Suicide research in Sweden from the early 1990’s until 2014
This review of suicide research in Sweden from the early 1990’s until 2014 was written by NASP, June 2014.
Description of the research
Suicide is a major public health problem worldwide and suicide research activities are therefore imperative. In Sweden, suicide research can be categorized into eight somewhat overlapping research areas:
- epidemiology and register studies;
- neurobiology and genetics;
- suicide risk assessment,
- treatment and care;
- public health interventions;
- suicide bereavement and euthanasia;
- suicide in low- and middle-income countries (LAMIC); as well as the
- suicidal experience and process in general.
The description below is a short report of the Swedish suicide research produced from the early 1990’s, published in international scientific journals. The scope of this review was limited to studies with an exclusive focus on the topic of suicidality. Papers related to, for instance, the determinants of depression, schizophrenia, or other mental health problems without an explicit intent to investigate suicidality were not included. Over of 540 papers were reviewed of which approximately 130 are cited in this document as examples of Swedish suicide research.
Epidemiology and register studies
A large number of studies from Sweden have focused on identifying factors associated with suicide. The aim of this type of research is to identify factors that can be addressed to reduce suicidality and to improve suicide risk assessment. For example, research targeting different aspects of alcohol consumption such as the early studies by the research group of Wasserman et al. (e.g., Wasserman, Värnik, & Eklund, 1994, 1998; Wasserman & Värnik, 1998) and Berglund et al. (e.g., Berglund & Ojehagen, 1998; Berglund, 1984) have increased the knowledge about the association between harmful use of alcohol and the risk of suicide.
These studies have had significant international impact. Similarly, a large number of studies have focused on the association of mental disorders to suicidality. These include research by the groups of Runeson et al. (e.g., Tidemalm, Långström, Lichtenstein, & Runeson, 2008), Wasserman et al. (e.g., Balázs et al., 2013; Bertolote, Fleischmann, De Leo, & Wasserman, 2003; 2004), Nordström et al. (e.g., Carlborg, Jokinen, Nordström, Jönsson, & Nordström, 2010; Carlborg, Winnerbäck, Jönsson, Jokinen, & Nordström, 2010) and Berglund et al. (e.g., Brådvik & Berglund, 2010, 2011).
In addition, research in Sweden has also been focused on understanding and identifying other individual risk factors that relate to suicidal behaviours. These include: exposure to adversity (e.g., Söderberg, Kullgren, & Salander Renberg, 2004), personality traits (e.g., Allebeck, Allgulander, & Fisher, 1988; Hirvikoski & Jokinen, 2012), intelligence (e.g., Gunnell, Magnusson, & Rasmussen, 2005), and physical illness and features (e.g., Allebeck, Bolund, & Ringbäck, 1989; Jiang, Rasmussen, & Wasserman, 1999; Magnusson, Rasmussen, Lawlor, Tynelius, & Gunnell, 2006; Sundström et al., 2010), as well as research family, relationship, life-styles and other societal factors (e.g., Carli, Mandelli et al., 2014; Ferrada-Noli & Asberg, 1997; Durkee et al., 2012; Johansson, Sundquist, Johansson, Qvist, & Bergman, 1997; Kuramoto & Runeson, 2013; Magne-Ingvar, Ojehagen, & Träskman-Bendz, 1992; Mittendorfer-Rutz, Rasmussen, & Wasserman, 2004; Moniruzzaman & Andersson, 2004; Sarchiapone et al., 2014; Schmidtke et al., 1996).
A number of studies in Sweden have also focused on understanding the prevalence, trends and patterns of suicide in Sweden, Europe and the world through epidemiological studies (e.g., Chotai & Salander Renberg, 2002; Cullberg, Wasserman, & Stefansson, 1988; Runeson, Tidemalm, Dahlin, Lichtenstein, & Långström, 2010; Schmidtke et al., 1996; Schmidtke et al., 1999; Värnik & Wasserman, 1992; Värnik, Kõlves, & Wasserman, 2005; Wasserman & Värnik, 1998a).
Although some risk factors for suicide are non-modifiable, such as gender, these can be useful in identifying risk groups. Selective suicide-prevention interventions can then target other modifiable risk factors, such as mental disorders, that may be present among a risk group. Research in Sweden concerning high risk groups has mainly focused on understanding suicidal behaviours among young people (e.g., Brunner et al., 2014; Carli, Hoven et al., 2014; Hawton et al., 1998; Hultén et al., 2001; Kosidou et al., 2013; Runeson & Beskow, 1991; Runeson, 1990; Mittendorfer-Rutz & Wasserman, 2004; Wasserman, Cheng, & Jiang, 2005) the elderly (e.g., De Leo et al., 2001; Fässberg et al., 2012; Rubenowitz, Waern, Wilhelmson, & Allebeck, 2001; Waern, Rubenowitz, & Wilhelmson, 2003; Waern, Rubenowitz, et al., 2002; Waern, Runeson, et al., 2002) and among immigrants and adoptees (e.g., Bursztein Lipsicas et al., 2012; Ferrada-Noli, Asberg, Ormstad, & Nordström, 1995; Hjern & Allebeck, 2002; Hjern, Lindblad, & Vinnerljung, 2002; Värnik, Kolves, & Wasserman, 2005) as well as the unemployed (Garcy & Vågerö, 2012; 2013; Lundin, Lundberg, Allebeck, & Hemmingsson, 2012).
Neurobiology and genetics
The risk of suicide can also be influenced by individual vulnerability or resiliency related to genetic and biological factors. For example, the role of genetics in suicidal behaviours has been investigated extensively by the research group of Wasserman et al. (e.g., Ben-Efraim, Wasserman, Wasserman, & Sokolowski, 2013; Geijer et al., 2000; Sokolowski, Ben-Efraim, Wasserman, & Wasserman, 2013; Sokolowski, Wasserman, & Wasserman, 2010; Wasserman, Terenius, Wasserman, & Sokolowski, 2010), with particular focus on gene-environment interactions regarding serotonergic as well as HPA-axis related genes.
The group of Åsberg and Träskman-Bendz et al. has investigated genetic and also neurobiological markers of suicidal behaviour such as specific serotonergic, dopaminergic and HPA activity (e.g., Engström, Alling, Blennow, Regnéll, & Träskman-Bendz, 1999; Jones et al., 1990; Nässberger & Träskman-Bendz, 1993; Träskman, Asberg, Bertilsson, & Sjöstrand, 1981; Träskman et al., 1980), as has the research group of Nordström (e.g., Jokinen, Nordström, & Nordström, 2009; Jokinen & Nordström, 2009; Nordström & Åsberg, 1992) but also others (e.g., Asberg, 1997; Lidberg, Åsberg, & Sundqvist-Stensman, 1984; Lidberg, Tuck, Åsberg, Scalia-Tomba, & Bertilsson, 1985).
Suicidality has also been investigated in relation to the biology of mental disorders (Ekström, Lavebratt, & Schalling, 2012; Johansson et al., 2001) as well as inflammatory factors (Hallberg et al., 2010; Janelidze, Mattei, Westrin, Träskman-Bendz, & Brundin, 2011).
Suicide risk assessment
Suicide assessment for identifying individuals at suicide-risk through screening tools has also been studied extensively in Sweden. Focus has been on the development of new psychometric tools, as well as validating existing ones (Jokinen et al., 2010; Stefansson, Nordström, & Jokinen, 2012; Waern, Sjöström, Marlow, & Hetta, 2010).
Psychological tests have also been developed for screening, such as those measuring participants reactions to subliminal exposures of clinically specific stimuli (Titelman, Nilsson, Estari, & Wasserman, 2004; Titelman, Nilsson, Svensson, Karlsson, & Bruchfeld, 2011) as well as biochemical/biological tests looking at dexamethasone suppression or skin conductance (Jokinen et al 2008; Thorell et al 2013).
Treatment and care
The research in Sweden regarding the treatment of suicidality has mainly been focused on psychopharmacological treatment with antidepressants (e.g., Brådvik & Berglund, 2011a; Isacsson, Holmgren, Wasserman, & Bergman, 1994, 1995; Göran Isacsson, Rich, Jureidini, & Raven, 2010). Other studies researched the management, follow-up and care of suicidal people in both Sweden and Europe (e.g., Bursztein Lipsicas et al., 2014; Hultén et al., 2000; Runeson & Wasserman, 1994; Talseth, Lindseth, Jacobsson, & Norberg, 1999).
Public health interventions
A number of large-scale international randomised controlled trials (RCT) of awareness and coping skills increasing programmes among young people have been coordinated by the Swedish research group of Wasserman in collaboration with several EU countries but not in Sweden. These have investigated the effectiveness of suicide prevention programmes aimed at the specific subgroups of the general public, such as adolescents (e.g., Balázs et al., 2013; Brunner et al., 2014; Carli, Hoven et al., 2014; Carli et al., 2013; Hoven, Wasserman, Wasserman, & Mandell, 2009; Kaess et al., 2013; Sarchiapone et al., 2014; C. Wasserman et al., 2012; D. Wasserman et al., 2010).
In addition, early work by Rutz has investigated the effectiveness of programmes for training health workers (e.g. GPs) for suicide prevention (e.g., Rutz, von Knorring, & Wålinder, 1989; Rutz, Knorring, Pihlgren, Rihmer, & Wålinder, 1995) with influence to other European countries.
Other research in Sweden regarding public health has been focused on understanding attitudes towards suicidal people across different groups (e.g., Renberg & Jacobsson, 2003; Samuelsson, Asberg, & Gustavsson, 1997), investigating the effects of alcohol-related policies for suicide prevention (e.g., Wasserman & Värnik, 1998b; Wasserman, Värnik, Kolves, & Toodling, 2007) and restricting access to common means of suicide (e.g., Beskow, Thorson, & Öström, 1994).
Suicide bereavement and euthanasia
Studies in Sweden have also focused on understanding the impact on friends and family of suicide attempters and completers (e.g., Magne-Ingvar & Öjehagen, 1999; Omerov, Steineck, Nyberg, Runeson, & Nyberg, 2013; Runeson & Beskow, 1991b; C. Wasserman et al., 2012) and euthanasia, (e.g., Wasserman, 1989).
The suicidal experience and process
Studies on the suicidal experience and process are important for increasing the knowledge about suicidality and the improvement of treatment, care and prevention of suicide. Although research focusing on the patients’ experience and the process of suicidality is generally limited, a number of Swedish studies have focused on understanding suicidality and provided insight into these issues (e.g., Hjelmeland et al., 2002; Omma, Sandlund, & Jacobsson, 2013; Runeson, Beskow, & Waern, 1996; Wasserman 1990a; 1990b).
A number of studies in Sweden have carried out research regarding suicide in low-and middle-income countries. These include for example research regarding the prevalence, risk and protective factors, interventions, understanding the suicidal process and expression, and attitudes toward suicide in LAMIC countries (e.g., Ahmadi, 2007; Bertolote et al., 2005, 2010; Burrows & Laflamme, 2008; Fleischmann, 2008; Fleischmann et al., 2005; Mofidi, Ghazinour, Salander-Renberg, & Richter, 2008; Ovuga, Boardman, & Wasserman, 2005; Rodríguez, Caldera, Kullgren, & Renberg, 2006; Sundbom, Jacobsson, Kullgren, & Penayo, 1998; Thanh et al., 2005).
Impact, Strengths and weaknesses
Swedish suicide research using epidemiological, cohort and other designs, aimed at identifying correlates to suicidality has a significant impact on the general understanding of risk and protective factors in suicide. The research carried out using the numerous high quality registries in Sweden and findings have great synergistic potential with other international research. However it’s important to note that risk-and protective factors identified in high income countries might not be applicable or even valid predictors of suicide in LAMIC countries (due to contextual differences). Intercultural and international application of the epidemiologic findings can in this way be challenging.
Most epidemiologic, genetic neurobiological research programmes are aimed at identifying correlates to suicidal behaviour. Although this type of information is useful in screening programs, it is difficult to assess what actual role these correlates play in the causal process that precedes a suicide. Specific studies aimed at disentangling the relationship between correlates, causes and effects make up a small proportion of the research in suicide in Sweden and elsewhere.
Swedish research programmes aimed at the rigorous evaluation of suicide prevention activities on universal, selected or indicated populations appear to be high in quality even compared to other international research, but unfortunately low in quantity (perhaps reflecting a lack of research funding).
In conclusion, suicide research conducted in Sweden is of high quality and has a significant international impact. Research group leaders create a strong next generation of researchers who provide a strong ground for the continuity and sustainability of future suicide research in Sweden.
In order to implement the nine suicide preventive strategies approved by the Swedish parliament and the Swedish government (Regeringsprop 2007/08:110) there is a considerable lack of the following research in order to assure a scientifically grounded implementation. Therefore, I recommend support to studies according to the list below.
- Intervention studies of suicide preventive methods in schools, workplaces and at the community level.
- Clinical treatment studies of well-defined (phenotype and genotype) psychiatric patient groups.
- Qualitative studies on how to improve the adherence, and implementation of policies and guidelines in public health and clinical suicide prevention.
- Studies regarding the effects of taboo and stigmatization surrounding suicide, on public health and clinical actions.
- Studies focused on anthropological aspects of suicidality and suicide prevention in minorities and in cross-cultural settings.
- Studies aimed at the rigorous falsification or validation existing psychological and neurobiological models of suicidality.
In the following strong areas of suicide research in Sweden, continued support of ongoing studies is needed:
- Studies designed to utilize the information from available high quality registers in Sweden.
- Research on neurobiological and genetic factors.
Ahmadi, A. (2007). Suicide by self-immolation: comprehensive overview, experiences and suggestions. J Burn Care Res., 28(1), 30-41.
Allebeck, P., Allgulander, C., & Fisher, L. D. (1988). Predictors of completed suicide in a cohort of 50,465 young men: role of personality and deviant behaviour. BMJ (Clinical Research Ed.), 297(6642), 176–8.
Allebeck, P., Bolund, C., & Ringbäck, G. (1989). Increased suicide rate in cancer patients: A cohort study based on the Swedish cancer-environment register. Journal of Clinical Epidemiology, 42(7), 611–616.
Asberg, M. (1997). Neurotransmitters and suicidal behavior. The evidence from cerebrospinal fluid studies. Annals of the New York Academy of Sciences, 836(5454), 158–81.
Balázs, J., Miklósi, M., Keresztény, A., Hoven, C. W., Carli, V., Wasserman, C., Apter, A., . . . Wasserman, D. (2013). Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. J Child Psychol Psychiatry, 54(6), 670-677. doi: 10.1111/jcpp.12016.
Ben-Efraim, Y. J., Wasserman, D., Wasserman, J., & Sokolowski, M. (2013). Family-based study of HTR2A in suicide attempts: observed gene, gene × environment and parent-of-origin associations. Molecular Psychiatry, 18(7), 758–66. doi:10.1038/mp.2012.86
Berglund, M. (1984). Suicide in alcoholism. A prospective study of 88 suicides: 1. The multidimensional diagnosis at first admission. Archives of General Psychiatry, 41, 888–891. doi:10.1080/08039480510023007
Berglund, M., & Ojehagen, A. (1998). The Influence of Alcohol Drinking and Alcohol Use Disorders on Psychiatric Disorders and Suicidal Behavior. Alcoholism: Clinical and Experimental Research, 22(7), 333S–345S.
Bertolote, J. M., Fleischmann, A., De Leo, D., Bolhari, J., Botega, N., De Silva, D., … Wasserman, D. (2005). Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey. Psychological Medicine, 35(10), 1457–65. doi:10.1017/S0033291705005404
Bertolote, J. M., Fleischmann, A., De Leo, D., Phillips, M. R., Botega, N. J., Vijayakumar, L., … Wasserman, D. (2010). Repetition of suicide attempts: data from emergency care settings in five culturally different low- and middle-income countries participating in the WHO SUPRE-MISS Study. Crisis, 31(4), 194–201. doi:10.1027/0027-5910/a000052
Bertolote, J. M., Fleischmann, A., De Leo, D., & Wasserman, D. (2003). Suicide and mental disorders: do we know enough? The British Journal of Psychiatry : The Journal of Mental Science, 183, 382–3.
Bertolote, J. M., Fleischmann, A., De Leo, D., & Wasserman, D. (2004). Psychiatric diagnoses and suicide: revisiting the evidence. Crisis, 25(4), 147–155.
Beskow, J., Thorson, J., & Öström, M. (1994). National suicide prevention programme and railway suicide. Social Science & Medicine, 38(3), 447–451.
Brunner, R., Kaess, M., Parzer, P., Fischer, G., Carli, V., Hoven, C. W., Wasserman, C., . . . Wasserman, D. (2014). Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: a comparative study of findings in 11 European countries. J Child Psychol Psychiatry, 55(4), 337-348. doi: 10.1111/jcpp.12166.
Brådvik, L., & Berglund, M. (2010). Depressive episodes with suicide attempts in severe depression: suicides and controls differ only in the later episodes of unipolar depression. Archives of Suicide Research : Official Journal of the International Academy for Suicide Research, 14(4), 363–7. doi:10.1080/13811118.2010.524068
Brådvik, L., & Berglund, M. (2011a). Antidepressant therapy in severe depression may have different effects on ego-dystonic and ego-syntonic suicidal ideation. Depression Research and Treatment, 2011, 896395. doi:10.1155/2011/896395
Brådvik, L., & Berglund, M. (2011b). Repetition of suicide attempts across episodes of severe depression. Behavioural sensitisation found in suicide group but not in controls. BMC Psychiatry, 11(1), 5. doi:10.1186/1471-244X-11-5
Burrows, S., & Laflamme, L. (2008). Suicide among urban South African adolescents. Int J Adolesc Med Health, 20(4), 519-28.
Bursztein Lipsicas, C., Mäkinen, I. H., Apter, A., De Leo, D., Kerkhof, A., Lönnqvist, J., … Wasserman, D. (2012). Attempted suicide among immigrants in European countries: an international perspective. Social Psychiatry and Psychiatric Epidemiology, 47(2), 241–51. doi:10.1007/s00127-010-0336-6
Bursztein Lipsicas, C., Mäkinen, I. H., Wasserman, D., Apter, A., Bobes, J., Kerkhof, A., … Schmidtke, A. (2014). Immigration and recommended care after a suicide attempt in Europe: equity or bias? European Journal of Public Health, 24(1), 63–5. doi:10.1093/eurpub/ckt090
Carlborg, A., Jokinen, J., Nordström, A.-L., Jönsson, E. G., & Nordström, P. (2010). Attempted suicide predicts suicide risk in schizophrenia spectrum psychosis. Nordic Journal of Psychiatry, 64(1), 68–72. doi:10.3109/08039480903274431
Carlborg, A., Winnerbäck, K., Jönsson, E. G., Jokinen, J., & Nordström, P. (2010). Suicide in schizophrenia. Expert Review of Neurotherapeutics, 10(7), 1153–64. doi:10.1586/ern.10.82
Carli, V., Mandelli, L., Zaninotto, L., Iosue, M., Hadlaczky, G., Wasserman, D., … Sarchiapone, M. (2014). Serious suicidal behaviors: socio-demographic and clinical features in a multinational, multicenter sample. Nordic Journal of Psychiatry, 68(1), 44–52. doi:10.3109/08039488.2013.767934
Carli, Vl., Hoven, Ch. W., Wasserman, Ca., Chiesa, F., Guffanti, G., Sarchiapone, M., … Wasserman, D. (2014). A newly identified group of adolescents at “ invisible” risk for psychopathology and suicidal behavior: findings from the SEYLE study. World Psychiatry, 13, 78–86.
Carli, V., Wasserman, C., Wasserman, D., Sarchiapone, M., Apter, A., Balazs, J., Bobes, J., . . . Hoven, C. W. (2013). The saving and empowering young lives in Europe (SEYLE) randomized controlled trial (RCT): methodological issues and participant characteristics. BMC Public Health, 13, 479. doi: 10.1186/1471-2458-13-479.
Chotai, J., & Salander Renberg, E. (2002). Season of birth variations in suicide methods in relation to any history of psychiatric contacts support an independent suicidality trait. Journal of Affective Disorders, 69(1-3), 69–81.
Cullberg, J., Wasserman, D., & Stefansson, C. G. (1988). Who commits suicide after a suicide attempt? An 8 to 10 year follow up in a suburban catchment area. Acta Psychiatrica Scandinavica, 77(5), 598–603.
De Leo, D., Padoani, W., Scocco, P., Lie, D., Bille-Brahe, U., Arensman, E., … Faria, S. (2001). Attempted and completed suicide in older subjects: results from the WHO/EURO Multicentre Study of Suicidal Behaviour. International Journal of Geriatric Psychiatry, 16(3), 300–10.
Durkee, T., Kaess, M., Carli, V., Parzer, P., Wasserman, C., Floderus, B., Apter, A., . . . Wasserman, D. (2012). Prevalence of pathological internet use among adolescents in Europe: demographic and social factors. Addiction, 107(12), 2210-2222. doi: 10.1111/j.1360-0443.2012.03946.x
Ekström, T. J., Lavebratt, C., & Schalling, M. (2012). The importance of epigenomic studies in schizophrenia. Epigenomics, 4(4), 359-62. doi: 10.2217/epi.12.33.
Engström, G., Alling, C., Blennow, K., Regnéll, G., & Träskman-Bendz, L. (1999). Reduced cerebrospinal HVA concentrations and HVA/5-HIAA ratios in suicide attempters. Monoamine metabolites in 120 suicide attempters and 47 controls. European Neuropsychopharmacology, 9(5), 399–405.
Fässberg, M. M., van Orden, K. a, Duberstein, P., Erlangsen, A., Lapierre, S., Bodner, E., … Waern, M. (2012). A systematic review of social factors and suicidal behavior in older adulthood. International Journal of Environmental Research and Public Health, 9(3), 722–45. doi:10.3390/ijerph9030722
Ferrada-Noli, M., & Asberg, M. (1997). Psychiatric health, ethnicity and socioeconomic factors among suicides in Stockholm. Psychological Reports, 81(1), 323–32.
Ferrada-Noli, M., Asberg, M., Ormstad, K., & Nordström, P. (1995). Definite and undetermined forensic diagnoses of suicide among immigrants in Sweden. Acta Psychiatrica Scandinavica, 91(2), 130–5.
Fleischmann, A. (2008). Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bulletin of the World Health Organization, 86(9), 703–709. doi:10.2471/BLT.07.046995
Fleischmann, A., Bertolote, J. M., De Leo, D., Botega, N., Phillips, M., Sisask, M., … Wasserman, D. (2005). Characteristics of attempted suicides seen in emergency-care settings of general hospitals in eight low- and middle-income countries. Psychological Medicine, 35(10), 1467–74. doi:10.1017/S0033291705005416
Garcy, A. M., & Vågerö, D. (2012). The length of unemployment predicts mortality, differently in men and women, and by cause of death: a six year mortality follow-up of the Swedish 1992-1996 recession. Soc Sci Med., 74, 1911–1920.
Garcy, A. M., & Vågerö, D. (2013). Unemployment and suicide during and after a deep recession: a longitudinal study of 3.4 million Swedish men and women. Am J Public Health, 103, 1031–1038.
Geijer, T., Frisch, A., Persson, M.-L., Wasserman, D., Rockah, R., Michaelovsky, E., Apter, A., . . . Weizman, A. (2000). Search for association between suicide attempt and serotenergic polymorphisms. Psychiatr Genet, 10, 19–26.
Gunnell, D., Magnusson, P. K. E., & Rasmussen, F. (2005). Low intelligence test scores in 18 year old men and risk of suicide: cohort study. BMJ (Clinical Research Ed.), 330(7484), 167. doi:10.1136/bmj.38310.473565.8F
Hallberg, L., Janelidze, S., Engstrom, G., Wisén, A. G., Westrin, A., & Brundin, L. (2010). Exercise-induced release of cytokines in patients with major depressive disorder. J Affect Disord, 126(1-2), 262-7. doi: 10.1016/j.jad.2010.02.133.
Hawton, K., Arensman, E., Wasserman, D., Hultén, a, Bille-Brahe, U., Bjerke, T., … Temesváry, B. (1998). Relation between attempted suicide and suicide rates among young people in Europe. Journal of Epidemiology and Community Health, 52(3), 191–4.
Hirvikoski, T., & Jokinen, J. (2012). Personality traits in attempted and completed suicide. European Psychiatry : The Journal of the Association of European Psychiatrists, 27(7), 536–41. doi:10.1016/j.eurpsy.2011.04.004
Hjelmeland, H., Hawton, K., Nordvik, H., Bille-Brahe, U., De Leo, D., Fekete, S., … Wasserman, D. (2002). Why people engage in parasuicide: a cross-cultural study of intentions. Suicide & Life-Threatening Behavior, 32(4), 380–93.
Hjern, A., & Allebeck, P. (2002). Suicide in first- and second-generation immigrants in Sweden: a comparative study. Social Psychiatry and Psychiatric Epidemiology, 37(9), 423–9. doi:10.1007/s00127-002-0564-5
Hjern, A., Lindblad, F., & Vinnerljung, B. (2002). Suicide, psychiatric illness, and social maladjustment in intercountry adoptees in Sweden: a cohort study. Lancet, 360(9331), 443–8. doi:10.1016/S0140-6736(02)09674-5
Hoven, C. W., Wasserman, D., Wasserman, C., & Mandell, D. J. (2009). Awareness in nine countries: a public health approach to suicide prevention. Legal Medicine (Tokyo, Japan), 11 Suppl 1, S13–7. doi:10.1016/j.legalmed.2009.01.106
Hultén, A., Jiang, G. X., Wasserman, D., Hawton, K., Hjelmeland, H., De Leo, D., … Schmidtke, A. (2001). Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors. European Child & Adolescent Psychiatry, 10(3), 161–9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11596816
Hultén, A., Wasserman, D., Hawton, K., Jiang, G. X., Salander-Renberg, E., Schmidtke, A., … Querejeta, I. (2000). Recommended care for young people (15-19 years) after suicide attempts in certain European countries. European Child & Adolescent Psychiatry, 9(2), 100–8.
Isacsson, G., Holmgren, P., Wasserman, D., & Bergman, U. (1994). Use of antidepressants among people committing suicide in Sweden. BMJ (Clinical Research Ed.), 308(6927), 506–9.
Isacsson, G., Holmgren, P., Wasserman, D., & Bergman, U. (1995). Antidepressants and suicide. BMJ (Clinical Research Ed.), 310(6972), 127.
Isacsson, G., Rich, C. L., Jureidini, J., & Raven, M. (2010). The increased use of antidepressants has contributed to the worldwide reduction in suicide rates. The British Journal of Psychiatry : The Journal of Mental Science, 196(6), 429–33. doi:10.1192/bjp.bp.109.076166
Janelidze, S., Mattei, D., Westrin, Å., Träskman-Bendz, L., & Brundin, L. (2011). Cytokine levels in the blood may distinguish suicide attempters from depressed patients. Brain Behav Immun., 25(2), 335-9. doi: 10.1016/j.bbi.2010.10.010.
Jiang, G. X., Rasmussen, F., & Wasserman, D. (1999). Short stature and poor psychological performance: risk factors for attempted suicide among Swedish male conscripts. Acta Psychiatrica Scandinavica, 100(6), 433–40.
Johansson, C,. Jansson, M., Linnér, L., Yuan, Q. P., Pedersen, N. L., Blackwood, D., Barden, N., . . . Schalling, M. (2001). Genetics of affective disorders. Eur Neuropsychopharmacol, 11(6), 385-94.
Johansson, L. M., Sundquist, J., Johansson, S.-E., Qvist, J., & Bergman, B. (1997). The influence of ethnicity and social and demographic factors on Swedish suicide rates: A four year follow-up study. Social Psychiatry and Psychiatric Epidemiology, 32, 165–170.
Jokinen, J., Forslund, K., Ahnemark, E., Gustavsson, J. P., Nordström, P., & Asberg, M. (2010). Karolinska Interpersonal Violence Scale predicts suicide in suicide attempters. The Journal of Clinical Psychiatry, 71(8), 1025–32. doi:10.4088/JCP.09m05944blu
Jokinen, J., Nordström, A.-L., & Nordström, P. (2008). ROC analysis of dexamethasone suppression test threshold in suicide prediction after attempted suicide. Journal of Affective Disorders, 106(1-2), 145–52. doi:10.1016/j.jad.2007.06.008
Jokinen, J., Nordström, A.-L., & Nordström, P. (2009). CSF 5-HIAA and DST non-suppression--orthogonal biologic risk factors for suicide in male mood disorder inpatients. Psychiatry Research, 165(1-2), 96–102. doi:10.1016/j.psychres.2007.10.007
Jokinen, J., & Nordström, P. (2009). HPA axis hyperactivity and attempted suicide in young adult mood disorder inpatients. Journal of Affective Disorders, 116(1-2), 117–20. doi:10.1016/j.jad.2008.10.015
Jones, S. J., Stanley, B., Mann, J., Frances, A. J., Guido, J. R., Träskman-Bendz, L., … Stanley, M. (1990). CSF 5-HIAA and HVA concentrations in elderly depressed patients who attempted suicide. Am J Psychiatry, 147(9), 1225–1227.
Kaess, M., Brunner, R., Parzer, P., Carli, V., Apter, A., Balazs, J. A., Bobes, J, . . . Wasserman, D. (2013). Risk-behaviour screening for identifying adolescents with mental health problems in Europe. Eur Child Adolesc Psychiatry.
Kosidou, K., Dalman, C., Fredlund, P., Lee, B. K., Galanti, R., Isacsson, G., & Magnusson, C. (2013). School performance and the risk of suicide attempts in young adults: a longitudinal population-based study. Psychological Medicine, 1–9. doi:10.1017/S0033291713001852
Kuramoto, S., & Runeson, B. (2013). Time to hospitalization for suicide attempt by the timing of parental suicide during offspring early development. JAMA …, 70(2), 149–157. doi:10.1001/jamapsychiatry.2013.274.Time
Lavebratt, C., Olsson, S., Backlund, L., Frisén, L., Sellgren, C., Priebe, L., Nikamo, P., . . . Schalling, M. (2014). The KMO allele encoding Arg452 is associated with psychotic features in bipolar disorder type 1, and with increased CSF KYNA level and reduced KMO expression. Mol Psychiatry, 19(3), 334-41. doi: 10.1038/mp.2013.11.
Lavebratt, C., Sjöholm, L. K., Soronen, P., Paunio, T., Vawter, M. P., Bunney, W. E., Adolfsson, R., . . . Schalling, M. (2010). CRY2 is associated with depression. PLoS One, 24, 5(2):e9407. doi: 10.1371/journal.pone.0009407.
Lidberg, L., Åsberg, M., & Sundqvist-Stensman, U. (1984). 5-Hydroxyindoleacetic acid levels in attempted suicides who have killed their children. The Lancet, 928.
Lidberg, L., Tuck, J. R., Åsberg, M., Scalia-Tomba, G. P., & Bertilsson, L. (1985). Homicide, suicide and CSF 5-HIAA. Acta Psychiatrica Scandinavica, 71, 230–236.
Lonsdorf, T. B., Rück, C., Bergström, J., Andersson, G., Ohman, A., Lindefors, N., & Schalling, M. (2010). The COMTval158met polymorphism is associated with symptom relief during exposure-based cognitive-behavioral treatment in panic disorder. BMC Psychiatry, 10, 99. doi: 10.1186/1471-244X-10-99.
Lundin, A., Lundberg, I., Allebeck, P., & Hemmingsson, T. (2012). Unemployment and suicide in the Stockholm population: a register-based study on 771,068 men and women. Public Health, 126(5), 371–7. doi:10.1016/j.puhe.2012.01.020
Magne-Ingvar, U., Ojehagen, a, & Träskman-Bendz, L. (1992). The social network of people who attempt suicide. Acta Psychiatrica Scandinavica, 86(2), 153–8.
Magne-Ingvar, U., & Öjehagen, A. (1999). Significant others of suicide attempters: their views at the time of the acute psychiatric consultation. Social Psychiatry and Psychiatric Epidemiology, 34, 73–79.
Magnusson, P. K. E., Rasmussen, F., Lawlor, D. a, Tynelius, P., & Gunnell, D. (2006). Association of body mass index with suicide mortality: a prospective cohort study of more than one million men. American Journal of Epidemiology, 163(1), 1–8. doi:10.1093/aje/kwj002
Mittendorfer-Rutz, E., Rasmussen, F., & Wasserman, D. (2004). Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort study. Lancet, 364(9440), 1135–40. doi:10.1016/S0140-6736(04)17099-2
Mofidi, N., Ghazinour, M., Salander-Renberg, E., & Richter, J. (2008). Attitudes towards suicide among Kurdish people in Iran. Social Psychiatry and Psychiatric Epidemiology, 43(4), 291–8. doi:10.1007/s00127-007-0296-7
Moniruzzaman, S., & Andersson, R. (2004). Relationship between economic development and suicide mortality: a global cross-sectional analysis in an epidemiological transition perspective. Public Health, 118(5), 346–8. doi:10.1016/j.puhe.2003.10.004
Nässberger, L., & Träskman-Bendz, L. (1993). Increased soluble interleukin-2 receptor concentrations in suicide attempters. Acta Psychiatrica Scandinavica, 88(1), 48–52.
Nordström, P., & Åsberg, M. (1992). Suicide risk and serotonin. International Clinical Psychopharmacology, 6 Suppl(6), 12–21.
Omerov, P., Steineck, G., Nyberg, T., Runeson, B., & Nyberg, U. (2013). Psychological morbidity among suicide-bereaved and non-bereaved parents: a nationwide population survey. BMJ Open, 3(8), e003108. doi:10.1136/bmjopen-2013-003108
Omma, L., Sandlund, M., & Jacobsson, L. (2013). Suicidal expressions in young Swedish Sami, a cross-sectional study. International Journal of Circumpolar Health, 72. doi:10.3402/ijch.v72i0.19862
Ovuga, E., Boardman, J., & Wasserman, D. (2005). Prevalence of suicide ideation in two districts of Uganda. Arch Suicide Res., 9, 321–32.
Renberg, E. S., & Jacobsson, L. (2003). Development of a questionnaire on attitudes towards suicide (ATTS) and its application in a Swedish population. Suicide & Life-Threatening Behavior, 33(1), 52–64.
Rodríguez, A. H., Caldera, T., Kullgren, G., & Renberg, E. S. (2006). Suicidal expressions among young people in Nicaragua: a community-based study. Social Psychiatry and Psychiatric Epidemiology, 41(9), 692–7. doi:10.1007/s00127-006-0083-x
Rubenowitz, E., Waern, M., Wilhelmson, K., & Allebeck, P. (2001). Life events and psychosocial factors in elderly suicides--a case-control study. Psychological Medicine, 31(7), 1193–202.
Runeson, B. (1990). PSYCHOACTIVE SUBSTANCE USE DISORDER IN YOUTH SUICIDE. Alcohol and Alcoholism, 25(5), 561–568.
Runeson, B., & Beskow, J. (1991a). Borderline personality disorder in young Swedish suicides. The Journal of Nervous and Mental Disease, 179, 153–156.
Runeson, B., & Beskow, J. (1991b). Reactions of survivors of suicide victims to interviews. Acta Psychiatrica Scandinavica, 83(3), 169–73.
Runeson, B. S., Beskow, J., & Waern, M. (1996). The suicidal process in suicides among young people. Acta Psychiatrica Scandinavica, 93(1), 35–42.
Runeson, B., Tidemalm, D., Dahlin, M., Lichtenstein, P., & Långström, N. (2010). Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study. BMJ, 340, c3222. doi:10.1136/bmj.c3222
Runeson, B., & Wasserman, D. (1994). Management of suicide attempters: what are the routines and the costs? Acta Psychiatrica Scandinavica, 90(3), 222–8.
Rutz, E. M., & Wasserman, D. (2004). Trends in adolescent suicide mortality in the WHO European Region. European Child & Adolescent Psychiatry, 13(5), 321–31. doi:10.1007/s00787-004-0406-y
Rutz, W., Knorring, L. Von, Pihlgren, H., Rihmer, Z., & Wålinder, J. (1995). Prevention of male suicides: lessons from Gotland study. The Lancet, 345, 524.
Rutz, W., von Knorring, L., & Wålinder, J. (1989). Frequency of suicide on Gotland after systematic postgraduate education of general practitioners. Acta Psychiatrica Scandinavica, 80(2), 151–4.
Samuelsson, M., Asberg, M., & Gustavsson, J. P. (1997). Attitudes of psychiatric nursing personnel towards patients who have attempted suicide. Acta Psychiatrica Scandinavica, 95(3), 222–30.
Sarchiapone, M., Mandelli, L., Carli, V., Iosue, M., Wasserman, C., Hadlaczky, G., Hoven, C. W., . . . Wasserman, D. (2014). Hours of sleep in adolescents and its association with anxiety, emotional concerns, and suicidal ideation. Sleep Med., 15(2), 248-254. doi: 10.1016/j.sleep.2013.11.780.
Schmidtke, A., Bille-Brahe, U., DeLeo, D., Kerkhof, A., Bjerke, T., Crepet, P., … Sampaio-Faria, J. G. (1996). Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatrica Scandinavica, 93(5), 327–38.
Sokolowski, M., Ben-Efraim, Y. J., Wasserman, J., & Wasserman, D. (2013). Glutamatergic GRIN2B and polyaminergic ODC1 genes in suicide attempts: associations and gene-environment interactions with childhood/adolescent physical assault. Molecular Psychiatry, 18(9), 985–92. doi:10.1038/mp.2012.112
Sokolowski, M., Wasserman, J., & Wasserman, D. (2010). Association of polymorphisms in the SLIT2 axonal guidance gene with anger in suicide attempters. Molecular Psychiatry, 15(1), 10–1. doi:10.1038/mp.2009.70
Stefansson, J., Nordström, P., & Jokinen, J. (2012). Suicide Intent Scale in the prediction of suicide. J Affect Disord., 136, 167–171.
Sundbom, E., Jacobsson, L., Kullgren, G., & Penayo, U. (1998). Personality and defenses: a cross-cultural study of psychiatric patients and healthy individuals in Nicaragua and Sweden. Psychol Rep., 83(3 Pt 2), 1331-47.
Sundström, A., Alfredsson, L., Sjölin-Forsberg, G., Gerdén, B., Bergman, U., & Jokinen, J. (2010). Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study. BMJ. doi:10.1136/bmj.c5812
Söderberg, S., Kullgren, G., & Salander Renberg, E. (2004). Childhood sexual abuse predicts poor outcome seven years after parasuicide. Social Psychiatry and Psychiatric Epidemiology, 39(11), 916–20. doi:10.1007/s00127-004-0839-0.
Talseth, A.-G., Lindseth, A., Jacobsson, L., & Norberg, A. (1999). The meaning of suicidal psychiatric in-patients’ experiences of being cared for by mental health nurses. Journal of Advanced Nursing, 29(5), 1034–1041.
Thanh, H. T. T., Jiang, G.-X., Van, T. N., Minh, D. P. T., Rosling, H., & Wasserman, D. (2005). Attempted suicide in Hanoi, Vietnam. Soc Psychiatry Psychiatr Epidemiol, 40, 64–71.
Thorell, L. H., Wolfersdorf, M., Straub, R., Steyer, J., Hodgkinson, S., Kaschka, W. P., & Jandl, M. (2013). Electrodermal hyporeactivity as a trait marker for suicidal propensity in uni- and bipolar depression. Journal of Psychiatric Research, 47(12), 1925–31. doi:10.1016/j.jpsychires.2013.08.017
Tidemalm, D., Långström, N., Lichtenstein, P., & Runeson, B. (2008). Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. BMJ, 337, a2205. doi:10.1136/bmj.a2205
Titelman, D., Nilsson, A., Estari, J., & Wasserman, D. (2004). Depression, anxiety, and psychological defense in attempted suicide: a pilot study using PORT. Archives of Suicide Research : Official Journal of the International Academy for Suicide Research, 8(3), 239–49. doi:10.1080/13811110490436855
Titelman, D., Nilsson, A., Svensson, B., Karlsson, H., & Bruchfeld, S. (2011). Suicide-nearness assessed with PORT, the Percept-genetic Object-Relation Test: A replication and a reliability study. Bulletin of the Menninger Clinic, 75(4), 295–314. doi:10.1521/bumc.2011.75.4.295
Träskman, L., Asberg, M., Bertilsson, L., & Sjöstrand, L. (1981). Monoamine metabolites in CSF and suicidal behavior. Archives of General Psychiatry, 38(6), 631–6.
Traskman, L., Tybring, G., Åsberg, M., Bertilsson, L., Lantto, O., & Schalling, D. (1980). Cortisol in the CSF of depressed and suicidal patients. Archives of General Psychiatry, 37, 761–767.
Värnik, A., Kõlves, K., & Wasserman, D. (2005). Suicide among Russians in Estonia: database study before and after independence. BMJ, 330(7484), 176–7. doi:10.1136/bmj.38328.454294.55
Värnik, A., & Wasserman, D. (1992). Suicides in the former Soviet republics. Acta Psychiatrica Scandinavica, 86(1), 76–8.
Värnik, P., Kolves, K., & Wasserman, D. (2005). Suicide among Russians in Estonia: database study before and after independence. BMJ, 330, 175–176. doi:10.1136/bmj.38328.559572.55
Waern, M., Rubenowitz, E., Runeson, B., Skoog, I., Wilhelmson, K., & Allebeck, P. (2002). Burden of illness and suicide in elderly people: case-control study. BMJ, 324(7350), 1355.
Waern, M., Rubenowitz, E., & Wilhelmson, K. (2003). Predictors of Suicide in the Old Elderly. Gerontology, 49(5), 328–334. doi:10.1159/000071715
Waern, M., Runeson, B. S., Allebeck, P., Beskow, J., Rubenowitz, E., Skoog, I., & Wilhelmsson, K. (2002). Mental disorder in elderly suicides: a case-control study. The American Journal of Psychiatry, 159(3), 450–5.
Waern, M., Sjöström, N., Marlow, T., & Hetta, J. (2010). Does the Suicide Assessment Scale predict risk of repetition? A prospective study of suicide attempters at a hospital emergency department. European Psychiatry, 25(7), 421–6. doi:10.1016/j.eurpsy.2010.03.014
Wasserman, D. (1989). Passive euthanasia in response to attempted suicide: one form of aggressiveness by relatives. Acta Psychiatrica Scandinavica, 79(5), 460–7.
Wasserman, D., Carli, V., Wasserman, C., Apter, A., Balazs, J., Bobes, J., … Hoven, C. W. (2010). Saving and empowering young lives in Europe (SEYLE): a randomized controlled trial. BMC Public Health, 10, 192. doi:10.1186/1471-2458-10-192
Wasserman, D., Cheng, Q., & Jiang, G.-X. (2005). Global suicide rates among young people aged 15-19. World Psychiatry : Official Journal of the World Psychiatric Association (WPA), 4(2), 114–20.
Wasserman, C., Hoven, C. W., Wasserman, D., Carli, V., Sarchiapone, M., Al-Halabí, S., Apter, A., . . . Poštuvan, V. (2012). Suicide prevention for youth--a mental health awareness program: lessons learned from the Saving and Empowering Young Lives in Europe (SEYLE) intervention study. BMC Public Health, 12, 776. doi: 10.1186/1471-2458-12-776.
Wasserman, D., Terenius, L., Wasserman, J., & Sokolowski, M. (2010). The 2009 Nobel conference on the role of genetics in promoting suicide prevention and the mental health of the population. Molecular Psychiatry, 15(1), 12–7. doi:10.1038/mp.2009.113
Wasserman, D., & Värnik, A. (1998a). Reliability of statistics on violent death and suicide in the former USSR, 1970-1990. Acta Psychiatrica Scandinavica. Supplementum, 394, 34–41.
Wasserman, D., & Värnik, A. (1998b). Suicide-preventive effects of perestroika in the former USSR: the role of alcohol restriction. Acta Psychiatrica Scandinavica. Supplementum, 394, 1–4.
Wasserman, D., Värnik, A., & Eklund, G. (1994). Male suicides and alcohol consumption in the former USSR. Acta Psychiatrica Scandinavica, 89(5), 306–13.
Wasserman, D., Värnik, A., & Eklund, G. (1998). Female suicides and alcohol consumption during perestroika in the former USSR. Acta Psychiatrica Scandinavica. Supplementum, 394, 26–33.
Wasserman, D., Värnik, A,, Kolves, K., Toodling, L. M. (2007). Diminishing alcohol consumption is the most effective suicide preventive program in modern history for males. European Psychiatry, 22, 36-36.