Suicide attempts among Greenlandic forensic psychiatric patients – prevalence and determinants

Jentz, Christian; P, Heilmann; Nathanielsen, Naaja; Upfold, Casey; Kleist, Inaluk; Sørensen, Lambert K.

doi:10.1080/22423982.2022.2037257

Cited by 7 publications

(12 citation statements)

References 34 publications

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“…Studies have shown that a series of variables were associated with suicide attempts, such as sex, grade, residence, family integrity, feeling meaningless in life, depression, bullying perpetrator, autonomy parenting, self-esteem, hopelessness, and stressful life events ( 5 ). Physical abuse in childhood, family history of substance misuse, and criminal convictions among family members might also play a role in affecting attempted suicide ( 25 ). However, these features were investigated among general adolescents but were not especially for predicting self-poisoning suicide.…”

Section: Discussionmentioning

confidence: 99%

“…Validation of the nomogram was conducted using discrimination and calibration. Discrimination was the capacity to discriminate patients with and without the positive event (23, 24), and the metrics that used to evaluate discrimination mainly included area under curve (AUC) and discrimination slope. Calibration was defined as the consistency of the anticipated and observed probability of the positive event (23, 24), and the metrics mainly included Brier score, Brier scaled score, and Hosmer and Lemeshow test.…”

Section: Nomogram Development and Validationmentioning

confidence: 99%

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Identification of risk factors for attempted suicide by self-poisoning and a nomogram to predict self-poisoning suicide

Zheng

Fan

et al. 2023

Front. Public Health

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PurposeSuicide is a global concern, especially among young people. Suicide prediction models have the potential to make it easier to identify patients who are at a high risk of suicide, but they have very little predictive power when there is a positive value for suicide mortality. Therefore, the aim of the study is to uncover potential risk factors associated with suicide by self-poisoning and further to provide a trustworthy nomogram to predict self-poisoning suicide among poisoned patients.MethodsThis study prospectively enrolled 237 patients who were treated for poisoning at the Fifth Medical Center of PLA General Hospital (Beijing) between May 2021 and May 2022. Patient's basic characteristics, daily activities, mental health status, and history of psychological illnesses were gathered to examine their predictive power for self-poisoning suicide. On developing a prediction model, patients were split 8:2 into a training (n = 196) group and a validation (n = 41) group at random via computer. The training group worked on model development, while the validation group worked on model validation. In this study, the Hosmer and Lemeshow test, accuracy, and area under the curve were the primary evaluation criteria. Shapley Additive exPlanations (SHAP) was determined to evaluate feature importance. To make the prediction model easy for researchers to utilize, it was presented in nomogram format. Two risk groups of patients were identified based on the ideal cut-off value.ResultsOf all poisoned patients, 64.6% committed suicide by self-poisoning. With regard to self-poisoning attempted suicide, multivariate analysis demonstrated that female gender, smoking, generalized anxiety disorder-7 (GAD-7), and beck hopelessness scale-20 (BHS-20) were significant risk factors, whereas married status, relatively higher education level, a sedentary time of 1–3 h per day, higher sport frequency per week, higher monthly income were significant protective features. The nomogram contained each of the aforementioned nine features. In the training group, the area under curve (AUC) of the nomogram was up to 0.938 (0.904–0.972), whereas in the validation group, it reached a maximum of 0.974 (0.937–1.000). Corresponding accuracy rates were up to 0.883 and 0.927, respectively, and the P-values for the Hosmer and Lemeshow test were 0.178 and 0.346, respectively. SHAP demonstrated that the top three most important features were BHS-20, GAD-7, and marital status. Based on the best cut-off value of the nomogram (40%), patients in the high-risk group had a nearly six-time larger likelihood of committing suicide by self-poisoning than patients in the low-risk group (88.68 vs. 15.38%, P < 0.001). The dynamic nomogram was made available at the following address: https://xiaobo.shinyapps.io/Nomogramselfpoisoningsuicide/.ConclusionsThis study proposes a prediction model to stratify patients at a high risk of suicide by self-poisoning and to guide individual preventive strategies. Patients in the high-risk group require further mental health counseling to alleviate anxiety and hopelessness, healthy lifestyle like quitting smoking and exercising more, and restriction of access to poison and psychiatric drugs.

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Section: Discussionmentioning

confidence: 99%

Section: Nomogram Development and Validationmentioning

confidence: 99%

Identification of risk factors for attempted suicide by self-poisoning and a nomogram to predict self-poisoning suicide

Zheng

Fan

et al. 2023

Front. Public Health

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“…Data in this retrospective cross-sectional study is part of a previous study of forensic psychiatric patients in Greenland. Data was collected on February 29th, 2020 [ 28 ].…”

Section: Methodsmentioning

confidence: 99%

“…The majority of Greenlandic forensic psychiatric patients are treated as outpatients [ 28 ]. The Department of Psychiatry in Nuuk has twelve beds.…”

Section: Methodsmentioning

confidence: 99%

“…Forensic psychiatric patients may be admitted to both the closed and open ward in Greenland, depending on their treatment and security need. More severely ill forensic psychiatric patients in need of treatment in a further specialised secure setting are routinely transferred to Denmark to a medium secure forensic psychiatric department in accordance with an agreement between the former home rule and the Central Denmark Region [ 28 , 39 , 40 ]. There are no concrete criteria that has to be fulfilled for a transfer.…”

Section: Methodsmentioning

confidence: 99%

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Nationwide study on antipsychotic polypharmacy among forensic psychiatric patients

Lassen,

Heintz,

Pedersen

et al. 2023

International Journal of Circumpolar Health

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This nationwide retrospective cross-sectional study examines the prevalence of antipsychotic polypharmacy (APP) and demographic, forensic, and clinical factors associated with its practice among Greenlandic forensic psychiatric patients. We collected data from electronic patient files, court documents, and forensic psychiatric assessments. We defined APP as two or more concurrent prescriptions of antipsychotic medication. The study population of 74 patients had a mean age of 41.4 years, and 61 were men. All included patients had either schizophrenia or another ICD-10 F2-diagnosis. We used unpaired t-tests and Chi 2 or Fisher’s exact test. The prevalence of APP was 35% ( n = 26), and there was a significant association between APP and a prescription of clozapine (Chi 2 , p = 0.010), olanzapine (Fisher’s test, p = 0.003), and aripiprazole (Fisher’s test, p = 0.013). Furthermore, we found a significant association between APP and prescription of a first-generation antipsychotic (FGA) (Chi 2 , p = 0.011). Despite recommendations in guidelines, the use of APP is common practice. The majority of forensic psychiatric patients suffer from severe psychiatric disorders, often with other comorbidities, including substance use disorder. The severity and complexity in mental health render forensic psychiatric patients at high risk of APP treatment. Further knowledge on APP use is crucial to secure and further improve the psychopharmacological treatment for this group of patients.

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Forensic psychiatry patients, services, and legislation in Nunavut and Greenland

Upfold,

Jentz,

Heilmann

et al. 2023

International Journal of Law and Psychiatry

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Suicide attempts among Greenlandic forensic psychiatric patients – prevalence and determinants

Cited by 7 publications

References 34 publications

Identification of risk factors for attempted suicide by self-poisoning and a nomogram to predict self-poisoning suicide

Identification of risk factors for attempted suicide by self-poisoning and a nomogram to predict self-poisoning suicide

Nationwide study on antipsychotic polypharmacy among forensic psychiatric patients

Forensic psychiatry patients, services, and legislation in Nunavut and Greenland

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