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Death and suicide among former child and adolescent psychiatric patients
Mid Sweden University, Faculty of Human Sciences, Department of Social Work.ORCID iD: 0000-0001-7740-9910
Karolinska University Hospital.
Responsible organisation
2006 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 6, article id 51Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Increased mortality rates among previous child and adolescent psychiatry (CAP) patients have been found in Scandinavian studies up to the 1980s. The suicide risk in this group has been estimated to be almost five times higher than expected. This article addresses two questions: Do Swedish CAP patients continue to risk premature death and what kind of information related to psychiatric symptoms and/or behavior problems can predict later suicide? METHODS: Hospital files, Sweden's census databases (including immigration and emigration) and administrative databases (including the Swedish Hospital Discharge register and the Persons Convicted of Offences register), and the Cause of Death register were examined to determine the mortality rate in a group of 1,400 former CAP inpatients and outpatients over a period of 12-33 years. Observed and expected numbers of deceased were calculated with the prospective method and the standardized mortality ratio (SMR) method. The relative risk or the risk ratio (RR) is presented with 95% confidence intervals (CIs). Significance level tests were made using two-by-two tables and chi-square tests. The Cox proportional-hazards regression model was used for survival analysis. RESULTS: Twenty-four males and 14 females died. Compared with the general population, the standardized mortality ratio in this group of CAP patients was significantly higher in both sexes. Behavioral problems, school problems, and co-morbid alcohol or drug abuse and criminality (including alcohol-related crimes) were found to be important predictors. Thirty-two deaths were attributed to suicide, intoxication, drug overdose, or accident; one patient died of an alcohol abuse-related disorder, and five patients died of natural causes. Suicide was the most common cause of death, but only 2 of these 19 cases were initially admitted for attempted suicide. CONCLUSION: We suggest that suicide and death prevention among CAP patients may not be a psychiatric issue per se but a future function of society's juvenile social-welfare investments and juvenile-delinquency prevention programs.

Place, publisher, year, edition, pages
2006. Vol. 6, article id 51
Keywords [en]
Premature mortality, suicide, child and adolescent psychiatry, psychiatry, psychosocial factors
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:miun:diva-3958DOI: 10.1186/1471-244X-6-51ISI: 000207942500051PubMedID: 17081290Scopus ID: 2-s2.0-33751021111Local ID: 4416OAI: oai:DiVA.org:miun-3958DiVA, id: diva2:28990
Available from: 2008-11-23 Created: 2008-11-23 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Suicides, psychotic disorders and criminality among former child and adolescent psychiatric patients followed into adulthood
Open this publication in new window or tab >>Suicides, psychotic disorders and criminality among former child and adolescent psychiatric patients followed into adulthood
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim was to provide information about child and adolescent psychiatric (CAP) patients and their outcome as adults: Were their difficulties in childhood due to mental illness, disablement and/or behaviour disorders? What happened to them as adults? Who were the patients in need of psychiatric care (GenP) in adulthood that had not had previous contact with CAP? Did this group differ from the former CAP group? Methods: Paper I-III: 1,400 CAP patients admitted 1975-1990 to inpatient or outpatient CAP care in Jämtland County, Sweden were followed until 2003. Paper IV: A sample of 167 GenP patients not treated in CAP was compared to GenP patients with a history of CAP care. Hospital records at CAP were reassessed according to a study specific protocol. Outcome was measured in relation to register data on mortality, suicides, psychiatric/somatic care, and criminal convictions. CAP records were examined for those treated for psychosis either at CAP and or in GenP. Results: Every third CAP patient has later received GenP care. They constituted a small part of the GenP patients in the same age-groups. The CAP patients showed an elevated rate of early death. Two of the 19 who later committed suicide had been initially admitted because of attempted suicide. Every third CAP patient had a criminal record. Over the past 50 years, the percentage of Swedish boys admitted to CAP care and later registered as criminals seems to have doubled while the corresponding percentage for girls has increased almost seven times. Behavioural disorders as a reason for CAP care were the most substantial risk factor for later criminality. Sixty-two former CAP patients (4.4%) received a psychosis diagnosis during the observation time 48 of them within the Schizophrenia categories and 14 with Psychotic Mood Disorder. Mean age at first onset was 21.4 years. Changes in behaviour, including social isolation, refusal to go to school, loneliness and odd behaviour in general were the initial signs and symptoms most frequently observed prior or upon admission to CAP-care. The GenP patients with and without a previous history in CAP care had similar problems as adults. Both groups had a larger need of somatic hospital inpatient-care before the age of 18 years when compared to the general population. More than a third of the treatment occasions occurred in paediatric care. Conclusions: Psychosocial risk factors and social maladjustment in childhood seem to be the most important predictors of early death, including suicide. The increased risk of later criminality is hypothetically the result of rising alcohol consumption in Sweden, the comorbid use of illegal drugs, and changes in the organization of child social welfare work, the school system, and CAP methods that has occurred since 1970. Patients with onset of schizophrenia before 13-17 years of age showed typical symptoms upon admission to CAP care; while late-onset psychosis among former CAP could not be predicted from information gathered during CAP care. There is a group of patients treated in paediatrics and in CAP during childhood and adolescence before becoming later patients in GenP. These patients can most likely be identified during childhood if a closer collaboration is developed between paediatrics and CAP services. Hypothetically, the need of GenP care as adults in the larger group of GenP patients without a previous CAP history may develop from accumulated stressful life-events.

Place, publisher, year, edition, pages
Stockholm: Karolinska institutet, 2009
Keywords
Psychiatry, child, adolescent, adult, mortality, suicide, crime, mental disorders, psychotic disorders, paediatrics, longitudinal studies
National Category
Psychiatry
Identifiers
urn:nbn:se:miun:diva-9118 (URN)978-91-7409-519-7 (ISBN)
Public defence
2009-06-12, Stockholm, 09:00 (English)
Available from: 2009-06-08 Created: 2009-06-08 Last updated: 2009-06-08Bibliographically approved

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