Biomedical subjects
Lars Mehlum
Publications and source records attributed to Lars Mehlum.
Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior?
OBJECTIVE: Studies show that childhood sexual and physical abuse predict repeated suicide attempts and self-mutilation. Little is known about the importance of sexual and physical abuse when compared to other severe childhood adversities with respect to chronic suicidal behavior. METHOD: Seventy-four subjects, 65% of whom were women, consecutively admitted to a general hospital after having made a suicide attempt, were interviewed as part of the intake interview about prior suicide attempts and self-mutilation and received DSM-IV diagnoses. Sexual abuse, physical abuse, neglect, antipathy from parents, loss of parents, and severe discord in the family before the age of 18, were covered by the Childhood Experience of Care and Abuse (CECA) interview schedule. RESULTS: The prevalence of severe sexual abuse was 35%, severe physical abuse 18%, neglect 27%, antipathy 34%, loss of caregiver 37% and exposure to family violence 31%. Physical and sexual abuse were independently associated with repeated suicide attempts when controlling for the effects of the other childhood adverse factors. No other childhood adversity was related to chronic suicidal behavior. The odds ratio of exposure to sexual or physical abuse was highest among those who both repeated suicide attempts and self-mutilated. CONCLUSION: Physical and sexual abuse are significantly and independently associated with repeated suicidal behavior.
A suicide prevention strategy for England.
Over the last decade an increasing number of countries have established national strategies for suicide prevention. In the autumn of 2002 the suicide prevention strategy for England was presented to the general public, introducing what could be called a second generation of national programs for suicide prevention. This strategy uses evidence-based criteria for its priorities more systematically than before. Furthermore, it has put an increased emphasis on goals being specific, preventive measures being practical, and the preventive potential being visible. Other guiding principles for this strategy are that suicide preventive measures and initiatives should be open to monitoring and evaluation, and that revisions and updates of the national strategy should be made regularly--thus constituting an evolving strategy. This paper examines the content of the new national strategy for suicide prevention in England and what new contributions to the field it may make.
Risk factors for fatal accidents and suicides in peacekeepers: is there an overlap?
OBJECTIVE: Previous research has indicated that there is an increased risk of fatal accidents in veterans of military operations and that such accidental deaths may be related to mental health problems. This study was conducted to investigate fatal accidents in Norwegian former peacekeepers. METHODS: A subgroup of alcohol-related fatal accidents was identified. Interview data with next of kin, military data and police report data from 17 cases of alcohol-related fatal accidents were compared with data from 28 cases of other accidents and 43 cases of suicide among Norwegian veterans of peacekeeping service. RESULTS: The alcohol-related fatal accidents were found to share many common features with the suicide group, such as depression, alcohol and substance abuse, and various social problems, and were also found to differ significantly from the other fatal accidents. CONCLUSIONS: The findings indicate a need for preventive measures directed at reducing the risk of premature death not only from suicide, but also from accidental death.
[Deliberate self harm in adolescents].
BACKGROUND: The multisenterstudy Child and Adolescent Self Harm in Europe aims at gaining more valid knowledge about the prevalence of deliberate self harm in adolescents and the factors associated with it. A new method was developed by which the adolescents' self-reported acts of deliberate self harm are included and categorised according to strict predefined criteria. MATERIAL AND METHOD: 4060 11th grade students (response rate 91.2 %) aged 15 and 16 in 36 Norwegian high schools filled in an anonymous self-report questionnaire. RESULTS: 266 (6.6 %) reported one or more acts of deliberate self harm that met the study criteria over the course of the previous twelve-month period. Cutting (74.1 %) and self-poisoning (16.9 %) were most prevalent. 14.7 % had been in contact with a hospital; 46.7 % of self-poisoning episodes but only 6.1 % of cutting episodes were treated in hospital. Deliberate self harm was more common in females than in males (10.2 % vs 3.1 %, odds ratio 3.5, 95 % CI 2.66 - 4.72). Multiple logistic regression showed significant associations for both sexes between deliberate self harm and low self-esteem, deliberate self harm by friends, serious conflicts with parents, or drug misuse. For girls, alcohol misuse, parents being divorced, being sexually abused, anxiety and impulsivity were also significant; so was deliberate self harm in the family for boys. INTERPRETATION: Deliberate self harm among adolescents requires varied and intensified efforts.
Suicide in peacekeepers--a cohort study of mortality from suicide in 22,275 Norwegian veterans from international peacekeeping operations.
OBJECTIVE: Several studies have investigated post-traumatic stress reactions and other psychosocial problems in former peacekeepers. The question has also been raised as to whether such veterans might be at increased risk of suicide. This study investigated the suicide mortality in Norwegian former peacekeepers. METHODS: Cause-specific mortality was identified in the population of Norwegian peacekeepers having participated in army missions in the years 1978-95. General population data were used for comparison. Standardized Mortality Ratios (SMRs) were calculated for different suicide methods and certain peacekeeping-related variables. Marital status was available for each year and controlled for by using separate suicide rates for unmarried, married and divorced. RESULTS: A moderately, but significantly, increased SMR of 1.4 for suicide was found among the former peacekeepers (95% confidence interval = 1.1-1.8). After adjusting for marital status, the SMR was reduced to insignificance (SMR = 1.1, 95% confidence interval = 0.9-1.4). There was a significant increase in suicide by means of firearms and carbon monoxide poisoning. CONCLUSIONS: The increased risk of suicide in former peacekeepers was related to the peace-keepers' lower marriage rate compared to the general population. This finding may indicate that the personnel were characterized by certain vulnerability factors before entering peacekeeping service, resulting in a reduced ability to enter into and remain in stable love relations. However, it cannot be excluded that stress reactions following peacekeeping may have contributed to possible strains on interpersonal relationships. Preventative work should, thus, include improved personnel selection routines and preferably also psychosocial support for veterans and their families. The increased number of suicides by use of firearms indicates that gun control might be an important prevention measure in this group.
Predictors of posttraumatic stress reactions in Norwegian U.N. peacekeepers 7 years after service.
A sample of 1,624 Norwegian veterans from the UNIFIL (United Nations Interim Force in Lebanon) was investigated on average 6.6 years after service, completing a questionnaire focusing on stress exposure and posttraumatic stress reactions. The prevalence of posttraumatic stress disorder (measured by the Posttraumatic Symptom Scale [PTSS-10]) was 5% overall, but 16% in the subgroup of personnel having been prematurely repatriated from UNIFIL. Multiple regression analyses showed that the following variables made separate and significant contributions to the explained variance of the PTSS-10: Service stress exposure, perceived lack of meaningfulness with respect to the military mission, and stressful life-events in life after service. These factors explained 25% (overall sample) and 37% (repatriated sample) of the variation in the posttraumatic symptom score.