Suicide and suicide attempts
Suicide is a public health problem. During the 1980s and 1990s, suicide rates decreased in Sweden, but during the 2000s there has been no further decrease. At the same time, there has been a sharp increase in suicide attempts and self-harm in recent decades, especially in young women but also in young men.
We study how to understand and manage the risk of suicide, in several studies on people who have already made a suicide attempt. We base our studies on register data as well as near-patient research, with assessments of suicide risk in patients. We have taken a particular interest in young people; for example, students. The common purpose is to find ways to understand suicidal behaviour and to prevent suicide. We work in close collaboration with Norra Stockholm Psychiatry (NSP), which harbours Sweden's largest psychiatric emergency department. We have studied the importance of a screening instrument for suicidal behaviour, which is used in all emergency room visits. We and NSP are now participating in a randomized, controlled multicenter study led by Lund University to evaluate the effect of the psychological treatment ASSIP (Attempted Suicide Short Intervention Program) for people who have attempted suicide.
Our group has shown that mental illness such as schizophrenia and affective disorder significantly increases the risk of dying by suicide after a suicide attempt compared to less severe mental disorders. Also among young people, psychosis is an important risk factor after suicide attempts. Using a violent method in suicide attempts increases the risk of later suicide. Among people who have been provided health care for self-harm in adolescence, men have a greater impact on social function in adulthood than do women, while the likelihood of later suicide or mental illness does not differ between boys and girls who have been treated for self-harm. In a unique study of more than 18,000 patients in a psychiatric emergency department where the outcome was completed suicide within a very short time after the emergency visit, the screening instrument C-SSRS Screen shows a value for predicting suicide. Resultas indicate that this instrument might be useful for triage and evaluation of patient safety aspects upon arrival at the psychiatric emergency department.
Transcultural psychiatry
Part of our group is linked to the Transcultural Centre - Region Stockholm's Knowledge Centre in Transcultural Psychiatry and Issues related to Migration and Health. We have expertise in qualitative research methods and have several research collaborations, e.g on asylum seekers and suicide and on development of culturally sensitive psychiatric diagnostics. We further participate in the project "Early intervention for newly arrived children" (TINA), run by the research group EPiCSS at the Department of Global Public Health at Karolinska Institutet. The TINA project aims to find new ways of overcoming barriers for children with migration backgrounds, to access of early support for mental illness. We are also involved in evaluations of education efforts on migration and mental health offered to healthcare professionals and in a project on welfare needs of the Sami population in Region Stockholm in collaboration with the Sami Society in Stockholm.
Research projects
- Suicide among university students
- Suicide among those who have not had contact with psychiatric care
- Clinical trial of suicide preventive psychological treatment (multicenter study in collaboration with Region Skåne)
- Development of culture-sensitive psychiatric diagnostics according to DSM-5
- "Early intervention for newly arrived children" (TINA) run by the research group EPiCSS at the Department of Global Public Health at Karolinska Institutet
- Being Sami in a big city. Mental health, care experiences and care needs.
Selected Publications
Columbia-Suicide Severity Rating Scale Screen Version: initial screening for suicide risk in a psychiatric emergency department
Bjureberg, J; Dahlin, M; Carlborg, A; Edberg, H; Haglund, A; Runeson, B.
Psychol Med. 2021 Mar 26;1-9.doi: 10.1017/S0033291721000751. Online ahead of print.
Suicide
Fazel, S, Runeson.
N Engl J Med 2020; 382:266-274. DOI: 10.1056/NEJMra1902944
Predicting suicide: A comparison between clinical suicide risk assessment and the Suicide Intent Scale
Lindh, AU; Beckman, K; Carlborg, A; Waern, M; Renberg, ES; Dahlin, M; Runeson, B
J Affect Disord. 2020 Feb 15;263:445-449. doi: 10.1016/j.jad.2019.11.131. Epub 2019 Nov 30.
Patients’ and clinicians’ experiences with the DSM-5 Cultural Formulation Interview– a mixed method study in a Swedish outpatient setting.
Idar Wallin M, Dahlin M, Nevonen L, Bäärnhielm S
Transcultural Psychiatry. 2020 57:4: 542-555
Differences in psychiatric care utilisation among unaccompanied refugee minors, accompanied migrant minors, and Swedish born minors.
Axelsson L, Bäärnhielm S, Dalman C, Hollander AC. (2020).
Social Psychiatry and Psychiatric Epidemiology. 55,1449–1456(2020)
Psychiatric care use among migrants to Sweden compared with Swedish-born residents: a longitudinal cohort study of 5,150,753 people.
Hollander AC, Mackay E, Sjöqvist H, Kirkbride J, Bäärnhielm S, Dalman C. (2020). BMJ Global Health136/bmjgh-2020-002471
Impulsive suicide attempts among young people-A prospective multicentre cohort study in Sweden.
Beckman K, Lindh AU, Waern M, Stromsten L, Renberg ES, Runeson B, et al
J Affect Disord 2019 01;243():421-426
Traditional Chinese Medicine. Explanatory Models of Depressive Disorders: a Qualitative Study.
Kam W, Zhang Z-J, Bäärnhielm S.
Cult Med Psychiatry 43, 387–403 (2019)
Method of self-harm in adolescents and young adults and risk of subsequent suicide.
Beckman K, Mittendorfer-Rutz E, Waern M, Larsson H, Runeson B, Dahlin M
J Child Psychol Psychiatry 2018 Sep;59(9):948-956
Challenges of Combining Perspectives.
Sundvall M, Titelman D, Bäärnhielm S
Crisis 2018 Sep;39(5):326-334
Suicide risk after nonfatal self-harm: a national cohort study, 2000-2008.
Runeson B, Haglund A, Lichtenstein P, Tidemalm D
J Clin Psychiatry 2016 02;77(2):240-6
Risk of suicide and self-harm in university students entering different university programs - a national register-based cohort study in Sweden
Lageborn, Christine Takami ; Bjureberg, Johan ; Song, Jie ; Runeson, Bo ; Möller, Jette ; Ljung, Rickard ; Dahlin, Marie
Social Psychiatry and Psychiatric Epidemiology, 2023