Inledning: Depression är ett globalt folkhälsoproblem som drabbar människor i alla åldrar oavsett kön. En tredjedel av alla patienter diagnostiserade med depression blir inte hjälpta av dagens behandlingsmetoder och i synnerhet läkemedel. Denna grupp av individer klassificeras som behandlingsresistenta. För individer som lever med behandlingsresistent depression (TRD) är situationen allvarlig. Suicidala tankar (SI) och beteenden är vanligt förekommande och ökar i takt med svårighetsgraden av depressionen. Upptäckten av ketamins snabba effekter mot depression under 2000-talet har givit nytt ljus åt forskningen och mycket forskning görs på området som indikerar på positiva effekter mot TRD och de suicidala benägenheterna. Ketamin är dock ett problematiskt läkemedel med svåra biverkningar som gör situationen mer komplex. Syfte: Syftet med detta litteraturarbete var att undersöka effekterna av intravenöst (iv) ketamin mot TRD och i synnerhet dess antisuicidala effekter. Metod: Fem kliniska studier har analyserats. Två databassökningar gjordes via databasen PubMed med sökorden ”TRD suicidal ideation ketamine infusion treatment” och ” treatment resistant depression ketamine suicidal cognition”. Inkluderade artiklar valdes utifrån fastställda inklusions- och exklusionskriterier. Resultat: Överlag påvisas ett positivt resultat av ketamins antisuicidala effekter vid TRD. Fyra av fem studier visade signifikanta resultat av en singeldos ketamin jämfört med placebo och en studie kunde visa positiva effekter av upprepade infusioner. Medan en studies resultat varken kunde påvisa positiva effekter på kort eller lång sikt. Diskussion: Sammanfattningsvis indikerar resultatet av inkluderade studier på att ketamin i viss grad har positiva effekter på SI vid TRD och att iv ketamin har potential som läkemedel för denna patientgrupp. Dock krävs det mer forskning kring effektens hållbarhet, långtidseffekter, biverkningar och beroenderisken av ketamin. Idag används ketamin i form av det intranasala läkemedlet Spravato mot svår depression, detta med försiktighet på grund av de allvarliga biverkningar som kan följa och dess okända långtidseffekter. / Introduction: Depression is a global public health problem that affects people of all ages regardless of gender. One third of all patients diagnosed with depression are not helped by today's treatment methods. This group of individuals is classified as the treatment resistant. For individuals living with treatment-resistant depression (TRD), the situation is dire. Suicidal thoughts (SI) and behaviors are common and increase with the severity of the depression. The discovery of ketamine's rapid effects against depression in the 21st century has given new light to research and much research are being done in the area that indicates positive effects against TRD and the suicidal tendencies. However, ketamine is a problematic drug with severe side effects that make the situation more complex. Aim: The aim of this review was to investigate the effects of intravenous (iv) ketamine against TRD and in particular its anti-suicidal effects. Method: Five clinical studies have been analyzed. Two database searches were made via the PubMed database with the keywords "TRD suicidal ideation ketamine infusion treatment" and "treatment resistant depression ketamine suicidal cognition". Included articles were selected based on established inclusion and exclusion criteria. Results: Overall, a positive result of ketamine's anti-suicidal effects in TRD is demonstrated. Four out of five studies showed significant results of a single dose of ketamine compared to placebo and one study was able to show positive effects of repeated infusions. While the results of one study could not demonstrate positive effects in the short or long term. Discussion: In summary, the results of included studies indicate that ketamine has, to some extent, positive effects on SI in TRD and that iv ketamine has potential as a drug for this patient group. However, more research is needed concerningdurability of the effect, long-term effects, side effects and the risk of addiction to ketamine. Today, ketamine is used in the form of the intranasal drug Spravato against severe depression, this with caution because of the serious side effects that can follow and its unknown long-term effects.

La dépression chez les adolescents est une préoccupation majeure en raison de son impact sur la santé mentale et sur le risque de suicide qui constitue la quatrième cause de décès chez les 15- 29 ans. Malgré l’existence d’alternatives thérapeutiques, la gestion des troubles dépressifs demeure complexe en raison de la résistance aux traitements. Comprendre les facteurs influençant la réponse aux thérapies est donc crucial. L'intervention préventive cognitive- comportementale PreVenture, conçue pour cibler des traits de personnalité spécifiques comme le désespoir, un facteur de risque pour le développement de la dépression, offre une alternative de traitement prometteuse pour les adolescents. Des résultats préliminaires ont démontré le potentiel de PreVenture à réduire les symptômes dépressifs et les pensées suicidaires chez des adolescents canadiens. Ce projet vise à étudier les modérateurs cognitifs impliqués dans la réponse à cette intervention, en évaluant leur influence sur les symptômes dépressifs et les idées suicidaires chez des adolescents de 12 à 13 ans. Un modèle de croissance latent a été utilisé pour étudier la croissance des symptômes dépressifs et des pensées suicidaires. L’analyse de modération a permis d’étudier l’interaction entre PreVenture et la cognition. Les résultats indiquent que les adolescents rencontrant des difficultés de mémoire avant l'intervention montrent une réduction significative de leurs idées suicidaires dans les années suivantes. Cependant, aucun des modérateurs cognitifs n'a été identifié pour les symptômes dépressifs. En incluant les profils cognitifs d’adolescents à risque, ce projet met en avant la contribution des caractéristiques individuelles dans la prévention du suicide chez les adolescents. / Depression among adolescents is a major concern due to its impact on mental health and the risk of suicide, which ranks as the fourth leading cause of death among 15- to 29-year-olds. Despite the existence of therapeutic alternatives, managing depressive disorders remains complex due to treatment resistance. Understanding the factors influencing treatment response is therefore crucial. The cognitive-behavioral preventive intervention PreVenture, designed to target specific personality traits such as hopelessness, a risk factor for depression development, offers a promising treatment alternative for adolescents. Preliminary results have demonstrated PreVenture's potential to reduce depressive symptoms and suicidal thoughts among Canadian adolescents. This project aims to study the cognitive moderators involved in the response to this intervention by assessing their influence on depressive symptoms and suicidal ideation in adolescents aged 12 to 13. A latent growth model was used to examine the growth of depressive symptoms and suicidal thoughts. Moderation analysis allowed the investigation of the interaction between PreVenture and cognition. The results indicate that adolescents with memory difficulties prior to the intervention show a significant reduction in suicidal ideation in the following years. However, none of the cognitive moderators were identified for depressive symptoms. By including cognitive profiles of at-risk adolescents, this project highlights the contribution of individual characteristics to adolescent suicide prevention.

Objective: The relationship between alcohol use and suicidal behaviors is well-accepted, but less is known about the contribution of its early initiation. This study was designed to test the association of early alcohol initiation versus later initiation with suicidal ideation and attempt in an ethnically diverse sample. Methods: The Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003 (n = 20,013), database was used. A total of 13,867 participants were selected included 56.9% females and 43.1% males. Race and ethnicity were reported as 28.8% non-Hispanic White, 39.1% Black, 20.3% Latino, and 11.9% Asian. Logistic regression analyses tested the associations between early (< =14 years) and later (> =15) age alcohol initiation with suicide ideation and attempts. Alcohol initiation was indexed by self-report of the first time that any alcohol product was consumed. Potential confounders were controlled. Results: Early alcohol initiation was associated with higher odds (AOR = 3.64, 95% CI [2.51, 5.28]) of suicide ideation as compared with adults who had initiated > = age 15 (AOR = 2.11, 95% CI [1.46, 3.04]). Early age initiation was also associated with higher odds (AOR = 3.81, 95% CI [2.02, 7.18]) of lifetime suicide attempt versus later age initiators (AOR = 2.03, 95% CI [1.08, 3.79]). Significant differences were found between early and later age of initiation. Conclusion: Early age of alcohol initiation has profoundly increased odds of suicide ideation or attempt. It is critical that effective prevention programs for children and their caregivers be implemented to prevent or delay alcohol initiation and lessen the risk for future suicidal behaviors.

Detta är en fördjupande studie baserat på en kvantitativ folkhälsoundersökning som visade samband i särskilt utsatthet bland förekomst av vilka som allvarligt övervägt självmord och demografiska faktorer hos folkbokförda i Umeå. Byggt på premissen av det pågående suicidpreventiva arbetet i Umeå tar denna studie i anspråk att utforska vilka livsomständigheter som skiljer sig åt mellan den generella populationen i Umeå jämfört med de som allvarligt övervägt självmord, samt föreslå suicidpreventiva åtgärdsförslag utifrån resultaten.    Data som omsattes i denna studie var ursprungligen insamlat av Övergripande planering Umeå kommun genom ett stratifierat urval som svarade mot olika demografiska områden av Umeå som resulterade i 2588 svaranden, med en svarsfrekvens av 37% som deltog i en folkhälsoundersökning som omfattade 102 frågor vilka var kvalitetskontrollerade av SCB.  Studieförfattarna utformade en metod för att skala ner urvalet av livsomständigheter till 15 variabler som skulle överensstämma med studiens teman: demografi, ekonomiska förutsättningar, vanor, mående och stöd som alla ställdes mot frågan: “Har du allvarligt övervägt självmord?”, där 10,7% av de tillfrågade svarade affirmativt. Slutsatser av denna studie är att undersökta livsomständigheter såsom socioekonomiska faktorer, vanor, demografiska faktorer, mående och stöd indikeras vara relaterade till en högre förekomst av att ha allvarligt övervägt självmord för folkbokförda i Umeå. Bland annat visas fulltidsanställda vara 22,9% mindre sannolika- där studerande är mer än dubbelt så sannolika- där personer som har sjuk- eller aktivitetsersättning var 444,9% mer sannolika att allvarligt ha övervägt självmord. Svaranden anger oftare sämre sömn (42,9% jämfört med 70,7%) hos de som allvarligt övervägt självmord. 77,4% av svaranden med ångestrelaterade svårigheter- 43,0% av svaranden med behov av psykisk vård som inte sökt- och 56,4% av svaranden med psykiska funktionshinder uppger att de allvarligt övervägt självmord jämfört med 10,7% hos generella svaranden. Utifrån studiens resultat föreslår studieförfattarna kompletterande lokala suicidpreventiva åtgärder, men finner behov av åtgärder med nationellt omfång för att svara mot de bredare socioekonomiska- och sociala problem som premissen och resultatet av denna studie belyser. / This is an in-depth study based on a quantitative public health survey which raised cause for concern about sociodemographic differences in occurrence of who has seriously considered suicide in the municipality of Umeå. Following the premise built on the current suicide prevention work in Umeå this study aims to give insight on which living circumstances differ regarding those with suicidal ideation in Umeå compared to the general population and what proposed actions might be indicated from the results.   The data used in this study was originally sampled by Övergripande planering, Umeå municipality using a stratified selection of different demographics in Umeå resulting in 2588 participants, an answer rate of 37% who answered a public health survey consisting of 102 questions, which was quality checked by SCB.   By process of elimination finding relevant living circumstances the authors designed a method of selection resulting in 15 variables consistent with the subtypes: demographics, economical circumstances, habits, health and support, all of which to correlate with the question translated to: “Have you seriously considered suicide?” where 10,7% of respondents answered positively.   Conclusions from this study are that certain life circumstances such as socioeconomic factors, habits, demographic factors, well-being and support is indicated being related to a higher prevalence of having seriously considered suicide amongst habitants of Umeå. Key findings include full-time employed was 22,9% less likely-, where students were more than two times more likely- and people on welfare or sick leave were 444,9% more likely to have seriously considered suicide. Respondents are less likely to have a good nights sleep (42,9% compared to 70,7%) if they have seriously considered suicide. 77,4% of those with anxiety-related issues, 43,0% of those in need of medical care for psychological health and 56,4% of respondents with psychological disability responds to have seriously considered suicide compared to the average of 10,7%. The authors provide examples of local implementations based on the findings but arrive at the need for a national scope to come to terms with the wider socio-economic and social issues that is suggested by the premise and result of this study.