Suicidal ideation in adolescents and young adults in Greece: prevalence and association with sociodemographic variables, mental health and substance use

Associations between sleep complaints, suicidal ideation and depressive symptoms among adolescents and young adults in Greece

Depression prevalence increases significantly during adolescence/early adulthood. Depression in youth may present suicidal ideation, while suicide represents the leading cause of death in this age group. Moreover, adolescents/young adults frequently report sleep complaints that may partially be due to depressive symptoms. Studies on the associations between depression, sleep complaints and suicidality in this age group are limited. We aimed to examine associations between depressive symptoms, sleep complaints and suicidal ideation in a large (n = 2771), representative sample of adolescents (age: 15-17 years, n = 512) and young adults (age: 18-24 years, n = 2259) from the general population in Greece. A telephone structured questionnaire was administered. Depressive symptoms were assessed using the modified Patient Health-7 questionnaire score, while presence of suicidal ideation and sleep complaints were assessed using the ninth and third question of Patient Health-9 questionnaire, respectively. Mediation logistic regression analysis revealed significant direct paths from depressive symptoms to sleep complaints (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.19-1.24; OR 1.21, 95% CI 1.18-1.24) and suicidal ideation (OR 1.18, 95% CI 1.14-1.22; OR 1.18, 95% CI 1.14-1.22), as well as sleep complaints and suicidal ideation (OR 1.82, 95% CI 1.32-2.50; OR 1.91, 95% CI 1.33-2.76) in the total group and in young adults, respectively, but not among adolescents. Moreover, we detected a significant indirect effect of depressive symptoms on suicidal ideation mediated by sleep complaints (18.8%) in young adults. These findings support the hypothesis that treatment of sleep disturbances among youth with depression may independently further reduce suicidal risk.

Suizide im Kindes- und Jugendalter

Hintergrund

Suizide stellen in Westeuropa nach Verkehrsunfällen den zweit- oder drittgrößten Anteil an Todesfällen von Kindern, Jugendlichen und Heranwachsenden dar und sind eine extreme Belastung für die Hinterbliebenen.

Methodik

In der anonymisierten Datenanalyse wurden nichtnatürliche Todesfälle von Kindern, Jugendlichen und Heranwachsenden im Einzugsgebiet des Instituts für Rechtsmedizin Leipzig, Sachsen, im Zeitraum 1998–2017 analysiert. Suizide wurden auf die Häufigkeit bezüglich des Geschlechts und der Methode hin untersucht und ihr Zusammenhang mit Alkohol- oder Drogenkonsum und psychiatrischen Erkrankungen dargestellt.

Ergebnisse

Es zeigten sich signifikant mehr männliche als weibliche Suizidenten (p < 0,05). Keiner von ihnen war jünger als 12 Jahre. Als häufigste Suizidmethode erwies sich der Bahnsuizid (27 %), gefolgt von Sturz aus großer Höhe (22 %), Intoxikation (21 %) und Erhängen (12 %). Es zeigte sich ein signifikanter Zusammenhang zwischen Suiziden und positiven toxikologischen Befunden (X2 = 27,16; p < 0,001), und es konnten Hinweise auf psychiatrische Erkrankungen bei Suizidenten herausgearbeitet werden.

Schlussfolgerungen

Substanzmissbrauch und psychiatrische Erkrankungen sind mit Suiziden bei Kindern, Jugendlichen und Heranwachsenden assoziiert. Eine besondere Bedeutung wird in diesem Kontext psychiatrischen Erkrankungen beigemessen, da diese das Suizidrisiko stark erhöhen können. Eine große Rolle in der Suizidprävention spielt das soziale Umfeld. Dieses kann durch rechtzeitiges Erkennen möglicher Vorzeichen – beispielsweise Veränderung des Verhaltens, Verletzungen oder Substanzkonsum – entscheidend aktiv werden.

Resting-State Functional Magnetic Resonance Image to Analyze Electrical Biological Characteristics of Major Depressive Disorder Patients with Suicide Ideation

The study was aimed to explore the brain imaging characteristics of major depressive disorder (MDD) patients with suicide ideation (SI) through resting-state functional magnetic resonance imaging (rs-fMRI) and to investigate the potential neurobiological role in the occurrence of SI. 50 MDD patients were selected as the experimental group and 50 healthy people as the control group. The brain images of the patients were obtained by MRI. Extraction of EEG biological features was from rs-fMRI images. Since MRI images were disturbed by noise, the initial clustering center of FCM was determined by particle swarm optimization algorithm so that the noise of the collected images was cleared by adaptive median filtering. Then, the image images were processed by the optimized model. The correlation between brain mALFF and clinical characteristics was analyzed. It was found that the segmentation model based on the FCM algorithm could effectively eliminate the noise points in the image; that the zALFF values of the right superior temporal gyrus (R-STG), left middle occipital gyrus (L-MOG), and left middle temporal gyrus (L-MTG) in the observation group were significantly higher than those in the control group (P < 0.05); and that the average zALFF values of left thalamus (L-THA) and left middle frontal gyrus (L-MFG) decreased. The mean zALFF values of L-MFG and L-SFG demonstrated good identification value for SI in MDD patients. In summary, MRI images based on FCM had a good convergence rate, and electrical biological characteristics of brain regions were abnormal in MDD patients with SI, which can be applied to the diagnosis and treatment of patients with depression in clinical practice.

How Loneliness Worked on Suicidal Ideation among Chinese Nursing Home Residents: Roles of Depressive Symptoms and Resilience

Suicide in later life is becoming severe under rapid population aging, especially for nursing home residents. Loneliness, an increasingly represented issue among nursing home residents, is found to be a risk factor for depressive symptoms. Both loneliness and depressive symptoms may contribute to the development of suicidal ideation. According to the Protective Factor Model, resilience can act as a moderating role interacting with risk factors to buffer the negative effects on the outcome. The present study aimed to assess the mediating role of depressive symptoms and the moderating effect of resilience on the risk factors of suicidal ideation to attenuate the adverse contribution among nursing home residents. A total of 538 nursing home residents participated in this cross-sectional study, and their suicidal ideation, resilience, loneliness, and depressive symptoms were measured. The mediating effect and moderated mediation model were tested using the Macro Process of SPSS 21.0. Statistics showed that 19.7% of participants had suicidal ideation. The mediating model (H1: B = 0.477, p < 0.001; H2: B = 0.325, p < 0.001; H3: B = 0.308, p < 0.001) and the moderating effect of resilience interacting loneliness (H4: B = −0.133, p < 0.001; H6: B = −0.109, p < 0.001) and depressive symptoms (H5: B = −0.077, p < 0.001) were statistically significant. The findings indicated the protective effect of resilience in alleviating the negative influence of risk factors for suicidal ideation, suggesting that positive psychological interventions for resilience building might be effective in suicide prevention among nursing home residents.