Trends in adolescent suicide mortality in the WHO European Region

The science of child and adolescent mental health in Greece: a nationwide systematic review

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [ https://rpubs.com/camhi/sysrev_table ]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.

Adolescent suicide attempts in three diverse island nations: patterns, contextual differences and demographic associations

Objective

Most epidemiological studies on suicidal behavior have been focused on high-income country settings. This study examine factors associated with suicidal behaviors among school-attending adolescents in three island nations. In this secondary analysis of the publicly available 2015 nationally representative GSHS data, we tested demographic, social, and behavioral attributes using multivariable logistic regression to association with suicide attempts.

Results

Within the recall period, 13.6% of participants reported having attempted suicide one or more times in the Cook Islands, 10.8% in Curaçao, and 9.8% in East Timor. In the Cook Islands, suicide ideation (AOR = 19.42, 95% CI = 9.11–41.41), anxiety (AOR = 2.51, 95% CI = 1.08–5.82), physical bullying (AOR = 3.3, 95% CI = 1.10–9.91), and cigarette smoking (AOR = 3.82, 95% CI = 1.38–10.54) were associated with suicide attempts. For Curaçaoo, suicide ideation (AOR = 7.88, 95% CI = 5.20–11.95) and suicide planning (AOR = 7.01, 95% CI = 4.24–11.60) were statistically significant. While for East Timor, suicide ideation (AOR = 4.59, 95% CI = 2.14–9.88), suicide planning (AOR = 3.36, 95% CI = 1.76–6.29), bullying victimization (AOR = 2.69, 95% CI = 1.02–7.12), and serious injuries (AOR = 2.22, 95% CI = 1.31–3.74) were statistically significant. Suicide attempt is relatively common in each of the three island nations. The socioeconomic context of adolescents might play a significant role in moderating suicidal behavior. Therefore, prevention efforts should be grounded in view of geographic, demographic, and socioeconomic contexts of the populations at risk.

Supplementary Information

The online version of this article 10.1186/s13104-021-05804-4 contains supplementary material, which is available to authorized users.

Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals: a cohort study

Background

To identify key information regarding potential treatment differences in refugees and the host population, we aimed to investigate patterns (trajectories) of antidepressant use during 3 years before and after a suicide attempt in refugees, compared with Swedish-born. Association of the identified trajectory groups with individual characteristics were also investigated.

Methods

All 20–64-years-old refugees and Swedish-born individuals having specialised healthcare for suicide attempt during 2009–2015 (n = 62,442, 5.6% refugees) were followed 3 years before and after the index attempt. Trajectories of annual defined daily doses (DDDs) of antidepressants were analysed using group-based trajectory models. Associations between the identified trajectory groups and different covariates were estimated by chi²-tests and multinomial logistic regression.

Results

Among the four identified trajectory groups, antidepressant use was constantly low (≤15 DDDs) for 64.9% of refugees. A ‘low increasing’ group comprised 5.9% of refugees (60–260 annual DDDs before and 510–685 DDDs after index attempt). Two other trajectory groups had constant use at medium (110–190 DDDs) and high (630–765 DDDs) levels (22.5 and 6.6% of refugees, respectively). Method of suicide attempt and any use of psychotropic drugs during the year before index attempt discriminated between refugees’ trajectory groups. The patterns and composition of the trajectory groups and their association, discriminated with different covariates, were fairly similar among refugees and Swedish-born, with the exception of previous hypnotic and sedative drug use being more important in refugees.

Conclusions

Despite previous reports on refugees being undertreated regarding psychiatric healthcare, no major differences in antidepressant treatment between refugees and Swedish-born suicide attempters were found.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01460-z.

Association of Youth Depression With Subsequent Somatic Diseases and Premature Death

IMPORTANCE

Early-onset depression has been linked to poor health outcomes. However, it is unclear the extent to which this disorder is associated with specific diseases and premature death and whether these associations remain after controlling for psychiatric comorbidity.

OBJECTIVE

To quantify the association of youth depression with subsequent diagnoses of numerous somatic diseases and mortality.

DESIGN, SETTING, AND PARTICIPANTS

A population-based cohort study was conducted using Swedish national registers containing data on all individuals born in Sweden between 1982 and 1996. A total of 1 487 964 participants were followed up from age 5 years through 2013 if no censoring occurred. Data analysis was performed from January 15, 2019, to August 10, 2020.

EXPOSURES

Youth depression was defined as having received at least 1 diagnosis of depression from inpatient or outpatient care between ages 5 and 19 years.

MAIN OUTCOMES AND MEASURES

This study examined 69 somatic conditions diagnosed after youth depression, as well as all-cause and cause-specific mortalities. Overall and sex-specific hazard ratios (HRs), together with 95% CIs, were estimated using Cox proportional hazards regression with attained age as underlying timescale and time-varying exposure, and adjusted for birth year and sex. All analyses were repeated controlling for psychiatric comorbidities. Absolute risk differences were calculated using standardization with Cox proportional hazards regression.

RESULTS

Of 1 487 964 individuals included in the analysis, 51.2% were male. A total of 37 185 patients (2.5%; 67.4% female) had an inpatient or outpatient contact for depression between ages 5 and 19 years (mean [SD] age at first recorded diagnosis of depression, 16.7 [2.1] years for males and 16.7 [1.8] years for females). Age at the end of follow-up ranged between 17 and 31 years. Individuals with youth depression had higher relative risks for 66 of the 69 somatic diagnoses. Strong associations were observed for certain injuries, especially self-harm in females (HR, 14.4; 95% CI, 13.8-15.1), sleep disorders (HR, 8.1; 95% CI, 7.6-8.7), viral hepatitis (HR, 6.1; 95% CI, 5.4-6.8), all-cause mortality (HR, 5.9; 95% CI, 5.3-6.6), and cause-specific mortalities, especially death by intentional self-harm (HR, 14.6; 95% CI, 12.6-16.9). Most associations were attenuated but persisted after adjusting for psychiatric comorbidity. The absolute risk difference of a specific disease within 12 years from the first diagnosis of depression during youth ranged from -0.2% (95% CI, -1.0% to 0.6%) for arthropathies among males to 23.9% (95% CI, 22.7%-25.0%) for the broader category of injuries among females.

CONCLUSIONS AND RELEVANCE

In this Swedish population cohort study, patients with depression diagnosed during their youth appeared to have increased risks for many somatic diseases as well as for mortality, even after controlling for other psychiatric disorders. These findings suggest that several medical conditions should be considered when investigating youth depression.

Healthcare use before and after suicide attempt in refugees and Swedish-born individuals

PURPOSE

There is a lack of research on whether healthcare use before and after a suicide attempt differs between refugees and the host population. We aimed to investigate if the patterns of specialised (inpatient and specialised outpatient) psychiatric and somatic healthcare use, 3 years before and after a suicide attempt, differ between refugees and the Swedish-born individuals in Sweden. Additionally, we aimed to explore if specialised healthcare use differed among refugee suicide attempters according to their sex, age, education or receipt of disability pension.

METHODS

All refugees and Swedish-born individuals, 20-64 years of age, treated for suicide attempt in specialised healthcare during 2004-2013 (n = 85,771 suicide attempters, of which 4.5% refugees) were followed 3 years before and after (Y - 3 to Y + 3) the index suicide attempt (t0) regarding their specialised healthcare use. Annual adjusted prevalence with 95% confidence intervals (CIs) of specialised healthcare use were assessed by generalized estimating equations (GEE). Additionally, in analyses among the refugees, GEE models were stratified by sex, age, educational level and disability pension.

RESULTS

Compared to Swedish-born, refugees had lower prevalence rates of psychiatric and somatic healthcare use during the observation period. During Y + 1, 25% (95% CI 23-28%) refugees and 30% (95% CI 29-30%) Swedish-born used inpatient psychiatric healthcare. Among refugees, a higher specialised healthcare use was observed in disability pension recipients than non-recipients.

CONCLUSION

Refugees used less specialised healthcare, before and after a suicide attempt, relative to the Swedish-born. Strengthened cultural competence among healthcare professionals and better health literacy among the refugees may improve healthcare access in refugees.

Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study

BACKGROUND

Despite a reported high rate of mental disorders in refugees, scientific knowledge on their risk of suicide attempt and suicide is scarce. We aimed to investigate (1) the risk of suicide attempt and suicide in refugees in Sweden, according to their country of birth, compared with Swedish-born individuals and (2) to what extent time period effects, socio-demographics, labour market marginalisation (LMM) and morbidity explain these associations.

METHODS

Three cohorts comprising the entire population of Sweden, 16-64 years at 31 December 1999, 2004 and 2009 (around 5 million each, of which 3.3-5.0% refugees), were followed for 4 years each through register linkage. Additionally, the 2004 cohort was followed for 9 years, to allow analyses by refugees' country of birth. Crude and multivariate hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. The multivariate models were adjusted for socio-demographic, LMM and morbidity factors.

RESULTS

In multivariate analyses, HRs regarding suicide attempt and suicide in refugees, compared with Swedish-born, ranged from 0.38-1.25 and 0.16-1.20 according to country of birth, respectively. Results were either non-significant or showed lower risks for refugees. Exceptions were refugees from Iran (HR 1.25; 95% CI 1.14-1.41) for suicide attempt. The risk for suicide attempt in refugees compared with the Swedish-born diminished slightly across time periods.

CONCLUSIONS

Refugees seem to be protected from suicide attempt and suicide relative to Swedish-born, which calls for more studies to disentangle underlying risk and protective factors.

[Age-related features of mental development and mental state of adolescents, who committed suicide]

OBJECTIVE

To identify age-related psychopathological disorders and psychological characteristics of mental development and mental state of minors who committed suicide.

MATERIAL AND METHODS

The study included a continuous sample of 285 reports of post-mortem psychological-psychiatric forensic assessment (CSPE) of juveniles, aged 11 to 17 years (average age 14.92±1.82), who committed suicide, in 7 federal districts of the Russian Federation. Within the total sample, two age groups were compared: adolescents from 11 to 14 years old (1) and 15-17 years old (2). Document analysis, clinical-psychopathological, clinical-psychological, qualitative and statistical methods were used.

RESULTS AND CONCLUSION

Within the period from 11 to 17 years, the exponential growth of suicide rate is observed. An increase of family- and school-related psychological problems as well as difficulties in the relationship with the opposite sex are typical for the older group. Simultaneously, the effect of maladaptive individual features increases and psychopathological states and disorders, including, stress and adjustment disorders and depressive disorders, develop.

Suicide risk among native- and foreign-origin persons in Sweden: a longitudinal examination of the role of unemployment status

PURPOSE

Prior research has documented an association between unemployment and elevated suicide risk. Yet, few Swedish studies have explicitly considered how such risk may vary by different migration background characteristics among persons of foreign-origin, who often experience diverse forms of labor market marginalization. This study examines the extent to which unemployment status may differentially influence suicide risk among the foreign-origin by generational status, region of origin, age at arrival, and duration of residence.

METHODS

Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993 to 2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models.

RESULTS

Elevated suicide risk observed among foreign-origin unemployed groups was generally of a similar or lower magnitude than that found in unemployed native-origin, although unemployed second-generation Swedish men demonstrated significantly greater (p < 0.05) excess risk of suicide than that observed among their native-origin counterparts. Unemployed foreign-born men with a younger age at arrival and longer duration of residence demonstrated an increased risk of suicide, while those who arrived as adults, and a shorter duration of residence did not show any increased risk. Among foreign-born women, excess suicide risk persisted regardless of age at arrival and duration of residence in the long-term unemployed.

CONCLUSIONS

Multiple migration background characteristics should be considered when examining relationships between employment status and suicide among the foreign-origin.

A Comparative Study of Suicide Rates among 10-19-Year-Olds in 29 OECD Countries

OBJECTIVE

This study had two main objectives: to compare current suicide rates in OECD countries among 10-19-year-olds and to identify patterns of suicide rates based on age, gender and time. Furthermore we investigated the main dimensions that contributed to the variation in child and adolescent suicide rates across countries.

METHODS

We combined the WHO mortality data and the population data released by OECD to calculate the suicide rates in 29 OECD countries. A self-organizing map (SOM), k-means clustering analysis, and multi-dimensional scaling were used to classify countries based on similarities in suicide rate structure and to identify the important dimensions accounting for differences among groups.

RESULTS

We identified significant differences in suicide rates depending on age, sex, country, and time period. Late adolescence and male gender were universal risk factors for suicide, and we observed a general trend of declining suicide rates in OECD countries. The SOM analysis yielded eight types of countries. Most countries showed gender gaps in suicide rates of similar magnitudes; however, there were outliers in which the gender gap was particularly large or small.

CONCLUSION

Significant variation exists with respect to suicide rates and their associated gender gaps in OECD countries.

What predicts medical lethality of suicide attempts in Asian youths?

This study explores youth suicide attempts in Singapore using multiple databases of comprehensive archival records. Three years of medical records related to suicide attempters (N=666) who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to retrospective analysis. Compared to other age groups, a peak in suicide attempts (n=207) was observed in youths aged between 15 and 24 years old (76.3% females; 23.7% males, mean age=19.30, SD=2.89). The model using recognized risk and protective factors was significant in predicting medical lethality, and correctly classified 62.8% of high lethality cases. Only resolution of precipitant made a unique statistical significant contribution. Analysis was separately conducted for males and females. Implications of the findings are discussed.

Forensic toxicology analysis of self-poisoning suicidal deaths in Tehran, Iran; trends between 2011-2015

Background

Suicide ranks among the top ten causes of death in all age groups all over the world. There are many methods for committing suicide including self-poisoning, firearm and hanging. The aim of the present study was to provide an overview of self-poisoning related suicidal deaths with special focus on forensic toxicology analysis results in Tehran, Iran from 2011 to 2015.

Methods

All suspicious cases with the the history of self-poisoning were investigated to define the cause and manner of death under the supervision of forensic medicine practitioners. Postmortem samples were analysed in forensic toxicology laboratory to confirm the presence of drugs in cadaver of suicidal cases. Drugs and poisons were analysed using thin layer chromatography, high performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography and gas chromatography equipped with nitrogen phosphorus detector. Demographic data were collected from autopsy reports of all cases with confirmed self-poisoning suicidal cause of death.

Results

Results showed that 674 cases of self-poisoning deaths were investigated during a five-year study period, of which 68.55% were male. The most often used suicide method was self-poisoning in young population. Phosphine gas liberated from aluminum phosphide tablets was the most toxic substance detected in postmortem samples (619 cases) followed by opioids, methamphetamine, organophosphates, cyanide and strychnine.

Conclusion

In conclusion self-poisoning suicidal death was predominant in young male population in Tehran, Iran. It seems that free access to suicide means such as drugs and poisons should be restricted by national and health authorities.

Trial registration

Not applicable.

Trends in external causes of child and adolescent mortality in Poland, 1999-2012

OBJECTIVES

To examine the pattern and trend of deaths due to external causes among Polish children and adolescents in 1999-2012, and to compare trends in Poland's neighboring countries.

METHODS

Death records were obtained from the Central Statistical Office of Poland. External causes mortality rates (MR) with 95 % confidence interval were calculated. The annual percentage change of MR was examined using linear regression. To compare MR with Belarus, Ukraine, Czech Republic and Germany, data from the European Mortality Database were used.

RESULTS

MR were the highest in the age 15-19 years (33.7/100,000) and among boys (22.7/100,000). Unintentional injuries including transport accidents, drowning, and suicides (especially in children over 10 years old), were the main cause of death in the analyzed groups. Between 1999 and 2012 annual MR for unintentional injuries declined substantially. MR due to injuries and poisoning in Poland were higher compared with Czech Republic and Germany and lower in comparison with Belarus and Ukraine.

CONCLUSIONS

Deaths due to unintentional injuries are still the leading cause of death among Polish children and adolescents. There are differences in death rates between Poland and neighboring countries.

Suicide attempts and behavioral correlates among a nationally representative sample of school-attending adolescents in the Republic of Malawi

BACKGROUND

Suicide is among the top causes of adolescent mortality worldwide. While correlates of suicidal behavior are better understood and delineated in upper-income countries, epidemiologic knowledge of suicidal behavior in low-income countries remains scant, particularly in the African continent. The present study sought to add to the epidemiologic literature on suicidal behavior in Africa by examining the behavioral correlates of suicide attempts among Malawi adolescents.

METHODS

A cross-sectional study using a nationally-representative sample extracted from publically-available data was conducted. Bivariate and multivariate analyses were performed to discern associations between suicide attempts and a host of behavioral variables. 2225 records were included in the study.

RESULTS

At the multivariate level, suicide attempters had significantly higher odds of being anxious, being physically bullied, having sustained a serious injury and having a greater number of lifetime sexual partners. Alcohol use (at an early age and within the past 30 days) was also associated with suicide attempts.

CONCLUSIONS

These findings have the potential to guide public health interventions geared toward suicide prevention in Africa and other, similar regions, as well as provide the impetus for future epidemiologic studies on suicidal behavior in low-income countries.

Disability pension due to common mental disorders and subsequent suicidal behaviour: a population-based prospective cohort study

OBJECTIVE

Adverse health outcomes, including suicide, in individuals on disability pension (DP) due to mental diagnoses have been reported. However, scientific knowledge on possible risk factors for suicidal behaviour (suicide attempt and suicide) in this group, such as age, gender, underlying DP diagnoses, comorbidity and DP duration and grade, is surprisingly sparse. This study aimed to investigate associations of different measures (main and secondary diagnoses, duration and grade) of DP due to common mental disorders (CMD) with subsequent suicidal behaviour, considering gender and age differences.

DESIGN

Population-based prospective cohort study based on Swedish nationwide registers.

METHODS

A cohort of 46,515 individuals aged 19-64 years on DP due to CMD throughout 2005 was followed-up for 5 years. In relation to different measures of DP, univariate and multivariate HRs and 95% CIs for suicidal behaviour were estimated by Cox regression. All analyses were stratified by gender and age.

RESULTS

During 2006-2010, 1036 (2.2%) individuals attempted and 207 (0.5%) completed suicide. Multivariate analyses showed that a main DP diagnosis of 'stress-related mental disorders' was associated with a lower risk of subsequent suicidal behaviour than 'depressive disorders' (HR range 0.4-0.7). Substance abuse or personality disorders as a secondary DP diagnosis predicted suicide attempt in all subgroups (HR range 1.4-2.3) and suicide in women and younger individuals (HR range 2.6-3.3). Full-time DP was associated with a higher risk of suicide attempt compared with part-time DP in women and both age groups (HR range 1.4-1.7).

CONCLUSIONS

Depressive disorders as the main DP diagnosis and substance abuse or personality disorders as the secondary DP diagnosis were risk markers for subsequent suicidal behaviour in individuals on DP due to CMD. Particular attention should be paid to younger individuals on DP due to anxiety disorders because of the higher suicide risk.

Emotional face recognition in adolescent suicide attempters and adolescents engaging in non-suicidal self-injury

Little is known about the bio-behavioral mechanisms underlying and differentiating suicide attempts from non-suicidal self-injury (NSSI) in adolescents. Adolescents who attempt suicide or engage in NSSI often report significant interpersonal and social difficulties. Emotional face recognition ability is a fundamental skill required for successful social interactions, and deficits in this ability may provide insight into the unique brain-behavior interactions underlying suicide attempts versus NSSI in adolescents. Therefore, we examined emotional face recognition ability among three mutually exclusive groups: (1) inpatient adolescents who attempted suicide (SA, n = 30); (2) inpatient adolescents engaged in NSSI (NSSI, n = 30); and (3) typically developing controls (TDC, n = 30) without psychiatric illness. Participants included adolescents aged 13-17 years, matched on age, gender and full-scale IQ. Emotional face recognition was evaluated using the diagnostic assessment of nonverbal accuracy (DANVA-2). Compared to TDC youth, adolescents with NSSI made more errors on child fearful and adult sad face recognition while controlling for psychopathology and medication status (ps < 0.05). No differences were found on emotional face recognition between NSSI and SA groups. Secondary analyses showed that compared to inpatients without major depression, those with major depression made fewer errors on adult sad face recognition even when controlling for group status (p < 0.05). Further, compared to inpatients without generalized anxiety, those with generalized anxiety made fewer recognition errors on adult happy faces even when controlling for group status (p < 0.05). Adolescent inpatients engaged in NSSI showed greater deficits in emotional face recognition than TDC, but not inpatient adolescents who attempted suicide. Further results suggest the importance of psychopathology in emotional face recognition. Replication of these preliminary results and examination of the role of context-dependent emotional processing are needed moving forward.

Annual research review: Secular trends in child and adolescent mental health

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.

Suicide among first-generation and second-generation immigrants in Sweden: association with labour market marginalisation and morbidity

BACKGROUND

Previous research suggests that first-generation immigrants have a lower suicide risk than those both born in Sweden and with both parents born in Sweden (natives), while the suicide risk in the second generation seems higher. The aim of this study was to investigate to what extent suicide risk in first-generation and second-generation (both parents born abroad) and intermediate-generation (only one parent born abroad) immigrants compared with natives is associated with sociodemographic factors, labour market marginalisation and morbidity.

METHODS

A prospective population-based cohort study of 4 034 728 individuals aged 16-50 years was followed from 2005 to 2010. HRs for suicide were calculated for first-generation, intermediate-generation and second-generation immigrants compared with natives. Analyses were controlled for sociodemographic factors, morbidity and labour market marginalisation.

RESULTS

The HR of suicide was significantly lower in first-generation immigrants (HR 0.83 CI 0.76 to 0.91), and higher in second-generation (HR 1.32, CI 1.15 to 1.52) and intermediate-generation immigrants (HR 1.20, CI 1.08 to 1.33) in comparison to natives. The excess risk was explained by differences in sociodemographics, morbidity and labour market marginalisation. In the fully adjusted models, a higher HR remained only for the Nordic second generation (HR 1.29, CI 1.09 to 1.52). There were no sex differences in HRs.

CONCLUSIONS

The risk of suicide was shown to be lower in the first generation and higher in the second generation compared with natives. The higher HR in the Nordic second generation was not explained by differences in sociodemographics, labour market marginalisation and morbidity. Further research is warranted to investigate factors underlying this excess risk.

Psychiatric diagnoses and risk of suicidal behaviour in young disability pensioners: prospective cohort studies of all 19-23 year olds in Sweden in 1995, 2000, and 2005, respectively

OBJECTIVE

Increasing rates of disability pension (DP) have been observed among young adults. We studied specific psychiatric DP diagnoses and subsequent risk of suicidal behaviour in a series of three cohorts of young adult in Sweden.

METHOD

In a nationwide register study, we included all young adults who in 1995, 2000, and 2005, respectively, were 19-23 years old and lived in Sweden (n≈500,000 per cohort). Rates of DP and specific psychiatric DP diagnoses were recorded in each cohort. Hazard ratios (HRs) and 95% confidence intervals (CIs) for suicidal behaviour during the following five years, with the corresponding age group as reference, were calculated by Cox proportional hazard regression, adjusted for demographic variables and previous own and parental suicidal behaviour.

RESULTS

The overall proportion with DP in this age group increased from 0.92% in 1995 to 2.29% in 2005, with particularly large increases in psychiatric diagnoses such as hyperkinetic disorders, pervasive developmental disorders, and depression/anxiety. The overall proportion of young disability pensioners attempting suicide during the five-year follow-up increased from 2.21% in the 1995 cohort to 3.81% in the 2005 cohort. Within most psychiatric DP diagnoses, the risk of attempted suicide did not change significantly over time, whereas suicide attempts increased in the reference group. Accordingly, the HRs for suicide attempt decreased in some psychiatric DP diagnoses. The highest adjusted HRs were observed for depression/anxiety (16.41; CI: 9.06 to 29.74) and schizophrenia (9.37; 6.13 to 14.31) in the 1995 cohort. The rate of suicide among young disability pensioners during follow-up ranged from 0.19% in 1995 to 0.37% in 2005, mainly occurring in individuals with psychiatric diagnoses.

CONCLUSION

Suicidal behaviour has become more prevalent among young disability pensioners, which co-occurred with an increased tendency to grant DP in psychiatric diagnoses with a known high risk of suicidal behaviour. Preventive measures are warranted.

Is transition to disability pension in young people associated with changes in risk of attempted suicide?

BACKGROUND

The aim of the present study was to investigate trajectories of suicide attempt risks before and after granting of disability pension in young people.

METHOD

The analytic sample consisted of all persons 16-30 years old and living in Sweden who were granted a disability pension in the years 1995-1997; 2000-2002 as well as 2005-2006 (n = 26,624). Crude risks and adjusted odds ratios for suicide attempt were computed for the 9-year window around the year of disability pension receipt by repeated-measures logistic regressions.

RESULTS

The risk of suicide attempt was found to increase continuously up to the year preceding the granting of disability pension in young people, after which the risk declined. These trajectories were similar for women and men and for disability pension due to mental and somatic diagnoses. Still, the multivariate odds ratios for suicide attempts for women and for disability pension due to mental disorders were 2.5- and 3.8-fold increased compared with the odds ratios for men and disability pension due to somatic disorders, respectively. Trajectories of suicide attempts differed for young individuals granted a disability pension during 2005-2006 compared with those granted during 1995-1997 and 2000-2002.

CONCLUSIONS

We found an increasing risk of suicide attempt up until the granting of a disability pension in young individuals, after which the risk decreased. It is of clinical importance to monitor suicide attempt risk among young people waiting for the granting of a disability pension.

Risk factors for suicidal behaviour in individuals on disability pension due to common mental disorders - a nationwide register-based prospective cohort study in Sweden

BACKGROUND

Common mental disorders (CMD) have become one of the leading causes for disability pension (DP). Studies on predictors of adverse health outcome following DP are sparse. This study aimed to examine the association of different socio-demographic factors and health care consumption with subsequent suicidal behaviour among individuals on DP due to CMD.

METHOD

This is a population-based prospective cohort study based on register data. All individuals aged 18-64 years, living in Sweden on 31-Dec-2004 who in 2005 were on DP due to CMD (N = 46 745) were followed regarding suicide attempt and suicide (2006-10). Univariate and multivariate hazard ratios (HR) and 95% confidence intervals (CI) for suicidal behaviour were estimated by Cox regression.

RESULTS

During the five-year follow-up, 1 046 (2.2%) and 210 (0.4%) individuals attempted and committed suicide, respectively. Multivariate analyses showed that young age (18-24 years) and low education predicted suicide attempt, while living alone was associated with both higher suicide attempt and suicide (range of HRs 1.23 to 1.68). Combined prescription of antidepressants with anxiolytics during 2005 and inpatient care due to mental diagnoses or suicide attempt (2001-05) were strongly associated with suicide attempt and suicide (range of HRs 1.3 to 4.9), while inpatient care due to somatic diagnoses and specialized outpatient care due to mental diagnoses during 2001-05 only predicted suicide attempt (HR 1.45; 95% CI: 1.3-1.7; HR 1.30; 95% CI: 1.1-1.7).

CONCLUSIONS

Along with socio-demographic factors, it is very important to consider type of previous healthcare use and medication history when designing further research or intervention aiming at individuals on DP due to CMD. Further research is warranted to investigate both characteristics of disability pension due to CMD, like duration, diagnoses and grade as well as mechanisms to subsequent suicidal behavior, taking potential gender differences into consideration.

Clinical and socio-demographic correlates of suicidal intent among young adults: a study from South India

BACKGROUND

Intent in attempted suicide is considered an indicator of subsequent suicide. Few studies in developing countries have examined correlates of suicidal intent among young adults.

AIMS

This study aimed to assess the intent score among a sample of young suicide attempters from South India and to identify the factors associated with suicide intent among them.

METHOD

The clinical charts of 64 consecutive subjects aged 15-24 years attending emergency services for attempted suicide were reviewed. All participants completed a semistructured proforma, the Presumptive Stressful Life Events Scale, the Beck Hopelessness Scale, the Pierce Suicide Intent Scale, and the Global Assessment of Functioning Scale. Psychiatric diagnoses were made according to the ICD-10 clinical descriptions and diagnostic guidelines.

RESULTS

The intent scores were in the moderate-to-high range for most subjects. Suicide intent score significantly varied depending on the presence or absence of psychiatric morbidity. In bivariate analysis, psychiatric morbidity and hopelessness correlated positively with suicide intent, and in linear regression, hopelessness emerged as a predictor of suicide intent.

CONCLUSION

A high intent of suicide in young is associated with psychiatric morbidity and presence of hopelessness. Hopelessness may be a key predictor of suicidal intent. Assessment of suicidal intent and hopelessness among young attempters is important and may help identify high-risk individuals who need intensive interventions.

Suicides in the Centre of Portugal: seven years analysis

As one of the more specific and distinctive problems of human beings, suicide has been investigated with increasing attention all over the world. Several risk factors have been described as well as limitations arising from their study. The World Health Organization estimates that this scourge affects one million people annually, which corresponds to one death every 40s worldwide. According to recent studies, Portugal, despite the good rates (10 suicide deaths per 100,000 inhabitants), had shown an increasing trend among younger people. This work aims to characterize the evolution of the suicidal profile autopsied at the Forensic Pathology Department of the Centre Branch of the National Institute of Legal Medicine and Forensic Sciences of Portugal, analyzing several variables: age, gender, marital status, employment status, suicidal methodology, toxicological analysis and some conditions/behaviors regarding personal history (alcoholism, suicidal ideation, suicide attempts, physical illness, psychiatric disorder). All the autopsies from the 1 January, 2003 to 31 December, 2009 were analyzed. The suicide profile achieved corresponded to a man (77%), aged between 65 and 74 years old (20.4%), married (54.5%), employed, who committed suicide by hanging, in September, May or February. Clinical records include an organic health problem or psychiatric one, in addition to risk behaviors such as alcoholism, suicidal thoughts or suicide attempts. The number of suicides autopsied at the Centre Branch has increased, resembling the profile to the result of many other authors. However, new medical and social developments place hanging as the favorite suicide method in our study. Many barriers remain to overthrow but several prevention programs begin to be designed and implemented. Future evaluations and interventions at the social and medical level, including the death certification process, will be fundamental to a better realistic understanding of this phenomenon.

Diagnosis-specific disability pension predicts suicidal behaviour and mortality in young adults: a nationwide prospective cohort study

OBJECTIVES

Increasing rates of disability pension (DP), particularly owing to mental diagnoses, have been observed among young adults in Organisation for Economic Co-operation and Development (OECD) countries. There is a lack of knowledge about the health prognosis in this group. The aim of this study was to investigate whether DP in young adulthood owing to specific mental diagnoses or somatic diagnoses predicts suicidal behaviour and all-cause mortality.

DESIGN

A nationwide prospective cohort study.

SETTING

A register study of all young adults who in 2005 were 19-23 years old and lived in Sweden. Registers held by the National Board of Health and Welfare, Statistics Sweden and the National Social Insurance Agency were used.

PARTICIPANTS

525 276 young adults. Those who in 2005 had DP with mental diagnoses (n=8070) or somatic diagnoses (n=3975) were compared to all the other young adults in the same age group (n=513 231).

OUTCOME MEASURES

HRs for suicide attempt, suicide and all-cause mortality in 2006-2010 were calculated by Cox proportionate hazard regression models, adjusted for sex, country of birth, parental education and parental and previous own suicidal behaviour.

RESULTS

The adjusted HR for suicide attempt was 3.32 (95% CI 2.98 to 3.69) among those on DP with mental diagnoses and 1.78 (95% CI 1.41 to 2.26) among those on DP with somatic diagnoses. For the specific mental diagnoses, the unadjusted HRs ranged between 2.42 (mental retardation) and 22.94 (personality disorders), while the adjusted HRs ranged between 2.03 (mental retardation) and 6.00 (bipolar disorder). There was an increased risk of mortality for young adults on DP in general, but only those with mental DP diagnoses had a significantly elevated HR of completed suicide with an adjusted HR of 3.92 (95% CI 2.83 to 5.43).

CONCLUSIONS

Young adults on DP are at increased risk of suicidal behaviour and preterm death, which emphasises the need for improved treatment and follow-up.

Adolescents' self-reported suicide attempts, self-harm thoughts and their correlates across 17 European countries

BACKGROUND

  Suicide is a leading cause of death among adolescents in Europe. Self-harm thoughts and behaviours are documented precursors of completed suicide. It is therefore of great importance to investigate the prevalence of suicide thoughts and attempts and their correlates, with the aim of preventing this major life-threatening public health problem. This study provides cross-national European data on self-reported suicidal thoughts and attempts among adolescents.

METHODS

  Data were obtained from 45,806 high school students aged 15-16 years from 17 countries that participated in the European School Survey Project on Alcohol and Other Drugs (ESPAD) 2007 school survey. The standardised methods of the ESPAD survey ensure comparability across countries. Students completed an anonymous questionnaire in their classrooms. The prevalences of suicidal thoughts and attempts are reported as well as their sociodemographic and psychosocial correlates identified in logistic regression.

RESULTS

  The median prevalence of any lifetime self-reported suicide attempt was 10.5% across the participating countries (range 4.1%-23.5%). The median of frequent self-harm thoughts (at least five times) was 7.4% (range 2.1%-15.3%). Suicidal behaviour and thoughts had significant associations with gender, substance use, family integrity and socioeconomic status. Countries with higher prevalence of substance use tended to have a weaker association between substance use and self-reported suicide attempts.

CONCLUSION

  Although self-reported self-harm thoughts and suicide attempts vary in prevalence within Europe, there are common correlates across countries. These have an important impact on understanding the phenomenon of suicide among young people and in guiding prevention.

Depression in adolescence

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.

A longitudinal epidemiological comparison of suicide and other causes of death in Italian children and adolescents

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.

Juvenile delinquency, social background and suicide--a Swedish national cohort study of 992,881 young adults

BACKGROUND

As the suicide rates in young adults do not show a clear decline, it is important to elucidate possible risk factors. Juvenile delinquency has been pointed out as a possible risk behaviour.

METHODS

This register-based cohort study comprises the birth cohorts between 1972 and 1981 in Sweden. We followed 992,881 individuals from the age of 20 years until 31 December 2006, generating 10 210 566 person-years and 1482 suicides. Juvenile delinquency was defined as being convicted of a crime between the ages of 15 and 19 years. Estimates of risk of suicide were calculated as incidence rate ratio (IRR) with 95% confidence intervals (CIs) using Poisson regression analysis with adjustment for potential confounding by their own and their parents' mental illness or substance abuse, parental education, single parenthood, social assistance, adoption and foster care.

RESULTS

Among females, 5.9%, and among males, 17.9%, had at least one conviction between the ages 15 and 19 years. In the fully adjusted model, females with one conviction had a suicide risk of 1.7 times higher (95% CI 1.2-2.4), the corresponding IRR for men was 2.0 (95% CI 1.7-2.4) and 5.7 (95% CI 2.5-13.1) and 6.6 (95% CI 5.2-8.3), for women and men with five or more convictions. The effect of severe delinquency on suicide was independent of parental educational level.

CONCLUSIONS

This study supports the hypothesis that individuals with delinquent behaviour in late adolescence have an increased risk of suicide as young adults. Regardless of causality issues, repeated juvenile offenders should be regarded by professionals in health, social and correctional services who come into contact with this group as a high-risk group for suicide.

Youth suicide trends in Finland, 1969-2008

BACKGROUND

There are only a few recent studies on secular trends in child and adolescent suicides. We examine here trends in rates and methods of suicide among young people in Finland, where suicide rates at these ages are among the highest in the world.

METHODS

The data, obtained from Statistics Finland, consisted of all suicides (n = 901) committed by persons under 18 years of age over the period 1969-2008. Gender-specific trends were analysed separately for the years 1969-1989 and 1990-2008 using 3-year moving averages. Trends in methods of suicide were examined from 1975 to 2008 in five-year periods.

RESULTS

The male-to-female ratio in youth suicides was 3.6:1. The male rates increased in 1969-1989, while the rates among females were inconsistent. After 1990, the rates decreased for males but turned to an increase among females. Shooting was the most common suicide method among males throughout the period, while hanging exceeded poisoning as the most common method among females after 1990. All violent suicides decreased for males and increased for females in 1990-2008.

CONCLUSIONS

The increase in violent, i.e., more lethal, suicide methods among young females is alarming, as females are known to have higher rates of attempted suicide than males. Alcohol consumption, rates and treatment of depression and violent behaviour among adolescents are discussed as approaches towards explaining this phenomenon.

50-year mortality trends in children and young people: a study of 50 low-income, middle-income, and high-income countries

BACKGROUND

Global attention has focused on mortality in children younger than 5 years. We analysed global mortality data for people aged 1-24 years across a 50-year period.

METHODS

The WHO mortality database was used to obtain mortality data from 1955 to 2004, by age-group (1-4, 5-9, 10-14, 15-19, and 20-24 years) and stratified by sex. To analyse change in mortality, we calculated mortality rates averaged over three 5-year periods (1955-59, 1978-82, and 2000-04) to investigate trends in deaths caused by communicable and non-communicable diseases and injury.

FINDINGS

Data were available for 50 countries (ten high income, 22 middle income, eight low income, seven very low income, and three unclassified), grouped as Organisation for Economic Co-operation and Development (OECD) countries, Central and South American countries, eastern European countries and ex-Soviet states, and other countries. In 1955, mortality was highest in the 1-4-year age-group. Across the study period, all-cause mortality reduced by 85-93% in children aged 1-4 years, 80-87% in children aged 5-9 years, and 68-78% in young people aged 10-14 years in OECD, Central and South American, and other countries. Smaller declines (41-48%) were recorded in young men (15-24 years), and by 2000-04, mortality in this group was two-to-three times higher than that in young boys (1-4 years). Mortality in young women (15-24 years) was equal to that of young girls (1-4 years) from 2000 onwards. Substantial declines in death caused by communicable diseases were seen in all age-groups and regions, although communicable and non-communicable diseases remained the main causes of death in children (1-9 years) and young women (10-24 years). Injury was the dominant cause of death in young men (10-24 years) in all regions by the late 1970s.

INTERPRETATION

Adolescents and young adults have benefited from the epidemiological transition less than children have, with a reversal of traditional mortality patterns over the past 50 years. Future global health targets should include a focus on the health problems of people aged 10-24 years.

FUNDING

None.

Suicide in Ireland: a cross-national view

Recent epidemiological trends in Irish suicide rates were examined and found to be consistent with worldwide trends. However, the time-series Irish suicide rate was not consistent with predictions made from Durkheim's classic theory of suicide. Finally, current theories of the etiology of suicide were used to derive a linear regression equation to predict the Irish suicide rate which turned out to be quite inaccurate. The task addressed in this article is a review of the epidemiology of suicide in Ireland and, in doing so, the suicide rate in Ireland will be compared with the suicide rates of other nations of the world. Table 1 reports the suicide rate in Ireland from 1901 to 1949, Table 2 for the period 1950-2001, overall and for men and women (and parallel data for Northern Ireland are shown in Table 3). These data were compiled from Lester and Yang and from World Health Organisation publications and online (www.who.int). It should be noted that suicide was decriminalised in Ireland in 1993.

Suicide and hospitalization for mental disorders in Sweden: a population-based case-control study

The aim of this study was to estimate suicide risk during hospitalization and in the year following discharge for patients with mental disorders. All suicide cases in Sweden 18 years and older, between 1991 and 2003 (N=20,675; 70% male), were individually matched to 10 controls from the general Swedish population. Discharge diagnoses in the year before suicide of any mental disorder, mood disorder, schizophrenia spectrum disorder, and alcohol use disorder were identified from the Swedish Patient Register. Highest suicide risk during hospitalization and in the year following discharge was found for mood disorder [odds ratio (OR) 55 (95% CI, 47-65) for men and 86 (95% CI, 70-107) for women], with the risk peaking in the first week following discharge [OR 177 (95% CI, 78-401) for men and OR 268 (95% CI, 85-846) for women]. Compared to that for mood disorder, the suicide risk for schizophrenia spectrum disorder and alcohol use disorder was about half and more constant over time. The majority of suicide victims with a psychiatric diagnosis had been discharged from psychiatric treatment more than a month before the suicide. Over time, a constant proportion of 25% of the suicide victims had been hospitalized with a mental disorder in the year before suicide (23% of males and 31% of females), despite a significant decrease in psychiatric hospitalizations in the population. In conclusion, suicide risk was found to vary by type of mental disorder, time since discharge, and sex. This should be taken into account when planning suicide preventive efforts.

Trends in adolescent emotional problems in England: a comparison of two national cohorts twenty years apart

BACKGROUND

Evidence about trends in adolescent emotional problems (depression and anxiety) is inconclusive, because few studies have used comparable measures and samples at different points in time. We compared rates of adolescent emotional problems in two nationally representative English samples of youth 20 years apart using identical symptom screens in each survey.

METHODS

Nationally representative community samples of 16-17-year-olds living in England in 1986 and 2006 were compared. In 1986, 4524 adolescents and 7120 parents of young people participated in the age-16-year follow-up of the 1970 British Cohort Study. In 2006, 719 adolescents and 734 parents participated in a follow-up of children sampled from the 2002/2003 Health Surveys for England. Adolescents completed the Malaise Inventory and 12-item General Health Questionnaire. Parents completed the Rutter-A scale. Individual symptoms of depression and anxiety were coded combining across relevant questionnaire items. Young people also reported frequency of feeling anxious or depressed.

RESULTS

Youth- and parent-reported emotional problems were more prevalent in 2006 for girls, and rates of parent-reported problems increased for boys. Twice as many young people reported frequent feelings of depression or anxiety in 2006 as in 1986. Some symptoms showed marked change in prevalence over time (e.g., worry, irritability, fatigue), whereas others showed no change (e.g., loss of enjoyment, worthlessness). There was no evidence of differential trends in emotional problems for young people from socially advantaged and disadvantaged or intact and non-intact families. Changes in family structure and ethnic composition did not account for trends in youth emotional problems.

CONCLUSIONS

The study provides evidence for a substantial increase in adolescent emotional problems in England over recent decades, especially among girls.

Recent time trends in levels of self-reported anxiety, mental health service use and suicidal behaviour in Stockholm

OBJECTIVE

To investigate recent time trends in several indicators of mental ill-health and the patterning of these indicators between genders and younger vs. older individuals in Stockholm County.

METHOD

Several indicators were used; self-reported anxiety from the Swedish Survey of Living Conditions, information on psychiatric in-patient and out-patient care, attempted and completed suicides from national and regional registers. Gender- and age-specific trends were compared for the time period of 1997-2006.

RESULTS

Self-reported anxiety and psychiatric service use increased among young individuals of both genders, while attempted suicides increased only among young women. By contrast, these indicators decreased or remained stable in the older age group from year 2001 and onwards.

CONCLUSION

Our data indicate a rising, and highly prevalent, mental ill-health among the young in Stockholm County, a region representative of urbanized, secular Western societies.

Suicide mortality in Italy from 1980 to 2002

The aim of this study is to update age and sex mortality rates for suicide in Italy; to evaluate the methods of suicide; to consider the effect of under-reporting on mortality rate for suicide; to compare age-adjusted mortality rates for suicide; and to examine some possible causes for the misclassification of suicide. Temporal trends, from 1980 to 2002, were analyzed using joinpoint regression. Suicide rates decreased from 1980 to 2002 by 10.5% for men and by 44% for women. The change in suicide methods indicated an increasing use of highly lethal methods. The under-reporting of suicide seems to have no effect on temporal changes in mortality rates or on the geographical distribution. These data indicate that Italy is a country at low risk for suicide.

Suicide in Italian children and adolescents

BACKGROUND

Data and statistics on suicide mortality in several countries have been published and discussed over the last few decades but gaps in knowledge are present in the epidemiology of suicide among Italian youths.

METHODS

Suicide mortality data for the years 1973-2002 were obtained from the Italian Central Institute of Statistics (ISTAT). Age-standardized mortality rates were calculated and examined for trends over time.

RESULTS

During the last 3 decades the Italian population's overall suicide rate increased slightly from 67.8 per million in 1973 to 76.7 in 2002. Suicide rates were higher in males than females (2.8:1) and in Northern compared to Southern Italy. Suicide rates increased with age from 4.4 per million for children 10-14 years old to 25.8 (15-19 years) and 95.6 (> or = 20 years). The major increase over time was observed for 15-19 year old males.

LIMITATIONS

Routine suicide mortality data have several weaknesses; these are especially, related to the level of accuracy in the certification of violent causes of death.

CONCLUSION

A national research programme to study suicidal behaviour and risk factors in children and adolescents is essential. The permanent monitoring of the situation, exploring gender and interpersonal issues with the aim to plan protective initiatives in an appropriate manner, is also fundamental.

Gender issues in suicide rates, trends and methods among youths aged 15-24 in 15 European countries

BACKGROUND

No recent cross-country examinations for youth suicide trends and methods for Europe were found.

AIM

The aim of the study is to specify differences in suicide rates, trends and methods used among 15-24 years olds by gender across 15 European countries.

METHOD

Data for 14,738 suicide cases in the age group 15-24 in 2000-2004/5 were obtained and analysed.

RESULTS

Suicide rates ranged 5.5-35.1 for males and 1.3-8.5 for females. Statistically significant decline since 2000 was observed in Germany, Scotland, Spain, and England for males and in Ireland for females. Hanging was most frequently used for both genders, followed by jumping and use of a moving object for males and jumping and poisoning by drugs for females. Male suicides had a higher risk than females of using firearms and hanging and lower risk of poisoning by drugs and jumping. There were large differences between single countries.

LIMITATIONS

The limitations of the study are the small numbers of specific suicide methods in some countries as well as the re-categorisation of ICD-9 codes into ICD-10 in England, Ireland and Portugal. Further, the use of suicides (X60-X84) without events of undetermined deaths (Y10-Y34) continues to be problematic considering the possibility of "hidden suicides".

CONCLUSIONS

The present study shows that suicide rates among young males are decreasing since 2000 in several European countries. Analysis of suicide methods confirms that there is a very high proportion of hanging in youths, which is extremely difficult to restrict. However, besides hanging there are also high rates of preventable suicide methods and reducing the availability of means should be one of the goals of suicide prevention.

Worldwide child and adolescent mental health begins with awareness: a preliminary assessment in nine countries

To temper untoward mental health outcomes in children and adolescents, the World Psychiatric Association's Presidential Global Child Mental Health Programme, in collaboration with the WHO and the International Association of Child and Adolescent Psychiatry and Allied Professionals, established a Child Mental Health Awareness Task Force headed by Sam Tyano. Its task was to develop methodologies to increase awareness among policy-makers, community leaders, health professionals, teachers, parents, and children. Based on a prior comprehensive international search for effective techniques for information dissemination, an awareness manual was written for use by health professionals in diverse communities so as to guide the design and implementation of location specific awareness campaigns. We assessed the children, parents and teachers both before and after the campaign to determine changes in knowledge, attitudes and understanding of mental health. The school-based studies were conducted in selected communities in nine countries on five different continents distinguished by their different languages, cultures and their differing levels of economic development: Armenia, Azerbaijan, Brazil, China, Egypt, Georgia, Israel, Russia, and Uganda. In the six sites that completed all assessments, indicators of positive change in awareness of child mental health were identified, and results demonstrated an increased willingness to discuss emotional problems freely. These data support the utility of collaborating with schools so as to foster better child mental health in such under-resourced communities.

Pregnancies in high psychosocial risk groups: research findings and implications for early intervention

Besides the well-known risk factors for youth suicidal behavior, recent evidence suggests that risk for youth suicidal behavior can be determined even very early in life, during the prenatal and perinatal period. Low birth weight and short birth length adjusted for gestational age were found to increase the risk for suicidal behavior, particularly by violent means. Several parental factors like low parental socioeconomic status, teenage and single parenthood, multiparity and parental psychopathology, substance abuse and suicidal behavior have been linked to an increase in youth suicidal behavior. Effective collaboration among the sectors within health care and social services is crucial for early detection and adequate intervention.

The role of randomized trials in testing interventions for the prevention of youth suicide

Epidemiological considerations point to a small handful of prevention strategies that have the potential for dramatically reducing suicide rates. Nearly all of those prevention approaches involve population-based strategies to either find an increased number of individuals at high risk for suicide or to reduce the prevalence of risk factors in members of a population that, as a whole, has a relatively low rate of suicide. Few of these approaches have been evaluated in rigorous trials. We argue that there are rigorous randomized trial designs that are both feasible and ethical and can be used to test both programmes and implementation strategies for population-based suicide prevention. We review existing suicide prevention trials and introduce two new randomized trial designs that are likely to achieve sufficient statistical power. The 'dynamic wait-listed design' randomizes across different time periods and is now being used to test a gatekeeper training programme in 32 schools. It could also be used to examine suicide prevention programmes in rural areas. The multi-trial follow-up study builds on the large number of successful population-based preventive interventions aimed at reducing known risk factors for suicide in youths to see whether these also cause a reduction in rates of completed suicide.

Twenty-year trends in emotional and behavioral problems in Dutch children in a changing society

OBJECTIVE

Research into changes in the prevalence of children's psychiatric diagnoses has indicated an increase in recent decades. However, methodological problems may have influenced results. This study compared children's emotional and behavioral problem levels across three population samples from different time points across 20 years, assessed with identical methodologies.

METHOD

We compared Child Behavior Checklists and Teacher's Report Forms across three population samples of 6- to 16-year olds, assessed in 1983, 1993, and 2003.

RESULTS

We found evidence for small increases in the mean population levels of parent-reported problems, and in the percentages of children with serious problems. These changes concerned mostly internalizing problems. Teacher reports showed less changes. Decreases in scores were found on several areas of competence. Changes were the strongest between 1993 and 2003.

CONCLUSION

We found evidence for small increases in Dutch children's problems. Further developments must be monitored, as this trend may continue and have serious societal consequences.

An Analysis of Parent-Female Adolescent Relationships in Female Adolescent Suicides

This study analyzed Turkish female adolescent-family relations, which is believed to be one of the significant factors in female adolescents' suicide attempts, from a multidimensional perspective. The Parent-Adolescent Relationship Inventory, a multidimensional evaluation tool based on the behavioral family-system approach was used as a research tool. The inventory consists of the concepts and techniques of behavioral theory, family system theory, and cognitive theory in parent-adolescent' problems and conflicts. Based on these theories, the parent-adolescent relations inventory (PARQ), involves three main dimensions: problem solving and communication skills, cognitive/internalized beliefs, and functions and structures in family systems. There are two forms of the inventory, the adolescent form and the parent form. Only the adolescent form of PARQ, including 284 items, was used in this research. The inventory also consists of 16 subscales. It was adapted into Turkish by Eryüksel (1996) . The subjects of the study were 52 female adolescents who had attempted suicide and were taken to the Emergency Department of The Faculty of Medicine in Çukurova University, and 52 normal female adolescents from two different secondary schools at the southern province in Turkey. The age range of the clinical and normal groups were 14–18 ([Formula: see text] = 16). The results of the study revealed that the general stress level of female adolescents who attempted suicide is higher than those of normal groups. The examination of family structures of these female adolescents made it clear that mothers were the mediator between fathers and adolescents. It was also observed that both mothers and fathers shared many somatic concerns.

Autumn peak in shooting suicides of children and adolescents from northern Finland

Suicide is one of the leading causes of death among adolescents worldwide. Studies on the seasonal pattern of youth suicides are rare and the results are very contradictory and heterogeneous. Generally, suicide methods affect the pattern of suicide seasonality. Shooting is the most common suicide method among Finnish adolescents. We investigated whether shooting suicides of victims aged less than 18 years are correlated with a specific period of the year. Also, the seasonal pattern of shooting suicides in adolescents was compared with that of adult victims. Our data comprised 42 adolescent suicide victims and, for comparison, 1,926 adult suicide victims over the years 1988 to 2004 from Northern Finland. Of these, 59.5% (n = 25) of the adolescents and 28.8% (n = 554) of the adults had committed suicide by shooting. We observed that shooting suicides among the under-aged showed a significant peak in autumn (ratio 2.70, 95% CI: 1.97-3.42), while those of adult victims peaked in spring (ratio 1.19, 95% CI: 1.05-1.35). The monthly pattern of suicides correlated significantly with the mean duration of daily sunshine hours (trailing by 3 months) in the under-aged (r = 0.67, p = 0.016), but not in the adults (r = 0.06, p = 0.854). The role of firearm availability, psychosocial factors such as start of the school year, and some biological factors are discussed.