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Liljedahl SI, Hellner C, Pettersson A, Ghaderi A. School-based self-harm prevention programs: A systematic review with implications for international implementation. Scand J Psychol 2023; 64:825-837. [PMID: 37366058 DOI: 10.1111/sjop.12945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
Both self-harm and suicidal behaviors have been targeted through school-based prevention programs, many of which have been developed in the United States. The aims of this systematic review were to assess effects of school-based prevention programs on suicide and self-harm and to evaluate whether they are fit to the exporting culture. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our inclusion criteria, structured according to population/problem, intervention, control/comparison, outome, were: children and youth up to 19 years of age, school-based programs at universal, selective or indicated levels compared with teaching as usual or with other programs, and outcomes of suicide or self-harm measured at least 10 weeks after intervention. Studies without a control group or using non-behavioral outcomes were excluded. A comprehensive and systematic literature search was conducted from the 1990s to March 2022. Risk for bias was assessed with checklists adapted from the Cochrane Risk of Bias (ROB) tool. A total of 1,801 abstracts were retrieved. Five studies fulfilled our inclusion criteria, but one had high risk for bias. Confidence in the evidence for effect was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Studies included in this review were evaluated with respect to applicability in the context of international export. Only two school-based programs demonstrated efficacy in preventing suicidal behaviors. Although implementation of evidence-based interventions is a crucial next step, further replication with simultaneous attention to dissemination and implementation issues are called for. Funding and registration: conducted on assignment by the Swedish government. The protocol is available at the SBU website in Swedish.
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Affiliation(s)
- Sophie I Liljedahl
- Department of Psychiatry for Affective Disorders, National Specialized Medical Care Unit for Severe Self-Harm Behaviour, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Clara Hellner
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Agneta Pettersson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Pierret ACS, Anderson JK, Ford TJ, Burn AM. Review: Education and training interventions, and support tools for school staff to adequately respond to young people who disclose self-harm - a systematic literature review of effectiveness, feasibility and acceptability. Child Adolesc Ment Health 2022; 27:161-172. [PMID: 33277965 DOI: 10.1111/camh.12436] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Self-harm among young people is a major public health concern, and whilst schools are well placed to identify and intervene with students who self-harm, the literature shows that school staff lack training and confidence in this area. This systematic review investigated the effectiveness, feasibility and acceptability of training interventions and support tools intended to equip school staff with skills and knowledge to adequately respond to students' disclosure of self-harm. METHOD References for this review were identified through systematic searches of Medline, Embase, PsycINFO, Child Development & Adolescent Studies, ERIC, ASSIA and British Education Index on with search terms 'self-harm', 'training', 'school staff' and 'young people'. Thematic synthesis was used to analyse qualitative data. RESULTS We found that all eight included studies evaluated interventions/tools that were highly effective in terms of an increase in knowledge, skills and confidence of staff in responding to self-harming youth. Acceptability was good with high levels of satisfaction and perceived benefit by staff, though data on feasibility of the interventions were lacking. Limitations of the studies included a paucity of follow-up data, and lack of data relating to student outcomes and actual changes in staff practice in schools. CONCLUSIONS The findings from this review indicate that more evidence is needed to determine the effectiveness, acceptability and feasibility of interventions/tools for school staff addressing self-harm. Further studies should focus on maintaining knowledge, confidence and comfort levels over time, and determine the feasibility of interventions/tools with different staff cohorts and across school settings, as well as address outcomes for students.
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Affiliation(s)
- Aureliane C S Pierret
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Gijzen MWM, Rasing SPA, Creemers DHM, Engels RCME, Smit F. Effectiveness of school-based preventive programs in suicidal thoughts and behaviors: A meta-analysis. J Affect Disord 2022; 298:408-420. [PMID: 34728296 DOI: 10.1016/j.jad.2021.10.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 10/01/2021] [Accepted: 10/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Suicidal thoughts and behaviors (STBs) among adolescents have hardly decreased despite preventative efforts. School-based prevention programs could have a great reach, yet suicide prevention is not an easy topic to address. To increase acceptability of school-based suicide prevention, it is important to evaluate whether programs that target known risk factors of STBs, such as depression, could be equally effective. METHODS We conducted a systematic literature search in major electronic databases. Outcomes were suicidal ideation and behaviors. Multivariate random effects meta-regression-analyses were conducted. RESULTS Eleven primary studies met the inclusion criteria, totalling 23,230 participants. The post-test effect size was small for both suicidal ideation (g = 0.15) and suicidal behaviors (g = 0.30). Meta-regression indicated that targeting known risk factors of STBs was not a significant modifier of effect size for ideation, indicating equal effectiveness. However, it was significant modifier of effect for behaviors, but only one intervention targeted know risk factors. Effects at follow-up (3-12 months) were also significant but small for both outcomes. LIMITATIONS Substantial heterogeneity between studies was noted. Only few and small sample size studies could be included that targeted known risk factors of STBs. Therefore, these results should be interpreted with caution. CONCLUSIONS School-based prevention of STBs shows some promise within three months post-test assessments, and potentially also have effects that are sustained over time. More studies are needed to make conclusions regarding school-based interventions that target risk factors of STBs.
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Affiliation(s)
- Mandy W M Gijzen
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, Utrecht 3500 AS, the Netherlands; Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands; GGZ Oost Brabant, P.O. Box 3, Boekel 5427 ZG, the Netherlands.
| | - Sanne P A Rasing
- GGZ Oost Brabant, P.O. Box 3, Boekel 5427 ZG, the Netherlands; Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, Nijmegen 6500 HE, the Netherlands
| | - Daan H M Creemers
- GGZ Oost Brabant, P.O. Box 3, Boekel 5427 ZG, the Netherlands; Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, Nijmegen 6500 HE, the Netherlands
| | - Rutger C M E Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands
| | - Filip Smit
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, Utrecht 3500 AS, the Netherlands; Department of Clinical, Neuro and Developmental Psychology and Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, P.O. Box 7057, Amsterdam 1007 MB, the Netherlands
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Soneson E, Howarth E, Ford T, Humphrey A, Jones PB, Thompson Coon J, Rogers M, Anderson JK. Feasibility of School-Based Identification of Children and Adolescents Experiencing, or At-risk of Developing, Mental Health Difficulties: a Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:581-603. [PMID: 32062764 PMCID: PMC7305254 DOI: 10.1007/s11121-020-01095-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Under-identification of mental health difficulties (MHD) in children and young people contributes to the significant unmet need for mental health care. School-based programmes have the potential to improve identification rates. This systematic review aimed to determine the feasibility of various models of school-based identification of MHD. We conducted systematic searches in Medline, Embase, PsycINFO, ERIC, British Education Index, and ASSIA using terms for mental health combined with terms for school-based identification. We included studies that assessed feasibility of school-based identification of students in formal education aged 3-18 with MHD, symptomatology of MHD, or exposed to risks for MHD. Feasibility was defined in terms of (1) intervention fit, (2) cost and resource implications, (3) intervention complexity, flexibility, manualisation, and time concerns, and (4) adverse events. Thirty-three studies met inclusion criteria. The majority focused on behavioural and socioemotional problems or suicide risk, examined universal screening models, and used cross-sectional designs. In general, school-based programmes for identifying MHD aligned with schools' priorities, but their appropriateness for students varied by condition. Time, resource, and cost concerns were the most common barriers to feasibility across models and conditions. The evidence base regarding feasibility is limited, and study heterogeneity prohibits definitive conclusions about the feasibility of different identification models. Education, health, and government agencies must determine how to allocate available resources to make the widespread adoption of school-based identification programmes more feasible. Furthermore, the definition and measurement of feasibility must be standardised to promote any future comparison between models and conditions.
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Affiliation(s)
- Emma Soneson
- University of Cambridge Department of Psychiatry, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK.
| | - Emma Howarth
- NIHR Applied Research Collaboration (ARC) East of England, University of Cambridge, Cambridge, UK
| | - Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | - Ayla Humphrey
- University of Cambridge Department of Psychiatry, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
| | - Peter B Jones
- University of Cambridge Department of Psychiatry, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
| | - Jo Thompson Coon
- NIHR ARC South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Morwenna Rogers
- NIHR ARC South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Joanna K Anderson
- NIHR Applied Research Collaboration (ARC) East of England, University of Cambridge, Cambridge, UK
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Kuiper N, Goldston D, Godoy Garraza L, Walrath C, Gould M, McKeon R. Examining the Unanticipated Adverse Consequences of Youth Suicide Prevention Strategies: A Literature Review with Recommendations for Prevention Programs. Suicide Life Threat Behav 2019; 49:952-965. [PMID: 29999179 DOI: 10.1111/sltb.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/16/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Youth suicide is a public health problem in the United States. Suicide prevention programs have been shown to be beneficial; however, knowledge of unanticipated adverse consequences of programs is limited. The objective of this review is to present what is known about these consequences so informed decisions and appropriate planning can be made prior to implementation of suicide prevention interventions. METHOD A narrative but systematic review was conducted assessing what is known about adverse consequences utilizing a comprehensive keyword search of EBSCO and PubMed databases. Study populations beyond youth were included. RESULTS Unanticipated adverse consequences of suicide prevention interventions were included in 22 publications. Consequences occur at three levels: at the level of the youth, those who identify or intervene with at-risk youth, and at the system level. While rare, unanticipated adverse consequences include an increase in maladaptive coping and a decrease in help-seeking among program targets, overburden or increased suicide ideation among program implementers, and inadequate systemic preparedness. CONCLUSIONS Overall, the benefits of youth suicide prevention outweigh the unanticipated adverse consequences. Nevertheless, these results may be utilized for informed decision-making regarding suicide prevention programming, and to ensure appropriate infrastructure is in place prior to prevention efforts.
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Affiliation(s)
| | - David Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Madelyn Gould
- Department of Epidemiology and Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Richard McKeon
- Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
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Improving Schools' Readiness for Involvement in Suicide Prevention: An Evaluation of the Creating Suicide Safety in Schools (CSSS) Workshop. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122165. [PMID: 31248082 PMCID: PMC6617090 DOI: 10.3390/ijerph16122165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/24/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022]
Abstract
Schools have an important role to play in combatting suicide, a significant public health problem that disproportionately affects adolescents and young adults. Schools can work to reduce youth suicidality by adopting policies that align with best practice recommendations pertaining to suicide prevention, intervention, and postvention. This study examined the impact of a one-day training, the Creating Suicide Safety in Schools (CSSS) workshop, on the readiness of school personnel to improve their schools’ suicide-related policies and procedures. Participants (N = 562) consisted predominantly of school-based mental health professionals working in communities of low or mixed socioeconomic status in New York State. Survey data were collected according to a one-group pre-test—post-test design with a 3-month follow-up. Workshop participants demonstrated improvements from pre-test to post-test in their attitudes about the importance of school-based suicide prevention, knowledge of best practices, perceptions of administrative support, and feelings of empowerment to work collaboratively to enhance their schools’ suicide safety. At follow-up, participants reported barriers to implementing changes, most commonly in the form of insufficient time and stigma surrounding the topic of suicide. The results of this study provide preliminary evidence for the effectiveness of the CSSS workshop as a promising method for improving schools’ suicide safety, yet additional research using randomized controlled trials needs to be conducted.
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Soneson E, Childs-Fegredo J, Anderson JK, Stochl J, Fazel M, Ford T, Humphrey A, Jones PB, Howarth E. Acceptability of screening for mental health difficulties in primary schools: a survey of UK parents. BMC Public Health 2018; 18:1404. [PMID: 30577830 PMCID: PMC6303970 DOI: 10.1186/s12889-018-6279-7] [Citation(s) in RCA: 11] [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: 06/14/2018] [Accepted: 11/28/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Many children and young people experiencing mental health difficulties (MHD) do not access care, often due to inadequate identification. Schools have a unique potential to improve early identification; however, evidence is limited regarding the acceptability of school-based identification programmes. This study aimed to examine parents' beliefs about the acceptability of school-wide MHD screening in primary schools. METHODS We collaborated with experts in school-based mental health to develop a questionnaire to measure parental attitudes toward school-wide MHD screening. The questionnaire contained 13 items relating to acceptability; three open-text boxes for comments on harms, benefits, and screening in general; and four questions that captured demographic information. Parents of children attending four primary schools in Cambridgeshire and Norfolk completed the questionnaire. We calculated counts, percentages, and means for each statement, and analysed responses to open-ended questions using content analysis. RESULTS Two hundred ninety parents returned the questionnaire across the four schools (61% response rate). In the 260 questionnaires analysed, a total of 254 parents (98%) believed that it is important to identify MHD early in life, and 251 (97%) believed that schools have an important role in promoting pupils' emotional health. The majority of parents (N = 213; 82%) thought that screening would be helpful, although 34 parents (13%) thought that screening would be harmful. Perceived harms of screening included inaccurate identification, stigmatisation, and low availability of follow-up care. There was no clear consensus regarding how to obtain consent or provide feedback of screening results. There were no significant differences in responses according to ethnicity, gender, age, or school. CONCLUSIONS Results suggest that most parents within the socio-demographic context of our study will accept MHD screening within primary schools, and that school-based screening is viable from the perspective of parents. The comments provided about potential harms as well as suggestions for programme delivery are relevant to inform the development and evaluation of acceptable and sustainable school-based identification models. Implementation and scale-up of such programmes will require further understanding of the perspectives of mental health professionals, school staff, and the general public as well as further evaluation against the established standards for identification programmes.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Cambridge, CB2 0SZ UK
| | - Jasmine Childs-Fegredo
- NIHR CLAHRC East of England, University of Cambridge, Institute of Public Health, Douglas House, 18 Trumpington Road, Cambridge, CB2 8AH UK
| | - Joanna K. Anderson
- NIHR CLAHRC East of England, University of Cambridge, Institute of Public Health, Douglas House, 18 Trumpington Road, Cambridge, CB2 8AH UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Cambridge, CB2 0SZ UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Tamsin Ford
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Ayla Humphrey
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Cambridge, CB2 0SZ UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Cambridge, CB2 0SZ UK
| | - Emma Howarth
- NIHR CLAHRC East of England, University of Cambridge, Institute of Public Health, Douglas House, 18 Trumpington Road, Cambridge, CB2 8AH UK
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Gould MS, Lake AM, Kleinman M, Galfalvy H, Chowdhury S, Madnick A. Exposure to Suicide in High Schools: Impact on Serious Suicidal Ideation/Behavior, Depression, Maladaptive Coping Strategies, and Attitudes toward Help-Seeking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E455. [PMID: 29509702 PMCID: PMC5877000 DOI: 10.3390/ijerph15030455] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 02/22/2018] [Accepted: 02/28/2018] [Indexed: 11/16/2022]
Abstract
Adolescents' exposure to a peer's suicide has been found to be associated with, as well as to predict, suicidal ideation and behavior. Although postvention efforts tend to be school-based, little is known about the impact of a schoolmate's suicide on the school's student population overall. The present study seeks to determine whether there is excess psychological morbidity among students in a school where a schoolmate has died by suicide, and whether students' attitudes about coping and help-seeking strategies are more or less problematic in such schools. Students in twelve high schools in Suffolk and Westchester counties in New York State-2865 students at six schools where a student had died by suicide within the past six months, and 2419 students at six schools where no suicide had occurred within the current students' tenure-completed an assessment of their suicidal ideation and behavior, depressive symptoms, coping and help-seeking attitudes, stressful life events, and friendship with suicide decedent (if applicable). No excess morbidity (i.e., serious suicidal ideation/behavior and depression) was evident among the general student population after a schoolmate's death by suicide; however, the risk of serious suicidal ideation/behavior was elevated among students at exposed schools who had concomitant negative life events. There was a significant relationship between friendship with the decedent and morbidity, in that students who were friends, but not close friends, of the decedents had the greatest odds of serious suicidal ideation/behavior. Overall, students in exposed schools had more adaptive attitudes toward help-seeking; but this was not true of the decedents' friends or students with concomitant negative life events. The implications of the findings for postvention strategies are discussed.
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Affiliation(s)
- Madelyn S Gould
- Division of Child & Adolescent Psychiatry and Department of Epidemiology, Columbia University Medical Center and The New York State Psychiatric Institute, 1051 Riverside Drive, Unit 72, New York, NY 10032, USA.
| | - Alison M Lake
- Division of Child & Adolescent Psychiatry, The New York State Psychiatric Institute, 1051 Riverside Drive, Unit 72, New York, NY 10032, USA.
| | - Marjorie Kleinman
- Division of Child & Adolescent Psychiatry, The New York State Psychiatric Institute, 1051 Riverside Drive, Unit 72, New York, NY 10032, USA.
| | - Hanga Galfalvy
- Departments of Psychiatry and Biostatistics, Columbia University Medical Center, 722 West 168 Street, New York, NY 10032, USA.
| | - Saba Chowdhury
- Division of Child & Adolescent Psychiatry, The New York State Psychiatric Institute, 1051 Riverside Drive, Unit 72, New York, NY 10032, USA.
| | - Alison Madnick
- Division of Child & Adolescent Psychiatry, The New York State Psychiatric Institute, 1051 Riverside Drive, Unit 72, New York, NY 10032, USA.
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Ream GL. The Interpersonal-Psychological Theory of Suicide in College Student Suicide Screening. Suicide Life Threat Behav 2016; 46:239-47. [PMID: 26317690 DOI: 10.1111/sltb.12188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/11/2015] [Indexed: 11/29/2022]
Abstract
Suicide screening on campus is limited by effectiveness of existing questionnaires. This study tests whether Interpersonal-Psychological Theory of Suicide (IPTS) constructs may be more effective in screening than traditional risk factors measures like the Interactive Screening Protocol (ISP). Participants were 188 traditional-age students from three different campuses recruited through a subject pool and peer recruiters. IPTS risk variables as a set explained all likelihood of higher risk responses to suicidality questions that was otherwise explained by risk factors, plus additional likelihood besides. Current IPTS measures are no screening "magic bullet," but further inquiry into use of these constructs is warranted.
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Affiliation(s)
- Geoffrey L Ream
- School of Social Work, Adelphi University, Garden City, NY, USA
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10
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Nadeem E, Santiago CD, Kataoka SH, Chang VY, Stein BD. School Personnel Experiences in Notifying Parents About Their Child's Risk for Suicide: Lessons Learned. THE JOURNAL OF SCHOOL HEALTH 2016; 86:3-10. [PMID: 26645415 PMCID: PMC4747656 DOI: 10.1111/josh.12346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 03/05/2015] [Accepted: 05/04/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Schools across the nation are increasingly implementing suicide prevention programs that involve training school staff and connecting students and their families to appropriate services. However, little is known about how parents are engaged in such efforts. METHODS This qualitative study examined school staff perspectives on parent involvement in the implementation of a district-wide suicide prevention program by analyzing focus group and interview data gathered on the program implementation processes. Participants included middle school teachers, administrators, and other school personnel. RESULTS Study results revealed that in the immediate wake of a crisis or concern about suicide, school staff routinely contacted parents. However, substantial barriers prevent some students from receiving needed follow-up care (eg, lack of consistent follow-up, financial strain, parental stress, availability of appropriate services). Despite these challenges, school staff identified strategies that could better support parents before, during, and after the crisis. In particular, school-based services increased the success of mental health referrals. CONCLUSIONS Our study suggests that systematic postcrisis follow-up procedures are needed to improve the likelihood that students and families receive ongoing support. In particular, school-based services and home visits, training and outreach for parents, and formal training for school mental health staff on parent engagement may be beneficial in this context.
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Affiliation(s)
- Erum Nadeem
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, Bronx, NY 10461.
- Department of Child & Adolescent Psychiatry, New York University School of Medicine, One Park Ave, 7th Floor, NYU Child Study Center, New York, NY 10016.
| | | | - Sheryl H Kataoka
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, 10920 Wilshire Boulevard, Los Angeles, CA 90024.
| | | | - Bradley D Stein
- RAND Corporation, Adjunct Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, 4570 Fifth Ave., Pittsburgh, PA 15213.
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Cotter P, Kaess M, Corcoran P, Parzer P, Brunner R, Keeley H, Carli V, Wasserman C, Hoven C, Sarchiapone M, Apter A, Balazs J, Bobes J, Cosman D, Haring C, Kahn JP, Resch F, Postuvan V, Värnik A, Wasserman D. Help-seeking behaviour following school-based screening for current suicidality among European adolescents. Soc Psychiatry Psychiatr Epidemiol 2015; 50:973-82. [PMID: 25656270 DOI: 10.1007/s00127-015-1016-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To screen and clinically interview European adolescents reporting current suicidality (suicidal ideation and suicide attempt) and investigate attendance at the clinical interview. METHODS The Saving and Empowering Young Lives in Europe (SEYLE) Project was carried out in 11 European countries. A baseline questionnaire was completed in school by 12,395 adolescents (mean age 14.9; SD 0.9). Those who screened positive for suicidality (attempting suicide and/or serious suicidal ideation or plans) in the past 2 weeks were invited to a clinical interview with a mental health professional. RESULTS Of the 12,395 adolescents, 4.2 % (n = 516) screened positive for current suicidality. The prevalence ranged from 1.1 % in Hungary to 7.7 % in Israel (p < 0.001). 37.6 % (n = 194) of those who screened positive subsequently attended the clinical interview. Female students were more likely to attend for interview (42.0 % versus 30.6 %, p = 0.010). The attendance rate varied considerably across countries, from 5.7 % in Italy to 96.7 % in France (p < 0.001). Improved attendance was associated with using school as the only interview setting (Mean attendance rate, MAR = 88 vs. 31 %, p = 0.006) and arranging the interview within 1 week of contacting the student (MAR = 64 vs. 23 %, p = 0.013). The greater the travel time to interview, the lower the attendance rate (Pearson's r = -0.64, p = 0.034). Independent of the variation by country, at the individual level, adolescents with more depressive symptoms and a recent suicide attempt more often attended for interview. CONCLUSION A high rate of current suicidality was found amongst European adolescents. However, the majority of these displayed limited help-seeking behaviour. Future studies should investigate ways of making screening programmes and other interventions more acceptable and accessible to young people, especially young males.
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Affiliation(s)
- Pádraig Cotter
- National Suicide Research Foundation, University College Cork, Western Gateway Building, Room 4.28, Cork, Ireland,
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12
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Abstract
Suicide is a public health problem affecting people across the lifespan. It is currently the 10th leading cause of death, with rates having remained relatively flat for the past century. This article summarizes the problem of suicide and suicidal behavior along with suicide prevention efforts in the United States. Part 1 provides an overview of the epidemiology of suicide, including groups most at risk of suicide and suicidal behavior. Part 2 provides a review of common risk factors, organized by developmental life stage. A brief discussion of the lesser well-researched area of protective factors follows. Part 3 provides an overview of suicide prevention today, including the major types of prevention strategies, their successes, including means restriction, quality improvement in behavioral services, and comprehensive programs; and limitations to date, such as a lack of evidence for impact on actual deaths or behavior, small sample sizes, and low base rates. Finally, part 4 discusses challenges and future directions with an eye toward the great many opportunities that exist for prevention.
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Affiliation(s)
- Deborah M Stone
- Division of Violence Prevention (DVP), National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Alex E Crosby
- Division of Violence Prevention (DVP), National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Kiperman S, Black MS, McGill TM, Harrell-Williams LM, Kamphaus RW. Predicting Behavior Assessment System for Children–Second Edition Self-Report of Personality Child Form Results Using the Behavioral and Emotional Screening System Student Form. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2014. [DOI: 10.1177/0734282914529200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study assesses the ability of a brief screening form, the Behavioral and Emotional Screening System–Student Form (BESS-SF), to predict scores on the much longer form from which it was derived: the Behavior Assessment System for Children–Second Edition Self-Report of Personality–Child Form (BASC-2-SRP-C). The present study replicates a former study included in the BESS manual with an entirely new sample. Participants included 252 students from a large, urban, Southwestern U.S. city school district in the third through fifth grades. The sample’s ethnic majority was Hispanic (81.7%). Results revealed high specificity and negative predictive values between the screener and omnibus form, suggesting a child who identifies as not “at-risk” on the BESS-SF will likely identify as not “at-risk” on the BASC-2-SRP-C domains. These results effectively replicate the previous findings with a new sample of largely Hispanic (Latino/a) students from a large urban school district.
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Mental health screening of African American adolescents and facilitated access to care. Community Ment Health J 2012; 48:71-8. [PMID: 21559920 DOI: 10.1007/s10597-011-9413-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 04/25/2011] [Indexed: 10/18/2022]
Abstract
This study retrospectively reviews de-identified records from school-based mental health screening in a predominantly African American community. We compare participation rates, screening results, referrals to services and access to care of white and African American adolescents. Among those offered screening, 20.1% of white students (n = 297), and 28.8% of African American students (n = 499) were screened (χ(2) = 32.47, df = 1, P < .001). African American students (45.1%) were significantly more likely than white students (33.0%), (AOR = 1.59; P = .003) to be identified as being at risk. In both racial groups, most youth accessed the school-based services (89.02%, 95% CI 82.25-95.79) and community services (86.57%, 95% CI 78.41-94.73) to which they were referred. The groups did not differ in the odds of accessing community-based services (AOR = .58; P = .49). African American students were, however, more likely than white students to access school-based services (AOR = 10.08; P = .022). The findings support the effectiveness of screening in school settings in predominantly African American communities.
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Husky MM, Sheridan M, McGuire L, Olfson M. Mental health screening and follow-up care in public high schools. J Am Acad Child Adolesc Psychiatry 2011; 50:881-91. [PMID: 21871370 DOI: 10.1016/j.jaac.2011.05.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 05/25/2011] [Accepted: 05/26/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Despite increased interest in screening adolescents for mental health problems and suicide risk, little is known regarding the extent to which youth are identified and connected with appropriate services. METHOD Between 2005 and 2009, a total of 4,509 ninth-grade students were offered screening. We reviewed the records of the 2,488 students who were screened. Students identified as being at risk were provided with a referral. Data were collected on screening results, mental health referrals, and completion of recommended treatment over approximately 90 days. RESULTS Among students screened, 19.6% were identified as being at risk, 73.6% of whom were not currently receiving any treatment. Students referred for school services tended to be less severely ill than those referred for community services, with lower rates of suicidal ideation, prior suicide attempts, and self-injury. Among at-risk students not currently in treatment, 76.3% of students referred received at least one mental health visit during the follow-up period. Overall, 74.0% of students were referred to school and 57.3% to community services. A great majority of school referrals (80.2%) successfully accessed services, although a smaller proportion of community services referrals successfully accessed treatment (41.9%). CONCLUSIONS Systematic voluntary school-based mental health screening and referral offers a feasible means of identifying and connecting high-risk adolescents to school- and community-based mental health services, although linkages to community-based services may require considerable coordination.
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Affiliation(s)
- Mathilde M Husky
- New York State Psychiatric Institute, Columbia University, New York, NY 10019, USA.
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16
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Nadeem E, Kataoka SH, Chang VY, Vona P, Wong M, Stein BD. The Role of Teachers in School-Based Suicide Prevention: A Qualitative Study of School Staff Perspectives. SCHOOL MENTAL HEALTH 2011; 3:209-221. [PMID: 27042239 DOI: 10.1007/s12310-011-9056-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In response to concerns over youth suicide, there has been an increase in school-based suicide prevention programs. However, we know little about teacher perspectives on school-based suicide prevention and mental health programs. This study examined teacher roles in the implementation of a district-wide suicide prevention program through focus groups and interviews with middle school teachers, administrators, and other school personnel. Study results highlighted teachers' critical role in detecting students at risk for suicide. Factors that appeared to facilitate teacher participation in the suicide prevention program included well-defined crisis policies and procedures, communication of these procedures, collaboration across staff, and the presence of on-campus mental health resources. Participants identified a need for direct teacher training on risk factors for suicide, crisis response, and classroom management. Other strategies for improving suicide prevention efforts included in-school trainings on mental health resources and procedures, regular updates to these trainings, and greater visibility of mental health staff.
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Affiliation(s)
- Erum Nadeem
- Division of Mental Health Services and Policy Research, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Sheryl H Kataoka
- Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA, UCLA Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vickie Y Chang
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Pamela Vona
- UCLA Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Marleen Wong
- School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Bradley D Stein
- RAND Corporation, Pittsburgh, PA, USA, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Stein BD, Kataoka SH, Hamilton AB, Schultz D, Ryan G, Vona P, Wong M. School personnel perspectives on their school's implementation of a school-based suicide prevention program. J Behav Health Serv Res 2010; 37:338-49. [PMID: 19291410 PMCID: PMC3711023 DOI: 10.1007/s11414-009-9174-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 02/07/2009] [Indexed: 10/21/2022]
Abstract
Youth suicide is a national public health priority, with policymakers highlighting schools as an ideal setting in which to deliver suicide prevention programs. Over the past decade, the number of schools implementing such programs has grown substantially, yet little is known about how successfully such programs are being implemented. This study examines the implementation of a district-wide suicide prevention program through key informant interviews with school personnel. Schools with higher rates of implementing district protocols for at-risk students had an organized system to respond to at-risk students, a process for effectively responding to students who were at-risk for suicide, and strong administrative support. In contrast, schools that had lower rates of implementing district protocols relied on a handful of individuals for suicide prevention activities and had limited administrative support. Attention to organizational factors leading to successful implementation of school-based suicide prevention programs may enhance the role of schools in national adolescent suicide prevention efforts.
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Affiliation(s)
- Bradley D. Stein
- University of Pittsburgh 4570 Fifth Avenue, Suite 600 Pittsburgh, PA 15213 Phone: (412) 683-2300 x4476 Fax: (412) 682-2800
| | - Sheryl H. Kataoka
- Division of Child and Adolescent Psychiatry UCLA Semel Institute 10920 Wilshire Boulevard, Suite 300 Los Angeles, CA 90024 Phone: (310) 794-3727 Fax: (310) 794-3724
| | - Alison B. Hamilton
- UCLA 1640 S. Sepulveda Blvd., Suite 200 Los Angeles, CA 90025 Phone: 310-267-5421 Fax: 310-473-7885
| | - Dana Schultz
- RAND Corporation 4570 Fifth Avenue, Suite 600 Pittsburgh, PA 15213 Phone: (412) 683-2300 x4613 Fax: (412) 683-2800
| | - Gery Ryan
- RAND Corporation 1776 Main Street Santa Monica, CA 90407 Phone: (412) 683-2300 x4613
| | - Pamela Vona
- UCLA Health Services Research Center 10920 Wilshire Blvd. Suite 300 Los Angeles, CA 90024 (310) 825-0495
| | - Marleen Wong
- Crisis Counseling and Intervention Services Los Angeles Unified School District 333 South Beaudry, 20 Floor Los Angeles, CA 90017 Phone: (213) 241-2174 Fax: (213) 241-6816
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Husky MM, Kaplan A, McGuire L, Flynn L, Chrostowski C, Olfson M. Identifying adolescents at risk through voluntary school-based mental health screening. J Adolesc 2010; 34:505-11. [PMID: 20561672 DOI: 10.1016/j.adolescence.2010.05.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 05/13/2010] [Accepted: 05/26/2010] [Indexed: 10/19/2022]
Abstract
This study compares referrals for mental health services among high school students randomized to two means of referral to mental health services: referral via systematic identification through a brief mental health screening procedure (n = 365) or referral via the usual process of identification by school personnel, parents, or students themselves (n = 291). Screened students were significantly more likely than control students (AOR: 21.64 95%CI 6.66-70.36) to receive a referral for mental health services, whether it be to school-based services (AOR: 11.68 95%CI 3.52-8.73) or community-based services (AOR: 20.02 95%CI 2.66-150.41). Post-study, for those screened, 95.5% of school-based mental health services referrals, and 39.3% of community-based referrals were accessed. School based mental health screening identified a significantly greater proportion of youth to be in clinical need of mental health services than would have likely been identified without screening, and increased rates of referral resulted in greater access to mental health services.
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Affiliation(s)
- Mathilde M Husky
- New York State Psychiatric Institute, Columbia University, 1775 Broadway, Suite 610, New York, NY 10019, USA.
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Takada M, Shima S. Characteristics and effects of suicide prevention programs: comparison between workplace and other settings. INDUSTRIAL HEALTH 2010; 48:416-426. [PMID: 20720333 DOI: 10.2486/indhealth.ms998] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The present study reviews the literature on suicide prevention programs conducted in the workplace and other settings, namely school, the community, medical facilities, jail, and the army, by conducting an electronic literature search of all articles published between 1967 and November 2007. From a total of 256 articles identified, various contents of suicide prevention programs were determined, and in 34 studies, the effect of programs was evaluated. A review of the literature reveals that the common contents of suicide prevention programs in the workplace and other settings are education and training of individuals, development of a support network, cooperation from internal and external resources, as well as education and training of managers and staff. Although the characteristic contents of suicide prevention programs at the workplace aimed at improving personnel management and health care, screening and care for high-risk individuals, as well as improvement of building structures, were not described. Although a reduction in undesirable attitudes and an increase in mental health knowledge and coping skills in the workplace are in agreement with findings in other settings, suicide rate, suicide-associated behavior, and depression, which were assessed in other settings, were not evaluated in the three studies targeting the workplace.
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Affiliation(s)
- Misato Takada
- Department of Community-oriented Medicine, Mie University.
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Abstract
PURPOSE OF REVIEW Every year, suicide claims the lives of tens of thousands of young people worldwide. Despite its high prevalence and known risk factors, suicidality is often undetected. Early identification of suicide risk may be an important method of mitigating this public health crisis. Screening youth for suicide may be a critical step in suicide prevention. This paper reviews suicide screening in three different settings: schools, primary care clinics and emergency departments (EDs). RECENT FINDINGS Unrecognized and thus untreated suicidality leads to substantial morbidity and mortality. With the onus of detection falling on nonmental health professionals, brief screening tools can be used to initiate more in-depth evaluations. Nonetheless, there are serious complexities and implications of screening all children and adolescents for suicide. Recent studies show that managing positive screens is a monumental challenge, including the problem of false positives and the burden subsequently posed on systems of care. Furthermore, nearly 60% of youth in need of mental health services do not receive the care they need, even after suicide attempt. Schools, primary care clinics and EDs are logical settings where screening that leads to intervention can be initiated. SUMMARY Valid, brief and easy-to-administer screening tools can be utilized to detect risk of suicide in children and adolescents. Targeted suicide screening in schools, and universal suicide screening in primary care clinics and EDs may be the most effective way to recognize and prevent self-harm. These settings must be equipped to manage youth who screen positive with effective and timely interventions. Most importantly, the impact of suicide screening in various settings needs to be further assessed.
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Reis C, Cornell D. An Evaluation of Suicide Gatekeeper Training for School Counselors and Teachers. ACTA ACUST UNITED AC 2008. [DOI: 10.5330/psc.n.2010-11.386] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Suicide is the third leading cause of death in adolescence, and medically serious suicide attempts occur in approximately 3% of adolescents. This review examines a number of risk factors that contribute to suicidal behavior. A prior suicide attempt is one of the best predictors of both a repeat attempt and eventual completed suicide. Depression, disruptive behavior disorders, and substance-use disorders also place adolescents at high risk for suicidal behavior, with comorbidity further increasing risk. Research on families indicates that suicidal behavior is transmitted through families. Groups at high risk for suicidal behavior include gay, lesbian, and bisexual youths, incarcerated adolescents, and homeless/runaway teens. Although abnormalities in the serotonergic system have not been consistently linked to suicidal behavior, genetic and neurobiologic studies suggest that impulsive aggression may be the mechanism through which decreased serotonergic activity is related to suicidal behavior. Findings from prevention and intervention studies are modest and indicate the need for substantially more theory-driven treatment research.
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Affiliation(s)
- Anthony Spirito
- Center for Alcohol and Addiction Studies and Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island 02912, USA.
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23
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Eckert TL, Miller DN, Riley-Tillman TC, DuPaul GJ. Adolescent suicide prevention: Gender differences in students' perceptions of the acceptability and intrusiveness of school-based screening programs. J Sch Psychol 2006. [DOI: 10.1016/j.jsp.2006.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shields LBE, Hunsaker DM, Hunsaker JC. Adolescent and Young Adult Suicide: A 10-Year Retrospective Review of Kentucky Medical Examiner Cases. J Forensic Sci 2006; 51:874-9. [PMID: 16882232 DOI: 10.1111/j.1556-4029.2006.00164.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The compilation of all suicidal causes of death attained the third highest ranking of mortality between the ages of 15 and 24 following unintentional deaths and homicide in the United States, accounting for approximately 4000 deaths in 2002. A variety of biopsychosocial factors may contribute to adolescent suicidal behavior, including psychiatric disorders, risk-taking behaviors, and lack of a cohesive family unit. The authors conducted a 10-year (1993-2002) retrospective review of 108 Medical Examiner cases of suicide ages 11-17 and 358 cases ages 18-24 in Kentucky, which represents two thirds of the Coroner cases in the state. The majority of victims were male and Caucasian. The major causes of death were the same for the two age groups, specifically, firearm injury (72.2% and 70.7%), hanging (22.2% and 18.7%), and drug intoxication (2.8% and 5.3%). An integrated Coroner-Medical Examiner system profits in the public health arena by providing collaborative research data for policy decisions. The prevalence of youth suicide by firearm should prompt further discussion regarding ways to better identify high-risk adolescents and young adults and restrict pediatric access to unsecured household firearms.
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Affiliation(s)
- Lisa B E Shields
- Office of the Chief Medical Examiner, Urban Government Center, Louisville, KY 40204, USA
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