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Salander Renberg, Ellinor
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Publications (10 of 74) Show all publications
Lindh, Å. U., Beckman, K., Carlborg, A., Waern, M., Salander Renberg, E., Dahlin, M. & Runeson, B. (2020). Predicting suicide: A comparison between clinical suicide risk assessment and the Suicide Intent Scale. Journal of Affective Disorders, 263, 445-449
Open this publication in new window or tab >>Predicting suicide: A comparison between clinical suicide risk assessment and the Suicide Intent Scale
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2020 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 263, p. 445-449Article in journal (Refereed) Published
Abstract [en]

Background: How suicide risk should be assessed is under discussion with arguments for both actuarial and clinical approaches. The aim of the present study was to compare the predictive accuracy of a clinical suicide risk assessment to that of the Suicide Intent Scale (SIS) in predicting suicide within one year of an episode of self-harm with or without suicidal intent.

Methods: Prospective clinical study of 479 persons assessed in a psychiatric emergency department after an episode of self-harm. The clinical risk assessment and the SIS rating were made independently of each other. Suicides within one year were identified in the National Cause of Death Register. Receiver operating characteristic (ROC) curves were constructed, optimal cut-offs were identified and accuracy statistics were calculated.

Results: Of 479 participants, 329 (68.7%) were women. The age range was 18-95 years. During one-year follow up, 14 participants died by suicide. The area under the curve (AUC) for the clinical risk assessment and the SIS score were very similar, as were the accuracy statistic measures at the optimal cut-offs of the respective methods. The positive predictive value (PPV) of each assessment method was 6%.

Limitations: The clinical suicide risk assessment is not standardized. The number of suicides is small, not allowing for stratification by e.g. gender or diagnosis.

Conclusion: Predictive accuracy was similar for a clinical risk assessment and the SIS, and insufficient to guide treatment allocation.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Self-harm, Suicide attempt, Suicide, Suicide risk assessment, Suicide Intent Scale
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-168224 (URN)10.1016/j.jad.2019.11.131 (DOI)000508874400057 ()31969276 (PubMedID)
Available from: 2020-02-26 Created: 2020-02-26 Last updated: 2020-02-26Bibliographically approved
Lindh, Å. U., Dahlin, M., Beckman, K., Strömsten, L. M. J., Jokinen, J., Wiktorsson, S., . . . Runeson, B. (2019). A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: A Clinical Cohort Study. Journal of Clinical Psychiatry, 80(6), Article ID 18m12707.
Open this publication in new window or tab >>A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: A Clinical Cohort Study
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2019 (English)In: Journal of Clinical Psychiatry, ISSN 0160-6689, E-ISSN 1555-2101, Vol. 80, no 6, article id 18m12707Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare the predictive accuracy of the Suicide Intent Scale (SIS), the Suicide Assessment Scale (SUAS), the Karolinska Interpersonal Violence Scale (KIVS), and the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicide attempts and suicides within 3 and 12 months of an episode of self-harm.

METHODS: This prospective multicenter cohort study included patients (N = 804) aged 18-95 years with a recent episode of self-harm assessed in psychiatric emergency settings from April 2012 to April 2016. Suicide attempts and suicides were identified in medical records and in the National Cause of Death Register. Receiver operating characteristic curves were constructed, and accuracy statistics were calculated. A sensitivity of at least 80% combined with a specificity of at least 50% were considered minimally acceptable.

RESULTS: At least 1 suicide attempt was recorded for 216 participants during follow-up, and 19 participants died by suicide. The SUAS and C-SSRS were better than chance in classifying the 114 suicide attempts occurring within the first 3 months; a C-SSRS score ≥ 27 yielded a sensitivity/specificity of 79.8%/51.5% (P < .001). During 1-year follow-up, the SUAS and C-SSRS also performed better than chance, but no cutoff on either instrument gave a sensitivity/specificity of ≥ 80%/≥ 50%. The SIS was the only instrument that could classify suicides correctly. At 3 months, the area under the curve (AUC) was 0.94 (95% CI, 0.89-0.99), and a score ≥ 21 predicted suicide with a sensitivity/specificity of 100%/81.9%, based on only 4 suicides. At 1-year follow-up, the AUC was 0.74 (95% CI, 0.61-0.87), and a score ≥ 17 predicted suicide with a sensitivity/specificity of 72.2%/57.9%.

CONCLUSIONS: Instruments that predicted nonfatal repeat suicide attempts did not predict suicide and vice versa. With the possible exception of the prediction of suicide by the SIS in a short time frame, the specificity of these instruments was low, giving them a limited relevance in the prediction of suicidal behaviors.

Place, publisher, year, edition, pages
Physicians Postgraduate Press, 2019
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-165430 (URN)10.4088/JCP.18m12707 (DOI)000517803900011 ()31747488 (PubMedID)
Funder
Swedish Research Council, 521-2011-299
Available from: 2019-11-25 Created: 2019-11-25 Last updated: 2020-04-07Bibliographically approved
Idenfors, H., Strömsten, L. & Salander Renberg, E. (2019). Are non-psychiatric hospitalisations before self-harm associated with an increased risk for suicide among young people?. Journal of Psychosomatic Research, 120, 96-101
Open this publication in new window or tab >>Are non-psychiatric hospitalisations before self-harm associated with an increased risk for suicide among young people?
2019 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 120, p. 96-101Article in journal (Refereed) Published
Abstract [en]

Objective: This study aimed to investigate any increased risk for suicide in young people with admission for self-harm and if the risk is further increased due to somatic inpatient admissions before a first act of self-harm.

Methods: This register study included 16,235 cases in the ages 16–24, with a first admission for self-harm, and 32,465 matched controls. All admissions and diagnoses were recorded from the year preceding cases first admission for self-harm. Subjects were followed until death or end of study, registering the cause of death for all deceased. Group differences were analysed using survival analysis with death by suicide as primary outcome.

Results: In cases with a previous somatic admission, the risk for death by suicide during the study period was higher than in cases without a somatic admission (457 and 316 suicides per 100,000 people and year, respectively, p = 0.01). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04–1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year.

Conclusions: This study suggests that admission for physical illness before self-harm is associated with a higher risk for suicide among young people, and that their contact with healthcare due to physical problems could provide an opportunity to detect suicide risk.

Keywords
Suicide, Young people, Self-harm, Case-control, Register study, Somatic disorders, Suicide risk, Suicide attempt
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-120696 (URN)10.1016/j.jpsychores.2019.02.013 (DOI)000464627300014 ()30929715 (PubMedID)
Note

Originally included in thesis in manuscript form

Available from: 2016-05-18 Created: 2016-05-18 Last updated: 2019-05-27Bibliographically approved
Beckman, K., Lindh, Å., Waern, M., Strömsten, L. M. J., Salander Renberg, E., Runesson, B. & Dahlin, M. (2019). Impulsive suicide attempts among young people: a prospective multicentre cohort study in Sweden. Journal of Affective Disorders, 243, 421-426
Open this publication in new window or tab >>Impulsive suicide attempts among young people: a prospective multicentre cohort study in Sweden
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2019 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 243, p. 421-426Article in journal (Refereed) Published
Abstract [en]

Background: We aimed to compare the prevalence of impulsive suicide attempts (ISA) among young adults and those over 25 who present at hospital in connection with attempted suicide. We also aimed to identify factors associated with ISA in young adults and to assess medical severity as well as the probability of repeated suicide attempts in this age group.

Method: A prospective multicentre cohort study included hospital known cases of suicide attempt (N = 666). The prevalence of ISA was compared between young adults (18-25) and adults aged > 26. We used logistic regression models to identify factors associated with ISA, associations of ISA with high medical severity and prediction of new fatal or non-fatal suicide attempts within 6 months.

Results: 43.7% of the young patients had made an ISA, and 30.2% among those aged > 26 (p = 0.001). Among the young, substance use disorder was associated with ISA; crude odds ratio (OR) 2.0 (1.0-4.2), and adjusted OR 2.1 (0.99-4.4). Affective disorder and unemployment/sickness absence implied lower odds of ISA. ISA resulted in injuries of high medical severity as often as more planned attempts and non-fatal or fatal repetition within 6 months was equally common (30%) in both groups.

Limitations: The study was set in psychiatric emergency services, which limits the generalizability.

Conclusions: Clinicians should acknowledge that suicide attempts among youth often occur without previous planning and may result in medically severe injuries. The probability of new fatal or non-fatal suicide attempts should be kept in mind also after an impulsive suicide attempt.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Suicide, Young, Suicide attempt, Cohort study, Mental illness
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-151956 (URN)10.1016/j.jad.2018.09.070 (DOI)000446860300055 ()30268958 (PubMedID)
Funder
Swedish Research Council, 521-2011-299Stockholm County CouncilVästerbotten County Council, ALFVLL-549931
Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2019-10-16Bibliographically approved
Lindgren, B.-M., Molin, J., Lundström, M., Strömbäck, M., Salander Renberg, E. & Ringnér, A. (2018). Does a new spatial design in psychiatric inpatient care influence patients’ and staff’s perception of their care/working environment?: A study protocol of a pilot study using a single-system experimental design. Pilot and Feasibility Studies, 4, Article ID 191.
Open this publication in new window or tab >>Does a new spatial design in psychiatric inpatient care influence patients’ and staff’s perception of their care/working environment?: A study protocol of a pilot study using a single-system experimental design
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2018 (English)In: Pilot and Feasibility Studies, ISSN 2055-5784, Vol. 4, article id 191Article in journal (Refereed) Published
Abstract [en]

Background: Research shows that worn-out physical environments are obstacles to psychiatric inpatient care. Patients want better relationships with staff and things to do; staff want an environment that offers hope, a calm atmosphere, and joint activities. A county council in northern Sweden and Philips Healthcare partnered to create solutions to the environmental challenges of psychiatric inpatient care. One ward at a county psychiatric clinic was selected for a pilot project to test solutions that could improve the care environment for patients, staff, and relatives. The aim of the overall project is to evaluate the effects of a newly designed psychiatric inpatient ward on patients and staff in terms of quality of care and stress. In this study, we focus on the feasibility through testing questionnaires and exploring barriers to recruiting staff and patients.

Methods: This study had a single-system experimental design, comparing a psychiatric unit pre- and post-implementation of the novel spatial design, using repeated measures with the same questionnaires twice a week during baseline and intervention phases. Primary outcomes were quality interactions (patients) and perceived stress (staff). Secondary outcomes were levels of anxiety and depression (patients), and stress of conscience (staff). A process evaluation was aimed to describe contextual factors and participant experiences of the new design. Data was collected using questionnaires and semi-structured individual interviews with patients and focus group discussions with staff. Both visual and statistical methods were used to analyse the quantitative data and content analysis for the qualitative data.

Discussion: The findings will contribute insights into whether and how a new spatial design might contribute to quality interactions and reduced stress. This is relevant both nationally and internationally, as similar interventions are needed but sparse. The findings will be disseminated through peer-reviewed publications and conference presentations.

Trial registration: ClinicalTrials.gov, NCT03140618, registered 4 May 2017.

Keywords
Activity, Environment, Feasibility, Intervention, Nursing, Process evaluation, Protocol, Psychiatric inpatient care, Quality interactions, Single-system design
National Category
Nursing Psychiatry
Identifiers
urn:nbn:se:umu:diva-154939 (URN)10.1186/s40814-018-0383-4 (DOI)30607254 (PubMedID)
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-11Bibliographically approved
Öhlund, L., Ott, M., Oja, S., Bergqvist, M., Lundqvist, R., Sandlund, M., . . . Werneke, U. (2018). Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study. BMC Psychiatry, 18, Article ID 37.
Open this publication in new window or tab >>Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study
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2018 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, article id 37Article in journal (Refereed) Published
Abstract [en]

Background: Lithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium’s proven benefits concerning the prevention of severe affective episodes and suicide.

Methods: Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good.

Results: Of 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001).

Conclusions: Stopping lithium treatment is common and occurs mostly due to adverse effects. It is important to discuss potential adverse effects with patients before initiation and continuously during lithium treatment, to reduce the frequency of potentially unnecessary discontinuations.

Keywords
Lithium, Bipolar disorder, Physical health, Compliance, Side effects
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-145594 (URN)10.1186/s12888-018-1622-1 (DOI)000424707200003 ()29415689 (PubMedID)
Note

Correction: Louise Öhlund, Michael Ott, Sofia Oja, Malin Bergqvist, Robert Lundqvist, Mikael Sandlund, Ellinor Salander Renberg and Ursula Werneke. Correction to: Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study. BMC Psychiatry, 2018;18:322. DOI: 10.1186/s12888-018-1895-4

Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2020-05-05Bibliographically approved
Lindh, Å. U., Waern, M., Beckman, K., Salander Renberg, E., Dahlin, M. & Runeson, B. (2018). Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm. BMC Psychiatry, 18, Article ID 319.
Open this publication in new window or tab >>Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm
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2018 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, article id 319Article in journal (Refereed) Published
Abstract [en]

Background: The Columbia-Suicide Severity Rating Scale (C-SSRS) is a relatively new instrument for the assessment of suicidal ideation and behaviour that is widely used in clinical and research settings. The predictive properties of the C-SSRS have mainly been evaluated in young US populations. We wanted to examine the instrument's predictive validity in a Swedish cohort of adults seeking psychiatric emergency services after an episode of self-harm. Methods: Prospective cohort study of patients (n = 804) presenting for psychiatric emergency assessment after an episode of self-harm with or without suicidal intent. Suicidal ideation and behaviours at baseline were rated with the C-SSRS and subsequent non-fatal and fatal suicide attempts within 6 months were identified by record review. Logistic regression was used to evaluate separate ideation items and total scores as predictors of non-fatal and fatal suicide attempts. Receiver operating characteristics (ROC) curves were constructed for the suicidal ideation (SI) intensity score and the C-SSRS total score. Results: In this cohort, the median age at baseline was 33 years, 67% were women and 68% had made at least one suicide attempt prior to the index attempt. At least one non-fatal or fatal suicide attempt was recorded during follow-up for 165 persons (20.5%). The single C-SSRS items frequency, duration and deterrents were associated with this composite outcome; controllability and reasons were not. In a logistic regression model adjusted for previous history of suicide attempt, SI intensity score was a significant predictor of a non-fatal or fatal suicide attempt (OR 1.08; 95% CI 1.03-1.12). ROC analysis showed that the SI intensity score was somewhat better than chance in correctly classifying the outcome (AUC 0.62, 95% CI 0.57-0.66). The corresponding figures for the C-SSRS total score were 0.65, 95% CI 0.60-0.69. Conclusions: The C-SSRS items frequency, duration and deterrents were associated with elevated short term risk in this adult psychiatric cohort, as were both the SI intensity score and the C-SSRS total score. However, the ability to correctly predict future suicidal behaviour was limited for both scores.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Self-harm, Suicide, Risk factors, Classification, Outcome
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-152881 (URN)10.1186/s12888-018-1883-8 (DOI)000446389100002 ()30285661 (PubMedID)
Funder
Swedish Research Council, 521-2011-299Swedish Research Council, ALFGBG-715841Stockholm County Council, 20120225Stockholm County Council, 20150290Västerbotten County Council, VLL-549931
Available from: 2018-10-31 Created: 2018-10-31 Last updated: 2018-10-31Bibliographically approved
Rajalin, M., Hirvikoski, T., Salander Renberg, E., Åsberg, M. & Jokinen, J. (2017). Family history of suicide and interpersonal functioning in suicide attempters. Psychiatry Research, 247, 310-314
Open this publication in new window or tab >>Family history of suicide and interpersonal functioning in suicide attempters
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2017 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 247, p. 310-314Article in journal (Refereed) Published
Abstract [en]

Difficulties in interpersonal relationships are associated with a wide range of psychiatric diagnoses and have been reported as a trigger for suicidal behavior, too. The aim of this study was to examine the relationship between interpersonal problems and family history of suicide in suicide attempters and to describe relevant patterns of interpersonal problems in this patient group. The study involves 181 patients having their clinical follow-up after a suicide attempt. Family history of suicide was assessed by using the Karolinska Self Harm History Interview or retrieved in patient records. The Inventory of Interpersonal Problems was used to assess personal style in an interpersonal context. Suicide attempters with a family history of suicide had significantly more often an intrusive personal style. The results remained significant after adjustment for personality disorder. The specific interpersonal patterns associated with family history of suicide may interfere with the ability to create stable, long-lasting relationships. In regards to treatment, these personal qualities could cause difficulties in the alliance with health care personnel and make it harder for suicide attempters to accept or benefit from treatment. Attention to suicide attempters’ interpersonal problems is of importance to lower their distress.

Keywords
Inventory of Interpersonal Problems, Interpersonal functioning suicide attempt, Familial transmission of suicidal behavior, Suicide
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-129645 (URN)10.1016/j.psychres.2016.11.029 (DOI)000392772400049 ()27951478 (Scopus ID)
Available from: 2017-01-06 Created: 2017-01-06 Last updated: 2018-08-08Bibliographically approved
Ott, M., Stegmayr, B., Salander Renberg, E. & Werneke, U. (2017). Prognosis and outcome of severe lithium poisoning: authors' reply [Letter to the editor]. Journal of Psychopharmacology, 31(9), 1275-1277
Open this publication in new window or tab >>Prognosis and outcome of severe lithium poisoning: authors' reply
2017 (English)In: Journal of Psychopharmacology, ISSN 0269-8811, E-ISSN 1461-7285, Vol. 31, no 9, p. 1275-1277Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Sage Publications, 2017
National Category
Neurology Psychiatry Pharmacology and Toxicology
Identifiers
urn:nbn:se:umu:diva-143950 (URN)000419008300016 ()
Available from: 2018-01-15 Created: 2018-01-15 Last updated: 2018-06-09Bibliographically approved
Idenfors, H., Strömsten, L. M. J. & Salander Renberg, E. (2016). Are Non-Psychiatric Hospitalisations Before Self-Harm Associated with Increased Risk of Unnatural Deaths Among Young People?. Journal of Psychosomatic Research, 85, 66-67
Open this publication in new window or tab >>Are Non-Psychiatric Hospitalisations Before Self-Harm Associated with Increased Risk of Unnatural Deaths Among Young People?
2016 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 85, p. 66-67Article in journal, Meeting abstract (Other academic) Published
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-123985 (URN)10.1016/j.jpsychores.2016.03.163 (DOI)000377627200046 ()
Note

Meeting Abstract: 37

Available from: 2016-08-19 Created: 2016-07-07 Last updated: 2018-06-07Bibliographically approved
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