Dag Tidemalm - Academia.edu (original) (raw)
Papers by Dag Tidemalm
The Journal of clinical psychiatry, Jan 4, 2015
To study the short-term risk of suicide after nonfatal deliberate self-harm and its association w... more To study the short-term risk of suicide after nonfatal deliberate self-harm and its association with coexisting mental disorders and with the method of self-harm used. We used linked Swedish national registers to design a cohort study with 34,219 individuals (59% females) who were admitted to hospital in 2000-2005 after deliberate self-harm (ICD-10-defined). They were followed for 3-9 years. The studied outcome was completed suicide; Cox regression models yielded hazard ratios (HRs) for suicide risk. Temporal patterns were plotted with Kaplan-Meier survival curves, calculated separately for each mental disorder and for the method used at the previous self-harm event. 1,182 subjects committed suicide during follow-up (670 males and 512 females). Coexisting bipolar disorder (in males, adjusted HR = 6.3; 95% confidence interval [CI], 3.8-10.3; in females, adjusted HR = 5.8; 95% CI, 3.4-9.7) and nonorganic psychotic disorder (in males, adjusted HR = 5.1; 95% CI, 3.5-7.4; in females, adj...
Psychological medicine, Jan 26, 2014
Background. Possible age-related differences in risk of completed suicide following non-fatal sel... more Background. Possible age-related differences in risk of completed suicide following non-fatal self-harm remain unexplored. We examined associations between self-harm and completed suicide across age groups of self-harming patients, and whether these associations varied by violent index method, presence of mental disorder, and repeated self-harm. Method. The design was a cohort study with linked national registers in Sweden. The study population comprised individuals aged ⩾10 years hospitalized during 1990-1999 due to non-fatal self-harm (n = 53 843; 58% females) who were followed for 9-19 years. We computed hazard ratios (HRs) across age groups (age at index self-harm episode), with time to completed suicide as outcome. Results. The 1-year HR for suicide among younger males (10-19 years) was 14.6 [95% confidence interval (CI) 4.1-51.9] for violent method and 8.4 (95% CI 1.8-40.0) for mental disorder. By contrast, none of the three potential risk factors increased the 1-year risks in...
Clinical practice and epidemiology in mental health : CP & EMH, 2008
Investigating mortality in those with mental disorder is one way of measuring effects of mental h... more Investigating mortality in those with mental disorder is one way of measuring effects of mental health care reorganisation. This study's aim was to investigate whether the excess mortality in those with severe mental disorder remains high in Sweden after the initiation of the Community Mental Health Care Reform. We analysed excess mortality by gender, type of mental health service and psychiatric diagnosis in a large community-based cohort with long-term mental disorder. A survey was conducted in Stockholm County, Sweden in 1997 to identify adults with long-term disabling mental disorder (mental retardation and dementia excluded). The 12 103 cases were linked to the Hospital Discharge Register and the Cause of Death Register. Standardised mortality ratios (SMRs) for 1998-2000 were calculated for all causes of death, in the entire cohort and in subgroups based on treatment setting and diagnosis. Mortality was increased in both genders, for natural and external causes and in all d...
J Clin Psychiatry, 2014
Released prisoners have high suicide rates compared with the general population, but little is kn... more Released prisoners have high suicide rates compared with the general population, but little is known about risk factors and possible causal pathways. We conducted a population-based cohort study to investigate rates and risk factors for suicide in people previously imprisoned. We identified individuals released from prison in Sweden between January 1, 2005, and December 31, 2009, through linkage of national population-based registers. Released prisoners were followed from the day of release until death, emigration, new incarceration, or December 31, 2009. Survival analyses were conducted to compare incidence rates and psychiatric morbidity with nonconvicted population controls matched on gender and year of birth. We identified 38,995 releases among 26,985 prisoners (7.6% female) during 2005-2009. Overall, 127 suicides occurred, accounting for 14% of all deaths after release (n = 920). The mean suicide rate was 204 per 100,000 person-years, yielding an incidence rate ratio of 18.2 (95% CI, 13.9-23.8) compared with general population controls. Previous substance use disorder (hazard ratio [HR] = 2.1; 95% CI, 1.4-3.2), suicide attempt (HR = 2.5; 95% CI, 1.7-3.7), and being born in Sweden versus abroad (HR = 2.1; 95% CI, 1.2-3.6) were independent risk factors for suicide after release. Released prisoners are at high suicide risk and have a slightly different pattern of psychiatric risk factors for suicide compared with the general population. Results suggest appropriate allocation of resources to facilitate transition to life outside prison and increased attention to prisoners with both a previous suicide attempt and substance use disorder.
Yearbook for Traditional Music, 1996
Social Psychiatry and Psychiatric Epidemiology, 2005
Rate of suicide is probably an indicator of the quality of mental health services within an area.... more Rate of suicide is probably an indicator of the quality of mental health services within an area. The aim of this study was to identify predictors of suicide in a large community-based cohort of persons with long-term mental disorder. A survey was conducted in Stockholm County, Sweden, in 1997 to identify adults with long-term disabling mental disorder (mental retardation and dementia excluded). The survey included an inventory of unmet needs as perceived by the service providers. The 12,247 cases were linked to the national in-patient register and the cause-of-death register. Predictors of suicide in 1997-2000 were determined by bivariate analysis and multiple logistic regression. Predictors of suicide included a history of in-patient psychiatric care, previous suicide attempt, substance abuse and unmet need of a contact person. Personality disorder, especially borderline personality disorder, was the strongest diagnostic predictor of suicide among those with a history of in-patient psychiatric care. Unmet needs may signal increased suicide risk in persons with severe mental disorder. Methods to improve suicide prevention in persons with personality disorder should be further developed. Interventions to reduce suicide in persons with a long-term mental disorder will require collaboration between psychiatric and social services.
Psychological Medicine, 2011
BackgroundResearch suggests that suicidal behaviour is aggregated in families. However, due to me... more BackgroundResearch suggests that suicidal behaviour is aggregated in families. However, due to methodological limitations, including small sample sizes, the strength and pattern of this aggregation remains uncertain.MethodWe examined the familial clustering of completed suicide in a Swedish total population sample. We linked the Cause of Death and Multi-Generation Registers and compared suicide rates among relatives of all 83 951 suicide decedents from 1952–2003 with those among relatives of population controls.ResultsPatterns of familial aggregation of suicide among relatives to suicide decedents suggested genetic influences on suicide risk; the risk among full siblings (odds ratio 3.1, 95% confidence interval 2.8–3.5, 50% genetic similarity) was higher than that for maternal half-siblings (1.7, 1.1–2.7, 25% genetic similarity), despite similar environmental exposure. Further, monozygotic twins (100% genetic similarity) had a higher risk than dizygotic twins (50% genetic similarity...
PLoS ONE, 2014
Objective: Bipolar disorder is associated with high risk of self-harm and suicide. We wanted to i... more Objective: Bipolar disorder is associated with high risk of self-harm and suicide. We wanted to investigate risk factors for attempted suicide in bipolar patients. Method: This was a cohort study of 6086 bipolar patients (60% women) registered in the Swedish National Quality Register for Bipolar Disorder 2004-2011 and followed-up annually 2005-2012. Logistic regression was used to calculate adjusted odds ratios for fatal or non-fatal attempted suicide during follow-up. Results: Recent affective episodes predicted attempted suicide during follow-up (men: odds ratio = 3.63, 95% CI = 1.76-7.51; women: odds ratio = 2.81, 95% CI = 1.78-4.44), as did previous suicide attempts (men: odds ratio = 3.93, 95% CI = 2.48-6.24; women: odds ratio = 4.24, 95% CI = 3.06-5.88) and recent psychiatric inpatient care (men: odds ratio = 3.57, 95% CI = 1.59-8,01; women: odds ratio = 2.68, 95% CI = 1.60-4.50). Further, those with many lifetime depressive episodes were more likely to attempt suicide. Comorbid substance use disorder was a predictor in men; many lifetime mixed episodes, early onset of mental disorder, personality disorder, and social problems related to the primary group were predictors in women. Conclusion: The principal clinical implication of the present study is to pay attention to the risk of suicidal behaviour in bipolar patients with depressive features and more severe or unstable forms of the disorder.
International Journal of Technology Assessment in Health Care, 1999
We conducted a retrospective cohort study based on a case note review to determine whether there ... more We conducted a retrospective cohort study based on a case note review to determine whether there are differences in the treatment pathways followed for men and women admitted with acute myocardial ischemia and infarction after adjusting for differences in case mix. Women were as likely as men to receive thrombolysis, but were less likely subsequently to undergo exercise testing (adjusted odds ratio, 0.58; 95% CI, 0.40–0.84) or angiography (adjusted odds ratio, 0.62; 95% CI, 0.39–0.99). Coronary anatomy was the strongest predictor of revascularization regardless of sex. Women with diagnosed cardiac pain are less likely than men to be placed on the investigative pathways that lead to revascularization. Those women who are investigated are as likely as men to undergo revascularization. These findings are independent of the effects of age, angina grade, comorbidity, or cardiac risk factors. Clinicians' and patients' beliefs and preferences about treatment require investigation.
year: 2010, 2010
Aims The subject of this thesis is suicide and other premature death related to mental disorder. ... more Aims The subject of this thesis is suicide and other premature death related to mental disorder. The overall aim is to provide knowledge to improve prevention strategies. The specific aims are as follows: Study I: To identify predictors of suicide in a cohort with long-term mental disorder. Study II: To analyse mortality by mental health service and psychiatric diagnosis in a cohort with long-term mental disorder. Study III: To investigate the impact of psychiatric morbidity on suicide risk following a suicide attempt. Study IV: To examine familial suicide risks in a total population sample. Methods Studies I and II: Adult residents with mental disorder in Stockholm County, Sweden, were identified in 1997. This register (n=12,247) was linked to national registers. Discharges from psychiatric inpatient care during 1990-2000 and deaths during 1997-2000 were identified. Predictors of suicide in the cohort were investigated; standardised mortality ratios were calculated. Study III: Data on all people living in Sweden 1973-82 were linked to national registers. People hospitalised during the period 1973-82 due to attempted suicide were identified. The cohort (n=39,685) consisted of those with a studied psychiatric diagnosis present at index attempt (cases) and those without a psychiatric diagnosis within a year after the suicide attempt (reference subjects). Patients were followed for 21-31 years. Survival curves for suicide were plotted and hazard ratios computed. Study IV: A population-based cohort (n=7,969,645) was created by linkage of Swedish national registers. Persons with death classified as definite or uncertain suicide 1952-2003 were identified (n=83,951). Odds ratios for suicide in relatives of suicide probands were calculated in relation to relatives of controls. Results Study I: Predictors of suicide included previous suicide attempt, a history of psychiatric inpatient care, and unmet need of a contact person. Borderline personality disorder was the strongest diagnostic predictor. Study II: Excess mortality was greater among those with a history of psychiatric inpatient care. The number of excess deaths due to natural causes was threefold that due to external causes. Study III: High proportions of suicides in all diagnostic groups took place within one year. The strongest predictors of completed suicide throughout the entire follow-up were schizophrenia and bipolar/unipolar disorder, with up to 39% suicide mortality. Study IV: The risk increase was threefold in full-siblings and twofold in children. The odds ratio for full-siblings was higher than that for maternal half-siblings. Odds ratios for second-and third-degree relatives were similar. Partners of suicide probands had a higher odds ratio than most biological relatives. Conclusions Treatment programs for persons with long-term mental disorder should target both physical and mental health. Unmet needs may signal increased suicide risk in persons with mental disorder. Psychiatric case management should focus on more intensive aftercare during the first years after a suicide attempt in patients with bipolar and unipolar disorder or schizophrenia. The findings of Study IV are not entirely consistent with variance by degree of genetic correlation; the study could identify impact of both shared environment and shared genes in familial transmission of suicidal behaviour.
The Journal of clinical psychiatry, Jan 4, 2015
To study the short-term risk of suicide after nonfatal deliberate self-harm and its association w... more To study the short-term risk of suicide after nonfatal deliberate self-harm and its association with coexisting mental disorders and with the method of self-harm used. We used linked Swedish national registers to design a cohort study with 34,219 individuals (59% females) who were admitted to hospital in 2000-2005 after deliberate self-harm (ICD-10-defined). They were followed for 3-9 years. The studied outcome was completed suicide; Cox regression models yielded hazard ratios (HRs) for suicide risk. Temporal patterns were plotted with Kaplan-Meier survival curves, calculated separately for each mental disorder and for the method used at the previous self-harm event. 1,182 subjects committed suicide during follow-up (670 males and 512 females). Coexisting bipolar disorder (in males, adjusted HR = 6.3; 95% confidence interval [CI], 3.8-10.3; in females, adjusted HR = 5.8; 95% CI, 3.4-9.7) and nonorganic psychotic disorder (in males, adjusted HR = 5.1; 95% CI, 3.5-7.4; in females, adj...
Psychological medicine, Jan 26, 2014
Background. Possible age-related differences in risk of completed suicide following non-fatal sel... more Background. Possible age-related differences in risk of completed suicide following non-fatal self-harm remain unexplored. We examined associations between self-harm and completed suicide across age groups of self-harming patients, and whether these associations varied by violent index method, presence of mental disorder, and repeated self-harm. Method. The design was a cohort study with linked national registers in Sweden. The study population comprised individuals aged ⩾10 years hospitalized during 1990-1999 due to non-fatal self-harm (n = 53 843; 58% females) who were followed for 9-19 years. We computed hazard ratios (HRs) across age groups (age at index self-harm episode), with time to completed suicide as outcome. Results. The 1-year HR for suicide among younger males (10-19 years) was 14.6 [95% confidence interval (CI) 4.1-51.9] for violent method and 8.4 (95% CI 1.8-40.0) for mental disorder. By contrast, none of the three potential risk factors increased the 1-year risks in...
Clinical practice and epidemiology in mental health : CP & EMH, 2008
Investigating mortality in those with mental disorder is one way of measuring effects of mental h... more Investigating mortality in those with mental disorder is one way of measuring effects of mental health care reorganisation. This study's aim was to investigate whether the excess mortality in those with severe mental disorder remains high in Sweden after the initiation of the Community Mental Health Care Reform. We analysed excess mortality by gender, type of mental health service and psychiatric diagnosis in a large community-based cohort with long-term mental disorder. A survey was conducted in Stockholm County, Sweden in 1997 to identify adults with long-term disabling mental disorder (mental retardation and dementia excluded). The 12 103 cases were linked to the Hospital Discharge Register and the Cause of Death Register. Standardised mortality ratios (SMRs) for 1998-2000 were calculated for all causes of death, in the entire cohort and in subgroups based on treatment setting and diagnosis. Mortality was increased in both genders, for natural and external causes and in all d...
J Clin Psychiatry, 2014
Released prisoners have high suicide rates compared with the general population, but little is kn... more Released prisoners have high suicide rates compared with the general population, but little is known about risk factors and possible causal pathways. We conducted a population-based cohort study to investigate rates and risk factors for suicide in people previously imprisoned. We identified individuals released from prison in Sweden between January 1, 2005, and December 31, 2009, through linkage of national population-based registers. Released prisoners were followed from the day of release until death, emigration, new incarceration, or December 31, 2009. Survival analyses were conducted to compare incidence rates and psychiatric morbidity with nonconvicted population controls matched on gender and year of birth. We identified 38,995 releases among 26,985 prisoners (7.6% female) during 2005-2009. Overall, 127 suicides occurred, accounting for 14% of all deaths after release (n = 920). The mean suicide rate was 204 per 100,000 person-years, yielding an incidence rate ratio of 18.2 (95% CI, 13.9-23.8) compared with general population controls. Previous substance use disorder (hazard ratio [HR] = 2.1; 95% CI, 1.4-3.2), suicide attempt (HR = 2.5; 95% CI, 1.7-3.7), and being born in Sweden versus abroad (HR = 2.1; 95% CI, 1.2-3.6) were independent risk factors for suicide after release. Released prisoners are at high suicide risk and have a slightly different pattern of psychiatric risk factors for suicide compared with the general population. Results suggest appropriate allocation of resources to facilitate transition to life outside prison and increased attention to prisoners with both a previous suicide attempt and substance use disorder.
Yearbook for Traditional Music, 1996
Social Psychiatry and Psychiatric Epidemiology, 2005
Rate of suicide is probably an indicator of the quality of mental health services within an area.... more Rate of suicide is probably an indicator of the quality of mental health services within an area. The aim of this study was to identify predictors of suicide in a large community-based cohort of persons with long-term mental disorder. A survey was conducted in Stockholm County, Sweden, in 1997 to identify adults with long-term disabling mental disorder (mental retardation and dementia excluded). The survey included an inventory of unmet needs as perceived by the service providers. The 12,247 cases were linked to the national in-patient register and the cause-of-death register. Predictors of suicide in 1997-2000 were determined by bivariate analysis and multiple logistic regression. Predictors of suicide included a history of in-patient psychiatric care, previous suicide attempt, substance abuse and unmet need of a contact person. Personality disorder, especially borderline personality disorder, was the strongest diagnostic predictor of suicide among those with a history of in-patient psychiatric care. Unmet needs may signal increased suicide risk in persons with severe mental disorder. Methods to improve suicide prevention in persons with personality disorder should be further developed. Interventions to reduce suicide in persons with a long-term mental disorder will require collaboration between psychiatric and social services.
Psychological Medicine, 2011
BackgroundResearch suggests that suicidal behaviour is aggregated in families. However, due to me... more BackgroundResearch suggests that suicidal behaviour is aggregated in families. However, due to methodological limitations, including small sample sizes, the strength and pattern of this aggregation remains uncertain.MethodWe examined the familial clustering of completed suicide in a Swedish total population sample. We linked the Cause of Death and Multi-Generation Registers and compared suicide rates among relatives of all 83 951 suicide decedents from 1952–2003 with those among relatives of population controls.ResultsPatterns of familial aggregation of suicide among relatives to suicide decedents suggested genetic influences on suicide risk; the risk among full siblings (odds ratio 3.1, 95% confidence interval 2.8–3.5, 50% genetic similarity) was higher than that for maternal half-siblings (1.7, 1.1–2.7, 25% genetic similarity), despite similar environmental exposure. Further, monozygotic twins (100% genetic similarity) had a higher risk than dizygotic twins (50% genetic similarity...
PLoS ONE, 2014
Objective: Bipolar disorder is associated with high risk of self-harm and suicide. We wanted to i... more Objective: Bipolar disorder is associated with high risk of self-harm and suicide. We wanted to investigate risk factors for attempted suicide in bipolar patients. Method: This was a cohort study of 6086 bipolar patients (60% women) registered in the Swedish National Quality Register for Bipolar Disorder 2004-2011 and followed-up annually 2005-2012. Logistic regression was used to calculate adjusted odds ratios for fatal or non-fatal attempted suicide during follow-up. Results: Recent affective episodes predicted attempted suicide during follow-up (men: odds ratio = 3.63, 95% CI = 1.76-7.51; women: odds ratio = 2.81, 95% CI = 1.78-4.44), as did previous suicide attempts (men: odds ratio = 3.93, 95% CI = 2.48-6.24; women: odds ratio = 4.24, 95% CI = 3.06-5.88) and recent psychiatric inpatient care (men: odds ratio = 3.57, 95% CI = 1.59-8,01; women: odds ratio = 2.68, 95% CI = 1.60-4.50). Further, those with many lifetime depressive episodes were more likely to attempt suicide. Comorbid substance use disorder was a predictor in men; many lifetime mixed episodes, early onset of mental disorder, personality disorder, and social problems related to the primary group were predictors in women. Conclusion: The principal clinical implication of the present study is to pay attention to the risk of suicidal behaviour in bipolar patients with depressive features and more severe or unstable forms of the disorder.
International Journal of Technology Assessment in Health Care, 1999
We conducted a retrospective cohort study based on a case note review to determine whether there ... more We conducted a retrospective cohort study based on a case note review to determine whether there are differences in the treatment pathways followed for men and women admitted with acute myocardial ischemia and infarction after adjusting for differences in case mix. Women were as likely as men to receive thrombolysis, but were less likely subsequently to undergo exercise testing (adjusted odds ratio, 0.58; 95% CI, 0.40–0.84) or angiography (adjusted odds ratio, 0.62; 95% CI, 0.39–0.99). Coronary anatomy was the strongest predictor of revascularization regardless of sex. Women with diagnosed cardiac pain are less likely than men to be placed on the investigative pathways that lead to revascularization. Those women who are investigated are as likely as men to undergo revascularization. These findings are independent of the effects of age, angina grade, comorbidity, or cardiac risk factors. Clinicians' and patients' beliefs and preferences about treatment require investigation.
year: 2010, 2010
Aims The subject of this thesis is suicide and other premature death related to mental disorder. ... more Aims The subject of this thesis is suicide and other premature death related to mental disorder. The overall aim is to provide knowledge to improve prevention strategies. The specific aims are as follows: Study I: To identify predictors of suicide in a cohort with long-term mental disorder. Study II: To analyse mortality by mental health service and psychiatric diagnosis in a cohort with long-term mental disorder. Study III: To investigate the impact of psychiatric morbidity on suicide risk following a suicide attempt. Study IV: To examine familial suicide risks in a total population sample. Methods Studies I and II: Adult residents with mental disorder in Stockholm County, Sweden, were identified in 1997. This register (n=12,247) was linked to national registers. Discharges from psychiatric inpatient care during 1990-2000 and deaths during 1997-2000 were identified. Predictors of suicide in the cohort were investigated; standardised mortality ratios were calculated. Study III: Data on all people living in Sweden 1973-82 were linked to national registers. People hospitalised during the period 1973-82 due to attempted suicide were identified. The cohort (n=39,685) consisted of those with a studied psychiatric diagnosis present at index attempt (cases) and those without a psychiatric diagnosis within a year after the suicide attempt (reference subjects). Patients were followed for 21-31 years. Survival curves for suicide were plotted and hazard ratios computed. Study IV: A population-based cohort (n=7,969,645) was created by linkage of Swedish national registers. Persons with death classified as definite or uncertain suicide 1952-2003 were identified (n=83,951). Odds ratios for suicide in relatives of suicide probands were calculated in relation to relatives of controls. Results Study I: Predictors of suicide included previous suicide attempt, a history of psychiatric inpatient care, and unmet need of a contact person. Borderline personality disorder was the strongest diagnostic predictor. Study II: Excess mortality was greater among those with a history of psychiatric inpatient care. The number of excess deaths due to natural causes was threefold that due to external causes. Study III: High proportions of suicides in all diagnostic groups took place within one year. The strongest predictors of completed suicide throughout the entire follow-up were schizophrenia and bipolar/unipolar disorder, with up to 39% suicide mortality. Study IV: The risk increase was threefold in full-siblings and twofold in children. The odds ratio for full-siblings was higher than that for maternal half-siblings. Odds ratios for second-and third-degree relatives were similar. Partners of suicide probands had a higher odds ratio than most biological relatives. Conclusions Treatment programs for persons with long-term mental disorder should target both physical and mental health. Unmet needs may signal increased suicide risk in persons with mental disorder. Psychiatric case management should focus on more intensive aftercare during the first years after a suicide attempt in patients with bipolar and unipolar disorder or schizophrenia. The findings of Study IV are not entirely consistent with variance by degree of genetic correlation; the study could identify impact of both shared environment and shared genes in familial transmission of suicidal behaviour.