Background: To investigate the impact of adolescent violent and non-violent criminality and subsequent risk of morbidity and mortality in adulthood in a large Swedish cohort of young men conscripted for military service in 1969/70. Methods: The cohort consisted of 49,398 18-year-old Swedish conscripts followed up for morbidity and mortality up to the age of 55 years in Swedish national registers. Information about convictions for crime before conscription was obtained from national crime registers. Data from a survey at conscription were scrutinized to get information on potential confounders. Results: Hospitalization due to alcohol and drug related diagnoses and attempted suicide were significantly more evident in the violent group compared to non-violent criminals and non-criminals. More than one fifth (21.13%) of the young violent offenders, 12.90% of the non-violent offenders and 4.96% of the non-criminals had died during the follow-up period. In Cox proportional multivariate analyses, young violent offenders had twice the hazard (HR = 4.29) of all-cause mortality than the non-violent offenders (HR = 2.16) during the follow-up period. Alcohol and drug related mortality, suicide and fatal accidents were most evident in both violent and non-violent offenders. Conclusions: Men with adolescent criminality received more inpatient care due to alcohol and drug related diagnoses and attempted suicide as adults. Mortality due to unnatural causes, alcohol, and drug related diagnoses, suicide and accidents was most evident in violent offenders, while these causes of death were much lower in non-criminals. Men with adolescent criminality are a high-risk group for multiple adverse health outcomes and for early death. Efforts for detection of substance use and psychiatric disorders in this group is important for the prevention work in both local- and community levels as well as national prevention programs.

Self-poisoning with licit or illicit opioids, alcohol or other prescribed drugs affects mostly young people, but also older patients are at risk for self-poisoning and suicide. This study investiga ...

This study investigates suicide and overdoses in 1,119 consecutive patients (64% women), 15 to 34 years of age, presenting at the emergency department after self-poisoning from1994 to 2000 and followed regarding death to 2006. Regression and Kaplan-Meier survival analyses were performed for suicide and other causes of death. The patients had about a 60 times higher risk (SMR = 61.95) of death due to suicide and 26 times higher (SMR = 26.47) for all-cause mortality. Men had a nearly 2 times higher risk for suicide than women and half of the suicides occurred during the first 2 years after admission. Poisoning was the most common suicide method and early prevention of self-poisoning is crucial to reducing future deaths.

Background: There is a paucity of studies on the role of early risk factors for the choice of methods for violent suicide attempts. Adolescent risk factors for the choice of violent or non-violent methods for suicide attempts and the risk of subsequent suicide were studied using a longitudinal design.Methods: A national Swedish cohort of 48 834 18-20-year-old young men conscripted for military service from 1969 to 1970 was followed through official registers during a 37-year period. Two questionnaires concerning their psychosocial background were answered by each conscript. Cox proportional hazard regression analyses were used to estimate the risk for different methods of attempted suicide and later suicide.Results: A total of 1195 (2.4 %) men had made a suicide attempt and of these, 133 (11.1 %) committed suicide later. The number of suicide victims among the non-attempters was 482 (1 %). Half of the suicides occurred during the same year as the attempt. Suicide victims had earlier onset of suicidal behaviour and had more often used hanging as a method of attempted suicide than those who did not later commit suicide. The early risk factors for both violent and non-violent methods of suicide attempt were quite similar.Conclusion: Violent suicide attempts, especially by hanging, are associated with a clearly elevated suicide risk in men and require special clinical and public health attention. The early risk factors related to the choice of either a violent or a non-violent suicide attempt method are interlinked and circumstantial factors temporally close to the suicide attempt, such as access to a specific method, may partly explain the choice of method.

Background: Studies on a national level concerning domestic violence (DV) among both men and women are few. DV and its relation to other social and health outcomes within the framework of the Swedish Public Health Survey have remained unexplored. Aim: To compare women and men regarding their social situation and health status in relation to self-reported exposure to physical DV as measured in the Swedish National Public Health Survey. Methods: This study used cross-sectional data from the Swedish Public Health Survey, years 2004-09 with a total sample of 50 350 respondents, of which 205 women and 93 men reported DV exposure. Logistic regression analyses stratified by sex with physical DV exposure as the outcome measure were conducted, and the multivariate models were fitted using the likelihood ratio test. Results: Being foreign-born [women odds ratio (OR) = 1.52, men OR= 1.92] and lack of social support (women OR= 2.81, men OR= 1.92) were associated with DV exposure among both sexes. Higher psychological distress (women OR= 2.81, men OR= 1.92) and hazardous drinking (women OR = 1.61, men OR = 2.33) were also associated with DV exposure. Among women, financial problems were associated with DV exposure (OR = 1.83), whereas among men, sum of medicines used and higher odds of DV were associated (OR = 1.17). Further, suicidal attempts were associated with DV exposure among both women (OR = 5.59) and men (OR = 8.34). Conclusions: In this national survey, prevalence rates of violence exposure were lower than in other studies, but despite this, both women and men exposed to physical DV reported increased odds of having attempted suicide.

The relationship between mental illness and violent crime is complex because of the involvement of many other confounding risk factors. In the present study, we analysed psychiatric and neurological disorders in relation to the risk of convictions for violent crime, taking into account early behavioural and socio-economic risk factors.

BACKGROUND:Suicidal and violent behaviours are interlinked and share common biological underpinnings. In the present study we analysed the association between violent behaviour as a child, childhood trauma, adult psychiatric illness, and substance abuse in relation to interpersonal violence as an adult in suicide attempters with mood disorders.METHODS:A total of 161 suicide attempters were diagnosed with Structured Clinical Interviews and assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to violence and expressed violent behaviour in childhood (between 6-14 years of age) and during adult life (15 years or older). Ninety five healthy volunteers were used as a comparison group. A logistic regression analysis was conducted with the two KIVS subscales, expressed violent behaviour as a child and exposure to violence in childhood together with substance abuse, personality disorder diagnoses and age as possible predictors of adult interpersonal violence in suicide attempters.RESULTS:Violent behaviour as a child, age and substance abuse were significant predictors of adult interpersonal violence. ROC analysis for the prediction model for adult violence with the KIVS subscale expressed violence as a child gave an AUC of 0.79. Using two predictors: violent behaviour as a child and substance abuse diagnosis gave an AUC of 0.84. The optimal cut-off for the KIVS subscale expressed violence as a child was higher for male suicide attempters.CONCLUSIONS:Violent behaviour in childhood and substance abuse are important risk factors for adult interpersonal violent behaviour in suicide attempters.

Objectives This study aimed to investigate whether violent and non-violent offending were related to elevated risk of suicide. We also investigated whether the risk was higher among those with repeated offences and how experiences of substance misuse and suicide attempt modified the relationship.Design A nationwide prospective cohort study.Setting A register study of 48 834 conscripted men in 1969/1970 in Sweden followed up during a 35-year period in official registers.Participants A birth cohort of 48 834 men who were mandatory conscripted for military service in 1969/70 at the age of 18-20years. Possible confounders were retrieved from psychological assessments at conscription and the cohort was linked to mortality and hospitalisation and crime records from 1970 onwards. Estimates of suicide risks were calculated as HR with 95% CIs using Cox proportional regression analyses with adjustment for potential confounding by family, psychological and behavioural factors including substance use and psychiatric disorders.Results Of the total cohort, 2671 (5.5%) persons died during the follow-up period. Of these, 615 (23%) persons died due to suicide. Non-violent criminality was evident for 29% and violent criminality for 4.7% of all the participants. In the crude model, the violent offenders had nearly five times higher risk (HR=4.69, 3.56 to 6.19) to die from suicide and non-violent criminals had about two times higher risk (HR=2.08, 1.72 to 2.52). In the fully adjusted model, the HRs were still significant for suicide in the non-violent group.Conclusions Experiences of violent or non-violent criminality were associated with increased risk of suicide. Comorbidity with alcohol and substance use and psychiatric disorders modified the risk, but the suicide risk remained significantly elevated for non-violent criminals. It is crucial to identify offenders and especially repeated offenders who also suffer from alcohol or substance misuse and psychiatric illness in clinical settings in order to prevent suicide.

The aim was to investigate life course criminality in relation to unintentional injury mortality and other causes of death among 49,398 male Swedish conscripts aged 18–20 years in 1969/70 and a follow-up through 35 years. All subjects completed two questionnaires at the time of conscription concerning family, social, behavioural risk factors including alcohol and drug use. The impacts of committed crimes, alcohol and drug use and other risk factors were estimated using proportional hazard ratios (HRs) from Cox regression analyses. Many adolescent offences entailed a nearly six-fold higher injury mortality risk (HR = 5.64) and a four-fold higher risk (HR = 3.93) for all other causes vs. no convictions. In multivariate analyses, adolescent criminality was still found to be significantly associated with time to unintentional injury mortality, while criminality limited to adulthood had a moderately higher risk for all other causes of deaths. Individuals with both adolescence and adult criminality showed elevated mortality from especially unintentional injury (HR = 5.06), with the hazards remaining elevated, even after adjustment for other behavioural risk factors. Men with behavioural risk factors including alcohol and/or drug misuse in combination with frequent criminality seem to be a vulnerable group of both unintentional and other causes of deaths.

IntroductionEarly environmental risk factors have a role in the development of violent behaviour in adulthood.AimsThe aim of the study was to assess the impact of childhood trauma, expressed violent behaviour as a child, co morbid personality disorder and substance abuse on self reported interpersonal violence as an adult in suicide attempters.MethodsA total of 161 suicide attempters were diagnosed with SCID I and II and assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to violence and expressed violent behaviour in childhood (between 6-14 years of age) and during adult life (15 years or older). A standard linear regression analyses was conducted with the two predictive KIVS subscales exposure to violence as a child and expressed violent behaviour as a child, Axis 1 mood and anxiety disorder diagnosis, co morbid substance abuse diagnosis, co morbid personality disorder diagnosis, age and gender as predictors of expressed interpersonal violence as an adult.ResultsThe regression model was significant with adjusted R square 0.22, F ratio 7.2, DF=7, p< 0.0001. Expressed violent behaviour as a child and personality disorder were significant predictors of expressed interpersonal violence as an adult. Broken down by gender expressed violent behaviour as a child was a significant predictor of violence as an adult in both men and women, whereas exposure to violence as a child and personality disorder predicted violence as an adult only in men.ConclusionsIt is important to take into account expressed violent behaviour in childhood in violence risk assessments.

BACKGROUND:Intimate partner violence (IPV) is a global public health concern with possible detrimental consequences for its victims. Studies have found prevalence rates of 15 to 71% for IPV. There is evidence that IPV exposed women perceive barriers to help-seeking and many remain undetected by care givers and authorities. This cross-sectional study aimed to examine IPV exposed women in relation to help-seeking versus non help-seeking from the social services or women's shelters with regard to social and psychological characteristics as well as relationship with the perpetrator and type of violence exposure.METHODS:Two groups of Swedish IPV exposed women were included: non help-seekers (n = 128) were recruited through ads in newspapers, while help-seekers (n = 347) were recruited from four social service sites and twenty women's shelters around Sweden. Participants were assessed with questionnaires regarding age, education, occupation and relation to the perpetrator as well as validated instruments measuring psychological distress, psychosocial functioning alcohol use and violence. Analyses were made using Chi2 and multivariate logistic regression.RESULTS:Help-seekers had significantly more often children together with the perpetrator than non help-seekers (64% and 29% respectively) and a high association was found in the fully adjusted model (Adj. OR = 5.46 95% CI 2.99-9.97). Many women in both groups reported a poor social situation and high levels of psychological distress, although more psychological distress was associated with elevated odds for help-seeking (Adj. OR = 2.83 95% CI 1.84-4.34). No differences were found between the groups regarding violence exposure and most women in both groups had experienced severe violence from an intimate partner (95% to 98%).CONCLUSIONS:Results indicate a high problem load among women who had not contacted the social services or women's shelters due to IPV, and that non help-seekers had similar experiences of severe IPV as help-seekers. This stresses a need to identify IPV exposed women outside specialized settings within the social services and women's shelters. Asking about partner violence in various health and social care settings could be a feasible strategy to identify battered women and provide them with alternatives for help that ultimately could lead to a life without violence.

BACKGROUND:Most previous studies on mortality in violent offenders or victims are based on prison or hospital samples, while this study analyzed overall and cause specific mortality among violent offenders, victims, and individuals who were both offenders and victims in a general sample of 48,834 18-20 year-old men conscripted for military service in 1969/70 in Sweden.METHODS:Each person completed two non-anonymous questionnaires concerning family, psychological, and behavioral factors. The cohort was followed for 35 years through official registers regarding violent offenses, victimization, and mortality. The impact of violence, victimization, early risk factors and hospitalization for psychiatric diagnosis or alcohol and drug misuse during follow up on mortality was investigated using Cox proportional hazard regression analyses.RESULTS:Repeat violent offenses were associated with an eleven fold higher hazard of dying from a substance-related cause and nearly fourfold higher hazard of dying from suicide. These figures remained significantly elevated also in multivariate analyses, with a 3.03 and 2.39 hazard ratio (HR), respectively. Participants with experience of violence and inpatient care for substance abuse or psychiatric disorder had about a two to threefold higher risk of dying compared to participants with no substance use or psychiatric disorder.CONCLUSIONS:Violent offending and being victimized are associated with excess mortality and a risk of dying from an alcohol or drug-related cause or suicide. Consequently, prevention of violent behavior might have an effect on overall mortality and suicide rates. Prevention of alcohol and drug use is also warranted.

Har ungdomar med en problematisk uppväxt en ökad risk att senare i livet drabbas av dödsolyckor generellt och trafikolyckor i synnerhet? En kohort av cirka 49 000 unga män i åldern 18-20 år som mönstrade 1969/70 i Sverige har följts i 35 år. Familjeförhållanden, psykisk och fysisk hälsa samt socialt beteende och dödsfall i skador har analyserats med Cox regression och Hazards Ratios (HR). Analyserna visar att den totala dödligheten i skador har en tydlig koppling till sociala riskfaktorer. En väsentligt reducerad medellivslängd för personer med många riskfaktorer, både totalt och i trafiken. Resultatet torde bekräfta den bild som finns hos de som arbetar med ungdomar inom kommuner och landsting. Det är dock motiverat att problemet ägnas mer systematisk uppmärksamhet både av föräldrar och ansvariga myndigheter och organisationer.

Injuries represent an important cause of mortality among young adults. We studied the associations between adolescents’ family, psychological, behavioural and drug-related risk factors in relation to unintentional injury death. A population-based cohort of 49,411 Swedish conscripts aged 18–20 years was followed for 35 years. The end-point of study was injury death up to 2004. The relationship between two family, four psychological and eight behavioural risk factors and injury death were analysed with Cox proportional hazards analyses and χ2 tests. Among 485 unintentional injury deaths, 40% occurred in subjects aged 25 years or under. The incidence per 1000 person years was 0.29 (95% CI, 0.26–0.31) and the mean age of death was 33 years. Problem drinking at both adolescent and adulthood was more strongly associated with injury death (HR=5.40) than illicit drug use (HR=2.70) even after adjusted for behavioural risk factors: (HR=3.43) and (HR=1.75), respectively. Adolescent risk factors such as contact with police and juvenile authorities, low emotional control, conduct problems at school and low social maturity were significant predictors of injury death in multivariate analyses. Young adults with social, behavioural and psychological problems and especially alcohol and drug use at both adolescent and adulthood have a high mortality rate due to road traffic injuries and all kind of injuries. Early identification of vulnerable groups of adolescents with psychological and behavioural problems including alcohol and drug use at local levels could make a difference.

BACKGROUND:Recent evidence suggests that factors predicting offending among individuals with no mental disorder may also predict offending among individuals with schizophrenia.AIMS:The aims of the study were (1) to explore the prevalence of risk factors for criminal offending reported at age 18 among males later diagnosed with schizophrenia, (2) to explore the associations between risk factors reported at age 18 and lifetime criminal offending, (3) to predict lifetime serious violent offending based on risk factors reported at age 18, and (4) to compare the findings with those in males with no later diagnosis of schizophrenia.METHODS:The study was a prospective, longitudinal study of a birth cohort followed up through registers after 35 years. The cohort consisted of 49,398 males conscripted into the Swedish Army in 1969-1970, of whom 377 were later diagnosed with schizophrenia.RESULTS:Among the subjects later diagnosed with schizophrenia, strong associations were found between four of the items reported at age 18 and lifetime criminal offending: (1) low marks for conduct in school, (2) contact with the police or child care authorities, (3) crowded living conditions, and (4) arrest for public drinking. Three of these four risk factors were found to double the risk of offending among males with no later diagnosis of schizophrenia.CONCLUSIONS:Criminality in individuals with schizophrenia may at least partly be understood as a phenomenon similar to criminality in individuals in the general population.

Background: Drug users in clinical samples have elevated mortality compared with the general population, but little is known about mortality among users of drugs within the general population. Aim: To determine whether self-reported use of illicit drugs and non-prescribed sedatives/hypnotics among young men in the general population is related to mortality.Methods: A 35-year follow-up of 48 024 Swedish men, born 1949-1951 and conscripted in 1969/1970, among whom drug use was reported by 8767 subjects. Cross-record linkage was effected between individual data from the Swedish conscription and other national registers. Deaths and causes of death/1000 person-years were calculated. Cox PH regression was used to estimate hazard ratios (HRs) for death with 95% confidence intervals (95% CIs). An HR was calculated for users of different dominant drugs at conscription compared with non-users by age interval, after adjusting for confounders and hospitalisation with a drug-related diagnosis.Results: Drug users showed elevated mortality (HR 1.61, p < 0.05) compared with non-users. After adjusting for risk factors, users of stimulants (HR 4.41, p < 0.05), cannabis (HR 4.27, p < 0.05), opioids (HR 2.83, p > 0.05), hallucinogens (HR 3.88, p < 0.05) and unspecified drugs (HR 4.62, p < 0.05) at conscription with a drug-related diagnosis during follow-up showed an HR approaching the standard mortality ratios in clinical samples. Among other drug users (95.5%), only stimulant users showed statistically significantly increased mortality (HR 1.96, p < 0.05).Conclusions: In a life-time perspective, drug use among young men in the general population was a marker of premature death, even a long time after exposure. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Introduction and Aims. Establishing subgroups in clinical practice is important for treatment planning. The aim of the study was to cluster the study group subjects according to personality traits and psychological health variables and to establish possible differences in treatment outcome in terms of: (i) drinking outcomes (gram and number of drinking days); (ii) perceived physiological health; and (iii) use of treatment resources (length of time in treatment and number of visits) among 134 treatment-seeking women with alcohol problems in a clinical context, between the two clusters obtained. Design and Methods. Data were collected from 134 consecutive women at a Swedish clinic specialised in treating women with alcohol problems. A hierarchical cluster analysis was performed on the basis of self-rated personality scale scores and psychological health variables. Results. Two clusters were identified: one in which the women displayed personality and psychological health scores indicating problems (Cluster 1); and another where the women showed personality and psychological health scores within the norm range (Cluster 2). Alcohol consumption rates at the start of treatment were the same in both clusters. The consumption rates were also the same at the end of treatment for the cluster, showing a significant decrease in alcohol consumption in each. The Cluster 1 women, however, had a significantly higher number of visits at the clinic, and rated the consequences of their alcohol drinking as being significantly worse than Cluster 2 women. Discussion and Conclusions. The importance of individual differences according to personality traits for treatment planning is discussed in terms of the need for variation in treatment time and methods. [Scheffel Birath C, DeMarinis V, Stenbacka M, af Klinteberg B. Women with alcohol problems: The possible significance of personality clustering for treatment planning. Drug Alcohol Rev 2010].

AIMS:To analyse whether changes in maintenance treatment of opiate-dependent subjects in Sweden were related to changes in opiate-related mortality and inpatient care from 1998 to 2006.DESIGN:We collected data from surveys of methadone maintenance treatment units, of buprenorphine and methadone sales, and of mortality and inpatient care in Sweden.SETTING:Sweden.PARTICIPANTS:Patients in maintenance treatment.MEASUREMENTS:Survey data of treatment policy to all units in 2003 and 2005. Trend tests and correlation analyses of data on sales, mortality, inpatient care and forensic investigations.FINDINGS:The surveys showed a marked change to a less restrictive policy, with increased use of 'take-away doses' and a reduction of discharges due to side misuse. The one-year retention rate stayed high. Sales of buprenorphine and methadone and the number of patients in treatment increased more than threefold from 2000 to 2006, with the greatest increase for buprenoprphine, introduced in year 2000. There was a significant 20-30% reduction in opiate-related mortality and inpatient care between 2000-2002 and 2004-2006 but not of other drug-related mortality and inpatient care. This decline was larger in Stockholm County, which had a less restricted treatment policy. However, a significant increase in buprenorphine- and methadone-related mortality occurred. For the study period 1998-2006, statistically significant declines occurred only in Stockholm County.CONCLUSIONS:The liberalization of Sweden's drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues.

INTRODUCTION AND AIMS:To examine the overall mortality and causes of deaths of a large cohort of users of illicit drugs in Stockholm over 37 years.DESIGN AND METHODS:People with substance abuse were identified through records collected by different institutions in Stockholm in 1967. Subjects were followed in registers recording mortality and cause of death and in-patient care stays until 2003.RESULTS:More than half (n = 860) of the 1705 identified substance abusers died at an average age of 47 years, 25-30 years younger than the general population. The standardised rate ratio (SRR) for mortality was 3.3 among men and 3.5 among women. Incidence of mortality per 1000 person-years was also increased, but somewhat lower for women. The difference between these two measures is mainly explained by a lower mortality among women in general. In-patient care stays with both alcohol and drug-related diagnoses were associated with higher risk of dying among women than men: SRR = 14.5 and SRR = 4.0, respectively. Accidents and suicide were the most common cause of death among the youngest subjects (15-24 years) and cardiovascular diseases and tumours among the oldest (> or =55 years).DISCUSSION AND CONCLUSIONS:Accidents and suicide, especially at a young age, are two common causes of death that might be prevented by increased awareness in medical personnel, along with better treatment and supportive measures.