Sexual orientation and adolescent suicide attempt and self-harm: a co-twin control study

The role of victimisation and sleep quality in self-harm and depression among sexual minority adolescents. A prospective cohort study

Sexual minority adolescents (SMA) have a disproportionately high prevalence of victimisation, self-harm, and depressed mood, relative to the general population. Yet, the contributing and mechanistic factors are unclear. We aim to explore the directional relationship between victimisation and self-harm and depressed mood, with poor sleep quality as a possible mediator. A secondary data analysis was conducted using a nationally representative birth cohort in the United Kingdom, where participants self-identified as sexual minority (N = 1922, aged 11-13, 67.1% female) and their parents completed questionnaires and interviews when the participants were aged 11, 14 and 17. Logistic and linear regression were used to test whether victimisation prospectively predicted self-harm and depressed mood with mediation analyses conducted to assess if sleep onset latency and nocturnal awakening mediated their relationships. After adjusting for demographic factors and baseline self-harm and depressed mood, victimisation at age 11 significantly predicted self-harm (OR = 1.40, p < .01) and depressed mood (B = 0.024, SE = 0.01, p < .05) at age 17. In the mediation analyses, frequent nocturnal awakening at age 14, but not sleep onset latency, significantly mediated the effect of victimisation at age 11 on self-harm (indirect effect B = 0.008, SE = 0.004, 95%CI = 0.001-0.017) and depressed mood (indirect effect B = 0.005, SE = 0.002 95%CI = 0.001-0.010) at age 17. Our findings supported that victimisation contributed to negative mental health among SMA. Poor sleep quality could be an indicator of maladjustment with victimisation, which further increased vulnerability to negative mental health. Victimisation and sleep quality could be important assessment targets in mental health campaign among sexual minority adolescents.

Childhood Gender Nonconformity and Parental Maltreatment as Mediators of Sexual Orientation Disparities in Childhood Emotional and Behavioral Difficulties

The mechanisms underlying sexual orientation differences in psychopathology originating in childhood remain understudied since sexual orientation does not directly manifest in childhood. This study tested whether childhood gender nonconformity and parental maltreatment before age 6 years 9 months partly explained sexual orientation disparities in the developmental trajectories of emotional and behavioral difficulties from age 6 years 9 months to 11 years 8 months. The Avon Longitudinal Study of Parents and Children was used (2182 boys and 2422 girls, Mage = 15.5, 90% White). After controlling for early life factors, non-heterosexual boys and girls displayed significantly greater emotional and behavioral difficulties than their heterosexual counterparts at all three ages. There was a sex difference in the mediating effects. For girls, sexual orientation disparities in childhood emotional and behavioral difficulties were partially explained by childhood gender nonconformity. For boys, sexual orientation disparities in childhood emotional and behavioral difficulties were partially explained by a path through greater childhood gender nonconformity, leading to increased risk of being the targets of parental maltreatment. Childhood gender nonconformity, parental maltreatment, and other early life factors only partially explain sexual orientation disparities in childhood emotional and behavioral difficulties. The mediating effects of childhood gender nonconformity and parental maltreatment on the association between sexual orientation and childhood emotional and behavioral difficulties differ between the sexes.

Risk factors for deliberate self-poisoning among children and adolescents in The Netherlands

INTRODUCTION

In the past decade, the number of deliberate self-poisonings involving young people has increased strongly worldwide. This study aimed to gain insight into risk factors associated with deliberate self-poisonings among children and adolescents reported to the Dutch Poisons Information Center.

METHODS

A study was performed between 1 February 2022 and 31 January 2023 involving those aged 8-17 years of age with deliberate self-poisoning. Data were collected on patient characteristics (age, gender, body mass index and living situation) and exposure characteristics (type of toxicant, way of acquiring toxicant and day of exposure).

RESULTS

The Dutch Poisons Information Center was consulted about 1,424 deliberate self-poisonings among children and adolescents (10-17 years old). A high percentage of patients were female (85 percent), had a body mass index classified as overweight/obese (27 percent) and lived in a mental healthcare facility (13 percent). Patients mainly exposed themselves to pharmaceuticals, especially over-the-counter medications such as paracetamol (46 percent) and ibuprofen (15 percent). Young people living with parents/caregivers had higher odds of ingesting prescription pharmaceuticals or over-the-counter medication, while those living in a mental healthcare facility were more likely to ingest household products, personal care products or foreign bodies (predominantly batteries).

DISCUSSION

This study sheds light on the pervasive issue of deliberate self-poisoning among children and adolescents, advocating for poisoning prevention strategies and promoting mental health of youth. Limitations include reliance on self-reported data from patients and the absence of clinical outcome data.

CONCLUSIONS

Female gender, a high body mass index and living in a mental healthcare facility are associated with in increased risk of deliberate self-poisonings in children and adolescents (10-17 years old). Prevention of deliberate self-poisonings among youth could focus on restricting access to medication and other potentially hazardous non-pharmaceuticals, such as household products and batteries, as well as limiting the sales of over-the-counter medication, especially paracetamol, to this young population.

Same-Sex Marriage and Common Mental Health Diagnoses: A Sibling Comparison and Adoption Approach

We aimed to test whether the association between same-sex marriage and common mental health diagnoses was explained by shared genetic and environmental familial influences using sibling comparison and adoption analyses. For the sibling comparison analysis, participants (1,177,712 men and 1,266,917 women) were individuals born in Sweden between 1932 and 1994 and had ever been recorded as married (in opposite-sex or same-sex marriages). For the adoption analysis, participants were 147,164 and 1,298 female-female full sibling and adoptive sibling pairs, respectively. Based on medical records, prescribed medication, and death certificates, depression, substance abuse, and suicide (completed and attempted) from age 18 years were identified. For both sexes, being in a same-sex marriage was associated with greater risk of depression, substance abuse, and suicide, compared with being in an opposite-sex marriage. Controlling for shared familial confounding reduced this difference by less than 20% in magnitude, but overall mental health disparities for individuals in same-sex marriages remained statistically significant. Among women, only the genetic correlation between same-sex marriage and depression was statistically significant (r = .33). Same-sex marriage, as a proxy for sexual orientation, was associated with increased risk of certain mental health diagnoses and shared familial confounding explained a small component of this association, depending on the diagnosis. The findings indicate that sexual orientation disparities in mental health outcomes may involve unmeasured factors, and a relatively small proportion should be considered that may be due to shared familial confounding relevant to both sexual orientation and psychopathology.

Sexual-orientation differences in risk of health-related impaired ability to work and to remain in the paid workforce: a prospective population-based twin study

BACKGROUND

Studies consistently show an increased risk of poor health among sexual minorities (i.e., those identifying as lesbian, gay, bisexual [LGB] or other non-heterosexuals individuals), as compared to those identifying as heterosexual. It is largely unknown whether the increased risk of mental and physical health problems among sexual minorities is also reflected in an increased risk of health-related impaired ability to work, in terms of sickness absence (SA) and disability pension (DP), or successfully remain in the paid workforce. This study made use of a large sample of Swedish twins with self-reported information about sexual behavior in young adulthood to examine sexual orientation difference in SA and DP during a 12-year follow-up period.

METHOD

Data from the Swedish Twin project of Disability pension and Sickness absence (STODS), including Swedish twins born 1959-1985 was used (N = 17,539; n = 1,238 sexual minority). Self-report survey data on sexual behavior was linked to information about SA and DP benefits from the MicroData for Analysis of the Social Insurance database (MiDAS), the National Social Insurance Agency. Sexual orientation differences in SA and DP between 2006 and 2018 was analyzed, as well as, the influence of sociodemographic, social stress exposure (i.e., victimization, discrimination), mental health treatment, and family confounding on these differences.

RESULTS

Compared to heterosexuals, sexual minorities were more likely to having experienced SA and having been granted DP. The odds were highest for DP, where sexual minorities were 58% more likely to having been granted DP compared to heterosexuals. The higher odds for SA due to any diagnosis could largely be explained by sociodemographic factors. The higher odds of SA due to mental diagnosis could partially be explained by increased risk of being exposed to discrimination and victimization, and partially by having received treatment with antidepressant medication. The higher odds of being granted DP could also partially be explain by increased risk of being exposed to social stress and treatment with antidepressant medication.

CONCLUSION

To our knowledge, this is the first study to report on sexual orientation differences in risk of SA and DP in a population-based sample. We found higher period prevalence of both SA and DP among sexual minorities as compared to heterosexuals. The higher odds of SA and DP could partially or fully be explained by sexual orientation differences in sociodemographic factors, exposure to social stress, and antidepressant treatment for depression. Future studies can extend these findings by continuing to investigate risk factors for SA and DP among sexual minorities and how such factors can be reduced.

Suicide attempts by adolescents assisted in an emergency department: a cross-sectional study

OBJECTIVES

to identify and characterize the care provided to adolescents admitted to an emergency department due to a suicide attempt.

METHODS

an observational, cross-sectional, descriptive study with a retrospective approach, carried out with medical records of adolescents aged 10 to 19 admitted for suicide attempts, between January 2015 and July 2020, in an emergency department. Data were subjected to descriptive and inferential analysis.

RESULTS

eighty-eight service occurrences were identified, mainly to females, exposed to multiple risk factors. Exogenous intoxication was the main method used, occurring at home and on weekdays. There were systemic repercussions, requiring multiple interventions and hospitalizations. Only 26% of cases were notified.

CONCLUSIONS

adolescents treated for suicide attempts were exposed to multiple risk factors, with intoxication as the main means used. There is concern about the underreporting of cases and the logic of clinical care and medicalization.

Sexual orientation disparities in the developmental trajectories of emotional and behavioral difficulties from childhood to early adolescence

BACKGROUND

Lesbian, gay, bisexual, and asexual adolescents are at increased risk of poor mental health outcomes but it remains unknown whether this disparity emerges from early childhood and through to adolescence. This study tested sexual orientation disparities in the developmental trajectories of emotional and behavioral difficulties from ages 5 to 14 years, and the influence of early life adversities upon them.

METHODS

The Millennium Cohort Study, a British birth cohort, was used (4,838 boys and 5,016 girls). Parent-report emotional and behavioral difficulties at ages 5, 7, 11, and 14 were measured using the Strength and Difficulties Questionnaire. Sexual orientation was measured via sexual attraction at age 17. Early life adversities in the first 5 years of life, including parental age at birth, birthweight, duration of breastfeeding, parent-child relationship quality, and parental absence, were collected prospectively.

RESULTS

Latent growth modeling suggested that, for both sexes, sexual orientation disparities in emotional and behavioral difficulties increased from age 5 to 14 years. Homosexual and bisexual girls displayed significantly greater emotional and behavioral difficulties than heterosexual girls at ages 7, 11, and 14. Homosexual and bisexual boys displayed significantly greater emotional and behavioral difficulties than heterosexual boys at ages 11 and 14. Asexual boys and girls displayed significantly greater emotional and behavioral difficulties than their heterosexual counterparts at all four ages. For both sexes, sexual orientation disparities in emotional and behavioral difficulties only reduced slightly in magnitude after controlling for early life adversities.

CONCLUSIONS

Sexual minority disparities in emotional and behavioral difficulties increased from childhood to early adolescence, possibly due to the accumulation of susceptibility to minority-related stressors. Sex and early life adversity may contribute to these developmental disparities.

Neuroticism and Sexual Orientation-Based Victimization as Mediators of Sexual Orientation Disparities in Mental Health

This study tested whether elevated risk of poorer mental health outcomes among nonheterosexual adolescents compared with heterosexual adolescents is plausibly explained by neuroticism and sexual orientation-based victimization. The Millennium Cohort Study, a large British prospective birth cohort, was used (4566 heterosexual boys, 77 bisexual boys, 129 homosexual boys, 96 asexual boys, 4444 heterosexual girls, 280 bisexual girls, 158 homosexual girls, and 182 asexual girls). We analyzed the following measures assessed at age 17 years: sexual orientation based on sexual attraction, neuroticism, sexual orientation-based victimization, self-harm attempts, and psychological well-being. Mediation analysis was undertaken separately by sex and yielded the following statistically significant findings: for both sexes, we found that bisexual and homosexual adolescents scored higher than heterosexual adolescents on neuroticism; for both sexes, bisexual and homosexual adolescents reported more negative psychological well-being scores and self-harm attempts compared with heterosexual adolescents, with total effects (standardized regression coefficients) ranging from .58 to .91; those associations were mediated through sexual orientation-based victimization and neuroticism scores, with the indirect effects (standardized regression coefficients) through sexual orientation-based victimization and neuroticism scores ranging from .09 to .26 and .16 to .55, respectively. Asexual adolescents did not differ significantly from their heterosexual counterparts in psychological well-being and self-harm attempts, with the total effects ranging from - .02 to .21. Sexual orientation-based victimization and neuroticism may both contribute to the sexual orientation-related disparities in psychological well-being and self-harm attempts. However, neuroticism appears to the more powerful factor.

Examining protective factors for substance use problems and self-harm behavior during adolescence: A longitudinal co-twin control study

Sports participation, physical activity, and friendship quality are theorized to have protective effects on the developmental emergence of substance use and self-harm behavior in adolescence, but existing research has been mixed. This ambiguity could reflect, in part, the potential for confounding of observed associations by genetic and environmental factors, which previous research has been unable to rigorously rule out. We used data from the prospective, population-based Child and Adolescent Twin Study in Sweden (n = 18,234 born 1994-2001) and applied a co-twin control design to account for potential genetic and environmental confounding of sports participation, physical activity, and friendship quality (assessed at age 15) as presumed protective factors for adolescent substance use and self-harm behavior (assessed at age 18). While confidence intervals widened to include the null in numerous co-twin control analyses adjusting for childhood psychopathology, parent-reported sports participation and twin-reported positive friendship quality were associated with increased odds of alcohol problems and nicotine use. However, parent-reported sports participation, twin-reported physical activity, and twin-reported friendship quality were associated with decreased odds of self-harm behavior. The findings provide a more nuanced understanding of the risks and benefits of putative protective factors for risky behaviors that emerge during adolescence.

Psychological and social risk factors associated with development of psychopathology, controlling for biological influence

PURPOSE OF REVIEW

To evaluate and summarize recent research investigating psychological, social and environmental risk factors for development of psychopathology in childhood, while controlling for biological (genetic) influences by using a matched sibling, twin or adoptee design.

RECENT FINDINGS

Nineteen studies were included, of which eleven were longitudinal and eight were cohort studies. Included studies used adequate designs and statistical methods, controlled for unmeasured confounders and, in many cases, for other measured risk factors. None of the studies used the framework for environmental factors presented in the International Classification of Functioning, Disability and Health (ICF). The outcome variable psychopathology was rarely assessed using a diagnostic standard. The findings were sorted in five themes based on included exposures: 'Social support, social rejection and perceived identity,' 'Early symptoms of psychopathology,' 'Antibiotic exposure,' 'Factors in the family' and 'Nature versus nurture'.

SUMMARY

Using twin/sibling/adoptee designs, a number of unique predictors of psychopathology were found, even when controlling for familial confounders and other specified risk factors. Future studies of psychopathology development should benefit from longitudinal, genetically sensitive designs and from use of diagnostic standards for psychopathology outcome, and should also incorporate ICF for classification of risk factors.