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Biomedical subjects

M J Marttunen

Publications and source records attributed to M J Marttunen.

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

Psychosocial factors and completed suicide in personality disorders.

The aim of the present study was to investigate the relationships between personality disorders (PD) and various psychosocial factors in a random sample (n = 229) of suicides with psychological autopsy-based DSM-III-R diagnoses representing the total 1-year suicide population in Finland. Background social factors and social interaction factors for 56 suicide victims with a PD diagnosis were compared with those of 56 age- and sex-matched non-PD diagnosis victims. The groups were similar with regard to marital status, socio-economic status, parental divorce, broken home before the age of 16 years, parental suicide attempts, and proportion of subjects living with parents. The PD suicide victims had more commonly had a companion of the opposite sex, lived alone, and resided in an urban area, but had less often experienced parental psychiatric hospitalization during their childhood. Although the groups did not differ with regard to complaints of loneliness before suicide, the lonely PD suicide victims had experienced more interpersonal loss and/or conflict than the lonely non-PD suicide victims. The PD suicide victims were very similar with regard to psychosocial factors, irrespective of sex, age, Axis-I comorbidity, or the cluster type of the PD. Only living alone was more common in young PD suicide victims, and male PD subjects had less often had confidants or friends with whom they shared common interests.

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↗
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

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

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

Psychosocial stressors more common in adolescent suicides with alcohol abuse compared with depressive adolescent suicides.

OBJECTIVE: Relationships between stressors and psychiatric diagnoses were studied among 13- to 19-year-old adolescent suicide victims with alcohol abuse/dependence (N = 14), depressive disorders (N = 18), and the remainder (N = 21). METHOD: The study included all adolescent suicides (N = 53) during a nationwide psychological autopsy study of suicides in Finland during a 12-month period (N = 1397). The data were collected through interviews with the victims' parents and health care personnel and from official records. RESULTS: Interpersonal separations and difficulties regarding discipline or the law were common recent stressors among the alcohol abuse victims, and interpersonal conflicts and somatic illness among those with depressive disorders. Compared with the depressive victims, an unstable earlier family history was more common among the alcohol abusers. The accumulation of stressors and weakened parental support during the previous year were also more frequently found in the alcohol abuse victims. CONCLUSIONS: The results indicate that specific psychosocial stressors may be critical for suicidal adolescents with different diagnoses. In the evaluation of suicidal adolescent substance abusers, particularly recent interpersonal separations and family support need to be carefully weighed. Disruptions in the adolescent's interpersonal relationships, excess accumulation of stress, and lacking support from the family may be warning signs of suicide potential and indications for additional social support, for more intensive treatment, or for a change in the treatment setting.

Adolescent↗
PubMed1994

Antisocial behaviour in adolescent suicide.

Antisocial behaviour among adolescent suicide victims (44 males, 9 females) was investigated in a nationwide psychological autopsy study of suicides in Finland. The data were collected through interviews of the victims' relatives and attending health care personnel, and from official records. Antisocial behaviour was reported among 43% of the victims. Separation from parents, parental alcohol abuse and parental violence were common among male victims with antisocial behaviour. Their psychosocial adjustment was poor, and they had experienced severe stressors. Depressive disorders were common among all suicides, but male victims with antisocial behaviour had more often alcohol abuse and comorbid mental disorders compared with victims without antisocial behaviour. The results indicate a strong relatedness between adolescent suicide and antisocial behaviour. Recognition and treatment of manifest mental symptoms and evaluation of suicide risk among adolescents with antisocial behaviour and substance abuse is emphasized. Antisocial symptoms with relatively short duration and not severe enough to meet the criteria for actual antisocial disorders also need to be taken into account.

Adolescent↗
PubMed1993

Precipitant stressors in adolescent suicide.

OBJECTIVE: Precipitant stressors in adolescent (aged 13 to 19 years) suicides (N = 53) were investigated in a nationwide psychological autopsy study in Finland. METHOD: Data were collected through interviews with the victims' parents and health care personnel, and from official records. RESULTS: Precipitants during the month preceding suicide were found in 70% of the cases. Almost half the precipitants occurred during the last 24 hours. Interpersonal separations and conflicts were the most common precipitants. Compared with other suicide victims, those with weakened parental support more often had interpersonal separation as a precipitant, a higher number of stressors during the final month, and had more often experienced major stress during the year before suicide. CONCLUSION: The findings highlight the importance of stress (acute, chronic, or both) in adolescent suicide. Interpersonal problems were common precipitants in adolescent suicide. Among adolescents with weakened parental support, interpersonal separations were especially common precipitants. Additional research on precipitants in adolescent suicide is needed with proper control subjects.

Adolescent↗
PubMed1993

Mental disorders and comorbidity in suicide.

OBJECTIVE: The purpose of this study was to investigate the prevalence and comorbidity of current mental disorders defined by DSM-III-R among a random sample of suicide victims from a nationwide suicide population. METHOD: Using a psychological autopsy method, the authors collected comprehensive data on all suicide victims in Finland during 1 year. Retrospective axis I-III consensus diagnoses were assigned to 229 (172 male, 57 female) victims. RESULTS: One or more diagnoses on axis I were made for 93% of the victims. The most prevalent disorders were depressive disorders (59%) and alcohol dependence or abuse (43%). The prevalence of major depression was higher among females (46%) than among males (26%). Alcohol dependence was more common among the males (39% versus 18% for females). A diagnosis on axis II was made for 31% and at least one diagnosis on axis III for 46% of the cases. Only 12% of the victims received one axis I diagnosis without any comorbidity. CONCLUSIONS: The majority of suicide victims suffered from comorbid mental disorders. Comorbidity needs to be taken into account when analyzing the relationship between suicide and mental disorders and in planning treatment strategies for suicide prevention in clinical practice.

Adolescent↗
PubMed1993

Adolescent development and youth suicide.

The adolescent years, being a period of unique developmental changes, are of great interest in understanding suicidal behavior. The occurrence of completed suicide by age in 1-year age groups in adolescence and young adulthood was studied via official Finnish mortality statistics and the population statistics. Suicide rates increased sharply by age during adolescence, starting somewhat earlier among boys than among girls. During the periods of rapidly rising and high suicide rates in the 1970s and 1980s among boys, the increase in suicide rates started at a younger age than during a spell of lower rates in the 1960s.

Adolescent↗