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Biomedical subjects

M E Heikkinen

Publications and source records attributed to M E Heikkinen.

At least 19 recordsLinked to original sources
PubMed1998

Antecedents of suicide in people with schizophrenia.

BACKGROUND: Suicides among people with schizophrenia are commonly believed to be impulsive and to occur unexpectedly. METHOD: As part of the National Suicide Prevention Project in Finland, a nationwide psychological autopsy study, suicide victims with DSM-III-R schizophrenia (n = 86; n = 64 in the active illness phase) and others (n = 1109; n = 666 without any evidence for psychosis) were compared for communication of suicidal intent (CSI), as well as previous suicide attempts known by the next of kin and/or an attending health care professional during the latest treatment relationship. RESULTS: More victims with schizophrenia (84%) had a history of previous CSI, and/or had made previous suicide attempt(s) than others (70%). Also, victims with active illness schizophrenia (56%) had more CSI and/or had made suicide attempts during their last three months than victims with no psychosis (41%). CONCLUSIONS: CSI and/or suicide attempts occur at least as often in people with schizophrenia as in those without schizophrenia, even in the active phase of the illness.

Adult↗
PubMed1998

Completed suicide among adolescents with no diagnosable psychiatric disorder.

The characteristics of male adolescent suicide victims with (n = 84) and without (n = 8) a diagnosable psychiatric disorder were compared. Using psychological autopsy methods--interviews with victims' family members and health care professionals, and review of records (e.g., medical, school, police)-data were collected on all adolescent suicides in Finland during a 12-month period. Compared with adolescents with a psychiatric disorder, those with no disorder tended to come from less disturbed families, had shown less antisocial behavior, and had less frequently utilized health care and social services. Adolescents with no disorder more often communicated suicidal thoughts for the first time just before the suicide, and difficulties with the law (discipline problems) were more common precipitants than among those with a disorder. It was concluded that the process leading to suicide seems to be relatively short among male adolescents with no diagnosable psychiatric disorder. Communication of suicidal intent and problems with discipline are among the few clinical warning signs.

Adolescent↗
PubMed1997

Recent life events and suicide in personality disorders.

This study investigates the relationships between personality disorders, recent life events, and comorbid axis I disorders in suicide. Life events during the last week and last 3 months before suicide of 56 suicide victims with a DSM-III-R axis II personality disorder (PD) were compared with those of 56 age- and sex-matched comparison suicides with evidence of no PD. These victims were from a random sample of suicides representing a total 1-year nationwide suicide population in Finland. Life events had been more common among PD victims, particularly job problems, family discord, financial trouble, unemployment, and interpersonal loss; most victims with PD had had multiple life events. Events possibly dependent on the victim's own behavior had been much more common among the PD group, especially in the final week (70% vs. 23%). Age, gender, comorbid axis I diagnosis of alcoholism or depression, or PD cluster type B or C seemed to be less important factors in terms of excess events in the PD group. Thus, PD should be assessed as an important factor when analyzing the relationship between recent life events and suicide. Our findings suggest that interpersonal and job-related/financial problems may precede suicide closely among individuals with PD.

Adolescent↗
PubMed1997

Suicide and schizophrenia: a nationwide psychological autopsy study on age- and sex-specific clinical characteristics of 92 suicide victims with schizophrenia.

OBJECTIVE: The authors examined the clinical characteristics of suicide victims with schizophrenia in the general population of Finland. METHOD: As part of the nationwide National Suicide Prevention Project in Finland, all suicides over a 12-month period of persons with DSM-III-R schizophrenia were investigated by using the psychological autopsy method. Clinical characteristics and their variation with age, sex, and illness duration were examined. RESULTS: Among all suicide victims, 7% (N = 92) were identified as having suffered schizophrenia. Suicides occurred throughout the course of schizophrenia. Both active illness (78%) and depressive symptoms (64%) were highly prevalent immediately before suicide, and a history of suicide attempts (71%) was also common. Women were more likely than men to have committed suicide during an acute exacerbation of the illness. Marked variation in depressive symptoms, alcoholism, and suicide methods was found among sexes and age groups. Alcoholism was most common among middle-aged men (45%), whereas middle-aged women had a high rate of depressive symptoms (88%). Younger male subjects most often used violent suicide methods. CONCLUSIONS: Suicide may occur at any point during the course of schizophrenia. The results indicate clinically important variation in depression, alcoholism, and suicide methods among suicide victims with schizophrenia. This suggestion of age- and sex-specific risk factors for suicide in schizophrenia needs further investigation.

Age Factors↗
PubMed1996

Suicide among subjects with personality disorders.

OBJECTIVE: There have been few psychological autopsy studies of suicide among individuals with personality disorders. The possible specificity of characteristics of suicide among such individuals has been little investigated. METHOD: A random sample of 229 subjects who committed suicide, representing all suicide victims in Finland within a 12-month period, were comprehensively examined by using the psychological autopsy method and were diagnosed according to DSM-III-R criteria. Within this random sample the authors investigated all subjects with axis II personality disorders (N = 67) and divided them into clusters B (N = 43), C (N = 23), and A (N = 1). Individuals with clusters B and C personality disorders were separately compared with sex- and age-matched suicide victims without personality disorder, in terms of sociodemographic characteristics, comorbid axis I and III syndromes, treatment histories, previous suicide attempts, communication of suicide intent, and suicide methods. RESULTS: All suicide victims with a personality disorder received at least one axis I diagnosis. In 95% this included a depressive syndrome, a psychoactive substance use disorder, or both. Individuals with cluster B personality disorders were more likely than comparison subjects to have psychoactive substance use disorders (79% versus 40%) and previous nonfatal suicide attempts (70% versus 37%) and were less likely to have axis III physical disorders (29% versus 50%). Subjects with cluster C personality disorders were not found to differ from the control subjects in any of the variables examined. CONCLUSIONS: Suicide victims with personality disorders were almost always found to have had current depressive syndromes, psychoactive substance use disorders, or both. Suicide victims with cluster B personality disorders differed from other suicide victims in several characteristics, while those with cluster C personality disorders did not.

Adult↗
PubMed1996

Panic disorder in completed suicide.

BACKGROUND: Patients with panic disorder are reportedly at increased risk of suicidal behavior, but in psychological autopsy studies of completed suicides, a current diagnosis of panic disorder has been rare or absent. The comorbidity and other clinical characteristics of panic disorder among suicides are not known. METHOD: On the basis of data from a psychological autopsy study of all suicides (N = 1397) in Finland occurring during 1 year, all victims with current DSM-III-R panic disorder were retrospectively identified and examined in terms of comorbidity, suicide methods, history of suicide attempts, treatment setting, and duration of panic disorder. RESULTS: Seventeen victims with current panic disorder, 1.2% of all suicides, were identified. The prevalence of panic disorder was higher among female (2.8%, 9 of 320) than male suicides (0.7%, 8 of 1077; p = .007). All victims with panic disorder suffered concurrent Axis I disorders, and 8 (47%) Axis II disorders. Major depression was diagnosed in 10 (59%), and substance dependence or abuse in 8 (47%) of the cases. The mean duration of panic disorder before suicide was 8 years. In most cases, the onset of panic disorder preceded comorbid Axis I disorders and previous suicide attempts. Most victims with panic disorder had a history of psychiatric treatment. CONCLUSION: Current panic disorder, and noncomorbid panic disorder in particular, seem to be rare among completed suicides. Suicide in persons with panic disorder is associated with superimposed major depression and substance abuse, and with personality disorders. For recognizing panic disorder patients at risk of suicide, the assessment and monitoring of the overall psychopathology are essential.

Adult↗
PubMed1996

Completed suicide and recent electroconvulsive therapy in Finland.

In the research phase of the National Suicide Prevention Project in Finland, all completed suicides in Finland (N = 1,397) within a 12-month period were comprehensively examined by using the psychological autopsy method. In this study, we examined the number of cases having received electroconvulsive therapy (ECT) during the 3 final months before suicide. Only two such cases (0.14% of all suicides) were found, a figure remarkably low considering the high prevalence of severe depression in the suicide population. In both of the two cases, the quality of treatment was questionable, and suicide occurred during a depressive relapse. The findings indirectly support earlier reports suggesting ECT to have a preventive effect concerning suicide. However, alternative explanations, such as low base rate of use of ECT in Finland during the study period, or withholding ECT from some patients because of comorbidity, as well as a combined effect of all the three factors, need also to be considered. Among all suicides, those within 3 months after ECT are rare, and the possible efficacy of ECT in preventing suicide warrants further study.

Autopsy↗
PubMed1995

Mental disorders in elderly suicide.

The purpose of this study was to investigate the prevalence and comorbidity of current mental disorders defined by DSM-III-R among elderly suicide victims and to compare them with the mental disorders among younger victims. Using a psychological autopsy method, we collected comprehensive data on all suicides in Finland during 1 year. Retrospective Axis I-III consensus diagnoses were assigned to a random sample consisting of 43 victims aged 60 years or over and 186 victims aged under 60 from the nationwide suicide population. At least one Axis I diagnosis was made for 91% of the elderly victims. Major depression as the principal diagnosis was more common among the elderly victims. Almost all elderly female victims were major depressives. Psychiatric comorbidity was more common among elderly male than among elderly female victims. More of the elderly victims (88%) than the younger (36%) received Axis III diagnoses. Suicide among the elderly without a diagnosable mental disorder and somatopsychiatric comorbidity seems to be rare.

Aged↗
PubMed1995

Recent life events in elderly suicide: a nationwide study in Finland.

The primary objectives of this study were to examine recent stressful life events and to explore possible social interaction factors across age groups in a population of suicides. Life events during the last 3 months preceding suicide (32 items) and factors related to social interaction (6 items) among 219 suicide victims aged 60 years and older were compared with those of 803 victims aged 20 to 59 years. The study population comprised all adult suicides who had life events interview data assessed as reliable by the interviewers in a nationwide total suicide population (1,397) of 1 year in Finland. Differences in life events were found across age groups: Family discord, loss (separation, death), financial trouble, job problems, unemployment, and residence change were more common among younger victims, and somatic illness was more common among elderly victims. Age groups were similar with regard to proportions of persons living alone, availability of confidants and friends with common interests, and reports of loneliness. Similarly, few differences were found among persons aged 60-74 compared to age 75+ with regard to rates of life events, living alone, opportunities for social interaction, and complaints of loneliness. loneliness was reported for persons who experienced loss among both younger and older suicides. In terms of age differences, younger men were more likely to have experienced job-related events, whereas older men were more likely to have had a somatic illness. Somatic illness appeared to be the most important stressor in elderly suicides, particularly for men. Living alone and diminished opportunity for social interaction were not common factors in late-life suicides. Controlled studies with age-matched comparisons are needed to further investigate how life events and social interaction factors vary in their risk for suicide across the life course.

Adolescent↗
PubMed1995

Suicide among female adolescents: characteristics and comparison with males in the age group 13 to 22 years.

OBJECTIVE: To characterize female suicides (n = 19) in an unselected nationwide youth suicide population aged 13 to 22 years (n = 116) and to compare them with male suicides with respect to variables indicating psychopathology and psychosocial functioning. METHOD: The data were collected in a psychological autopsy study of all suicides (N = 1,397) in Finland during a 12-month period. Data collection included interviews of next of kin and professionals and information from records after the suicide. RESULTS: Two thirds (68%) of the female victims had suffered from a mood disorder, and 73% had communicated their suicidal intent. Half (47%) of the female subjects had been in psychiatric care at some point in their lives, and 42% had been hospitalized. Compared with young male suicides, the young female victims more often had made previous suicide attempts (63% versus 30%), received more often a diagnosis of major depression (37% versus 14%), and had more often been in psychiatric care (47% versus 21%) during the year preceding the suicide. The females were more often incapable of working, and their psychosocial impairment was more severe during the final week. Alcohol abuse was almost as common among the female as the male victims (21% versus 26%). CONCLUSION: The results suggest that young females who commit suicide may have suffered from more severe psychopathology than young male victims. Substance abuse seems to be a major factor also in female suicides. Preventive efforts within psychiatric care are likely to reach a higher proportion of the young females than males at high risk for suicide.

Adolescent↗
PubMed1995

Age-related variation in recent life events preceding suicide.

Recent life events as reported by the next of kin were explored in male and female suicide victims to see how these factors varied across age groups by decade of age. The study population comprised all 1022 suicide victims aged 20 years and older in Finland during a 12-month period who had life event data assessed as reliable by the interviewing mental health professionals. Age-related patterns of variation of life events were found: separation, serious family arguments, financial trouble, job problems, unemployment, and residence change were more common among younger victims, whereas somatic illness and retirement were more common among older victims. Mean number of life events, greater among men than women, tended to decline gradually across the age range. In terms of sex differences, somatic illness was more common among elderly men, while separation, financial trouble, and unemployment were more common among younger men. Most life events among younger age groups were possibly dependent upon the victims' own behavior. Logistic regression indicated association between specific life events and alcohol misuse: separation, serious family arguments, financial trouble and unemployment were especially related to alcohol misuse. Violent suicide method lacked association with life events, being commoner only among males and those not having misused alcohol. Age- and sex-specific control groups and multidimensional life event interview schedules are needed to further investigate the relative risk of life events in suicide.

Adult↗
PubMed1995

Mental disorders and suicide prevention.

In the research phase of the National Suicide Prevention Project, all suicides (n = 1397) in Finland between March 1987 and April 1988 were examined retrospectively using the psychological autopsy method. Careful retrospective diagnostic evaluation of the victims according to DSM-III-R criteria was done by weighing and integrating all available information. A series of studies addressing the mental disorders among suicide victims, the treatment received before death and the life events is now reviewed. Among a random sample of suicide victims from the natiowide suicide population, at least one psychiatric diagnosis was made for 93% of the victims. The most prevalent disorders were depressive syndromes (66%) and alcohol dependence/abuse (43%). The prevalence of major depression was higher among women than among men. Major depression as the principal diagnosis was more common among the elderly suicides. Among adolescent victims, depressive syndromes were also the most prevalent disorders. Adjustment disorders were common (25%) among male adolescent suicides. The majority of suicide victims of all ages suffered from comorbid mental disorders. Among suicide victims who had had contact with a health carer before death, inadequacy of treatment for mental disorders seems to have been common. Of the major depressive victims only 3% were found to have received adequate psychopharmacological treatment, and only 7% received weekly psychotherapy by a trained therapist. The analysis of the massive database collected in the research phase of the National Suicide Prevention Project in Finland is still ongoing, and the implications of the findings for suicide prevention will be refined during the research process. The necessity to improve recognition and treatment for comorbid depressive disorders in all age groups seems evident already.

Adolescent↗
PubMed1995

The last appointment before suicide: is suicide intent communicated?

OBJECTIVE: The authors' goal was to determine whether people who committed suicide within 4 weeks after having made contact with a health care professional communicated their intent to commit suicide during that final contact. METHOD: Using data from a nationwide psychological autopsy study of all suicides in Finland that occurred in 1 year, the authors examined the 571 cases of suicide victims whose last appointment with a health care professional took place up to 28 days before suicide, including 100 cases of victims who had appointments on the day of suicide. RESULTS: Suicide intent was reportedly discussed in only 22% of the cases; it was particularly uncommon in general practice and nonpsychiatric specialist settings. CONCLUSIONS: The majority of patients who commit suicide do not seem to communicate their intent to do so during their last appointment.

Adolescent↗
PubMed1995

Social factors in suicide.

BACKGROUND: The study objective was to investigate the age-related variation of social factors in suicide. METHOD: Age-related variations in marital status, living arrangements, employment and social interaction were investigated in an entire 12-month suicide population in Finland (n = 1067); these findings were compared with appropriate census data. RESULTS: Several social factors varied across age groups among suicides, with some age-related sex differences. Compared with the general population, the suicides were more commonly never married (especially men aged 30-39 years), divorced, and widowed (especially women aged 60-69 years); living alone was more frequent among the suicides, as was living with parents among male suicides aged 25-39 years. A history of psychiatric admission was especially common among young male suicides who had never married or were living with parents. Living alone was particularly frequent among middle-aged male suicides who had misused alcohol. CONCLUSIONS: While most of the age-related variation in social factors found in suicide seems to parallel the natural variation of these factors in the general population, some social findings in suicide might be related to the victims' psychopathology and excessive alcohol use.

Adolescent↗
PubMed1994

Differences in recent life events between alcoholic and depressive nonalcoholic suicides.

The purpose of this study was to investigate the main differences in recent life events preceding suicide between alcoholic and depressive nonalcoholic suicide victims, how much these differences were sex- and age-dependent, and how social support varied between these groups. Using the psychological autopsy method, retrospective best-estimate diagnoses by DSM-III-R criteria were assigned to a randomized 16.4% sample (n = 229) of suicide victims drawn from a 1-year total nationwide suicide population (n = 1,397) in Finland. Life events during the last 3 months (32 items) and social support (6 items) of 75 suicide victims with alcohol abuse/dependence diagnoses were compared with those of 69 nonalcoholic depressive victims. Among male suicides, the alcoholics had experienced more separations and family discord, financial trouble, and unemployment, whereas the depressives had experienced more somatic illness. Among females, adverse interpersonal events had been common in both alcoholic and depressive victims. Among the alcoholics, unlike the depressives, the number of adverse interpersonal life events had not diminished with increasing age. Living alone had been twice as common among the alcoholic suicides and, in these cases, recent separation, unemployment, and financial trouble were remarkably common, suggesting a concurrent stressor effect. Our results confirm and extend the earlier findings of excess interpersonal stressors among alcoholic suicides compared with depressive suicides. The findings suggest that multiple adverse life events and living alone need to be taken into account in clinical practice when assessing psychosocial stress and suicidal danger in alcoholism.

Adolescent↗
PubMed1994

Suicide in major depression.

OBJECTIVE: The purpose of this study was to examine a sample representing all suicide victims with current DSM-III-R major depression in Finland within 1 year in aspects relevant to suicide prevention, including comorbidity, clinical history, current treatment, suicide methods, and communication of suicide intent. METHOD: Using the psychological autopsy method, the authors examined all 71 suicide victims with current unipolar DSM-III-R major depression, taken from a random sample of 229 subjects representing 16.4% of all suicide victims in Finland in 1 year. RESULTS: The majority (85%) were complicated cases with comorbid diagnoses, and comorbidity varied according to the subjects' sex and age. Three-quarters had a history of psychiatric treatment, but only 45% were receiving psychiatric treatment at the time of death. Most suicide victims had received no treatment for depression. Only 3% had received antidepressants in adequate doses, 7% weekly psychotherapy, and 3% ECT. None of the 24 psychotic subjects had received adequate psychopharmacological treatment. Few (8%) had used an antidepressant overdose as a suicide method. Men had received less treatment for depression and had more commonly used violent suicide methods. CONCLUSIONS: Although about half of the suicide victims with major depression were receiving psychiatric care at the time of death, few were receiving adequate treatment for depression. There were significant sex differences in current and previous treatment and suicide methods. For suicide prevention in major depression, it would seem crucial to improve treatment and follow-up, for males with major depression, in particular.

Adolescent↗
PubMed1994

Suicide in major depression in different treatment settings.

BACKGROUND: Whether suicide victims having suffered from major depression differ in their characteristics and treatment of depression received in various settings prior to death has been unknown. METHOD: From a random sample representing all completed suicides in Finland within a 12-month period, cases with a best estimate diagnosis of current unipolar DSM-III-R major depression (N = 71) were comprehensively analyzed using the method of psychological autopsy. Suicide victims with major depression were classified according to treatment setting, and the victims in different settings--psychiatric care (N = 32), medical care (N = 27), and no contact with health care (N = 12)--were compared. RESULTS: The sex distribution of suicides who had major depression was equal within psychiatric care; but in medical care or without contact with health care, 77% (30 of 39) were men (p = .018). Significantly more victims in psychiatric than in medical care had communicated to attending personnel their intent to commit suicide (59% [19 of 32] vs. 19% [5 of 27], p = .004). Antidepressants were received by 60% of victims in psychiatric care but only 16% in medical care (p = .002). CONCLUSION: Suicide victims with major depression differ in sex distribution and communication of suicide intent among treatment settings, which may complicate the ability to generalize research findings, particularly from psychiatric to medical care. Promoting suicide prevention in major depressive disorders would seem to require improving not only the quality of treatment within psychiatric care, but also basic skills in recognizing and treating depression in medical care, especially for male patients.

Age Distribution↗