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

AbstractObjectiveDesignSettingSubjectsMain outcome measuresResultsConclusionImplications\nKEY POINTSTo describe and compare contacts regarding self-injurious thoughts and behaviours to other contacts to emergency primary care.Observational study.A sentinel network of seven emergency primary care centres throughout Norway.Initial contacts regarding patients 10 years and older during 12 consecutive months (11/2021–10/2022).Contacts due to self-injurious thoughts and behaviours.Self-injurious thoughts and behaviours were the reason for contact for 0.6% (n = 478) of initial contacts for patients aged 10 years or older (n = 77 344). When compared to other contacts, self-injurious thoughts and behaviours were associated with female gender, younger age, occurrence during evening and nighttime, higher urgency, and more physician consultations and call-outs. Of contacts about self-injurious thoughts and behaviours, 58.2% were regarding thoughts and 41.8% about behaviours, and in 75.0% a history of similar contacts was recorded. Contacts regarding thoughts often concerned threats (30.6%) and were more often handled by telephone advice than contacts regarding behaviours. Contacts regarding behaviours with suicidal intent were associated with higher urgency and more physician call-outs than contacts regarding non-suicidal behaviours.Self-injurious thoughts and behaviours are rare reasons for contact to emergency primary care but are assessed as more urgent than other contact reasons and trigger more extensive medical help. Many of the patients are known to the service through a history of similar contacts.The infrequency and severity of these encounters might necessitate training, decision support and procedures to compensate for the health care personnel’s limited exposure.Self-injurious thoughts and behaviours are major health concerns which are associated with need for immediate medical care. Within Norwegian emergency primary care, self-injurious thoughts and behaviours were rare but urgent contact reasons requiring relatively extensive medical help.Many patients with self-injurious thoughts and behaviours had a history of similar contacts indicating the need for integral care.Training, decision support and procedures may be needed to compensate for limited exposure in daily work.Within Norwegian emergency primary care, self-injurious thoughts and behaviours were rare but urgent contact reasons requiring relatively extensive medical help.Many patients with self-injurious thoughts and behaviours had a history of similar contacts indicating the need for integral care.Training, decision support and procedures may be needed to compensate for limited exposure in daily work. [ABSTRACT FROM AUTHOR]

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. 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. 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)). 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. [ABSTRACT FROM AUTHOR]

According to the cry of pain model of suicidal behavior, an over-general autobiographical memory function is often found in suicide attempters. The model has received empirical support in several studies, mainly of depressed patients. The present study investigated whether deficits in autobiographical memory may be associated with an increased frequency of suicide attempts in patients with schizophrenia. We found support for our hypothesis that patients with schizophrenia and previous suicide attempts have an over-generalized autobiographical memory compared to patients with schizophrenia without previous suicide attempts. Adjustment for sociodemographic and clinical variables did not change the results.

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

Abstract Background Rating scales are valuable tools in suicide research and can also be useful supplements to the clinical interview in suicide risk assessments. This study describes the psychometric properties of a Norwegian language version of the Suicide Assessment Scale Self-report version (SUAS-S). Methods Participants were fifty-two patients (mean age = 39.3 years, SD = 10.7) with major depression (53.8%), bipolar disorder (25.0%) and/or a personality disorder (63.5%) referred to a psychiatric outpatient clinic. The SUAS-S, the screening section of the Beck Scale for Suicidal Ideation (BSS-5), the Beck Depression Inventory (BDI), Beck’s Hopelessness Scale (BHS), the Symptom Check-List-90 R (SCL-90R) and the Clinical Global Impression for Severity of Suicidality (CGI-SS) were administered. One week later, the patients completed the SUAS-S a second time. Results Cronbach’s alpha for SUAS-S was 0.88 and the test–retest reliability was 0.95 (95% CI: 0.93– 0.97). SUAS-S was positively correlated with the BSS-5 (r = 0.66; 95% CI: 0.47–0.85) for the study sample as a whole and for the suicidal (r = 0.52) and non-suicidal groups (r = 0.50) respectively. There was no difference between the SUAS-S and the BSS-5 in the ability to identify suicidality. This ability was more pronounced when the suicide risk was high. There was a substantial intercorrelation between the score on the SUAS-S and the BDI (0.81) and the BHS (0.76). The sensitivity and specificity of the SUAS-S was explored and an appropriate clinical cut-off value was assessed. Conclusions The study revealed good internal consistency, test–retest reliability and concurrent validity for the Suicide Assessment Scale Self-report version. The discriminatory ability for suicidality was comparable to that of the BSS-5.