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Shapero BG, Curley EE, Black CL, Alloy LB. The interactive association of proximal life stress and cumulative HPA axis functioning with depressive symptoms. Depress Anxiety 2019; 36:1089-1101. [PMID: 31614065 DOI: 10.1002/da.22957] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/13/2019] [Accepted: 09/07/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Stress is consistently implicated in depression. Using a vulnerability-stress framework, the hypothalamic-pituitary-adrenal (HPA) axis may be one factor affecting the stress-depression association. However, the interactive influence of recent life stress and HPA axis functioning on depressive symptoms remains unclear. It is particularly important to understand the synergistic association during adolescence, as this is a developmental period associated with a high risk for depression. METHODS A community sample of 58 adolescents (67% female, 59% Caucasian; mean age, 15.07 years) participated. Adolescents completed a well-validated measure of depressive symptoms and a structured life events interview to assess recent life stress. Hair cortisol concentration was obtained to measure cumulative exposure to HPA axis functioning. RESULTS Recent life stress and cumulative HPA axis exposure measured through hair cortisol were directly associated with higher depressive symptoms. Further, cumulative HPA axis exposure moderated the relationship between recent life stress and depressive symptoms. The recent life stress-depression association occurred for adolescents who experienced average and high, but not low, levels of cumulative HPA axis exposure. CONCLUSIONS The current study builds on prior work and finds both a direct and interactive association of recent life stress and cumulative HPA axis functioning with depressive symptoms during adolescence. Identifying youth who experience high levels of HPA axis exposure is important to prevent the onset of depression.
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Affiliation(s)
- Benjamin G Shapero
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Erin E Curley
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Chelsea L Black
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lauren B Alloy
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
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Li JY, Li J, Liang JH, Qian S, Jia RX, Wang YQ, Xu Y. Depressive Symptoms Among Children and Adolescents in China: A Systematic Review and Meta-Analysis. Med Sci Monit 2019; 25:7459-7470. [PMID: 31586039 PMCID: PMC6792515 DOI: 10.12659/msm.916774] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Depressive symptoms are a pervasive mental health problem in Chinese adolescents. The aim of this article was to systematically assess the trend of depressive symptoms in China among adolescents (1988 to 2018). Material/Methods A systematic and comprehensive literature search was conducted in both English and Chinese databases, including PubMed, EMBASE, Cochrane CENTRAL, CNKI, and Wan Fang Database, to identify relevant studies published between 1988 and 2018. Batteries of analyses in this meta-analysis were undertaken using Stata version 12.0 statistical software. Results Sixty-two related reports involving 232 586 participants finally met our inclusion and exclusion criteria. The results suggest the prevalence of depressive symptoms has generally increased over time. The prevalence estimates before 2000 were 18.4% (95% CI, 14.5–22.3%), and were 26.3% (95% CI, 21.9–30.8%) after 2016. The pooled prevalence of depressive symptoms among children and adolescents was 22.2% (95% CI: 19.9–24.6%, I2=99.6%, p<0.001). More subgroup analyses classified by screening instrument, gender, and region were carried out in this meta-analysis. Conclusions Results of our meta-analysis suggest that depressive symptoms have become more prevalent among Chinese adolescents. This trend emphasizes the need for effective prevention strategies and greater availability of screening tools for this vulnerable population.
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Affiliation(s)
- Jia-Yu Li
- Department of Child and Adolescent Health, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jing Li
- Department of Child and Adolescent Health, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jing-Hong Liang
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, Jiangsu, Christmas island
| | - Sheng Qian
- Department of Child and Adolescent Health, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Rui-Xia Jia
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Ying-Quan Wang
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Yong Xu
- Department of Child and Adolescent Health, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China (mainland).,Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, Jiangsu, CA, China (mainland)
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Pitman A, Tham SG, Hunt IM, Webb RT, Appleby L, Kapur N. Access to means of lethal overdose among psychiatric patients with co-morbid physical health problems: Analysis of national suicide case series data from the United Kingdom. J Affect Disord 2019; 257:173-179. [PMID: 31301620 DOI: 10.1016/j.jad.2019.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/28/2019] [Accepted: 06/29/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many physical health problems are associated with elevated suicide risk whilst also providing access to means of overdose. We aimed to investigate whether psychiatric patients with physical co-morbidities who die by suicide were more likely than those without co-morbidities to self-poison with non-psychotropic medications. METHODS We analysed data on 14,648 psychiatric patients who died by suicide in England & Wales during 2004-2015, as recorded by the National Confidential Inquiry into Suicide and Safety in Mental Health. Using logistic regression models adjusted for age, gender, ethnicity, and primary drug dependence/misuse we compared patients diagnosed with physical co-morbidities versus those without to assess whether a greater proportion of the former had died by overdose, and medication prescribed to treat such disorders (e.g. opioids, insulin). RESULTS 24% (n = 3525) were recorded as having physical co-morbidity. A greater proportion of these individuals died by self-poisoning than those without physical co-morbidity (37% vs. 20%, p < .001; adjusted OR 2.47; 95% CI 2.26-2.70), and they were more likely to have used medications for a physical health disorder in overdose (50% vs. 34%; adjusted OR 2.10; 95% CI 1.80-2.46), particularly opioids (30% vs. 22%; p < .001), paracetamol/opioid compounds (11% vs. 7%, p < .001) and insulin (4% vs. 1%, p < .001). LIMITATIONS Use of survey data may have resulted in under-reporting of physical health problems and/or overdose medications. CONCLUSIONS Overdose, rather than hanging, is the leading cause of suicide among psychiatric patients with physical co-morbidities, particularly using non-psychotropic medications. There is potential for means restriction in preventing suicide among these patients.
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Affiliation(s)
- Alexandra Pitman
- UCL Division of Psychiatry, University College London, UK; Camden & Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK.
| | - Su-Gwan Tham
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Isabelle M Hunt
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Roger T Webb
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Piqueras JA, Soto-Sanz V, Rodríguez-Marín J, García-Oliva C. What is the Role of Internalizing and Externalizing Symptoms in Adolescent Suicide Behaviors? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142511. [PMID: 31337102 PMCID: PMC6679016 DOI: 10.3390/ijerph16142511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 01/04/2023]
Abstract
Suicide is the second leading cause of death in adolescents and young adults aged 15 to 29 years. Specifically, the presence of internalizing and externalizing symptomatology is related to increased risk for suicide at these ages. Few studies have analyzed the relations between these symptoms and their role as mediators in predicting suicide behavior. This study aimed to examine the relation between internalizing and externalizing symptomatology and suicide behaviors through a longitudinal study. The sample consisted of 238 adolescents aged 12 to 18 years. The data were analyzed via the PROCESS Statistical Package. The main results showed that previous depression symptoms had a significant indirect effect, through previous suicide behaviors and current depression symptoms, on current suicide behaviors, accounting for 61% of the total variance explained. Additionally, being a girl increased this risk. Therefore, the implementation of early identification and intervention programs to address youth symptoms of depression and suicidal behaviors could significantly reduce the risk for future suicidal behaviors in adolescence.
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Radeloff K, Schraven SP, Radeloff D, Kraus F. [Functional rehabilitation of severe laryngopharyngeal injuries after near-lethal suicide attempt by hanging]. HNO 2018; 67:110-117. [PMID: 30406269 DOI: 10.1007/s00106-018-0578-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hanging is a common method of suicide with an estimated mortality rate of about 70%. Survival of patients with severe laryngopharyngeal injuries after strangulation is not common. However, clinical findings of patients reaching the hospital alive may be minimal. A rapid onset of multidisciplinary diagnostic and therapeutic management is mandatory, followed by psychiatric treatment and functional rehabilitation. CASE PRESENTATION AND RESULTS Two uncommon cases after severe laryngopharyngeal injury due to near-lethal suicide attempt by hanging demonstrate the emergency management and reconstructive surgery. Subsequent tracheal cannula management and swallowing therapy to full recovery are described. In addition, a proposal for an interdisciplinary treatment algorithm for those patients is presented. CONCLUSION Minimal external clinical findings after near-lethal suicide attempts by hanging do not exclude severe internal injuries of the upper aerodigestive tract structures. After reconstructive surgery an appropriate tracheal cannula management and an early and intensive swallowing therapy parallel to the psychiatric treatment is mandatory to restore voice, airway and deglutition.
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Affiliation(s)
- K Radeloff
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universität Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland. .,Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Evangelisches Krankenhaus Oldenburg, Medizinischer Campus, Universität Oldenburg, Steinweg 13-17, 26122, Oldenburg, Deutschland.
| | - S P Schraven
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - D Radeloff
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Universität Leipzig, Liebigstraße 20a, 04103, Leipzig, Deutschland
| | - F Kraus
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universität Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
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Depressive Symptoms and Associated Factors in Female Students in Fukushima Four Years after the Fukushima Nuclear Power Plant Disaster. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112411. [PMID: 30380803 PMCID: PMC6266081 DOI: 10.3390/ijerph15112411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/24/2018] [Accepted: 10/27/2018] [Indexed: 11/25/2022]
Abstract
Young women in their late teens and early 20s are at the highest risk for depression onset. The present study aimed to assess depressive symptoms among female college students in Fukushima. More specifically, it aimed to clarify factors predicting possible symptom profiles, with an emphasis on determining how nuclear radiation risks affect the reporting of depression symptoms. A cross-sectional survey was conducted of 310 female students at a college in the Fukushima prefecture, Japan, in December 2015, and 288 participants submitted valid questionnaires. In total, 222 (77.1%) participants lived in Fukushima at the time of the Great East Japan Earthquake. The measures included the World Health Organization-Five Well-Being Index, the Fukushima Future Parents Attitude Measure, and risk perception of radiation health effects. A total of 46.5% of participants reported depressive symptoms. Path analysis revealed that higher radiation risk perceptions and reduced efficacy with reproduction related to a decline in self-esteem and self-efficacy, which was subsequently associated with increased depressive symptoms. These findings highlight the importance of radiation education among children and young adults, both after a nuclear accident and during disaster preparation, particularly in the context of reproductive and mental health.
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Jones S, Riste L, Barrowclough C, Bartlett P, Clements C, Davies L, Holland F, Kapur N, Lobban F, Long R, Morriss R, Peters S, Roberts C, Camacho E, Gregg L, Ntais D. Reducing relapse and suicide in bipolar disorder: practical clinical approaches to identifying risk, reducing harm and engaging service users in planning and delivery of care – the PARADES (Psychoeducation, Anxiety, Relapse, Advance Directive Evaluation and Suicidality) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundBipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery after inadequate treatment.ObjectivesA programme of linked studies to reduce relapse and suicide in BD.DesignThere were five workstreams (WSs): a pragmatic randomised controlled trial (RCT) of group psychoeducation (PEd) versus group peer support (PS) in the maintenance of BD (WS1); development and feasibility RCTs of integrated psychological therapy for anxiety in bipolar disorder (AIBD) and integrated for problematic alcohol use in BD (WS2 and WS3); survey and qualitative investigations of suicide and self-harm in BD (WS4); and survey and qualitative investigation of service users’ (SUs) and psychiatrists’ experience of the Mental Capacity Act 2005 (MCA), with reference to advance planning (WS5).SettingParticipants were from England; recruitment into RCTs was limited to certain sites [East Midlands and North West (WS1); North West (WS2 and WS3)].ParticipantsAged ≥ 18 years. In WS1–3, participants had their diagnosis of BD confirmed by the Structural Clinical Interview for theDiagnostic and Statistical Manual of Mental Disorders.InterventionsIn WS1, group PEd/PS; in WS3 and WS4, individual psychological therapy for comorbid anxiety and alcohol use, respectively.Main outcome measuresIn WS1, time to relapse of bipolar episode; in WS2 and WS3, feasibility and acceptability of interventions; in WS4, prevalence and determinants of suicide and self-harm; and in WS5, professional training and support of advance planning in MCA, and SU awareness and implementation.ResultsGroup PEd and PS could be routinely delivered in the NHS. The estimated median time to first bipolar relapse was 67.1 [95% confidence interval (CI) 37.3 to 90.9] weeks in PEd, compared with 48.0 (95% CI 30.6 to 65.9) weeks in PS. The adjusted hazard ratio was 0.83 (95% CI 0.62 to 1.11; likelihood ratio testp = 0.217). The interaction between the number of previous bipolar episodes (1–7 and 8–19, relative to 20+) and treatment arm was significant (χ2 = 6.80, degrees of freedom = 2;p = 0.034): PEd with one to seven episodes showed the greatest delay in time to episode. A primary economic analysis indicates that PEd is not cost-effective compared with PS. A sensitivity analysis suggests potential cost-effectiveness if decision-makers accept a cost of £37,500 per quality-adjusted life-year. AIBD and motivational interviewing (MI) cognitive–behavioural therapy (CBT) trials were feasible and acceptable in achieving recruitment and retention targets (AIBD:n = 72, 72% retention to follow-up; MI-CBT:n = 44, 75% retention) and in-depth qualitative interviews. There were no significant differences in clinical outcomes for either trial overall. The factors associated with risk of suicide and self-harm (longer duration of illness, large number of periods of inpatient care, and problems establishing diagnosis) could inform improved clinical care and specific interventions. Qualitative interviews suggested that suicide risk had been underestimated, that care needs to be more collaborative and that people need fast access to good-quality care. Despite SUs supporting advance planning and psychiatrists being trained in MCA, the use of MCA planning provisions was low, with confusion over informal and legally binding plans.LimitationsInferences for routine clinical practice from WS1 were limited by the absence of a ‘treatment as usual’ group.ConclusionThe programme has contributed significantly to understanding how to improve outcomes in BD. Group PEd is being implemented in the NHS influenced by SU support.Future workFuture work is needed to evaluate optimal approaches to psychological treatment of comorbidity in BD. In addition, work in improved risk detection in relation to suicide and self-harm in clinical services and improved training in MCA are indicated.Trial registrationCurrent Controlled Trials ISRCTN62761948, ISRCTN84288072 and ISRCTN14774583.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steven Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lisa Riste
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Peter Bartlett
- School of Law and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Caroline Clements
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Linda Davies
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Fiona Holland
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Nav Kapur
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
- Manchester Mental Health & Social Care NHS Trust, Manchester, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Rita Long
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Chris Roberts
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Lynsey Gregg
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Dionysios Ntais
- Institute of Population Health, University of Manchester, Manchester, UK
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Hussain H, Dubicka B, Wilkinson P. Recent developments in the treatment of major depressive disorder in children and adolescents. EVIDENCE-BASED MENTAL HEALTH 2018; 21:101-106. [PMID: 30045844 PMCID: PMC10270457 DOI: 10.1136/eb-2018-102937] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 01/22/2023]
Abstract
Major depressive disorder in adolescents is an important public health concern. It is common, a risk factor for suicide and is associated with adverse psychosocial consequences. The UK National Institute for Health and Care Excellence guidelines recommend that children and young people with moderate-to-severe depression should be seen within Child and Adolescent Mental Health Services and receive specific psychological interventions, possibly in combination with antidepressant medication. Cognitive behavioural therapy (in some studies) and interpersonal psychotherapy have been demonstrated to be more effective than active control treatments for depressed adolescents. For children with depression, there is some evidence that family focused approaches are more effective than individual therapy. Fluoxetine is the antidepressant with the greatest evidence for effectiveness compared with placebo. Treatment with antidepressants and/or psychological therapy is likely to reduce suicidality, although in some young people, selective serotonin reuptake inhibitors lead to increased suicidality. There is limited evidence that combination of specific psychological therapy and antidepressant medication is better than treatment with monotherapy. There are methodological limitations in the published literature that make it difficult to relate study findings to the more severely ill clinical population in Child and Adolescent Mental Health Services. Young people should have access to both evidence-based psychological interventions and antidepressants for paediatric depression. Collaborative decisions on treatment should be made jointly by young people, their carers and clinicians, taking into account individual circumstances and potential benefits, risks and availability of treatment.
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Affiliation(s)
- Haseena Hussain
- Academic Clinical Fellow and Specialty Registrar in Child and Adolescent Psychiatry, University of Cambridge and Hertfordshire Partnership University NHS Foundation Trust, Cambridge, UK
| | - Bernadka Dubicka
- Consultant Child and Adolescent Psychiatrist, Pennine Care Foundation trust and honorary reader, University of Manchester, UK
| | - Paul Wilkinson
- Consultant and clinical Lecturer in Child and Adolescent Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Yucel A, Essien EJ, Sanyal S, Mgbere O, Aparasu RR, Bhatara VS, Alonzo JP, Chen H. Racial/ethnic differences in the treatment of adolescent major depressive disorders (MDD) across healthcare providers participating in the medicaid program. J Affect Disord 2018; 235:155-161. [PMID: 29656260 DOI: 10.1016/j.jad.2018.04.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/09/2018] [Accepted: 04/04/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND To examine whether racial/ethnic differences in receipt of MDD treatment could be explained by the specialty of provider diagnosing the adolescent. METHOD Adolescents (10-20 years-old) with ≥2 MDD diagnoses were identified using 2005-2007 Medicaid data from Texas. Patients were categorized based on the types of provider who gave the initial MDD diagnosis (psychiatrist (PSY-I), social worker/psychologist (SWP-I), and primary care physician (PCP-I)). Within the sub-cohorts identified by each type of provider, patients were further divided by racial/ethnic groups. RESULTS Of the 13,234-new pediatric MDD cases diagnosed, 61% were SWP-I, 33% PSY-I and 6% PCP-I. Results of the analysis using general linear multi-level model showed that being first diagnosed by a psychiatrist was associated with higher chance of receiving MDD related treatment (PCP-I vs. PSY-I (OR: 0.54, 95%CI: 0.4-0.7) and SWP-I vs. PSY-I (OR: 0.17, 95%CI: 0.1-0.2)). Specifically, regarding the receipt of pharmacotherapy, an interaction effect was detected between types of identifying providers and patients' race/ethnicity. The analysis stratified by race/ethnicity found Whites received comparable treatment regardless being PCP-Is or PSY-Is, while for Hispanics, being first identified by a PCP was associated with lower likelihood of receiving treatment as compared to being first identified by a psychiatrist. Further analysis stratified by provider types showed that a significant racial/ethnic variation in medication utilization was observed in PCP-Is, but not in PSY-Is. CONCLUSION For adolescents with MDD, being first diagnosed by a psychiatrist was associated with higher treatment rate and reduced racial/ethnic variation in the utilization of pharmacotherapy.
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Affiliation(s)
- Aylin Yucel
- University of Houston College of Pharmacy, Houston, TX, USA.
| | - Ekere J Essien
- University of Houston College of Pharmacy, Houston, TX, USA.
| | - Swarnava Sanyal
- University of Houston College of Pharmacy, Houston, TX, USA.
| | - Osaro Mgbere
- Bureau of Epidemiology, Houston Health Department.
| | | | | | - Joy P Alonzo
- University of Houston College of Pharmacy, Houston, TX, USA.
| | - Hua Chen
- University of Houston College of Pharmacy, Houston, TX, USA.
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Eynan R, Shah R, Heisel MJ, Eden D, Jhirad R, Links PS. The Feasibility and Clinical Utility of Conducting a Confidential Inquiry Into Suicide in Southwestern Ontario. CRISIS 2017; 39:283-293. [PMID: 29256267 DOI: 10.1027/0227-5910/a000500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Given the effectiveness of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI) in the UK, the present study evaluated this approach in Southwestern Ontario. A systematic confidential examination of suicides in Ontario was developed to guide quality improvement of services and suicide prevention. METHOD A 3-year case series of consecutive suicides in Southwestern Ontario identified by the Office of the Chief Coroner was compiled. Clinicians who provided care to suicide decedents completed an online confidential suicide questionnaire offered through a secured portal. RESULTS A total of 476 suicide cases were analyzed. In all, 270 invitations to clinicians were sent, 237 (87.8%) responded to the invitation and 187 (69.3%) completed the online questionnaire. The majority of the suicide decedents (54.6%, n = 260), were between the ages of 40 and 64 (x = 47.2, SD = 17.1), White (91.4%, n = 416), single (34.2%, n = 439), and male (74.4%, n = 476). Of the 86 cases of self-poisoning, prescription medications were used in 66.3%. Almost two thirds of decedents visited the clinician in the month prior to their death. LIMITATIONS The results of the survey were drawn from suicides in Southwestern Ontario and generalizing these findings should be done with caution. CONCLUSION This study highlights (a) the value of the clinicians' survey to identify gaps in clinical services and (b) the necessity of improvements in suicide risk assessment/management and restriction of prescription medications.
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Affiliation(s)
- Rahel Eynan
- 1 Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,2 Lawson Health Research Institute, London, ON, Canada
| | - Ravi Shah
- 1 Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Marnin J Heisel
- 1 Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,2 Lawson Health Research Institute, London, ON, Canada
| | - David Eden
- 3 Office of the Chief Coroner of Ontario, Toronto, ON, Canada
| | - Reuven Jhirad
- 3 Office of the Chief Coroner of Ontario, Toronto, ON, Canada
| | - Paul S Links
- 1 Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,2 Lawson Health Research Institute, London, ON, Canada
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Sousa GSD, Santos MSPD, Silva ATPD, Perrelli JGA, Sougey EB. Revisão de literatura sobre suicídio na infância. CIENCIA & SAUDE COLETIVA 2017; 22:3099-3110. [DOI: 10.1590/1413-81232017229.14582017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/18/2017] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivou-se analisar a literatura específica sobre os fatores associados ao comportamento suicida em crianças com até 14 anos. Trata-se, portanto, de uma revisão integrativa sobre este tema. Os dados foram coletados nas bases de dados PubMed e Psycinfo, a partir dos seguintes descritores: “risk of suicide”; “children”; “suicide”; “childhood”. O tempo de publicação foi limitado ao período de 1980 a 2016. Um total de 29 artigos preencheu os critérios de elegibilidade e, portanto, foram selecionados e analisados. Os resultados indicaram haver associação do suicídio com fatores neurobiológicos, escolares, sociais e mentais, dentre eles destaca-se o papel da impulsividade. Além disso, evidenciou-se que a maioria dos fatores de vulnerabilidade ao comportamento suicida podem ser prevenidos desde que sejam identificados e a criança receba tratamento psicológico e médico. Conclui-se que conflitos familiares, problemas na escola, bullying, impulsividade e depressão estão associados ao suicídio na infância. Adicionalmente, a escassez de pesquisas no âmbito nacional acerca da temática do suicídio pode contribuir para a invisibilidade desse tema na instauração de programas de promoção e tratamento de saúde.
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Zainum K, Cohen MC. Suicide patterns in children and adolescents: a review from a pediatric institution in England. Forensic Sci Med Pathol 2017; 13:115-122. [PMID: 28349246 DOI: 10.1007/s12024-017-9860-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 11/24/2022]
Abstract
Suicide is a catastrophic event to both families and communities yet it is potentially preventable. This study aims to determine incidence and patterns of suicide in children and young adolescents in our region, raise awareness of this entity as a potentially preventable cause of death in this age group, and identify its possible associated risk factors. We retrospectively reviewed suicide cases presenting as sudden unexpected death in children and adolescents that underwent coronial post-mortems at our institution. This is the largest pathological review of completed suicide in children and young adolescents within a single institution in the United Kingdom. We identified 23 suicide cases during a 12 year period from 2003 to 2015, in which 18 cases (78%) were male and 5 cases (22%) were female. The age range was from 8 to 16 years (mean age 12.82 +/- 2.52 SD). With the exception of one case, all of the victims were Caucasian. The majority, 19 cases (81%), were found dead inside their place of residence, 15 of whom were discovered in their own bedrooms. Twenty-one cases (91%) died from neck compression due to hanging; 6 cases (26%) had used the cord of a dressing gown and 5 (22%) opted to use a belt as the ligature. Two cases (9%) that died from multiple-drug toxicity were female. In 7 cases (30.5%) there was evidence of self-harm and in 3 cases (13%) there was a history of previous suicide attempts. Petechial hemorrhages were found at autopsy in more than half of hanging victims and only three cases (14%) displayed dual distribution of post-mortem hypostasis (back and legs). Seven victims (30.5%) left some form of suicide message to family members and friends, 2 of which wrote the message on their arm. Parental separation, conflict with parents, and depression, were common amongst decedents prior to committing suicide. Substance abuse was uncommon in suicide within our cases. Valuable information is available from thorough review of suicide data in children and young adolescents from a single institution. Pathologists and clinicians can play crucial roles in identifying potential risk factors that may contribute to prevent future deaths.
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Affiliation(s)
- Khairul Zainum
- Department of Histopathology, Sheffield Children's Hospital Foundation Trust, Western Bank, S10 2TH, Sheffield, UK
- Department of Forensic Medicine, Hospital Sultanah Aminah, Johor Bharu, Johore, Malaysia
| | - Marta C Cohen
- Department of Histopathology, Sheffield Children's Hospital Foundation Trust, Western Bank, S10 2TH, Sheffield, UK.
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Saleh D, Camart N, Romo L. Predictors of Stress in College Students. Front Psychol 2017; 8:19. [PMID: 28179889 PMCID: PMC5263159 DOI: 10.3389/fpsyg.2017.00019] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 01/04/2017] [Indexed: 01/07/2023] Open
Abstract
University students often face different stressful situations and preoccupations: the first contact with the university, the freedom of schedule organization, the selection of their master's degree, very selective fields, etc. The purpose of this study is to evaluate a model of vulnerability to stress in French college students. Stress factors were evaluated by a battery of six scales that was accessible online during 3 months. A total of 483 students, aged between 18 and 24 years (Mean = 20.23, standard deviation = 1.99), was included in the study. The results showed that 72.9, 86.3, and 79.3% of them were suffering from psychological distress, anxiety and depressive symptoms, respectively. More than half the sample was also suffering from low self-esteem (57.6%), little optimism (56.7%), and a low sense of self-efficacy (62.7%). Regression analyses revealed that life satisfaction, self-esteem, optimism, self-efficacy and psychological distress were the most important predictors of stress. These findings allow us to better understand stress-vulnerability factors in students and drive us to substantially consider them in prevention programs.
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Affiliation(s)
- Dalia Saleh
- EA4430 CLIPSYD, UFR SPSE, Paris Nanterre UniversityNanterre, France; Counseling Psychology, Tishreen UniversityLatakia, Syria
| | - Nathalie Camart
- EA4430 CLIPSYD, UFR SPSE, Paris Nanterre University Nanterre, France
| | - Lucia Romo
- EA4430 CLIPSYD, UFR SPSE, Paris Nanterre University Nanterre, France
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John A, Marchant AL, Fone DL, McGregor JI, Dennis MS, Tan JOA, Lloyd K. Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study. Psychol Med 2016; 46:3315-3327. [PMID: 27879187 PMCID: PMC5122314 DOI: 10.1017/s0033291716002099] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/28/2016] [Accepted: 07/26/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Concerns relating to increased use of psychotropic medication contrast with those of under-treatment and under-recognition of common mental disorders in children and young people (CYP) across developed countries. Little is known about the indications recorded for antidepressant prescribing in primary care in CYP. METHOD This was an electronic cohort study of routinely collected primary-care data from a population of 1.9 million, Wales, UK. Poisson regression was undertaken to model adjusted counts of recorded depression symptoms, diagnoses and antidepressant prescriptions. Associated indications were explored. RESULTS 3 58 383 registered patients aged 6-18 years between 1 January 2003 and 31 December 2013 provided a total of 19 20 338 person-years of follow-up. The adjusted incidence of antidepressant prescribing increased significantly [incidence rate ratio (IRR) for 2013 = 1.28], mainly in older adolescents. The majority of new antidepressant prescriptions were for citalopram. Recorded depression diagnoses showed a steady decline (IRR = 0.72) while depression symptoms (IRR = 2.41) increased. Just over half of new antidepressant prescriptions were associated with depression (diagnosis or symptoms). Other antidepressant prescribing, largely unlicensed, was associated with diagnoses such as anxiety and pain. CONCLUSION Antidepressant prescribing is increasing in CYP while recorded depression diagnoses decline. Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose. Unlicensed antidepressant prescribing is associated with a wide range of diagnoses, and while accepted practice, is often not supported by safety and efficacy studies. New strategies to implement current guidance for the management of depression in CYP are required.
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Affiliation(s)
- A. John
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
| | - A. L. Marchant
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
| | - D. L. Fone
- Division of Population Medicine,
School of Medicine, Cardiff University,
Cardiff, UK
| | - J. I. McGregor
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
| | - M. S. Dennis
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
| | - J. O. A. Tan
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
| | - K. Lloyd
- Farr Institute of Health Informatics Research,
Swansea University Medical School, Singleton Park,
Swansea, UK
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Kapur N, Ibrahim S, Hunt IM, Turnbull P, Shaw J, Appleby L. Mental health services, suicide and 7-day working. Br J Psychiatry 2016; 209:334-339. [PMID: 27388571 DOI: 10.1192/bjp.bp.116.184788] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/03/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients admitted to hospital at the weekend appear to be at increased risk of death compared with those admitted at other times. However, a 'weekend effect' has rarely been explored in mental health and there may also be other times of year when patients are vulnerable. AIMS To investigate the timing of suicide in high-risk mental health patients. METHOD We compared the incidence of suicide at the weekend v. during the week, and also in August (the month of junior doctor changeover) v. other months in in-patients, patients within 3 months of discharge and patients under the care of crisis resolution home treatment (CRHT) teams (2001-2013). RESULTS The incidence of suicide was lower at the weekends for each group (incidence rate ratio (IRR) = 0.88 (95% CI 0.79-0.99) for in-patients, IRR = 0.85 (95% CI 0.78-0.92) for post-discharge patients, IRR = 0.87 (95% CI 0.78-0.97) for CRHT patients). Patients who died by suicide were also less likely to have been admitted at weekends than during the week (IRR = 0.52 (95% CI 0.45-0.60)). The incidence of suicide in August was not significantly different from other months. CONCLUSIONS We found evidence of a weekend effect for suicide risk among high-risk mental health patients, but with a 12-15% lower incidence at weekends. Our study does not support the claim that safety is compromised at weekends, at least in mental health services.
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Affiliation(s)
- Nav Kapur
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Saied Ibrahim
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Isabelle M Hunt
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Jenny Shaw
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Louis Appleby
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
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Redmore J, Kipping R, Trickey A, May MT, Gunnell D. Analysis of trends in adolescent suicides and accidental deaths in England and Wales, 1972-2011. Br J Psychiatry 2016; 209:327-333. [PMID: 27284083 PMCID: PMC5046738 DOI: 10.1192/bjp.bp.114.162347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 01/12/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous analyses of adolescent suicides in England and Wales have focused on short time periods. AIMS To investigate trends in suicide and accidental deaths in adolescents between 1972 and 2011. METHOD Time trend analysis of rates of suicides and deaths from accidental poisoning and hanging in 10- to 19-year-olds by age, gender and deprivation. Rate ratios were estimated for 1982-1991, 1992-2001 and 2002-2011 with 1972-1981 as comparator. RESULTS Suicide rates have remained stable in 10- to 14-year-olds, with strong evidence for a reduction in accidental deaths. In males aged 15-19, suicide rates peaked in 2001 before declining. Suicide by hanging is the most common method of suicide. Rates were higher in males and in 15- to 19-year-olds living in more deprived areas. CONCLUSIONS Suicide rates in adolescents are at their lowest since the early 1970s with no clear evidence that changes in coroners' practices underlie this trend.
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Affiliation(s)
| | - Ruth Kipping
- James Redmore, BSc, MPH, Ruth Kipping, MA(Cantab), MSc, MA(Lond), PhD, FFPH, Adam Trickey, BSc, MSc, Margaret T. May, MA(Cantab), MSc, PhD, David Gunnell, MB ChB, PhD, FFPH, MRCGP, MFPHM, DSc, FMedSci, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Gaete J, Martinez V, Fritsch R, Rojas G, Montgomery AA, Araya R. Indicated school-based intervention to improve depressive symptoms among at risk Chilean adolescents: a randomized controlled trial. BMC Psychiatry 2016; 16:276. [PMID: 27488266 PMCID: PMC4973098 DOI: 10.1186/s12888-016-0985-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/28/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Depression is a disabling condition affecting people of all ages, but generally starting during adolescence. Schools seem to be an excellent setting where preventive interventions may be delivered. This study aimed to test the effectiveness of an indicated school-based intervention to reduce depressive symptoms among at-risk adolescents from low-income families. METHODS A two-arm, parallel, randomized controlled trial was conducted in 11 secondary schools in vulnerable socioeconomic areas in Santiago, Chile. High-risk students in year 10 (2° Medio) were invited to a baseline assessment (n = 1048). Those who scored ≥10 (boys) and ≥15 (girls) in the BDI-II were invited to the trial (n = 376). A total of 342 students consented and were randomly allocated into an intervention or a control arm in a ratio of 2:1. The intervention consisted of 8 group sessions of 45 min each, based on cognitive-behavioural models and delivered by two trained psychologists in the schools. Primary (BDI-II) and secondary outcomes (measures of anxiety, automatic thoughts and problem-solving skills) were administered before and at 3 months post intervention. The primary outcome was the recovery rate, defined as the proportion of participants who scored in the BDI-II <10 (among boys) and <15 (among girls) at 3 months after completing the intervention. RESULTS There were 229 participants in the intervention group and 113 in the control group. At 3-month follow-up 81.4 % in the intervention and 81.7 % in the control group provided outcome data. The recovery rate was 10 % higher in the intervention (50.3 %) than in the control (40.2 %) group; with an adjusted OR = 1.62 (95 % CI: 0.95 to 2.77) (p = 0.08). No difference between groups was found in any of the secondary outcomes. Secondary analyses revealed an interaction between group and baseline BDI-II score. CONCLUSIONS We found no clear evidence of the effectiveness of a brief, indicated school-based intervention based on cognitive-behavioural models on reducing depressive symptoms among Chilean adolescents from low-income families. More research is needed in order to find better solutions to prevent depression among adolescents. TRIAL REGISTRATION Current Controlled Trials ISRCTN33871591 . Retrospectively registered 29 June 2011.
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Affiliation(s)
- Jorge Gaete
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Departamento de Salud Pública y Epidemiología, Facultad de Medicina, Universidad de los Andes, Monseñor Álvaro del Portillo 12455, Las Condes, Santiago, Chile.
| | - Vania Martinez
- Millennium Institute for Research in Depression and Personality, Av. Vicuña Mackenna 4860, Macul, Santiago Chile ,Universidad de Chile, Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, Av. Profesor Zañartu 1030, Independencia, Santiago Chile
| | - Rosemarie Fritsch
- Universidad de Chile, Departamento de Psiquiatría y Salud Mental, Clínica Psiquiátrica Universitaria, Av. La Paz 1003, Recoleta, Santiago Chile
| | - Graciela Rojas
- Millennium Institute for Research in Depression and Personality, Av. Vicuña Mackenna 4860, Macul, Santiago Chile ,Universidad de Chile, Departamento de Psiquiatría y Salud Mental, Clínica Psiquiátrica Universitaria, Av. La Paz 1003, Recoleta, Santiago Chile
| | - Alan A. Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Ricardo Araya
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Cavanagh B, Ibrahim S, Roscoe A, Bickley H, While D, Windfuhr K, Appleby L, Kapur N. The timing of general population and patient suicide in England, 1997-2012. J Affect Disord 2016; 197:175-81. [PMID: 26994435 DOI: 10.1016/j.jad.2016.02.055] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/29/2016] [Accepted: 02/26/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND There have been conflicting findings on temporal variation in suicide risk and few have examined the phenomenon in clinical populations. The study investigated seasonal and other temporal patterns using national data. METHODS Data on 73,591 general population and 19,318 patient suicide deaths in England between 1997 and 2012 were collected through the National Confidential Inquiry into Suicide examining suicide rates in relation to month of the year, day of the week, and individual days of national or religious significance. RESULTS Suicide incidence fell over successive months of the year and there was evidence of an overall spring peak. Monday was associated with the highest suicide rates and in the patient population this effect appeared to be more pronounced in those aged over 50 or those who lived alone. Suicide risk was significantly lower during Christmas, particularly for women. There was a peak in suicide on New Year's Day in the general population. Other 'special days' were not associated with a change in suicide incidence. LIMITATIONS We were limited to identifying associations between the variables investigated and were unable to explore causal mechanisms. We did not carry out comprehensive multi-variable adjustment in our regression models. CONCLUSIONS There is substantial seasonal and temporal variation in suicide deaths, and there appears to be some evidence in the clinical as well as the general population in England. Clinical services should be aware of the risk of suicide just after the weekend, especially in people who live alone, and the potential need for closer supervision during this period.
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Affiliation(s)
| | - Saied Ibrahim
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, The University of Manchester, UK.
| | - Alison Roscoe
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, The University of Manchester, UK
| | - Harriet Bickley
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, The University of Manchester, UK
| | - David While
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, The University of Manchester, UK
| | - Kirsten Windfuhr
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, The University of Manchester, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, The University of Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, The University of Manchester, UK; Manchester Mental Health and Social Care Trust, Manchester, UK
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Depression and resting state heart rate variability in children and adolescents — A systematic review and meta-analysis. Clin Psychol Rev 2016; 46:136-50. [DOI: 10.1016/j.cpr.2016.04.013] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 04/18/2016] [Accepted: 04/23/2016] [Indexed: 12/13/2022]
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Gontijo Guerra S, Vasiliadis HM. Gender Differences in Youth Suicide and Healthcare Service Use. CRISIS 2016; 37:290-298. [PMID: 27245811 DOI: 10.1027/0227-5910/a000387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Healthcare service use among suicide decedents must be well characterized and understood since a key strategy for preventing suicide is to improve healthcare providers' ability to effectively detect and treat those in need. AIMS To determine gender differences in healthcare service use 12 months prior to suicide. METHOD Data for 1,231 young Quebec residents (≤ 25 years) who died by suicide between 2000 and 2007 were collected from public health insurance agency databases and coroner registers. Healthcare visits were categorized according to the setting (emergency department [ED], outpatient, and hospital) and their nature (mental health vs. non-mental health). RESULTS Girls were more likely than boys (82.5% vs. 74.9%, p = .011) to have used healthcare services in the year prior to death. A higher proportion of girls had used outpatient services (79.0% vs. 69.5%, p = .003), had been hospitalized (25.7% vs. 15.6%, p < .001) and had received a mental health-related diagnosis (46.7% vs. 33.1%, p < .001). However, no gender differences were observed in ED visits (59.5% vs. 54.5%, p = .150). CONCLUSION There is an important proportion of suicide decedents who did not receive a mental health diagnosis and healthcare services in the year prior to death. Future studies should focus on examining gender-specific individual and health system barriers among suicide decedents as well as the quality of care offered regarding detection and treatment.
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Affiliation(s)
- Samantha Gontijo Guerra
- 1 Department of Community Health Sciences, Faculty of Medicine and Health Sciences of the University of Sherbrooke, Charles Le Moyne Hospital Research Center, Longueuil, QC, Canada
| | - Helen-Maria Vasiliadis
- 1 Department of Community Health Sciences, Faculty of Medicine and Health Sciences of the University of Sherbrooke, Charles Le Moyne Hospital Research Center, Longueuil, QC, Canada
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Kapur N, Ibrahim S, While D, Baird A, Rodway C, Hunt IM, Windfuhr K, Moreton A, Shaw J, Appleby L. Mental health service changes, organisational factors, and patient suicide in England in 1997-2012: a before-and-after study. Lancet Psychiatry 2016; 3:526-34. [PMID: 27107805 DOI: 10.1016/s2215-0366(16)00063-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/29/2016] [Accepted: 02/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research into which aspects of service provision in mental health are most effective in preventing suicide is sparse. We examined the association between service changes, organisational factors, and suicide rates in a national sample. METHODS We did a before-and-after analysis of service delivery data and an ecological analysis of organisational characteristics, in relation to suicide rates, in providers of mental health care in England. We also investigated whether the effect of service changes varied according to markers of organisational functioning. FINDINGS Overall, 19 248 individuals who died by suicide within 12 months of contact with mental health services were included (1997-2012). Various service changes related to ward safety, improved community services, staff training, and implementation of policy and guidance were associated with a lower suicide rate after the introduction of these changes (incidence rate ratios ranged from 0·71 to 0·79, p<0·0001). Some wider organisational factors, such as non-medical staff turnover (Spearman's r=0·34, p=0·01) and incident reporting (0·46, 0·0004), were also related to suicide rates but others, such as staff sickness (-0·12, 0·37) and patient satisfaction (-0·06, 0·64), were not. Service changes had more effect in organisations that had low rates of staff turnover but high rates of overall event reporting. INTERPRETATION Aspects of mental health service provision might have an effect on suicide rates in clinical populations but the wider organisational context in which service changes are made are likely to be important too. System-wide change implemented across the patient care pathway could be a key strategy for improving patient safety in mental health care. FUNDING The Healthcare Quality Improvement Partnership commissions the Mental Health Clinical Outcome Review Programme, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, Social Services and Public Safety, and the States of Jersey and Guernsey.
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Affiliation(s)
- Nav Kapur
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Manchester Mental Health and Social Care Trust, Manchester, UK.
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - David While
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Alison Baird
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Cathryn Rodway
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Isabelle M Hunt
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Adam Moreton
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Jenny Shaw
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Radeloff D, Lempp T, Rauf A, Bennefeld-Kersten K, Kettner M, Freitag CM. [Suicide and suicide tendencies in adolescent detainees]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 44:9-18; quiz 19-20. [PMID: 26864223 DOI: 10.1024/1422-4917/a000394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Following accidents, suicide is the second leading cause of death in adolescence. This stage of life has the most suicide attempts of all age groups. In addition to mentally ill juveniles, adolescent delinquents represent a high-risk group for suicidal behavior and completed suicide. In particular, the population of detainees, an extreme form of juvenile delinquency, have a 16- to 18-fold higher risk of suicidal behavior and suicide compared to the general population. Because the composition of juvenile detainees differs greatly from that of detained adults, age-specific scientific approaches and prevention programs are needed. This task cannot be addressed by juvenile detention staff alone, but rather demands close cooperation between adolescent psychiatrists, psychologists, prison medical staff, legal experts and prison officers to use the opportunity for suicide prevention in juvenile detention facilities.
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Affiliation(s)
- Daniel Radeloff
- 1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Klinikum der Goethe-Universität Frankfurt am Main
| | - Thomas Lempp
- 1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Klinikum der Goethe-Universität Frankfurt am Main
| | - Amna Rauf
- 1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Klinikum der Goethe-Universität Frankfurt am Main
| | | | - Mattias Kettner
- 3 Institut für Rechtsmedizin, Klinikum der Goethe-Universität Frankfurt am Main
| | - Christine M Freitag
- 1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Klinikum der Goethe-Universität Frankfurt am Main
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Schulte-Körne G. Mental Health Problems in a School Setting in Children and Adolescents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:183-90. [PMID: 27118666 PMCID: PMC4850518 DOI: 10.3238/arztebl.2016.0183] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND 10-20% of children and adolescents have a mental health problem of some type. Manifestations such as attention deficits, cognitive disturbances, lack of motivation, and negative mood all adversely affect scholastic development. It is often unclear what factors associated with school affect children's mental development and what preventive measures and interventions at school might be effective. METHODS This review is based on systematic reviews, meta-analyses, and randomized and non-randomized controlled trials that were retrieved by a selective search in the PubMed, PsycInfo, and Google Scholar databases. RESULTS The prevalence of hyperkinetic disorder is 1-6%. Its main manifestations are motor hyperactivity, an attention deficit, and impulsive behavior. Learning disorders such as dyscalculia and dyslexia affect 4-6% of children each, while 4-5% of children and adolescents suffer from depression, which is twice as prevalent in girls as in boys. Mental health problems increase the risk of repeating a grade, truancy, and dropping out of school. The risk of developing an internalizing or externalizing mental health problem can be lessened by changes in the school environment and by the implementation of evidencebased school programs. CONCLUSION Physicians, in collaboration with school social workers and psychologists, should help teachers recognize and contend with mental health problems among the children and adolescents whom they teach, to enable the timely detection of stress factors at school and the initiation of the necessary measures and aids. In particular, the school-entrance examination and screening for risk factors at school can make a positive contribution. Evidence-based preventive programs should be implemented in schools, and beneficial changes of the school environment should be a further goal.
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Affiliation(s)
- Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität München
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75
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Hunt IM, Clements C, Saini P, Rahman MS, Shaw J, Appleby L, Kapur N, Windfuhr K. Suicide after absconding from inpatient care in England: an exploration of mental health professionals' experiences. J Ment Health 2016; 25:245-53. [PMID: 27150467 DOI: 10.3109/09638237.2015.1124394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Absconding from inpatient care is associated with suicide risk in psychiatric populations. However, little is known about the real world context of suicide after absconding from a psychiatric ward or the experiences of clinical staff caring for these patients. AIMS To identify the characteristics of inpatients who died by suicide after absconding and to explore these and further key issues related to suicide risk from the perspective of clinical staff. METHODS A mixed-methods study using quantitative data of all patient suicides in England between 1997 and 2011 and a thematic analysis of semi-structured interviews with 21 clinical staff. RESULTS Four themes were identified as areas of concern for clinicians: problems with ward design, staffing problems, difficulties in assessing risk, and patient specific factors. CONCLUSIONS Results suggest that inpatients who died by suicide after absconding may have more complex and severe illness along with difficult life events, such as homelessness. Closer monitoring of inpatients and access points, and improved risk assessments are important to reduce suicide in this patient group.
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Affiliation(s)
- Isabelle M Hunt
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Caroline Clements
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Pooja Saini
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Mohammad Shaiyan Rahman
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Jenny Shaw
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Louis Appleby
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Nav Kapur
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Kirsten Windfuhr
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
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76
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De-la-Iglesia M, Olivar JS. Risk Factors for Depression in Children and Adolescents with High Functioning Autism Spectrum Disorders. ScientificWorldJournal 2015; 2015:127853. [PMID: 26413564 PMCID: PMC4562099 DOI: 10.1155/2015/127853] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/14/2015] [Accepted: 05/24/2015] [Indexed: 12/28/2022] Open
Abstract
The objective of our study was to examine, discuss, and provide proposals on diagnostic comorbidity of depression in children and adolescents with high functioning autism spectrum disorder (HFASD) in the following aspects. (1) Prevalence. It was concluded that there are an elevated depression rate and the need for longitudinal studies to determine prevalence and incidence based on functioning level, autistic symptoms, gender, age, type of depression, prognosis, duration, and treatment. (2) Explicative Hypotheses and Vulnerability. The factors that present the greatest specific risk are higher cognitive functioning, self-awareness of deficit, capacity for introspection, stressful life events, adolescence, quality of social relationships, and alexithymia. (3) Risk of Suicide. The need for control and detection of suicidal tendencies and bullying is emphasised. (4) Depressive Symptoms. Indicators for early detection are proposed and their overlap with HFASD is analysed, examining the assessment techniques used and arguing that specific adapted tests are needed.
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Affiliation(s)
- Myriam De-la-Iglesia
- Departamento de Psicología, Facultad de Educación, Universidad de Valladolid, Campus María Zambrano, Plaza Alto de los Leones 1, 40005 Segovia, Spain
- Laboratoire LPPS, EA 4057, 92100 Paris, France
| | - José-Sixto Olivar
- Laboratoire LPPS, EA 4057, 92100 Paris, France
- Departamento de Psicología, Facultad de Educación y Trabajo Social, Universidad de Valladolid, Campus Miguel Delibes, Paseo de Belén 1, 47011 Valladolid, Spain
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Posporelis S, Paspali A, Takayanagi Y, Sawa A, Banerjea P, Kyriakopoulos M. Demographic and clinical correlates of suicidality in adolescents attending a specialist community mental health service: a naturalistic study. J Ment Health 2015. [PMID: 26203534 DOI: 10.3109/09638237.2015.1022249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adolescents comprise a unique and often challenging group of patients with diverse presentations to the Mental Health Services; suicidal behavior being one of them. AIMS The main aim of this naturalistic project was to investigate demographic and clinical correlates of adolescent suicidal and self-harm events, which may be of value to decision-making in clinical practice. METHOD All adolescents (n = 149) registered and actively managed by a specialist community mental health service in South London were included in the study. Clinical information from their files was used to determine suicidality/self-harm events. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) was utilised for classification purposes. Logistic regression was used to explore the effects of age, sex, diagnosis, medication, substance use (alcohol and/or cannabis) and ethnicity on suicidality/self-harming behaviors. RESULTS Age, sex and use of psychotropic medication were identified to play a significant role in determining the risk of engaging in self-harming behavior. The risk was higher with increasing age and female sex. Medication seemed to have a protective effect. Reporting a 20% prevalence of non-suicidal self-injury (NSSI) in our population, we highlight the importance of NSSI as a distinct diagnostic category. CONCLUSIONS Our findings have implications for risk assessment and appropriate decision-making in clinical settings. Results are translatable and relevant to other metropolitan areas.
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Affiliation(s)
- Sotirios Posporelis
- a Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA .,b Child and Adolescent Mental Health Services Clinical Academic Group , South London and Maudsley NHS Foundation Trust , London , UK
| | - Aspasia Paspali
- b Child and Adolescent Mental Health Services Clinical Academic Group , South London and Maudsley NHS Foundation Trust , London , UK
| | - Yoichiro Takayanagi
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Akira Sawa
- a Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Partha Banerjea
- b Child and Adolescent Mental Health Services Clinical Academic Group , South London and Maudsley NHS Foundation Trust , London , UK
| | - Marinos Kyriakopoulos
- b Child and Adolescent Mental Health Services Clinical Academic Group , South London and Maudsley NHS Foundation Trust , London , UK .,d Institute of Psychiatry, Psychology and Neuroscience King's College London , London , UK , and.,e Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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78
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Duffy A, Jones S, Goodday S, Bentall R. Candidate Risks Indicators for Bipolar Disorder: Early Intervention Opportunities in High-Risk Youth. Int J Neuropsychopharmacol 2015; 19:pyv071. [PMID: 26116493 PMCID: PMC4772266 DOI: 10.1093/ijnp/pyv071] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/16/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Psychiatric illnesses like bipolar disorder are increasingly understood to be neurodevelopmental disorders with clinical, psychological, and biological indicators recognizable long before the emergence of the full-blown syndromes. METHODS This paper is a selective review of findings from studies of high-risk children of affected parents that inform the knowledge of illness risk and development markers of bipolar disorder. We specifically focus on candidate clinical, biological, and psychological risk indicators that could serve as targets for future early intervention and prevention studies. RESULTS There is convergent evidence from prospective studies that bipolar disorder typically debuts as depressive episodes after puberty. In some high-risk children, sleep and anxiety disorders precede mood disorders by several years and reflect an increased vulnerability. An association between early exposure to adversity (eg, exposure to parental illness, neglect from mother) and increased risk of psychopathology may be mediated through increased stress reactivity evident at both behavioral and biological levels. Inter-related psychological processes including reward sensitivity, unstable self-esteem, rumination, and positive self-appraisal are risk factors for mood disorders. Disturbances in circadian rhythm and immune dysfunction are associated with mood disorders and may be vulnerability markers influenced by these other risk factors. CONCLUSIONS There is accruing evidence of a number of measurable and potentially modifiable markers of vulnerability and developing illness in youth at familial risk for bipolar disorder. Longitudinal studies of multiple biological and psychological risk processes in high-risk offspring, both individually and together, will improve our understanding of illness onset and lead to the development of specific early interventions.
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Affiliation(s)
- Anne Duffy
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Dr Duffy); Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada (Dr Duffy); Lancaster University, Division of Health Research, Lancaster, United Kingdom (Dr Jones); Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Ms Goodday, Dr Bentall); University of Liverpool, Institute of Psychology Health and Society, Liverpool, United Kingdom (Ms Goodday and Dr Bentall).
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Collishaw S. Annual research review: Secular trends in child and adolescent mental health. J Child Psychol Psychiatry 2015; 56:370-93. [PMID: 25496340 DOI: 10.1111/jcpp.12372] [Citation(s) in RCA: 403] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Child and adolescent mental health problems are common, associated with wide-ranging functional impairments, and show substantial continuities into adult life. It is therefore important to understand the extent to which the prevalence of mental health problems has changed over time, and to identify reasons behind any trends in mental health. SCOPE AND METHODOLOGY This review evaluates evidence on whether the population prevalence of child and adolescent mental health problems has changed. The primary focus of the review is on epidemiological cross-cohort comparisons identified by a systematic search of the literature (using the Web of Knowledge database). FINDINGS Clinical diagnosis and treatment of child and adolescent psychiatric disorders increased over recent decades. Epidemiological comparisons of unselected population cohorts using equivalent assessments of mental health have found little evidence of an increased rate of ADHD, but cross-cohort comparisons of rates of ASD are lacking at this time. Findings do suggest substantial secular change in emotional problems and antisocial behaviour in high-income countries, including periods of increase and decrease in symptom prevalence. Evidence from low- and middle-income countries is very limited. Possible explanations for trends in child and adolescent mental health are discussed. The review also addresses how cross-cohort comparisons can provide valuable complementary information on the aetiology of mental illness.
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Affiliation(s)
- Stephan Collishaw
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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80
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Saini P, While D, Chantler K, Windfuhr K, Kapur N. Assessment and Management of Suicide Risk in Primary Care. CRISIS 2014; 35:415-25. [DOI: 10.1027/0227-5910/a000277] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services. Aims: To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide. Method: Data collection from clinical proformas, case records, and semistructured face-to-face interviews with general practitioners. Results: Primary and secondary care data were available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall κ = .127, p = .10). Depression, care setting (after discharge), suicidal ideation at last contact, and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices, and 33% of staff received training in suicide risk assessments. Conclusion: Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care.
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Affiliation(s)
- Pooja Saini
- School of Public Health and Policy, University of Liverpool, UK
| | - David While
- Centre for Mental Health and Risk, University of Manchester, UK
| | - Khatidja Chantler
- School of Social Work, University of Central Lancashire, Preston, UK
| | | | - Navneet Kapur
- Centre for Mental Health and Risk, University of Manchester, UK
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81
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Hunt IM, Rahman MS, While D, Windfuhr K, Shaw J, Appleby L, Kapur N. Safety of patients under the care of crisis resolution home treatment services in England: a retrospective analysis of suicide trends from 2003 to 2011. Lancet Psychiatry 2014; 1:135-41. [PMID: 26360577 DOI: 10.1016/s2215-0366(14)70250-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Community care provided by crisis resolution home treatment teams is used increasingly as an alternative to admission to psychiatric wards. No systematic analysis has been done of the safety of these teams in terms of rates of suicide. We aimed to compare the rate and number of suicides among patients under the care of crisis resolution home treatment teams with those of psychiatric inpatients. We also assessed the clinical features of individuals who died by suicide in both home and hospital settings. METHODS We did a retrospective longitudinal analysis between 2003 and 2011 of all adults (aged 18 years or older) treated by the National Health Service in England who died by suicide while under the care of crisis resolution home treatment services or as a psychiatric inpatient. We obtained data from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness and from the Mental Health Minimum Dataset. FINDINGS 1256 deaths by suicide (12% of all patient suicides) were recorded among patients cared for under crisis resolution home treatment teams, an average of 140 deaths per year. Different denominators meant that direct comparison between groups was difficult, but the average rate of suicide under crisis resolution home treatment services (14·6 per 10 000 episodes under crisis care) seemed higher than the average rate of suicide among psychiatric inpatients (8·8 per 10 000 admissions). The number of suicides in patients under the care of crisis resolution home treatment teams increased from an average of 80 per year (in 2003 and 2004) to 163 per year (in 2010 and 2011) and were twice as frequent as inpatient suicides in the last few years of the study. However, because of the growing number of patients under the care of crisis resolution home treatment teams, the average rate of suicide fell by 18% between the first and last 2 years of the study. 548 (44%) patients who died by suicide under the care of crisis resolution home treatment teams lived alone and 594 (49%) had had a recent adverse life event. In a third of patients (n=428) under the care of crisis resolution home treatment teams, suicide happened within 3 months of discharge from psychiatric inpatient care. INTERPRETATION Although the number of suicides under the care of crisis resolution home treatment teams has risen since 2003, the rate has fallen. However, suicide rates remain high compared with the inpatient setting, and safety of individuals cared for by crisis resolution home treatment teams should be a priority for mental health services. For some vulnerable people who live alone or have adverse life circumstances, crisis resolution home treatment might not be the most appropriate care setting. Use of crisis resolution home treatment teams to facilitate early discharge could present a risk to some patients, which should be investigated further. FUNDING Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Isabelle M Hunt
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK.
| | - Mohammad Shaiyan Rahman
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - David While
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Jenny Shaw
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
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Rodway C, Flynn S, While D, Rahman MS, Kapur N, Appleby L, Shaw J. Patients with mental illness as victims of homicide: a national consecutive case series. Lancet Psychiatry 2014; 1:129-34. [PMID: 26360576 DOI: 10.1016/s2215-0366(14)70221-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The media attention received by homicides committed by patients with mental illness is thought to increase stigma. However, people with mental illness can also be victims of violence. We aimed to assess how often victims of homicide are current mental health patients and their relationship to the perpetrators. METHODS In a national consecutive case-series study, we obtained data for victims and perpetrators of all confirmed homicides between Jan 1, 2003, and Dec 31, 2005, in England and Wales. We requested information about contact with mental health services in the 12 months before the homicide for all victims and perpetrators. For victims and perpetrators who had contact with mental health services in the 12 months before homicide, we sent questionnaires to the clinician responsible for the patient's care. FINDINGS 1496 victims of confirmed homicide died between Jan 1, 2003, and Dec 31, 2005, in England and Wales. Patients with mental illness were more likely to die by homicide than were people in the general population (incidence rate ratio 2·6, 95% CI 1·9-3·4). 90 homicide victims (6%) had contact with mental health services in the 12 months before their death. 213 patients with mental illness were convicted of homicide in the same 3 year period. 29 of 90 patient victims were killed by another patient with mental illness. In 23 of these 29 cases, the victim and perpetrator were known to each other, and in 21 of these cases, the victims and perpetrators were undergoing treatment at the same National Health Service Trust. In these 29 cases in which patient victims were killed by another patient with mental illness, alcohol and drug misuse (19 victims [66%], 27 perpetrators [93%]) and previous violence (7 victims [24%], 7 perpetrators [24%]) were common in both victims and, particularly, perpetrators. In seven of the 29 cases in which the victim was killed by another patient with mental illness, both victim and perpetrator were diagnosed with schizophrenia. INTERPRETATION The high risk of patients with mental illness being victims of homicide is an important antistigma message, although this risk partly comes from other patients with mental illness; overall, the risk of patients committing homicide is greater than the risk of being a victim of homicide. Identification and safeguarding of patients at risk of violence should be prominent in clinical risk assessment. FUNDING Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Cathryn Rodway
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK.
| | - Sandra Flynn
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - David While
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Mohammed S Rahman
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Louis Appleby
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Jenny Shaw
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
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83
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Dubicka B, Brent D. Combined Therapy in Adolescent Depression. Int J Cogn Ther 2014. [DOI: 10.1521/ijct.2014.7.2.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Flynn S, Rodway C, Appleby L, Shaw J. Serious violence by people with mental illness: national clinical survey. JOURNAL OF INTERPERSONAL VIOLENCE 2014; 29:1438-1458. [PMID: 24309910 DOI: 10.1177/0886260513507133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study aimed to estimate the prevalence of mental disorder in offenders convicted of serious violence, examine their social and clinical characteristics, and compare them with patients convicted of homicide. We examined a national clinical survey of all people convicted of serious violence in England and Wales in 2004. Mental disorder was measured by contact with mental health services within 12 months of the offense. Of the 5,966 serious violent offenders, 293 (5%) had been in recent contact with mental health services. Personality disorder (63, 22%) and schizophrenia (55, 19%) were the most common diagnoses. Most had previous convictions for violence (168, 61%). Seventy-two (25%) patients were at high risk of violence and 34 (49%) were not subject to the Care Programme Approach. Compared with serious violence offenders, homicide offenders were more likely to have been patients (293, 5% vs. 65, 10%; p < .01). We conclude that patients were responsible for a small proportion of serious violent offenses; however, high-risk patients require closer supervision, and regular inquiry about changing delusional beliefs, thoughts of violence, and weapon carriage.
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Galvao TF, Silva MT, Zimmermann IR, Souza KM, Martins SS, Pereira MG. Pubertal timing in girls and depression: a systematic review. J Affect Disord 2014; 155:13-9. [PMID: 24274962 DOI: 10.1016/j.jad.2013.10.034] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 10/01/2013] [Accepted: 10/22/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Because the incidence of depression increases after puberty, it is possible that pubertal timing in girls influences the onset of depression. Our objective was to assess the effect of early and late puberty in girls on the incidence of depression. METHODS We systematically searched relevant databases for controlled studies that assessed the impact of pubertal timing in girls on the incidence of depression or depressive symptoms. The last search was completed in August 2013. Two authors selected the studies, extracted the data, and assessed the quality of the evidence. Meta-analyses of the adjusted and unadjusted results were calculated using random effects. RESULTS Four cohort studies were included (n=8055 participants). Early puberty significantly increased the risk of new cases of depression in the unadjusted meta-analysis (RR=1.33; CI 95%: 1.02, 1.73) but not in the adjusted estimate of two of the included studies (RR=1.48; CI 95%: 0.69, 2.28). For late puberty, no significant associations were found (unadjusted RR=1.28; CI 95%: 0.87, 1.88). Two studies assessed the effect of early puberty on depressive symptoms and found positive associations. The quality of the available evidence was rated as very low. LIMITATIONS The polled results had wide confidence intervals, and the available evidence was of very low quality. CONCLUSIONS The available evidence supports little confidence regarding the impact of pubertal timing on the onset of depression in girls but suggests that early puberty in girls may increase the risk of depression. Further higher quality studies are needed to clarify the association between pubertal timing and the incidence of depression in girls and women.
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Affiliation(s)
- Tais F Galvao
- Faculty of Medicine, University of Brasilia, P.O. Box 4472, CEP 70904-970, Brasilia, Federal District, Brazil; Getulio Vargas University Hospital, Federal University of Amazonas, Manaus, Amazonas, Brazil
| | - Marcus T Silva
- Faculty of Medicine, Federal University of Amazonas, Manaus, Amazonas, Brazil
| | - Ivan R Zimmermann
- Faculty of Medicine, University of Brasilia, P.O. Box 4472, CEP 70904-970, Brasilia, Federal District, Brazil
| | - Kathiaja M Souza
- Faculty of Medicine, University of Brasilia, P.O. Box 4472, CEP 70904-970, Brasilia, Federal District, Brazil
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mauricio G Pereira
- Faculty of Medicine, University of Brasilia, P.O. Box 4472, CEP 70904-970, Brasilia, Federal District, Brazil.
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Windfuhr K, While D, Hunt IM, Shaw J, Appleby L, Kapur N. Suicide and accidental deaths in children and adolescents in England and Wales, 2001-2010. Arch Dis Child 2013; 98:945-50. [PMID: 24013808 DOI: 10.1136/archdischild-2012-302539] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the impact of narrative verdicts on suicide statistics among 10-19-year-olds; to identify the number and rate of suicide and accidental deaths, particularly in 10-14-year-olds. DESIGN National cohort study. SETTING England and Wales. METHODS Mid-year population estimates from the Office for National Statistics (ONS) were used to calculate rates per 100,000 population for suicide (undetermined and suicide verdicts) and accidental deaths (poisoning, hanging) for those aged 10-14 and 15-19. Trends in rates over time (2001-2010) were investigated using Poisson regression. Interaction tests were carried out to determine differences in trends between the two time periods (2001-2005 and 2006-2010). RESULTS There were 1523 suicides (2.25/100,000). Suicide rates were highest in those aged 15-19 years (4.04/100,000) and in males (3.14/100,000). Between 2001 and 2010, rates significantly decreased among those aged 15-19 years (incidence rate-ratio (IRR): 0.95; 95% CI 0.93 to 0.97), with no change in rates of accidental deaths (IRR: 1.01, 95% CI 0.95 to 1.07). However, there was a significant interaction between the two time periods for accidental poisonings (2001-2005: IRR: 0.79 (95% CI 0.69 to 0.91); 2006-2010: IRR: 1.01 (95% CI 0.89 to 1.15), interaction p=0.012) and accidental hangings (2001-2005: IRR: 0.93 (95% CI 0.76 to 1.14); 2006-2010: IRR: 1.25 (95% CI 1.04 to 1.49), interaction=0.01) Undetermined deaths significantly decreased among females aged 15-19 yeras (IRR: 0.93; 95% CI 0.88 to 0.98). There were no significant trends among 10-14-year-olds. CONCLUSIONS Rates of suicide are higher among older adolescents and males. There was a significant fall in suicide rates in males aged 15-19 years that was not accounted for by changes in rates of accidental death. The absence of a significant trend in suicide or accidental deaths in those aged 10-14 years may have been the result of small numbers. However, monitoring should continue to identify longitudinal trends in all young people.
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Affiliation(s)
- Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Risk, Institute of Brain, Behaviour and Mental Health, University of Manchester, , Manchester, UK
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87
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Hannon G, Taylor EP. Suicidal behaviour in adolescents and young adults with ASD: Findings from a systematic review. Clin Psychol Rev 2013; 33:1197-204. [DOI: 10.1016/j.cpr.2013.10.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/30/2013] [Accepted: 10/07/2013] [Indexed: 11/25/2022]
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Clements C, Morriss R, Jones S, Peters S, Roberts C, Kapur N. Suicide in bipolar disorder in a national English sample, 1996-2009: frequency, trends and characteristics. Psychol Med 2013; 43:2593-2602. [PMID: 23510515 DOI: 10.1017/s0033291713000329] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bipolar disorder (BD) has been reported to be associated with high risk of suicide. We aimed to investigate the frequency and characteristics of suicide in people with BD in a national sample. METHOD Suicide in BD in England from 1996 to 2009 was explored using descriptive statistics on data collected by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI). Suicide cases with a primary diagnosis of BD were compared to suicide cases with any other primary diagnosis. RESULTS During the study period 1489 individuals with BD died by suicide, an average of 116 cases/year. Compared to other primary diagnosis suicides, those with BD were more likely to be female, more than 5 years post-diagnosis, current/recent in-patients, to have more than five in-patient admissions, and to have depressive symptoms. In BD suicides the most common co-morbid diagnoses were personality disorder and alcohol dependence. Approximately 40% were not prescribed mood stabilizers at the time of death. More than 60% of BD suicides were in contact with services the week prior to suicide but were assessed as low risk. CONCLUSIONS Given the high rate of suicide in BD and the low estimates of risk, it is important that health professionals can accurately identify patients most likely to experience poor outcomes. Factors such as alcohol dependence/misuse, personality disorder, depressive illness and current/recent in-patient admission could characterize a high-risk group. Future studies need to operationalize clinically useful indicators of suicide risk in BD.
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Affiliation(s)
- C Clements
- Centre for Mental Health and Risk, Institute of Brain, Behaviour and Mental Health, The University of Manchester, UK
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89
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Zakharov S, Navratil T, Pelclova D. Suicide attempts by deliberate self-poisoning in children and adolescents. Psychiatry Res 2013; 210:302-7. [PMID: 23810383 DOI: 10.1016/j.psychres.2013.03.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 03/23/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
Abstract
AIM The objective of the study was to examine the toxicological characteristics of suicide attempts by deliberate self-poisoning in children and adolescents. METHOD From the Toxicological Information Centre's database, the inquiries due to the suicide attempts in children (9-13 years old) and adolescents (14-18 years old) were evaluated. RESULTS AND CONCLUSIONS From 10,492 calls concerning suicide attempts, 2393 concerned children and adolescents. Most suicide attempts were attempted in spring (31.3%). Among the toxic agents, drugs were used in 97.8% cases. The most frequent ingestions appeared using drugs affecting the nervous system and anti-inflammatory non-steroids. The dose was evaluated as toxic in 73.4%, severely toxic in 3.0% and unknown in 11.2% cases. Only one in 10 children used a non-toxic dose. Girls, more frequently than boys (13.2% vs. 8.9%), used non-toxic doses. The symptoms of moderate and severe intoxications were present in 10.5% of the cases. Poison centre consultation was accessed within the first hour after the ingestion in one-fifth of the patients. In both age groups, the severity of the intoxication was greater among elder males who reached the medical facilities later than 4 h after the poisoning. The combinations of three or more drugs affecting central nervous system were present in the most severe cases.
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Affiliation(s)
- Sergey Zakharov
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
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90
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Rhodes AE, Skinner R, McFaull S, Katz LY. Canada-wide effect of regulatory warnings on antidepressant prescribing and suicide rates in boys and girls. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:640-5. [PMID: 24246435 DOI: 10.1177/070674371305801110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the impact of the Health Canada regulatory warnings regarding antidepressant (AD) prescribing on suicide rates in boys and girls under the age of 18 and aged 18 to 19 years in Canada between 2004 and 2009. We hypothesized that an increase in suicide rates would be specific to girls, reflecting higher AD prescribing rates in girls than boys. METHOD We graphed and tested the difference between Canada-wide suicide rates before and after the regulatory warning periods (either from 1995 to 2006 or from 1995 to 2009) in boys and girls under the age of 18 or aged 18 to 19 years. For comparison with prior studies, we estimated rate ratios and 95% confidence intervals using either Poisson regression or negative binomial regression. RESULTS There was no statistically significant increase in suicide rates in girls under the age of 18, or aged 18 to 19 years in response to the AD regulatory warnings. In boys under the age of 18 or aged 18 to 19 years, suicide rates declined after 2003. CONCLUSIONS We did not find increased rates of suicide after the AD regulatory warnings in boys or girls under the age of 18 or aged 18 to 19 years in Canada-wide rates. However, this does not rule out the possibility that such an effect occurred in some jurisdictions in girls and (or) the regulatory warnings prevented the trend toward declining suicide rates. Factors influencing the downward trend in boys merit further attention.
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Affiliation(s)
- Anne E Rhodes
- Research Scientist, The Suicide Studies Research Unit and the Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario; Associate Professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario; Associate Professor, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario; Adjunct Scientist, The Institute for Clinical Evaluative Sciences, Toronto, Ontario
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91
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Wijlaars LPMM, Nazareth I, Whitaker HJ, Evans SJW, Petersen I. Suicide-related events in young people following prescription of SSRIs and other antidepressants: a self-controlled case series analysis. BMJ Open 2013; 3:e003247. [PMID: 24056479 PMCID: PMC3780295 DOI: 10.1136/bmjopen-2013-003247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/05/2013] [Accepted: 08/09/2013] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES We aimed to examine the temporal association between selective serotonin reuptake inhibitors (SSRI) and tricyclic antidepressant (TCA) prescriptions and suicide-related events in children and adolescents. DESIGN Self-controlled case series. SETTING Electronic health records were used from 479 general practices in The Health Improvement Network (THIN) UK primary care database from 1995 to 2009. PARTICIPANTS 81 young people aged 10-18 years with a record of completed suicide, 1496 who attempted suicide, 1178 with suicidal ideation and 2361 with intentional self-harm. MAIN OUTCOME MEASURES Incidence Rate Ratios (IRRs) for completed and attempted suicide, suicidal ideation and intentional self-harm. RESULTS For non-fatal suicide-related behaviour, IRRs were similar for the time the person was prescribed either SSRIs or TCAs: IRRs increased during pre-exposure, peaked on prescription day, were stable up to the fourth prescription-week, and decreased after the prescriptions were stopped. For both types of antidepressants, IRRs were lower or similar to pre-exposure levels during the period of prescription. For SSRIs, there was an increase in the IRR for completed suicide on the day of prescription (N=5; IRR=42.5, 95% CI 4.5 to 403.4), and during the fourth week of SSRI prescription (N=2; IRR=11.3, 95% CI 1.1 to 115.6). CONCLUSIONS We found that a very small number of young people were prescribed antidepressants and that there was an absence of a sustained increase in rates of suicide-related events in this group. There were no systematic differences between the association of TCAs and SSRIs and the incidence risk ratios for attempted suicide, suicidal ideation or intentional self-harm and, apart from the day of prescription, rates did not exceed pre-exposure levels. The pattern of IRR for suicide for SSRIs was similar to that found in non-fatal suicide-related events. Our results warrant a re-evaluation of the current prescription of SSRIs in young people. We recommend the creation of a pragmatic registry for active pharmacovigilance.
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Affiliation(s)
- Linda P M M Wijlaars
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | - Heather J Whitaker
- Department of Mathematics and Statistics, The Faculty of Mathematics, Computing and Technology, The Open University, Milton Keynes, Buckinghamshire, UK
| | - Stephen J W Evans
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London Medical School, London, UK
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92
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Suicidal childhood deaths with firearms in Antalya, Turkey. J Forensic Leg Med 2013; 20:644-6. [PMID: 23910852 DOI: 10.1016/j.jflm.2013.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/24/2013] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to determine the characteristics of suicidal childhood deaths with the use of firearms that occurred from 2000 to 2009 in Antalya. The autopsy reports of the Antalya branch of the Turkish Forensic Medicine Council and judicial records were reviewed retrospectively. There were 60 suicidal deaths between 0 and 18 years of age. Firearms were used in 20 cases (11 males, 9 females). The shotgun (n = 15) was the most frequently used weapon. The site of bullet entries were the chest (n = 6), abdomen (n = 5), right temple (n = 5), mouth (n = 2) and neck (n = 2). Most suicides (n = 16) were in the home. In contrast to many other studies, the most frequently used weapon for suicides was the shotgun in this study.
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93
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Rhodes AE, Khan S, Boyle MH, Tonmyr L, Wekerle C, Goodman D, Bethell J, Leslie B, Lu H, Manion I. Sex differences in suicides among children and youth: the potential impact of help-seeking behaviour. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:274-82. [PMID: 23756287 DOI: 10.1177/070674371305800504] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe sex differences in health service use among children and youth who died by suicide. METHOD This is a retrospective study of children and youth (aged 10 to 25 years) living in Ontario who died by suicide between April 1, 2003, and December 31, 2007. Coroner records were individually linked to outpatient physician visit, emergency department (ED) presentation, and inpatient stay administrative health care records for 724 people (192 girls and 532 boys). Only 77 (10.6%) were aged 10 to 15 years. The health services types used, number of contacts made, and the last contact were compared in boys and girls. RESULTS About 80% of subjects had contact with the health care system in the year before their death, typically to an outpatient physician and (or) the ED. However, not all were seen for mental health reasons. Girls had more outpatient physician and ED contact than boys and closer in time to their death. Further, girls were more likely than boys to have contact in more than one setting. Still, boys and girls did not differ in their use of an outpatient psychiatrist, some ED presentations, and in the nature and number of inpatient stays. CONCLUSIONS While most people were seen by an outpatient physician and (or) in the ED in the year before their death, not all received mental health care. Further research is needed to determine whether boys and girls who died by suicide differ from their peers in their health service use to guide preventive interventions.
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94
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Zakharov S, Navratil T, Pelclova D. Non‐Fatal Suicidal Self‐Poisonings in Children and Adolescents over a 5‐Year Period (2007–2011). Basic Clin Pharmacol Toxicol 2013; 112:425-30. [DOI: 10.1111/bcpt.12047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/27/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Sergey Zakharov
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital Prague Czech Republic
| | - Tomas Navratil
- Department of Biophysical Chemistry J. Heyrovský Institute of Physical Chemistry of AS CR, v.v.i Prague Czech Republic
| | - Daniela Pelclova
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine Charles University in Prague and General University Hospital Prague Czech Republic
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95
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Adegbite-Adeniyi C, Gron B, Rowles BM, Demeter CA, Findling RL. An update on antidepressant use and suicidality in pediatric depression. Expert Opin Pharmacother 2013; 13:2119-30. [PMID: 22984934 DOI: 10.1517/14656566.2012.726613] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION In 2003, public health advisories in North America and Europe regarding suicidality associated with selective serotonin reuptake inhibitors (SSRIs) led to the addition of black box warnings to antidepressant package inserts in 2004. Subsequently, a series of events appeared to result from these regulatory actions. AREAS COVERED This review provides an overview of the temporal associations of regulatory agencies' actions in North America and Europe with rates of depression diagnoses, pediatric antidepressant prescription rates, follow-up visits to physicians prescribing antidepressants, and rates of completed suicide and suicidal ideation in children and adolescents. In addition, evidence-based predictors of suicidal behavior and suicide risk, as provided by large, multisite studies of depressed children and adolescents, are outlined. Finally, this review considers key advancements in the study of young patients at risk for suicide and describes innovations in current research methodology, to more accurately identify suicidality and the relationship to antidepressant use within this vulnerable patient population. EXPERT OPINION Evaluating the role of antidepressants in those youths who do not respond to evidence-based psychotherapeutic interventions may be a useful future research direction. Until more data are available, however, closely monitored antidepressant treatment in combination with CBT may provide the most benefit.
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Affiliation(s)
- Clara Adegbite-Adeniyi
- University Hospitals Case Medical Center, Division of Child and Adolescent Psychiatry, Cleveland, OH 44106, USA.
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96
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Abstract
Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%. The burden is highest in low-income and middle-income countries. Depression is associated with substantial present and future morbidity, and heightens suicide risk. The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress. Inherited risks, developmental factors, sex hormones, and psychosocial adversity interact to increase risk through hormonal factors and associated perturbed neural pathways. Although many similarities between depression in adolescence and depression in adulthood exist, in adolescents the use of antidepressants is of concern and opinions about clinical management are divided. Effective treatments are available, but choices are dependent on depression severity and available resources. Prevention strategies targeted at high-risk groups are promising.
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Affiliation(s)
- Anita Thapar
- Child & Adolescent Psychiatry Section, Department of Psychological Medicine and Neurology, School of Medicine, Cardiff University, Wales, UK. thapar@Cardiff .ac.uk
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97
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While D, Bickley H, Roscoe A, Windfuhr K, Rahman S, Shaw J, Appleby L, Kapur N. Implementation of mental health service recommendations in England and Wales and suicide rates, 1997-2006: a cross-sectional and before-and-after observational study. Lancet 2012; 379:1005-12. [PMID: 22305767 DOI: 10.1016/s0140-6736(11)61712-1] [Citation(s) in RCA: 201] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research investigating which aspects of mental health service provision are most effective in prevention of suicide is scarce. We aimed to examine the uptake of key mental health service recommendations over time and to investigate the association between their implementation and suicide rates. METHODS We did a descriptive, cross-sectional, and before-and-after analysis of national suicide data in England and Wales. We collected data for individuals who died by suicide between 1997 and 2006 who were in contact with mental health services in the 12 months before death. Data were obtained as part of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. When denominator data were missing, we used information from the Mental Health Minimum Data Set. We compared suicide rates for services implementing most of the recommendations with those implementing fewer recommendations and examined rates before and after implementation. We stratified results for level of socioeconomic deprivation and size of service provider. FINDINGS The average number of recommendations implemented increased from 0·3 per service in 1998 to 7·2 in 2006. Implementation of recommendations was associated with lower suicide rates in both cross-sectional and before-and-after analyses. The provision of 24 h crisis care was associated with the biggest fall in suicide rates: from 11·44 per 10 000 patient contacts per year (95% CI 11·12-11·77) before to 9·32 (8·99-9·67) after (p<0·0001). Local policies on patients with dual diagnosis (10·55; 10·23-10·89 before vs 9·61; 9·18-10·05 after, p=0·0007) and multidisciplinary review after suicide (11·59; 11·31-11·88 before vs 10·48; 10·13-10·84 after, p<0·0001) were also associated with falling rates. Services that did not implement recommendations had little reduction in suicide. The biggest falls in suicide seemed to be in services with the most deprived catchment areas (incidence rate ratio 0·90; 95% CI 0·88-0·92) and the most patients (0·86; 0·84-0·88). INTERPRETATION Our findings suggest that aspects of provision of mental health services can affect suicide rates in clinical populations. Investigation of the relation between new initiatives and suicide could help to inform future suicide prevention efforts and improve safety for patients receiving mental health care. FUNDING National Patient Safety Agency, UK.
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Affiliation(s)
- David While
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Manchester Academic Health Sciences Centre, University of Manchester, UK
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Pompili M, Vichi M, De Leo D, Pfeffer C, Girardi P. A longitudinal epidemiological comparison of suicide and other causes of death in Italian children and adolescents. Eur Child Adolesc Psychiatry 2012; 21:111-21. [PMID: 22286089 DOI: 10.1007/s00787-011-0238-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 12/26/2011] [Indexed: 11/30/2022]
Abstract
The objective of the study is to evaluate temporal trends, gender effects and methods of completed suicide amongst children and adolescent (aged 10-17) when compared with temporal trends of deaths from other causes. Data were extracted from the Italian Mortality Database, which is collected by the Italian National Census Bureau (ISTAT) and processed by the Statistics Unit of National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS) at the National Institute of Health (Istituto Superiore di Sanità). A total of 1,871 children and adolescents, age 10-17 years, committed suicide in Italy from 1971 to 2003 and 109 died by suicide during the last 3-year period of observation (2006-2008). The average suicide rate over the entire period of observation was 0.91 per 100,000; the rate was 1.21 for males and 0.59 for females. During the study period, the general mortality of children and adolescents, age 10-17 years, decreased dramatically, the average annual percentage change decrease was of -3.3% (95% CI -4.4 to -1.9) for males and -2.9% (95% IC -4.4 to -2.5) for females. The decrease was observed, for both genders, for all causes of deaths except suicide. For males, the most frequent method was hanging (54.5%), followed by shooting/fire arms (19.6%), falls/jumping from high places (12.7%); for females, the most frequent method, jumping from high places/falls, accounted for 35.7% of suicides during the whole study period. In conclusion, this study highlights that over the course of several decades suicide is a far less preventable cause of death as compared to other causes of death amongst children and adolescents. Our study demonstrated that suicide rates in adolescents are not a stable phenomenon over the 40 years period of study. It suggested that rates for males and females differed and varied in different ways during specific time periods of this study. National suicide prevention actions should parallel prevention measures implemented to reduce other causes of death.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
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Freuchen A, Kjelsberg E, Lundervold AJ, Grøholt B. Differences between children and adolescents who commit suicide and their peers: A psychological autopsy of suicide victims compared to accident victims and a community sample. Child Adolesc Psychiatry Ment Health 2012; 6:1. [PMID: 22216948 PMCID: PMC3284874 DOI: 10.1186/1753-2000-6-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 01/04/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to gain knowledge about the circumstances related to suicide among children and adolescents 15 years and younger. METHODS We conducted a psychological autopsy, collecting information from parents, hospital records and police reports on persons below the age of 16 who had committed suicide in Norway during a 12-year period (1993-2004) (n = 41). Those who committed suicide were compared with children and adolescents who were killed in accidents during the same time period (n = 43) and with a community sample. RESULTS Among the suicides 25% met the criteria for a psychiatric diagnosis and 30% had depressive symptoms at the time of death. Furthermore, 60% of the parents of the suicide victims reported the child experienced some kind of stressful conflict prior to death, whereas only 12% of the parents of the accident victims reported such conflicts. CONCLUSION One in four suicide victims fulfilled the criteria for a psychiatric diagnosis. The level of sub-threshold depression and of stressful conflict experienced by youths who committed suicide did not appear to differ substantially from that of their peers, and therefore did not raise sufficient concern for referral to professional help.
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Affiliation(s)
- Anne Freuchen
- Department of Psychiatry, Faculty of Medicine, University of Oslo, N-0316 Oslo, Norway.
| | - Ellen Kjelsberg
- Centre for Forensic Psychiatry, Oslo University Hospital, N-0407 Oslo, Norway
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, Uni Research, K.G.Jebsen Centre for Reasearch on Neuropschyiatric Disorders, University of Bergen, N-5009 Bergen, Norway
| | - Berit Grøholt
- Institute of clinical medicine, Faculty of medicine, University of Oslo, N-0361 Oslo, Norway
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100
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Loh C, Tai BC, Ng WY, Chia A, Chia BH. Suicide in young Singaporeans aged 10-24 years between 2000 to 2004. Arch Suicide Res 2012; 16:174-82. [PMID: 22551047 DOI: 10.1080/13811118.2012.667335] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objective of this study was to understand the features of young suicide in order to contribute to suicide prevention efforts. In this article, the demographic, clinical, and suicide-related features of all cases of young suicide (aged 10-24 years) in Singapore for the years 2000-2004 are described. We also compared those who sought mental health services to those who did not. Overall, the suicide rate was 5.7 per 100, 000, with gender ratio of 1:1 and higher rates among ethnic Indians. Psychosocial stressors and suicide by jumping from height were common. Mental health service use was associated with unemployment, previous suicide attempts, family history of suicide, more use of lethal methods, lack of identifiable stressor, and less suicide notes. Suicide prevention efforts should promote awareness of suicide risks and access to mental health services.
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Affiliation(s)
- Cheryl Loh
- Department of Psychological Medicine, Changi General Hospital, Singapore
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