Influence of coping strategies on the efficacy of YAM (Youth Aware of Mental Health): a universal school-based suicide preventive program

Global public concern of childhood and adolescence suicide: a new perspective and new strategies for suicide prevention in the post-pandemic era

BACKGROUND

Suicide is the second leading cause of death in young people worldwide and is responsible for about 52,000 deaths annually in children and adolescents aged 5-19 years. Familial, social, psychological, and behavioral factors play important roles in suicide risk. As traumatic events such as the COVID-19 pandemic may contribute to suicidal behaviors in young people, there is a need to understand the current status of suicide in adolescents, including its epidemiology, associated factors, the influence of the pandemic, and management initiatives.

DATA SOURCES

We investigated global and regional suicide mortality rates among children and adolescents aged 5-19 years using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The suicide mortality rates from 1990 to 2019 were examined in 204 countries and territories across six World Health Organization (WHO) regions. Additionally, we utilized electronic databases, including PubMed/MEDLINE and Scopus, and employed various combinations of terms such as "suicide", "adolescents", "youth", "children", "risk factors", "COVID-19 pandemic", "prevention", and "intervention" to provide a narrative review on suicide within the pediatric population in the post-pandemic era.

RESULTS

Despite the decreasing trend in the global suicide mortality rate from 1990 to 2019, it remains high. The mortality rates from suicide by firearms or any other specified means were both greater in males. Additionally, Southeast Asia had the highest suicide rate among the six WHO regions. The COVID-19 pandemic seems to contribute to suicide risk in young people; thus, there is still a strong need to revisit appropriate management for suicidal children and adolescents during the pandemic.

CONCLUSIONS

The current narrative review integrates up-to-date knowledge on suicide epidemiology and the effects of the COVID-19 pandemic, risk factors, and intervention strategies. Although numerous studies have characterized trends in suicide among young people during the pre-pandemic era, further studies are required to investigate suicide during the pandemic and new strategies for suicide prevention in the post-pandemic era. It is necessary to identify effective prevention strategies targeting young people, particularly those at high risk, and successful treatment for individuals already manifesting suicidal behaviors. Care for suicidal children and adolescents should be improved with parental, school, community, and clinical involvement.

Facilitating Access to Mental Health Services: A Stakeholder-Driven Improvement of the Children and Young People (CYP) as One Referral Platform

(1) Background: Pre-pandemic, child and adolescent mental health service (CAMHS) referrals were paper based in Liverpool and Sefton (England, United Kingdom), causing delays in waiting times. The "CYP as One" online mental health referral platform was co-created to overcome these challenges. (2) Methods: This study aims to improve "CYP as One" accessibility and usability and, subsequently, support CAMHS to improve waiting times. The current study utilised the Living Lab approach. We conducted content analysis on completed online referrals extracted from the "CYP as One" platform. These findings were supplemented by seven online focus groups, with 16-19-year-old young people, parents of children under 16, and health service providers. Thematic analysis was conducted on all data. (3) Results: The thematic analysis returned seven themes, namely (i) "CYP as One" vs. Traditional Referrals, (ii) Gender and Language Dynamics, (iii) Digital Empathy in Action, (iv) the Influence of the Provider Perspective, (v) Age and Social Sensitivity, (vi) Enhancing Access to Information, and (vii) Boosting Admin and Clinical Efficiency. (4) Conclusions: Digital content that seeks to replace in-person referrals can provide adequate support to children and young people who have faced difficulties accessing mental health services.

Educational agents and institutions called into action in suicide prevention, intervention, and postvention

Introduction

Suicide is the second leading cause of death in the 15 to 29 age group worldwide, and is a severe public health problem. Adolescent and young adult individuals attend educational institutions which can play an essential role in detecting and preventing suicide. For this reason, the purpose of this research is to identify what educational institutions and agents are called into action in suicide prevention, intervention, and postvention.

Methods

The method of systematic review of the literature based on the PRISMA protocol was used. The review protocol was registered in PROSPERO (PROSPERO 2020 CRD42020189127). The systematic review yielded 66 articles published between 1990 and February 2023.

Results

The results show that a wide variety of educational stakeholders are required to intervene for suicide prevention, interventions and postvention between primary education and college. The study describes the different programs that have been provided, the countries in which they have been implemented and the agents who have been targeted. It also identifies gaps in the research on suicide in the educational field.

Discussion

Overall, educational suicide initiatives report positive effects on participants' understanding, attitudes, and beliefs regarding suicide and suicide prevention, although some studies have expressed some caution.

Metacognition vulnerabilities in time of crisis: Who to protect from suicidal risk?

INTRODUCTION

During stressful events, we are all trying to cope. We may not be equal depending on our emotional, psychological, and mental states. During the COVID-19 pandemic, we could try to avoid negative information processing and anxiogenics content to prevent unhealthy thinking processes. One of the processes we can observe regarding our way of thinking and its impact on our psychological well-being is Metacognition.

METHODS

We recruited 104 outpatients in 2018. In 2020, during the pandemic, we recruited 216 outpatients and 176 healthy controls. We assessed their level of metacognition with the MCQ30 scale together with Suicidal risk and Hopelessness.

RESULTS

All three groups showed significant differences, with the nonclinical sample having higher scores in MCQ30. Regression revealed the different profiles where Hopelessness was the only predictor for the clinical sample, whereas metacognition was an adjunctive predictor of suicidal risk for the nonclinical sample.

CONCLUSION

Our results showed that the COVID-19 crisis influenced metacognitive levels for the nonclinical sample but not for the clinical population. Moreover, Hopelessness predicted suicide risk for both populations, but Metacognition was also a predictive factor for the nonclinical sample. We conclude with the possible impact of preventive measures based on Metacognitive work that can be created out of these results.

Profiles of Passive and Active Suicidal Ideation and Attempts Among Secondary School Students in Australia: A Cross-Sectional Analysis

INTRODUCTION

Suicide is a leading cause of death among young people (aged 15-24 years), and as such, identifying targets for early intervention is essential to reducing this risk. Using baseline data from a school-based universal suicide prevention trial, we investigate factors associated with different types of suicidal ideation in secondary school students with implications for youth suicide preventive efforts.

METHODS

A self-report questionnaire was administered to students aged 13-16 years (Year 9) before program delivery in four regions across New South Wales, Australia (N = 556). Multinomial logistic regression was used to identify correlates of suicidal ideation type (passive vs. active).

RESULTS

Approximately half the total sample reported recent suicidal ideation (51.6% in the previous two weeks), which included almost one-third reporting active suicidal ideation (32.2% seriously considered suicide or made plans). Participants that were significantly more likely to report active suicidal ideation compared to passive suicidal ideation identified as female (OR = 1.91, 95% CI = 1.02-3.59), Indigenous (OR = 0.21, 95% CI = 0.05-0.80), as sexual minorities (OR = 0.36, 95% CI = 0.13-0.97), and had greater depression severity (OR = 1.11, 95% CI = 1.04-1.19).

CONCLUSIONS

Suicidal thoughts are prevalent among young people. Universal and indicated preventive interventions that address depression, as well as bullying and discrimination of minority groups would benefit all young people, particularly those more vulnerable to severe suicidal ideation and suicide attempts.HighlightsActive suicidal ideation (SI) was reported by 32.2% of our student sample aged 13-16 years.Active SI is linked to sex (female), Indigeneity status, sexual minority status, and greater depression severity.Improved bullying and discrimination policy within schools, and well-being programs targeting depression and promoting help-seeking, would benefit youth.

Problems with Suicidal Behavior Prevention in Adolescents: a Narrative Literature Review

BACKGROUND

Among the existing issues related to the health and quality of life of Russian adolescents, suicidal behavior is being actively discussed; however, the available comprehensive measures for prevention of suicide and attempts at suicide at this age do not provide an adequate solution. This is due to the fact that suicide is an integrative phenomenon, and the act of suicide itself is interpreted, in essence, as the "tip of the iceberg". What is especially clearly manifested in adolescence is the fact that the readiness to commit suicide is associated not so much with the level of severity of mental pathology and personality dysfunction, but with the general social context lack of well-being of total trouble. Therefore, suicide prevention cannot be based purely on the timely identification of persons at risk for mental pathology.

AIM

The purpose of this work is to analyze the available literature on current approaches that have demonstrated their efficacy in reducing suicidal behavior in adolescents.

METHODS

The authors performed a narrative review of the relevant literature published between 2012 and 2021. They analyzed the works presented in the PubMed, MEDLINE, and Web of Science electronic databases. Descriptive analysis was used to generalize the data obtained.

RESULTS

The article discusses preventive approaches to suicidal behavior in adolescents, which are most often studied, and which are also used in practical healthcare. It outlines the problems associated with the implementation and evaluation of the efficacy of these preventive programs.

CONCLUSIONS

The continuing high rate of suicide among adolescents calls for an urgent concerted effort to develop, disseminate, and implement more effective prevention strategies. School-based approaches are the most convenient in practical terms, but they require systematic and long-term use of anti-suicidal programs. Digital interventions can reduce the economic burden of their use, including assessing suicidal risk and identifying psychopathology associated with suicidality.

Did we learn something positive out of the COVID-19 pandemic? Post-traumatic growth and mental health in the general population

Background

When facing a traumatic event, some people may experience positive changes, defined as posttraumatic growth (PTG).

Methods

Understanding the possible positive consequences of the pandemic on the individual level is crucial for the development of supportive psychosocial interventions. The present paper aims to: 1) evaluate the levels of PTG in the general population; 2) to identify predictors of each dimension of post-traumatic growth.

Results

The majority of the sample (67%, N = 13,889) did not report any significant improvement in any domain of PTG. Participants reported the highest levels of growth in the dimension of “appreciation of life” (2.3 ± 1.4), while the lowest level was found in the “spiritual change” (1.2 ± 1.2). Female participants reported a slightly higher level of PTG in areas of personal strength (p < .002) and appreciation for life (p < .007) compared to male participants, while no significant association was found with age. At the multivariate regression models, weighted for the propensity score, only the initial week of lockdown (between 9-15 April) had a negative impact on the dimension of “relating to others” (B = −.107, 95% CI = −.181 to −.032, p < .005), while over time no other effects were found. The duration of exposure to lockdown measures did not influence the other dimensions of PTG.

Conclusions

The assessment of the levels of PTG is of great importance for the development of ad hoc supportive psychosocial interventions. From a public health perspective, the identification of protective factors is crucial for developing ad-hoc tailored interventions and for preventing the development of full-blown mental disorders in large scale.

How to improve the quality of World Psychiatric Association educational activities? Results from an online survey with World Psychiatric Association zonal representatives

INTRODUCTION

The World Psychiatric Association (WPA), a global association representing 145 psychiatric societies in 121 countries, has a specific focus on education and learning, promoting educational programs on a regular basis. Education in mental health is a continuously evolving phenomenon, although it happens quite often that it is still based on a knowledge formed in the last century and with the latest scientific updates mainly available in English. The WPA is constantly committed in improving and updating the type of educational materials available and ready to be disseminated worldwide.

METHODS

An online survey has been developed and sent to the 18 WPA zonal representatives in order: to evaluate the educational needs for mental health, to translate materials into native languages or inclusivity, and to prioritize educational activities to be developed by the WPA in the next years.

RESULTS

Fifteen out of the 18 zonal representatives participated in the study. According to the public mental health perspective, collaboration with general practitioners (GPs) (80%), communities/stakeholders (66.7%) and programs for promoting mental health in schools (53.3%) are the most prioritized activities carried out. Programs for suicide prevention (86.7%) and promotion of mental health and well-being in the general population (66.7%) are considered as the most relevant to be implemented. From the healthcare perspective, new knowledge on pharmacological and non-pharmacological interventions (73%) was requested. The educational packages are mostly available in the English language, although respondents prioritize the translation of WPA educational material into, at least, Spanish and French. The most preferred formats for educational activities are webinar live (80%) and key opinion lectures (66.7%).

CONCLUSIONS

These findings represent the first step in the continuing promotion of education carried out by the WPA. We aim to run these kinds of initiatives from time to time in order to adapt themes and topics of these materials to the real educational needs of all mental healthcare professionals worldwide.

Suicide prevention in childhood and adolescence: a narrative review of current knowledge on risk and protective factors and effectiveness of interventions

INTRODUCTION

Suicide is a global mental health problem for people of all ages. While rates of suicide in children and adolescents are reported as lower than those in older populations worldwide, they represent the third leading cause of death in 15-19-year-olds. The rates are higher among boys than girls worldwide, though the death rates for girls exceed those for boys in Bangladesh, China, India, and Nepal. There has been a general decrease in adolescent suicide rates over recent decades. However, increases are reported in South East Asia as well as South America over the same time period.

METHODS

A narrative review method has been used to summarize current knowledge about risk and protective factors for suicide among children and adolescents and to discuss evidence-based strategy for suicide prevention in this age group.

RESULTS

Identified suicide risk and protective factors for children and adolescents largely overlap with those for adults. Nevertheless, developmental characteristics may strengthen the impact of some factors, such as decision-making style, coping strategies, family and peer relationships, and victimization. The implementation of evidence-based suicide preventive strategies is needed. Restricting access to lethal means, school-based awareness and skill training programs, and interventions delivered in clinical and community settings have been proven effective. The effectiveness of gatekeeper training and screening programs in reducing suicidal ideation and behavior is unproven but widely examined in selected settings.

DISCUSSION

Since most studies have been conducted in western countries, future research should assess the effectiveness of these promising strategies in different cultural contexts. The use of more rigorous study designs, the use of both short- and long-term follow-up evaluations, the larger inclusion of individuals belonging to vulnerable groups, the evaluation of online intervention, and the analysis of programs' cost-effectiveness are also required.

Developing a health education comic book: the advantages of learning the behaviours of a target audience

The objective of this study was to determine the positive and negative coping mechanisms practiced by parents of paediatric inpatients and outpatients in order to prepare a health educational comic aimed at improving these response mechanisms. Data were collected from parents visiting general paediatric outpatient clinics or hospitalisation units, at a children's hospital in a metropolitan city. Data analysis was based on 258 completed surveys received from 308 (83.77%) respondents. Each parent completed a survey that included the Brief-COPE-Coping Orientation to Problems Experienced questionnaire that encompassed 14 subscales of positive and negative coping mechanisms. Parents used both positive and negative coping mechanisms in outpatient clinics and hospitalisation units. Scores involving negative coping mechanisms were increased and associated with the severity of a child's reason for visiting a children's hospital. The lowest scores were reported by parents whose children were seen at outpatient clinics, whereas the highest scores were reported by parents whose children were treated in critical care units. Learning about parents' coping mechanisms provided key information for preparing an electronic health education comic book (electronically distributed free of charge) and can be used to teach and promote the reinforcement of positive rather than negative coping mechanisms.

Predictors of Anxiety-Induced Sleep Disturbance among in-School Adolescents in Ghana: Evidence from the 2012 Global School-Based Health Survey

(1) Background: Psychological problems of adolescents have become a global health and safety concern. Empirical evidence has shown that adolescents experience diverse mental health conditions (e.g., anxiety, depression, and emotional disorders). However, research on anxiety-induced sleep disturbance among in-school adolescents has received less attention, particularly in low- and middle-income countries. This study's central focus was to examine factors associated with t anxiety-induced sleep disturbance among in-school adolescents in Ghana. (2) Methods: Analysis was performed using the 2012 Global School-based Health Survey (GSHS). A sample of 1342 in-school adolescents was included in the analysis. The outcome variable was anxiety-induced sleep disturbance reported during the past 12 months. Frequencies, percentages, chi-square, and multivariable logistic regression analyses were conducted. Results from the multivariable logistic regression analysis were presented as crude and adjusted odds ratios at 95% confidence intervals (CIs) and with a statistical significance declared at p < 0.05. (3) Results: Adolescents who went hungry were more likely to report anxiety-induced sleep disturbance compared to their counterparts who did not report hunger (aOR = 1.68, CI = 1.10, 2.57). The odds of anxiety-induced sleep disturbance were higher among adolescents who felt lonely compared to those that never felt lonely (aOR = 2.82, CI = 1.98, 4.01). Adolescents who had sustained injury were more likely to have anxiety-induced sleep disturbance (aOR = 1.49, CI = 1.03, 2.14) compared to those who had no injury. Compared to adolescents who never had suicidal ideations, those who reported experiencing suicidal ideations had higher odds of anxiety-induced sleep disturbance (aOR = 1.68, CI = 1.05, 2.71). (4) Conclusions: Anxiety-induced sleep disturbance among in-school adolescents were significantly influenced by the psychosocial determinants such as hunger, loneliness, injury, and suicidal ideation in this study. The findings can help design appropriate interventions through effective strategies (e.g., early school-based screening, cognitive-behavioral therapy, face-face counseling services) to reduce psychosocial problems among in-school adolescents in Ghana.