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Estrada CAM, Lomboy MFTC, Gregorio ER, Amalia E, Leynes CR, Quizon RR, Kobayashi J. Religious education can contribute to adolescent mental health in school settings. Int J Ment Health Syst 2019; 13:28. [PMID: 31057663 PMCID: PMC6485104 DOI: 10.1186/s13033-019-0286-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background Mental disorders contribute substantial burden to the society due to their widespread occurrence and debilitating effects. A quarter of the world’s population are children and adolescents, a significant number of whom experience mental disorders as early as the age of 14. Some interventions have been found to effectively reduce the risk factors and reinforce protective or preventive factors. However, there is still a need to put emphasis on mental health promotion strategies such as religious education. This paper aims to discuss the importance of religious education in promoting mental health. Discussion Religious education can be instrumental to improving adolescent mental health. Specifically, it can: (1) help develop healthier reaction to stimuli through the internalization of religious morality; (2) reinforce religious coping mechanisms which reduce the impact of stresses, enhance coping skills, and promote a less risky lifestyle; (3) increase awareness regarding religious beliefs and practices and their influence on the individual, the family, and the community; and finally, (4) promote connectedness which can enhance self-esteem and well-being. However, negative health outcomes such as discrimination and social isolation can also develop, especially among religious or gender minority groups. Conclusion It is important to reflect on the crucial role of religious education on adolescent mental health. School-based mental health education and promotion strategies can maximize the benefits of religious education by putting emphasis on effective implementation of religious education to positively influence adolescent mental health.
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Affiliation(s)
- Crystal Amiel M Estrada
- 1Department of Global Health, School of Health Sciences, University of the Ryukyus, Okinawa, Japan
| | - Marian Fe Theresa C Lomboy
- 2Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Ernesto R Gregorio
- 3Department of Health Promotion and Education, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Emmy Amalia
- 4Faculty of Medicine, Mataram University, Mataram, Indonesia
| | - Cynthia R Leynes
- 5Department of Psychiatry and Behavioral Medicine, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Romeo R Quizon
- 2Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Jun Kobayashi
- 1Department of Global Health, School of Health Sciences, University of the Ryukyus, Okinawa, Japan.,Japanese Consortium for Global School Health Research, Nishihara, Japan
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Estrada CAM, Nonaka D, Gregorio ER, Leynes CR, del Castillo RT, Hernandez PMR, Hayakawa T, Kobayashi J. Suicidal ideation, suicidal behaviors, and attitudes towards suicide of adolescents enrolled in the Alternative Learning System in Manila, Philippines-a mixed methods study. Trop Med Health 2019; 47:22. [PMID: 30976193 PMCID: PMC6439964 DOI: 10.1186/s41182-019-0149-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/15/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Globally, suicide is a significant cause of death among adolescents. Previous studies conducted in high-income countries suggest that students in alternative schools are more likely to engage in suicidal behaviors than those in formal schools. This study aimed to document suicidal ideation and behaviors among adolescent learners enrolled in the Alternative Learning System (ALS) in Manila, Philippines. METHODS A mixed methods study was conducted in 24 ALS centers in the city of Manila. ALS centers were stratified according to congressional district and selected using probability proportionate sampling. A cross-sectional survey to determine attitudes towards suicide and prevalence of suicidal ideation and behaviors was administered to 171 learners aged 13 to 17 years old. In-depth interviews with 18 teachers and 12 learners were conducted to explore the school psychosocial environment's role on learners' suicidal ideation and behaviors. Exploratory factor analysis was used to extract attitude factors. Fisher's exact test and Student's t-test were used to identify differences in sociodemographic characteristics and attitudes towards suicide between learners with or without suicidal ideation or behaviors. Qualitative data were analyzed using thematic analysis. RESULTS Non-specific active thoughts were the most common type of lifetime suicidal ideation (40.9%) while passive ideation was the most common in the past month (13.5%). Aborted suicide attempt was the most frequent behavior in both lifetime (16.4%) and in the past month (4.7%). Non-fatal suicide attempt in the past month was 2.3%, reaching 12.9% for the entire lifetime. Age, sex, education, and attitudes towards suicide were significantly associated with suicidal ideation or behavior. Thematic analysis showed five themes: (1) fostering belongingness, (2) securing learners' safety, (3) teaching philosophy, (4) teacher and learner beliefs towards suicidal behavior, and (5) availability of school-offered and community-based services. CONCLUSION Suicidal ideation and behaviors are prevalent among adolescent ALS learners. This study also showed a significant difference in attitudes towards suicide and sociodemographic characteristics between learners with and without suicidal ideation behaviors. It also suggests that the school psychosocial environment, through social norms and learner-teacher interactions, can potentially prevent progression of suicidal ideation to behavior, influence help-seeking, and promote mental health among learners.
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Affiliation(s)
- Crystal Amiel M. Estrada
- Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, Japan
| | - Daisuke Nonaka
- Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, Japan
| | - Ernesto R. Gregorio
- Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, Japan
- SEAMEO-TROPMED Regional Center for Public Health, Hospital Administration, Environmental and Occupational Health, Manila, Philippines
- Department of Health Promotion and Education, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Cynthia R. Leynes
- Department of Psychiatry and Behavioral Medicine, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Ronald T. del Castillo
- SEAMEO-TROPMED Regional Center for Public Health, Hospital Administration, Environmental and Occupational Health, Manila, Philippines
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Paul Michael R. Hernandez
- Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila, Manila, Philippines
- SEAMEO-TROPMED Regional Center for Public Health, Hospital Administration, Environmental and Occupational Health, Manila, Philippines
| | - Tatsuro Hayakawa
- Department of Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, Japan
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Epstein S, Roberts E, Sedgwick R, Finning K, Ford T, Dutta R, Downs J. Poor school attendance and exclusion: a systematic review protocol on educational risk factors for self-harm and suicidal behaviours. BMJ Open 2018; 8:e023953. [PMID: 30552271 PMCID: PMC6303662 DOI: 10.1136/bmjopen-2018-023953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Schools have an important role in recognising and preventing self-harm and suicidal behaviour in their students, however little is known about which educational factors are associated with heightened risk. We will systematically review the existing evidence on two key educational performance indicators that are routinely collected by school administrative systems: school attendance and exclusion. We will investigate their association with self-harm and suicidal behaviour in school-age children and adolescents. Knowledge of this association could help inform suicide prevention strategies at clinical, school and population levels. METHODS AND ANALYSIS We will conduct a systematic search of Medline, EMBASE, PsycINFO, British Education Index and Education Resources Information Centre (ERIC) from 1 January 1990, and conduct a manual search for additional references. We aim to identify studies that explore the association between poor school attendance or exclusion and self-harm or suicidal behaviours in school-age children and adolescents. Two independent reviewers will screen titles, abstracts and full-text documents and independently extract relevant data for analysis. Study quality will be assessed using a modified Newcastle-Ottawa Scale. A descriptive analysis will be performed, and where appropriate, results will be combined in meta-analyses. ETHICS AND DISSEMINATION This is a systematic review of published literature, and therefore ethical approval will not be sought. We will publish reports in health and education journals, present our work at conferences focused on school mental health and communicate our findings to practitioners and managers in public health, education and child mental health. PROSPERO REGISTRATION NUMBER CRD42018088608.
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Affiliation(s)
- Sophie Epstein
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emmert Roberts
- South London and Maudsley NHS Foundation Trust, London, UK
- National Addiction Centre, King’s College London, London, UK
- Department of Psychological Medicine, King’s College London, London, UK
| | - Rosemary Sedgwick
- Department of Child and Adolescent Psychiatry, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | - Rina Dutta
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King’s College London, London, UK
| | - Johnny Downs
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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O’Connor RC, Portzky G. Looking to the Future: A Synthesis of New Developments and Challenges in Suicide Research and Prevention. Front Psychol 2018; 9:2139. [PMID: 30538647 PMCID: PMC6277491 DOI: 10.3389/fpsyg.2018.02139] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/17/2018] [Indexed: 12/13/2022] Open
Abstract
Suicide and attempted suicide are major public health concerns. In recent decades, there have been many welcome developments in understanding and preventing suicide, as well as good progress in intervening with those who have attempted suicide. Despite these developments, though, considerable challenges remain. In this article, we explore both the recent developments and the challenges ahead for the field of suicide research and prevention. To do so, we consulted 32 experts from 12 countries spanning four continents who had contributed to the International Handbook of Suicide Prevention (2nd edition). All contributors nominated, in their view, (i) the top 3 most exciting new developments in suicide research and prevention in recent years, and (ii) the top 3 challenges. We have synthesized their suggestions into new developments and challenges in research and practice, giving due attention to implications for psychosocial interventions. This Perspective article is not a review of the literature, although we did draw from the suicide research literature to obtain evidence to elucidate the responses from the contributors. Key new developments and challenges include: employing novel techniques to improve the prediction of suicidal behavior; testing and applying theoretical models of suicidal behavior; harnessing new technologies to monitor and intervene in suicide risk; expanding suicide prevention activities to low and middle-income countries; moving toward a more refined understanding of sub-groups of people at risk and developing tailored interventions. We also discuss the importance of multidisciplinary working and the challenges of implementing interventions in practice.
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Affiliation(s)
- Rory C. O’Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Gwendolyn Portzky
- Unit for Suicide Research, Flemish Centre of Expertise in Suicide Prevention, Ghent University, Ghent, Belgium
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Settipani CA, Hawke LD, Virdo G, Yorke E, Mehra K, Henderson J. Social Determinants of Health among Youth Seeking Substance Use and Mental Health Treatment. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2018; 27:213-221. [PMID: 30487936 PMCID: PMC6254257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The extent to which social determinants of health problems occur among youth with mental health and addiction concerns and the impact of social determinants on their treatment is unknown. This study examined the prevalence of social determinants of health problems among treatment-seeking youth, their perceptions of interference with treatment, and the association between social determinants of health and mental health/addiction difficulties. METHOD Youth ages 15-24 seeking out-patient treatment for substance use concerns, with or without concurrent mental health concerns, reported on substance use, mental health and social determinants of health. Descriptive statistics and logistic regression analyses were used to determine the extent of social determinant of health problems and their relationship with mental health, substance use, and crime or violence problems. RESULTS In all, 80% of youth endorsed social determinants of health concerns in at least one domain; nearly 70% identified financial concerns, and many identified substantial problems in each domain and anticipated treatment impacts. Youth most frequently identified financial problems as likely to impact treatment. Cumulative number of social determinants of health problems and individual domains of social determinants of health problems were related to overall mental health and addiction concerns. CONCLUSIONS Given their prevalence and association with mental health and addiction concerns, social determinants of health problems should be routinely assessed among treatment-seeking youth and integrative services that address these concerns in addition to symptomatology should be considered.
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Affiliation(s)
- Cara A Settipani
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Lisa D Hawke
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Guytano Virdo
- Department of Politics and Public Administration, Ryerson University, Toronto, Ontario
| | | | - Kamna Mehra
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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School-Based Suicide Prevention Laws in Action: A Nationwide Investigation of Principals’ Knowledge of and Adherence to State School-Based Suicide Prevention Laws. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9287-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Condron S, Godoy Garraza L, Kuiper N, Sukumar B, Walrath C, McKeon R. Comparing the Effectiveness of Brief Versus In-Depth Gatekeeper Training on Behavioral Outcomes for Trainees. CRISIS 2018; 40:115-124. [PMID: 30109967 DOI: 10.1027/0227-5910/a000539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND A common suicide prevention strategy is training gatekeepers to identify at-risk individuals and refer them to services. AIMS The study aimed to examine whether differences in training outcomes were observed for brief versus in-depth gatekeeper trainings for trainees from varied professional settings while controlling for differences in trainee characteristics and community context. METHOD Trainees' identification and referral behavior 3 months after gatekeeper training was compared with a sample of respondents matched on individual- and community-level variables using propensity score-based techniques. The value was estimated, in terms of additional identification and associated costs, of adopting in-depth training. RESULTS A higher proportion of trainees who participated in in-depth trainings from K-12 and community settings identified at-risk youth, and a higher proportion of in-depth trainees from mental health settings referred youth to services compared with participants of brief trainings from the same setting and with similar characteristics. The effect of training type on outcomes varied by professional role and community context. LIMITATIONS Self-report measures were used to assess outcomes. Similar measures are used in other studies; their validity has not been conclusively established. CONCLUSION Findings suggest certain individuals may benefit from in-depth training more than others, which favors targeting this intervention to particular gatekeepers.
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Affiliation(s)
| | | | | | | | | | - Richard McKeon
- 3 Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
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Brown RC, Straub J, Bohnacker I, Plener PL. Increasing Knowledge, Skills, and Confidence Concerning Students' Suicidality Through a Gatekeeper Workshop for School Staff. Front Psychol 2018; 9:1233. [PMID: 30079042 PMCID: PMC6062960 DOI: 10.3389/fpsyg.2018.01233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/27/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Around one-third of adolescents in Germany report a lifetime history of suicide ideation. School staff (e.g., teachers or school social workers) can serve as gatekeepers to identify adolescents at risk and transfer them to appropriate mental health professionals. The aim of this study was to evaluate a gatekeeper training for school staff. Methods: A total of N = 603 school social workers, school psychologists, and teachers participated in one of 33 1.5-day workshops. Knowledge, attitudes, confidence in skills, and perceived knowledge were assessed at pre and post workshops and at 6-month follow-up (FU). Behavioral changes were assessed via self-report at FU. Results: Knowledge, perceived knowledge, and confidence in own skills concerning suicidality increased significantly from pre- to post-assessment and was still significantly increased at 6-month FU. Attitudes toward suicidal adolescents were neutral to positive before the workshop and remained un-changed at FU. Overall, participants were very satisfied with the workshop. Although participants stated to be motivated to make behavioral changes at 6-month FU, they reported obstacles such as lack of resources and support from school administration. Discussion: This 1.5-day gatekeeper workshop was effective in enhancing knowledge and confidence in school staff regarding suicidality. Future workshops would benefit from ongoing supervision and inclusion of school administration in order to facilitate long-term changes on a behavioral level.
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Affiliation(s)
- Rebecca C. Brown
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Joana Straub
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Isabelle Bohnacker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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Mo PKH, Ko TT, Xin MQ. School-based gatekeeper training programmes in enhancing gatekeepers' cognitions and behaviours for adolescent suicide prevention: a systematic review. Child Adolesc Psychiatry Ment Health 2018; 12:29. [PMID: 29930701 PMCID: PMC5992649 DOI: 10.1186/s13034-018-0233-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/02/2018] [Indexed: 12/03/2022] Open
Abstract
Suicide is a leading cause of death in adolescence. School provides an effective avenue both for reaching adolescents and for gatekeeper training. This enables gatekeepers to recognize and respond to at-risk students and is a meaningful focus for the provision of suicide prevention. This study provides the first systematic review on the effectiveness of school-based gatekeeper training in enhancing gatekeeper-related outcomes. A total of 815 studies were identified through four databases (Ovid Medline, Embase, PsycINFO and ERIC) using three groups of keywords: 'school based', 'Suicide prevention programme' and 'Gatekeeper'. Fourteen of these studies were found to be adequate for inclusion in this systematic review. The improvement in gatekeepers' knowledge; attitudes; self-efficacy; skills; and likelihood to intervene were found in most of the included studies. Evidence of achieving improvement in attitudes and gatekeeper behaviour was mixed. Most included studies were methodologically weak. Gatekeeper training appears to have the potential to change participants' knowledge and skills in suicide prevention, but more studies of better quality are needed to determine its effectiveness in changing gatekeepers' attitudes. There is also an urgent need to investigate how best improvements in knowledge and skills can be translated into behavioural change.
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Affiliation(s)
- Phoenix K. H. Mo
- 0000 0004 1937 0482grid.10784.3aDivision of Behavioral Health and Health Promotion, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong
| | - Ting Ting Ko
- 0000 0004 1937 0482grid.10784.3aFaculty of Medicine, School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong
| | - Mei Qi Xin
- 0000 0004 1937 0482grid.10784.3aDivision of Behavioral Health and Health Promotion, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong
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Ardiles-Irarrázabal RA, Alfaro-Robles PA, Díaz-Mancilla IE, Martínez-Guzmán VV. Riesgo de suicidio adolescente en localidades urbanas y rurales por género, región de Coquimbo, Chile. AQUICHAN 2018. [DOI: 10.5294/aqui.2018.18.2.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: comparar el riesgo de suicidio de adolescentes de enseñanza media, residentes de localidades urbanas y rurales por género en la Región de Coquimbo, Chile. Material y método: la investigación es de tipo cuantitativo descriptivo no experimental, en una muestra no probabilística. En noviembre del 2016, de forma anónima, se aplicó el Cuestionario de Screening de Suicidalidad de Okasha, sobre tendencia suicida, a una muestra de 349 adolescentes de 14-19 años (48,7 % hombres-51,3 % mujeres), que asistían a establecimientos educativos urbanos y rurales, de la región de Coquimbo, en Chile. Se utilizó una ANOVA de dos vías para las variables localidad y género. Resultados: no existen diferencias en el riesgo de suicidio según localización geográfica, pero sí por género; se presentó un 15,76 % de adolescentes femeninas con riesgo suicida. Conclusiones: el suicidio es un problema de salud pública mundial, sobre el que no se ha abordado adecuadamente a nivel de prevención y promoción en salud; existe diversidad de factores que influyen en el riesgo suicida y el factor asociado al género femenino presenta un mayor riesgo; mientras que la ubicación geográfica de residencia no registra riesgo.
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Fortier J, Chartier M, Turner S, Murdock N, Turner F, Sareen J, Afifi TO, Katz LY, Brownell M, Bolton J, Elias B, Isaak C, Woodgate R, Jiang D. Adapting and enhancing PAX Good Behavior Game for First Nations communities: a mixed-methods study protocol developed with Swampy Cree Tribal Council communities in Manitoba. BMJ Open 2018; 8:e018454. [PMID: 29449291 PMCID: PMC5829659 DOI: 10.1136/bmjopen-2017-018454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION High rates of mental health problems, such as suicidal behaviours, among First Nations youth in Canada are a major public health concern. The Good Behavior Game (GBG) is a school-based intervention that provides a nurturing environment for children and has been shown to promote positive outcomes. PAX Good Behavior Game (PAX GBG) is an adaptation and enhancement of the GBG. While PAX GBG has been implemented in Indigenous communities, little research exists examining the cultural and contextual appropriateness and effectiveness of the intervention in First Nations communities. METHODS AND ANALYSIS The present paper describes a protocol of the mixed-methods approach guided by an Indigenous ethical engagement model adopted to implement, adapt and evaluate PAX GBG in First Nations communities in Manitoba, Canada. First, implementation outcomes (eg, acceptability, adoption) of PAX GBG will be evaluated using qualitative interviews with teachers, principals and community members from Swampy Cree Tribal Council (SCTC) communities. Second, by linking administrative databases to programme data from schools in 38 First Nations communities, we will compare PAX GBG and control groups to evaluate whether PAX GBG is associated with improved mental health and academic outcomes. Third, the qualitative results will help inform a cultural and contextual adaptation of PAX GBG called First Nations PAX (FN PAX). Fourth, FN PAX will be implemented in a few SCTC communities and evaluated using surveys and qualitative interviews followed by the remaining communities the subsequent year. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Manitoba Health Research Ethics Board and will be obtained from the Health Information Privacy Committee and respective data providers for the administrative database linkages. Dissemination and knowledge translation will include community and stakeholder engagement throughout the research process, reports and presentations for policymakers and community members, presentations at scientific conferences and journal publications.
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Affiliation(s)
- Janique Fortier
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mariette Chartier
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sarah Turner
- Departments of Community Health Sciences and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nora Murdock
- Manitoba First Nations Education Resource Centre, Winnipeg, Canada
| | - Frank Turner
- Cree Nation Tribal Health Centre, Manitoba, Canada
| | - Jitender Sareen
- Departments of Psychiatry, Psychology, and Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Tracie O Afifi
- Departments of Community Health Sciences and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Laurence Y Katz
- Departments of Community Health Sciences and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marni Brownell
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James Bolton
- Departments of Community Health Sciences and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Brenda Elias
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Corinne Isaak
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Roberta Woodgate
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Manitoba, Canada
| | - Depeng Jiang
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Singer JB, Erbacher TA, Rosen P. School-Based Suicide Prevention: A Framework for Evidence-Based Practice. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9245-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Ross V, Kõlves K, De Leo D. Teachers' Perspectives on Preventing Suicide in Children and Adolescents in Schools: A Qualitative Study. Arch Suicide Res 2017; 21:519-530. [PMID: 27578394 DOI: 10.1080/13811118.2016.1227005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Given the important role teachers play as gatekeepers in school suicide prevention, this study explored teachers' perspectives on what should be done to improve current suicide prevention efforts. The study, in Queensland, Australia, was part of a large-scale survey examining teachers' knowledge, attitudes and experience of suicidality. One hundred and fifteen teachers responded to an online survey question regarding their views on the requirements for school suicide prevention. Qualitative analysis identified five themes from teachers' responses: awareness and stigma reduction, support services for students, education and training, bullying and the role of social media. The results of this study provide some profound insights into teachers' perspectives on suicide and highlight the critical need for improved suicide prevention efforts in schools.
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Holland KM, Vivolo-Kantor AM, Logan JE, Leemis RW. Antecedents of Suicide among Youth Aged 11-15: A Multistate Mixed Methods Analysis. J Youth Adolesc 2017; 46:1598-1610. [PMID: 27844461 PMCID: PMC5961726 DOI: 10.1007/s10964-016-0610-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
Suicide is the second leading cause of death for youth aged 11 to 15, taking over 5,500 lives from 2003 to 2014. Suicide among this age group is linked to risk factors such as mental health problems, family history of suicidal behavior, biological factors, family problems, and peer victimization and bullying. However, few studies have examined the frequency with which such problems occur among youth suicide decedents or the context in which decedents experience these risk factors and the complex interplay of risk that results in a decedent's decision to take his/her own life. Data from a random sample of 482 youth (ages 11-15) suicide cases captured in the National Violent Death Reporting System from 2003 to 2014 were analyzed. The sample had fewer girls than boys (31 vs. 69 %) and comprised primarily White youth (79 %), but also African Americans (13 %), Asians (4 %), and youth of other races (4 %). Narrative data from coroner/medical examiner and law enforcement investigative reports were coded and analyzed to identify common behavioral patterns that preceded suicide. Emergent themes were quantified and examined using content and constant comparative analysis. Themes regarding antecedents across multiple levels of the social ecology emerged. Relationship problems, particularly with parents, were the most common suicide antecedent. Also, a pattern demonstrating a consistent progression toward suicidal behavior emerged from the data. Narratives indicated that youth were commonly exposed to one or more problems, often resulting in feelings of loneliness and burdensomeness, which progressed toward thoughts and sometimes plans for or attempts at suicide. Continued exposure to negative experiences and thoughts/plans about suicide, and/or self-injurious acts resulted in an acquired capacity to self-harm, eventually leading to suicide. These findings provide support for theories of suicidal behavior and highlight the importance of multi-level, comprehensive interventions that address individual cognitions and build social connectedness and support, as well as prevention strategies that increase awareness of the warning signs and symptoms of suicide, particularly among family members of at-risk youth.
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Affiliation(s)
- Kristin M Holland
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Alana M Vivolo-Kantor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph E Logan
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruth W Leemis
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Labouliere CD, Tarquini SJ, Totura CMW, Kutash K, Karver MS. Revisiting the concept of knowledge: how much is learned by students participating in suicide prevention gatekeeper training? CRISIS 2016; 36:274-80. [PMID: 26440624 DOI: 10.1027/0227-5910/a000323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although gatekeeper training is effective at increasing knowledge, some question the effectiveness of these programs due to high pretraining knowledge levels. However, knowledge scores may be artificially inflated when students guess answer options correctly but lack information needed to assist suicidal peers. AIMS To use free-recall questions to evaluate suicide prevention knowledge and compare levels of knowledge using this methodology with established assessment methods in the literature. METHOD Free-recall knowledge questions were examined before and after participation in a student gatekeeper training program. Focus groups with students enriched interpretation of quantitative results. RESULTS Unlike in studies using forced-choice assessment, students' baseline knowledge was markedly low using free-recall questions and, despite making significant improvement from pretraining levels, posttraining knowledge barely approached passable levels. Focus group findings suggest that training sessions may need to be more engaging and interactive in order to improve knowledge transfer. CONCLUSION Free-recall questions may provide a less inflated measure of accessible knowledge learned from school-based suicide prevention curricula. Evaluators and programmatic partners should be cognizant of this methodological issue and consider using a mix of assessment methodologies to determine students' actual levels of knowledge after participation in gatekeeper training.
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Affiliation(s)
- Christa D Labouliere
- 1 Division of Child and Adolescent Psychiatry, The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | | | | | - Krista Kutash
- 4 Louis De La Parte Florida Mental Health Institute at the University of South Florida, Tampa, FL, USA
| | - Marc S Karver
- 5 Department of Psychology at the University of South Florida, Tampa, FL, USA
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Das JK, Salam RA, Lassi ZS, Khan MN, Mahmood W, Patel V, Bhutta ZA. Interventions for Adolescent Mental Health: An Overview of Systematic Reviews. J Adolesc Health 2016; 59:S49-S60. [PMID: 27664596 PMCID: PMC5026677 DOI: 10.1016/j.jadohealth.2016.06.020] [Citation(s) in RCA: 242] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/28/2016] [Accepted: 07/01/2016] [Indexed: 01/08/2023]
Abstract
Many mental health disorders emerge in late childhood and early adolescence and contribute to the burden of these disorders among young people and later in life. We systematically reviewed literature published up to December 2015 to identify systematic reviews on mental health interventions in adolescent population. A total of 38 systematic reviews were included. We classified the included reviews into the following categories for reporting the findings: school-based interventions (n = 12); community-based interventions (n = 6); digital platforms (n = 8); and individual-/family-based interventions (n = 12). Evidence from school-based interventions suggests that targeted group-based interventions and cognitive behavioral therapy are effective in reducing depressive symptoms (standard mean difference [SMD]: -.16; 95% confidence interval [CI]: -.26 to -.05) and anxiety (SMD: -.33; 95% CI: -.59 to -.06). School-based suicide prevention programs suggest that classroom-based didactic and experiential programs increase short-term knowledge of suicide (SMD: 1.51; 95% CI: .57-2.45) and knowledge of suicide prevention (SMD: .72; 95% CI: .36-1.07) with no evidence of an effect on suicide-related attitudes or behaviors. Community-based creative activities have some positive effect on behavioral changes, self-confidence, self-esteem, levels of knowledge, and physical activity. Evidence from digital platforms supports Internet-based prevention and treatment programs for anxiety and depression; however, more extensive and rigorous research is warranted to further establish the conditions. Among individual- and family-based interventions, interventions focusing on eating attitudes and behaviors show no impact on body mass index (SMD: -.10; 95% CI: -.45 to .25); Eating Attitude Test (SMD: .01; 95% CI: -.13 to .15); and bulimia (SMD: -.03; 95% CI: -.16 to .10). Exercise is found to be effective in improving self-esteem (SMD: .49; 95% CI: .16-.81) and reducing depression score (SMD: -.66; 95% CI: -1.25 to -.08) with no impact on anxiety scores. Cognitive behavioral therapy compared to waitlist is effective in reducing remission (odds ratio: 7.85; 95% CI: 5.31-11.6). Psychological therapy when compared to antidepressants have comparable effect on remission, dropouts, and depression symptoms. The studies evaluating mental health interventions among adolescents were reported to be very heterogeneous, statistically, in their populations, interventions, and outcomes; hence, meta-analysis could not be conducted in most of the included reviews. Future trials should also focus on standardized interventions and outcomes for synthesizing the exiting body of knowledge. There is a need to report differential effects for gender, age groups, socioeconomic status, and geographic settings since the impact of mental health interventions might vary according to various contextual factors.
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Affiliation(s)
- Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Marium Naveed Khan
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Vikram Patel
- London School of Hygiene & Tropical Medicine, London, United Kingdom; Public Health Foundation of India, New Delhi, India; Sangath, Goa, India
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.
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Calear AL, Brewer JL, Batterham PJ, Mackinnon A, Wyman PA, LoMurray M, Shand F, Kazan D, Christensen H. The Sources of Strength Australia Project: study protocol for a cluster randomised controlled trial. Trials 2016; 17:349. [PMID: 27456094 PMCID: PMC4960686 DOI: 10.1186/s13063-016-1475-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 07/05/2016] [Indexed: 11/21/2022] Open
Abstract
Background The school system has been identified as an ideal setting for the implementation of prevention and early intervention programs for suicide. However, in Australia, suicide-prevention programs that are routinely delivered in the schools are lacking. Internationally, evidence exists for the effectiveness of peer-led interventions that take a social connectedness approach to improve help-seeking for suicide. The aim of the current trial is to test the effectiveness of the Sources of Strength program to promote help-seeking for suicide in adolescents in Australian high schools. Methods/design This study is a two-arm, cluster-randomised, controlled trial that will compare the evidence-based Sources of Strength program to a wait-list control condition. Sixteen Australian high schools will be recruited to the trial, with all adolescents in years 7 to 10 (12–16 years of age) invited to participate. Peer leaders from intervention-condition schools will receive training in the Sources of Strength program and will integrate positive messages, across 3 months, with the support of adult advisors. Activities may take the form of class presentations, posters, videos, and messages on social media sites and will aim to change help-seeking norms, strengthen youth-adult connections, and promote positive coping. The primary outcome measure for the study is help-seeking intentions, whereas secondary outcomes include help-seeking behaviour, help-seeking attitudes and norms, referral of distressed peers, availability of adult help, positive coping, and suicidal behaviour. Data will be collected pre-intervention, post-intervention (after the initial 3 months of messaging), and at the end of the first (6-month follow-up) and the second year after implementation (18-month follow-up). Primary analyses will compare changes in help-seeking intentions for the intervention condition relative to the wait-list control condition using mixed-effect repeated-measures analyses to account for clustering within schools. Discussion If proven effective, this universal social connectedness program for suicide could be more widely delivered in Australian high schools, providing a valuable new resource. The Sources of Strength program has the potential to significantly contribute to the mental health of young people in Australia by improving help-seeking for suicide. The findings from this research will also contribute to the evidence-base for peer-leadership programs internationally. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616000048482. Registered on 19 January 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1475-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton ACT 2601, Canberra, Australia.
| | - Jacqueline L Brewer
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton ACT 2601, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton ACT 2601, Canberra, Australia
| | - Andrew Mackinnon
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Peter A Wyman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Dominique Kazan
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton ACT 2601, Canberra, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, Australia
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Flynn A, Zackula R, Klaus NM, McGinness L, Carr S, Macaluso M. Student Evaluation of the Yellow Ribbon Suicide Prevention Program in Midwest Schools. Prim Care Companion CNS Disord 2016; 18:15m01852. [PMID: 27733952 PMCID: PMC5035808 DOI: 10.4088/pcc.15m01852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 03/07/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Yellow Ribbon is a gatekeeper-type suicide prevention program that is widely used in public schools. However, data on its effectiveness are limited. The purpose of our study was to evaluate self-reported changes in knowledge and comfort level communicating about suicide following Yellow Ribbon training for a large, representative sample of students from a public school system in the midwestern United States. METHODS The program was administered to students within the same school district during 2006 through 2009. A pre-post survey using a 4-point Likert scale was administered to rate students' knowledge of risk factors and available resources, comfort level communicating about suicide, estimate of friends at risk for suicide, and behavioral intent toward help-seeking. RESULTS Aggregate responses from 3,257 students, aged 11 to 18 years, were collected by the schools; 51% were female, 33% were Hispanic, and 30% were white. Suicide-related knowledge of risk factors, where to go for help, and resources, along with comfort level in asking for help, all significantly improved following program participation (Cramer's V = 0.243 to 0.376, P < .001). Responses were associated with age and gender, indicating that younger males may benefit more than older males. CONCLUSIONS Implementation of the Yellow Ribbon school-based suicide prevention program appears to be beneficial for students in the midwestern United States. We observed significant improvement in knowledge, comfort level, and behavioral intent for help-seeking if suicidal thoughts occur. Findings also suggested that Yellow Ribbon training administered during middle school may be especially helpful for males.
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Affiliation(s)
| | | | | | - Liz McGinness
- Sedgwick County Suicide Prevention Coalition, Kansas Youth Suicide Prevention Program, McGinness Family Foundation, Wichita, Kansas
| | - Susan Carr
- Department of Psychiatry and Behavioral Sciences and
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Musci RJ, Hart SR, Ballard ED, Newcomer A, Van Eck K, Ialongo N, Wilcox H. Trajectories of Suicidal Ideation from Sixth through Tenth Grades in Predicting Suicide Attempts in Young Adulthood in an Urban African American Cohort. Suicide Life Threat Behav 2016; 46:255-65. [PMID: 26395337 DOI: 10.1111/sltb.12191] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 06/26/2015] [Indexed: 11/27/2022]
Abstract
The trajectory of suicidal ideation across early adolescence may inform the timing of suicide prevention program implementation. This study aimed to identify developmental trajectories of suicidal ideation among an urban cohort of community-residing African Americans (AA) longitudinally followed from middle school through early adulthood (ages 11-19 years). Subtypes based on the developmental course of suicidal ideation from late childhood through mid-adolescence were identified using longitudinal latent class analysis (LLCA) with 581 AA adolescents (52.7% male; 71.1% free or reduced school meals). The developmental trajectories of suicidal ideation were then used to predict suicide attempts in young adulthood. Our LLCA indicated two subtypes (i.e., ideators and nonideators), with 8% of the sample in the ideator class. This trajectory class shows a peak of suicidal ideation in seventh grade and a steady decline in ideation in subsequent grades. Additionally, suicidal ideation trajectories significantly predicted suicide attempt. Results of these analyses suggest the need for suicide prevention approaches prior to high school for AA youth.
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Affiliation(s)
- Rashelle J Musci
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shelley R Hart
- Department of Child Development, California State University, Chico, CA, USA
| | | | - Alison Newcomer
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Kathryn Van Eck
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nicholas Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Evans R, Hurrell C. The role of schools in children and young people's self-harm and suicide: systematic review and meta-ethnography of qualitative research. BMC Public Health 2016; 16:401. [PMID: 27179765 PMCID: PMC4867904 DOI: 10.1186/s12889-016-3065-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/28/2016] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Evidence reports that schools influence children and young people's health behaviours across a range of outcomes. However there remains limited understanding of the mechanisms through which institutional features may structure self-harm and suicide. This paper reports on a systematic review and meta-ethnography of qualitative research exploring how schools influence self-harm and suicide in students. METHODS Systematic searches were conducted of nineteen databases from inception to June 2015. English language, primary research studies, utilising any qualitative research design to report on the influence of primary or secondary educational settings (or international equivalents) on children and young people's self-harm and suicide were included. Two reviewers independently appraised studies against the inclusion criteria, assessed quality, and abstracted data. Data synthesis was conducted in adherence with Noblit and Hare's meta-ethnographic approach. Of 6744 unique articles identified, six articles reporting on five studies were included in the meta-ethnography. RESULTS Five meta-themes emerged from the studies. First, self-harm is often rendered invisible within educational settings, meaning it is not prioritised within the curriculum despite students' expressed need. Second, where self-harm transgresses institutional rules it may be treated as 'bad behaviour', meaning adequate support is denied. Third, schools' informal management strategy of escalating incidents of self-harm to external 'experts' serves to contribute to non-help seeking behaviour amongst students who desire confidential support from teachers. Fourth, anxiety and stress associated with school performance may escalate self-harm and suicide. Fifth, bullying within the school context can contribute to self-harm, whilst some young people may engage in these practices as initiation into a social group. CONCLUSIONS Schools may influence children and young people's self-harm, although evidence of their impact on suicide remains limited. Prevention and intervention needs to acknowledge and accommodate these institutional-level factors. Studies included in this review are limited by their lack of conceptual richness, restricting the process of interpretative synthesis. Further qualitative research should focus on the continued development of theoretical and empirical insight into the relationship between institutional features and students' self-harm and suicide.
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Affiliation(s)
- Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
| | - Chloe Hurrell
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
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A systematic review of psychosocial suicide prevention interventions for youth. Eur Child Adolesc Psychiatry 2016; 25:467-82. [PMID: 26472117 DOI: 10.1007/s00787-015-0783-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/05/2015] [Indexed: 01/12/2023]
Abstract
Youth suicide is a significant public health problem. A systematic review was conducted to examine the effectiveness of school, community and healthcare-based interventions in reducing and preventing suicidal ideation, suicide attempts and deliberate self-harm in young people aged 12-25 years. PsycInfo, PubMed and Cochrane databases were searched to the end of December 2014 to identify randomised controlled trials evaluating the effectiveness of psychosocial interventions for youth suicide. In total, 13,747 abstracts were identified and screened for inclusion in a larger database. Of these, 29 papers describing 28 trials fulfilled the inclusion criteria for the current review. The results of the review indicated that just over half of the programs identified had a significant effect on suicidal ideation (Cohen's d = 0.16-3.01), suicide attempts (phi = 0.04-0.38) or deliberate self-harm (phi = 0.29-0.33; d = 0.42). The current review provides preliminary support for the implementation of universal and targeted interventions in all settings, using a diverse range of psychosocial approaches. Further quality research is needed to strengthen the evidence-base for suicide prevention programs in this population. In particular, the development of universal school-based interventions is promising given the potential reach of such an approach.
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Abstract
Suicide is a complex public health problem of global importance. Suicidal behaviour differs between sexes, age groups, geographic regions, and sociopolitical settings, and variably associates with different risk factors, suggesting aetiological heterogeneity. Although there is no effective algorithm to predict suicide in clinical practice, improved recognition and understanding of clinical, psychological, sociological, and biological factors might help the detection of high-risk individuals and assist in treatment selection. Psychotherapeutic, pharmacological, or neuromodulatory treatments of mental disorders can often prevent suicidal behaviour; additionally, regular follow-up of people who attempt suicide by mental health services is key to prevent future suicidal behaviour.
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Affiliation(s)
- Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada.
| | - David A Brent
- Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
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Abstract
Purpose
– The purpose of this paper is to contribute to the evidence base to support whole school approaches.
Design/methodology/approach
– The authors conduct a review of published evaluations and evidence syntheses across six areas in the international health-promoting schools literature.
Findings
– Although whole school approaches are often advocated in literature and policy on health-promoting schools, the evidence base for their effectiveness is partial and is often health topic specific. This paper reviews the evidence base across six different health-related areas, namely: sexual health; bullying; alcohol and drug use; mental health; school connectedness; and access to services. It identifies commonalities in learning, enabling a confluence of evidence on the factors central to the provision of effective health education and support within schools. Whilst findings endorse a whole school approach, they also suggest that some of the more subtle evidence-based principles on which such approaches are underpinned are not generally explicitly reflected in practice.
Originality/value
– The paper offers the first cross-topic synthesis of findings on health education effects and effectiveness in six health-related areas, to identify commonalities in learning. Findings contribute to the evidence base for the use of a whole school approach when undertaking health education in schools.
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Lassi ZS, Salam RA, Das JK, Wazny K, Bhutta ZA. An unfinished agenda on adolescent health: Opportunities for interventions. Semin Perinatol 2015; 39:353-60. [PMID: 26162972 DOI: 10.1053/j.semperi.2015.06.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Millennium Development Goal era has resulted in improvements in maternal and child health worldwide. As more children are surviving past their fifth birthday, the population of adolescents is increasing. Adolescence is a time of significant developmental transition; adolescence sets the stage for adult health through risks taken and beneficial and detrimental habits that are formed and it is thus an optimal time to target health interventions. Beginning interventions in adolescence or even earlier in childhood maximizes the impact on the individual's health in adult life. Evidence suggests that interventions to promote sexual and reproductive health, physical activity and healthy lifestyle, mental health and wellbeing, safe and hazard-free environment, improving access to nutritious and healthy foods, and minimizing exposure to substance abuse can improve health outcomes in young adolescents. School-based delivery strategies appear to be the most highly evaluated for improving adolescent health; they have been used to deliver interventions such as sexual health, substance abuse prevention, and nutritional interventions. Use of social media and information technologies, cash transfers, social protection, and micro-finance initiatives are promising strategies; however, given the lack of rigorous evaluations, there is a need for further research. Additional research is also warranted to strengthen the evidence base by establishing causality, understanding the differential impacts of adolescent health in different contexts particularly in low- and middle-income countries. In addition, research and evaluation in the domain of adolescent health must focus on how to implement interventions effectively at-scale, sustain the impacts over time and ensure equitable outcomes.
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Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Kerri Wazny
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan; Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Bennett K, Rhodes AE, Duda S, Cheung AH, Manassis K, Links P, Mushquash C, Braunberger P, Newton AS, Kutcher S, Bridge JA, Santos RG, Manion IG, McLennan JD, Bagnell A, Lipman E, Rice M, Szatmari P. A Youth Suicide Prevention Plan for Canada: A Systematic Review of Reviews. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:245-57. [PMID: 26175322 PMCID: PMC4501582 DOI: 10.1177/070674371506000603] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 11/01/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We conducted an expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based strategies and nonschool-based interventions designed to prevent repeat attempts. METHODS Systematic review of review methods were applied. Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations derived from the findings. RESULTS No included review addressing school-based prevention (n = 7) reported decreased suicide death rates based on randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts (n = 14) found the following: emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness. Consensus on 6 recommendations ranged from 73% to 100%. CONCLUSIONS Our EKS facilitates decision maker access to what is known about effective youth suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention.
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Affiliation(s)
| | - Anne E Rhodes
- Research Scientist, St Michael’s Hospital, Toronto, Ontario; Associate Professor, University of Toronto, Toronto, Ontario
| | - Stephanie Duda
- Research Coordinator, McMaster University, Hamilton, Ontario
| | - Amy H Cheung
- Psychiatrist, Sunnybrook Health Sciences Centre, Toronto, Ontario; Associate Professor, University of Toronto, Toronto, Ontario
| | - Katharina Manassis
- Psychiatrist and Director, Anxiety Disorders, Hospital for Sick Children, Toronto, Ontario; Professor, University of Toronto, Toronto, Ontario
| | - Paul Links
- Chief of Psychiatry, London Health Sciences Centre, London, Ontario; Professor and Chair, Department of Psychiatry, The University of Western Ontario, London, Ontario
| | - Christopher Mushquash
- Assistant Professor, Lakehead University and Northern Ontario School of Medicine, Thunder Bay, Ontario
| | - Peter Braunberger
- Psychiatrist, St Joseph’s Care Group, Thunder Bay, Ontario; Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, Ontario
| | - Amanda S Newton
- Assistant Professor, University of Alberta, Edmonton, Alberta
| | - Stanley Kutcher
- Professor, Dalhousie University, Halifax, Nova Scotia; Psychiatrist, IWK Health Centre, Halifax, Nova Scotia
| | - Jeffrey A Bridge
- Investigator, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio; Associate Professor, The Ohio State University College of Medicine, Columbus, Ohio
| | - Robert G Santos
- Executive Director of Science and Policy, Healthy Child Manitoba Office, Government of Manitoba, Winnipeg, Manitoba; Assistant Professor, University of Manitoba, Winnipeg, Manitoba
| | - Ian G Manion
- Clinical Psychologist, Researcher, and Executive Director, Provincial Centre of Excellence for Child and Youth Mental Health, Children’s Hospital of Eastern Ontario, Ottawa, Ontario; Clinical Professor, University of Ottawa, Ottawa, Ontario
| | - John D McLennan
- Assistant Professor, University of Calgary, Calgary, Alberta; Child Psychiatry Consultant, Alberta Health Services, Edmonton, Alberta
| | - Alexa Bagnell
- Psychiatrist, IWK Health Centre, Halifax, Nova Scotia; Associate Professor, Dalhousie University, Halifax, Nova Scotia
| | - Ellen Lipman
- Psychiatrist, McMaster Children’s Hospital, Hamilton, Ontario; Professor, McMaster University, Hamilton, Ontario
| | - Maureen Rice
- Librarian and Research Coordinator, McMaster University, Hamilton, Ontario
| | - Peter Szatmari
- Chief, Child and Youth Mental Health Collaborative, Centre for Addiction and Mental Health, Hospital for Sick Children, and University of Toronto, Toronto, Ontario
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Shah HR. The role of a Psychiatric Society: Aligning our aims to needs of the community. Mens Sana Monogr 2015; 13:156-64. [PMID: 25838735 PMCID: PMC4381311 DOI: 10.4103/0973-1229.153332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 01/27/2015] [Accepted: 02/13/2015] [Indexed: 11/04/2022] Open
Abstract
Psychiatric Societies and Associations have variegated roles and functions. They provide their members an academic resource and a place for social networking. They also have responsibilities to the profession and to the community they serve. The nature of work they conduct should be aligned to the needs of all stakeholders. Only when there is such harmonious working will the community respect the fraternity and the Association. We, therefore, need to respond to the need of the hour, which in the current time is prevention of suicide in children and adolescents and facilitation of continuing professional development for our members.
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Affiliation(s)
- Henal R Shah
- BPS President, 2010-2011. Professor (Additional), Department of Psychiatry, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India - 400 008
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Wei Y, Kutcher S, LeBlanc JC. Hot Idea or Hot Air: A Systematic Review of Evidence for Two Widely Marketed Youth Suicide Prevention Programs and Recommendations for Implementation. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2015; 24:5-16. [PMID: 26336375 PMCID: PMC4357329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 12/18/2014] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Youth suicide is highly related to mental disorders. While communities and schools are marketed to with a plethora of suicide prevention programs, they often lack the capacity to choose evidence-based programs. METHODS We conducted a systematic review of two youth suicide prevention programs to help determine if the quality of evidence available justifies their wide spread dissemination. We searched Medline, PsycINFO, EMBASE, CINAHL, the Cochrane Library, Campbell Collaboration SPECTR database, SocIndex, Sociological Abstracts, Social Services Abstracts, ERIC, Social Work Abstracts, Research Library, and Web of Science, for relevant studies. We included studies/systematic reviews/meta-analysis that evaluated the effectiveness, cost-effectiveness, and/or safety of Signs of Suicide (SOS) and Yellow Ribbon (YR) suicide prevention programs that target adolescents. We applied the Office of Justice Program What Works Repository (OJP-R) to evaluate the quality of the included studies as effective, effective with reservation, promising, inconclusive evidence, insufficient evidence, and ineffective. Two SOS studies were ranked as "inconclusive evidence" based on the OJP-R. One SOS study was ranked as having "insufficient evidence" on OJP-R. The YR study was ranked as "ineffective" using OJP-R. We only included studies in peer-reviewed journals in English and therefore may have missed reports in grey literature or non-English publications. RESULTS We cannot recommend that schools and communities implement either the SOS or YR suicide prevention programs. Purchasers of these programs should be aware that there is no evidence that their use prevents suicide. CONCLUSIONS Academics and organizations should not overstate the positive impacts of suicide prevention interventions when the evidence is lacking.
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Affiliation(s)
| | - Stan Kutcher
- Department of Psychiatry and Sun Life Financial Chair in Adolescent Mental Health, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia
| | - John C. LeBlanc
- Department of Pediatrics, Psychiatry, Epidemiology and Community Health, Dalhousie University, Halifax, Nova Scotia
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78
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McMartin SE, Kingsbury M, Dykxhoorn J, Colman I. Time trends in symptoms of mental illness in children and adolescents in Canada. CMAJ 2014; 186:E672-8. [PMID: 25367419 PMCID: PMC4259795 DOI: 10.1503/cmaj.140064] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Existing research and media reports convey conflicting impressions of trends in the prevalence of mental illness. We sought to investigate trends in the prevalence of symptoms of mental illness in a large population-based cohort of Canadian children and adolescents. METHODS We obtained population-based data from the National Longitudinal Survey of Children and Youth. Every 2 years, participants completed self-reported measures of mental illness indicators, including conduct disorder, hyperactivity, indirect aggression, suicidal behaviour, and depression and anxiety. We analyzed trends in mean scores over time using linear regression. RESULTS We evaluated 11 725 participants aged 10-11 years from cycles 1 (1994/95) through 6 (2004/05), 10 574 aged 12-13 years from cycles 2 (1996/97) through 7 (2006/07), and 9835 aged 14-15 years from cycles 3 (1998/99) through 8 (2008/09). The distribution of scores on depression and anxiety, conduct and indirect aggression scales remained stable or showed small decreases over time for participants of all ages. The mean hyperactivity score increased over time in participants aged 10-11 years (change per 2-year cycle: 0.16, 95% CI 0.02 to 0.12) and those aged 12-13 years (0.13, 95% CI 0.09 to 0.18). Over time, fewer participants aged 12-13 years (0.40% per cycle, 95% CI -0.78 to -0.07) and aged 14-15 years (0.56% per cycle, 95% CI -0.91 to -0.23) reported attempting suicide in the previous 12 months. INTERPRETATION With the exception of hyperactivity, the prevalence of symptoms of mental illness in Canadian children and adolescents has remained relatively stable from 1994/95 to 2008/09. Conflicting reports of escalating rates of mental illness in Canada may be explained by differing methodologies between studies, an increase in treatment-seeking behaviour, or changes in diagnostic criteria or practices.
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Affiliation(s)
- Seanna E McMartin
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont
| | - Mila Kingsbury
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont
| | - Jennifer Dykxhoorn
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont
| | - Ian Colman
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
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Fazel M, Hoagwood K, Stephan S, Ford T. Mental health interventions in schools 1: Mental health interventions in schools in high-income countries. Lancet Psychiatry 2014; 1:377-387. [PMID: 26114092 PMCID: PMC4477835 DOI: 10.1016/s2215-0366(14)70312-8] [Citation(s) in RCA: 255] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mental health services embedded within school systems can create a continuum of integrative care that improves both mental health and educational attainment for children. To strengthen this continuum, and for optimum child development, a reconfiguration of education and mental health systems to aid implementation of evidence-based practice might be needed. Integrative strategies that combine classroom-level and student-level interventions have much potential. A robust research agenda is needed that focuses on system-level implementation and maintenance of interventions over time. Both ethical and scientific justifications exist for integration of mental health and education: integration democratises access to services and, if coupled with use of evidence-based practices, can promote the healthy development of children.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Kimberly Hoagwood
- Department of Child Psychiatry, New York University Langone Medical Center and School of Medicine, New York, NY, USA
| | - Sharon Stephan
- Center for School Mental Health, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tamsin Ford
- Child and Adolescent Psychiatry, University of Exeter Medical School, Veysey Building, Exeter, Devon, UK
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80
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Glenn CR, Franklin JC, Nock MK. Evidence-based psychosocial treatments for self-injurious thoughts and behaviors in youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2014; 44:1-29. [PMID: 25256034 PMCID: PMC4557625 DOI: 10.1080/15374416.2014.945211] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to review the current evidence base of psychosocial treatments for suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) in youth. We reviewed major scientific databases (HealthSTAR, MEDLine, PsycINFO, PubMed) for relevant studies published prior to June 2013. The search identified 29 studies examining interventions for suicidal or nonsuicidal SITBs in children or adolescents. No interventions currently meet the Journal of Clinical Child and Adolescent Psychology standards for Level 1: well-established treatments. Six treatment categories were classified as Level 2: probably efficacious or Level 3: possibly efficacious for reducing SITBs in youth. These treatments came from a variety of theoretical orientations, including cognitive-behavioral, family, interpersonal, and psychodynamic theories. Common elements across efficacious treatments included family skills training (e.g., family communication and problem solving), parent education and training (e.g., monitoring and contingency management), and individual skills training (e.g., emotion regulation and problem solving). Several treatments have shown potential promise for reducing SITBs in children and adolescents. However, the probably/possibly efficacious treatments identified each have evidence from only a single randomized controlled trial. Future research should focus on replicating studies of promising treatments, identifying active treatment ingredients, examining mediators and moderators of treatment effects, and developing brief interventions for high-risk periods (e.g., following hospital discharge).
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81
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Ferrari AJ, Norman RE, Freedman G, Baxter AJ, Pirkis JE, Harris MG, Page A, Carnahan E, Degenhardt L, Vos T, Whiteford HA. The burden attributable to mental and substance use disorders as risk factors for suicide: findings from the Global Burden of Disease Study 2010. PLoS One 2014; 9:e91936. [PMID: 24694747 PMCID: PMC3973668 DOI: 10.1371/journal.pone.0091936] [Citation(s) in RCA: 282] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 02/16/2014] [Indexed: 12/13/2022] Open
Abstract
Background The Global Burden of Disease Study 2010 (GBD 2010) identified mental and substance use disorders as the 5th leading contributor of burden in 2010, measured by disability adjusted life years (DALYs). This estimate was incomplete as it excluded burden resulting from the increased risk of suicide captured elsewhere in GBD 2010's mutually exclusive list of diseases and injuries. Here, we estimate suicide DALYs attributable to mental and substance use disorders. Methods Relative-risk estimates of suicide due to mental and substance use disorders and the global prevalence of each disorder were used to estimate population attributable fractions. These were adjusted for global differences in the proportion of suicide due to mental and substance use disorders compared to other causes then multiplied by suicide DALYs reported in GBD 2010 to estimate attributable DALYs (with 95% uncertainty). Results Mental and substance use disorders were responsible for 22.5 million (14.8–29.8 million) of the 36.2 million (26.5–44.3 million) DALYs allocated to suicide in 2010. Depression was responsible for the largest proportion of suicide DALYs (46.1% (28.0%–60.8%)) and anorexia nervosa the lowest (0.2% (0.02%–0.5%)). DALYs occurred throughout the lifespan, with the largest proportion found in Eastern Europe and Asia, and males aged 20–30 years. The inclusion of attributable suicide DALYs would have increased the overall burden of mental and substance use disorders (assigned to them in GBD 2010 as a direct cause) from 7.4% (6.2%–8.6%) to 8.3% (7.1%–9.6%) of global DALYs, and would have changed the global ranking from 5th to 3rd leading cause of burden. Conclusions Capturing the suicide burden attributable to mental and substance use disorders allows for more accurate estimates of burden. More consideration needs to be given to interventions targeted to populations with, or at risk for, mental and substance use disorders as an effective strategy for suicide prevention.
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Affiliation(s)
- Alize J. Ferrari
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- * E-mail:
| | - Rosana E. Norman
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia
| | - Greg Freedman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Amanda J. Baxter
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Jane E. Pirkis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Meredith G. Harris
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Andrew Page
- School of Science and Health, University of Western Sydney, Campbelltown, New South Wales, Australia
| | - Emily Carnahan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Louisa Degenhardt
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Theo Vos
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Harvey A. Whiteford
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
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