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Brockie T, Wissow L, Campbell JC, Ivanich J, Nelson K, Wallen G, Wetsit L, Wilcox H. Relationship between family history of mandatory boarding school experiences and suicide risk in US reservation-based Native American youth: a cross-sectional analysis. Inj Prev 2024:ip-2023-045095. [PMID: 39009436 DOI: 10.1136/ip-2023-045095] [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: 08/31/2023] [Accepted: 04/29/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Suicide is a leading cause of death among Native American youth and adolescents in the USA. A myriad of factors have been correlated with risk for suicide ideation (SI)/suicide attempt (SA), including historical trauma; however, accurate measurement of historical trauma has been inconsistent. OBJECTIVE To examine the association of family history of a negative mandatory boarding school experience with SI and SAs. METHODS An anonymous online survey was conducted with 288 Native youth aged 15-24 years from the Fort Peck Reservation in Montana. Multinomial regression was applied adjusting for other known risk and protective factors of SI and SAs. RESULTS Thirty-five percent reported past SAs and 15% reported ideation without prior attempt. Of the 129 (45%) reporting a family history of mandatory boarding school experiences, 28% perceived the experience as positive while 22% as negative. After adjusting for risk and protective factors, both SI and SAs were associated with a family history of negative mandatory boarding school experiences (adjusted OR (AOR)=4.8 and 4.3, respectively) and polydrug use (AOR=3.6 and 2.3). SAs were also associated with post-traumatic stress disorder (AOR=2.6) and depressive symptoms (AOR=3.6). CONCLUSION The association between family history of negative mandatory boarding school experiences and SI and SAs implies that culturally responsive interventions are needed to reduce the intergenerational impacts of historical trauma.
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Affiliation(s)
- Teresa Brockie
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Lawrence Wissow
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Jerreed Ivanich
- Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado, USA
| | - Katie Nelson
- Center for Indigenous Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Holly Wilcox
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ehlers CL, Gilder DA, Benedict J, Wills DN, Phillips E, Gonzales C, Karriker-Jaffe KJ, Bernert RA. Social zeitgeber and sleep loss as risk factors for suicide in American Indian adolescents. Transcult Psychiatry 2024; 61:273-284. [PMID: 38311923 PMCID: PMC11376403 DOI: 10.1177/13634615241227679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
American Indians / Alaska Natives (AI/AN) bear a high burden of suicide, the reasons for which are not completely understood, and rates can vary by tribal group and location. This article aims to identify circumstances reported by a community group of American Indian adolescent participants to be associated with their depression and/or suicide. American Indian adolescents (n = 360) were recruited from contiguous reservations and were assessed with a semi-structured diagnostic interview. Twenty percent of the adolescents reported suicidal thoughts (ideation, plans), an additional 8% reported a history of suicide attempts, and three deaths due to suicide were reported. Suicidal behaviors and major depressive disorder (MDD) co-occurred and were more common among female adolescents. The distressing events that adolescents most often reported were: death in the family, family disruption, peer relationship problems, and school problems. All of these events were significantly associated with suicidal behaviors, however those with suicidal acts were more likely to report death in the family. Those with MDD but no suicidal behaviors were more likely to report disruptions in the family. Disruptions in falling asleep were also associated with suicidal behaviors and having experienced a death in the family. Disruptions in important relationships, particularly through death or divorce, may be interpreted as a loss or disruption in "social zeitgebers" that may in turn disturb biological rhythms, such as sleep, thus potentially increase the risk for MDD and/or suicide. Prevention programs aimed at ameliorating the impact of disruptions in important relationships may potentially reduce suicidal behaviors in AI/AN adolescents.
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Affiliation(s)
- Cindy L Ehlers
- Neurosciences Department, The Scripps Research Institute, USA
| | - David A Gilder
- Neurosciences Department, The Scripps Research Institute, USA
| | | | - Derek N Wills
- Neurosciences Department, The Scripps Research Institute, USA
| | - Evie Phillips
- Neurosciences Department, The Scripps Research Institute, USA
| | - Cathy Gonzales
- Neurosciences Department, The Scripps Research Institute, USA
- Pala Band of Mission Indians, Pala, CA, USA
| | | | - Rebecca A Bernert
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
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Roche CS, Sang HI, Ahmeti M. A Call for Help: A Retrospective National Study of Self-Inflicted Trauma Among American Indians and Alaskan Natives. Cureus 2024; 16:e53624. [PMID: 38449970 PMCID: PMC10916905 DOI: 10.7759/cureus.53624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Background Self-inflicted injury accounts for approximately 312,000 emergency department visits annually. American Indians/Alaskan Natives (AIAN) have significantly higher rates of suicide. The National Trauma Data Bank (NTDB) was analyzed for the incidence of self-inflicted trauma. Methods Data were obtained from the NTDB 2012-2017. Patients were selected using ICD codes for self-inflicted trauma. Categorical and continuous variables were tested for significance. Results AIAN patients accounted for 1,176 of the 78,668 patients. The AIAN patients were younger, had lower injury severity score (ISS) scores, were more female, utilized Medicaid more frequently, were more likely to present with a cut or piercing injury, and had higher rates of positive alcohol and drug tests. AIAN patients had shorter lengths of stay in the ICU and overall hospital stay. Conclusion Despite a higher rate of suicide completion, the AIAN population had lower rates of presentation to the hospital and lower ISS scores. AIAN patients were younger, had higher rates of drug use, and utilized cutting/stabbing. This discrepancy could indicate a physical manifestation of a "call for help".
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Affiliation(s)
- Conor S Roche
- General Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
- General Surgery, Sanford Health, Fargo, USA
| | | | - Mentor Ahmeti
- Trauma and Acute Care Surgery, Sanford Health, Fargo, USA
- General Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
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Ehlers CL, Gilder DA, Karriker-Jaffe KJ, Bernert R. Comorbidity of anxiety/affective, conduct/antisocial, attention deficit, and alcohol use disorders with suicidal behaviors in an American Indian community sample of adults and adolescents. J Psychiatr Res 2023; 167:63-70. [PMID: 37837862 PMCID: PMC10997741 DOI: 10.1016/j.jpsychires.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
AIMS To study the associations of anxiety/affective disorders, conduct/antisocial disorders (ASPD/CD), attention deficit disorders (ADHD), and alcohol use disorders (AUD) with suicidal behaviors in an American Indian (AI) community sample of adolescents and adults. METHODS Participants were AI (360 adolescents, 925 adults) recruited from reservations who were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). RESULTS Among AI adults (mean age = 33 years), 17% percent reported lifetime experiences of suicidal thoughts (ideation and/or plans) and 14% reported suicidal acts (including either a suicide attempt history or verified death by suicide; n = 19 deaths). Among AI adolescents (mean age = 15 years), 20% experienced suicidal thoughts and 9% experienced suicidal acts (including 3 deaths). In logistic regression analyses, suicidal thoughts were significantly associated with lifetime diagnoses of affective disorder, CD and ADHD in adolescents, and with anxiety disorder, affective disorder, and ASPD/CD in adults. Suicidal acts were associated with affective disorder, ADHD, and alcohol drinking in adolescents and with anxiety disorder, ASPD/CD and AUD in adults. The number of comorbid disorders greatly increased the risk of both suicidal thoughts and acts among both adolescents and adults. CONCLUSIONS In addition to affective disorders, both ADHD and CD in adolescents, and ASPD in adults, demonstrated an association with suicidal thoughts. Alcohol use by adolescents and AUD among adults also were associated with suicidal attempts in this AI sample. These findings suggest need for additional research and potential integration of alcohol in screening and intervention programs focused on the prevention of suicide among AI.
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Affiliation(s)
- Cindy L Ehlers
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA.
| | - David A Gilder
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA
| | | | - Rebecca Bernert
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Armstrong G, Sutherland G, Pross E, Mackinnon A, Reavley N, Jorm A. Effects of an Aboriginal and Torres Strait Islander Mental Health First Aid training programme for non-suicidal self-injury on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions: an uncontrolled trial with precourse and postcourse measurement and 6-month follow-up. BMJ Open 2023; 13:e066043. [PMID: 36631233 PMCID: PMC9835939 DOI: 10.1136/bmjopen-2022-066043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Non-suicidal self-injury (NSSI) is a complex issue affecting Aboriginal and/or Torres Strait Islander Peoples in Australia. We evaluated the effects of an Aboriginal and Torres Strait Islander Mental Health First Aid (AMHFA) training course on assisting an Aboriginal and/or Torres Strait Islander person engaging in NSSI, including the effects on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions. DESIGN Uncontrolled trial with precourse and postcourse measurement (n=49) and 6-month follow-up (n=17). SETTING Participants attended courses that were run in Queensland and Victorian communities and through one national organisation. PARTICIPANTS Participants were 49 adults who worked directly with Aboriginal and/or Torres Strait Islander Peoples. INTERVENTION The 5-hour 'Talking About Non-Suicidal Self-Injury' course was delivered by accredited AMHFA instructors and teaches people how to support an Aboriginal and/or Torres Strait Islander person who is engaging in NSSI. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome measures were stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a person engaging in NSSI. RESULTS Improvements were observed in stigmatising attitudes, with significant changes from precourse in both the 'weak-not-sick' (postcourse p<0.0623; follow-up p=0.0058) and 'dangerous/unpredictable' (postcourse p<0.0001; follow-up p=0.0036) subscales. Participants' confidence in ability to assist increased significantly both postcourse (p<0.0001) and at follow-up (p<0.0001). Despite a high level of endorsement for the nine recommended assisting actions at precourse, significant improvements (p<0.05) were observed in endorsement for six and four of the assisting actions postcourse and at follow-up, respectively. Course content was rated as being somewhat (3.4%), mostly (13.8%) or very (82.7%) culturally appropriate by participants who identified as Aboriginal and/or Torres Strait Islander. CONCLUSIONS The results of this uncontrolled trial were encouraging, suggesting that the Talking About Non-Suicidal Self-Injury course was able to improve participants' attitudes, confidence and intended assisting actions.
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Affiliation(s)
- Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georgina Sutherland
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Eliza Pross
- Mental Health First Aid Australia, Melbourne, Victoria, Australia
| | - Andrew Mackinnon
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Ehlers CL, Yehuda R, Gilder DA, Bernert R, Karriker-Jaffe KJ. Trauma, historical trauma, PTSD and suicide in an American Indian community sample. J Psychiatr Res 2022; 156:214-220. [PMID: 36265258 PMCID: PMC9842016 DOI: 10.1016/j.jpsychires.2022.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
AIMS To study the associations between perceived historical trauma, current traumatic events, diagnoses of post-traumatic stress disorder (PTSD), and suicidal behaviors in an American Indian community sample. METHODS Participants were American Indians recruited from reservations who were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), as well as the Historical Loss Scale, Historical Loss Associated Symptoms Scale, and Stressful Life Events Scale. RESULTS In data from 447 American Indian adults (mean age = 33 years), twenty percent reported lifetime experiences of suicidal thoughts (ideation and/or plans) and 14% reported suicidal acts, (including either a suicide attempt history or verified death by suicide (n = 4)). Diagnosis of PTSD and experience of assaultive trauma were each significantly associated with suicidal thoughts and acts, although assaultive trauma did not remain significant in models adjusting for gender and PTSD. High endorsement of symptoms associated with historical trauma was significantly associated with suicidal acts, and this remained significant when adjusting for gender and PTSD. CONCLUSIONS PTSD and historical trauma have an association with suicide and suicidal attempts in this American Indian community. Although further research is needed to evaluate the causal nature of these relations, these findings suggest treatment and prevention programs for American Indian suicide may benefit from addressing issues related to feelings of historical losses, PTSD, and their associated symptomatology.
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Affiliation(s)
- Cindy L Ehlers
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA.
| | - Rachel Yehuda
- James J. Peters Bronx Medical Center and Psychiatry Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David A Gilder
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA
| | - Rebecca Bernert
- Department of Psychiatry and Behavioral Sciences Stanford University, Stanford, CA, USA
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Ivanich JD, O'Keefe V, Waugh E, Tingey L, Tate M, Parker A, Craig M, Cwik M. Social Network Differences Between American Indian Youth Who have Attempted Suicide and Have Suicide Ideation. Community Ment Health J 2022; 58:589-594. [PMID: 34196904 PMCID: PMC8929287 DOI: 10.1007/s10597-021-00857-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022]
Abstract
Suicide is a crucial public health concern for American Indian and Alaska native (AIAN) communities. AIANs have the highest suicide rate compared to all other ethnic groups in the United States. Social relations are a salient fixture of AIAN culture. The primary aims of this study were to describe the personal networks of AI youth that have recently had a suicide attempt or suicidal ideation and to identify key network differences between the two groups. This study uses personal networks collected among AIs living on a reservation in the Southwest. Our sample included 46 American Indians that have recently attempted suicide or had suicidal ideation. We explored social network characteristics of the two groups descriptively as well as comparatively (t-tests). Our findings suggest that AI youth that have attempted suicide nominate more friends in their networks that have used alcohol and drugs compared to the networks of AI youth that have recent suicide ideation. Additionally, AI youth that recently attempted suicide have used alcohol and drugs with their network peers at a higher rate than youth that have had recent suicide ideation. Lastly, AI youth that have attempted suicide recently were significantly more likely to have more nominated friends in their networks that they had reached out to when they were struggling with suicide compared to their peers that have experienced recent suicide ideation. These results indicate a promising method moving forward to identify unique intervention strategies that extend beyond the individual.
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Affiliation(s)
- Jerreed D Ivanich
- Centers for American Indian and Alaska Native Health, Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
| | - Victoria O'Keefe
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma Waugh
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren Tingey
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Tate
- White Mountain Apache Tribe, Whiteriver, AZ, USA
| | | | | | - Mary Cwik
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ko LK, Tingey L, Ramirez M, Pablo E, Grass R, Larzelere F, Cisneros O, Chu HY, D’Agostino EM. Mobilizing Established School Partnerships to Reach Underserved Children During a Global Pandemic. Pediatrics 2022; 149:e2021054268F. [PMID: 34737178 PMCID: PMC9153654 DOI: 10.1542/peds.2021-054268f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
The coronavirus disease 2019 pandemic has led to drastic public health measures, including school closures to slow the spread of severe acute respiratory syndrome coronavirus 2 infection. Reopening educational settings by using diagnostic testing approaches in schools can help accelerate the safe return of students and staff to on-site learning by quickly and accurately identifying cases, limiting the spread of severe acute respiratory syndrome coronavirus 2, and ultimately preventing unnecessary school and work absenteeism. Although the National Institutes of Health has identified community partnerships as the foundation for reducing health disparities, we found limited application of a community-based participatory research (CBPR) approach in school engagement. Guided by the CBPR conceptual model, we provide case studies of 2 established and long-standing school-academic partnerships built on CBPR processes and practices that have served as a research infrastructure to reach underserved children and families during the coronavirus disease 2019 pandemic. The process described in this article can serve as an initial platform to continue to build capacity toward increasing health equity.
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Affiliation(s)
- Linda K. Ko
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lauren Tingey
- Center for American Indian Health, Department of International Health, Johns Hopkins University, Baltimore, Maryland
| | - Magaly Ramirez
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Elliott Pablo
- Center for American Indian Health, Department of International Health, Johns Hopkins University, Whiteriver, Arizona
| | - Ryan Grass
- Center for American Indian Health, Department of International Health, Johns Hopkins University, Whiteriver, Arizona
| | - Francene Larzelere
- Center for American Indian Health, Department of International Health, Johns Hopkins University, Whiteriver, Arizona
| | | | - Helen Y. Chu
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Emily M. D’Agostino
- Departments of Orthopaedic Surgery and Population Health Sciences, Duke University, Durham, North Carolina
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Abstract
This article summarizes current knowledge and consensus about depression and suicide among the indigenous young people of the United States. American Indians represent more than 500 tribes and also vary among settings-reservations, urban, suburban, and rural-but as a group, remain at high risk for suicide and possibly for depressive syndromes. Particular risk factors and correlates, as well as approaches to treatment, are discussed.
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Armstrong G, Ironfield N, Kelly CM, Dart K, Arabena K, Bond K, Jorm AF. Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait Islanders who are engaging in non-suicidal self-injury. BMC Psychiatry 2017; 17:300. [PMID: 28830485 PMCID: PMC5568063 DOI: 10.1186/s12888-017-1465-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 08/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) disproportionally affects Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is engaging in NSSI. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islanders who are engaging in NSSI were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions. METHODS The Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non-Indigenous frontline workers can take, and information they should have, to help someone who is engaging in NSSI. The statements were sourced from systematic searches of peer-reviewed literature, grey literature, books, websites and online materials, and existing NSSI courses. A panel was formed, comprising 26 Aboriginal and Torres Strait Islanders with expertise in NSSI. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important. RESULTS From a total of 185 statements shown to the expert panel, 115 were endorsed as helping statements to be included in the re-developed guidelines. CONCLUSIONS A panel of Aboriginal and Torres Strait Islander people with expertise in NSSI were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander engaging in NSSI. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version. The re-developed guidelines will form the basis of an Aboriginal mental health first aid short course on NSSI for Indigenous community members and non-Indigenous frontline workers that will be evaluated in an upcoming trial.
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Affiliation(s)
- Gregory Armstrong
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria 3010 Australia
| | - Natalie Ironfield
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria 3010 Australia
| | - Claire M. Kelly
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, Victoria 3053 Australia
| | - Katrina Dart
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, Victoria 3053 Australia
| | - Kerry Arabena
- Indigenous Health Equity Unit, Melbourne School of Population Health, University of Melbourne, 207 Bouverie St, Carlton, Victoria 3010 Australia
| | - Kathy Bond
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, Victoria 3053 Australia
| | - Anthony F. Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria 3010 Australia
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Hagaman AK, Maharjan U, Kohrt BA. Suicide surveillance and health systems in Nepal: a qualitative and social network analysis. Int J Ment Health Syst 2016; 10:46. [PMID: 27274355 PMCID: PMC4895957 DOI: 10.1186/s13033-016-0073-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 05/10/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite increasing recognition of the high burden of suicide deaths in low- and middle-income countries, there is wide variability in the type and quality of data collected and reported for suspected suicide deaths. Suicide data are filtered through reporting systems shaped by social, cultural, legal, and medical institutions. Lack of systematic reporting may underestimate public health needs or contribute to misallocation of resources to groups most at risk. METHODS The goal of this study was to explore how institutional structures, cultural perspectives on suicide, and perceived criminality of self-harm influence the type and quality of suicide statistics, using Nepal as an example because of its purported high rate of suicide in the public health literature. Official documentation and reporting networks drawn by police, policy makers, and health officials were analyzed. Thirty-six stakeholders involved in various levels of the death reporting systems in Nepal participated in in-depth interviews and an innovative drawn surveillance system elicitation task. RESULTS Content analysis and social network analysis revealed large variation across the participants perceived networks, where some networks were linear pathways dominated by a single institution (police or community) with few nodes involved in data transmission, while others were complex and communicative. Network analysis demonstrated that police institutions controlled the majority of suicide information collection and reporting, whereas health and community institutions were only peripherally involved. Both health workers and policy makers reported that legal codes criminalizing suicide impaired documentation, reporting, and care provision. However, legal professionals and law review revealed that attempting suicide is not a crime punishable by incarceration. Another limitation of current reporting was the lack of attention to male suicide. CONCLUSIONS Establishment and implementation of national suicide prevention strategies will not be possible without reliable statistics and comprehensive standardized reporting practices. The case of Nepal points to the need for collaborative reporting and accountability shared between law enforcement, administrative, and health sectors. Awareness of legal codes among health workers, in particular dispelling myths of suicide's illegality, is crucial to improve mental health services and reporting practices.
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Affiliation(s)
- Ashley K. Hagaman
- />School of Human Evolution and Social Change, Arizona State University, Tempe, USA
| | - Uden Maharjan
- />Health Research and Social Development Forum, Kathmandu, Nepal
| | - Brandon A. Kohrt
- />Duke Global Health Institute and Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC USA
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Chambers R, Tingey L, Beach A, Barlow A, Rompalo A. Testing the efficacy of a brief sexual risk reduction intervention among high-risk American Indian adults: study protocol for a randomized controlled trial. BMC Public Health 2016; 16:366. [PMID: 27129956 PMCID: PMC4850664 DOI: 10.1186/s12889-016-3040-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/26/2016] [Indexed: 04/17/2023] Open
Abstract
Background American Indian adults are more likely to experience co-occurring mental health and substance use disorders than adults of other racial/ethnic groups and are disproportionately burdened by the most common sexually transmitted infections, namely chlamydia and gonorrhea. Several behavioral interventions are proven efficacious in lowering risk for sexually transmitted infection in various populations and, if adapted to address barriers experienced by American Indian adults who suffer from mental health and substance use problems, may be useful for dissemination in American Indian communities. The proposed study aims to examine the efficacy of an adapted evidence-based intervention to increase condom use and decrease sexual risk-taking and substance use among American Indian adults living in a reservation-based community in the Southwestern United States. Methods/Design The proposed study is a randomized controlled trial to test the efficacy of an adapted evidence-based intervention compared to a control condition. Participants will be American Indian adults ages 18–49 years old who had a recent episode of binge substance use and/or suicide ideation. Participants will be randomized to the intervention, a two-session risk-reduction counseling intervention or the control condition, optimized standard care. All participants will be offered a self-administered sexually transmitted infection test. Participants will complete assessments at baseline, 3 and 6 months follow-up. The primary outcome measure is condom use at last sex. Discussion This is one of the first randomized controlled trials to assess the efficacy of an adapted evidence-based intervention for reducing sexual risk behaviors among AI adults with substance use and mental health problems. If proven successful, there will be an efficacious program for reducing risk behaviors among high-risk adults that can be disseminated in American Indian communities as well as other rural and under-resourced health systems. Trial Registration Clinical Trials NCT02513225
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Affiliation(s)
- Rachel Chambers
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA.
| | - Lauren Tingey
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Anna Beach
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Allison Barlow
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
| | - Anne Rompalo
- Johns Hopkins School of Medicine, Johns Hopkins University, 415 North Washington Street Suite 400, Baltimore, Maryland, 21224, USA
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Gholamrezaei M, De Stefano J, Heath NL. Nonsuicidal self-injury across cultures and ethnic and racial minorities: A review. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2015; 52:316-326. [PMID: 26644040 DOI: 10.1002/ijop.12230] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/01/2015] [Indexed: 11/08/2022]
Abstract
The field of nonsuicidal self-injury (NSSI) is dominated by research conducted with Caucasian-majority samples in Western countries such as United States, Canada, Australia and European countries. This article critically reviewed the empirical research on NSSI in non-Western countries and among ethnic/racial minority individuals who live in the West to give voice to and understand the patterns of NSSI among individuals who do not fall within the dominant Caucasian majority. The study found both similarities and differences between Western and non-Western data in terms of characteristics and functions of NSSI. Differences in gender patterns in regards to prevalence of NSSI and methods used as well as presence of a more relational functionality of NSSI rather than emotion regulation functionality were two points of divergence in the findings of these studies. In addition, the findings seem to indicate that the role of ethnicity/race is mediated by important factors such as socioeconomic status (SES) and gender. Existing gaps in the literature and suggestions for further research are discussed.
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Affiliation(s)
- Maryam Gholamrezaei
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Jack De Stefano
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Nancy L Heath
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
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Bresin K, Schoenleber M. Gender differences in the prevalence of nonsuicidal self-injury: A meta-analysis. Clin Psychol Rev 2015; 38:55-64. [DOI: 10.1016/j.cpr.2015.02.009] [Citation(s) in RCA: 288] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 02/21/2015] [Accepted: 02/27/2015] [Indexed: 11/16/2022]
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Ford JD, Gómez JM. The relationship of psychological trauma and dissociative and posttraumatic stress disorders to nonsuicidal self-injury and suicidality: a review. J Trauma Dissociation 2015; 16:232-71. [PMID: 25758363 DOI: 10.1080/15299732.2015.989563] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.
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Affiliation(s)
- Julian D Ford
- a Department of Psychiatry , University of Connecticut School of Medicine , Farmington , Connecticut , USA
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16
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Tingey L, Cwik MF, Goklish N, Larzelere-Hinton F, Lee A, Suttle R, Walkup JT, Barlow A. Risk pathways for suicide among Native American adolescents. QUALITATIVE HEALTH RESEARCH 2014; 24:1518-1526. [PMID: 25168705 DOI: 10.1177/1049732314548688] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Native American (Native) adolescents have the highest suicide rates in the United States, yet no conceptual models describing risk factors specific to this population exist. We sought to further hone a Native-specific conceptual model developed from quantitative data with qualitative data collected from a longitudinal series of interviews with (N = 22) Native adolescents who had attempted suicide. Four levels of suicide risk emerged, detailing individual, family, community, and societal factors that affect youths' pathways to suicide, along with a variety of subthemes and constructs. Some themes parallel established models of suicide risk; however, others are unique to the experience of this sample, including the impact of overtaxed households and family composition, significant grief burden, contagion, and stigma surrounding treatment seeking. We suggest adaptations of existing themes and constructs in the model. We discuss practical implications for research and intervention development, along with strengths and limitations of the study.
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Affiliation(s)
| | - Mary F Cwik
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Angelita Lee
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | - John T Walkup
- Weill Cornell Medical College, New York City, New York, USA
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Victor SE, Klonsky ED. Correlates of suicide attempts among self-injurers: A meta-analysis. Clin Psychol Rev 2014; 34:282-97. [DOI: 10.1016/j.cpr.2014.03.005] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 02/11/2014] [Accepted: 03/25/2014] [Indexed: 12/27/2022]
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18
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Swannell SV, Martin GE, Page A, Hasking P, St John NJ. Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav 2014; 44:273-303. [PMID: 24422986 DOI: 10.1111/sltb.12070] [Citation(s) in RCA: 844] [Impact Index Per Article: 84.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/28/2013] [Indexed: 12/13/2022]
Abstract
Published prevalence estimates of nonsuicidal self-injury (NSSI) among nonclinical samples are highly heterogeneous, raising concerns about their reliability and hindering attempts to explore the alleged increase in NSSI over time. Accordingly, the objectives of this study were to investigate the influence of methodological factors on heterogeneity in NSSI prevalence estimates, explore changes over time, and estimate overall international NSSI prevalence. Results showed that methodological factors contributed over half (51.6%) of the heterogeneity in prevalence estimates, and, after adjusting for these factors, NSSI prevalence did not increase over time. Overall, pooled NSSI prevalence was 17.2% among adolescents, 13.4% among young adults, and 5.5% among adults. Clearly, development of standardized methodology in NSSI research is crucial if accurate estimates are desired.
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Affiliation(s)
- Sarah V Swannell
- School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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19
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Cwik MF, Barlow A, Goklish N, Larzelere-Hinton F, Tingey L, Craig M, Lupe R, Walkup J. Community-based surveillance and case management for suicide prevention: an American Indian tribally initiated system. Am J Public Health 2014; 104 Suppl 3:e18-23. [PMID: 24754618 DOI: 10.2105/ajph.2014.301872] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The National Strategy for Suicide Prevention highlights the importance of improving the timeliness, usefulness, and quality of national suicide surveillance systems, and expanding local capacity to collect relevant data. This article describes the background, methods, process data, and implications from the first-of-its-kind community-based surveillance system for suicidal and self-injurious behavior developed by the White Mountain Apache Tribe with assistance from Johns Hopkins University. The system enables local, detailed, and real-time data collection beyond clinical settings, with in-person follow-up to facilitate connections to care. Total reporting and the proportion of individuals seeking treatment have increased over time, suggesting that this innovative surveillance system is feasible, useful, and serves as a model for other communities and the field of suicide prevention.
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Affiliation(s)
- Mary F Cwik
- Mary F. Cwik, Allison Barlow, Novalene Goklish, Francene Larzelere-Hinton, and Lauren Tingey are with the Department of International Health, Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, MD. Mariddie Craig is with the White Mountain Apache Tribe's Native American Research Centers in Health, Whiteriver, AZ. Ronnie Lupe is with the White Mountain Apache Tribal Council, Whiteriver. John Walkup is with the Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, NY
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Wyman L, Crum R, Celentano D. Depressed mood and cause-specific mortality: a 40-year general community assessment. Ann Epidemiol 2012; 22:638-43. [PMID: 22835415 PMCID: PMC3462815 DOI: 10.1016/j.annepidem.2012.06.102] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 05/10/2012] [Accepted: 06/20/2012] [Indexed: 01/12/2023]
Abstract
PURPOSE The current study describes how the excess mortality risk associated with depression translates into specific causes of death occurring during a 40-year follow-up period, with focus on deaths related to injuries, cardiovascular diseases, and cancer. METHODS Data come from a cross-sectional survey (Community Mental Health Epidemiology Study) conducted in the early 1970s in Washington County, Maryland. Random sampling for the survey resulted in 2762 interviews. For the current analyses, baseline depressed mood was linked to current participant vital status through the use of death certificates. RESULTS The relative subdistribution hazards for cardiovascular deaths (3.08 [1.74-5.45]) and fatal injuries (4.63 [1.76-12.18]) were significant during the entire 40-year period for young adults (18-39 years old at baseline). The relative subdistribution hazard for cardiovascular deaths during the first 15 years of follow-up was pronounced in elderly (≥ 65 years) males (2.99 [1.67-5.37]) subjects. There were no significant associations between depressed mood and cancer deaths. CONCLUSIONS Individuals in the general community with depressed mood may be at increased risk of deaths as the result of cardiovascular disease and injury, even several decades after exposure assessment. Young adults with depressed mood appear to be particularly vulnerable to these associations.
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Affiliation(s)
- Lisa Wyman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rosa Crum
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - David Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Barlow A, Tingey L, Cwik M, Goklish N, Larzelere-Hinton F, Lee A, Suttle R, Mullany B, Walkup JT. Understanding the Relationship between Substance Use and Self-Injury in American Indian Youth. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:403-8. [PMID: 22931073 DOI: 10.3109/00952990.2012.696757] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Allison Barlow
- Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
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Tingey L, Cwik M, Goklish N, Alchesay M, Lee A, Strom R, Suttle R, Walkup J, Barlow A. Exploring Binge Drinking and Drug Use among American Indians: Data from Adolescent Focus Groups. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:409-15. [DOI: 10.3109/00952990.2012.705204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rauber R, Hefti S, In-Albon T, Schmid M. Wie psychisch belastet fühlen sich Jugendliche mit selbstverletzendem Verhalten? KINDHEIT UND ENTWICKLUNG 2012. [DOI: 10.1026/0942-5403/a000067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In den letzten Jahren wurden zahlreiche Prävalenzstudien zum selbstverletzenden Verhalten bei Heranwachsenden in unterschiedlichen Ländern veröffentlicht. Aus der Schweiz liegen jedoch keine belastbaren Zahlen vor. Kritisch ist bei der Vielzahl der Studien anzumerken, dass sich diese oft auf ein „einfaches“ Feststellen der Prävalenz beschränken und kaum Hinweise für eine effektive Frühintervention geben. Im Rahmen einer epidemiologischen Fragebogenuntersuchung im Kanton Basel-Stadt wurden 447 Schüler (M = 14.95 Jahre, SD = 0.74, 52 % männlich) untersucht. Neben der Erfassung der Form und Art der Selbstverletzung wurde auch die psychische Belastung der Schüler erfasst. Es sollte überprüft werden, wie viele Selbstverletzer sich im Screening für psychische Störungen (SPS-J) als psychisch belastet beschreiben. 61 (13.6 %) Jugendliche gaben an, sich bereits mindestens einmal selbstverletzt zu haben. 29 (6.4 %) haben sich im letzten Monat selbst verletzt, 4 davon häufiger als viermal. Die Ergebnisse bestätigten die hohen Prävalenzraten für selbstverletzendes Verhalten. Interessant ist, dass Selbstverletzer im Schnitt zwar wesentlich höhere Werte im SPS-J erzielten, sich aber bei weitem nicht alle als psychisch auffällig beschrieben (18 von 61 selbstverletzenden Jugendlichen erzielten unauffällige Werte). Für eine effektivere Identifikation sollten daher Fragen zum selbstverletzenden Verhalten in psychopathologische Screeningfragebögen integriert werden, um diese Symptomatik adäquat abbilden zu können. Die Ergebnisse und die hohen Prävalenzen legen nahe, dass verschiedene Subgruppen von Selbstverletzern existieren, die passgenaue Hilfen für ihre Symptomatik benötigen.
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Affiliation(s)
- Rachel Rauber
- Kinder- und Jugendpsychiatrische Klinik der UPK Basel
- Kinder- und Jugendpsychiatrische Dienste St. Gallen
| | | | - Tina In-Albon
- Fakultät für Psychologie der Universität Basel, Abteilung Klinische Psychologie und Psychotherapie
| | - Marc Schmid
- Kinder- und Jugendpsychiatrische Klinik der UPK Basel
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