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Bansema CH, Vermeiren RRJM, de Soet R, van Ewijk H, Nijland L, Nooteboom LA. A systematic review exploring characteristics of youth with severe and enduring mental health problems (SEMHP). Eur Child Adolesc Psychiatry 2024; 33:1313-1325. [PMID: 37093338 PMCID: PMC11098915 DOI: 10.1007/s00787-023-02216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/15/2023] [Indexed: 04/25/2023]
Abstract
A small group of youth and emerging adults deals with severe and enduring mental health problems (SEMHP). Current mental health care struggles to recognize and treat this group timely and adequately, leaving these youth between the cracks of the system. A first step to improve care for this group is to gain a deeper understanding of the characteristics of youth with SEMHP. Therefore, this study aimed at reviewing current literature about this target group and what is known so far about their characteristics. We included 39 studies with a focus on youth aged 12-25 years with SEMHP. After critical appraisal, a content analysis and in-depth thematic analysis were conducted. According to the included studies, youth with SEMHP were characterized by severe distress and recurrent comorbid mental health problems, with pervasive suicidality. Further, underlying trauma, family conflicts, peer rejection, deep feelings of hopelessness, and psychosocial malfunctioning characterized SEMHP. It was described that for youth with SEMHP a pervasive pattern of dysfunction in multiple domains is present leading to a detrimental impact. Subsequently, this pattern exerts a reciprocal influence on the mental health problems, causing a vicious circle further worsening SEMHP. Our findings emphasize the need for a holistic approach and to look beyond the traditional classification system in order to meet the needs of these youth with wide-ranging comorbid mental health problems.
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Affiliation(s)
- C H Bansema
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands.
| | - R R J M Vermeiren
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
- Youz, Parnassia Group, The Hague, The Netherlands
| | - R de Soet
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - H van Ewijk
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - L Nijland
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - L A Nooteboom
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
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Onay Z, Sidis A, Robinson L, Deane FP. Young people's pathways to a specialist suicide prevention service and the influence of caregiver prior suicidality and mental health treatment. Early Interv Psychiatry 2024. [PMID: 38356407 DOI: 10.1111/eip.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/13/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
AIM Timely help-seeking and pathways to care (PtC) have been linked to positive outcomes in suicidal adolescents. While the importance of formal contacts is recognized, caregivers also play a significant role in these pathways. Caregiver's familiarity with mental health issues may influence an adolescent's PtC. This study explores the relationship between a caregiver's prior suicidality and mental health treatment on their children's pathways to entering a specialist suicide prevention treatment program. METHOD Caregivers (n = 118, 35 males and 83 females) of young individuals (12-25 years) who were admitted into an outpatient suicide prevention service, completed a self-report questionnaire describing their child's onset of symptoms, help-seeking, PtC and the caregiver's prior suicidality and mental health treatment. RESULTS Parents were the source most likely to recognize the onset of suicidality, with general practitioners and psychologists the most common first contacts. Significant delays were identified for onset duration averaging 48.0 weeks, and it was observed that shorter delays in treatment were related to fewer number of contacts. Caregiver prior suicidality was associated with longer delays in treatment but had no relationship with onset duration. CONCLUSION Caregivers and professional contacts are vital agents in improving the PtC of suicidal adolescents. Results highlight the significant delays in treatment and the added complexity of a caregiver's prior experience of suicidality to these pathways. These complexities warrant further exploration to minimize obstacles that hinder help-seeking and lengthen PtC, as this may improve interventions and outcomes for suicidal adolescents and their caregivers.
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Affiliation(s)
- Zozan Onay
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anna Sidis
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Laura Robinson
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
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Zhu AY, Crawford MH. Risk factors associated with adolescent suicidality before and during the COVID-19 pandemic. Suicide Life Threat Behav 2023; 53:981-993. [PMID: 37650548 DOI: 10.1111/sltb.12997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/27/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To evaluate the impact of the coronavirus disease 2019 pandemic on youth suicidal behaviors. METHOD This study examined two national surveys of high school students, the 2019 Youth Risk Behavior Survey (YRBS) and the 2021 Adolescent Behaviors and Experiences Survey (ABES). RESULTS The YRBS 2019 had 13,677 entries: 18.6% (17.5-19.8) (weighted percentage and 95% confidence intervals [CIs]) of youth had suicidal ideation (SI) and 8.9% (7.9-10.0) had at least one suicide attempt (SA). The ABES 2021 had 7705 entries: 19.9% (18.0-22.0) of youth had SI and 9.0% (7.7-10.5) had SA. In ABES 2021, both the percentage of youth with SI or SA was highest at age 14, at 21.8% (16.9-27.8) and 10.0% (6.6-14.8), respectively. The top factors associated with both SI and SA were parental abuse, sexual violence, illicit drug use, misuse of prescription pain medicine, and being bullied electronically. Screen time ≥3 h per day (not including schoolwork) was associated with a lower risk of SA (odds ratio [OR] 0.553, 95% CI: 0.382-0.799), but not SI (OR 1.011, 0.760-1.344). CONCLUSIONS Earlier onset of adolescent suicidality, at age 14, was noted during the pandemic. The association of higher non-school work-related screen time with lower SA is unexpected and warrants validation.
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Affiliation(s)
- Allison Y Zhu
- The Lawrenceville School, Lawrenceville, New Jersey, USA
| | - Michael H Crawford
- University of California, San Francisco School of Medicine, San Francisco, California, USA
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Vélez-Grau C, McTernan M, Mufson L, Lindsey MA. The role of thwarted belongingness and perceived burdensomeness in passive suicide ideation among Latinx and Black youth. Suicide Life Threat Behav 2023. [PMID: 37720934 DOI: 10.1111/sltb.13003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/06/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION The interpersonal theory of suicide (IPTS) is used to evaluate suicide risk. Yet, it has not been sufficiently tested with ethnoracially minoritized youth. This study aimed to test whether thwarted belongingness (TB) and perceived burdensomeness (PB) were associated with passive suicide ideation (SI) among Latinx and Black youth. METHODS Data were obtained from a cross-sectional study. Some youth participants were recruited from an ongoing NIMH study of depressed Black youth in schools (N = 20). The rest were participants in a supplemental study of non-depressed Latinx and Black youth in community agencies (N = 61). Multivariate logistic regression analyses were conducted to examine the relationships between passive SI and the IPTS constructs. RESULTS Most participants identified as male (63.5%) and Latinx (59.5%), mean age 15.23 (SD = 1.4). Only TB remained significant when adjusting for age and gender, even after adding a measure of depression symptoms as a covariate. Notably, the interaction term (TBXPB) was not significantly associated with increased odds of passive SI in this sample. CONCLUSION These findings confirm the importance of examining the IPTS constructs and their relationship to passive SI in diverse populations. The relationship between TB and SI in Latinx and Black youth suggests it may be an important target for suicide prevention.
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Affiliation(s)
| | | | - Laura Mufson
- Department of Psychiatry, Columbia University, New York City, New York, USA
| | - Michael A Lindsey
- School of Social Work, New York University, New York City, New York, USA
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Buitron V, Jiménez-Colón G, Duarté-Vélez Y. Mental health services use and social support among Latinx families with adolescents who engage in suicidal behavior. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 8:194-205. [PMID: 37383484 PMCID: PMC10299760 DOI: 10.1080/23794925.2023.2183433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Latinx communities experience a significant child mental health disparity. Research is needed to examine mental health services use and social support in Latinx adolescents, with particular attention to acculturative factors and youth who have high levels of clinical severity. The current study examined whether acculturation and enculturation, and related proxies, are associated with prior history of services use and social support in Latinx families with adolescents who had a recent suicidal crisis. Participants were 110 youths, recently admitted to psychiatric hospitalization, ages 12 to 17 years and their caregivers. Results indicated that approximately 20% of the overall sample did not access any formal mental health services (e.g., outpatient mental health care, primary care support, school staff support) before high acuity hospital care. First generation status and higher caregiver enculturation were associated with a lower likelihood of formal mental health services use, even when controlling for clinical covariates. Adolescent preference for Spanish was associated with lower social support. Findings suggest that families with higher enculturation and first-generation immigrant families (both caregivers and youth born outside of the U.S.), in the context of severe clinical impairment, experience systemic and sociocultural barriers conducive to limited engagement with mental health support. Implications for improving the accessibility of mental health supports are reviewed.
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Affiliation(s)
| | - Gisela Jiménez-Colón
- Department of Psychiatry and Human Behavior, Emma Pendleton Bradley Hospital and Brown University, Coro West Suite 1.300, Box #36, 25 Hoppin St., Providence, RI 02903
| | - Yovanska Duarté-Vélez
- Department of Psychiatry and Human Behavior, Emma Pendleton Bradley Hospital and Brown University, Coro West Suite 1.300, Box #36, 25 Hoppin St., Providence, RI 02903
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Kohlbeck S, Armanious M, Pickett M. Assessing the Healthcare Utilization of Youth Who Died by Suicide: A Case-Control Study. Arch Suicide Res 2023; 27:80-88. [PMID: 34416132 DOI: 10.1080/13811118.2021.1967238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Suicide is the second leading cause of death in youth ten years old or older. Healthcare utilization prior to death by suicide is high in adults, but there is conflicting evidence in youth. The objective of this study was to compare healthcare utilization in youth who died by suicide to youth who died in a motor vehicle accident (MVC) to determine whether healthcare utilization is associated with death by suicide in youth. METHODS This retrospective case-control study used death records from Coroners/Medical Examiners (C/MEs) for children 11-17 years old who died by suicide (case) and MVC (control) between October 2013 and October 2018 were obtained. Data from the electronic medical record (EMR) at a healthcare system was reviewed. The primary outcome was healthcare utilization. Secondary outcomes included mental health diagnosis. Data was analyzed using Fisher's Exact Test and considered significant if p < 0.05. RESULTS The analysis included 60 youth who died by suicide and 14 youth who died by MVC. Most decedents were male (68%) and white (80%). Mean age at death was 16 years old. Only 25 decedents had a corresponding record in the EMR, with no significant difference based on manner of death (35% suicide vs 29% MVC, p = 0.8). Fourteen decedents had a known mental health diagnosis in their EMR with no difference based on manner of death (p = 0.5). CONCLUSIONS There was no difference in healthcare utilization or mental health diagnosis in youth who died by suicide compared to youth who died by MVC. Strict reliance on both of these factors when considering youth who may be at risk of suicide is inadequate. Expanding universal suicide screening to other settings, including schools or primary care, can help identify youth at risk for suicide and may prevent unnecessary deaths.HIGHLIGHTSLittle is known regarding the healthcare utilization of youth who died by suicide prior to their death.This study uses a case-control design to investigation healthcare utilization of youth who died by suicide versus youth who died in a motor vehicle crash.We did not find a significant difference in healthcare utilization between cases and controls. These findings suggest that non-clinical interventions would be useful in detecting suicide risk.
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Grunewald W, Ortiz SN, Kinkel-Ram SS, Smith AR. Longitudinal relationships between muscle dysmorphia symptoms and suicidal ideation. Suicide Life Threat Behav 2022; 52:683-695. [PMID: 35253940 DOI: 10.1111/sltb.12852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Muscle Dysmorphia (MD) is a severe subtype of body dysmorphic disorder (BDD) that shares symptomatic overlap with eating disorders. Although associations between eating disorders/BDD and suicidality are well documented, research has rarely examined associations between MD symptoms and suicidality, which is concerning given MD is associated with additional suicide risk factors compared with these disorders. Further, existing associations between MD symptoms and suicidality have yet to establish temporal ordering for these relationships. Therefore, the current study investigated longitudinal relationships between MD symptoms and suicidal ideation to establish the direction of the MD-suicidality relationship. METHODS Participants were 272 US men displaying sub-clinical MD symptoms who completed self-report measurement at three time points over 6 weeks. Longitudinal relationships between MD symptoms and suicidal ideation were examined using a three-wave autoregressive cross-lagged model. RESULTS Certain MD symptoms were longitudinally predicted by suicidal ideation. Specifically, suicidal ideation longitudinally predicted increased drive for size and appearance intolerance. CONCLUSIONS Results may suggest that individuals engage in MD symptoms potentially to cope with distressing thoughts of suicide. Clinicians should provide clients with comorbid MD and suicidality with appropriate coping tools to manage distress from suicidal thoughts outside of engaging in compulsive exercise characteristic of MD symptoms.
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Affiliation(s)
- William Grunewald
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio, USA
| | | | - April R Smith
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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Gillette C, Bodner G, Grant J, Aldrich R, Mospan C, Ip EHS, Daniel S, Crandall S. PAs' attitudes about adolescent suicide screening: The Theory of Planned Behavior. JAAPA 2021; 34:38-45. [PMID: 34608015 DOI: 10.1097/01.jaa.0000794968.09686.b3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Suicide is an increasing public health problem for adolescents and young adults. The purpose of this study was to identify the frequency of physician assistants' (PAs') self-reported adolescent suicide risk assessments and to elicit salient beliefs regarding behavioral attitudes, norm referents, control factors, and intention to conduct suicide risk assessment with adolescents. METHODS A convenience sample of PAs completed an anonymous cross-sectional questionnaire. Relationships were assessed using bivariate analyses and qualitative theme analysis. RESULTS Forty-three PAs completed the questionnaire. Many PAs supported suicide risk assessment screening as a strategy to identify adolescents who are suicidal at an earlier stage of their illness; lack of time during the visit and problematic parental involvement were identified as barriers. CONCLUSIONS PAs recognized that screening adolescents for suicide ideation may help prevent suicides. Their practice behaviors, however, did not correspond to this belief.
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Affiliation(s)
- Chris Gillette
- In the PA program at Wake Forest School of Medicine in Winston-Salem, N.C., Chris Gillette is an associate professor and assistant director of research and scholarship, Gayle Bodner is an assistant professor and director of clinical education, and Jill Grant is an assistant professor and director of the Office of Academic Excellence. Rosalie Aldrich is the John and Corinne Graf Professor in the Department of Communication Studies at Indiana University East in Richmond, Ind. Cortney Mospan is an assistant professor in the School of Pharmacy at Wingate (N.C.) University. Edward Hak-Sing Ip is a professor in the Department of Social Sciences and Health Policy at Wake Forest School of Medicine. Stephanie Daniel is a professor in the Department of Family Medicine at Wake Forest School of Medicine. Sonia Crandall is a professor and director of research and scholarship in the PA program at Wake Forest School of Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Borentain S, Nash AI, Dayal R, DiBernardo A. Patient-reported outcomes in major depressive disorder with suicidal ideation: a real-world data analysis using PatientsLikeMe platform. BMC Psychiatry 2020; 20:384. [PMID: 32703173 PMCID: PMC7376651 DOI: 10.1186/s12888-020-02758-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The current analysis utilized data collected via an online patient community platform, PatientsLikeMe (PLM) to compare patient-reported experiences in patients with major depressive disorder (MDD) with suicidal ideation (MDSI) to those with MDD but without suicidal ideation. METHODS PLM members who joined PLM between May-2007 and February-2018 and reported a diagnosis of MDD were included. The MDSI cohort included patients with MDD who reported at least one suicide-related symptom at a severity greater than "none". Demographics, comorbidities, symptoms, and side-effects were compared between MDSI and MDD cohorts. Factors correlated with suicidal ideation (SI) were determined by a random forest procedure. RESULTS Patients in the MDSI cohort (n = 266) were younger (median age, 36 vs 44 years) with an earlier disease onset (before 30 years, 83% vs 71%), and a longer diagnosis latency (median, 4 vs 2 years) vs patients in the MDD cohort (n = 11,963). Majority of patients were women in both cohorts (73% vs 83%). Median number of psychiatric comorbidities was higher in the MDSI cohort (4 vs 3). Unprompted symptoms (e.g., loneliness, feeling of hopelessness, social anxiety, impulsivity, and self-hating thoughts) were more frequent in the MDSI cohort. Hopelessness, loneliness, anhedonia, social anxiety, and younger age were highly correlated with suicidal ideation. CONCLUSIONS This analysis utilized patient-reported data to better understand symptoms, experiences, and characteristics of patients with MDSI compared to patients with MDD. The results identified various risk factors correlated with suicidal ideation that may help guide clinical judgement for patients with MDD who may not voluntarily report suicidal ideation.
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Affiliation(s)
| | - Abigail I. Nash
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, Titusville, NJ USA
| | - Rachna Dayal
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Titusville, NJ USA
| | - Allitia DiBernardo
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Titusville, NJ USA
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Kleiman EM. Suicidal thinking as a valuable clinical endpoint. EClinicalMedicine 2020; 23:100399. [PMID: 32566922 PMCID: PMC7298405 DOI: 10.1016/j.eclinm.2020.100399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/21/2022] Open
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Liu RT, Walsh RFL, Sheehan AE, Cheek SM, Carter SM. Suicidal Ideation and Behavior Among Sexual Minority and Heterosexual Youth: 1995-2017. Pediatrics 2020; 145:e20192221. [PMID: 32041813 PMCID: PMC7049944 DOI: 10.1542/peds.2019-2221] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In this study, we determined trends in prevalence of suicidal thoughts and behaviors among lesbian, gay, bisexual, and heterosexual youth from 1995 to 2017 using population-based surveillance data. METHODS Data were drawn from the Massachusetts Youth Risk Behavior Survey from 1995 to 2017 (unweighted N = 41 636). The annual percent change (APC) in prevalence of suicidal ideation, plans, and attempts was stratified by sexual orientation as indexed by sexual identity and sexual behavior. RESULTS Among sexual minority youth, prevalence rates declined over the entire study period for suicidal ideation (APCsexual identity = -1.25; APCsexual behavior = -1.83), plans (APCsexual identity = -1.88; APCsexual behavior = -1.95), and attempts (APCsexual identity = -2.64; APCsexual behavior = -2.47). Among heterosexual youth, prevalence rates declined from 1995 to 2007 for suicidal ideation (APCsexual identity = -6.67; APCsexual behavior = -6.77) and plans (APCsexual identity = -5.73; APCsexual behavior = -6.25). These declines in ideation and plans were steeper than those for sexual minority youth. Prevalence of suicide attempts declined across the entire study period among heterosexual youth (APCsexual identity = -3.66; APCsexual behavior = -4.01). Prevalence of all 3 outcomes remained markedly high among sexual minority youth across the 23-year study period. CONCLUSIONS Although suicidal thoughts and behavior have generally declined among sexual minority and heterosexual youth, disparities in these outcomes persist, and their prevalence among sexual minority youth has remained consistently elevated. Prioritized screening for risk for suicidal thoughts and behaviors in this vulnerable population is imperative to reduce disparities and prevalence of these outcomes.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island;
| | - Rachel F L Walsh
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Ana E Sheehan
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Shayna M Cheek
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina; and
| | - Sarina M Carter
- Department of Psychology, University of Massachusetts Amherst, Amherst, Massachusetts
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Increasing Recognition and Diagnosis of Adolescent Depression: Project RedDE: A Cluster Randomized Trial. Pediatr Qual Saf 2019; 4:e217. [PMID: 31745520 PMCID: PMC6805099 DOI: 10.1097/pq9.0000000000000217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/27/2019] [Indexed: 12/28/2022] Open
Abstract
Supplemental Digital Content is available in the text. Adolescent depression causes appreciable morbidity and is underdiagnosed in primary care. This study investigated whether a quality improvement collaborative (QIC) increases the frequency of adolescent depression diagnoses, thus reducing missed diagnoses.
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Porras-Segovia A, Pérez-Rodríguez MM, López-Esteban P, Courtet P, Barrigón M ML, López-Castromán J, Cervilla JA, Baca-García E. Contribution of sleep deprivation to suicidal behaviour: A systematic review. Sleep Med Rev 2019; 44:37-47. [DOI: 10.1016/j.smrv.2018.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 12/11/2022]
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General Practitioners' experience of child and adolescent suicidal ideation and behaviour - a survey. Ir J Psychol Med 2017; 34:89-97. [PMID: 30115212 DOI: 10.1017/ipm.2015.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES A major cause of death in Irish men aged 15-24 is suicide and the rates for those aged 15-19 are amongst the highest in Europe. Despite concerns over suicidal ideation or behaviour, little research has been done in the Irish primary care context. We therefore aimed to carry out a study of Irish General Practitioners (GPs)' experience regarding suicidal ideation or behaviour in children and adolescents. METHODS The study design was a descriptive, cross-sectional, questionnaire survey. We randomly selected 480 GPs and invited them to participate via post. RESULTS In total, 198 GPs replied, representing a response rate of 41% with a sampling error of ±6.8%. In total, 184 of respondents (93%) saw more than 50 children and adolescent patients annually, however, presentations of suicidal ideation and behaviour were relatively rare, with 36% reporting seeing none, 58% seeing between one and five and 6% seeing more than five such presentations annually. In total, 119 (62%) of GPs reported a willingness to prescribe antidepressants for this age group. In total, 66% of GPs felt this was either 'always' or 'usually' a difficult patient group to manage, and the single most commonly reported difficulty by GPs was access to services [n=48 (33%)]. CONCLUSIONS GPs reported that their management of children and adolescents with suicidal ideation or behaviour is often difficult. GPs play a key liaison role in the area of child and adolescent mental health, but our results indicate that GPs are also involved in the treatment of this patient group. However, ongoing education was not a priority according to GPs themselves.
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Kim TK, Lee SG, Han KT, Choi Y, Lee SY, Park EC. The association between perceived unmet medical need and mental health among the Republic of Korea Armed Forces. J ROY ARMY MED CORPS 2016; 163:184-192. [PMID: 27660285 DOI: 10.1136/jramc-2016-000625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/17/2016] [Accepted: 08/07/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We investigated the effect of unmet medical need on the mental health of Republic of Korea (ROK) Armed Forces personnel, as most of the service members work in remote areas and often experience such unmet needs. METHODS This study used secondary data from the 2014 Military Health Survey (MHS), conducted by the ROK School of Military Medicine and designed to collect military health determinants. Descriptive statistics showed the general characteristics of the study populations by variable. We specifically compared the population after stratifying participants by suicide ideation. An analysis of variance was also carried out to compare Kessler Psychological Distress Scale 10 Scores. Additionally, dependent spouses and children of both active-duty service members and retirees are included among those entitled to Military Health System healthcare. RESULTS Among the 4967 military personnel, 681 (13.7%) individuals reported an experience of unmet medical need within the past 12 months and gave reasons of 'no time (5.15%)', 'long office wait (2.6%)', 'no money (0.22%)', 'long distance from base (1.19%)', 'illness but not very serious (1.65%)', 'mistrust in doctors (1.95%)' and 'pressure due to performance appraisal (0.95%)'. Regression analysis revealed that unmet medical need was significantly associated with negative mental health (β=1.753, p<0.0001) and increased suicide ideation (OR=2.649, 95% CI 1.84 to 3.82). Also, soldiers reporting unmet medical need due to 'no money', 'no time' or 'pressure due to performance appraisal' were significantly more likely to experience similar negative mental health effects. CONCLUSIONS Our study indicates that unmet medical need is significantly associated with soldiers' mental health decline and suicide ideation, highlighting the importance of providing military personnel with timely, affordable and sufficient medical care.
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Affiliation(s)
- Tae Kyung Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - S G Lee
- Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - K-T Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Y Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - S Y Lee
- Department of Nursing, Seoul National University Hospital, Seoul, Republic of Korea
| | - E-C Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
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16
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Susanne Condron D, Garraza LG, Walrath CM, McKeon R, Goldston DB, Heilbron NS. Identifying and Referring Youths at Risk for Suicide Following Participation in School-Based Gatekeeper Training. Suicide Life Threat Behav 2015; 45:461-76. [PMID: 25442731 DOI: 10.1111/sltb.12142] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 09/12/2014] [Indexed: 11/27/2022]
Abstract
Gatekeeper training is a core strategy of the Garrett Lee Smith Memorial Suicide Prevention Act of 2004. Using data gathered from school-based gatekeeper trainings implemented by GLS grantees, this analysis examines training and gatekeeper factors associated with (1) identification and referral patterns and (2) services at-risk youths receive. Time spent interacting with youths was positively correlated with the number of gatekeeper identifications and knowledge about service receipt. Gatekeepers who participated in longer trainings identified proportionately more at-risk youths than participants in shorter trainings. Most gatekeeper trainees referred the identified youths to services regardless of training type.
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Affiliation(s)
| | | | | | - Richard McKeon
- Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
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17
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18
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Breland DJ, McCarty CA, Zhou C, McCauley E, Rockhill C, Katon W, Richardson LP. Determinants of mental health service use among depressed adolescents. Gen Hosp Psychiatry 2014; 36:296-301. [PMID: 24417955 PMCID: PMC4517666 DOI: 10.1016/j.genhosppsych.2013.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Evaluate determinants of mental health service use among depressed adolescents. METHOD We assessed mental health services use over the 12 months following screening among 113 adolescents (34 males, 79 females) from an integrated healthcare system who screened positive for depression (Patient Health Questionnaire-9 score ≥11). Youth characteristics (demographics, depression severity, and co-morbidity) and parent characteristics (parent history of depression, parent-report of youth externalizing and internalizing problems) were compared among youth who had received mental health services and those who had not. Multivariate regression was used to evaluate the strongest factors associated with mental health service use. RESULTS Overall, 52% of adolescents who screened positive for depression received mental health service in the year following screening. Higher parent-reported youth internalizing problems (OR 5.37, CI 1.77-16.35), parental history of depression/anxiety (OR 4.12, CI 1.36-12.48) were significant factors associated with mental health service use. Suicidality and functional impairment were not associated with increased mental health services use. CONCLUSION Parental factors including recognition of the adolescent's internalizing symptoms and parental experience with depression/anxiety are strongly associated with mental health service use for depressed adolescents. This highlights the importance of educating parents about depression and developing systems to actively screen and engage youth in treatment for depression.
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Affiliation(s)
- David J. Breland
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Carolyn A. McCarty
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Elizabeth McCauley
- Seattle Children’s Hospital,Psychiatry and Behavioral Medicine, University of Washington School of Medicine
| | - Carol Rockhill
- Seattle Children’s Hospital,Psychiatry and Behavioral Medicine, University of Washington School of Medicine
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences; UW School of Medicine
| | - Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
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19
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Pisani AR, Schmeelk-Cone K, Gunzler D, Petrova M, Goldston DB, Tu X, Wyman PA. Associations between suicidal high school students' help-seeking and their attitudes and perceptions of social environment. J Youth Adolesc 2012; 41:1312-24. [PMID: 22562217 PMCID: PMC3534737 DOI: 10.1007/s10964-012-9766-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 04/07/2012] [Indexed: 10/28/2022]
Abstract
Suicide is a leading cause of death among adolescents, many of whom fail to disclose suicide concerns to adults who might help. This study examined patterns and predictors of help-seeking behavior among adolescents who seriously considered suicide in the past year. 2,737 students (50.9 % female, 46.9 % male; racial distribution 79.5 % Caucasian, 11.9 % Hispanic/Latino, and 3.6 % Black/African-American) from 12 high schools in rural/underserviced communities were surveyed to assess serious suicide ideation (SI) in the past year, disclosure of SI to adults and peers, attempts to get help, attitudes about help-seeking, perceptions of school engagement, and coping support. Help-seeking was defined as both disclosing SI to an adult and perceiving oneself as seeking help. The relationship between adolescents' help-seeking disclosure and (1) help-seeking attitudes and (2) perceptions of social resources was examined among suicidal help-seeking youth, suicidal non-help-seeking youth, and non-suicidal youth. Of the 381 (14 %) students reporting SI, only 23 % told an adult, 29 % sought adult help, and 15 % did both. Suicidal help-seekers were similar to non-suicidal peers on all measures of help-seeking attitudes and social environment perceptions. Positive attitudes about help-seeking from adults at school, perceptions that adults would respond to suicide concerns, willingness to overcome peer secrecy requests, and greater coping support and engagement with the school were associated with students' increased disclosure of SI and help-seeking. This study supports prevention strategies that change student norms, attitudes and social environments to promote help-seeking among adolescents with SI. Promising intervention targets include increasing students' perceptions of the availability and capability of adults to help them, and strengthening students' understanding of how existing resources can help them cope.
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Affiliation(s)
- Anthony R Pisani
- Department of Psychiatry, University of Rochester, Rochester, NY 14623, USA.
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20
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Rushton J. Pediatric mental health services: complex problems demand comprehensive solutions. Acad Pediatr 2011; 11:353-4. [PMID: 21903088 DOI: 10.1016/j.acap.2011.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 07/25/2011] [Indexed: 12/01/2022]
Affiliation(s)
- Jerry Rushton
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.
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