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Siilbek E, Streimann K. Adaptation of the Communities That Care Youth Survey for Use in Estonia: A Pilot Study. JOURNAL OF PREVENTION (2022) 2024; 45:483-500. [PMID: 38568317 DOI: 10.1007/s10935-024-00777-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 07/21/2024]
Abstract
The Communities That Care Youth Survey (CTCYS) assesses risk and protective factors, predicting a range of behavioural health problems, including substance use, violence, and delinquency. Although the survey has been adapted to other contexts and languages, further studies on cross-cultural adaptations, particularly in non-English speaking countries, are needed. In 2022, CTCYS was adapted for Estonia, incorporating 38 risk and protective factors, along with measures of substance use, antisocial behaviour, mental health problems, and self-harm. This study investigated the psychometric properties and applicability of the CTCYS in Estonia. The adaptation process involved translating and refining the US CTCYS, followed by focus group discussions with students and specialists and a pilot study in two municipalities, with data obtained from 265 students. A focus group with municipality members explored the measure's feasibility. Results indicate that the original CTC framework largely captures key issues within the Estonian context. Overall, the survey showed good validity, as evidenced by its ability to predict problem outcomes through both risk and protective factors. Regarding reliability, with the removal of one item, internal consistency reached acceptable levels for all but eight risk and protective factor subscales. The most problematic scales in the Estonian context were Prosocial Involvement, Social Skills, and Belief in the Moral Order. Municipality members perceived the measure as useful but highlighted some challenges regarding its practicality and comprehensibility. It became clear that other elements are needed to effectively support communities in using the CTCYS results for preventive efforts.
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Affiliation(s)
- Eike Siilbek
- National Institute for Health Development, Tallinn, Estonia.
- University of Tartu, Tartu, Estonia.
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2
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Nawaz RF, Anderson JK, Colville L, Fraser-Andrews C, Ford TJ. Review: Interventions to prevent or manage self-harm among students in educational settings - a systematic review. Child Adolesc Ment Health 2024; 29:56-69. [PMID: 36625166 DOI: 10.1111/camh.12634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND At least half of all young people who die by suicide have previously self-harmed and most of those who self-harm will not seek help from health services for self-harming behaviours. By default, schools, colleges and universities necessarily play a key role in identifying those who self-harm and supporting them to access help. METHODS We conducted a systematic review (PROSPERO ID: CRD42021243692) of five databases (Medline, PsycINFO, ASSIA, ERIC and BEI) for quantitative studies evaluating interventions to reduce self-harm among students in schools, colleges and universities. RESULTS We identified six eligible studies that reported interventions. Two interventions used mindfulness-based approaches and the remaining four interventions focused on in-classroom education. Three interventions reported a significant reduction in self-harm, all three used in-classroom education. Of the six studies, one study was rated methodologically moderate, while the remaining five were weak. CONCLUSION In summary, the evidence base is limited in size and quality. Most current interventions to address self-harm in schools focus on training staff in awareness, with a significant gap in direct support for students.
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Affiliation(s)
| | | | - Louise Colville
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Tamsin Jane Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Gyori D, Farkas BF, Komaromy D, Horvath LO, Kollarovics N, Garas P, Balazs J. The Association between Nonsuicidal Self-Injury and Perfectionism in Adolescence: The Role of Mental Disorders. Eur J Investig Health Psychol Educ 2023; 13:2299-2327. [PMID: 37998053 PMCID: PMC10670610 DOI: 10.3390/ejihpe13110163] [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: 08/23/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023] Open
Abstract
Previous evidence has drawn attention to the fact that maladaptive perfectionism is a risk factor for engagement in nonsuicidal self-injury (NSSI). Until now, few studies have examined this topic, especially among community adolescents. The aim of this study was to explore the relationship between perfectionism dimensions and NSSI functions to examine the potential mediating effect of mental disorders. Altogether, 146 Hungarian community adolescents (ages 13-18 years) were involved. All participants completed the Hungarian adaptation of the Inventory of Statements about Self-Injury (ISAS), the Frost Multidimensional Perfectionism Scale (FMPS), and the Mini International Neuropsychiatric Interview Kid. To analyse the interrelationships among NSSI, perfectionism, and mental disorders, we conducted regression and network analysis. Of the 146 adolescents, 90 (61.64%, girls: 71.11%) engaged in NSSI. The Concern over Mistakes and Doubts about Action scales of the FMPS significantly and positively predicted both NSSI intrapersonal and interpersonal motivation, with comparable effect sizes, and this association was fully mediated by anxiety disorders. There was a significant direct negative relationship between the FMPS Organisation dimension and both main NSSI functions. This study draws attention to an increasing trend and the extremely high NSSI prevalence rate among community adolescents. Adolescents with perfectionistic concerns are at heightened risk for anxiety disorders, which can increase their vulnerability to NSSI engagement.
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Affiliation(s)
- Dora Gyori
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
| | - Bernadett Frida Farkas
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Daniel Komaromy
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Department of Behavioural and Movement Sciences, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Lili Olga Horvath
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Pedagogical Services, 1141 Budapest, Hungary
| | - Nora Kollarovics
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Peter Garas
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Department of Psychology, Oslo New University College, 0456 Oslo, Norway
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Bürger A, von Schoenfeld C, Scheiner C, Seidel A, Wasserscheid A, Gad D, Kittel-Schneider S, Romanos M, Reiter AMF. Universal prevention for non-suicidal self-injury in adolescents is scarce - A systematic review. Front Psychiatry 2023; 14:1130610. [PMID: 37937233 PMCID: PMC10627158 DOI: 10.3389/fpsyt.2023.1130610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 10/02/2023] [Indexed: 11/09/2023] Open
Abstract
Non-suicidal self-injury (NSSI) during adolescence is a high-risk marker for the development and persistence of mental health problems and has been recognized as a significant public health problem. Whereas targeted prevention has indeed shown to be effective in reducing NSSI and improve mental health problems, access to such programs is limited. By face validity, universal prevention of NSSI seems an ideal starting point for a stepped-care model to circumvent a lack of resources in the medical care system. However, it is yet unclear how effective such approaches are. Here, we provide a summary of existing work on universal prevention of NSSI in adolescents younger than 21 years based on a systematic literature search. We found that only seven studies are available. None of the programs evaluated was found to be effective in reducing the incidence or frequency of NSSI. After providing a comprehensive summary of the existing work, we evaluate the fact that existing work primarily focusses on selected/targeted prevention and on psychoeducational methods. We derive implications for future directions in the field of universal prevention of NSSI.
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Affiliation(s)
- Arne Bürger
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
- German Centre of Prevention Research in Mental Health, University of Würzburg, Würzburg, Germany
| | - Cornelia von Schoenfeld
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Christin Scheiner
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Alexandra Seidel
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Antonia Wasserscheid
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Doreya Gad
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
- Acute Adult Mental Health Unit, Department of Psychiatry and Neurobehavioural Science, Cork University Hospital, Cork, Ireland
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
- German Centre of Prevention Research in Mental Health, University of Würzburg, Würzburg, Germany
| | - Andrea M. F. Reiter
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
- German Centre of Prevention Research in Mental Health, University of Würzburg, Würzburg, Germany
- Department of Psychology, University of Würzburg, Würzburg, Germany
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Lustig S, Kaess M, Schnyder N, Michel C, Brunner R, Tubiana A, Kahn JP, Sarchiapone M, Hoven CW, Barzilay S, Apter A, Balazs J, Bobes J, Saiz PA, Cozman D, Cotter P, Kereszteny A, Podlogar T, Postuvan V, Värnik A, Resch F, Carli V, Wasserman D. The impact of school-based screening on service use in adolescents at risk for mental health problems and risk-behaviour. Eur Child Adolesc Psychiatry 2023; 32:1745-1754. [PMID: 35488938 PMCID: PMC10460322 DOI: 10.1007/s00787-022-01990-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
Early detection and intervention can counteract mental disorders and risk behaviours among adolescents. However, help-seeking rates are low. School-based screenings are a promising tool to detect adolescents at risk for mental problems and to improve help-seeking behaviour. We assessed associations between the intervention "Screening by Professionals" (ProfScreen) and the use of mental health services and at-risk state at 12 month follow-up compared to a control group. School students (aged 15 ± 0.9 years) from 11 European countries participating in the "Saving and Empowering Young Lives in Europe" (SEYLE) study completed a self-report questionnaire on mental health problems and risk behaviours. ProfScreen students considered "at-risk" for mental illness or risk behaviour based on the screening were invited for a clinical interview with a mental health professional and, if necessary, referred for subsequent treatment. At follow-up, students completed another self-report, additionally reporting on service use. Of the total sample (N = 4,172), 61.9% were considered at-risk. 40.7% of the ProfScreen at-risk participants invited for the clinical interview attended the interview, and 10.1% of subsequently referred ProfScreen participants engaged in professional treatment. There were no differences between the ProfScreen and control group regarding follow-up service use and at-risk state. Attending the ProfScreen interview was positively associated with follow-up service use (OR = 1.783, 95% CI = 1.038-3.064), but had no effect on follow-up at-risk state. Service use rates of professional care as well as of the ProfScreen intervention itself were low. Future school-based interventions targeting help-seeking need to address barriers to intervention adherence.Clinical Trials Registration: The trial is registered at the US National Institute of Health (NIH) clinical trial registry (NCT00906620, registered on 21 May, 2009), and the German Clinical Trials Register (DRKS00000214, registered on 27 October, 2009).
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Affiliation(s)
- Sophia Lustig
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Nina Schnyder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- School of Public Health, The University of Queensland, Brisbane, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
- Clinic of Child and Adolescents Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Alexandra Tubiana
- Department of Psychiatry and Clinical Psychology, Centre Psychothérapique de Nancy, Nancy, France
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Psychothérapique de Nancy, Nancy, France
- Université de Lorraine, Nancy, France
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Christina W Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Shira Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
- Department of Community Health, University of Haifa, Haifa, Israel
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Bjørknes University College, Oslo, Norway
| | - Julio Bobes
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Pilar Alejandra Saiz
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Doina Cozman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Padraig Cotter
- Child and Adolescent Mental Health Services North Cork Area, HSE South, Mallow, Ireland
| | - Agnes Kereszteny
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Tina Podlogar
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Vita Postuvan
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Airi Värnik
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia
- Tallinn University School of Natural Science and Health, Tallinn, Estonia
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Vladimir Carli
- Department of Public Health Sciences, Methods Development and Training in Suicide Prevention, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)WHO Collaborating Centre for ResearchKarolinska Institute, Stockholm, Sweden
| | - Danuta Wasserman
- National Institute for Health, Migration and Poverty, Rome, Italy
- Department of Public Health Sciences, Methods Development and Training in Suicide Prevention, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)WHO Collaborating Centre for ResearchKarolinska Institute, Stockholm, Sweden
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6
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Rezaei Z, Mohammadi S, Aghaei A, Pouragha H, Latifi A, Keshavarz-Mohammadi N. Assessment of risk factors for suicidal behavior: results from the Tehran University of Medical Sciences Employees' Cohort study. Front Public Health 2023; 11:1180250. [PMID: 37674684 PMCID: PMC10478100 DOI: 10.3389/fpubh.2023.1180250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/19/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Suicide is a major issue of concern for public health. It is estimated that suicide accounts for 700,000 deaths every year. A personal history of one or more suicide attempts is the most important determinant of suicide among the general population. This study aimed to assess the major risk factors associated with suicidal behaviors among Iranian employees in a medical setting. Methods In this study, 3,913 employees of Tehran University of Medical Sciences who participated in the employees' cohort study conducted by the university were recruited. Suicidal behaviors (SBs) and their associated risk factors were evaluated using the World Mental Health Composite International Diagnostic Interview (CIDI) Version 3.0. Univariate and multivariate logistic regressions were performed to identify the determinants of SBs among the participants, and crude and adjusted odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs) were calculated. Results Overall, 49.6% of respondents (n = 1,939) reported that they were tired of life and thinking about death. The lifetime prevalence rate of suicidal ideation (SI) was 8.1% (n = 317), that of suicide planning (SP) was 7.3% (n = 287), and that of suicide attempts (SA) was 3.1% (n = 122). Being female (OR: 1.87, CI: 1.64-2.12), being divorced (OR: 3.13, CI: 1.88-5.22), having a low level of education (OR: 1.57, CI: 1.15-2.14), and working in clinical and medical services (OR: 1.25, CI: 1.09-1.43) were associated with being tired of life and thinking about death. These factors were also associated with SI, SP, and SA. Discussion These findings highlight the need to prioritize mental health for suicide prevention, especially for high-risk groups, in workplace mental health promotion programs and policies.
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Affiliation(s)
- Zahed Rezaei
- Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
- Asadabad School of Medical Sciences, Asadabad, Iran
| | - Samira Mohammadi
- Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Abbas Aghaei
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hamidreza Pouragha
- Center for Research on Occupational Disease, Tehran University of Medical Sciences, Tehran, Iran
- Department of Environmental Engineering, Mehralborz University (MAU), Tehran, Iran
| | - Arman Latifi
- Department of Public Health, School of Public Health, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Nastaran Keshavarz-Mohammadi
- Department of Public Health, School of Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hughes JL, Horowitz LM, Ackerman JP, Adrian MC, Campo JV, Bridge JA. Suicide in young people: screening, risk assessment, and intervention. BMJ 2023; 381:e070630. [PMID: 37094838 DOI: 10.1136/bmj-2022-070630] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. This review outlines the epidemiology of suicide and suicidal behavior in young people. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that are prime targets for implementation of effective treatment programs and interventions aimed at rapidly reducing the suicide rate in young people. It provides an overview of current approaches to screening and assessment of suicide risk in young people and the commonly used screening tools and assessment measures. It discusses universal, selective, and indicated evidence based suicide focused interventions and highlights components of psychosocial interventions with the strongest evidence for reducing risk. Finally, the review discusses suicide prevention strategies in community settings and considers future research directions and questions challenging the field.
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Affiliation(s)
- Jennifer L Hughes
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lisa M Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institutes of Mental Health, NIH, Bethesda, MD, USA
| | - John P Ackerman
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Molly C Adrian
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - John V Campo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey A Bridge
- Departments of Pediatrics and Psychiatry and Behavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center College of Medicine, Columbus, OH, USA
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Staines L, Healy C, Corcoran P, Keeley H, Coughlan H, McMahon E, Cotter P, Cotter D, Kelleher I, Wasserman C, Brunner R, Kaess M, Sarchiapone M, Hoven CW, Carli V, Wasserman D, Cannon M. Investigating the effectiveness of three school based interventions for preventing psychotic experiences over a year period - a secondary data analysis study of a randomized control trial. BMC Public Health 2023; 23:219. [PMID: 36726107 PMCID: PMC9890687 DOI: 10.1186/s12889-023-15107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Psychotic experiences (PEs) are associated with increased risk of later mental disorders and so could be valuable in prevention studies. However, to date few intervention studies have examined PEs. Given this lack of evidence, in the current study a secondary data analysis was conducted on a clustered-randomized control trial (RCT) of 3 school based interventions to reduce suicidal behaviour, to investigate if these may reduce rates of PEs, and prevent PE, at 3-month and 1-year follow-up. METHODS The Irish site of the Saving and Empowering Young Lives in Europe study, trial registration (DRKS00000214), a cluster-RCT designed to examine the effect of school-based interventions on suicidal thoughts and behaviour. Seventeen schools (n = 1096) were randomly assigned to one of three intervention arms or a control arm. The interventions included a teacher training (gate-keeper) intervention, an interactive educational (universal-education) intervention, and a screening and integrated referral (selective-indicative) intervention. The primary outcome of this secondary data-analysis was reduction in point-prevalence of PEs at 12 months. A second analysis excluding those with PEs at baseline was conducted to examine prevention of PEs. Additional analysis was conducted of change in depression and anxiety scores (comparing those with/without PEs) in each arm of the intervention. Statistical analyses were conducted using mixed-effects modelling. RESULTS At 12-months, the screening and referral intervention was associated with a significant reduction in PEs (OR:0.12,95%CI[0.02-0.62]) compared to the control arm. The teacher training and education intervention did not show this effect. Prevention was also observed only in the screening and referral arm (OR:0.30,95%CI[0.09-0.97]). Participants with PEs showed higher levels of depression and anxiety symptoms, compared to those without, and different responses to the screening and referral intervention & universal-education intervention. CONCLUSIONS This study provides the first evidence for a school based intervention that reduce & prevent PEs in adolescence. This intervention is a combination of a school-based screening for psychopathology and subsequent referral intervention significantly reduced PEs in adolescents. Although further research is needed, our findings point to the effectiveness of school-based programmes for prevention of future mental health problems.
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Affiliation(s)
- Lorna Staines
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland.
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Helen Keeley
- Child and Adolescent Mental Health Services North Cork, Health Service Executive, Cork, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
| | - Elaine McMahon
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Padraig Cotter
- Research Society of Process Oriented Psychology United Kingdom (RSPOPUK), Old Hampstead Townhall 213 Haverstock Hill, NW3 4QP, London, UK
- Park Royal Centre for Mental Health, Central and North West London (CNWL) NHS Trust, Central Way, Off Acton Lane, NW10 7NS, London, UK
| | - David Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, EH10 5HF, Edinburgh, UK
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Romuald Brunner
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
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Volz HP, Stirnweiß J, Kasper S, Möller HJ, Seifritz E. Subthreshold depression - concept, operationalisation and epidemiological data. A scoping review. Int J Psychiatry Clin Pract 2022; 27:92-106. [PMID: 35736807 DOI: 10.1080/13651501.2022.2087530] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: In diagnostic systems (e.g., DSM-5, ICD-10), depression is defined categorically. However, the concept of subthreshold depression (SD) has gained increasing interest in recent years. The purpose of the present paper was to review, based on a scoping review, the relevant papers in this field published between October 2011 and September 2020.Materials and methods: Of the 1,160 papers identified, 64 records could be included in further analysis. The scoping review was conducted using both electronic and manual methods.Results: The main result of the analysis is that the operationalisation criteria used are highly heterogeneous, which also leads to very heterogenous epidemiological data.Conclusions: Clear conclusions are not possible scrutinising the reported results. Most definitions seem to be arbitrary, with considerable overlap (e.g., between SD and minor depression). The review also revealed that the impact of SD on quality of life and related parameters appear to be in the range of the respective impact of major depression (MD) and therapeutic approaches might be helpful for SD and also for the prevention of conversion from SD to MD. Keeping the presented difficulties in mind, a proposal for the definition of SD is made in the present paper in order to facilitate the discussion leading to more homogeneous criteria.
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Affiliation(s)
- Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy und Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Johanna Stirnweiß
- Hospital for Psychiatry, Psychotherapy und Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Siegfried Kasper
- Center of Brain Research, Medical University of Vienna, Vienna, Austria
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics. Psychiatric Hospital, University of Zürich, Zürich, Switzerland
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10
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 301] [Impact Index Per Article: 150.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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11
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Kaess M, Schnyder N, Michel C, Brunner R, Carli V, Sarchiapone M, Hoven CW, Wasserman C, Apter A, Balazs J, Bobes J, Cosman D, Haring C, Kahn JP, Keeley H, Kereszteny A, Podlogar T, Postuvan V, Varnik A, Resch F, Wasserman D. Twelve-month service use, suicidality and mental health problems of European adolescents after a school-based screening for current suicidality. Eur Child Adolesc Psychiatry 2022; 31:229-238. [PMID: 33320300 PMCID: PMC8837507 DOI: 10.1007/s00787-020-01681-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
Suicide is one of the leading causes of death in adolescents and help-seeking behaviour for suicidal behaviour is low. School-based screenings can identify adolescents at risk for suicidal behaviour and might have the potential to facilitate service use and reduce suicidal behaviour. The aim of this study was to assess associations of a two-stage school-based screening with service use and suicidality in adolescents (aged 15 ± 0.9 years) from 11 European countries after one year. Students participating in the 'Saving and Empowering Young Lives in Europe' (SEYLE) study completed a self-report questionnaire including items on suicidal behaviour. Those screening positive for current suicidality (first screening stage) were invited to an interview with a mental health professional (second stage) who referred them for treatment, if necessary. At 12-month follow-up, students completed the same self-report questionnaire including questions on service use within the past year. Of the N = 12,395 SEYLE participants, 516 (4.2%) screened positive for current suicidality and were invited to the interview. Of these, 362 completed the 12-month follow-up with 136 (37.6%) self-selecting to attend the interview (screening completers). The majority of both screening completers (81.9%) and non-completers (91.6%) had not received professional treatment within one year, with completers being slightly more likely to receive it (χ2(1) = 8.948, V = 0.157, p ≤ 0.01). Screening completion was associated with higher service use (OR 2.695, se 1.017, p ≤ 0.01) and lower suicidality at follow-up (OR 0.505, se 0.114, p ≤ 0.01) after controlling for potential confounders. This school-based screening offered limited evidence for the improvement of service use for suicidality. Similar future programmes might improve interview attendance rate and address adolescents' barriers to care.
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Affiliation(s)
- Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Stöckli, 3000, Bern 60, Switzerland.
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany.
| | - N Schnyder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Stöckli, 3000, Bern 60, Switzerland
- School of Public Health, The University of Queensland, Brisbane, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Australia
| | - C Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Stöckli, 3000, Bern 60, Switzerland
| | - R Brunner
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - V Carli
- Department of Learning, Informatics , Management and Ethics, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm, Sweden
| | - M Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - C W Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - C Wasserman
- Department of Learning, Informatics , Management and Ethics, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm, Sweden
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - A Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - J Balazs
- Bjørknes University College, Oslo, Norway
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - J Bobes
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - D Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - C Haring
- Institute for Clinical Evaluation, Department for Psychiatry and Psychotherapy B, State Hospital Hall, Tyrol, Austria
| | - J-P Kahn
- Department of Psychiatry and Clinical Psychology, CHRU de Nancy and Centre Psychothérapique de Nancy, Université de Lorraine, Nancy, France
| | - H Keeley
- North Cork Child and Adolescent Services, Health Service Executive South, Mallow Primary Healthcare Service, Gouldshill, Mallow Co Cork, Ireland
| | - A Kereszteny
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - T Podlogar
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - V Postuvan
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - A Varnik
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia
- Tallinn University School of Natural Science and Health, Tallinn, Estonia
| | - F Resch
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - D Wasserman
- Department of Learning, Informatics , Management and Ethics, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm, Sweden
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12
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Buerger A, Emser T, Seidel A, Scheiner C, von Schoenfeld C, Ruecker V, Heuschmann PU, Romanos M. DUDE - a universal prevention program for non-suicidal self-injurious behavior in adolescence based on effective emotion regulation: study protocol of a cluster-randomized controlled trial. Trials 2022; 23:97. [PMID: 35101116 PMCID: PMC8802249 DOI: 10.1186/s13063-021-05973-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 12/23/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) has become a substantial public health problem. NSSI is a high-risk marker for the development and persistence of mental health problems, shows high rates of morbidity and mortality, and causes substantial health care costs. Thus, there is an urgent need for action to develop universal prevention programs for NSSI before adolescents begin to show this dangerous behavior. Currently, however, universal prevention programs are lacking. METHODS The main objective of the present study is to evaluate a newly developed universal prevention program ("DUDE - Du und deine Emotionen / You and your emotions"), based on a skills-based approach in schools, in 3200 young adolescents (age 11-14 years). The effectiveness of DUDE will be investigated in a cluster-randomized controlled trial (RCT) in schools (N = 16). All groups will receive a minimal intervention called "Stress-free through the school day" as a mental health literacy program to prevent burnout in school. The treatment group (N = 1600; 8 schools) will additionally undergo the universal prevention program DUDE and will be divided into treatment group 1 (DUDE conducted by trained clinical psychologists; N = 800; 4 schools) and treatment group 2 (DUDE conducted by trained teachers; N = 800; 4 schools). The active control group (N = 1600; 8 schools) will only receive the mental health literacy prevention. Besides baseline assessment (T0), measurements will occur at the end of the treatment (T1) and at 6- (T2) and 12-month (T3) follow-up evaluations. The main outcome is the occurrence of NSSI within the last 6 months assessed by a short version of the Deliberate Self-Harm Inventory (DSHI-9) at the 1-year follow-up (primary endpoint; T3). Secondary outcomes are emotion regulation, suicidality, health-related quality of life, self-esteem, and comorbid psychopathology and willingness to change. DISCUSSION DUDE is tailored to diminish the incidence of NSSI and to prevent its possible long-term consequences (e.g., suicidality) in adolescents. It is easy to access in the school environment. Furthermore, DUDE is a comprehensive approach to improve mental health via improved emotion regulation. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00018945. Registered on 01 April 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00018945.
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Affiliation(s)
- Arne Buerger
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
- German Centre of Prevention Research in Mental Health, University of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
| | - Theresa Emser
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
| | - Alexandra Seidel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
| | - Christin Scheiner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
| | - Cornelia von Schoenfeld
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
| | - Viktoria Ruecker
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Josef-Schneider-Strasse, 97080 Wuerzburg, Germany
| | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Josef-Schneider-Strasse, 97080 Wuerzburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
- German Centre of Prevention Research in Mental Health, University of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany
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13
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Kaess M, Klar J, Kindler J, Parzer P, Brunner R, Carli V, Sarchiapone M, Hoven CW, Apter A, Balazs J, Barzilay S, Bobes J, Cozman D, Gomboc V, Haring C, Kahn JP, Keeley H, Meszaros G, Musa GJ, Postuvan V, Saiz P, Sisask M, Varnik P, Resch F, Wasserman D. Excessive and pathological Internet use - Risk-behavior or psychopathology? Addict Behav 2021; 123:107045. [PMID: 34332272 DOI: 10.1016/j.addbeh.2021.107045] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/10/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Abstract
Pathological Internet use (but only with respect to gaming) is classified as mental disorder in the ICD-11. However, there is a large group of adolescents showing excessive Internet use, which may rather be considered adolescent risk-behavior. The aim was to test whether pathological and excessive Internet use should be considered as "psychopathology" or "risk-behavior". A representative, cross-sectional sample of 11.110 students from 10 European Union countries was analyzed. Structural equation models, including the factors "risk-behavior" and "psychopathology" and the variables excessive and pathological Internet use, were tested against each other. "Risk-behavior" was operationalized by several risk-behaviors (e.g. drug abuse, truancy, etc). "Psychopathology" included measures of several mental disorders (e.g. depression, hyperactivity, etc). Excessive Internet use was assessed as the duration and frequency of Internet use. Pathological Internet use was assessed with the Young Diagnostic Questionnaire (i.e., presence of addiction criteria). Excessive Internet use loaded on "risk-behavior" (λ = 0.484, p < .001) and on "psychopathology" (λ = 0.071, p < .007). Pathological Internet use loaded on "risk-behavior" (λ = 0.333, p < .001) and on "psychopathology" (λ = 0.852, p < .001). Chi-square tests determined that the loadings of excessive Internet use (χ2 (1) = 81.98, p < .001) were significantly stronger on "risk-behavior" than "psychopathology". Vice versa, pathological Internet use loaded significantly stronger on "psychopathology" (χ2 (1) = 107.10, p < .001). The results indicate that pathological Internet use should rather be considered as psychopathology. Excessive Internet use on the other hand, should be classified as adolescent risk-behavior.
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14
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McMahon EM, Corcoran P, Keeley H, Clarke M, Coughlan H, Wasserman D, Hoven CW, Carli V, Sarchiapone M, Healy C, Cannon M. Risk and protective factors for psychotic experiences in adolescence: a population-based study. Psychol Med 2021; 51:1220-1228. [PMID: 32026792 DOI: 10.1017/s0033291719004136] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Psychotic experiences (PEs) are reported by a significant minority of adolescents and are associated with the development of psychiatric disorders. The aims of this study were to examine associations between PEs and a range of factors including psychopathology, adversity and lifestyle, and to investigate mediating effects of coping style and parental support on associations between adversity and PEs in a general population adolescent sample. METHOD Cross-sectional data were drawn from the Irish centre of the Saving and Empowering Young Lives in Europe study. Students completed a self-report questionnaire and 973 adolescents, of whom 522 (53.6%) were boys, participated. PEs were assessed using the 7-item Adolescent Psychotic Symptom Screener. RESULTS Of the total sample, 81 (8.7%) of the sample were found to be at risk of PEs. In multivariate analysis, associations were found between PEs and number of adverse events reported (OR 4.48, CI 1.41-14.25; p < 0.011), maladaptive/pathological internet use (OR 2.70, CI 1.30-5.58; p = 0.007), alcohol intoxication (OR 2.12, CI 1.10-4.12; p = 0.025) and anxiety symptoms (OR 4.03, CI 1.57-10.33; p = 0.004). There were small mediating effects of parental supervision, parental support and maladaptive coping on associations between adversity and PEs. CONCLUSION We have identified potential risk factors for PEs from multiple domains including adversity, mental health and lifestyle factors. The mediating effect of parental support on associations between adversity and PEs suggests that poor family relationships may account for some of this mechanism. These findings can inform the development of interventions for adolescents at risk.
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Affiliation(s)
- Elaine M McMahon
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University CollegeCork, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University CollegeCork, Ireland
| | - Helen Keeley
- Child and Adolescent Mental Health Services North Cork, Health Service Executive, Ireland
| | - Mary Clarke
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Dept of Child and Adolescent Psychiatry, New York State Psychiatric Institute; Dept of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Institute of Neuroscience, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin, Ireland
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15
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Influence of coping strategies on the efficacy of YAM (Youth Aware of Mental Health): a universal school-based suicide preventive program. Eur Child Adolesc Psychiatry 2020; 29:1671-1681. [PMID: 32025960 DOI: 10.1007/s00787-020-01476-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
The school-based mental health promotion and suicide prevention universal program Youth Aware of Mental Health (YAM) significantly reduces incident suicide attempts and severe suicidal ideation. This paper aims at elucidating psychological mechanisms underlying YAM's efficacy. Our hypothesis is that YAM operates through interactions with coping strategies (CS) on the reduction of suicidal ideation (SI). In the Saving and Empowering Young Lives in Europe (SEYLE) study, five coping strategies were assessed at baseline (T0) and 12-month follow-up (T12): "learning", "help-seeking", "arts", "sports" and "fight". We analyzed interactions between the YAM intervention, coping strategies and SI in the YAM group (N = 1693) and the minimal intervention group (N = 1909), after excluding prevalent cases with SI and previous suicide attempts from our total sample (N = 5654). General Linear Mixed Model regressions were performed. The present study confirms that coping strategies play an influential role on suicidal ideation. Our results showed that YAM acts whatever the prevailing coping strategies used. It is particularly efficient for pupils insufficiently using adaptive coping strategies such as LEARN and HELP-SEEKING or using maladaptive coping strategies, such as ARTS and FIGHT. The socialization induced by the YAM intervention seems to be a strong component of its efficiency.
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Clauss-Ehlers CS, Carpio MG, Weist MD. Mental Health Literacy: A Strategy for Global Adolescent Mental Health Promotion. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676610666200204104429] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background:
Adolescence is defined by key transitional elements which are considered
within a cross-cultural context. The importance of building mental health capacity for
adolescents in low- and middle-income countries (LMICs) as well as high-income countries
(HICs) is reviewed.
Objectives:
To review the developmental period of adolescence, global needs for mental
health promotion, the needs of LMICs while emphasizing building adolescent mental health
capacity, and the importance of efforts to promote mental health literacy.
Methods:
Mental health literacy (MHL) is presented as a strategy that can increase public
awareness regarding mental health issues among adolescents. Increased awareness through
an MHL framework is discussed as a way to build adolescent mental health capacity; with
this work ideally occurring through global communities of practice (COP), dialogue, collaboration,
and mutual support that aim to build innovation in systems of mental health promotion.
Results:
The authors review structural components in research, practice, and policy that seek
to build global adolescent mental health capacity, nested within COPs involving HICs and
LMICs working together to advance mental health promotion for children, adolescents, and
young people.
Conclusion:
The article concludes with a discussion of how the three structural components
(i.e., research, practice, and policy) can address gaps in the provision of global mental health
services for adolescents to meet adolescent mental health needs in LMICs and HICs. A
multi-sectoral approach emphasizing a global COP is presented as a way to scale up capacity
and maximize outcomes.
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17
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Lindow JC, Hughes JL, South C, Minhajuddin A, Gutierrez L, Bannister E, Trivedi MH, Byerly MJ. The Youth Aware of Mental Health Intervention: Impact on Help Seeking, Mental Health Knowledge, and Stigma in U.S. Adolescents. J Adolesc Health 2020; 67:101-107. [PMID: 32115325 PMCID: PMC7311230 DOI: 10.1016/j.jadohealth.2020.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Suicide is a leading cause of death among U.S. youth aged 12-18 years. Youth Aware of Mental Health (YAM), a promising, universal, school-based mental health promotion/suicide primary prevention intervention for adolescents, has been evaluated in Europe but not in the U.S. The present study used an uncontrolled, pretest/post-test design to document the potential for YAM to reduce suicidal ideation, attempt, and suicide. A demonstration that help seeking behaviors, mental health literacy, and mental health stigmatizing attitudes improve after the intervention would suggest that the program is promising in the U.S., as well as in Europe, and that further investigation is merited. METHODS YAM was delivered to 1,878 students in 11 schools as part of regular school curricula. A subset of these students (n = 436) completed surveys before and 3 months postdelivery. Surveys included five questions about help seeking behaviors, a measure of intent to seek help (General Help Seeking Questionnaire), two mental health literacy scales, and two mental illness stigma scales (Reported and Intended Behavior Scale and Personal Stigma and Social Distance Scale). Both McNemar's test and repeated measures linear models were used to determine whether the survey outcomes changed after YAM delivery. RESULTS Among the 436 adolescents (286 and 150 in Montana and Texas, respectively), significant increases were found pre- to post-intervention in three of five help seeking behaviors, along with improved mental health literacy and decreased mental health-related stigma. Intent to seek help was unchanged. CONCLUSIONS Several help seeking behavioral factors, mental health knowledge, and stigma improved post-YAM intervention. All three domains are likely protective against suicide. A randomized controlled trial testing the efficacy of YAM in preventing suicidal behaviors is warranted.
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Affiliation(s)
- Janet C. Lindow
- Center for Mental Health Research and Recovery, Department of Cell Biology and Neuroscience, Montana State University, Bozeman, Montana, USA,Correspondence: Address correspondence to: Janet Lindow, PhD, Biomedical Research and Education Foundation of Southern Arizona, 3601 S. 6 Ave. Bldg. 77, MC (0-151), Tucson, AZ 85723; phone: +1-520-1450 x6631;
| | - Jennifer L. Hughes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Charles South
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Abu Minhajuddin
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Luis Gutierrez
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth Bannister
- Center for Mental Health Research and Recovery, Department of Cell Biology and Neuroscience, Montana State University, Bozeman, Montana, USA
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew J. Byerly
- Center for Mental Health Research and Recovery, Department of Cell Biology and Neuroscience, Montana State University, Bozeman, Montana, USA
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de Oliveira JM, Calderón PV, Caballero PB. “I Wish I Could Have Helped Him in Some Way or Put the Family on Notice”: an Exploration of Teachers’ Perceived Strengths and Deficits in Overall Knowledge of Suicide. JOURNAL OF LOSS & TRAUMA 2020. [DOI: 10.1080/15325024.2020.1772449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Becker M, Correll CU. Suicidality in Childhood and Adolescence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:261-267. [PMID: 32449889 DOI: 10.3238/arztebl.2020.0261] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/01/2019] [Accepted: 01/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The suicide of minors in Germany is rare in absolute numbers: there were only 212 suicides among persons aged 10 to 20 in Germany in 2017. Nonetheless, in school surveys, 36.4-39.4% of those surveyed reported suicidal ideation, and 6.5-9% reported suicide attempts. Suicide among children and adolescents is thus a clinically and societally relevant problem. METHODS This review is based on pertinent articles retrieved by a selective literature search in the PubMed and PsycInfo databases (April 2019) employing the search terms "suicidality," "suicidal*," and "suicide," and on further information from several textbooks (1991-2017). RESULTS In children and adolescents with a mental illness, the risk of suicide is higher by a factor of 3 to 12. Mobbing experiences increase the suicide risk as well (odds ratio [OR] = 2.21, p <0.05). Non-suicidal self-injurious behavior (NSSB) is also a risk factor for both suicidal ideation (OR = 2.95) and suicide attempts (hazard ratio [HR] = 2.00). Intoxication with medications is the most common method of attempted suicide (67.7%). Most suicides are preceded by early warning signs. Psychiatric hospitalization is indicated for children and adolescents who are in acute danger of doing harm to themselves. Specific types of treatment, family-centered methods in particular, have been found to lessen the frequency of suicidal ideation and suicide attempts. The administration of antidepressant drugs to children and adolescents is controversial, as there is evidence of increased suicidality (but not mortality) for single medications. Antidepressant drugs should not, however, be withheld for this reason, if indicated. The prerequisite in all cases is close observation. CONCLUSION To prevent suicide and improve outcomes, risk factors for suicide must be considered, and the indications for primary and secondary preventive and therapeutic measures must be established. Online therapeutic modalities may become more widely used in the near future, particularly among young patients, who are well versed in the use of the Internet.
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Affiliation(s)
- Merle Becker
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité University Medical Center, Berlin; The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA;Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine,Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for PsychiatricNeuroscience, Manhasset, NY, USA
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20
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Lindow JC, Hughes JL, South C, Gutierrez L, Bannister E, Trivedi MH, Byerly MJ. Feasibility and Acceptability of the Youth Aware of Mental Health (YAM) Intervention in US Adolescents. Arch Suicide Res 2020; 24:269-284. [PMID: 31159674 PMCID: PMC6942243 DOI: 10.1080/13811118.2019.1624667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Suicide is the second leading cause of death among US adolescents, and rates of suicide among youth have been increasing for the past decade. This study assessed the feasibility and acceptability of the universal, school-based Youth Aware of Mental Health (YAM) program, a promising mental health promotion and suicide primary prevention intervention, in US youth. Using an uncontrolled design, the feasibility and acceptability of delivering and studying YAM were assessed in Montana and Texas schools. Thirteen of 16 (81.3%) schools agreed to support YAM delivery, and five Montana and 6 Texas schools were included in analyses. Facilitators delivered YAM in 78 classes (1,878 students) as regular high school curriculum. Of the total number of students who received YAM, 519 (27.6%) provided parental consent and assent. 436 (84.0%) consented students participated in pre- and post-surveys. Students, parents, and school staff found YAM highly acceptable based on satisfaction surveys. In summary, this study found YAM feasible to implement in US schools. Results also suggest students, parents, and school staff supported school-based programs and were highly satisfied with the YAM program. A randomized controlled trial is warranted to test the efficacy of YAM in promoting mental health and preventing suicidal thoughts and behaviors in US adolescents.
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21
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Life Events Predicting the First Onset of Adolescent Direct Self-Injurious Behavior-A Prospective Multicenter Study. J Adolesc Health 2020; 66:195-201. [PMID: 31677986 DOI: 10.1016/j.jadohealth.2019.08.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Self-injurious behavior is a frequent phenomenon in adolescence. The present study prospectively examined life events as risk factors for the first onset of direct self-injurious behavior (D-SIB) in the Saving and Empowering Young Lives in Europe school-based multicenter sample. METHODS Longitudinal assessments with an interval of 1 year were performed within a sample of 1,933 adolescents (51.47% females; mean age 14.84 ± .9 years) from 10 European countries and Israel. RESULTS The number of life events during the past 6 months predicted the first onset of D-SIB in the following year. Gender neither predicted the onset of D-SIB nor moderated the association with life events. Moreover, analyses of individual events identified a range of mainly interpersonal events within both family and peer group as proximal risk factors for first episode D-SIB. CONCLUSIONS The results support the critical role of interpersonal life events in the development of D-SIB for both genders and refine the conceptualization of proximal risk factors in terms of accumulated stressors and interpersonal events.
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22
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Horváth LO, Győri D, Komáromy D, Mészáros G, Szentiványi D, Balázs J. Nonsuicidal Self-Injury and Suicide: The Role of Life Events in Clinical and Non-Clinical Populations of Adolescents. Front Psychiatry 2020; 11:370. [PMID: 32435210 PMCID: PMC7218062 DOI: 10.3389/fpsyt.2020.00370] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is highly prevalent in clinical and non-clinical populations of adolescents. Several studies have supported both the distinction and the strong association between NSSI and suicidal behavior. Although there is a great deal of data on the role of life events in both suicidal behavior and NSSI, few studies have assessed the role of life events in the NSSI-suicidal behavior relationship. Our aims were to explore the relationship between NSSI and suicidal behavior, and the possible moderating role of stressful life events in a clinical and non-clinical adolescent population. METHOD A clinical (n = 202) and a nonclinical (n = 161) population of adolescents, aged 13-18 years were assessed. The Mini International Neuropsychiatric Interview Kid, Deliberate Self-Harm Inventory and the Life Events List were used. Group differences related to suicidal behavior, NSSI, and life events were tested with Wilcoxon tests. Two- and three-way interactions were tested with negative binomial regression models including zero-inflation parameter. RESULTS The prevalence of suicidal behavior (W = 7,306, p < .001), NSSI (W = 9,652, p < .001) and life events (W = 10,410 p < .001) were significantly higher in the clinical than in the non-clinical group. Between number of life events and NSSI, a moderate effect size (.38, 95%CI [.28,.46]) was found. The main effect of NSSI (χ2 (1) = 109.65, p < .001) and group membership (χ2 (1) = 39.13, p < .001) predicted suicidal behavior; the main effect of quantity of life events did not explain suicidal behavior. The interaction between NSSI and number of life events (χ2 (1) = 10.49, p < .01) was associated with suicidal behavior. Among interpersonal, non-interpersonal events and adverse childhood circumstances, only interpersonal events were associated with both suicidal behavior (χ2 (1) = 6.08, p < .05) and had a moderating effect (χ2 (1) = 8.59, p < .01) on the NSSI-suicidal behavior relationship. Patterns of the effects of life events on the NSSI-suicidal behavior relationship did not differ in the two groups. CONCLUSION Our results confirm the importance of prevention and intervention of NSSI, considering its high prevalence and frequent co-occurrence with suicidal behavior in both clinical and non-clinical adolescent populations. Moreover, to support NSSI and suicide prevention, we would like to highlight the importance of stressful life events, especially those associated with interpersonal conflicts, require special attention.
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Affiliation(s)
- Lili Olga Horváth
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Dóra Győri
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Dániel Komáromy
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Faculty of Social and Behavioral Sciences, Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Gergely Mészáros
- Mental Health Sciences, School of PhD Studies, Semmelweis University, Budapest, Hungary.,Vadaskert Child Psychiatry Hospital and Outpatient Clinic, Budapest, Hungary
| | - Dóra Szentiványi
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Pedagogical Assistance Services, Budapest, Hungary
| | - Judit Balázs
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Psychology, Bjørknes University College, Oslo, Norway
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Witt K, Townsend E, Arensman E, Gunnell D, Hazell P, Taylor Salisbury T, Van Heeringen K, Hawton K. Psychosocial Interventions for People Who Self-Harm: Methodological Issues Involved in Trials to Evaluate Effectiveness. Arch Suicide Res 2020; 24:S32-S93. [PMID: 30955501 DOI: 10.1080/13811118.2019.1592043] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We have assessed the methodological quality of randomized controlled trials (RCTs) of interventions to prevent self-harm repetition and suicide. Trials were identified in two systematic reviews of RCTs of psychosocial treatments following a recent (within six months) episode of self-harm indexed in any of five electronic databases (CCDANCTR-Studies and References, CENTRAL, Medline, Embase, and PsycINFO) between 1 January, 1998 and 29 April, 2015. A total of 66 trials were included, 55 in adults and 11 in children and adolescents. While evidence for efficacy of some approaches has grown, there were few trials from low-to-middle income countries, little information on interventions for males, information on the control condition was often limited, data on suicides were often not reported, and, while trials have increased in size in recent years, most have included too few participants to detect clinically significant results. There are major limitations in many trials of interventions for individuals who self-harm. Improved methodology, especially with regard to study size, provision of details of control therapy, and evaluation of key outcomes, would enhance the evidence base for clinicians and service users.
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Barzilay S, Apter A, Snir A, Carli V, Hoven CW, Sarchiapone M, Hadlaczky G, Balazs J, Kereszteny A, Brunner R, Kaess M, Bobes J, Saiz PA, Cosman D, Haring C, Banzer R, McMahon E, Keeley H, Kahn JP, Postuvan V, Podlogar T, Sisask M, Varnik A, Wasserman D. A longitudinal examination of the interpersonal theory of suicide and effects of school-based suicide prevention interventions in a multinational study of adolescents. J Child Psychol Psychiatry 2019; 60:1104-1111. [PMID: 31512239 DOI: 10.1111/jcpp.13119] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Predictions of two different models for suicide attempts (SA) over 12 months, as differentially impacted by specific school-based suicide prevention interventions, were compared. These were as follows: (a) interpersonal theory (IPTS) and (b) a two-pathway model, one path associated with externalizing symptoms and continuum of self-harm behaviors, and the other with internalizing symptoms. METHODS Self-report questionnaires were completed by 11,110 high school students from ten EU countries enrolled in the Saving and Empowering Young Lives in Europe (SEYLE) study. Baseline measures included perceived burdensomeness, thwarted belongingness from parents and peers, health risk behaviors, self-injury, suicide ideation (SI), and attempts (SA). SI and SA were reassessed at 12-month follow-up. Each model's predictions of SI and SA groups over time (i.e., repeated SA, remitted SA, SA onset, and no SA) were estimated in the no intervention/control group. The superior model was estimated across intervention groups. RESULTS Interpersonal theory showed better fit compared to the two-pathway model. In partial agreement with IPTS predictions, parental low belongingness but not peer belongingness or burdensomeness predicted greater likelihood of SI. The likelihood of repeated SA versus no SA was higher among adolescents who reported SI, self-injury, risk behaviors, and particularly both SI and self-injury. All three interventions attenuated the combined effect of SI and self-injury. Youth Aware of Mental Health Program (YAM) additionally decreased the effect of risk behaviors on the likelihood of repeated SA. CONCLUSIONS Interpersonal theory assumptions were partially supported. Perceived interpersonal difficulties with parents were primarily related with SI, and risk behaviors and self-injury were important predictors of SA. Suicide prevention interventions may be effective by mitigating the hazardous effect of varying self-harm behaviors and may be further advanced by increasing parental involvement.
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Affiliation(s)
- Shira Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Avigal Snir
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy.,National Institute for Health, Migration and Poverty, Rome, Italy.,Kazakh National Medical University, Almaty, Kazakhstan
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary.,Bjørknes University College, Oslo, Norway
| | - Agnes Kereszteny
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - Romuald Brunner
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Pilar A Saiz
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Research Division for Mental Health, University for Medical Information Technology (UMIT), Hall in Tirol, Austria
| | | | | | - Helen Keeley
- National Suicide Research Foundation, Cork, Ireland
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France
| | - Vita Postuvan
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Tina Podlogar
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Airi Varnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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Hayes D, Moore A, Stapley E, Humphrey N, Mansfield R, Santos J, Ashworth E, Patalay P, Bonin E, Boehnke JR, Deighton J. School-based intervention study examining approaches for well-being and mental health literacy of pupils in Year 9 in England: study protocol for a multischool, parallel group cluster randomised controlled trial (AWARE). BMJ Open 2019; 9:e029044. [PMID: 31481370 PMCID: PMC6731836 DOI: 10.1136/bmjopen-2019-029044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The prevalence of emotional difficulties in young people is increasing. This upward trend is largely accounted for by escalating symptoms of anxiety and depression. As part of a public health response, there is increasing emphasis on universal prevention programmes delivered in school settings. This protocol describes a three-arm, parallel group cluster randomised controlled trial, investigating the effectiveness and cost-effectiveness of two interventions, alongside a process and implementation evaluation, to improve mental health and well-being of Year 9 pupils in English secondary schools. METHOD A three-arm, parallel group cluster randomised controlled trial comparing two different interventions, the Youth Aware of Mental Health (YAM) or the Mental Health and High School Curriculum Guide (The Guide), to Usual Provision. Overall, 144 secondary schools in England will be recruited, involving 8600 Year 9 pupils. The primary outcome for YAM is depressive symptoms, and for The Guide it is intended help-seeking. These will be measured at baseline, 3-6 months and 9-12 months after the intervention commenced. Secondary outcomes measured concurrently include changes to: positive well-being, behavioural difficulties, support from school staff, stigma-related knowledge, attitudes and behaviours, and mental health first aid. An economic evaluation will assess the cost-effectiveness of the interventions, and a process and implementation evaluation (including a qualitative research component) will explore several aspects of implementation (fidelity, quality, dosage, reach, participant responsiveness, adaptations), social validity (acceptability, feasibility, utility), and their moderating effects on the outcomes of interest, and perceived impact. ETHICS AND DISSEMINATION This trial has been approved by the University College London Research Ethics Committee. Findings will be published in a report to the Department for Education, in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER ISRCTN17631228. PROTOCOL V1 3 January 2019. Substantial changes to the protocol will be communicated to the trials manager to relevant parties (eg, ISRCTN).
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Affiliation(s)
- Daniel Hayes
- Evidence Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families (AFNCCF), London, UK
| | - Anna Moore
- Evidence Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families (AFNCCF), London, UK
| | - Emily Stapley
- Evidence Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families (AFNCCF), London, UK
| | - Neil Humphrey
- Institute of Education, University of Manchester, Manchester, UK
| | - Rosie Mansfield
- Institute of Education, University of Manchester, Manchester, UK
| | - Joao Santos
- Institute of Education, University of Manchester, Manchester, UK
| | - Emma Ashworth
- Institute of Education, University of Manchester, Manchester, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing and the Centre for Longitudinal Studies, University College London, London, UK
| | - Eva Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | | | - Jessica Deighton
- Evidence Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families (AFNCCF), London, UK
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Levi-Belz Y, Gavish-Marom T, Barzilay S, Apter A, Carli V, Hoven C, Sarchiapone M, Wasserman D. Psychosocial Factors Correlated with Undisclosed Suicide Attempts to Significant Others: Findings from the Adolescence SEYLE Study. Suicide Life Threat Behav 2019; 49:759-773. [PMID: 29851140 DOI: 10.1111/sltb.12475] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/06/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Suicide attempt (SA) is recognized as one of the risk factors for completed suicides. The concealment of this behavior often hinders detection and management of suicide risk. Thus, in this study, we sought to shed light on adolescents' psychosocial processes that could facilitate disclosure of SAs. Specifically, we sought to identify antecedents of adolescent SAs that had not been revealed to significant others. METHOD A high school sample) N = 990 (completed a self-report questionnaire tapping psychiatric, personal, and interpersonal characteristics, as well as suicidality, as part of the SEYLE project. Twenty-seven adolescents acknowledged having made an SA without disclosing it to parents or to other significant others. They were compared with 47 adolescents who made SAs that were communicated to others and with a control group of 916 adolescents having no history of suicidal behavior. RESULTS Compared with disclosures and controls, non-disclosing suicide attempters were characterized by higher levels of suicide ideation, distress, and victimization. Low levels of self-disclosure and parental support were significantly associated with undisclosed SAs. CONCLUSIONS Interpersonal difficulties may be related to loneliness and a thwarted sense of belongingness, which may explain the failure to disclose SAs. Implications related to assessment and prevention are discussed.
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Affiliation(s)
- Yossi Levi-Belz
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.,The Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Timor Gavish-Marom
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Shira Barzilay
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan Apter
- The Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.,The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Cristina Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mario Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Dnuta Wasserman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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27
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Ghinea D, Koenig J, Parzer P, Brunner R, Carli V, Hoven CW, Sarchiapone M, Wasserman D, Resch F, Kaess M. Longitudinal development of risk-taking and self-injurious behavior in association with late adolescent borderline personality disorder symptoms. Psychiatry Res 2019; 273:127-133. [PMID: 30641342 DOI: 10.1016/j.psychres.2019.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/31/2022]
Abstract
Self-injurious behavior and risk-taking behaviors are associated with adolescent borderline personality disorder (BPD). Developmental trajectories of self-injurious and risk-taking behavior in predicting BPD have not been fully understood. The aim of the present study was to examine self-injurious and risk-taking behavior development and their prospective influence on BPD symptoms in adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the German Saving and Empowering Young Lives in Europe cohort were analyzed. Self-injurious and risk-taking behaviors were assessed at baseline and one-year follow-up. BPD symptoms were assessed at two-year follow-up. In fully adjusted stepwise binominal regression analyses, recent onset, termination and maintenance of risky alcohol use and self-injurious behavior remained as significant predictors of BPD. Highest ORs were found for alcohol termination and maintenance of self-injurious behavior. Other facets of risk-taking behavior were not associated with increased ORs of BPD symptoms at two-year follow-up. These findings highlight the importance of self-injurious behavior and specific facets of risk-taking behavior in the development of adolescent BPD. Clinicians should focus on efforts in preventing adolescents from risk-taking and self-injurious behavior, since engaging in young age and therefore in potentially longer periods of these behaviors is associated with the highest risk of BPD.
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Affiliation(s)
- Denisa Ghinea
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Peter Parzer
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; Clinic and Policlinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg District Hospital, Regensburg, Germany
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Marco Sarchiapone
- Department of Medical and Health Sciences, University of Molise, Campobasso, Italy
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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Miranda-Mendizabal A, Castellví P, Parés-Badell O, Alayo I, Almenara J, Alonso I, Blasco MJ, Cebrià A, Gabilondo A, Gili M, Lagares C, Piqueras JA, Rodríguez-Jiménez T, Rodríguez-Marín J, Roca M, Soto-Sanz V, Vilagut G, Alonso J. Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. Int J Public Health 2019; 64:265-283. [PMID: 30635683 PMCID: PMC6439147 DOI: 10.1007/s00038-018-1196-1] [Citation(s) in RCA: 344] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/12/2018] [Accepted: 12/19/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To assess the association between gender and suicide attempt/death and identify gender-specific risk/protective factors in adolescents/young adults. METHODS Systematic review (5 databases until January 2017). Population-based longitudinal studies considering non-clinical populations, aged 12-26 years, assessing associations between gender and suicide attempts/death, or evaluating their gender risk/protective factors, were included. Random effect meta-analyses were performed. RESULTS Sixty-seven studies were included. Females presented higher risk of suicide attempt (OR 1.96, 95% CI 1.54-2.50), and males for suicide death (HR 2.50, 95% CI 1.8-3.6). Common risk factors of suicidal behaviors for both genders are previous mental or substance abuse disorder and exposure to interpersonal violence. Female-specific risk factors for suicide attempts are eating disorder, posttraumatic stress disorder, bipolar disorder, being victim of dating violence, depressive symptoms, interpersonal problems and previous abortion. Male-specific risk factors for suicide attempt are disruptive behavior/conduct problems, hopelessness, parental separation/divorce, friend's suicidal behavior, and access to means. Male-specific risk factors for suicide death are drug abuse, externalizing disorders, and access to means. For females, no risk factors for suicide death were studied. CONCLUSIONS More evidence about female-specific risk/protective factors of suicide death, for adolescent/young adults, is needed.
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Affiliation(s)
- Andrea Miranda-Mendizabal
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
- Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Pere Castellví
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
- Department of Psychology, Jaen University, Jaén, Spain
| | - Oleguer Parés-Badell
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Itxaso Alayo
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - José Almenara
- Preventive Medicine Area and Public Health, University of Cádiz, Cádiz, Spain
| | | | - Maria Jesús Blasco
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
- Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Annabel Cebrià
- Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | - Andrea Gabilondo
- Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, San Sebastian, Spain
- Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute, San Sebastian, Spain
| | - Margalida Gili
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain
- Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca, Spain
| | - Carolina Lagares
- Department of Statistics and Operative Research, University of Cádiz, Cádiz, Spain
| | | | | | | | - Miquel Roca
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain
- Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca, Spain
| | - Victoria Soto-Sanz
- Department of Health Psychology, Miguel Hernandez University of Elche, Elche, Spain
| | - Gemma Vilagut
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jordi Alonso
- Health Services Research Group, IMIM-Institut Hospital del Mar d´Investigacions Mèdiques, PRBB Building. Doctor Aiguader 88, 08003, Barcelona, Spain.
- Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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Brunstein Klomek A, Barzilay S, Apter A, Carli V, Hoven CW, Sarchiapone M, Hadlaczky G, Balazs J, Kereszteny A, Brunner R, Kaess M, Bobes J, Saiz PA, Cosman D, Haring C, Banzer R, McMahon E, Keeley H, Kahn JP, Postuvan V, Podlogar T, Sisask M, Varnik A, Wasserman D. Bi-directional longitudinal associations between different types of bullying victimization, suicide ideation/attempts, and depression among a large sample of European adolescents. J Child Psychol Psychiatry 2019; 60:209-215. [PMID: 30024024 DOI: 10.1111/jcpp.12951] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The association between bullying victimization and depression, suicide ideation and suicide attempts has been studied mainly in cross-sectional studies. This study aims to test the bidirectional effect and the chronicity versus sporadic effect of physical, verbal, and relational bullying victimization on suicidal ideation/attempts and depression. METHODS Longitudinal assessments with an interval of 3- and 12-months were performed within a sample of 2,933 adolescents (56.1% females; mean age 14.78, SD = .89) from 10 European countries, participating in the Saving and Empowering Young Lives in Europe (SEYLE) school-based multicenter control sample. Multilevel Structural Equation Models were used, controlling for sociodemographic variables. Victimization was considered chronic when a student was victimized in the first two time points and sporadic when it was reported only at one point but not in another. RESULTS Bidirectional prospective association between all types of victimization and depression were found. Among participants, who reported victimization once (but not twice), physical victimization, but not verbal and relational, was associated with later suicidal ideation and attempts. Chronic victimization of any type increased likelihood for later depression compared with sporadic and no-victimization. Chronic relational victimization increased the likelihood of later suicidal ideation, and chronic physical victimization increased the likelihood for suicidal attempts. CONCLUSIONS The results support the bidirectional effect of victimization and depression and indicate that there are complex longitudinal associations between victimization and suicidal ideation/attempts. Physical victimization may especially carry effect on suicidal risk over time. Interventions should focus on victimization as a cause of distress but also aim to prevent vulnerable adolescents from becoming targets of victimization.
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Affiliation(s)
- Anat Brunstein Klomek
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel.,Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzlyia, Israel
| | - Shira Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy.,National Institute for Health, Migration and Poverty, Rome, Italy.,Kazakh National Medical University, Almaty, Kazakhstan
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Judit Balazs
- Vadaskert Child Psychiatry Hospital, Budapest, Hungary.,Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - Agnes Kereszteny
- Vadaskert Child Psychiatry Hospital, Budapest, Hungary.,Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Pilar A Saiz
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Department Psychiatry and Psychotherapy, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | | | | | - Helen Keeley
- National Suicide Research Foundation, Cork, Ireland
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France
| | - Vita Postuvan
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Tina Podlogar
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Airi Varnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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Kaess M, Ritter S, Lustig S, Bauer S, Becker K, Eschenbeck H, Moessner M, Rummel-Kluge C, Salize HJ, Thomasius R, Resch F, Koenig J. Promoting Help-seeking using E-technology for ADolescents with mental health problems: study protocol for a randomized controlled trial within the ProHEAD Consortium. Trials 2019; 20:94. [PMID: 30704534 PMCID: PMC6357507 DOI: 10.1186/s13063-018-3157-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/22/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The highest incidence and prevalence of mental health problems across the lifespan as well as the first onset of most long-term mental health conditions are reported for youths between 14 and 25 years of age. At the same time, only 25% of adolescents with mental health problems receive professional treatment. One explanation for poor treatment access in youths is their low help-seeking behavior. Barriers that can keep children and adolescents (C&A) from seeking professional help include a lack of perceived need, structural barriers, or stigma. Interventions based on e-technology might present an effective approach, overcoming these barriers by reducing stigma and providing low-threshold access with enhanced reach, ultimately facilitating help-seeking for mental health problems among youths. METHODS The study is designed as a multi-center, randomized controlled trial. In total, an estimated number of n = 1,500 C&A with mental health problems, drawn from a school-based sample of n = 15,000 pupils attending school grades 6 to 13 (≥ 12 years of age), recruited in five regions of Germany, will be randomized either to an intervention (ProHEAD online) or a control condition. C&A in the intervention group will receive online access to tailored information and individual advice on where to seek professional help for their specific needs close to their place of living, case reports of and interaction with peers, as well as the opportunity for online and telephone counseling. C&A in the control intervention will receive a recommendation to seek help and online information on where to find professional help. All participants will be asked to complete questionnaires concerning their help-seeking behavior at baseline, during the intervention (monitoring), and also at a 1 and 2 year follow-up. The primary endpoint is the number of C&A seeking conventional face-to-face professional help in the real-world setting within 1 year after their initial screening. DISCUSSION The trial will investigate if an Internet-based intervention can increase professional help-seeking in C&A with mental health problems. With its randomized controlled design and large-scale school-based sampling, the study aims to overcome the shortages of previous research. The intervention has the potential to narrow the treatment gap in C&A and to ultimately improve the mental health care system. TRIAL REGISTRATION German Clinical Trials Register, DRKS00014685 . Registered on 7 July, 2018.
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Affiliation(s)
- Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstr. 8, 69115 Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Stöckli, Bolligenstrasse 141c, 3000 Bern 60, Switzerland
| | - Sabrina Ritter
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstr. 8, 69115 Heidelberg, Germany
| | - Sophia Lustig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstr. 8, 69115 Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr 54, 69115 Heidelberg, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Hans-Sachs-Str. 6, 35039 Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-University of Marburg, 35043 Marburg, Germany
| | - Heike Eschenbeck
- Department of Psychology, University of Education Schwäbisch Gmünd, Oberbettringer Str. 200, 73525 Schwäbisch Gmünd, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr 54, 69115 Heidelberg, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, University Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Hans-Joachim Salize
- Mental Health Services Research Group, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159 Mannheim, Germany
| | - Rainer Thomasius
- German Center for Addiction Research in Childhood and Adolescence, University Hospital Hamburg-Eppendorf, Martinistr 52, W29, 20246 Hamburg, Germany
| | - Franz Resch
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstr. 8, 69115 Heidelberg, Germany
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstr. 8, 69115 Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Stöckli, Bolligenstrasse 141c, 3000 Bern 60, Switzerland
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Affiliation(s)
- Om Prakash Singh
- Professor of Psychiatry, WBMES and Consultant Psychiatrist, AMRI Hospitals, Kolkata, West Bengal, India
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Gambadauro P, Carli V, Wasserman C, Hadlaczky G, Sarchiapone M, Apter A, Balazs J, Bobes J, Brunner R, Cosman D, Haring C, Hoven CW, Iosue M, Kaess M, Kahn JP, McMahon E, Postuvan V, Värnik A, Wasserman D. Psychopathology is associated with reproductive health risk in European adolescents. Reprod Health 2018; 15:186. [PMID: 30400907 PMCID: PMC6220505 DOI: 10.1186/s12978-018-0618-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/01/2018] [Indexed: 01/21/2023] Open
Abstract
Background Reproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood. This cross-sectional study evaluated the association between psychopathology and reproductive health risk among European adolescents. Methods A structured self-report questionnaire was delivered to 12,395 pupils of 179 randomly selected schools in 11 European countries within the EU funded “Saving and Empowering Young Lives in Europe” (SEYLE) project. The questionnaire included items about sexual initiation and reproductive health risk factors, such as number of sexual partners, frequency of condom use, and pregnancy involvement. Psychopathology was evaluated with validated instruments and/or ad-hoc questions. Results Of 11,406 respondents (median age 15; interquartile range [IQR] 14–15; 57% females), 18.8% reported sexual initiation. Sixty percent of them also reported at least one reproductive risk factor. Sexual initiation was significantly more common among pupils older than 15 years (38% versus 13.2% younger pupils) and males (21.3% versus 16.9% females). It was also more common among pupils with depression (age/sex-adjusted odds ratio [aOR] 1.871), anxiety (aOR 2.190), severe suicidal ideation (aOR 2.259), self-injurious behaviour (aOR 2.892), and suicide attempts (aOR 3.091). These associations were particularly strong among pupils ≤15 years old and, for overt psychopathology, among pupils with low non-sexual risk behaviour profile and females. Depression (aOR 1.937), anxiety (aOR 2.282), severe suicidal ideation (aOR 2.354), self-injurious behaviour (aOR 3.022), and suicide attempts (aOR 3.284) were associated with higher reproductive health risk, defined by an increasing number of coexisting reproductive risk factors. Conclusions These findings suggest an alignment between mental and reproductive health risk and support the value of cross-domain collaboration in adolescent health. The association between psychopathology and reproductive health risk, as well as its variations with age, sex, and associated risk behaviours, should be considered when designing health-promoting or disease-preventing interventions for adolescents.
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Affiliation(s)
- Pietro Gambadauro
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden. .,Res Medica Sweden, Gynaecology and Reproductive Medicine, 75224, Uppsala, Sweden.
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Camilla Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, USA
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, 86100, Campobasso, Italy.,National Institute of Health for Migration and Poverty, Via di San Gallicano 25/a, 00100, Rome, Italy
| | - Alan Apter
- Schneider Children's Medical Center of Israel, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, 1021, Hungary.,Institute of Psychology, Eötvös Loránd University, Izabella u. 46, Budapest, 1064, Hungary
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, CIBERSAM School of Medicine, Julian Claveria 6 - 3°, 33006, Oviedo, Spain
| | - Romuald Brunner
- Department of Child & Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, D-69115, Heidelberg, Germany
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Department for Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Tirol-kliniken, Milser Straße 10, A- 6060, Hall, Austria
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Miriam Iosue
- Department of Medicine and Health Science, University of Molise, 86100, Campobasso, Italy
| | - Michael Kaess
- Department of Child & Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, D-69115, Heidelberg, Germany
| | - Jean Pierre Kahn
- Department of Psychiatry and Clinical Psychology, CHRU de NANCY and Pôle 6, Centre Psychothérapique de Nancy-Laxou, Université de Lorraine, NANCY, France
| | - Elaine McMahon
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Vita Postuvan
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Muzejski trg 2, 6000, Koper, Slovenia
| | - Airi Värnik
- Estonian-Swedish Mental Health & Suicidology Institute, Ctr. Behav. & Hlth. Sci, Tallinn University, Tallinn, Estonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
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A cost-effectiveness analysis of school-based suicide prevention programmes. Eur Child Adolesc Psychiatry 2018; 27:1295-1304. [PMID: 29442231 DOI: 10.1007/s00787-018-1120-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
Suicide is one of the leading causes of death among young people globally. In light of emerging evidence supporting the effectiveness of school-based suicide prevention programmes, an analysis of cost-effectiveness is required. We aimed to conduct a full cost-effectiveness analysis (CEA) of the large pan-European school-based RCT, Saving and Empowering Young Lives in Europe (SEYLE). The health outcomes of interest were suicide attempt and severe suicidal ideation with suicide plans. Adopting a payer's perspective, three suicide prevention interventions were modelled with a Control over a 12-month time period. Incremental cost-effectiveness ratios (ICERs) indicate that the Youth Aware of Mental Health (YAM) programme has the lowest incremental cost per 1% point reduction in incident for both outcomes and per quality adjusted life year (QALY) gained versus the Control. The ICERs reported for YAM were €34.83 and €45.42 per 1% point reduction in incident suicide attempt and incident severe suicidal ideation, respectively, and a cost per QALY gained of €47,017 for suicide attempt and €48,216 for severe suicidal ideation. Cost-effectiveness acceptability curves were used to examine uncertainty in the QALY analysis, where cost-effectiveness probabilities were calculated using net monetary benefit analysis incorporating a two-stage bootstrapping technique. For suicide attempt, the probability that YAM was cost-effective at a willingness to pay of €47,000 was 39%. For severe suicidal ideation, the probability that YAM was cost-effective at a willingness to pay of €48,000 was 43%. This CEA supports YAM as the most cost-effective of the SEYLE interventions in preventing both a suicide attempt and severe suicidal ideation.Trial registration number DRKS00000214.
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Greenbaum VJ, Titchen K, Walker-Descartes I, Feifer A, Rood CJ, Fong HF. Multi-level prevention of human trafficking: The role of health care professionals. Prev Med 2018; 114:164-167. [PMID: 29981790 DOI: 10.1016/j.ypmed.2018.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/26/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
As a major public health issue, human trafficking (HT) affects individuals, families, communities, and societies around the world. A public health approach to combating HT has been advocated. Such an approach seeks to prevent HT by engaging diverse stakeholder groups in addressing risk factors at multiple levels. As a key stakeholder group, health care professionals (HCPs) play a critical role in HT prevention. Herein, we use the Centers for Disease Control (CDC) Social-Ecological Model as a framework to present potential HT prevention strategies for health care professionals. As clinicians, HCPs may deliver tailored interventions to patients and families to address individual- and relationship-level risk factors for HT in the health care setting. As educators, advocates, and researchers, HCPs may collaborate across sectors to implement community- and society-level prevention strategies. Such strategies may include enhancing awareness of HT through education; advocating for local and national policies that promote community health and wellness; combating social or cultural norms that contribute to HT; and building a strong evidence-base to guide future HT prevention programs. Guided by the CDC Social-Ecological Model, we recommend that HCPs use their diverse skills to target risk factors for HT at multiple levels and thereby expand their impact in preventing this form of exploitation.
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Affiliation(s)
- V Jordan Greenbaum
- Stephanie V. Blank Center for Safe and Healthy Children, Children's Healthcare of Atlanta, International Centre for Missing and Exploited Children, 975 Johnson Ferry Rd, NE, Ste 350, Atlanta, GA 30342, United States of America.
| | - Kanani Titchen
- Children's Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467, United States of America
| | - Ingrid Walker-Descartes
- Maimonides Children's Hospital at Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, United States of America
| | - Anastasia Feifer
- Harbor-UCLA Medical Center, Department of Pediatrics, K.I.D.S. Hub, 1000 W. Carson St., Bldg. N-26, Torrance, CA 90502, United States of America
| | - Corey J Rood
- University of Utah School of Medicine, Center for Safe and Healthy Families, Primary Children's Hospital, 81 N Mario Capecchi Dr, Salt Lake City, UT 84113, United States of America
| | - Hiu-Fai Fong
- Division of General Pediatrics, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, 21 Autumn St, Boston, MA 02215, United States of America
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Balázs J, Miklósi M, Keresztény A, Hoven CW, Carli V, Wasserman C, Hadlaczky G, Apter A, Bobes J, Brunner R, Corcoran P, Cosman D, Haring C, Kahn JP, Postuvan V, Kaess M, Varnik A, Sarchiapone M, Wasserman D. Comorbidity of Physical and Anxiety Symptoms in Adolescent: Functional Impairment, Self-Rated Health and Subjective Well-Being. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081698. [PMID: 30096890 PMCID: PMC6121583 DOI: 10.3390/ijerph15081698] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 12/17/2022]
Abstract
Physical disorders and anxiety are frequently comorbid. This study investigates the characteristics of physical disorders, self-rated heath, subjective well-being and anxiety in adolescents. Data were drawn from the Saving and Empowering Young Lives in Europe cohort study. From 11 countries 11,230 adolescents, aged 14–16 years were included. Zung Self-Rating Anxiety Scale (SAS), WHO-5 Well-Being Index and five questions prepared for this study to evaluate physical illnesses and self-rated heath were administered. Anxiety levels were significantly higher in adolescents who reported having physical disability (p < 0.001, Cohen’s d = 0.40), suffering from chronic illnesses (p < 0.001, Cohen’s d = 0.40), impairments associated to health conditions (p < 0.001, Cohen’s d = 0.61), or reported poor to very poor self-rated health (p < 0.001, Cohen’s d = 1.11). Mediational analyses revealed no direct effect of having a chronic illness/physical disability on subjective well-being, but the indirect effects through higher levels of anxiety were significant. Functional impairment related to health conditions was both directly and indirectly (through higher levels of anxiety) associated with lower well-being. The co-occurrence of anxiety and physical disorders may confer a greater level of disability and lower levels of subjective well-being. Clinicians have to screen anxiety, even in a subthreshold level in patients with choric physical illness or with medically unexplained physical symptoms.
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Affiliation(s)
- Judit Balázs
- Vadaskert Child and Adolescent Psychiatric Hospital, 1021 Budapest, Hungary.
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Hungary.
| | - Mónika Miklósi
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Hungary.
- Heim Pál National Pediatric Institute, 1131 Budapest, Hungary.
| | - Agnes Keresztény
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Hungary.
- School of Ph.D. Studies, Semmelweis University, 1085 Budapest, Hungary.
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, SE-171 77 Stockholm, Sweden.
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
- Department of Health Sciences, University of Molise, 86100 Campobasso, Italy.
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, SE-171 77 Stockholm, Sweden.
| | - Alan Apter
- Feinberg Child Study Center, Schneider Children's Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, University of Oviedo; Centro de InvestigaciónBiomédica en Red de Salud Mental, CIBERSAM, 33006 Oviedo, Spain.
| | - Romuald Brunner
- Section Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, University of Heidelberg, 69117 Heidelberg, Germany.
- Department of Child and Adolescent Psychiatry, University of Regensburg, 93053 Regensburg, Germany.
| | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland.
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
| | - Christian Haring
- Research Division for Mental Health, University for Medical Information Technology (UMIT), 6060 Hall in Tirol, Austria.
| | - Jean-Pierre Kahn
- Department of Psychiatry, Centre Hospitalo-Universitaire (CHU) de NANCY, Université H. Poincaré, 54003 Nancy, France.
| | - Vita Postuvan
- Mental Health Department, PINT, University of Primorska, 6000 Koper, Slovenia.
| | - Michael Kaess
- Section Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, University of Heidelberg, 69117 Heidelberg, Germany.
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, 3012 Bern, Switzerland.
| | - Airi Varnik
- Estonian-Swedish Mental Health & Suicidology Institute, Ctr. Behav & Hlth Sci, Tallinn University, 10120 Tallinn, Estonia.
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, 86100 Campobasso, Italy.
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, SE-171 77 Stockholm, Sweden.
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Horváth LO, Balint M, Ferenczi-Dallos G, Farkas L, Gadoros J, Gyori D, Kereszteny A, Meszaros G, Szentivanyi D, Velo S, Sarchiapone M, Carli V, Wasserman C, Hoven CW, Wasserman D, Balazs J. Direct Self-Injurious Behavior (D-SIB) and Life Events among Vocational School and High School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1068. [PMID: 29795028 PMCID: PMC6025121 DOI: 10.3390/ijerph15061068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/28/2018] [Accepted: 05/19/2018] [Indexed: 01/21/2023]
Abstract
Although several studies have recently assessed direct self-injurious behavior (D-SIB) among adolescents, it is still understudied in adolescents attending vocational schools: an educational setting generally associated with lower socioeconomic status. After extending the "Saving and Empowering Young Lives in Europe" (SEYLE) project to a vocational school population, we examined their D-SIB and life event characteristics compared to the high school population. SEYLE's Hungarian randomly selected high school sample (N = 995) was completed with a randomly selected vocational school sample (N = 140) in Budapest, Hungary. Participants aged 14⁻17 years completed the SEYLE project's self-administered questionnaires. D-SIB lifetime prevalence was significantly higher (29.4%) in the vocational school group compared to the high school group (17.2%) (Χ²(1) = 12.231, p< 0.001). D-SIB was associated with suicidal ideation in the vocational school group. Different life events were more frequent in the high school than in the vocational school group, and associations between D-SIB and life events differed in the vocational school group compared to the high school group. In conclusion, vocational school students are a vulnerable population with a higher prevalence of D-SIB compared to high school students. Life events and their association with D-SIB also differ in vocational school students compared to high school students. Taking all these into account might contribute to prevention/intervention designed for this population.
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Affiliation(s)
- Lili O Horváth
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Maria Balint
- Pedagogical Services, Budapest District 12, 1126 Budapest, Hungary.
| | | | - Luca Farkas
- West Hertfordshire Specialist CAMHS St Albans Clinic, AL3 5TL St Albans, UK.
| | - Julia Gadoros
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
| | - Dora Gyori
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Agnes Kereszteny
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Semmelweis University, Mental Health Sciences Doctoral School, 1083 Budapest, Hungary.
| | - Gergely Meszaros
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
- Semmelweis University, Mental Health Sciences Doctoral School, 1083 Budapest, Hungary.
| | - Dora Szentivanyi
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Szabina Velo
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, 86100 Molise, Italy.
| | - Vladimir Carli
- Department of Health Sciences, University of Molise, 86100 Molise, Italy.
- Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Camilla Wasserman
- Global Psychiatric Epidemiology, Columbia University-New York State Psychiatric Institute, New York, NY 10032, USA.
| | - Christina W Hoven
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | | | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
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Wasserman C, Postuvan V, Herta D, Iosue M, Värnik P, Carli V. Interactions between youth and mental health professionals: The Youth Aware of Mental health (YAM) program experience. PLoS One 2018; 13:e0191843. [PMID: 29420556 PMCID: PMC5805239 DOI: 10.1371/journal.pone.0191843] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/12/2018] [Indexed: 12/13/2022] Open
Abstract
THE YOUTH AWARE OF MENTAL HEALTH (YAM) EXPERIENCE Youth stand at the core of much mental health promotion, yet little is written about their experiences of such efforts. We aimed to take this on by interviewing youth after they participated in Youth Aware of Mental Health (YAM), a universal mental health promotion program. YAM has a non-anticipatory methodology that provides youth with a safe space for reflection, role-play, and discussion. Addressing everyday mental health, YAM invites the experiences and issues relevant to the youth present to influence the program in a slightly different direction every time. The YAM instructor guides the participants but does not present the youth with given formulas on how to solve their problems. Like any mental health promotion, YAM appeals to some more than others in its intended audience and individuals engage with the program in many different ways. We set out to learn more about these experiences. CONVERSATIONS ABOUT MENTAL HEALTH Thirty-two semi-structured interviews were conducted with 15-17 year olds in Estonia, Italy, Romania and Spain. In these interviews, the researchers made an effort to discuss mental health in terms relevant to youth. Still, wide-ranging levels of motivation, ease with engaging in dialogue with mental health professionals, and comfort with the format and content of YAM were detected. The youth were clustered in five different groups relating to their positioning vis-à-vis the researcher during the interview. The following evocative labels were used: "interested", "foot in the door", "respect for authority", "careful", and "not my topic". Corresponding labels were devised for their YAM experience: "engaged", "initially hesitant", "cautious", "eager to please", or "disengaged". We also observed that the researchers brought their own expectations and employed a variety of approaches that led to anticipating answers, stating the obvious, or getting along better with some of the youth. These modes of interaction were categorized under: "favoritism", "familiarity", "frustration", "out of sync", and "insecurity". Similar power dynamics likely transpire in other encounters between youth and researchers, including interventions such as YAM. YOUTH AND MENTAL HEALTH PROFESSIONALS: NOTICING THE DYNAMICS AT PLAY As mental health professionals, we need to be aware of the professional habits and biases that sometimes obstruct us in understanding the experiences of youth. By initiating dialogue and listening closely to youth we can find a way to those experiences. Qualitative research can help bring the underlying interplay between mental health professionals and youth to the surface while also orienting the conversation towards topics that matter to youth. Some youth are more interested or feel more at ease in speaking openly with mental health professionals, while others find such exchanges less appealing or almost intolerable. Future mental health promotion initiatives would benefit from involving youth in the design of interventions to create an inclusive atmosphere and engage with topics that appeal to youth with diverse experiences of mental health.
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Affiliation(s)
- Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, United States of America
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Vita Postuvan
- Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Dana Herta
- Medical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Miriam Iosue
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Peeter Värnik
- Estonian-Swedish Mental Health & Suicidology Institute, Tallinn, Estonia
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
- WHO Collaborating Centre for Research, Training and Methods Development at Karolinska Institutet, Stockholm, Sweden
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Gambadauro P, Carli V, Hadlaczky G, Sarchiapone M, Apter A, Balazs J, Banzer R, Bobes J, Brunner R, Cosman D, Farkas L, Haring C, Hoven CW, Kaess M, Kahn JP, McMahon E, Postuvan V, Sisask M, Värnik A, Zadravec Sedivy N, Wasserman D. Correlates of sexual initiation among European adolescents. PLoS One 2018; 13:e0191451. [PMID: 29420612 PMCID: PMC5805230 DOI: 10.1371/journal.pone.0191451] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/04/2018] [Indexed: 11/18/2022] Open
Abstract
Background Sexuality is a physiological component of adolescent development, though early initiation is associated with reproductive health risk. This study aimed at identifying correlates and predictors of sexual initiation in a large multinational cohort of European adolescents. Methods A questionnaire addressing socio-demographics, behaviours, mental health and sexual activity, was delivered to 11,110 adolescents recruited from 168 randomly selected schools in 10 European countries between 2009 and 2011. A follow-up questionnaire was delivered after 12 months. The longitudinal association of baseline risk behaviors, psychological attributes and contextual vulnerabilities, with sexual initiation during follow-up was evaluated through simple and multivariable age/sex stratified logistic regression. Multinomial logistic regression measured the association between predictors and sexual initiation with or without coexisting reproductive risk factors, such as multiple partners or infrequent condom use. Results Baseline sexual experience was reported by 19.2% of 10,757 respondents (median age 15; IQR 14–15; females 59.6%). This was significantly more frequent among pupils older than 15 (41%) and males (20.8%). Of 7,111 pupils without previous experience who were available at follow-up (response rate 81.8%), 17% reported sexual initiation, without differences between females and males. Baseline smoking (age/sex adjusted odds ratio [aOR] 3.63), alcohol use (aOR 2.95), illegal drugs use (aOR 2.72), and poor sleep (aOR 1.71) predicted sexual initiation. Stratified analyses showed a particularly strong association in case of younger and female pupils, and, among girls, when initiation was reported together with multiple partners and/or infrequent condom use. Externalizing (i.e. conduct and hyperactivity) symptoms independently predicted sexual initiation. Internalizing difficulties (i.e. emotional and peer problems) were negatively associated with early and risky sexual initiation among boys. Significant predictors included also being bullied, fighting, truancy, and low parental involvement. Conclusions Adolescent sexual behaviours are related to non-sexual risk behaviours, psychological difficulties and contextual vulnerabilities. While gateway effects explain some associations, a comprehensive model is needed to understand adolescent sexual behaviours, their physical, mental, and social health outcomes, and their potential positive effects on wellbeing. Tailored interventions may need to consider younger girls as a particularly vulnerable group in view of a strong association between non-sexual and sexual behaviors.
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Affiliation(s)
- Pietro Gambadauro
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Res Medica Sweden, Gynaecology and Reproductive Medicine, Uppsala, Sweden
- * E-mail:
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
- National Institute of Health for Migration and Poverty, Rome, Italy
| | - Alan Apter
- Schneider’s Children Medical Center of Israel, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Raphaela Banzer
- Addiction Help Services BIN, Innsbruck, Austria
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, CIBERSAM School of Medicine, Oviedo, Spain
| | - Romuald Brunner
- Department of Child & Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luca Farkas
- Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary
| | - Christian Haring
- Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall, Austria
| | - Christina W. Hoven
- Department of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States of America
| | - Michael Kaess
- Department of Child & Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jean Pierre Kahn
- Department of Psychiatry and Clinical Psychology, CHRU de NANCY and Pôle 6, Centre Psychothérapique de Nancy-Laxou, Université de Lorraine, Nancy, France
| | - Elaine McMahon
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Vita Postuvan
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Merike Sisask
- Estonian-Swedish Mental Health & Suicidology Institute, Tallinn, Estonia
- School of Governance, Law and Society (SOGOLAS), Tallinn University, Tallinn, Estonia
| | - Airi Värnik
- Estonian-Swedish Mental Health & Suicidology Institute, Tallinn, Estonia
- School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Nusa Zadravec Sedivy
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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Pereira Simões R, Santos J, Façanha J, Erse M, Loureiro C, Marques L, Quaresma H, Matos E. Promoção do bem-estar em adolescentes: contributos do projeto +Contigo. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2018. [DOI: 10.1159/000486468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objetivos:</i></b> O projeto +Contigo insere-se no âmbito da promoção da saúde mental e bem-estar e da prevenção de comportamentos autolesivos e enquanto projeto de investigação longitudinal é baseado numa intervenção multinível em rede. Tem como um dos objetivos gerais promover o bem-estar em adolescentes do 3º ciclo e do ensino secundário. <b><i>Métodos:</i></b> Estudo de natureza quasi-experimental, com grupo de controlo, avaliado no início, no final e seis meses após intervenção ao longo do ano letivo. A intervenção dirigida aos adolescentes é composta por 7 sessões em sala de aula, abordando o estigma, a adolescência, o autoconceito, a resolução de problemas, a depressão e o bem-estar. O instrumento de recolha de dados, aplicado sob a forma de questionário é constituído por vários instrumentos de medida entre os quais o índice de bem-estar (OMS, 1998). Foi autoadministrado a 2.105 adolescentes, de escolas da região centro de Portugal com adesão ao projeto +Contigo, durante os anos letivos de 2011/2012 e 2012/2013. <b><i>Resultados:</i></b> A amostra é constituída por 2.105 adolescentes, maioritariamente do género masculino, com idade entre os 13 e os 14 anos, pertencentes maioritariamente a turmas do 8º ano. O índice de bem-estar demonstra um aumento ao longo das três fases, no grupo alvo de intervenção, com diferença estatisticamente significativa para o grupo de controlo. Os adolescentes do género masculino apresentam melhores índices de bem-estar, existindo no decorrer do projeto aumento deste índice para ambos os géneros, com diferenças estatisticamente significativas no género masculino. Os adolescentes do 7º, 8º e 9º ano evoluíram favoravelmente no índice de bem-estar em todas as fases de avaliação. <b><i>Conclusão:</i></b> A intervenção produz resultados positivos a curto e a médio prazo para o índice de bem-estar, com resultados estatisticamente significativos para o grupo de intervenção comparativamente ao grupo de controlo. Estas repercussões ao nível do bem-estar dos adolescentes reforçam a estratégia preventiva de comportamentos suicidários adotada, já que, sendo o bem-estar um indicador de saúde mental acredita-se que poderá ajudar a prevenir os comportamentos autolesivos nos adolescentes.
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Snir A, Apter A, Barzilay S, Feldman D, Rafaeli E, Carli V, Wasserman C, Hadlaczky G, Hoven CW, Sarchiapone M, Wasserman D. Explicit Motives, Antecedents, and Consequences of Direct Self-Injurious Behaviors. CRISIS 2017; 39:255-266. [PMID: 29216755 DOI: 10.1027/0227-5910/a000493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Self-injurious behaviors in adolescence are a serious public health concern. AIMS The current study aims to expand our understanding of motives for direct self-injurious behaviors (D-SIB). We examined the explicit motives but also the actual antecedents and consequences of D-SIB over time. METHOD As part of the Saving and Empowering Young Lives in Europe (SEYLE) study, adolescents between the ages of 14 and 18 years from Israel completed self-report questionnaires at baseline, 3-month, and 12-month follow-ups. RESULTS Decreases in social support predicted later increases in D-SIB, an effect mediated by negative affect. Both peer and parental support also exerted quadratic effects on D-SIB. Thus, low as well as high support predicted subsequent D-SIB. In turn, D-SIB was followed by increased peer and parental support. LIMITATIONS Our methodology relies on self-reports, affected by social desirability and recall biases. CONCLUSION The findings support a causal path for the development of D-SIB: from interpersonal distress to emotional distress and then to D-SIB. They also point to interesting avenues regarding subgroupings of adolescents who self-injure depending on their motives. Finally, our results reveal that D-SIB, although of negative import, might paradoxically be effective in serving certain functions such as gaining support from parents and peers.
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Affiliation(s)
- Avigal Snir
- 1 1Feinberg Child Study Centre, Schneider Children's Medical Centre, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.,2 Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Alan Apter
- 1 1Feinberg Child Study Centre, Schneider Children's Medical Centre, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Shira Barzilay
- 1 1Feinberg Child Study Centre, Schneider Children's Medical Centre, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.,2 Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Dana Feldman
- 1 1Feinberg Child Study Centre, Schneider Children's Medical Centre, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.,2 Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Eshkol Rafaeli
- 2 Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Vladimir Carli
- 3 National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Camilla Wasserman
- 4 Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,6 Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Gergö Hadlaczky
- 3 National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- 4 Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,5 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marco Sarchiapone
- 6 Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Danuta Wasserman
- 3 National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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McMahon EM, Corcoran P, Keeley H, Cannon M, Carli V, Wasserman C, Sarchiapone M, Apter A, Balazs J, Banzer R, Bobes J, Brunner R, Cozman D, Haring C, Kaess M, Kahn JP, Kereszteny A, Bitenc UM, Nemes B, Poštuvan V, Sáiz PA, Sisask M, Tubiana A, Värnik P, Hoven CW, Wasserman D. Mental health difficulties and suicidal behaviours among young migrants: multicentre study of European adolescents. BJPsych Open 2017; 3:291-299. [PMID: 29234521 PMCID: PMC5707442 DOI: 10.1192/bjpo.bp.117.005322] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/11/2017] [Accepted: 10/19/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Migration has been reported to be associated with higher prevalence of mental disorders and suicidal behaviour. AIMS To examine the prevalence of emotional and behavioural difficulties, suicidal ideation and suicide attempts among migrant adolescents and their non-migrant peers. METHOD A school-based survey was completed by 11 057 European adolescents as part of the Saving and Empowering Young Lives in Europe (SEYLE) study. RESULTS A previous suicide attempt was reported by 386 (3.6%) adolescents. Compared with non-migrants, first-generation migrants had an elevated prevalence of suicide attempts (odds ratio (OR) 2.08; 95% CI 1.32-3.26; P=0.001 for European migrants and OR 1.86; 95% CI 1.06-3.27; P=0.031 for non-European migrants) and significantly higher levels of peer difficulties. Highest levels of conduct and hyperactivity problems were found among migrants of non-European origin. CONCLUSIONS Appropriate mental health services and school-based supports are required to meet the complex needs of migrant adolescents. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Elaine M McMahon
- , PhD, National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Paul Corcoran
- , PhD, National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Helen Keeley
- , MD, MRCPsych, Child and Adolescent Psychiatry, Health Service Executive, Cork, Ireland
| | - Mary Cannon
- , PhD, FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Vladimir Carli
- , MD, PhD, National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Camilla Wasserman
- , PhD, National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden; Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Marco Sarchiapone
- , MD, PhD, Department of Medicine and Health Science, University of Molise, Campobasso, Italy; National Institute for Health, Migration and Poverty, Rome, Italy
| | - Alan Apter
- , MD, Schneider Children's Medical Centre of Israel, Tel-Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- , MD, PhD, Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary; Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | | | - Julio Bobes
- , MD, PhD, Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Romuald Brunner
- , MD, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Doina Cozman
- , MD, PhD, Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- , MD, MSc, Department Psychiatry and Psychotherapy, Tirol Kliniken, Hospital Hall in Tyrol, Innsbruck, Austria
| | - Michael Kaess
- , MD, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jean-Pierre Kahn
- , MD, PhD, University of Lorraine, Nancy, France and Centre Hospitalier Régional Universitaire de Nancy, Nancy, France; Department of Psychiatry and Clinical Psychology, Centre Psychothérapique de Nancy, Nancy, France
| | - Agnes Kereszteny
- , MA, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary; Doctoral School of Semmelweis University, Budapest, Hungary
| | - Ursa Mars Bitenc
- , BSc, Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Bogdan Nemes
- , MD, PhD, Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vita Poštuvan
- , PhD, Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Pilar A Sáiz
- , MD, PhD, Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Merike Sisask
- , PhD, Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia; School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Alexandra Tubiana
- , MA, Department of Psychiatry and Clinical Psychology, Centre Psychothérapique de Nancy, Nancy, France
| | - Peeter Värnik
- , PhD, Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia
| | - Christina W Hoven
- , DrPh, MPH, Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Danuta Wasserman
- , MD, PhD, National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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Barzilay S, Brunstein Klomek A, Apter A, Carli V, Wasserman C, Hadlaczky G, Hoven CW, Sarchiapone M, Balazs J, Kereszteny A, Brunner R, Kaess M, Bobes J, Saiz P, Cosman D, Haring C, Banzer R, Corcoran P, Kahn JP, Postuvan V, Podlogar T, Sisask M, Varnik A, Wasserman D. Bullying Victimization and Suicide Ideation and Behavior Among Adolescents in Europe: A 10-Country Study. J Adolesc Health 2017; 61:179-186. [PMID: 28391968 DOI: 10.1016/j.jadohealth.2017.02.002] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/08/2017] [Accepted: 02/02/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE To examine risk and protective factors moderating the associations between three types of bullying victimization (physical, verbal, and relational bullying) with suicide ideation/attempts in a large representative sample of European adolescents. METHODS We analyzed cross-sectional data on 11,110 students (mean age = 14.9, standard deviation = .89) recruited from 168 schools in 10 European Union countries involved in the Saving and Empowering Young Lives in Europe study. A self-report questionnaire was used to measure victimization types, depression, anxiety, parental and peer support, and suicide ideation and attempts. For each outcome, we applied hierarchical nonlinear models controlling for sociodemographics. RESULTS Prevalence of victimization was 9.4% physical, 36.1% verbal, and 33.0% relational. Boys were more likely to be physically and verbally victimized, whereas girls were more prone to relational victimization. Physical victimization was associated with suicide ideation, and relational victimization was associated with suicide attempts. Other associations between victimization and suicidality (ideation/attempts) were identified through analysis of interactions with additional risk and protective factors. Specifically, verbal victimization was associated with suicide ideation among adolescents with depression who perceived low parental support. Similarly, low peer support increased the associations between verbal victimization and suicide ideation. Verbal victimization was associated with suicide attempts among adolescents with anxiety who perceived low parental support. CONCLUSIONS Findings support the development of prevention strategies for adolescent victims of bullying who may be at elevated risk for suicide ideation/behavior, by taking into account gender, the type of bullying, symptomatology, and availability of interpersonal support.
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Affiliation(s)
- Shira Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel; Child and Adolescent Psychiatry, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Anat Brunstein Klomek
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel; Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel.
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Camilla Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden; Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy; National Institute for Health, Migration and Poverty, Rome, Italy
| | - Judit Balazs
- Vadaskert Child Psychiatry Hospital, Budapest, Hungary; Institute of Psychology Eotvos Lorand University, Budapest, Hungary
| | - Agnes Kereszteny
- Institute of Psychology Eotvos Lorand University, Budapest, Hungary
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Pilar Saiz
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Research Division for Mental Health, University for Medical Information Technology (UMIT), Hall in Tirol, Austria
| | | | | | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France
| | - Vita Postuvan
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Tina Podlogar
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia; School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Airi Varnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia; School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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Koenig J, Brunner R, Fischer-Waldschmidt G, Parzer P, Plener PL, Park J, Wasserman C, Carli V, Hoven CW, Sarchiapone M, Wasserman D, Resch F, Kaess M. Prospective risk for suicidal thoughts and behaviour in adolescents with onset, maintenance or cessation of direct self-injurious behaviour. Eur Child Adolesc Psychiatry 2017; 26:345-354. [PMID: 27558490 DOI: 10.1007/s00787-016-0896-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/16/2016] [Indexed: 11/25/2022]
Abstract
Direct self-injurious behaviour (D-SIB) is associated with suicidal behaviour and suicide risk. It is not known if D-SIB cessation reduces these risks. The aim of this study was to explore trajectories of D-SIB and their prospective influence on suicidal thoughts and behaviour during adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the Saving and Empowering Young Lives in Europe study were analysed. D-SIB and suicidal thoughts and behaviour were assessed at baseline (T0), 1- (T1) and 2-year follow-up (T2). Onset and maintenance of D-SIB between T0 and T1 were associated with a two to threefold increased odds ratio for suicidal thoughts and behaviour at T2. Suicidal thoughts and behaviour in those terminating D-SIB before T1 were similar compared to those with no life-time history of D-SIB. Late onset and maintenance of D-SIB prospectively indicate risk for suicidal thoughts and behaviour. This is the first study showing that D-SIB cessation reduces later risk for suicidal thoughts and behaviour in adolescence. Suicide prevention efforts should set one focus on reducing adolescent D-SIB.
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Affiliation(s)
- Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
| | - Romuald Brunner
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gloria Fischer-Waldschmidt
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - JiYeon Park
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
| | - Camilla Wasserman
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Franz Resch
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany.
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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44
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Factors associated with different smoking status in European adolescents: results of the SEYLE study. Eur Child Adolesc Psychiatry 2017; 26:1319-1329. [PMID: 28386649 PMCID: PMC5656692 DOI: 10.1007/s00787-017-0980-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/22/2017] [Indexed: 11/17/2022]
Abstract
Early onset and long-term smoking are associated with physical and psychological health problems. The aim of the presented analysis was to investigate risk and influencing factors for different smoking status in a big sample of European adolescents. In the context of the "saving and empowering young lives in Europe" (SEYLE) study we surveyed 12,328 adolescents at the age of 13-17 from 11 countries. The survey took place in a school-based context using a questionnaire. Overall 58% reported the onset of ever-smoking under the age of 14 and 30.9% smoke on a daily basis. Multinomial logistic regression model showed significant positive associations between adolescent smoking and internalizing problems (suicidal behavior, direct self-injurious behavior, anxiety), externalizing problems (conduct problems, hyperactivity, substance consumption) and family problems (parental substance consumption, broken home). Our data show that smoking among adolescents is still a major public health problem and adolescents who smoke are at higher risk for mental problems. Further, adolescent smoking is associated with broken home families and parental behaviors. Therefore, early preventive measures are necessary not only for adolescents, but also for their parents.
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45
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McMahon EM, Corcoran P, O'Regan G, Keeley H, Cannon M, Carli V, Wasserman C, Hadlaczky G, Sarchiapone M, Apter A, Balazs J, Balint M, Bobes J, Brunner R, Cozman D, Haring C, Iosue M, Kaess M, Kahn JP, Nemes B, Podlogar T, Poštuvan V, Sáiz P, Sisask M, Tubiana A, Värnik P, Hoven CW, Wasserman D. Physical activity in European adolescents and associations with anxiety, depression and well-being. Eur Child Adolesc Psychiatry 2017; 26:111-122. [PMID: 27277894 DOI: 10.1007/s00787-016-0875-9] [Citation(s) in RCA: 288] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/30/2016] [Indexed: 11/28/2022]
Abstract
In this cross-sectional study, physical activity, sport participation and associations with well-being, anxiety and depressive symptoms were examined in a large representative sample of European adolescents. A school-based survey was completed by 11,110 adolescents from ten European countries who took part in the SEYLE (Saving and Empowering Young Lives in Europe) study. The questionnaire included items assessing physical activity, sport participation and validated instruments assessing well-being (WHO-5), depressive symptoms (BDI-II) and anxiety (SAS). Multi-level mixed effects linear regression was used to examine associations between physical activity/sport participation and mental health measures. A minority of the sample (17.9 % of boys and 10.7 % of girls; p < 0.0005) reported sufficient activity based on WHO guidelines (60 min + daily). The mean number of days of at least 60 min of moderate-to-vigorous activity in the past 2 weeks was 7.5 ± 4.4 among boys and 5.9 days ± 4.3 among girls. Frequency of activity was positively correlated with well-being and negatively correlated with both anxiety and depressive symptoms, up to a threshold of moderate frequency of activity. In a multi-level mixed effects model more frequent physical activity and participation in sport were both found to independently contribute to greater well-being and lower levels of anxiety and depressive symptoms in both sexes. Increasing activity levels and sports participation among the least active young people should be a target of community and school-based interventions to promote well-being. There does not appear to be an additional benefit to mental health associated with meeting the WHO-recommended levels of activity.
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Affiliation(s)
- Elaine M McMahon
- National Suicide Research Foundation, University College Cork, Cork, Ireland.
| | - Paul Corcoran
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Grace O'Regan
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | | | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, USA.,Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.,National Institute for Health, Migration and Poverty, Rome, Italy
| | - Alan Apter
- Schneider Children's Medical Centre of Israel, Tel-Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Maria Balint
- Pedagogical Consultation Services, Budapest, Hungary
| | - Julio Bobes
- Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Doina Cozman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Department Psychiatry and Psychotherapy, Tirol Kliniken, Hospital Hall in Tyrol, Innsbruck, Austria
| | - Miriam Iosue
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, University of Lorraine, Nancy, France
| | - Bogdan Nemes
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tina Podlogar
- Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Vita Poštuvan
- Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Pilar Sáiz
- Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Alexandra Tubiana
- Department of Psychiatry and Clinical Psychology, University of Lorraine, Nancy, France
| | - Peeter Värnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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46
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Brunstein Klomek A, Snir A, Apter A, Carli V, Wasserman C, Hadlaczky G, Hoven CW, Sarchiapone M, Balazs J, Bobes J, Brunner R, Corcoran P, Cosman D, Haring C, Kahn JP, Kaess M, Postuvan V, Sisask M, Tubiana A, Varnik A, Žiberna J, Wasserman D. Association between victimization by bullying and direct self injurious behavior among adolescence in Europe: a ten-country study. Eur Child Adolesc Psychiatry 2016; 25:1183-1193. [PMID: 27010553 DOI: 10.1007/s00787-016-0840-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 03/07/2016] [Indexed: 11/26/2022]
Abstract
Previous studies have examined the association between victimization by bullying and both suicide ideation and suicide attempts. The current study examined the association between victimization by bullying and direct-self-injurious behavior (D-SIB) among a large representative sample of male and female adolescents in Europe. This study is part of the Saving and Empowering Young Lives in Europe (SEYLE) study and includes 168 schools, with 11,110 students (mean age = 14.9, SD = 0.89). Students were administered a self-report survey within the classroom, in which they were asked about three types of victimization by bullying (physical, verbal and relational) as well as direct self-injurious behavior (D-SIB). Additional risk factors (symptoms of depression and anxiety, suicide ideation, suicide attempts, loneliness, alcohol consumption, drug consumption), and protective factors (parent support, peer support, pro-social behavior) were included. The three types of victimization examined were associated with D-SIB. Examination of gender as moderator of the association between victimization (relational, verbal, and physical) and D-SIB yielded no significant results. As for the risk factors, depression, but not anxiety, partially mediated the effect of relational victimization and verbal victimization on D-SIB. As for the protective factors, students with parent and peer support and those with pro-social behaviors were at significantly lower risk of engaging in D-SIB after being victimized compared to students without support/pro-social behaviors. This large-scale study has clearly demonstrated the cross-sectional association between specific types of victimization with self-injurious behavior among adolescents and what may be part of the risk and protective factors in this complex association.
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Affiliation(s)
- Anat Brunstein Klomek
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), P.O. Box 167, Herzliya, 46150, Israel.
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel.
| | - Avigal Snir
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
- Department of Health Sciences, University of Molise, Campobasso, Italy
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Judit Balazs
- Vadaskert Child Psychiatry Hospital, Lipótmezei str. 1-5, 1021, Budapest, Hungary
- Institute of Psychology Eötvös Loránd University, Izabella str. 46, 1064, Budapest, Hungary
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Research Division for Mental Health, University for Medical Information Technology (UMIT), Hall in Tirol, Austria
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Vita Postuvan
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia
- Institute of Social Work, Tallinn University, Tallinn, Estonia
| | - Alexandra Tubiana
- Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France
| | - Airi Varnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia
- Institute of Social Work, Tallinn University, Tallinn, Estonia
| | - Janina Žiberna
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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Hedeland RL, Teilmann G, Jørgensen MH, Thiesen LR, Andersen J. Risk factors and characteristics of suicide attempts among 381 suicidal adolescents. Acta Paediatr 2016; 105:1231-8. [PMID: 27146308 DOI: 10.1111/apa.13458] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 03/02/2016] [Accepted: 05/02/2016] [Indexed: 11/28/2022]
Abstract
AIM This study explored the relationships between suicidal adolescents and their parents, siblings and friends. It examined how much adolescents talked to their parents before suicide attempts, the frequency of self-mutilation, the extent of suicidal ideation, previous suicide attempts and suicide attempts in the adolescent's surroundings. METHODS We performed a cross-sectional case-control study that focused on 381 adolescents aged 10-17 years who were admitted to hospitals across Denmark after suicide attempts with acetaminophen and 296 age- and gender-matched controls recruited from schools. The study used questionnaires and medical and child psychiatric records. RESULTS The study group were ten times more likely to report dissociated parental relationships than the control group (41.5% versus 4%), and there were significant relationships between these reports and feelings of not being heard (p < 0.0001), dissociated relationships with friends (p < 0.0001) and siblings (p < 0.0001) and self-mutilation (p = 0.009). Almost two-thirds (62.5%) of the suicidal adolescents who tried to talk to their parents about their problems felt unheard, and there was a significant relationship between this feeling and the duration of suicidal ideation (p = 0.01) and self-mutilation (p = 0.003). CONCLUSION Early risk factors for suicide were dissociated relationships with parents, siblings and friends, feeling unheard, self-mutilation and extended suicidal ideation.
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Affiliation(s)
| | - Grete Teilmann
- Department of Pediatric and Adolescent Medicine; Nordsjaellands Hospital; Hillerød Denmark
| | | | - Line Rejkjaer Thiesen
- Department of Pediatric and Adolescent Medicine; Nordsjaellands Hospital; Hillerød Denmark
| | - Jesper Andersen
- Department of Pediatric and Adolescent Medicine; Nordsjaellands Hospital; Hillerød Denmark
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48
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Hetrick SE, Cox GR, Witt KG, Bir JJ, Merry SN. Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents. Cochrane Database Syst Rev 2016; 2016:CD003380. [PMID: 27501438 PMCID: PMC8407360 DOI: 10.1002/14651858.cd003380.pub4] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Depression is common in young people. It has a marked negative impact and is associated with self-harm and suicide. Preventing its onset would be an important advance in public health. This is an update of a Cochrane review that was last updated in 2011. OBJECTIVES To determine whether evidence-based psychological interventions (including cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and third wave CBT)) are effective in preventing the onset of depressive disorder in children and adolescents. SEARCH METHODS We searched the specialised register of the Cochrane Common Mental Disorders Group (CCMDCTR to 11 September 2015), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched conference abstracts and reference lists of included trials and reviews, and contacted experts in the field. SELECTION CRITERIA We included randomised controlled trials of an evidence-based psychological prevention programme compared with any comparison control for young people aged 5 to 19 years, who did not currently meet diagnostic criteria for depression. DATA COLLECTION AND ANALYSIS Two authors independently assessed trials for inclusion and rated their risk of bias. We adjusted sample sizes to take account of cluster designs and multiple comparisons. We contacted trial authors for additional information where needed. We assessed the quality of evidence for the primary outcomes using GRADE. MAIN RESULTS We included 83 trials in this review. The majority of trials (67) were carried out in school settings with eight in colleges or universities, four in clinical settings, three in the community and four in mixed settings. Twenty-nine trials were carried out in unselected populations and 53 in targeted populations.For the primary outcome of depression diagnosis at medium-term follow-up (up to 12 months), there were 32 trials with 5965 participants and the risk of having a diagnosis of depression was reduced for participants receiving an intervention compared to those receiving no intervention (risk difference (RD) -0.03, 95% confidence interval (CI) -0.05 to -0.01; P value = 0.01). We rated this evidence as moderate quality according to the GRADE criteria. There were 70 trials (73 trial arms) with 13,829 participants that contributed to the analysis for the primary outcome of depression symptoms (self-rated) at the post-intervention time point, with results showing a small but statistically significant effect (standardised mean difference (SMD) -0.21, 95% CI -0.27 to -0.15; P value < 0.0001). This effect persisted to the short-term assessment point (up to three months) (SMD -0.31, 95% CI -0.45 to -0.17; P value < 0.0001; 16 studies; 1558 participants) and medium-term (4 to 12 months) assessment point (SMD -0.12, 95% CI -0.18 to -0.05; P value = 0.0002; 53 studies; 11,913 participants); however, the effect was no longer evident at the long-term follow-up. We rated this evidence as low to moderate quality according to the GRADE criteria.The evidence from this review is unclear with regard to whether the type of population modified the overall effects; there was statistically significant moderation of the overall effect for depression symptoms (P value = 0.0002), but not for depressive disorder (P value = 0.08). For trials implemented in universal populations there was no effect for depression diagnosis (RD -0.01, 95% CI -0.03 to 0.01) and a small effect for depression symptoms (SMD -0.11, 95% CI -0.17 to -0.05). For trials implemented in targeted populations there was a statistically significantly beneficial effect of intervention (depression diagnosis RD -0.04, 95% CI -0.07 to -0.01; depression symptoms SMD -0.32, 95% CI -0.42 to -0.23). Of note were the lack of attention placebo-controlled trials in targeted populations (none for depression diagnosis and four for depression symptoms). Among trials implemented in universal populations a number used an attention placebo comparison in which the intervention consistently showed no effect. AUTHORS' CONCLUSIONS Overall the results show small positive benefits of depression prevention, for both the primary outcomes of self-rated depressive symptoms post-intervention and depression diagnosis up to 12 months (but not beyond). Estimates of numbers needed to treat to benefit (NNTB = 11) compare well with other public health interventions. However, the evidence was of moderate to low quality using the GRADE framework and the results were heterogeneous. Prevention programmes delivered to universal populations showed a sobering lack of effect when compared with an attention placebo control. Interventions delivered to targeted populations, particularly those selected on the basis of depression symptoms, had larger effect sizes, but these seldom used an attention placebo comparison and there are practical difficulties inherent in the implementation of targeted programmes. We conclude that there is still not enough evidence to support the implementation of depression prevention programmes.Future research should focus on current gaps in our knowledge. Given the relative lack of evidence for universal interventions compared with attention placebo controls and the poor results from well-conducted effectiveness trials of universal interventions, in our opinion any future such trials should test a depression prevention programme in an indicated targeted population using a credible attention placebo comparison group. Depressive disorder as the primary outcome should be measured over the longer term, as well as clinician-rated depression. Such a trial should consider scalability as well as the potential for the intervention to do harm.
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Affiliation(s)
- Sarah E Hetrick
- The National Centre of Excellence in Youth Mental HealthOrygen35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Georgina R Cox
- The National Centre of Excellence in Youth Mental HealthOrygen35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | | | - Julliet J Bir
- University of AucklandDepartment of PsychiatryPrivate Bag 92109AucklandNew Zealand
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicinePrivate Bag 92019AucklandNew Zealand
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Kaess M, Parzer P, Brunner R, Koenig J, Durkee T, Carli V, Wasserman C, Hoven CW, Sarchiapone M, Bobes J, Cosman D, Värnik A, Resch F, Wasserman D. Pathological Internet Use Is on the Rise Among European Adolescents. J Adolesc Health 2016; 59:236-9. [PMID: 27267140 DOI: 10.1016/j.jadohealth.2016.04.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/11/2016] [Accepted: 04/11/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Increased Internet accessibility has been accompanied by an increased awareness of pathological Internet use (PIU). The aim of the study was to investigate a potential increase of PIU among European adolescents. METHODS Comparable data from two large cross-sectional multicentre, school-based studies conducted in 2009/2010 and 2011/2012 in five European countries (Estonia, Germany, Italy, Romania, and Spain) were used. The Young's Diagnostic Questionnaire was used to assess the prevalence of PIU. RESULTS The comparison of the two samples provides evidence that the prevalence of PIU is on the rise (4.01%-6.87%, odds ratio = 1.69, p < .001) except in Germany. Comparison with data on Internet accessibility suggests that the rise in prevalence of adolescent PIU may be a consequence of increased Internet accessibility. CONCLUSIONS Our findings are the first data to confirm the rise of PIU among European adolescents. They definitively warrant further efforts in the implementation and evaluation of preventive interventions.
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Affiliation(s)
- Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
| | - Peter Parzer
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Tony Durkee
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York; Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Doina Cosman
- Department of Clinical Psychology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Airi Värnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn University, Tallinn, Estonia
| | - Franz Resch
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
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50
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A 2-year longitudinal study of prospective predictors of pathological Internet use in adolescents. Eur Child Adolesc Psychiatry 2016; 25:725-34. [PMID: 26526444 DOI: 10.1007/s00787-015-0779-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/28/2015] [Indexed: 02/05/2023]
Abstract
Longitudinal studies of prospective predictors for pathological Internet use (PIU) in adolescents as well as its course are lacking. This three-wave longitudinal study was conducted within the framework of the European Union-funded project "Saving and Empowering Young Lives in Europe" over a 2-year period. The sample consisted of 1444 students at the baseline investigation (T0); 1202 students after 1 year (T1); and 515 students after 2 years (T2). Structured self-report questionnaires were administered at all three time points. PIU was assessed using the Young Diagnostic Questionnaire (YDQ). In addition, demographic (i.e., gender), social (i.e., parental involvement), psychological (i.e., emotional problems), and Internet use-related factors (i.e., online activities) were assessed as prospective predictors. The prevalence of PIU was 4.3 % at T0, 2.7 % at T1 and 3.1 % at T2. However, only 3 students (0.58 %) had persistent categorical PIU (YDQ score of ≥5) over the 2-year period. In univariate models, a variety of variables that have been previously identified in cross-sectional investigations predicted PIU at T2. However, multivariate regression demonstrated that only previous PIU symptoms and emotional problems were significant predictors of PIU 2 years later (adjusted R (2) 0.23). The stability of categorical PIU in adolescents over 2 years was lower than previously reported. However, current PIU symptoms were the best predictor of later PIU; emotional symptoms also predicted PIU over and above the influence of previous problematic Internet use. Both PIU symptoms and emotional problems may contribute to the vicious cycle that supports the perpetuation of PIU.
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