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Cannabis smoking increases the risk of suicide ideation and suicide attempt in young individuals of 11-21 years: A systematic review and meta-analysis. J Psychiatr Res 2022; 153:90-98. [PMID: 35810604 DOI: 10.1016/j.jpsychires.2022.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 05/20/2022] [Accepted: 06/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cannabis is the most frequently consumed drug around the world. Its use has been associated with increased suicide behaviors; nonetheless, the association of cannabis smoking and suicide behaviors in adolescents has not yet been established. The aim of this systematic review and meta-analysis was to evaluate the risk of suicide attempt, suicidal ideation or suicide planning in individuals of 11-21 years of age who smoke cannabis. METHODS We performed an online searched using PubMed, EBSCO and Science Direct databases, up to July 2021. We calculated odds ratio with 95% confidence intervals to evaluate the association between suicide attempt, suicidal ideation or suicide planning and cannabis smoking in individuals of 11-21 years of age. RESULTS Twenty studies reported suicide attempts in 34,859 young individuals, suicidal ideation in 26, 937 individuals, and suicide planning in 9054 young individuals. We found an increased risk of suicide attempt in cannabis smokers than in non-cannabis users (OR: 2.33; 95% CI: 1.78-3.05; Z p value; <0.0001; I2 = 97.12%), as well as a significant association between cannabis smoking and suicidal ideation (OR: 2.04; 95%CI: 1.64-2.53; Z p value: <0.001; I2: 94.88) and suicide planning (OR: 1.674; 95% CI: 1.554-1.804; Z p value: 0.000; I2: 92.609). Subgroup analyses showed that American teens have an increased risk of suicidal ideation; the meta-regression analysis revealed that age was negatively associated with the risk of suicide attempt. CONCLUSIONS This meta-analysis shows that cannabis smoking increased the risk of suicide attempt, suicidal ideation and suicide planning in young individuals of 11-21 years of age. The high risk of suicide behaviors could vary depending on the population studied; therefore, more studies are necessary to corroborate the risk of presenting suicide behaviors in individuals of 11-21 years of age who smoke cannabis.
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Grocott LR, Mair A, Galione JN, Armey MF, Huang J, Nugent NR. Days with and without self-injurious thoughts and behaviors: Impact of childhood maltreatment on adolescent online social networking. J Adolesc 2022; 94:748-762. [PMID: 35695124 DOI: 10.1002/jad.12060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Among adolescents, an increasing rate of interpersonal interactions occurs online. Previous research has shown that interpersonal context exerts a robust impact on suicidal thoughts or behaviors, yet little attention has focused on examining the content of online interactions surrounding self-injurious thoughts or behaviors. As such, the present study sought to compare online social networking behaviors among adolescents on days with and without experiencing self-injurious thoughts or behaviors, as influenced by childhood maltreatment history. METHOD Adolescents aged 13-18 hospitalized for self-injurious thoughts or behaviors were recruited as part of an ongoing longitudinal study. A subsample (N = 22) of adolescents provided data from their online social networking platforms (i.e., text messages, Facebook, Instagram, and Twitter). Using a mixed-methods approach, online social networking data on days of experiencing self-injurious thoughts or behaviors and days of not experiencing self-injurious thoughts or behaviors were compared. RESULTS Results indicate the frequency and content of online social networking messaging do not change by day of self-injurious thoughts or behaviors or history of childhood maltreatment. However, childhood maltreatment predicts received conflictual messages as well as sent symptomatic messages on days of experiencing self-injurious thoughts or behaviors. CONCLUSIONS Childhood maltreatment may play a role in the content of adolescent online behaviors, particularly on days when they experience self-injurious thoughts or behaviors. Implications for intervention are discussed.
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Affiliation(s)
- Lauren R Grocott
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Anneliese Mair
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Janine N Galione
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Michael F Armey
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jeff Huang
- Department of Computer Science, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Epstein S, Roberts E, Sedgwick R, Polling C, Finning K, Ford T, Dutta R, Downs J. School absenteeism as a risk factor for self-harm and suicidal ideation in children and adolescents: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2020; 29:1175-1194. [PMID: 30989389 PMCID: PMC7116080 DOI: 10.1007/s00787-019-01327-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/30/2019] [Indexed: 11/29/2022]
Abstract
Self-harm and suicidal ideation in children and adolescents are common and are risk factors for completed suicide. Social exclusion, which can take many forms, increases the risk of self-harm and suicidal ideation. One important marker of social exclusion in young people is school absenteeism. Whether school absenteeism is associated with these adverse outcomes, and if so to what extent, remains unclear. To determine the association between school absenteeism and both self-harm (including completed suicide) and suicidal ideation in children and adolescents, we conducted a systematic review of observational studies. We conducted meta-analysis and report a narrative synthesis where this was not possible. Meta-analysis of cross-sectional studies showed that school absenteeism was associated with an increased risk of self-harm [pooled adjusted odds ratio (aOR) 1.37, 95% confidence interval 1.20-1.57, P = 0.01] and of suicidal ideation (pooled aOR 1.20, 95% CI 1.02-1.42, P = 0.03). A small number of studies showed that school absenteeism had a longitudinal association with both adverse outcomes. Heterogeneity in the exposure and outcome variables, study design and reporting was prominent and limited the extent to which it was appropriate to pool results. School absenteeism was associated with both self-harm and suicidal ideation in young people, but this evidence was derived from a small number of cross-sectional studies. Further research into the mechanisms of this association could help to inform self-harm and suicide prevention strategies at clinical, school and population levels.
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Affiliation(s)
- Sophie Epstein
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Child and Adolescent Psychiatry, King's College London, London, UK.
| | - Emmert Roberts
- South London and Maudsley NHS Foundation Trust, London, UK
- National Addiction Centre, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Rosemary Sedgwick
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Catherine Polling
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | - Rina Dutta
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Johnny Downs
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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Influence of exposure to perinatal risk factors and parental mental health related hospital admission on adolescent deliberate self-harm risk. Eur Child Adolesc Psychiatry 2017; 26:791-803. [PMID: 28160098 DOI: 10.1007/s00787-017-0948-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
Adolescent deliberate self-harm (DSH) has been found to be associated with a range of bio-psycho-social factors. Simultaneous investigations of these factors enable more robust estimation of the independent effect of a specific risk factor by adjusting for a more complete set of covariates. However, few studies have had the ability to examine all of these factors together. This study used the linkage of population-level de-identified data collections from government agencies to investigate a range of biological, psychological, and social risk factors and their effects on adolescent risk of DSH (with or without suicidal intent). The investigation was undertaken by progressively adjusting for plausible covariates, including fetal growth status and birth order, early familial social factors, parental hospital admissions due to psychiatric disorders or DSH, and parental all-cause death. Conditional logistic regression was used for data analysis. Children's psychiatric history was analysed to examine the extent to which it may account for the link between the risk factors and adolescent DSH risk. This study identified significant biological and perinatal social risk factors for adolescent DSH risk, including overdue birth, high birth order (≥2), single or teen/young motherhood, high neighbourhood socioeconomic disadvantage, and parental psychiatric and/or DSH-related hospital admissions. Further, parental psychiatric and/or DSH-related admissions, and children's psychiatric admissions in particular, largely attenuated the effects of the perinatal social risk factors but not the biological factors on adolescent DSH risk. These results highlight the importance of taking joint actions involving both health and social services in the prevention of adolescent DSH.
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Rees N, Rapport F, Snooks H, John A, Patel C. How do emergency ambulance paramedics view the care they provide to people who self harm?: Ways and means. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 50:61-67. [PMID: 27237959 DOI: 10.1016/j.ijlp.2016.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The UK has one of the highest rates of self harm (SH) in Europe, and almost four times more people die by suicide than in road traffic collisions. Emergency ambulance paramedics are often the first health professionals involved in the care of people who have self-harmed, yet little is known about the care provided or issues raised in these encounters. The aim of this study is to explore paramedics' perceptions and experiences of caring for people who SH, to inform education and policy. Semi structured interviews were conducted with paramedics, and themes generated by constant comparison coding. This paper reports two emerging themes: Firstly, professional, legal, clinical and ethical tensions, linked to limited decision support, referral options and education. The second theme of relationships with police, revealed practices and surreptitious strategies related to care and detention, aimed at overcoming complexities of care. In the absence of tailored education, guidance or support for self-harm care, 'ways and means' have evolved which may negatively influence care and challenge ethical and legal frameworks. There is an urgent need to include evidence from this study in revised guidance and educational materials for paramedics working with people who self-harm in the prehospital emergency setting.
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Affiliation(s)
- N Rees
- Institute of Life Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, United Kingdom.
| | - F Rapport
- Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.
| | - H Snooks
- Institute of Life Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, United Kingdom.
| | - A John
- Institute of Life Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, United Kingdom.
| | - C Patel
- School of Human and Health Science, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, United Kingdom.
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Rosychuk RJ, Johnson DW, Urichuk L, Dong K, Newton AS. Does emergency department use and post-visit physician care cluster geographically and temporally for adolescents who self-harm? A population-based 9-year retrospective cohort study from Alberta, Canada. BMC Psychiatry 2016; 16:229. [PMID: 27400782 PMCID: PMC4940757 DOI: 10.1186/s12888-016-0941-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clustering of adolescent self-harming behaviours in the context of health care utilization has not been studied. We identified geographic areas with higher numbers of adolescents who (1) presented to an emergency department (ED) for self-harm, and (2) were without a physician follow-up visit for mental health within 14 days post-ED visit. METHODS We extracted a population-based cohort of adolescents aged 15-17 years (n = 3,927) with ED visits during 2002-2011 in Alberta, Canada. We defined the case as an individual with one or more ED presentations for self-harm in the fiscal year of the analysis. Crude case rates were calculated and clusters were identified using a spatial scan. RESULTS The rates decreased over time for ED visits for self-harm (differences: girls -199.6/100,000; p < 0.01; boys -58.8/100,000; p < 0.01), and for adolescents without a follow-up visit within 14 days following an ED visit for self-harm (differences: girls -108.3/100,000; p < 0.01; boys -61.9/100,000; p < 0.01). Two space-time clusters were identified: (1) a North zone cluster during 2002-2006 (p < 0.01) and (2) a South zone cluster during 2003-2007 (p < 0.01). These clusters had higher numbers of adolescents who presented to the ED for self-harm (relative risks [RRs]: 1.58 for cluster 1, 3.54 for cluster 2) and were without a 14-day physician follow-up (RRs: 1.78 for cluster 1, 4.17 for cluster 2). In 2010/2011, clusters in the North, Edmonton, and Central zones were identified for adolescents with and without a follow-up visit within 14 days following an ED visit for self-harm (p < 0.01). CONCLUSIONS The rates for ED visits for adolescents who self-harm and rates of adolescents without a 14-day physician follow-up visit following emergency care for self-harm decreased during the study period. The space-time clusters identified the areas and years where visits to the ED by adolescents for self-harm were statistically higher than expected. These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care. The 2010/2011 geographic cluster suggests that the northern part of the province still has elevated numbers of adolescents visiting the ED for self-harm. Prospective research is needed to determine outcomes associated with adolescents who receive physician follow-up following ED-based care for self-harm compared to those who do not.
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Affiliation(s)
- Rhonda J. Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, AB Canada ,Women & Children’s Health Research Institute, Edmonton, AB Canada ,Department of Pediatrics, University of Alberta, Rm 3–524, Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue NW, Edmonton, AB T6G 1C9 Canada
| | - David W. Johnson
- Department of Pedatrics, Cumming School of Medicine, University of Calgary, Calgary, AB Canada ,Department of Pharmacology and Physiology, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Liana Urichuk
- Addiction & Mental Health, Alberta Health Services, Edmonton, AB Canada ,Department of Psychiatry, University of Alberta, Edmonton, AB Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, AB Canada
| | - Amanda S. Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB Canada ,Women & Children’s Health Research Institute, Edmonton, AB Canada
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du Roscoät E, Legleye S, Guignard R, Husky M, Beck F. Risk factors for suicide attempts and hospitalizations in a sample of 39,542 French adolescents. J Affect Disord 2016; 190:517-521. [PMID: 26561942 DOI: 10.1016/j.jad.2015.10.049] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/07/2015] [Accepted: 10/10/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The high frequency of suicide attempts during adolescence is a serious public health concern. In particular attempts leading to hospitalization, often due to their severity, require careful consideration. METHODS Participants were drawn from a large adolescent general population survey conducted by the French Monitoring Center for Drugs and Drug Addiction and the National Service department. The final sample included 39,542 adolescents aged 17. Participants were surveyed during the "one-day session of civic and military information" using a pen and paper self-administered questionnaire. RESULTS Depressive symptoms, family socio-economic status, familial situation, relationship with parents, school situation, substance use and body image were significant independent predictors of lifetime suicide attempts. Among suicide attempts, hospitalization was independently predicted by daily smoking in both genders, school dropout, grade repetition, absence of relationship with the mother, regular cannabis smoking and lifetime other illicit drug use in girls. LIMITATIONS The main limitation of the present study is the absence of a thorough assessment of psychiatric disorders, depressive symptomatology being the only indicator of mental health status at the time of the survey. Second, the survey was cross-sectional thus limiting the interpretation of the findings. CONCLUSIONS The variables associated with suicide attempts and among them, those associated with hospitalization should be used to identify and provide additional services to adolescents at risk for serious suicidal behavior. Primary prevention in the field of parenting and family support, as well as intervention tackling normative beliefs related to body image should be considered.
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Affiliation(s)
- Enguerrand du Roscoät
- French Institute for Health Promotion and Health Education (INPES), Saint-Denis, France; Laboratoire Parisien de Psychologie Sociale (LAPPS), EA 4386, Université Paris Ouest Nanterre-La Défense, France.
| | - Stéphane Legleye
- French Institute of Demography (Ined), Paris, France; Inserm, U1178, Univ Paris-Sud and Univ Paris Descartes, UMR-S1178 Paris, France
| | - Romain Guignard
- French Institute for Health Promotion and Health Education (INPES), Saint-Denis, France
| | - Mathilde Husky
- Institut de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, Institut Universitaire de France, Boulogne Billancourt, France
| | - François Beck
- French Monitoring Centre for Drugs and Drug Addiction (OFDT), Saint-Denis, France; ERES, Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), 75012, Paris, France
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James S, Freeman KR, Mayo D, Riggs ML, Morgan JP, Schaepper MA, Montgomery SB. Does Insurance Matter? Implementing Dialectical Behavior Therapy with Two Groups of Youth Engaged in Deliberate Self-harm. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 42:449-61. [PMID: 25199812 PMCID: PMC4362888 DOI: 10.1007/s10488-014-0588-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This paper presents the outcomes of a Dialectical Behavior Treatment (DBT) program, implemented in intensive outpatient care with two groups of adolescents (n = 55 and n = 45), ages 12-18, who engaged in deliberate self-harm (DSH) but had different insurance/funding sources and risk backgrounds. This pre-post study examined variability in clinical functioning and treatment utilization between the two groups and investigated moderating risk factors. Findings support DBT's effectiveness in improving clinical functioning for youth with DSH regardless of insurance type. However, lower rates of treatment completion among youth without private insurance call for extra engagement efforts to retain high-risk youth in DBT.
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Affiliation(s)
- Sigrid James
- Institute for Social Work and Social Welfare, University of Kassel, Kassel, Germany,
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Cotter P, Kaess M, Corcoran P, Parzer P, Brunner R, Keeley H, Carli V, Wasserman C, Hoven C, Sarchiapone M, Apter A, Balazs J, Bobes J, Cosman D, Haring C, Kahn JP, Resch F, Postuvan V, Värnik A, Wasserman D. Help-seeking behaviour following school-based screening for current suicidality among European adolescents. Soc Psychiatry Psychiatr Epidemiol 2015; 50:973-82. [PMID: 25656270 DOI: 10.1007/s00127-015-1016-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To screen and clinically interview European adolescents reporting current suicidality (suicidal ideation and suicide attempt) and investigate attendance at the clinical interview. METHODS The Saving and Empowering Young Lives in Europe (SEYLE) Project was carried out in 11 European countries. A baseline questionnaire was completed in school by 12,395 adolescents (mean age 14.9; SD 0.9). Those who screened positive for suicidality (attempting suicide and/or serious suicidal ideation or plans) in the past 2 weeks were invited to a clinical interview with a mental health professional. RESULTS Of the 12,395 adolescents, 4.2 % (n = 516) screened positive for current suicidality. The prevalence ranged from 1.1 % in Hungary to 7.7 % in Israel (p < 0.001). 37.6 % (n = 194) of those who screened positive subsequently attended the clinical interview. Female students were more likely to attend for interview (42.0 % versus 30.6 %, p = 0.010). The attendance rate varied considerably across countries, from 5.7 % in Italy to 96.7 % in France (p < 0.001). Improved attendance was associated with using school as the only interview setting (Mean attendance rate, MAR = 88 vs. 31 %, p = 0.006) and arranging the interview within 1 week of contacting the student (MAR = 64 vs. 23 %, p = 0.013). The greater the travel time to interview, the lower the attendance rate (Pearson's r = -0.64, p = 0.034). Independent of the variation by country, at the individual level, adolescents with more depressive symptoms and a recent suicide attempt more often attended for interview. CONCLUSION A high rate of current suicidality was found amongst European adolescents. However, the majority of these displayed limited help-seeking behaviour. Future studies should investigate ways of making screening programmes and other interventions more acceptable and accessible to young people, especially young males.
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Affiliation(s)
- Pádraig Cotter
- National Suicide Research Foundation, University College Cork, Western Gateway Building, Room 4.28, Cork, Ireland,
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Rees N, Rapport F, Snooks H. Perceptions of paramedics and emergency staff about the care they provide to people who self-harm: Constructivist metasynthesis of the qualitative literature. J Psychosom Res 2015; 78:529-35. [PMID: 25819635 DOI: 10.1016/j.jpsychores.2015.03.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/26/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Presentations of self-harm to paramedic and emergency staff are increasing, and despite being the first professionals encountered, patients who self-harm report the quality of care and attitudes from these staff are unsatisfactory. Understanding this care may provide opportunities to improve services. The aim of this study is to enhance knowledge building and theory generation in order to develop practice and policy through a metasynthesis of qualitative research relating to perceptions of paramedic and emergency care for people who self-harm. METHODS The metasynthesis draws on Evolved Grounded Theory Methodology (EGTM). A search was undertaken of CINAHL, MEDLINE, OVID and Psych INFO, and grey literature. Subject headings of 'self-harm' were used alongside key words 'suicide', 'paramedic' 'emergency', 'overdose', 'pre-hospital' mental health, ambulance, perceptions of care, emergency. RESULTS A total of 1103 papers were retrieved; 12 were finally included. No papers investigated paramedic care for self-harm. The following metaphors emerged: (a) frustration, futility and legitimacy of care; (b) first contact in the pre-hospital environment: talking, immediate and lasting implications of the moral agent; (c) decision making in self-harm: balancing legislation, risk and autonomy; (d) paramedics' perceptions: harnessing professionalism and opportunities to contribute to the care of self-harm. CONCLUSION Paramedics are often the first health professional contact following self-harm, yet limited qualitative literature has explored this encounter. Metaphors revealed in this paper highlight challenges in decision making and legislation, also opportunities to improve care through professionalization and tailored education.
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Affiliation(s)
- Nigel Rees
- Swansea University, Pre Hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom.
| | - Frances Rapport
- Swansea University, Pre Hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom
| | - Helen Snooks
- Swansea University, Pre Hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom
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Rees N, Rapport F, Thomas G, John A, Snooks H. Perceptions of paramedic and emergency care workers of those who self harm: a systematic review of the quantitative literature. J Psychosom Res 2014; 77:449-56. [PMID: 25263398 DOI: 10.1016/j.jpsychores.2014.09.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/04/2014] [Accepted: 09/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The U.K. has one of the highest rates of self harm in Europe at 400 per 100,000 of population. Paramedics and emergency staff may be the first professionals encountered, therefore understanding their views and approaches to care is crucial. The aim of this study was to systematically review published quantitative literature relating to paramedic and emergency workers' perceptions and experiences of caring for people who self harm. METHODS CINAHL®, MEDLINE®, OVID ® and Psych INFO® databases were searched, PRISMA guidelines were followed, two researchers independently screened titles, abstracts and full papers against a priori eligibility criteria. Data synthesis was achieved by extracting and descriptively analysing study characteristics and findings. RESULTS 16 studies met inclusion criteria; one included ambulance staff, all used questionnaires. Training, policies and guidelines improved staff knowledge and confidence in caring for people who self harm. Limited access to training was reported, ranging from 75% to 90% of staff lacking any. Limited departmental guidelines were also reported. Staff in acute settings exhibited increased feelings of negativity, becoming less positive closer to front line care. Recent studies report positive attitudes amongst emergency staff. DISCUSSION Despite guidelines indicating need for education and policies to guide staff in self harm care, there is limited evidence of this happening in practice. The lack of literature including paramedics suggests a gap in our understanding about care for self harm patients. This gap warrants greater attention in order to improve care for patients who self harm in their first point of contact.
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Affiliation(s)
- Nigel Rees
- Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom.
| | - Frances Rapport
- Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom
| | - Gareth Thomas
- Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom
| | - Ann John
- Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom
| | - Helen Snooks
- Swansea University, Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom
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Tørmoen AJ, Rossow I, Mork E, Mehlum L. Contact with child and adolescent psychiatric services among self-harming and suicidal adolescents in the general population: a cross sectional study. Child Adolesc Psychiatry Ment Health 2014; 8:13. [PMID: 24742154 PMCID: PMC3997749 DOI: 10.1186/1753-2000-8-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 03/31/2014] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Studies have shown that adolescents with a history of both suicide attempts and non-suicidal self-harm report more mental health problems and other psychosocial problems than adolescents who report only one or none of these types of self-harm. The current study aimed to examine the use of child and adolescent psychiatric services by adolescents with both suicide attempts and non-suicidal self-harm, compared to other adolescents, and to assess the psychosocial variables that characterize adolescents with both suicide attempts and non-suicidal self-harm who report contact. METHODS Data on lifetime self-harm, contact with child and adolescent psychiatric services, and various psychosocial risk factors were collected in a cross-sectional sample (response rate = 92.7%) of 11,440 adolescents aged 14-17 years who participated in a school survey in Oslo, Norway. RESULTS Adolescents who reported any self-harm were more likely than other adolescents to have used child and adolescent psychiatric services, with a particularly elevated likelihood among those with both suicide attempts and non-suicidal self-harm (OR = 9.3). This finding remained significant even when controlling for psychosocial variables. In adolescents with both suicide attempts and non-suicidal self-harm, symptoms of depression, eating problems, and the use of illicit drugs were associated with a higher likelihood of contact with child and adolescent psychiatric services, whereas a non-Western immigrant background was associated with a lower likelihood. CONCLUSIONS In this study, adolescents who reported self-harm were significantly more likely than other adolescents to have used child and adolescent psychiatric services, and adolescents who reported a history of both suicide attempts and non-suicidal self-harm were more likely to have used such services, even after controlling for other psychosocial risk factors. In this high-risk subsample, various psychosocial problems increased the probability of contact with child and adolescent psychiatric services, naturally reflecting the core tasks of the services, confirming that they represents an important area for interventions that aim to reduce self-harming behaviour. Such interventions should include systematic screening for early recognition of self-harming behaviours, and treatment programmes tailored to the needs of teenagers with a positive screen. Possible barriers to receive mental health services for adolescents with immigrant backgrounds should be further explored.
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Affiliation(s)
- Anita J Tørmoen
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, Building 12, Oslo 0372, Norway
| | - Ingeborg Rossow
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, Building 12, Oslo 0372, Norway,Norwegian Institute for Alcohol and Drug Research, POB 565 Sentrum, Oslo N-0105, Norway
| | - Erlend Mork
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, Building 12, Oslo 0372, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, Building 12, Oslo 0372, Norway
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Fadum EA, Stanley B, Rossow I, Mork E, Törmoen AJ, Mehlum L. Use of health services following self-harm in urban versus suburban and rural areas: a national cross-sectional study. BMJ Open 2013; 3:e002570. [PMID: 23892421 PMCID: PMC3731709 DOI: 10.1136/bmjopen-2013-002570] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/20/2013] [Accepted: 06/21/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study examines whether there is a difference between urban versus suburban and rural adolescents in their use of health services following two types of self-harm distinguished as self-harm with or without suicide intent. SETTING A nationwide cross-sectional school survey of 11 406 Norwegian adolescents aged 13-19 years in 73 Norwegian junior and senior high schools. PARTICIPANTS Adolescents who reported self-harm and provided valid responses to a follow-up question about having received subsequent help or treatment (n=959) were included in the study. Adolescents were divided into urban versus suburban and rural depending on: (1) the location of municipalities where they attended school and (2) the place of residence. Associations between urban versus suburban and rural areas and the use of health services following self-harm were assessed in those who self-harmed with and without suicide intent. PRIMARY OUTCOME MEASURE Use of health services following self-harm. RESULTS 1 in 4 adolescents reported using health services following self-harm. Adolescents reporting self-harm with suicide intent were more likely to use health services than those who self-harmed without suicide intent. Following self-harm without suicide intent, adolescents in urban areas were four times more likely to use health services than adolescents in suburban and rural areas. There was no statistically significant area difference in the use of health services following self-harm with suicide intent. CONCLUSIONS This study found a geographical variation in the use of health services following self-harm without suicide intent, but not following self-harm with suicide intent. Differences in perception of self-harm and help-seeking behaviour between areas and different accessibility to services are suggested as possible explanations. There is a need to better understand how the interplay between individual characteristics and accessibility to services influences adolescents' use of health services following self-harm. We suggest that multilevel models are a valuable approach to achieve this goal.
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Affiliation(s)
- Elin Anita Fadum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Barbara Stanley
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Ingeborg Rossow
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian Institute for Alcohol and Drug Research, Oslo, Norway
| | - Erlend Mork
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anita J Törmoen
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Michelmore L, Hindley P. Help-seeking for suicidal thoughts and self-harm in young people: a systematic review. Suicide Life Threat Behav 2012; 42:507-24. [PMID: 22889130 DOI: 10.1111/j.1943-278x.2012.00108.x] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
There is a growing body of evidence to suggest that only a minority of young people experiencing suicidal thoughts or self-harm present to any health services. This is of concern given that young people with suicidal thoughts or self-harm often require treatment for mental illness as well as to reduce their risk of completed suicide. We reviewed previously published international community epidemiological studies examining help-seeking for suicidal thoughts or self-harm in young people up to the age of 26. The studies confirm that the majority of these young people do not seek professional help, and this includes seeking medical help after an overdose. The majority of young people studied do, however, seek help from social networks that most commonly are peers. Factors influencing and barriers to help-seeking are discussed and highlight a need for further research into the role that peers and family play in the help-seeking process for young people with suicidal thoughts or self-harm.
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Affiliation(s)
- Lisa Michelmore
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, England.
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15
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Buckner JD, Joiner TE, Schmidt NB, Zvolensky MJ. Daily marijuana use and suicidality: the unique impact of social anxiety. Addict Behav 2012; 37:387-92. [PMID: 22154236 PMCID: PMC3288149 DOI: 10.1016/j.addbeh.2011.11.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 09/21/2011] [Accepted: 11/16/2011] [Indexed: 10/15/2022]
Abstract
Despite a clear relationship between marijuana use and suicidality, little is known about psychological vulnerability factors that may interact with marijuana use to increase suicidality among this high-risk group. The present study examined the moderational impact of social anxiety on the relationship between marijuana use status (current users vs abstainers) and suicidality among 343 community adults. We also examined whether social anxiety moderated the relation between more frequent use (daily vs less frequent) among the 134 current marijuana users. Although social anxiety did not moderate the relation between use status and suicidality, it did moderate the relation between daily use status and suicidality after controlling for a wide range of relevant variables (e.g., demographics, depression, negative affect, and other types of anxiety). The overall model accounted for 59% of the variance in suicidality such that daily marijuana users with elevated social anxiety reported the highest suicidality. Findings highlight the importance of considering social anxiety in efforts to understand and prevent suicidality among this high-risk population.
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Affiliation(s)
- Julia D. Buckner
- Department of Psychology, Louisiana State University, Audubon Hall, Baton Rouge, LA 70803. Telephone: 1-225-578-4096; Fax: 1-225-578-4125
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, 1107 W. Call Street Tallahassee, FL 32306-4301, Phone: 1-850-644-2040, Fax:1-850-644-7739
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, 1107 W. Call Street Tallahassee, FL 32306-4301, Phone: 1-850-644-2040, Fax:1-850-644-7739
| | - Michael J. Zvolensky
- Department of Psychology, University of Vermont. John Dewey Hall, Burlington, VT 05405-0134, Telephone: 1-802-656-3831; Fax: 1-802-656-8783
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Early substance use initiation and suicide ideation and attempts among students in France and the United States. Int J Public Health 2011; 57:95-105. [PMID: 21523616 DOI: 10.1007/s00038-011-0255-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 04/05/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE In response to recent research documenting a link between early substance use and suicidal behaviors among youth, the current study sought to examine the associations between ages of substance use initiation and suicidal behavior among students in France and the USA. METHODS Cross-sectional logistic regression analyses based on the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) survey (France; n = 13,187) and the 2003 Youth Risk Behavior Survey (YRBS) (United States; n = 15,136) assessed associations between early substance use initiation (i.e., alcohol, cigarette and cannabis/marijuana) and suicide ideation and attempts while controlling for potential confounders. RESULTS Early alcohol use initiation (OR(adj) = 1.52; 95% CI 1.17-1.97) and early cannabis/marijuana use initiation (OR(adj) = 2.90; 95% CI 2.20-3.83) were associated with suicide attempt in France. Early smoking was associated with suicide attempt in both France (OR(adj) = 1.92; 95% CI 1.55-2.37) and the USA (OR(adj) = 1.53; 95% CI 1.02-2.28). Sex differences were also noted. CONCLUSIONS The associations between substance use initiation and suicidal behaviors differed in the United States and France. These findings, placed into context, can assist the development and implementation of prevention strategies that seek to reduce the harmful consequences of early substance use among youth.
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Abstract
The tragedy of suicide in adolescents is experienced by all countries of the world with as many as 200,000 youth and young adults ending their life in the prime of their life because of self-murder each year. Such a tragedy should be unacceptable to clinicians of the world and this article examines factors leading to such death in our youth with recommendations on how to prevent such a worldwide carnage. A major issue in suicide prevention is to screen all children and adolescents for depression and other factors that may trigger suicide in adolescence.
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Reasons for adolescent deliberate self-harm: a cry of pain and/or a cry for help? Findings from the child and adolescent self-harm in Europe (CASE) study. Soc Psychiatry Psychiatr Epidemiol 2009; 44:601-7. [PMID: 19023507 DOI: 10.1007/s00127-008-0469-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 11/02/2008] [Indexed: 11/27/2022]
Abstract
The present study examines reasons for adolescent deliberate self-harm. A cross-sectional survey using an anonymous self-report questionnaire was carried out in seven countries (Australia, Belgium, England, Hungary, Ireland, the Netherlands and Norway). Data on 30,477 school pupils between the ages of 14-17 were analysed. Past year and lifetime deliberate self-harm were assessed, along with the self-reported reasons for deliberate self-harm. The results showed that 'wanted to get relief from a terrible state of mind' and 'wanted to die' were most commonly reported. Principal component analysis indicated two underlying dimensions in the reasons for deliberate self-harm, i.e. a cry of pain motive and/or a cry for help motive. The majority of self-harmers reported at least one cry of pain motive ('to die', 'to punish myself', and 'to get relief from a terrible state of mind') and an additional cry for help motive ('to show how desperate I was feeling', to frighten someone', 'to get my own back on someone', 'to find out whether someone really loved me', and 'to get some attention'). Females reported more reasons than males. Only females showed an age difference, with girls aged 16-17 more frequently reporting a cry for help motive. There was considerable consistency in choice of motives across countries and genders. Systematic assessment of the reasons for deliberate self-harm can help clinicians to better understand the meaning of self harming behaviour, select appropriate treatment, suggest alternative coping strategies, and hopefully prevent future suicidal behaviour.
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Ystgaard M, Arensman E, Hawton K, Madge N, van Heeringen K, Hewitt A, de Wilde EJ, De Leo D, Fekete S. Deliberate self-harm in adolescents: comparison between those who receive help following self-harm and those who do not. J Adolesc 2008; 32:875-91. [PMID: 19028399 DOI: 10.1016/j.adolescence.2008.10.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 09/23/2008] [Accepted: 10/10/2008] [Indexed: 11/15/2022]
Abstract
This international comparative study addresses differences between adolescents who engage in deliberate self-harm (DSH) and who receive help following the DSH episode versus those who do not. A standardised self-report questionnaire was completed by pupils aged 14-17 in Australia, Belgium, England, Hungary, Ireland, The Netherlands, and Norway (n=30,532). An act of DSH in the year prior to the study was reported by 1660 participants. Nearly half (48.4%) had not received any help following DSH, 32.8% had received help from their social network only and 18.8% from health services. Except for Hungary, cross-national comparisons revealed remarkably similar findings. Adolescents who had been in contact with health services following DSH reported more often a wish to die, lethal methods, alcohol/drug problems and DSH in the family compared to those who had not. However, those who received no help or help from their social network only were also heavily burdened.
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Affiliation(s)
- Mette Ystgaard
- Centre for Child and Adolescent Mental Health, Oslo, Norway.
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20
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Fedorowicz VJ, Fombonne E. Suicidal behaviours in a population-based sample of French youth. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:772-9. [PMID: 18186177 DOI: 10.1177/070674370705201204] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To estimate the prevalence of suicidal ideation and behaviours in a large, representative sample of French youth and to evaluate age and sex correlates. METHOD We surveyed a large (n = 1106) cohort of French adolescents and young adults, aged 15 to 26 years and diversified throughout France, using a mailed-in self-report questionnaire. RESULTS Lifetime prevalence rates for suicidal ideation, plans, and attempts were 47.2%, 14.8%, and 5.7%, respectively. Rates for female youth were higher than for male youth across the entire spectrum of suicide-related outcomes. Rates generally increased between the ages of 15 and 20 years and decreased after age 21. CONCLUSIONS The findings suggest that suicidal thoughts and behaviours are widespread phenomena among adolescents and constitute a major public health issue.
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21
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Ferdinand RF, van der Ende J, Verhulst FC. Parent-teacher disagreement regarding psychopathology in children: a risk factor for adverse outcome? Acta Psychiatr Scand 2007; 115:48-55. [PMID: 17201866 DOI: 10.1111/j.1600-0447.2006.00843.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate if parent-teacher discrepancies in reports of behavioral/emotional problems in children predict poor outcome. METHOD A total of 1154 4- to 12-year-old children from the general population were followed up. At the first assessment, parent and teacher ratings were obtained with the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF). Fourteen years later, DSM-IV diagnoses were assessed, and ratings of self-reported and parent-rated behavioral and emotional problems were obtained. RESULTS CBCL and TRF scores predicted most of the outcomes, but in general, discrepancies between CBCL and TRF scores did not. There were some exceptions. For instance, higher parental vs. teacher ratings of aggressive behaviors increased the risk of suicide attempts/self-mutilation. CONCLUSION Risk factors for self-mutilating behaviors may be supplemented with parent-reported aggressive behaviors that are not observed by the teachers. In general, whereas CBCL and TRF scale scores were useful predictors of outcome, parent-teacher discrepancies were not.
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Affiliation(s)
- R F Ferdinand
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam/Sophia Children's Hospital, The Netherlands.
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22
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Chiou PN, Chen YS, Lee YC. Characteristics of adolescent suicide attempters admitted to an acute psychiatric ward in Taiwan. J Chin Med Assoc 2006; 69:428-35. [PMID: 17051754 DOI: 10.1016/s1726-4901(09)70286-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To investigate the characteristics of adolescent suicide attempters in Taiwan, compare with Western reports and provide reference for suicide preventive interventions in adolescence. METHODS During a 3-year period, the charts of 109 adolescent psychiatric inpatients were retrospectively reviewed. Twenty-eight adolescents admitted to an acute psychiatric ward as a result of recent suicide attempts were investigated to unravel factors related to suicide. Fifty-five adolescents with at least 1 suicide attempt recently or in the past were analyzed for risk factors of suicidal behavior compared to others. RESULTS Of the 109 adolescents admitted, 28 (25.6%) patients had been admitted due to recent suicide attempt. The most common diagnosis was depressive disorder (50%), followed by bipolar disorder (14.3%), schizophrenia (14.3%), and finally adjustment disorder (10.7%). There were significantly more girls than boys who attempted suicide. Suicide attempts increased with age, but this trend was not statistically significant. The most common precipitating factors were school stress (46%), parent-child conflict (25%), and psychopathology (25%) including feeling of hopelessness and psychotic symptoms. Adolescents with substance abuse or panic symptoms comprised a higher risk group for suicide. After discharge, 34.9% (38/109) of patients were lost to follow-up, and 15.5% (11/71) of the follow-up patients continued to manifest suicidal behavior. CONCLUSION Our study confirms some previous Western reports that adolescents with depressive disorders commonly manifest suicide attempts. There are, however, some cultural differences in risk factors. School-related problems play an important role in Taiwan among the adolescent suicides, and prior suicide attempts predict future suicidal behavior. Enhancing school-based screening for adolescents with suicide risk and transferring them to psychiatric professionals for intervention is important. We should focus suicide prevention resources mainly on the adolescent population with psychiatric illness, prior suicide attempts, and with high risk factors.
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Affiliation(s)
- Pei-Ning Chiou
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Conason AH, Oquendo MA, Sher L. Psychotherapy in the treatment of alcohol and substance abusing adolescents with suicidal behavior. Int J Adolesc Med Health 2006; 18:9-13. [PMID: 16639852 DOI: 10.1515/ijamh.2006.18.1.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Adolescence is a unique time period in an individual's life, one in which suicide and substance abuse become substantial health risks. Currently, suicide accounts for approximately 14% of all deaths among 15-24 year olds in the U.S.A. Drug, alcohol abuse and dependence are the most prevalent causes of adolescent morbidity and mortality in the USA. Numerous studies have demonstrated the link between adolescent alcohol, substance abuse and suicide. When compared to community controls, the rate of a substance abuse disorder was 8.5 times higher in a sample of adolescent suicide completers and the rate of alcohol abuse was 7.5 times higher. Genetic and biological variables may also be responsible for either alcohol and substance abuse or suicide or both alcohol and substance abuse and suicide. There is little empirical research evaluating the effectiveness of alcohol and substance abuse treatments for adolescents. Therapies such as multisystemic therapy, functional family therapy, motivational interviewing, community reinforcement, the 12-step approach and contingency management reinforcement seem to be effective treatments. Despite the strong association between adolescent alcohol and substance use and suicidal behaviors, few studies have investigated the combined treatment of these two issues. Cognitive behavioral therapy, particularly dialectical behavior therapy, seems to be a promising psychotherapy treatment for suicidality in alcohol and substance abusing adolescents. Further research is needed to determine the efficacy of various treatments of alcohol and substance abusing adolescents with suicidal behavior.
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Affiliation(s)
- Alexis H Conason
- Division of Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10032, USA
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