) rankings among OECD members. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2010). Gender and diagnostic profiles of life events among patients consecutively admitted to a general hospital after attempted suicide. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2010). Differences and similarities of number of life events among patients admitted after attempted suicide. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2010). Suicide Among Ethnic Minorities: Rates and Risk Factors. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2010). The Norwegian Causes of Death Register: A Note on Quality of Data. Fulltekst i vitenarkiv
• Mehlum, Lars & Ramberg, Maria (2010). Continuity of Care in the Treatment of Suicide AttemptersCurrent Challenges. Archives of Suicide Research. ISSN 1381-1118. 14(2), s. 105–108. doi: 10.1080/13811111003704472. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2010). Differences and similarities of number of life events among patients admitted after attempted suicide. European psychiatry. ISSN 0924-9338. 25, s. 1365–1365. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2010). Gender and diagnostic profiles of life events among patients consecutively admitted to a general hospital after attempted suicide. European psychiatry. ISSN 0924-9338. 25, s. 630–630. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2010). Gender and Comorbidity Profiles of Suicide Attempters Admitted to a General Hospital. Fulltekst i vitenarkiv
• Nrugham, Latha; Herrestad, Henning & Mehlum, Lars (2010). Suicidality Among Norwegian Youth: Review of Research on Risk Factors. Fulltekst i vitenarkiv
• Mork, Erlend; Mehlum, Lars & Walby, Fredrik A (2010). The clinical course of suicide attempts and nonsuicidal self injurious behaviour in schizophrenia disorder patients. A cross-sectional catchment area based study. Fulltekst i vitenarkiv
• Mehlum, Lars; Gravseth, Hans Magne Ulrik; Bjerkedal, Tor & Kristensen, Petter (2009). Risikofaktorer for selvmord blant unge voksne i Norge i et livstidsperspektiv. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2009). Gender and diagnostic profiles of life events among patients consecutively admitted to a general hospital after attempted suicide. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2009). Patterns of deliberate self-harm (DSH) among in-patients admitted after a suicide attempt. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2009). Differences and similarities of number of life events among patients admitted after attempted suicide. Fulltekst i vitenarkiv
• Nrugham, Latha & Mehlum, Lars (2009). A prospective study of alcohol abuse among patients admitted after an act of deliberate self-harm (DSH). Fulltekst i vitenarkiv
• Barrett, Elizabeth Ann; Sundet, Kjetil Søren; Simonsen, Carmen Elisabeth; Agartz, Ingrid; Lorentzen, Steinar & Mehlum, Lars [Vis alle 9 forfattere av denne artikkelen] (2009). SUICIDE ATTEMPTS AND NEUROCOGNITIVE FUNCTIONING IN SCHIZOPHRENIA SPECTRUM DISORDERS. Schizophrenia Bulletin. ISSN 0586-7614. 35, s. 279–279. Fulltekst i vitenarkiv
• Mehlum, Lars (2008). Hjelp ved psykososiale kriser. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 128(18), s. 2048–2048. Fulltekst i vitenarkiv
• Mehlum, Lars (2008). Dialektisk atferdsterapi. Fulltekst i vitenarkiv
• Mehlum, Lars (2008). Selvmord kan forebygges. Fulltekst i vitenarkiv
• Mehlum, Lars (2008). Forebygging av selvmord I psykisk helsevern. Hva sier de nye retningslinjene? Fulltekst i vitenarkiv
• Mehlum, Lars (2008). Chronically suicidal patients – a therapeutic challenge. Fulltekst i vitenarkiv
• Mehlum, Lars (2008). Nye mål for forebygging. Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116. Fulltekst i vitenarkiv
• Mehlum, Lars (2008). One size fits all? Developing and evaluating suicide preventive programmes for veterans from international military operations. Fulltekst i vitenarkiv
• Mehlum, Lars (2008). Internasjonale nettverk for selvmordsforebygging: International Association for Suicide Prevention (IASP). Suicidologi. ISSN 1501-6994. 11(1), s. 18–20. Fulltekst i vitenarkiv
• Mork, Erlend; Mehlum, Lars & Walby, Fredrik A. (2008). Characteristics of patients with schizophrenia with and without a lifetime history of deliberate selfharm. Fulltekst i vitenarkiv
• Walby, Fredrik A.; Ødegaard, Erik & Mehlum, Lars (2008). Post-discharge suicides in Norway: a blinded case-control study. Fulltekst i vitenarkiv
• Tørmoen, Anita Johanna; Larsson, Bo & Mehlum, Lars (2008). Psychosocial risk factors and help-seeking behaviour related to type and repetition of suicide-related behaviours among Norwegian adolescents. Fulltekst i vitenarkiv
• Werbel, Aaron; Mehlum, Lars & Dooren, Vicky Van (2008). Task force on defense and police suicide prevention: Identifying needs and setting priorities. Fulltekst i vitenarkiv
• Mehlum, Lars (2008). The chain of care for suicide attempters. Fulltekst i vitenarkiv
• Mehlum, Lars (2008). Traumatisk stress og suicidal atferd. Fulltekst i vitenarkiv
• Fadum, Elin Anita; Mehlum, Lars; Reinholdt, Nils Petter; Mork, Erlend & Rossow, Ingeborg (2007). Monitoring deliberate self harm patients at Norwegian general hospitals. Fulltekst i vitenarkiv
• Thoresen, Siri & Mehlum, Lars (2007). Traumatic stress and suicidal ideation in peacekeepers – a seven years follow-up study. Fulltekst i vitenarkiv
• Thoresen, Siri & Mehlum, Lars (2007). Traumatic stress and suicidal ideation in male peacekeepers. Fulltekst i vitenarkiv
• Mehlum, Lars (2006). Restricting access to fire arms: recent developments from the norwegian national strategy for suicide prevention. Psychiatria Danubina. ISSN 0353-5053. s. 104–104. Fulltekst i vitenarkiv
• Mellesdal, Liv; Mehlum, Lars; Jørgensen, Hugo & Wentzel-Larsen, Tore (2006). Suicidality in psychiatric emergency admissions: the SIPEA study, a prospective follow-up study. Psychiatria Danubina. ISSN 0353-5053. s. 140–140. Fulltekst i vitenarkiv
• Mehlum, Lars; Rozanov, Vsevolod & Stiliha, Richard (2006). Preventing suicide in the military - experiences from the Ukraine, United States and Norway. Psychiatria Danubina. ISSN 0353-5053. s. 98–98. Fulltekst i vitenarkiv
• Hestetun, Ingebjørg; Ystgaard, Mette; Loeb, Mitchell Elliott & Mehlum, Lars (2006). The impact of abuse and neglect in childhood on later events and difficulties in a group of suicide attempters. Psychiatria Danubina. ISSN 0353-5053. s. 85–85. Fulltekst i vitenarkiv
• Mehlum, Lars (2006). Trauma as a life event and its impact on suicidal behaviour. Psychiatria Danubina. ISSN 0353-5053. s. 76–76. Fulltekst i vitenarkiv
• Larsson, Bo; Grøholt, Berit & Mehlum, Lars (2006). Behandling vid upprepad självskada och suicidforsök hos tonåringar: en randomiserad kontrollerad mulicenter-studie. Suicidologi. ISSN 1501-6994. 11, s. 16–17. Fulltekst i vitenarkiv
• Mehlum, Lars (2006). Drap innen familien. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. s. 1514–1514. Fulltekst i vitenarkiv
• Mehlum, Lars (2006). Kortfattet om katastrofer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. s. 1512–1512. Fulltekst i vitenarkiv
• Mehlum, Lars; Høifødt, Tordis Sørensen & Silvola, Kirsti (2005). Integrating suicide intervention training in medical education. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). Selvmord – et samfunnsmessig problem. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). Traumatic stress and suicidal behaviour. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). Pesticides and suicide prevention. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). Suicide Prevention is our business. Fulltekst i vitenarkiv
• Mellesdal, Liv; Mehlum, Lars & Jørgensen, Hugo (2005). Suicidality in psychiatric emergency admissions – the SIPEA study. Fulltekst i vitenarkiv
• Thoresen, Siri; Mehlum, Lars; Røysamb, Espen & Tønnessen, Arnfinn (2005). Risk factors for suicide attempt in Norwegian peace-keepers. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). Suicide Prevention in the military context. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). The chain of care for deliberate self-harm patients. Collaboration between primary health care and hospitals. Fulltekst i vitenarkiv
• Walby, Fredrik A.; Ødegaard, Erik & Mehlum, Lars (2005). Risk Factors for completed suicide in psychiatric inpatients. Fulltekst i vitenarkiv
• Thoresen, Siri; Mehlum, Lars; Røysamb, Espen & Tønnessen, Arnfinn (2005). Repatriation as an independent risk factor for completed suicide in veterans of peacekeeping. Fulltekst i vitenarkiv
• Thoresen, Siri; Mehlum, Lars; Røysamb, Espen & Tønnessen, Arnfinn (2005). Predictors of attempted and completed suicide in veterans of peacekeeping. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). By their own hand Part 1 & 2. [Radio]. BBC World Service. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). Førstehjelp ved selvmordsfare. [TV]. NRK. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). Seksjon for selvmordsforskning og forebygging. Medisinsk informasjon. ISSN 0801-4612. s. 24–25. Fulltekst i vitenarkiv
• Mehlum, Lars & Myhre, Wenche Margrethe (2005). Selvmord og selvbestemt livsavslutning. [Radio]. NRK. Fulltekst i vitenarkiv
• Mehlum, Lars (2005). ”Lykkepiller” og selvmordsrisiko. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Selvmord kan forebygges. Fulltekst i vitenarkiv
• Walby, Fredrik A.; Ødegaard, Erik & Mehlum, Lars (2004). Does DSM-IV disorders and comorbidity predict post discharge suicides? Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Letter from the new IASP president. Crisis. ISSN 0227-5910. 25, s. 41–42. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Når noen skader seg med vilje. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. s. 2734–2734. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). National strategies for suicide prevention - Norwegian experiences. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Innovations in the chain of care for suicide attempters. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Complex, comprehensive and coordinated. Overview of national strategies for suicide prevention. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Educating the gatekeeper. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Tidlig traumatisering og suicidal atferd. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). National strategies for suicide prevention � A collaborative approach. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Focussed educational interventions for physicians. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Confronting cultural barriers to means restriction. Experiences from military personnel. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Suicide prevention in a global context. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Strategies for suicide prevention � Health Service Responses. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). The chain of care for suicide attempters. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Deliberate self harm and suicide prevention. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Psykiske reaksjoner etter tjeneste i fredsbevarende operasjoner � hva sier forskningen? Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Prosessen fram mot selvmordet. Se, favne, tåle. Kirkens SOS. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Suicidal prosess og suicidale motiver belyst ved kunstneren Vincent van Goghs kunst, livsløp og sykehistorie. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Forebygging gjennom begrensninger i tilgang til selvmordsmidler. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Håp. Hvilke selvmordsforebyggende metoder er effektive? Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Increasing the societal basis for suicide prevention. Fulltekst i vitenarkiv
• Mehlum, Lars (2004). Preconference Workshop on suicide prevention. Fulltekst i vitenarkiv
• Mehlum, Lars; Ystgaard, Mette & Hestetun, Ingebjørg (2003). Traumatic stress symptomatology � its influence on the clinical outcome in suicide attempters � a follow-up study. Fulltekst i vitenarkiv
• Mehlum, Lars (2003). Prevention of suicide and premature mortality in a Eurpean perspective. Fulltekst i vitenarkiv
• Thoresen, Siri & Mehlum, Lars (2003). Risk factors in subgroups of accidental death compared with suicide. Fulltekst i vitenarkiv
• Mehlum, Lars; Ystgaard, Mette; Ekeid, Gunnar & Mork, Erlend (2003). Psychosocial Follow-up after Parasuicide in Norwegian General Hospitals. Fulltekst i vitenarkiv Vis sammendrag

  Background: Routines and standards of care for parasuicide patients in general hospitals in Norway were reviewed in relation to international and national recommendations. Material and methods: Telephone interviews were conducted with personnel at all Norwegian general hospitals with emergency units. Fifty-five of a total of 58 hospitals participated (95%). Results: Two thirds of the hospitals reported that most parasuicide patients were routinely psychiatrically evaluated and then referred to psychiatric or community aftercare. At almost half of the hospitals (46%) the staff had, however, not received any specific training in clinical management of parasuicide patients during the last three years. Structured collaboration, regarding parasuicide patients, with external aftercare providers was non-existent in 43% of the hospitals. Hospitals with specific projects aimed at psychosocial follow-up of parasuicide patients or hospitals with a specific team or a person responsible for the follow-up, scored, however, significantly higher on a wide range of supplementary measures for the quality of care for parasuicide patients than hospitals without projects or teams. Interpretation: The study shows great variations between Norwegian general hospitals in their routines and standards of care for psychosocial follow-up of parasuicide patients. Increasing the staff&apos;s competence, developing written routines and establishing mutually binding co-operation between the hospital and external caregivers are important areas for further development. To establish a specific local team or key person dedicated to this type of work seems clearly to increase the quality of care for parasuicide patients.

• Mehlum, Lars (2003). Lessons learned from peace-keeping forces. Fulltekst i vitenarkiv
• Walby, Fredrik A.; Ødegaard, Erik; Ekeland, Harry & Mehlum, Lars (2003). Selvmord under og etter innleggelser i psykisk helsevern 1992-98. Fulltekst i vitenarkiv
• Walby, Fredrik A.; Ødegaard, Erik & Mehlum, Lars (2003). DSM-IV disorders, comorbidity and completed suicide after discharge from inpatient psychiatric care. Fulltekst i vitenarkiv
• Herrestad, Henning & Mehlum, Lars (2003). A comprehensive education programme in suicide prevention. Fulltekst i vitenarkiv
• Walby, Fredrik A.; Ødegaard, Erik & Mehlum, Lars (2003). DSM-IV disorders, comorbidity and suicide after discharge from inpatient psychiatric care. � A blind case-control study. Fulltekst i vitenarkiv
• Hestetun, Ingebjørg; Ystgaard, Mette; Loeb, Mitch & Mehlum, Lars (2003). Life adversities among suicide attempters in a life perspective. Fulltekst i vitenarkiv
• Mehlum, Lars (2003). Forslag til klinisk håndtering av kronisk suicidale pasienter. Fulltekst i vitenarkiv
• Mehlum, Lars (2003). Kliniske utfordringer i møte med selvmordsnære pasienter. Fulltekst i vitenarkiv
• Mehlum, Lars (2003). Den viktige behandlingskjeden. Fulltekst i vitenarkiv
• Mehlum, Lars (2003). Selvmordsforebyggende arbeid i Norge. Status og videre utfordringer. Fulltekst i vitenarkiv
• Mehlum, Lars (2002). Utbrent, arbeidsløs, ufrivillig beordret - hvor galt kan det gå? Fulltekst i vitenarkiv
• Thoresen, Siri & Mehlum, Lars (2002). Suicide and accidental death in peacekeepers: A psychological autopsy study. Fulltekst i vitenarkiv
• Mehlum, Lars (2002). Selvmordsforebygging. Fulltekst i vitenarkiv
• Mehlum, Lars (2002). Evaluation of national strategies for suicide prevention. Fulltekst i vitenarkiv
• Weisæth, Lars; Mehlum, Lars & Lie, Terje (2002). Traumatic Stressors in Terrorism: Norwegian Merchant Sailors in the Arabian Gulf 1984-1988. Fulltekst i vitenarkiv
• Mehlum, Lars (2002). National Strategies for Suicide Prevention - Norwegian Experiences. Fulltekst i vitenarkiv
• Mehlum, Lars & Dyregrov, Kari (2002). Strenghtened support for suicide survivors - from research to practice. Fulltekst i vitenarkiv
• Mehlum, Lars (2002). Suicidal Behaviour and Traumatic Stress. Fulltekst i vitenarkiv
• Mehlum, Lars (2002). Selvmordsforebyggende arbeid. Fulltekst i vitenarkiv
• Koldsland, Bjørn & Mehlum, Lars (2002). Military Observers - A Follow-Up Study Focusing on Mental Health and Social Adjustment of Norwegian Officers in the Years after Completed Missions. Fulltekst i vitenarkiv
• Hauge, Nils-Petter & Mehlum, Lars (2002). Health effects of downsizing and job insecurity: A prospective longitudinal study. Fulltekst i vitenarkiv Vis sammendrag

  The Norwegian Armed Forces have decided to reduce staff in peacetime by some 6 000 employees before 2005. In order to study possible ill-effects of downsizing and job insecurity a prospective longitudinal study of predictors of mental health problems in employees of three military bases was conducted. All employees received a comprehensive anonymous questionnaire at two time points (separated by 12 months) during the downsizing process. Response rates were generally favourable (at T1 - 77% and at T2 76%). Altogether 396 employees answered the questionnaire at T1 and 260 employees at T2. The 12-item General Health Questionnaire was used as a measure of mental health at both T1 and T2. Of those who reported favourable mental health at T1 (N=105), 68% reported to have retained their good health at T2 whereas 18% had a slight decrease in self-reported health. Fifteen percent had a substantially reduced mental health. GHQ12 was furthermore used as dependent variable in the analysis of predictors of mental health at T2.

• Thoresen, Siri; Mehlum, Lars & Møller, Bjørn (2002). Suicide in Peacekeepers: An Epidemiological Study of Suicide in 22,275 Veterans from Norwegian Peacekeeping Operations. Fulltekst i vitenarkiv
• Andreassen, Anne Lie; Thoresen, Siri & Mehlum, Lars (2002). Veterans from Peacekeeping: Evaluation of a Follow-Up Programme. Fulltekst i vitenarkiv
• Walby, Fredrik A.; Mehlum, Lars; Ødegaard, Erik & Hytten, Karsten (2002). Blinded case-control study of risk factors for suicide after discharge from psychiatric inpatient care: Preliminary results. Fulltekst i vitenarkiv Vis sammendrag

  Despite that psychiatric disorders per se, and the period after discharge from hospital, both are well established and very important high-risk factors for completed suicide, there is still a lack of studies investigating this using a control group design. A controlled design is necessary both to identify and quantify risk. Another methodological problem of earlier studies is that none of them have, to our knowledge, retrieved the information available with assessors blinded as to the suicide outcome. This creates a possible source of bias. Aims: To identify and quantify psychological, psychiatric and delivery of care related risk factors for completed suicide in patients after discharge from psychiatric hospitals using historical-prospective data from clinical records and other available written material. Method: All suicides within 3 years of discharge from inpatient care at all of the psychiatric hospitals and departments in Oslo, Norway were identified. Information on suicide date and method was gathered from the national population registry and cause of death registry. The cases were matched for age, gender and time of discharge to controls on a one to one basis. Information on risk factors was gathered from psychiatric clinical records with raters blinded to the case or control status of the patient and using a structured protocol including several rating scales. The information was checked for inter-rater reliability. Results: It proved feasible to obtain the data in a blinded fashion. Results from the inter-rater reliability analysis as well as preliminary results from multiple logistic regression analysis of risk factors will be presented.

• Mehlum, Lars (2002). Krisepsykiatri på svensk. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 122, s. 536–536. Fulltekst i vitenarkiv
• Hestetun, Ingebjørg; Ystgaard, Mette; Mehlum, Lars; Schjelderup, Georg & Loeb, Mitch (2001). Childhood abuse, soul murder and suicidal bahaviour. The Oslo follow-up study. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Studies have documented that abuse in childhood results in increased risk of later suicidal behaviour. Less is known about how these factors influence the suicidal process, and is focused on in the Oslo follow-up study of suicide attempters. Method: Comprehensive interviews were conducted on 74 patients who had been admitted to a general hospital after a suicide attempt. Information about childhood abuse was obtained by use of the Childhood Experience of Care and Abuse Interview (CECA). This instrument is based on an intensive semi-structured interview, and contextual ratings of a wide range of childhood events and experiences. Tendency to dissociate was measured by the Dissociative Experiences Scale (DES). Results: Within the group of suicide attempters those who had been exposed to childhood abuse showed more problems and lower functioning on several central areas, such as tendency to dissociate, general anxiety and post traumatic stress disorder (PTSD). Based on these findings the relation between child sexual abuse and suicidal behaviour will be discussed with reference to the concept of soul murder, and illustrated with a clinical case.

• Mehlum, Lars (2001). Dangers and possibilities of the internet in suicide prevention especially among young people. Fulltekst i vitenarkiv
• Mehlum, Lars (2001). Effective suicide prevention in the military. Fulltekst i vitenarkiv
• Mehlum, Lars (2001). Social and cultural correlates to youth suicide in postmodern Norway. Fulltekst i vitenarkiv
• Mehlum, Lars (2001). Selvmord og forebygging blant unge. Fulltekst i vitenarkiv
• Andreassen, Anne Lie; Thoresen, Siri & Mehlum, Lars (2001). Clinical follow-up of high-risk veterans from international military operations. Fulltekst i vitenarkiv
• Mehlum, Lars (2001). Fra forskning til forebyggelse. Fulltekst i vitenarkiv
• Mehlum, Lars; Mork, Erlend; Ekeid, Gunnar; Ystgaard, Mette & Holte, Arne (2001). Psychosocial follow-up after parasuicide in Norwegian General Hospitals. Fulltekst i vitenarkiv
• Mehlum, Lars (2001). Educational Aspects in National Strategies for Suicide Prevention. Fulltekst i vitenarkiv
• Mehlum, Lars (2001). Selvmord. Hvor stort er problemet og hva kan vi gjøre for å forebygge? Fulltekst i vitenarkiv
• Lunde, Ketil Berge; Qin, Ping; Mehlum, Lars & Melle, Ingrid (2025). Deliberate Self-Harm (DSH) in Young Adults: Patient Characteristics, Follow-Up Psychiatric Care, and Repetition Risk in Norwegian Public Healthcare. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

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

• Dibaj, Iselin Solerød; Mehlum, Lars & Tørmoen, Anita Johanna (2025). Long-term change in adolescents treated for deliberate self-harm and borderline features: Exploring the role of emotion dysregulation. Universitetet i Oslo. ISSN 9788234806247. Fulltekst i vitenarkiv Vis sammendrag

  Deliberate self-harm (DSH) peaks during adolescence and is associated with an increased risk of future suicide attempts and mental health problems. DSH can effectively be treated in adolescents, however, the long-term effects of such treatment in adulthood remained unknown when this study was conducted. To date, the treatment that has received the most empirical support in DSH treatment is Dialectical behaviour therapy for adolescents (DBT-A). The main aim of this PhD thesis was to examine adult life outcomes after DBT-A, both when it came to DSH as well as other outcomes, including suicidal ideation, and emotion regulation ability. The specific papers focused on treatment effects, response trajectories, and mechanisms of change. The study was a follow-up study of an RCT conducted 12 years earlier, comparing DBT-A with usual care for adolescents with repetitive DSH and features of borderline personality disorder. The sample was examined with structured interviews and self-report questionnaires at baseline, 1-, 3- and 12-years follow-up. At the final follow-up, participants also reported data through Ecological Momentary Assessment, by receiving short questionnaires six times daily on their phones over a week. DBT-A was associated with earlier and more robust reduction of DSH, however the difference between the groups diminished over time, and DSH was rarely reported in adulthood across the whole sample. As adults, the majority were either working or studying, and suicide attempts were rare. Moreover, DBT-A was associated with less suicidal ideation in adulthood. DBT-A participants also reported lower negative affect after having used coping skills in their daily life. Finally, remission of DSH one year after treatment was associated with better emotion regulation ability in adulthood. Overall, the findings in this thesis highlight the importance of early targeted intervention and suggest an optimistic long-term prognosis for adolescents who are treated for DSH, extending beyond symptom remission.

• 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.

• Neupane, Sudan Prasad; Fjelli, Nora; Bekkevold-Jernberg, Ina; Larsen, Kim Sverre; Kruse, Anja Emilie & Bergman, Solveig [Vis alle 8 forfattere av denne artikkelen] (2022). Selvmordsproblematikk blant utsatte for og utøvere av vold og overgrep: En systematisk gjennomgang av oversiktsartikler. N/A. Fulltekst i vitenarkiv
• Mork, Erlend & Mehlum, Lars (2014). Self-harm in patients with schizophrenia: risk factors and clinical characteristics. Universitetet i Oslo. Fulltekst i vitenarkiv
• Nrugham, Latha; Holen, Are & Mehlum, Lars (2010). Associates and predictors of attempted sucide among depressed adolescents. NTNU-trykk. ISSN 9788247125328. Fulltekst i vitenarkiv
• Mehlum, Lars; Dieserud, Gudrun Klemetsdal; Ekeberg, Øivind; Grøholt, Berit; Mellesdal, Liv Solrunn & Walby, Fredrik A [Vis alle 7 forfattere av denne artikkelen] (2007). Forebygging av selvmord, del 2. Folkehelseinstituttet. ISSN 9788281211469. Fulltekst i vitenarkiv Vis sammendrag

  Rapporten er utarbeidet etter oppdrag fra Sosial- og helsedirektoratet og er ment å være en del av grunnlagsmaterialet ved utarbeidelsen av nasjonale retningslinjer for selvmordsforebyggende arbeid i psykiatrisk spesialisthelsetjeneste.

• Mehlum, Lars; Dieserud, Gudrun Klemetsdal; Ekeberg, Øivind; Grøholt, Berit; Mellesdal, Liv Solrunn & Walby, Fredrik A [Vis alle 7 forfattere av denne artikkelen] (2006). Forebygging av selvmord, del 1: Psykoterapi, medikamentelle intervensjoner og elektrokonvulsiv terapi. Folkehelseinstituttet. ISSN 9788281211322. Fulltekst i vitenarkiv Vis sammendrag

  Kunnskapsoppsummeringen omhandler effekt av selvmordsforebyggende tiltak i psykiatrisk spesialisthelsetjeneste. Foreliggende delrapport 1 omhandler psykoterapi, medikamentelle intervensjoner og elektrokonvulsiv terapi. Rapporten er utarbeidet etter oppdrag fra Sosial- og helsedirektoratet og er ment å være en del av grunnlagsmaterialet ved utarbeidelsen av nasjonale retningslinjer for selvmordsforebyggende arbeid i psykiatrisk spesialisthelsetjeneste.

• Ystgaard, Mette; Husby, Jorulf & Mehlum, Lars (2002). Mestring, hjelp og støtte. Resultater fra videregående skole i Hedmark. Seksjon for selvmordsforskning og -forebygging. Fulltekst i vitenarkiv
• Andreassen, Anne Lie; Thoresen, Siri & Mehlum, Lars (2002). Oppfølgingsstudie av repatriert og traumatisert personell. FO/SAN og Universitetet i OSLO. Fulltekst i vitenarkiv
• Andreassen, Anne Lie; Thoresen, Siri & Mehlum, Lars (2002). Traumeeksponert og repatriert personell fra militært FN/NATO-operasjoner. Rapport fra en oppfølgingsundersøkelse. Forsvarets Overkomando. Sanitetsstaben. Kontor for psykiatri. Fulltekst i vitenarkiv
• Ystgaard, Mette; Reinholdt, Nils Petter & Mehlum, Lars (2001). Mestring, hjelp og støtte. Resultater fra videregående skole i Oppland. Universitetet i Oslo. Fulltekst i vitenarkiv
• Ystgaard, Mette; Reinholdt, Nils Petter & Mehlum, Lars (2001). Mestring, hjelp og støtte. Resultater fra videregående skole i Oppland. Universitetet i Oslo. Fulltekst i vitenarkiv
• Amundsen, Kirsti; Mehlum, Lars & Schjelderup, Georg (2001). Humanistisk-medisinske perspektiver på selvmord og forebygging. Universitetet i Oslo. ISSN 9788299581608. Fulltekst i vitenarkiv Vis sammendrag

  Fra selvmordsforståelse til forebygging var temaet for en nordisk konferanse i Oslo våren 1999. I denne boka foreligger det et utvalg av de viktigste foredragene under konferansen. Formålet var å få belyst selvmordstematikken i et perspektiv utover det medisinske og psykologiske. I artiklene drøftes selvmord og selvmordsatferd ut fra filosofisk, kulturelt, sosiologisk, psykosomatisk og psykiatrisk perspektiv. I egne kapitler blir dessuten de nasjonale handlingsplanene mot selvmord i Finland, Sverige, Grønland, Danmark og Norge presentert og diskutert. Boka gir et godt utgangspunkt for refleksjon over årsakene til selvmord i ulike teoretiske perspektiver, og drøfter konsekvenser for forebygging.

• Amundsen, Kirsti; Mehlum, Lars & Schjelderup, Georg (2001). Humanistisk-medisinske perspektiver på selvmord og forebygging. Universitetet i Oslo. ISSN 9788299581608. Fulltekst i vitenarkiv
• Amundsen, Kirsti; Mehlum, Lars & Schjelderup, Georg (2001). Humanistisk-medisinske perspektiver på selvmord og forebygging. Universitetet i Oslo. ISSN 9788299581608. Fulltekst i vitenarkiv
• Amundsen, Kirsti; Mehlum, Lars & Schjelderup, Georg (2001). Humanistisk-medisinske perspektiver på selvmord og forebygging. Universitetet i Oslo. ISSN 9788299581608. Fulltekst i vitenarkiv

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