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Yavuz BE, Turan S, Mutlu C, Çamlı ŞE. A comparison of the social cognition and neurocognitive characteristics of adolescents with suicide behavior, adolescent with depression and healthy controls. Suicide Life Threat Behav 2024; 54:785-797. [PMID: 38738815 DOI: 10.1111/sltb.13090] [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: 01/15/2024] [Revised: 03/31/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Deficits in neurocognition and social-cognition have been suggested to be an endophenotype for suicidal behavior. We aimed to compare the social-cognition and neurocognitive characteristics of adolescents diagnosed with depression with and without suicidal behavior and to investigate whether these functions predict suicide. METHOD Adolescents diagnosed with Major Depressive Disorder (MDD) with suicidal behavior (n = 42); MDD without suicidal behavior (n = 44) and age- and sex-matched controls (n = 43) were included. The University of Pennsylvania Computerized Neurobehavioral Test Battery and Autism Spectrum Screening Questionnaire (ASSQ) were used to evaluate social-cognition and neurocognitive characteristics. RESULTS Several neurocognitive domain values of MDD groups, were significantly different from the control group. Neutral emotion recognition task (p = 0.025) and ASSQ scores were found to be significantly impaired in the patient groups (p < 0.001). Logistic regression analysis showed that, only the increase in the Suicide Probability Scale score was found to be significant as a risk factor predicting suicide (p = 0.007, OR: 1.246). CONCLUSION While the neurocognitive and social-cognitive performances of adolescents with MDD were significantly lower than the control group, these performances in the two depression groups were similar. When the predictors of suicidal behavior were examined, it was found that only the increase in suicidal ideation scores predicted suicide.
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Affiliation(s)
- B Ece Yavuz
- Department of Child and Adolescent Psychiatry, TC Sağlık Bakanlığı Cizre Dr. Selahattin Cizrelioğlu Devlet Hastanesi, Şırnak, Turkey
| | - Serkan Turan
- Department ofChild and Adolescent Psychiatry, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Caner Mutlu
- Department ofChild and Adolescent Psychiatry, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Şafak Eray Çamlı
- Department ofChild and Adolescent Psychiatry, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
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2
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Yang C, Huebner ES, Tian L. Longitudinal associations among basic psychological need satisfaction at school, self-esteem, and suicidal ideation from middle childhood to early adolescence: Disentangling between‑ and within‑person associations. J Adolesc 2024. [PMID: 38922699 DOI: 10.1002/jad.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION The current study aimed to examine the longitudinal associations among basic psychological need satisfaction at school (BPNSS), self-esteem, and suicidal ideation (SI), including whether self-esteem functioned as a mediator of the relations between BPNSS and SI at the within-person level after disentangling between- and within-person associations encompassing middle childhood to early adolescence. METHODS A total of 650 Chinese students (53.54% boys, Mage = 9.95, SD = 0.75 at Time 1) completed measures on four occasions across 1.5 years, using 6-month intervals. Random intercept cross-lagged panel models were applied to disaggregate between- and within-person effects, thus providing greater confidence in elucidating the causal relations among study variables. RESULTS The results showed that at the within-person level: (a) BPNSS negatively predicted SI; (b) BPNSS positively predicted self-esteem; (c) Self-esteem negatively predicted SI; and (d) BPNSS indirectly predicted SI via self-esteem. CONCLUSION These findings advanced the literature by demonstrating longitudinal associations among BPNSS, self-esteem, and SI at the within-person level, and highlighting the significance of distinguishing between- and within-person effects in developing prevention and intervention programs aimed at reducing SI over time from middle childhood to early adolescence.
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Affiliation(s)
- Chi Yang
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou, P.R. China
- School of Psychology, South China Normal University, Guangzhou, P.R. China
| | - E Scott Huebner
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Lili Tian
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou, P.R. China
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Glenn CR, Kalgren T, Dutta S, Kandlur R, Allison KK, Duan A, Eskin CK, Leets M, Gould MS. Evaluating the Experience of Teen-to-Teen Crisis Line Volunteers: A Pilot Study. Community Ment Health J 2024:10.1007/s10597-024-01298-z. [PMID: 38833081 DOI: 10.1007/s10597-024-01298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
Teen-to-teen (t2t) crisis lines are a special type of crisis service where youth volunteers help their peers. Although prior research has examined the experience of adult crisis line responders, no research has examined the experience of adolescents who do this work. In collaboration with two of the largest t2t lines in the U.S., this pilot study is the first examination of t2t crisis line work. Volunteers (ages 14-20) reported: their primary motivation for joining the crisis lines was to help others and give back to the community; responding to a range of peers' problems on the t2t crisis line, including high-risk suicide contacts; and a range of ways the crisis line work impacted their lives. Findings provide preliminary information about the experience of adolescents engaging in t2t crisis line work. Additional research is needed in larger and more diverse samples to understand the impact of crisis line work for youth.
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Affiliation(s)
- Catherine R Glenn
- Old Dominion University, Norfolk, VA, USA.
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA.
| | | | | | - Raksha Kandlur
- Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | | | - Annie Duan
- University of Rochester, Rochester, NY, USA
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Esposito EC, Ellerkamp H, Eisenberg AM, Handley ED, Glenn CR. Suicide Ideation Among Transgender and Gender Diverse Adolescents: The Role of Parental Invalidation of Adolescents' Gender Identity. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01203-y. [PMID: 38767739 DOI: 10.1007/s10802-024-01203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/22/2024]
Abstract
Transgender and gender diverse (TGD) youth experience chronic and acute stress associated with their gender identity contributing to their increased risk of suicide and suicide ideation (SI) compared to non-TGD peers. This study examined how invalidating and accepting gender-related experiences with a parent impact SI severity among TGD adolescents cross-sectionally and longitudinally, within-person. Participants were 15 TGD adolescents with past month SI recruited across community and clinical settings. Adolescents completed a baseline assessment of validated interviews and self-report measures on parental invalidation and SI severity. Over a 14-day follow-up period, adolescents reported instances of parental gender invalidation and acceptance, relative stress of those experiences, and SI severity multiple times/day via ecological momentary assessment (EMA). Bivariate associations of parental invalidation and acceptance with SI were examined at baseline, while multilevel models examined the relationship within-person over follow-up. Cross-sectionally, greater perceived invalidation and non-affirmation by their parents was associated with more severe SI. Over the follow up, instances of perceived parental invalidation were associated with passive SI within-person. Findings partially support the minority stress theory and social safety perspective by showing that perceived gender-invalidation from parents affects SI in TGD adolescents, both cross-sectionally and longitudinally. Further research is needed to identify specific emotional and cognitive factors, such as perceived stress, that contribute to the risk of SI among TGD youth and inform the development of targeted interventions for this vulnerable population.
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Affiliation(s)
- Erika C Esposito
- Department of Psychology, Mt. Hope Family Center, University of Rochester, 355 Meliora Hall, Box 270266, Rochester, NY, 14627, USA.
| | - Hannah Ellerkamp
- Northwell Health Physician Partners LGBTQ Transgender Program, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, Hempstead, USA
| | - Alana M Eisenberg
- Department of Psychology, Mt. Hope Family Center, University of Rochester, 355 Meliora Hall, Box 270266, Rochester, NY, 14627, USA
| | - Elizabeth D Handley
- Department of Psychology, Mt. Hope Family Center, University of Rochester, 355 Meliora Hall, Box 270266, Rochester, NY, 14627, USA
| | - Catherine R Glenn
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
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Fan XF, Peng JY, Zhang L, Hu YL, Li Y, Shi Y, Zhang TM. The impact of mindfulness therapy combined with mentalization-based family therapy on suicidal ideation in adolescents with depressive disorder: randomized intervention study. Ann Gen Psychiatry 2024; 23:16. [PMID: 38720347 PMCID: PMC11080205 DOI: 10.1186/s12991-024-00503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Adolescents with depression who engage in non-suicidal self harming behaviors are more likely to adopt negative coping strategies when faced with negative events. Therefore, these patients should be introduced to positive coping strategies. Evidences have showed that mindfulness-based interventions can positively impact the psychology of patients with mental disorders. This study was to explore the impact of a combination of mindfulness therapy and mentalization-based family therapy (MBFT) on suicidal ideation in adolescents with depressive disorder. METHODS Eighty adolescent patients with depression and suicidal ideation admitted to our hospital from September 2021 to February 2022 were selected as subjects. They were divided into a control group and a study group using the random number table method, with each group comprising 40 subjects. The control group received MBFT, whereas the study group received both mindfulness therapy and MBFT. The psychological status and suicidal ideations of the two groups were compared before and after the intervention. RESULTS The psychological health scores of both groups of patients were lower after the intervention, with the scores of the study group being lower than those of the control group (P < 0.05). The scores on the suicidal ideation scales for both groups were lower after intervention, and the study group scored lower than the control group (P < 0.05). The absolute values of the differences in psychological health scale scores and suicidal ideation scale scores before and after the intervention were higher in the study group than in the control group (P < 0.05). CONCLUSION The combination of mindfulness therapy and MBFT can improve the psychological condition of adolescents with depression, reduce their suicidal ideations, and help them develop a healthy and positive outlook toward life, making this method worthy of clinical recommendation.
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Affiliation(s)
- Xiao-Fen Fan
- Department of Mental Health, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Ju-Yi Peng
- Department of Mental Health, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, China.
| | - Li Zhang
- Department of Mental Health, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Ya-Li Hu
- Department of Mental Health, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Yan Li
- Department of Mental Health, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Yue Shi
- Department of Mental Health, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Tian-Mei Zhang
- Department of Mental Health, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, China
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Yang C, Huebner ES, Tian L. Prediction of suicidal ideation among preadolescent children with machine learning models: A longitudinal study. J Affect Disord 2024; 352:403-409. [PMID: 38387673 DOI: 10.1016/j.jad.2024.02.070] [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: 08/19/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Machine learning (ML) has been widely used to predict suicidal ideation (SI) in adolescents and adults. Nevertheless, studies of accurate and efficient models of SI prediction with preadolescent children are still needed because SI is surprisingly prevalent during the transition into adolescence. This study aimed to explore the potential of ML models to predict SI among preadolescent children. METHODS A total of 4691 Chinese children (54.89 % boys, Mage = 10.92 at baseline) and their parents completed relevant measures at baseline and the children provided 6-month follow-up data for SI. The current study compared four ML models: Random Forest (RF), Decision Tree (DT), Support Vector Machine (SVM), and Multilayer Perceptron (MLP), to predict SI and to identify variables with predictive value based on the best-performing model among Chinese preadolescent children. RESULTS The RF model achieved the highest discriminant performance with an AUC of 0.92, accuracy of 0.93 (balanced accuracy = 0.88). The factors of internalizing problems, externalizing problems, neuroticism, childhood maltreatment, and subjective well-being in school demonstrated the highest values in predicting SI. CONCLUSION The findings of this study suggested that ML models based on the observation and assessment of children's general characteristics and experiences in everyday life can serve as convenient screening and evaluation tools for suicide risk assessment among Chinese preadolescent children. The findings also provide insights for early intervention.
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Affiliation(s)
- Chi Yang
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents, South China Normal University, Ministry of Education, Guangzhou 510631, People's Republic of China; School of Psychology, South China Normal University, Guangzhou 510631, People's Republic of China
| | - E Scott Huebner
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Lili Tian
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents, South China Normal University, Ministry of Education, Guangzhou 510631, People's Republic of China.
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Lévy-Bencheton J, Chaste P, Sansen M. Link between neurodevelopmental disorders and suicidal risk in children. L'ENCEPHALE 2024:S0013-7006(24)00042-3. [PMID: 38523026 DOI: 10.1016/j.encep.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Suicide represents a significant public health issue among children and adolescents. However, in this population, while the literature seems to support a link between suicidal risk and neurodevelopmental disorders, there are still few studies on the subject. The psychopathological description of children who have realized a suicide attempt with a high potential for lethality, which can be defined as "serious", appears to resemble that of children who have died by suicide. This study aimed to characterize the dimensional aspects of the neurodevelopmental profile of a population of children and adolescents hospitalized at Necker-Enfants-Malades Hospital for a serious suicide attempt. METHODS This is an observational, prospective, and single-center study. Questionnaires for collecting general information and dimensional scales of neurodevelopment (Autism-Tics, ADHD, and Other Comorbidities Inventory, Social Responsiveness Scale, and Conners-3 for parents) were used. This study included 21 patients aged 9 to 15 years at the time of their hospitalization. RESULTS The results supported the presence of at least one neurodevelopmental disorder (autistic traits, attention-deficit/hyperactivity disorder, learning disorder, or motor disorder) in 70% (n=14) of the subjects, and at least one behavioral disorder (oppositional defiant disorder, conduct disorder) in 65% (n=13) of these subjects. CONCLUSION The observed frequency of traits indicative of neurodevelopmental disorders in our population was higher than that observed in the general population, without the presented symptoms being eligible for categorical diagnosis. Considering the dimensional aspects of neurodevelopmental symptoms would therefore enable better identification of children at suicidal risk and more tailored interventions to contribute to the prevention of suicide in children.
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Affiliation(s)
- Julie Lévy-Bencheton
- Child psychiatry department, Necker-Enfants-Malades Hospital, 75015 Paris, France.
| | - Pauline Chaste
- Child psychiatry department, Necker-Enfants-Malades Hospital, 75015 Paris, France
| | - Mélisande Sansen
- Child psychiatry department, Necker-Enfants-Malades Hospital, 75015 Paris, France
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Levy T, Kil H, Schachar RJ, Itzhaky L, Andrade BF. Suicidality risk in children and adolescents with externalizing disorders: symptoms profiles at high risk and the moderating role of dysregulated family relationships. Eur Child Adolesc Psychiatry 2024; 33:811-820. [PMID: 37043094 DOI: 10.1007/s00787-023-02190-z] [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: 12/10/2022] [Accepted: 03/08/2023] [Indexed: 04/13/2023]
Abstract
Children and adolescents with externalizing disorders are at risk for suicidal ideation or behavior. Factors that put them at risk could be symptoms related or facilitated by their environment. We evaluated the links of symptoms profiles with suicidality, and the effects of family relationship characteristics on these links. Latent profile analysis was used to subgroup participants referred for ADHD assessment (n = 1249, aged 6-17) based on their externalizing and internalizing symptoms. Self- and parent-reported child suicidal ideation (S-SI, P-SI), and parent-reported self-harm behavior (P-SHB) were compared across profiles. The moderating effects of parent-reported marital conflict and parenting practices were examined. A four-profile model showed optimal fit. Participants of the Low Symptoms profile followed by the Inattentive-Hyperactive/Impulsive profile showed lower P-SI compared to those of the Irritable-Defiant and the Conduct Problems profiles. Low Symptoms participants also reported lower S-SI compared to those of the Inattentive-Hyperactive/Impulsive and the Irritable-Defiant profiles. Participants of the Irritable-Defiant and the Conduct Problems profiles had higher P-SHB compared to the Low Symptoms and the Inattentive-Hyperactive/Impulsive participants. Dysregulated marital conflict practices were associated with greater increase in P-SI in all profiles compared to the Low Symptoms profile. Aggressive marital conflict practices were associated with increased P-SHB in the Conduct Problems profile compared to the Inattentive-Hyperactive/Impulsive profile. Children and adolescents with irritability and defiance symptoms with or without conduct problems show higher risk for suicidal ideation and behavior compared to those with ADHD symptoms alone. Dysregulated and aggressive marital conflict practices might pose additional suicidality risk in children and adolescents with disruptive behavior.
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Affiliation(s)
- Tomer Levy
- Behavior Regulation Service, Geha Mental Health Center, 1 Helsinki St., 49100, Petah-Tikva, Israel.
- Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel.
| | - Hali Kil
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Russell James Schachar
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Liat Itzhaky
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Brendan F Andrade
- McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Pears KC, Tiberio SS, Kim HK. Reducing Suicidal Ideation in Preadolescents With a History of Foster Care by Promoting School Readiness in Early Childhood. CHILD MALTREATMENT 2024; 29:165-175. [PMID: 35835729 DOI: 10.1177/10775595221115209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Preadolescents with a history of foster care placement report suicidal ideation (SI) at higher rates than their peers, which increases their risk for suicide attempts in adolescence. Despite these increased risks, few interventions have been shown to reduce SI in these youth. This study examined the main and mediated long-term effects of a program to increase school readiness in children in foster care at age 5 years on SI when the children were ages 9-11 years, 4-6 years after the intervention ended. Children who received the intervention were less likely to report SI, although the difference did not reach statistical significance. The intervention reduced SI indirectly through its positive effect on children's self-esteem at age 9 years. Implications for programming to reduce SI and subsequent suicide attempts in youth with a history of foster care are discussed.
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Affiliation(s)
- Katherine C Pears
- Oregon Social Learning Center, Eugene, OR, USA
- OSLC Developments, Inc, Eugene, OR, USA
| | | | - Hyoun K Kim
- Department of Child & Family Studies, Yonsei University, Seodaemun-gu, Korea
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Zhang N, Smith IC, Ginsburg G. Do Self-Processes and Parenting Mediate the Effects of Anxious Parents' Psychopathology on Youth Depression and Suicidality? Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01657-z. [PMID: 38206536 DOI: 10.1007/s10578-023-01657-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
To understand how anxious parents' global psychopathology increases children's risks for depression and suicidality, we tested mediational pathways through which parent global psychopathology was associated with youth depression and suicidality over a six-year period. Parents (n = 136) who had an anxiety disorder at baseline reported global psychopathology and youth internalizing problems. Youth did not have any psychiatric disorder at baseline and they reported self-esteem, perceived control, and perceived parental warmth and rejection at baseline and 1-year follow-up. At 6-year follow-up, youth depression and suicidality were assessed via multiple reporters including the self, parent, and/or an independent evaluator. Results showed that parental psychopathology had an indirect but not direct effect on youth depression and suicidality via perceived control. No associations were found for the other hypothesized mediators. Perceived control might be a transdiagnostic intervention target in depression and suicide prevention programs for youth exposed to parental anxiety.
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Affiliation(s)
- Na Zhang
- Department of Human Development and Family Sciences, University of Connecticut, 1 University Place, Stamford, CT, 06901, USA.
| | - Isaac C Smith
- Hartford Hospital, Institute of Living, Hartford, CT, USA
- University of Vermont Medical Center, Burlington, VT, USA
| | - Golda Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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Gregersen M, Møllegaard Jepsen JR, Marie Brandt J, Søndergaard A, Birkehøj Rohd S, Veddum L, Bruun Knudsen C, Krogh Andreassen A, Klee Burton B, Hjorthøj C, Falkenberg Krantz M, Neergaard Greve A, Bliksted V, Mors O, Nordentoft M, Elgaard Thorup AA, Hemager N. Suicidal Ideation and Non-Suicidal Self-Injury Following Early Childhood Psychotic Experiences in Preadolescent Children at Familial High Risk of Schizophrenia or Bipolar Disorder-The Danish High Risk and Resilience Study, VIA 11. Schizophr Bull 2023; 49:1602-1613. [PMID: 37171862 PMCID: PMC10686355 DOI: 10.1093/schbul/sbad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND HYPOTHESIS Suicide is a leading cause of death in youth and is often preceded by suicidal ideation (SI) and non-suicidal self-injury (NSSI). Identifying early markers of risk for SI and NSSI could improve timely identification of at-risk individuals. STUDY DESIGN Children (mean age 11.9, SD 0.2) at familial high risk of schizophrenia (N = 171), or bipolar disorder (N = 104), and controls (N = 174) were assessed for psychotic experiences (PE), SI, NSSI, and Axis I mental disorders in face-to-face interviews in early and middle childhood (age 7 and 11). STUDY RESULTS Having 2 types of early childhood PE predicted middle childhood SI after accounting for previous SI, NSSI, and mental disorders (OR 2.8, 95% CI 1.1-6.9; P = .03). Two PE predicted NSSI (OR 3.0, 95% CI 1.2-7.7; P = .02) in excess of previous SI, NSSI, mental disorders, and familial risk. Persistent and incident PE predicted SI (OR 3.2, 95% CI, 1.1-8.8; P = .03; OR 3.8, 95% CI, 1.3-11.5; P = .02) in the fully adjusted model. Nineteen percent of children with persistent PE reported middle childhood SI vs 3.8% of those who never reported PE. In children with early childhood mental disorders, those who reported 2 PE had 4.4-fold increased odds of later SI (95% CI, 1.2-16.7; P = .03) after adjustments. PE were nondifferentially associated with outcomes across familial risk groups. CONCLUSIONS Early childhood PE index elevated risk for subsequent SI and NSSI beyond what can be attributed to presence of mental disorders. Mental health screenings and clinical assessments should include early childhood PE.
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Affiliation(s)
- Maja Gregersen
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Jens Richardt Møllegaard Jepsen
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Julie Marie Brandt
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Søndergaard
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sinnika Birkehøj Rohd
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Lotte Veddum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Christina Bruun Knudsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Anna Krogh Andreassen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark
| | - Carsten Hjorthøj
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Mette Falkenberg Krantz
- Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Aja Neergaard Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Vibeke Bliksted
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark
| | - Merete Nordentoft
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicoline Hemager
- CORE – Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
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12
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Chen Q, Armstrong SE, Vakil F, Bridge JA, Keilp JG, Sheftall AH. Neurocognitive and clinical characteristics of elementary school-aged children with a history of suicidal thoughts and behaviors. J Affect Disord 2023; 339:318-324. [PMID: 37442443 PMCID: PMC10530242 DOI: 10.1016/j.jad.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/16/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Suicidal thoughts and behaviors (STBs) in elementary school-aged youth have increased in recent years. Understanding the risks associated with childhood STBs is necessary for prevention efforts. METHODS The current study examined clinical and neurocognitive characteristics of a community sample of elementary school-aged children with (STB+) and without (STB-) a history of STBs. The final sample included 93 families with children average age of 7.8 years (SD = 1.3). Children in this sample were racially diverse, evenly split by sex, and most identified as non-Hispanic. Neurocognitive functioning was assessed using computerized behavioral measures. Child clinical characteristics were assessed using self-report measures and STB history was assessed using semi-structured interviews. RESULTS Of the 93 families, 64 STB- children and 29 STB+ children participated. On average, STB+ children were older, reported higher levels of depressive and anxiety symptoms, and were more likely to have a parental history of suicidal behavior (PH+). Regarding neurocognitive functioning, STB+ children exhibited lower raw scores for both the NIH Dimensional Change Card Sort Task (NIH-DCCS) and NIH Flanker Inhibitory Control and Attention Test (NIH-Flanker). Multivariable regression analyses revealed raw scores for NIH-DCCS and NIH-Flanker, PH+ status, and child age were associated with childhood STBs. LIMITATIONS Prospective data is needed to confirm cross-sectional findings. CONCLUSIONS Poorer neurocognitive functioning and PH+ status may serve as risk markers for STBs in elementary school-aged children. Targeting prevention programming for these risks may reduce the likelihood of STBs in at-risk elementary school-aged youth.
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Affiliation(s)
- Qi Chen
- Columbia University, NY, New York, United States of America
| | | | - Fatima Vakil
- Abdul Latif Jameel Poverty Action Lab (J-PAL) North America, Massachusetts Institute of Technology (MIT), Cambridge, MA, United States of America
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Departments of Pediatrics and Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - John G Keilp
- Department of Psychiatry, Columbia University, NY, New York, United States of America
| | - Arielle H Sheftall
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America.
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13
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Polanco-Roman L, DeLapp RCT, Dackis MN, Ebrahimi CT, Mafnas KSW, Gabbay V, Pimentel SS. Racial/ethnic discrimination and suicide-related risk in a treatment-seeking group of ethnoracially minoritized adolescents. Clin Child Psychol Psychiatry 2023; 28:1305-1320. [PMID: 36210796 PMCID: PMC10082132 DOI: 10.1177/13591045221132682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND AIMS Despite growing evidence demonstrating the negative mental health effects of racism-related experiences, racial/ethnic discrimination is seldom examined in youth suicide risk. The present study tested the association between racial/ethnic discrimination and well-supported correlates of suicide-related risk including emotion reactivity and dysregulation, and severity of psychiatric symptoms in a sample of ethnoracially minoritized adolescents receiving outpatient psychiatric services. METHODS Participants were adolescents (N = 46; 80.4% female; 65.2% Latinx) who ranged in age from 13-20 years old (M=15.42; SD=1.83) recruited from a child outpatient psychiatry clinic in a low-resourced community in Northeast US. Youth completed a clinical interview and a battery of surveys. RESULTS Findings from separate linear regression models show that increases in frequency of racial/ethnic discrimination were associated with increases in severity of suicidal ideation (SI), independent of emotion reactivity and dysregulation, and symptoms of PTSD and depression. Discriminatory experiences involving personal insults, witnessing family being discriminated, and school-based contexts were uniquely associated with SI. DISCUSSION AND CONCLUSION Preliminary findings support the association between racial/ethnic discrimination and increased severity of suicide-related risk in ethnoracially minoritized adolescents. Accounting for racial/ethnic discrimination may improve the cultural responsiveness of youth suicide prevention strategies within outpatient psychiatric care.
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Affiliation(s)
| | - Ryan CT DeLapp
- Psychiatry and Behavioral Sciences, Montefiore Medical Center, USA
- Albert Einstein College of Medicine, USA
| | | | | | | | - Vilma Gabbay
- Psychiatry and Behavioral Sciences, Montefiore Medical Center, USA
- Albert Einstein College of Medicine, USA
- Nathan Kline Institute for Psychiatric Research, USA
| | - Sandra S Pimentel
- Psychiatry and Behavioral Sciences, Montefiore Medical Center, USA
- Albert Einstein College of Medicine, USA
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14
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Liu J, Ran G, Zhang Q, Li Y, Zhang Q. The association between callous-unemotional traits and suicide ideation among youth: A conditional process analysis. J Affect Disord 2023; 328:245-254. [PMID: 36806662 DOI: 10.1016/j.jad.2023.02.063] [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: 03/14/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND The relationship between callous-unemotional (CU) traits (the affective facet of psychopathy and the psychopathy that occurs during childhood and adolescence) and suicide ideation (SI) remains unclear. The mechanisms underlying this association still have a gap in the literature. The aims of this study were to determine whether and how callous-unemotional traits were associated with suicide ideation, and to evaluate the mediating effect of negative affect (includes irritability, depression, and anxiety) and the moderating effect of future orientation on the association. METHODS Data were extracted from a longitudinal study involving middle and high school students, with 1,913 students (55.3% girls) aged 11 to 19 years (14.9 ± 1.6 years) completing a self-reported online survey. The conditional process analysis was examined using Mplus 8.3. RESULTS We found that callous-unemotional traits positively predicted youths' current suicide ideation, with the observed positive relationship partly mediated by negative affect. However, callous-unemotional traits did not predict the worst-point suicide ideation, which indicated the connection fully mediated by negative affect. Furthermore, future orientation moderated these indirect effects. LIMITATIONS Use of self-report measures and cross-sectional design. CONCLUSIONS These findings provided evidence for current debates and conflicting conclusions, and set the foundation for future research, as well as implied the important intervention goals for reducing suicide ideation in youth.
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Affiliation(s)
- Juncai Liu
- Department of Psychology, Institute of Education, China West Normal University, Nanchong 637002, China
| | - Guangming Ran
- Department of Psychology, Institute of Education, China West Normal University, Nanchong 637002, China.
| | - Qi Zhang
- College of Preschool and Primary Education, China West Normal University, Nanchong 637002, China
| | - Yinglun Li
- Sichuan Jianmenguan High School, Guangyuan 628317, China
| | - Qiongzhi Zhang
- Department of Psychology, Institute of Education, China West Normal University, Nanchong 637002, China
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15
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Conley MI, Hernandez J, Salvati JM, Gee DG, Baskin-Sommers A. The role of perceived threats on mental health, social, and neurocognitive youth outcomes: A multicontextual, person-centered approach. Dev Psychopathol 2023; 35:689-710. [PMID: 35232507 PMCID: PMC9437149 DOI: 10.1017/s095457942100184x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Perceived threat in youth's environments can elevate risk for mental health, social, and neurocognitive difficulties throughout the lifespan. However, few studies examine variability in youth's perceptions of threat across multiple contexts or evaluate outcomes across multiple domains, ultimately limiting our understanding of specific risks associated with perceived threats in different contexts. This study examined associations between perceived threat in youth's neighborhood, school, and family contexts at ages 9-10 and mental health, social, and neurocognitive outcomes at ages 11-12 within a large US cohort (N = 5525) enrolled in the Adolescent Brain Cognitive DevelopmentSM Study (ABCD Study®). Latent profile analysis revealed four distinct profiles: Low Threat in all contexts, Elevated Family Threat, Elevated Neighborhood Threat, and Elevated Threat in all contexts. Mixed-effect models and post hoc pairwise comparisons showed that youth in Elevated Threat profile had poorer mental health and social outcomes 2 years later. Youth in the Elevated Family Threat profile uniquely showed increased disruptive behavior symptoms, whereas youth in the Elevated Neighborhood Threat profile predominantly displayed increased sleep problems and worse neurocognitive outcomes 2 years later. Together, findings highlight the importance of considering perceptions of threat across multiple contexts to achieve a more nuanced developmental picture.
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Affiliation(s)
- May I. Conley
- Department of Psychology, Yale University, New Haven, CT,
USA
| | | | - Joeann M. Salvati
- Department of Psychiatry and Behavioral Sciences, Feinberg
School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dylan G. Gee
- Department of Psychology, Yale University, New Haven, CT,
USA
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16
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Guo Y, Zhang J, Guo Y, Cui Y, Huang X, Cui Y, Fu J, Wang K, Yu F. Psychosocial predictors of persistent suicidal ideation among Chinese adolescents: A longitudinal study. J Affect Disord 2023; 334:137-144. [PMID: 37119869 DOI: 10.1016/j.jad.2023.04.090] [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: 12/11/2022] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Suicide is the fourth leading cause of death among adolescents. Studies have shown that persistent suicidal ideation has a more important effect on suicidal behavior. The objective of this study was to identify predictors of persistent suicidal ideation. METHODS Data were collected from 4225 Chinese middle and high school students. These adolescents were assessed for suicidal ideation at baseline and the second year. We used multinomial logistic regression (n = 4171) for the predictive effect of these factors on persistent suicidal ideation. We controlled for gender, residence, clinical diagnosis, clinical diagnosis family, suicide planning, and suicide attempts. RESULTS Depressive symptoms are essential in predicting persistent suicidal ideation (OR = 14.0; p < 0.001). Persistent suicidal ideation was predicted by sleep disorders, such as poor sleep quality (OR = 2.3; p = 0.008), difficulty falling asleep (OR = 2.4; p = 0.005), frequently midnight awakening (OR = 1.9; p = 0.044), and frequent nightmares (OR = 2.1; p = 0.040). There was a significant association between concern with persistent ideation and parental-peer alienation (OR for father, 1.9[p = 0.024]; OR for mother, 3.1[p < 0.001]; OR for peer, 2.3[p = 0.003]). LIMITATIONS All measures are based on self-report rather than objective assessment or clinical diagnostic assessment. CONCLUSIONS Persistent suicidal ideation had a more important role in influencing suicide planning and attempt. Interventions targeting sleep disorders and attention to attachments in the home and school are particularly important in preventing persistent suicidal ideation in adolescents.
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Affiliation(s)
- Yang Guo
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Jingyi Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Yaru Guo
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Yanan Cui
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Xinyu Huang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Yuqiu Cui
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Jiyi Fu
- Psychiatry Department of Hefei Fourth People's Hospital, Hefei, China
| | - Kai Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui, China.
| | - Fengqiong Yu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China; Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.
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17
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Yuruk D, Ozger C, Garzon JF, Leffler JM, Shekunov J, Vande Voort JL, Zaccariello MJ, Nakonezny PA, Croarkin PE. Sequential bilateral accelerated theta burst stimulation in adolescents with suicidal ideation associated with major depressive disorder: Protocol for a randomized controlled trial. PLoS One 2023; 18:e0280010. [PMID: 37053246 PMCID: PMC10101506 DOI: 10.1371/journal.pone.0280010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/26/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of death in adolescents worldwide. Previous research findings suggest that suicidal adolescents with depression have pathophysiological dorsolateral prefrontal cortex (DLPFC) deficits in γ-aminobutyric acid neurotransmission. Interventions with transcranial magnetic stimulation (TMS) directly address these underlying pathophysiological deficits in the prefrontal cortex. Theta burst stimulation (TBS) is newer dosing approach for TMS. Accelerated TBS (aTBS) involves administering multiple sessions of TMS daily as this dosing may be more efficient, tolerable, and rapid acting than standard TMS. MATERIALS AND METHODS This is a randomized, double-blind, sham-controlled trial of sequential bilateral aTBS in adolescents with major depressive disorder (MDD) and suicidal ideation. Three sessions are administered daily for 10 days. During each session, continuous TBS is administered first to the right DPFC, in which 1,800 pulses are delivered continuously over 120 seconds. Then intermittent TBS is applied to the left DPFC, in which 1,800 pulses are delivered in 2-second bursts and repeated every 10 seconds for 570 seconds. The TBS parameters were adopted from prior research, with 3-pulse, 50-Hz bursts given every 200 ms (at 5 Hz) with an intensity of 80% active motor threshold. The comparison group will receive 3 daily sessions of bilateral sham TBS treatment for 10 days. All participants will receive the standard of care for patients with depression and suicidal ideation including daily psychotherapeutic skill sessions. Long-interval intracortical inhibition (LICI) biomarkers will be measured before and after treatment. Exploratory measures will be collected with TMS and electroencephalography for biomarker development. DISCUSSION This is the first known randomized controlled trial to examine the efficacy of sequential bilateral aTBS for treating suicidal ideation in adolescents with MDD. Results from this study will also provide opportunities to further understand the neurophysiological and molecular mechanisms of suicidal ideation in adolescents. TRIAL REGISTRATION Investigational device exemption (IDE) Number: G200220, ClinicalTrials.gov (ID: NCT04701840). Registered August 6, 2020. https://clinicaltrials.gov/ct2/show/NCT04502758?term=NCT04701840&draw=2&rank=1.
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Affiliation(s)
- Deniz Yuruk
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Can Ozger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Juan F. Garzon
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jarrod M. Leffler
- Virginia Treatment Center for Children, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Julia Shekunov
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jennifer L. Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Children’s Research Center, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michael J. Zaccariello
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Children’s Research Center, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Paul A. Nakonezny
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Children’s Research Center, Mayo Clinic, Rochester, Minnesota, United States of America
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18
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Zhu S, Li X, Wong PWC. Risk and protective factors in suicidal behaviour among young people in Hong Kong: A comparison study between children and adolescents ✰. Psychiatry Res 2023; 321:115059. [PMID: 36796255 DOI: 10.1016/j.psychres.2023.115059] [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: 07/03/2022] [Revised: 01/05/2023] [Accepted: 01/14/2023] [Indexed: 02/05/2023]
Abstract
Suicide is the leading cause of death among young people worldwide. Few studies examined the factors of childhood suicidality and compared them with adolescent suicidality to meet their age-specific needs. We examined the similarities and differences in risk and protective factors of children and adolescent suicidality in Hong Kong. A school-based survey with 541 students in grades 4-6 and 3,061 students in grades 7-11 from 15 schools was conducted. We measured the demographic, familial, school, mental health, and psychological factors of suicidality. Hierarchical binary logistic regressions were performed to examine the association between correlates and child and youth suicidality, and the interaction effects of these factors and school-age groups. Approximately 17.51% and 7.84% of secondary school respondents and 15.76% and 8.17% of primary school respondents reported suicidal ideation and attempt, respectively. Common correlates for suicidal ideation were depression, bullying, loneliness, self-compassion, and growth mindset, while those for suicide attempt were depression and bullying. Secondary school respondents with higher life satisfaction reported less suicidal ideation, while primary school respondents with higher self-control reported fewer suicide attempts. In conclusion, we recommended recognizing the factors of suicidal ideation and attempt in children and adolescents to tailor preventive strategies in a culturally sensitive manner.
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Affiliation(s)
- Shimin Zhu
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Room GH348, Kowloon, Hong Kong; Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong.
| | - Xiaomin Li
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Room GH348, Kowloon, Hong Kong
| | - Paul W C Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Room 511, JC Teaching Tower, Centennial Campus, Pokfulam, Hong Kong.
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19
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Colic L, Villa LM, Dauvermann MR, van Velzen LS, Sankar A, Goldman DA, Panchal P, Kim JA, Quatrano S, Spencer L, Constable RT, Suckling J, Goodyer IM, Schmaal L, van Harmelen AL, Blumberg HP. Brain grey and white matter structural associations with future suicidal ideation and behaviors in adolescent and young adult females with mood disorders. JCPP ADVANCES 2022; 2:e12118. [PMID: 36817186 PMCID: PMC9937714 DOI: 10.1002/jcv2.12118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background To reduce suicide in females with mood disorders, it is critical to understand brain substrates underlying their vulnerability to future suicidal ideation and behaviors (SIBs) in adolescence and young adulthood. In an international collaboration, grey and white matter structure was investigated in adolescent and young adult females with future suicidal behaviors (fSB) and ideation (fSI), and without SIBs (fnonSIB). Methods Structural (n = 91) and diffusion-weighted (n = 88) magnetic resonance imaging scans at baseline and SIB measures at follow-up on average two years later (standard deviation, SD = 1 year) were assessed in 92 females [age(SD) = 16.1(2.6) years] with bipolar disorder (BD, 28.3%) or major depressive disorder (MDD, 71.7%). One-way analyses of covariance comparing baseline regional grey matter cortical surface area, thickness, subcortical grey volumes, or white matter tensor-based fractional anisotropy across fSB (n = 40, 43.5%), fSI (n = 33, 35.9%) and fnonSIB (n = 19, 20.6%) groups were followed by pairwise comparisons in significant regions (p < 0.05). Results Compared to fnonSIBs, fSIs and fSBs showed significant decreases in cortical thickness of right inferior frontal gyrus pars orbitalis and middle temporal gyrus, fSIs of left inferior frontal gyrus, pars orbitalis. FSIs and fSBs showed lower fractional anisotropy in left uncinate fasciculus and corona radiata, and fSBs in right uncinate and superior fronto-occipital fasciculi. Conclusions The study provides preliminary evidence of grey and white matter alterations in brain regions subserving emotional and behavioral regulation and perceptual processing in adolescent and young adult females with mood disorders with, versus without, future SIBs. Findings suggest potential targets to prevent SIBs in female adolescents and young adults.
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Affiliation(s)
- Lejla Colic
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- German Center for Mental Health, Jena, Germany
| | - Luca M. Villa
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Maria R. Dauvermann
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Laura S. van Velzen
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Anjali Sankar
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Danielle A. Goldman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, Connecticut, USA
| | - Priyanka Panchal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jihoon A. Kim
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Susan Quatrano
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - R. Todd Constable
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ian M. Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Lianne Schmaal
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Anne-Laura van Harmelen
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
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Bayliss LT, Christensen S, Lamont-Mills A, du Plessis C. Suicide capability within the ideation-to-action framework: A systematic scoping review. PLoS One 2022; 17:e0276070. [PMID: 36301944 PMCID: PMC9612581 DOI: 10.1371/journal.pone.0276070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide capability is theorised to facilitate the movement from suicidal ideation to suicide attempt. Three types of contributors are posited to comprise suicide capability: acquired, dispositional, and practical. Despite suicide capability being critical in the movement from ideation-to-attempt, there has been no systematic synthesis of empirical evidence relating to suicide capability that would enable further development and refinement of the concept. This study sought to address this synthesis gap. A scoping review was conducted on suicide capability studies published January 2005 to January 2022. Eleven electronic databases and grey literature sources were searched returning 5,212 potential studies. After exclusion criteria application, 90 studies were included for final analysis. Results synthesis followed a textual narrative approach allocating studies based on contributors of suicide capability. Most studies focused on investigating only one factor within contributors. Painful and provocative events appear to contribute to acquired capability more so than fearlessness about death. Whilst emerging evidence for dispositional and practical contributors is promising, the small number of studies prevents further conclusions from being drawn. An unexpected additional cognitive contributor was identified. The focus of a single factor from most studies and the limited number of studies on contributors other than acquired capability limits the theoretical development and practical application of suicide capability knowledge. Given that suicide is a complex and multifaceted behaviour, future research that incorporates a combination of contributors is more likely to advance our understandings of suicide capability.
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Auger N, Chadi N, Ayoub A, Brousseau É, Low N. Suicide Attempt and Risk of Substance Use Disorders Among Female Youths. JAMA Psychiatry 2022; 79:710-717. [PMID: 35544235 PMCID: PMC9096685 DOI: 10.1001/jamapsychiatry.2022.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Suicide attempts are prevalent among female youths, yet little is known about the subsequent development of substance use disorders. OBJECTIVE To assess the association between suicide attempts among females before 20 years of age and future risk of substance use disorders. DESIGN, SETTING, AND PARTICIPANTS In this longitudinal cohort study, females aged 8 to 19 years (hereafter referred to as youths) who attempted suicide were matched with female youths with no attempt between April 1, 1989, and March 31, 2019, in Quebec, Canada. The cohort was followed up for 31 years, for a total of 2 409 396 person-years, to identify subsequent substance use disorders. EXPOSURES Confirmed suicide attempts among females 8 to 19 years of age. MAIN OUTCOMES AND MEASURES The main outcome measure was hospitalization for a substance use disorder later in life. Hazard ratios (HRs) and 95% CIs for the association of suicide attempt with substance use disorders were estimated using Cox proportional hazards regression models adjusted for baseline age, mental illness, resource-limited socioeconomic status, and year at start of follow-up. RESULTS Among 122 234 female youths (mean [SD] age, 15.6 [1.9] years), 5840 (4.8%) attempted suicide and 4341 (3.6%) developed a substance use disorder. Compared with the 116 394 matched female youths who did not attempt suicide (95.2%), those who attempted suicide had a greater risk of hospitalization for any substance use disorder during the follow-up period (HR, 6.03; 95% CI, 5.39-6.77), especially sedative or hypnotic use disorders (HR, 32.24; 95% CI, 23.29-44.64). Suicide attempt was associated with the development of sedative or hypnotic use disorders up to 5 years (HR, 66.69; 95% CI, 34.72-128.09), although risks remained elevated up to 3 decades later for all substances. Compared with those without suicide attempt, female youths with 3 or more suicide attempts had 21.20 (95% CI, 13.53-32.90) times the risk of substance use disorders, whereas female youths with 1 attempt had 5.70 (95% CI, 5.08-6.41) times the risk of these disorders. CONCLUSIONS AND RELEVANCE In this cohort study, female youths who attempted suicide had increased risk of subsequent substance use disorders compared with female youths who did not attempt suicide. These findings suggest that closer management and prevention of substance use among female youths who attempt suicide may be beneficial.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada,Institut national de santé publique du Québec, Montreal, Quebec, Canada,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Nicholas Chadi
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada,Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Émilie Brousseau
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada,Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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22
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Alvarez K, Polanco-Roman L, Breslow AS, Molock S. Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems. Am J Psychiatry 2022; 179:422-433. [PMID: 35599542 PMCID: PMC9765395 DOI: 10.1176/appi.ajp.21101001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Suicide rates among ethnoracially minoritized youth (i.e., youth of color) peak before the age of 30, and striking disparities in access to mental health services have been identified in this age group. However, suicide prevention strategies have yet to fully address structural racism as a mechanism in producing disparities in risk, protective factors, and access to quality effective intervention for youth of color. Such an approach is critical to provide more culturally responsive mental health care. Through an adapted socio-ecological model, the authors propose the Structural Racism and Suicide Prevention Systems Framework and illustrate pathways through which structural racism impacts suicide prevention and intervention for youth of color in the United States. The authors contextualize the impact of structural racism in three key settings where youth suicide prevention occurs: mental health services, schools, and the interface between crisis care and law enforcement. The authors posit that critical attention must be paid to the intersection of mutually reinforcing, interdependent systems rather than to systems in isolation. The authors then propose recommendations to address structural racism in suicide prevention, including macro-level interventions to improve societal conditions, research strategies to inform structural solutions, training approaches to address institutional racism, and clinical approaches to address the impact of racism and racial trauma on youths and families.
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA,Correspondence: Kiara Alvarez, Massachusetts General Hospital Disparities Research Unit, Department of Medicine, 50 Staniford Street, Suite 830, Boston, MA 02114; ; Phone: 617-724-1237; Fax: 617-726-4120
| | | | - Aaron Samuel Breslow
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY,Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
| | - Sherry Molock
- Department of Psychological & Brain Sciences, The George Washington University, Washington, DC
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23
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Stark L, Seff I, Yu G, Salama M, Wessells M, Allaf C, Bennouna C. Correlates of Suicide Ideation and Resilience Among Native- and Foreign-Born Adolescents in the United States. J Adolesc Health 2022; 70:91-98. [PMID: 34412951 DOI: 10.1016/j.jadohealth.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Nearly 20% of U.S. adolescents have considered suicide. Yet, gaps remain in understanding correlates of resilience and suicide risk, especially among populations born outside the United States who may face unique migration- and acculturation-related stressors. This study adds to the literature by exploring correlates of suicide ideation among a diverse population. METHODS This study analyzes quantitative data (N = 357) from the Study of Adolescent Lives after Migration to America, in Detroit and Harrisonburg. More than 40% of the sample was born outside the United States, with the majority born in the Middle East and North Africa. Path analysis was used to model dual outcomes of resilience and suicide ideation using measures of hope, school belonging, stressful life events, and being born outside the United States. RESULTS Suicide ideation and resilience were negatively correlated (ß = -.236[.069]; p < .001). Adolescents with greater hope (ß = .367; p < .001) and school belonging (ß = .407; p < .001) reported higher resilience, while lower levels of school belonging correlated with higher levels of suicide ideation (ß = -.248; p = .009). More stressful life events were associated with suicide ideation (ß = .243; p < .001), while fewer were correlated with resilience (ß = -.106; p = .003). Being born outside the United States was associated with suicide ideation (ß = .186; P-.015), with this finding driven by those from the Middle East and North Africa region, who faced significantly increased risk of suicide ideation (ß = .169; p = .036). CONCLUSIONS Findings suggest that adolescents born in the Middle East and North Africa region may represent a vulnerable group needing targeted and culturally responsive interventions to destigmatize mental health and psychosocial well-being, boost existing sources of resilience, and encourage help-seeking behaviors.
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Affiliation(s)
- Lindsay Stark
- Brown School at Washington University in St. Louis, St. Louis, Missouri.
| | - Ilana Seff
- Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Mariam Salama
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michael Wessells
- Mailman School of Public Health, Columbia University, New York, New York
| | | | - Cyril Bennouna
- Department of Political Science, Brown University, Providence, Rhode Island
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24
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Sleep problems predict next-day suicidal thinking among adolescents: A multimodal real-time monitoring study following discharge from acute psychiatric care. Dev Psychopathol 2021. [DOI: 10.1017/s0954579421000699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractSuicidal thoughts and behaviors (STBs) are major public health concerns among adolescents, and research is needed to identify how risk is conferred over the short term (hours and days). Sleep problems may be associated with elevated risk for STBs, but less is known about this link in youth over short time periods. The current study utilized a multimodal real-time monitoring approach to examine the association between sleep problems (via daily sleep diary and actigraphy) and next-day suicidal thinking in 48 adolescents with a history of STBs during the month following discharge from acute psychiatric care. Results indicated that specific indices of sleep problems assessed via sleep diary (i.e., greater sleep onset latency, nightmares, ruminative thoughts before sleep) predicted next-day suicidal thinking. These effects were significant even when daily sadness and baseline depression were included in the models. Moreover, several associations between daily-level sleep problems and next-day suicidal thinking were moderated by person-level measures of the construct. In contrast, sleep indices assessed objectively (via actigraphy) were either not related to suicidal thinking or were related in the opposite direction from hypothesized. Together, these findings provide some support for sleep problems as a short-term risk factor for suicidal thinking in high-risk adolescents.
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25
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Martinez-Levy GA, Campos AI, Rabinowitz JA, García-Marín LM, Benjet C, Méndez E, Rentería ME, Cruz-Fuentes CS. Suicidal ideation and planning among Mexican adolescents are associated with depression polygenic risk scores. Am J Med Genet B Neuropsychiatr Genet 2021; 186:476-484. [PMID: 34173322 DOI: 10.1002/ajmg.b.32864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/10/2021] [Accepted: 06/05/2021] [Indexed: 01/04/2023]
Abstract
Suicide is a major public health problem in Mexico and around the world. Genetic predisposition for major depressive disorder (MDD) has been associated with increased risk for suicidal behaviors (SB) in populations of European ancestry (EA). Here, we examine whether MDD polygenic risk scores (MDD PRS), derived from a genome-wide association study involving EA individuals, predict SB, including ideation, planning, and attempt, among Mexican youth using a longitudinal design. At baseline, participants (N = 1,128, 12-17 years, 55% women) were interviewed and genotyped as part of a general population survey on adolescent mental health. Eight years later, they were recontacted for a follow up visit (N = 437, 20-25 years, 63% women). At both assessments, individuals reported on their engagement in SB within the past year. MDD PRS were significantly positively associated with SB, particularly suicide ideation and planning during adolescence, accounting for ~4-5% of the variance in these outcomes. In contrast, associations between MDD PRS and SB during young adulthood did not reach statistical significance. Our results suggest that increased genetic liability for depression increased risk for SB, particularly during adolescence, expanding our knowledge of the genetic underpinnings of SB.
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Affiliation(s)
- Gabriela A Martinez-Levy
- Departamento de Genética, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Adrian I Campos
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luis M García-Marín
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Corina Benjet
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Enrique Méndez
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Miguel E Rentería
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Carlos S Cruz-Fuentes
- Departamento de Genética, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico
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26
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Daskalakis NP, Schultz LM, Visoki E, Moore TM, Argabright ST, Harnett NG, DiDomenico GE, Warrier V, Almasy L, Barzilay R. Contributions of PTSD polygenic risk and environmental stress to suicidality in preadolescents. Neurobiol Stress 2021; 15:100411. [PMID: 34765698 PMCID: PMC8569631 DOI: 10.1016/j.ynstr.2021.100411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 09/17/2021] [Accepted: 10/23/2021] [Indexed: 11/19/2022] Open
Abstract
Suicidal ideation and attempts (i.e., suicidality) are complex behaviors driven by environmental stress, genetic susceptibility, and their interaction. Preadolescent suicidality is a major health problem with rising rates, yet its underlying biology is understudied. Here we studied effects of genetic stress susceptibility, approximated by the polygenic risk score (PRS) for post-traumatic-stress-disorder (PTSD), on preadolescent suicidality in participants from the Adolescent Brain Cognitive Development (ABCD) Study®. We further evaluated PTSD-PRS effects on suicidality in the presence of environmental stressors that are established suicide risk factors. Analyses included both European and African ancestry participants using PRS calculated based on summary statistics from ancestry-specific genome-wide association studies. In European ancestry participants (N = 4,619, n = 378 suicidal), PTSD-PRS was associated with preadolescent suicidality (odds ratio [OR] = 1.12, 95%CI 1-1.25, p = 0.038). Results in African ancestry participants (N = 1,334, n = 130 suicidal) showed a similar direction but were not statistically significant (OR = 1.21, 95%CI 0.93-1.57, p = 0.153). Sensitivity analyses using non-psychiatric polygenic score for height and using cross-ancestry PTSD-PRS did not reveal any association with suicidality, supporting the specificity of the association of ancestry-specific PTSD-PRS with suicidality. Environmental stressors were robustly associated with suicidality across ancestries with moderate effect size for negative life events and family conflict (OR 1.27-1.6); and with large effect size (OR ∼ 4) for sexual-orientation discrimination. When combined with environmental factors, PTSD-PRS showed marginal additive effects in explaining variability in suicidality, with no evidence for G × E interaction. Results support use of cross-phenotype PRS, specifically stress-susceptibility, as a genetic marker for suicidality risk early in the lifespan.
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Affiliation(s)
- Nikolaos P. Daskalakis
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Laura M. Schultz
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
- Lifespan Brain Institute, CHOP and Penn Medicine, Philadelphia, PA, USA
| | - Elina Visoki
- Lifespan Brain Institute, CHOP and Penn Medicine, Philadelphia, PA, USA
| | - Tyler M. Moore
- Lifespan Brain Institute, CHOP and Penn Medicine, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Nathaniel G. Harnett
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | | | - Varun Warrier
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Laura Almasy
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
- Lifespan Brain Institute, CHOP and Penn Medicine, Philadelphia, PA, USA
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ran Barzilay
- Lifespan Brain Institute, CHOP and Penn Medicine, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA
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27
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Fu XL, Wu H, Qian Y, Jin XH, Yu HR, Du L, Chen HL, Shi YQ. Incidence of suicide mortality among childhood cancer survivors: A population-based retrospective study. Psychiatry Res 2021; 304:114119. [PMID: 34325189 DOI: 10.1016/j.psychres.2021.114119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
The aim of our study was to investigate the suicide rates among childhood cancer survivors and assess factors associated with higher suicide risk. A review of data from Surveillance, Epidemiology, and End Results (SEER) program from 1975 to 2016 was performed for this study. This program is based on the US population and is supported by the US National Cancer Institute (NCI). Survivors diagnosed with childhood cancer were recorded. There were 40 suicides among 567,233 person-years, giving a suicide rate of 7.1 per 100,000 person-years. Compared with cancer diagnosed between 10 and 14 years old, survivors with cancer diagnosed between 0 and 4 years old had lower suicide risk. Females had a lower risk of suicide than males. Compared with survivors of thyroid cancer, the aHRs were 0.16 for acute lymphocytic leukemia, 0.15 for nodal Hodgkin's lymphoma, 0.14 for brain cancers and 0.09 for kidney cancers. Most suicides occurred after 15 years old. Suicide was a problem for survivors, especially those with thyroid cancer. Beside treating patients holistically, early psychological interventions such as communicating effectively, providing social support and follow-up care related to psychological health are needed.
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Affiliation(s)
- Xue-Lei Fu
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001, PR China
| | - Hua Wu
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001, PR China
| | - Yan Qian
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, PR China
| | - Xiao-Hong Jin
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, PR China
| | - Hai-Rong Yu
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, PR China
| | - Lin Du
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001, PR China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, 226019, PR China.
| | - Ya-Qin Shi
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001, PR China.
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28
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Luk JW, Goldstein RB, Yu J, Haynie DL, Gilman SE. Sexual Minority Status and Age of Onset of Adolescent Suicide Ideation and Behavior. Pediatrics 2021; 148:e2020034900. [PMID: 34580171 PMCID: PMC9446478 DOI: 10.1542/peds.2020-034900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if sexual minority adolescents have earlier onset of suicidality and faster progressions from ideation to plan and attempt than heterosexual adolescents. METHODS A population-based longitudinal cohort of 1771 adolescents participated in the NEXT Generation Health Study. Participants reported sexual minority status (defined by sexual attraction) in 2010-2011 and retrospectively reported age at onset of suicidality in 2015-2016. RESULTS Sexual minority adolescents (5.8% of weighted sample) had higher lifetime risk of suicide ideation (26.1% vs 13.0%), plan (16.6% vs 5.4%), and attempt (12.0% vs 5.4%) than heterosexual adolescents. Survival analyses adjusted for demographic characteristics and depressive symptoms revealed positive associations of sexual minority status with time to first onset of suicide ideation (hazard ratio [HR] = 1.77; 95% confidence interval [CI] 1.03-3.06) and plan (HR = 2.69; 95% CI 1.30-5.56). The association between sexual minority status and age at onset of suicide attempt was stronger at age <15 (HR = 3.26; 95% CI 1.25-8.47) than age ≥15 (HR = 0.59; 95% CI 0.21-1.66). The association between sexual minority status and progression from ideation to plan was stronger in the same year of first ideation (HR = 2.01; 95% CI 1.07-3.77) than ≥1 year after first ideation (HR = 1.33; 95% CI 0.26-6.77). CONCLUSIONS Sexual minority adolescents had earlier onset of suicidality and faster progression from suicide ideation to plan than heterosexual adolescents. The assessment of sexual minority status in routine pediatric care has the potential to inform suicide risk screening, management, and intervention efforts among early sexual minority adolescents.
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Affiliation(s)
- Jeremy W Luk
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Risë B Goldstein
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Jing Yu
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Denise L Haynie
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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29
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Glenn CR, Kleiman EM, Kandlur R, Esposito EC, Liu RT. Thwarted Belongingness Mediates Interpersonal Stress and Suicidal Thoughts: An Intensive Longitudinal Study with High-risk Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 51:295-311. [PMID: 34570668 PMCID: PMC8957618 DOI: 10.1080/15374416.2021.1969654] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Interpersonal negative life events (NLEs) have been linked to risk for suicidal thoughts and behaviors. However, little is known about how this risk is conferred over the short term and the mechanisms linking interpersonal NLEs to suicide risk, particularly in adolescents. This study used an intensive longitudinal design to examine thwarted belongingness with family and friends as potential mechanisms linking interpersonal NLEs to suicidal thoughts. METHOD Forty-eight adolescents (Mage = 14.96 years; 64.6% female, 77.1% White), who recently received acute psychiatric care for suicide risk, were followed intensely for 28 days after discharge. Smartphone-based ecological momentary assessment was used to measure presence of interpersonal NLEs at the day level, fluctuations in thwarted belongingness with family and friends (separately) within day, and fluctuations in suicidal thoughts within day. A multi-level structural equation model was utilized to examine family thwarted belongingness and friend thwarted belongingness as parallel mediators in the relationship between interpersonal NLEs and next-day suicidal thoughts. RESULTS Significant direct effects were observed between interpersonal NLEs and family thwarted belongingness, family thwarted belongingness and suicidal thoughts, and friend thwarted belongingness and suicidal thoughts. In addition, family, but not friend, thwarted belongingness significantly mediated the association between interpersonal NLEs and next-day suicidal thoughts. CONCLUSIONS Interpersonal NLEs predicted greater suicidal thoughts over the short term (next day) in high-risk adolescents. Findings suggest how interpersonal NLEs may confer risk for suicidal thoughts - by reducing feelings of family belongingness. Future research is needed to examine how modifying belongingness may reduce suicide risk in adolescents.
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Affiliation(s)
- Catherine R Glenn
- Department of Psychology, Old Dominion University.,Department of Psychology, University of Rochester.,Department of Psychiatry, University of Rochester Medical Center
| | - Evan M Kleiman
- Department of Psychology, Rutgers, The State University of New Jersey
| | | | | | - Richard T Liu
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital.,Department of Psychiatry, Harvard Medical School
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30
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Lawrence HR, Burke TA, Sheehan AE, Pastro B, Levin RY, Walsh RFL, Bettis AH, Liu RT. Prevalence and correlates of suicidal ideation and suicide attempts in preadolescent children: A US population-based study. Transl Psychiatry 2021; 11:489. [PMID: 34552053 PMCID: PMC8458398 DOI: 10.1038/s41398-021-01593-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 08/16/2021] [Accepted: 09/01/2021] [Indexed: 12/16/2022] Open
Abstract
The present study evaluated sociodemographic and diagnostic predictors of suicidal ideation and attempts in a nationally representative sample of preadolescent youth enrolled in the Adolescent Brain Cognitive Development Study. Rates and predictors of psychiatric treatment utilization among suicidal youth also were examined. Eleven thousand eight hundred and seventy-five 9- and 10-year-old children residing in the United States were assessed. Children and their parents/guardians provided reports of children's lifetime history of suicidal ideation, suicide attempts, and psychiatric disorders. Parents also reported on sociodemographic characteristics and mental health service utilization. Multivariate logistic regression analyses were employed to evaluate sociodemographic and diagnostic correlates of suicidal ideation, suicide attempts among youth with suicidal ideation, and treatment utilization among youth with suicidal ideation and suicide attempts. Lifetime prevalence rates were 14.33% for suicidal ideation and 1.26% for suicide attempts. Youth who identified as male, a sexual minority, or multiracial had greater odds of suicidal ideation, and sexual minority youth and youth with a low family income had greater odds of suicide attempts. Comorbid psychopathology was associated with higher odds of both suicidal ideation and suicide attempts. In youth, 34.59% who have suicidal ideation and 54.82% who had attempted suicide received psychiatric treatment. Treatment utilization among suicidal youth was lower among those who identified as female, Black, and Hispanic. Suicidal ideation and attempts among preadolescent children are concerningly high and targeted assessment and preventative efforts are needed, especially for males, racial, ethnic, and sexual minority youth, and those youth experiencing comorbidity.
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Affiliation(s)
- Hannah R. Lawrence
- grid.240206.20000 0000 8795 072XDepartment of Psychiatry, McLean Hospital, Belmont, CA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Taylor A. Burke
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Ana E. Sheehan
- grid.33489.350000 0001 0454 4791Department of Psychological and Brain Sciences, University of Delaware, Newark, DE USA
| | - Brianna Pastro
- grid.240206.20000 0000 8795 072XDepartment of Psychiatry, McLean Hospital, Belmont, CA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Rachel Y. Levin
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Rachel F. L. Walsh
- grid.264727.20000 0001 2248 3398Department of Psychology, Temple University, Philadelphia, PA USA
| | - Alexandra H. Bettis
- grid.412807.80000 0004 1936 9916Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | - Richard T. Liu
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
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Hutchinson EA, Sequeira SL, Silk JS, Jones NP, Oppenheimer C, Scott L, Ladouceur CD. Peer Connectedness and Pre-Existing Social Reward Processing Predicts U.S. Adolescent Girls' Suicidal Ideation During COVID-19. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2021; 31:703-716. [PMID: 34448297 PMCID: PMC8407247 DOI: 10.1111/jora.12652] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 05/03/2023]
Abstract
There is major concern about the impact of the COVID-19 pandemic on adolescent suicidal ideation (SI) and peer relationships. We investigated (1) rates of SI and (2) the extent to which peer connectedness and pre-existing neural activation to social reward predicted SI during the initial stay-at-home orders of the pandemic (April-May 2020) in a longitudinal sample of adolescent girls (N = 93; Mage = 15.06; 69% White non-Hispanic). Daily diary and fMRI methods were used to assess peer connectedness and neural activation to social reward, respectively. Nearly 40% of girls endorsed SI during the initial stay-at-home orders. Greater peer connectedness and neural responsivity to anticipated social reward were associated with a reduced odds of SI during the pandemic among girls.
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Ferrara P, Franceschini G, Corsello G, Mestrovic J, Giardino I, Vural M, Pop TL, Namazova-Baranova L, Indrio F, Pettoello-Mantovani M. Increased Exposure to Violence and Risk of Neurodevelopmental Disorders in Children. J Pediatr 2021; 236:335-336.e2. [PMID: 34102213 DOI: 10.1016/j.jpeds.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Pietro Ferrara
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Italian Society of Pediatrics, Rome, Italy; University Campus BioMedico, Rome, Italy
| | | | - Giovanni Corsello
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Italian Society of Pediatrics, Rome, Italy
| | - Julije Mestrovic
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Medical School of Split, University Hospital of Split, Split, Croatia
| | - Ida Giardino
- Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Mehmet Vural
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Faculty of Medicine, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Tudor Lucian Pop
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
| | - Leyla Namazova-Baranova
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Russian Academy of Pediatrics, Moscow, Russia
| | - Flavia Indrio
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Department of Pediatrics, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy
| | - Massimo Pettoello-Mantovani
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Department of Pediatrics, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy.
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Short-term associations between nonsuicidal and suicidal thoughts and behaviors: A daily diary study with high-risk adolescents. J Affect Disord 2021; 292:337-344. [PMID: 34139406 PMCID: PMC8282747 DOI: 10.1016/j.jad.2021.05.104] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/28/2021] [Accepted: 05/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In this daily dairy study of adolescents at elevated suicide risk, we examined proximal associations between nonsuicidal self-injury (NSSI) and suicidal thoughts as well as behaviors. We also investigated the prominence of the anti-suicide function underlying NSSI engagement, relative to intrapersonal and interpersonal motives. METHODS Seventy-eight adolescents (67.9% female; ages 13-17) hospitalized due to suicide risk completed daily surveys assessing NSSI and suicidal thoughts for four weeks after discharge (n=1621 observations). Suicidal behavior (actual, aborted, interrupted suicide attempts) was assessed at 1-month follow-up. RESULTS Over and above lifetime NSSI, adolescents who generally experienced more enduring (OR=2.54, p=<.001) and intense (OR=1.87, p=.002) suicidal ideation were more likely to engage in NSSI on a given day. Moreover, NSSI likelihood increased when adolescents experienced more enduring (OR=1.99, p<.001) and intense (OR=1.66, p<.001) ideation relative to their typical levels. This pattern was consistent for those with recent NSSI. The anti-suicide function of NSSI was frequently endorsed at hospitalization and when NSSI occurred daily (65.6% of the time), alongside the intrapersonal-negative motive (to avoid aversive states). Exploratory analyses suggest adolescents with suicidal behavior within the month after discharge experienced higher NSSI levels reported daily over the same period (Hedge's g=1.26, p=<.001). LIMITATIONS Daily-level associations were examined concurrently and generalizability of results is limited by sample characteristics. CONCLUSIONS The notable proximal associations between NSSI and suicidal thoughts and behaviors, as well as the prominence of the anti-suicide function, point to the importance of intervention efforts targeting these intersecting phenomena among adolescents at elevated suicide risk.
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Rioux C, Huet AS, Castellanos-Ryan N, Fortier L, Le Blanc M, Hamaoui S, Geoffroy MC, Renaud J, Séguin JR. Substance use disorders and suicidality in youth: A systematic review and meta-analysis with a focus on the direction of the association. PLoS One 2021; 16:e0255799. [PMID: 34358273 PMCID: PMC8345848 DOI: 10.1371/journal.pone.0255799] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Reviews and meta-analyses suggest that substance use and suicidality (i.e., suicidal ideations and attempts) are associated in youth, but the direction of this association remains unclear. Theoretically, the secondary psychiatric disorder hypothesis (SPDH) posits that substance use leads to suicidality, while the secondary substance use disorder hypothesis (SSUDH) posits that suicidality leads to substance use. To clarify these associations, this meta-analysis systematically reviewed studies that examined the prospective associations between SUDs and suicidality in youth (age 25 and younger) and compared results according to the direction of the association. METHODS Web of Science, Embase, PsycINFO, PubMed, Medline and ProQuest Dissertations & Theses Global were searched from inception to March 8, 2020, and 55 effect sizes from 23 samples were included and analyzed using a three-level meta-analysis. RESULTS SUDs significantly predicted subsequent suicidality (OR = 2.16, 95%CI 1.57-2.97), suicidality significantly predicted subsequent SUDs (OR = 2.16, 95%CI 1.53-3.04), and these effect sizes did not differ (p = 0.49). CONCLUSIONS Considering that 65% of reviewed studies only examined the SPDH, this review highlights that more attention should be given to the SSUDH, and that studies should examine bidirectional associations between SUDs and suicidality across time. Clinically, because SUDs and suicidality were found to influence each other, results suggest that mental health and SUDs should ideally be detected and treated early, and that co-occurring disorders should be assessed and treated concomitantly.
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Affiliation(s)
- Charlie Rioux
- Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, Texas, United States of America
| | - Anne-Sophie Huet
- Department of Child and Adolescent Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Natalie Castellanos-Ryan
- School of Psychoeducation, Université de Montréal, Montreal, Québec, Canada
- CHU Ste-Justine Research Centre, Montreal, Québec, Canada
| | - Laurianne Fortier
- School of Psychoeducation, Université de Montréal, Montreal, Québec, Canada
| | - Myriam Le Blanc
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Québec, Canada
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Québec, Canada
| | - Stéphanie Hamaoui
- Department of Psychology, Université du Québec à Montréal, Montreal, Québec, Canada
| | - Marie-Claude Geoffroy
- Department of Educational and Counselling Psychology, McGill University, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Québec, Canada
| | - Johanne Renaud
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Québec, Canada
- Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Montreal, Québec, Canada
| | - Jean R. Séguin
- CHU Ste-Justine Research Centre, Montreal, Québec, Canada
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Québec, Canada
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Mulraney M, Coghill D, Bishop C, Mehmed Y, Sciberras E, Sawyer M, Efron D, Hiscock H. A systematic review of the persistence of childhood mental health problems into adulthood. Neurosci Biobehav Rev 2021; 129:182-205. [PMID: 34363845 DOI: 10.1016/j.neubiorev.2021.07.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/18/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023]
Abstract
Many adult mental disorders have their origins in childhood yet our knowledge about this largely comes from studies assessing adults utilising retrospective recall of age of onset. In this systematic review we evaluate the current state of knowledge of how childhood exposure to mental health problems is associated with adult mental disorders using data from prospective longitudinal studies. We identified 40 studies that assessed mental health in childhood or adolescence and reassessed adults for mental disorders. Although there was substantial heterogeneity across studies in terms of methodology and findings, there was a clear pattern that experiencing mental health problems prior to 14 years of age increases risk of adult mental disorder. Importantly, elevated symptoms rather than diagnosis in childhood were generally more strongly associated with adult disorder. These findings provide strong support for the argument that prevention needs to be targeted to children in the primary school years and early intervention efforts to those who are beginning to experience elevated symptoms rather than waiting until a diagnosable disorder is evident.
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Affiliation(s)
- Melissa Mulraney
- Institute for Social Neuroscience, ISN Innovations, Ivanhoe, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia.
| | - David Coghill
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia
| | - Caitlin Bishop
- School of Psychology, Deakin University, Geelong, Australia
| | - Yasemin Mehmed
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - Emma Sciberras
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; School of Psychology, Deakin University, Geelong, Australia
| | - Michael Sawyer
- Women's and Children's Health Network, North Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia
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A Latent Class Analysis of Health Lifestyles in Relation to Suicidality among Adolescents in Mauritius. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136934. [PMID: 34203501 PMCID: PMC8296868 DOI: 10.3390/ijerph18136934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 12/31/2022]
Abstract
Suicidality, which includes suicidal thoughts, planning, and suicide attempts, results mainly from a combination of psychological, sociological, and environmental factors. Despite a high prevalence of suicidality among adolescents in Africa, only a few studies have considered these factors simultaneously. The objective of the study was to identify the prevalence of suicidality, to draw up profiles of concomitant risks, and to examine the associations between these profiles and suicidality in Mauritius. This study used data from the 2017 Mauritian Global School-based Student Health Survey including 3012 adolescents with a mean age of 14.9 ± 1.4 years. Factors related to lifestyle such as consumptions of alcohol and tobacco, physical activity, violence, parental support, anxiety, and loneliness were considered. A latent class analysis was performed to identify the profiles. Finally, a modified Poisson regression analysis with generalized estimating equations, adjusted with sociodemographic characteristics, was used to assess the association between these profiles and suicidality. Overall, more than one in ten adolescents had at least one of the suicidality behaviors. Three profiles were identified: 1 = "low risk group" (63.9%); 2 = "problems with violence" (15.2%); 3 = "problems with violence, alcohol, tobacco and psychological distress" (20.9%). Profiles 2 and 3 were mainly made up of males. Adolescents under 15 represented the majority of individuals in profile 2. Finally, the risk of suicidality was higher in adolescents belonging to profiles 2 and 3 compared to profile 1 for the three suicidality behaviors (profile 3: Prevalence ratio (PR) for suicidal thoughts = 1.26, 95% CI = 1.19-1.34; PR for planning = 1.23, 95% CI = 1.17-1.30; PR for attempt = 1.23, 95% CI = 1.17-1.29). This study highlights the high prevalence of suicidality and a list of concomitant risks, emphasizing this suicidality in Mauritian adolescents. Therefore, these results recommend focusing preventive efforts toward a simultaneous consideration of these factors.
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Fenton MP, Forthun LF, Aristild S, Vasquez KB. The Role of the Rural Context in the Transition to Adulthood: A Scoping Review. ADOLESCENT RESEARCH REVIEW 2021; 7:101-126. [PMID: 34127948 PMCID: PMC8190761 DOI: 10.1007/s40894-021-00161-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
Rural adolescents are transitioning to adulthood in the context of growing disparities. To advance research on the social, behavioral, and contextual factors that influence rural young adult development, this study conducted a scoping review. The review sought to identify how researchers defined rural and how/which theories guided their work; how they integrated the rural context into the research design and methods; and how they used variables, concepts, and outcomes to measure rural experiences. Included articles were published between January 2009 and November 2020, included young adults ages 18-29, measured adult role achievement and/or behavioral health outcomes and reported on these outcomes for young adults, and focused on a rural sample within the United States. A systematic search of four databases resulted in 25 empirical articles for the inductive, qualitative analysis. Most studies used atheoretical approaches focusing on outcomes related to adult social roles, substance use, and mental health. Five themes emerged focused on the definitions of rural, the level of integration into the research design and method, and variables salient to the rural experience. These results reveal that future research should clearly define the rural context and better integrate the rural context into the conceptualization, design, methods, and implications of the empirical research.
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Affiliation(s)
- Melissa Pearman Fenton
- Department of Family, Youth and Community Sciences, University of Florida, 3041 McCarty D, PO BOX 110310, Gainesville, FL 32611 USA
| | - Larry F. Forthun
- Department of Family, Youth and Community Sciences, University of Florida, 3041 McCarty D, PO BOX 110310, Gainesville, FL 32611 USA
| | - Saprina Aristild
- Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd. MDC BOX 40, Tampa, FL 33612 USA
| | - Katherine B. Vasquez
- Department of Family, Youth and Community Sciences, University of Florida, 3041 McCarty D, PO BOX 110310, Gainesville, FL 32611 USA
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Shoval G, Visoki E, Moore TM, DiDomenico GE, Argabright ST, Huffnagle NJ, Alexander-Bloch AF, Waller R, Keele L, Benton TD, Gur RE, Barzilay R. Evaluation of Attention-Deficit/Hyperactivity Disorder Medications, Externalizing Symptoms, and Suicidality in Children. JAMA Netw Open 2021; 4:e2111342. [PMID: 34086035 PMCID: PMC8178707 DOI: 10.1001/jamanetworkopen.2021.11342] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Childhood suicidality (ie, suicidal ideation or attempts) rates are increasing, and attention-deficit/hyperactivity disorder (ADHD) and externalizing symptoms are common risk factors associated with suicidality. More data are needed to describe associations of ADHD pharmacotherapy with childhood suicidality. OBJECTIVE To investigate the associations of ADHD pharmacotherapy with externalizing symptoms and childhood suicidality. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, cross-sectional and 1-year-longitudinal associations were examined using data (collected during 2016-2019) from the Adolescent Brain Cognitive Development (ABCD) Study, a large, diverse US sample of children aged 9 to 11 years. Data analysis was performed from November to December 2020. EXPOSURES Main and interaction associations of externalizing symptoms (hyperactivity ADHD symptoms, oppositional defiant, and conduct disorder symptoms) and ADHD medication treatment (methylphenidate and amphetamine derivatives, α-2-agonists, and atomoxetine) at baseline assessment. MAIN OUTCOMES AND MEASURES Child-reported suicidality (past and present at baseline; current at longitudinal assessment). Covariates were age, sex, race/ethnicity, parents' education, marital status, and concomitant child psychiatric pharmacotherapy (antidepressants and antipsychotics). RESULTS Among 11 878 children at baseline assessment (mean [SD] age, 9.9 [0.6] years; 6196 boys [52.2%]; 8805 White [74.1%]), 1006 (8.5%) were treated with ADHD medication and 1040 (8.8%) reported past or current suicidality. Externalizing symptoms (median [range], 1 [0-29] symptom count) were associated with suicidality (for a change of 1 SD in symptoms, odds ratio [OR], 1.34; 95% CI, 1.26-1.42; P < .001), as was ADHD medication treatment (OR, 1.32; 95% CI, 1.06-1.64; P = .01). ADHD medication use was associated with less suicidality in children with more externalizing symptoms (significant symptom-by-medication interaction, B = -0.250; SE = 0.086; P = .004), such that for children who were not receiving ADHD medications, there was an association between more externalizing symptoms and suicidality (for a change of 1 SD in symptoms, OR, 1.42; 95% CI, 1.33-1.52; P < .001); however, for children who were receiving ADHD medication, there was no such association (OR, 1.15; 95% CI, 0.97-1.35; P = .10). The association with medication remained even when covarying for multiple confounders, including risk and protective factors for suicidality in ABCD, and was replicated in 1-year longitudinal follow-up. Sensitivity analyses matching participants with high numbers of externalizing symptoms taking and not taking ADHD medication treatment confirmed its association with less suicidality. CONCLUSIONS AND RELEVANCE These findings suggest that ADHD medication treatment is associated with less suicidality in children with substantial externalizing symptoms and may be used to inform childhood suicide prevention strategies.
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Affiliation(s)
- Gal Shoval
- Geha Mental Health Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Elina Visoki
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
| | - Tyler M. Moore
- Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Grace E. DiDomenico
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
| | - Stirling T. Argabright
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
| | - Nicholas J. Huffnagle
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
| | - Aaron F. Alexander-Bloch
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rebecca Waller
- Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
- Department of Psychology, University of Pennsylvania, Philadelphia
| | - Luke Keele
- Division of Epidemiology and Biostatistics, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tami D. Benton
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raquel E. Gur
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ran Barzilay
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Kaasbøll J, Sigurdson JF, Skokauskas N, Sund AM. Cohort profile: The Youth and Mental Health Study (YAMHS) - a longitudinal study of the period from adolescence to adulthood. PLoS One 2021; 16:e0247036. [PMID: 33606731 PMCID: PMC7895392 DOI: 10.1371/journal.pone.0247036] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 01/29/2021] [Indexed: 11/19/2022] Open
Abstract
The aim of this article is to provide a detailed description of the Youth and Mental Health Study (YAMHS),a population-based, representative (cluster sampling), prospective cohort study that was conducted to investigate risk and resilience factors for mental health conditions, specifically depressive symptoms and disorders, from adolescence to adulthood. The baseline data were collected in 1998 (T1) in two counties in central Norway from 2464 adolescents (response rate 88.3%, mean age 13.7 years). The first follow-up was conducted in 1999 (T2) (n = 2432, response rate of 87.1%, mean age 14.9 years). A subgroup of individuals was assessed at T2 (n = 345) with clinical interviews, and this subgroup was reassessed in 2005 (T3) (n = 265, 70.1%, 20 years). The last follow-up (of participants assessed at T1 and T2) was conducted in 2012 (T4) (n = 1266, 51.9%, 27.2 years). Demographics, depressive symptoms, general psychopathology, suicidal ideation and attempts and psychological and somatic factors were recorded. Among adolescents of both sexes, psychosocial variables were correlated with and predicted depressive symptom severity. The strongest predictors were sex (female), the levels of depressive symptoms the preceding year, and the total number of stressful events. The association between stressful life events and depressive symptoms was moderated by physical activity, while the relationship between stressful events and coping style was mediated by depressive symptoms. The rate of use of specialised mental health services among the depressed was low. The lifetime prevalence of depressive disorders was 23% at 15 years, and the most common disorder was minor depression. Adolescents who attempted suicide were more often victims of violence and less resilient than were non-suicide attempters. The existing longitudinal data from the cohort will be further analysed. Follow-up data will be obtained from existing national registries by links created with individual identification numbers.
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Affiliation(s)
- Jannike Kaasbøll
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Trondheim, Norway
- Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Johannes Foss Sigurdson
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Trondheim, Norway
| | - Norbert Skokauskas
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Trondheim, Norway
| | - Anne Mari Sund
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s Hospital, Trondheim, Norway
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Gårdvik KS, Torgersen T, Rygg M, Lydersen S, Indredavik MS. Suicidality, function and associated negative life events in an adolescent psychiatric population at 3-year follow-up. BMC Psychiatry 2021; 21:109. [PMID: 33602162 PMCID: PMC7893950 DOI: 10.1186/s12888-021-03100-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We aimed to examine psychosocial function, suicidality and school dropout in a clinical psychiatric population over a 3-year period from adolescence to young adulthood and explore associations with negative life events. METHODS This study is part of the Health Survey in Department of Children and Youth, St. Olavs hospital, Norway. In the first study visit (T1), 717 (43.5% of eligible) participated, aged 13-18 years (2009-2011), and 3 years later (T2), 570 answered a questionnaire (school functioning and negative life events), and 549 completed Kiddie SADS as telephone interview assessing DSM-IV diagnoses, psychosocial functioning and suicidality. RESULTS Suicidal ideation was more frequent among girls (17.9%) than among boys (5.4%) (risk difference; RD = 12.5%, CI (7.2 to 17.7), p < 0.001), as was suicidal behavior (25.0% vs. 9.5%, RD = 15.5%, CI (9.2 to 21.4), p < 0.001). Girls had lower psychosocial functioning than boys (Children's Global Assessment Scale; Mean score 68.2 vs. 75.2, Mean difference = - 7.0, CI (- 9.4 to - 4.7), p < 0.001), and more school dropout (22.5% vs. 13.2%, RD = 9.3%, CI (2.8 to 15.5), p = 0.006). For those with a psychiatric disorder, 24.8% of girls had suicidal ideation and 30.0% suicidal behavior, which was larger than for boys (RD = 18.0%, CI (10.8 to 24.7), p < 0.001, and RD = 18.3%, CI (10.2 to 25.8), p < 0.001, respectively). Exposure to negative life events was frequent for both genders, but more girls had experienced sexually uncomfortable or abusive situations, the last 3 years (23.5% vs. 2.9%, RD = 20.6%, CI (15.4 to 25.7), p < 0.001), and ever (44.4% vs. 7.9%, RD = 36.5%, CI (29.9 to 42.7), p < 0.001). Suicidal behavior was associated with having been threatened, physically harassed or violently hurt (RD = 16.7%, CI (9.5 to 23.9), p < 0.001), and for girls been put into sexually uncomfortable or abusive situations (RD = 20.1%, CI (10.4 to 29.9), p < 0.001) and seen others violently hurt (RD = 14.6%, CI (3.4 to 25.8), p = 0.011). CONCLUSIONS The high frequency of suicidality and school dropout confirms the severity of adolescent psychiatric disorders, especially among girls. Specific life events were associated risk factors and should be target points for prevention and intervention.
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Affiliation(s)
- Kari Skulstad Gårdvik
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Children and Youth, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Terje Torgersen
- Orkdal District Psychiatric Centre, Division of Mental Health Care, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit Sæbø Indredavik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Hill SY, Jones BL, Haas GL. Suicidal ideation and aggression in childhood, genetic variation and young adult depression. J Affect Disord 2020; 276:954-962. [PMID: 32745832 PMCID: PMC7484359 DOI: 10.1016/j.jad.2020.07.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 06/01/2020] [Accepted: 07/05/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Suicidal thoughts and behaviors have been studied in association with a variety of risk factors. The aim of the present study was to determine if levels of child/adolescent aggression and/or variation in candidate genes previously associated with suicidal behaviors in adults would influence the presence of suicidal ideation in childhood/adolescence, and to determine if ideation was associated with young adult depression. METHODS A longitudinal study of children, adolescents and young adults who were at high or low risk for alcohol and other substance use disorders by familial background were assessed. The Child Behavior Checklist (CBCL) aggression scale scores with derived subtypes (physical and relational) and genetic variation (ANKK1, DRD2, COMT, SLC6A4, HTR2C) were used as predictors of the presence and onset of suicidal ideation in childhood using survival analysis. Structural equation models (SEM) were fit to determine the relative importance of the predictors controlling for background variables. RESULTS CBCL aggression was significantly associated with child/adolescent suicidal ideation. One SNP in the ANKK1 gene (rs1800497), one in the HTR2C gene (rs6318), and two haplotypes, AAAC in the ANKK1-DRD2 complex and the CCC haplotype of the HTR2C gene, were significantly associated with the presence and onset of child/adolescent suicidal ideation. Follow up in young adulthood showed a significant relationship between suicidal ideation in childhood/adolescence and young adult depression. CONCLUSIONS Genetic variation and presence of elevated aggression scores from the childhood CBCL are significant predictors of childhood suicidal ideation. Suicidal ideation in childhood and being female are predictors of young adult depression.
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Affiliation(s)
- Shirley Y. Hill
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 15213,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA 15213,Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA USA 15213
| | - Bobby L. Jones
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 15213
| | - Gretchen L. Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 15213,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA 15213,VA Pittsburgh Healthcare System, Pittsburgh, PA USA 15213
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Song J, Kweon YS, Hong SH, Kim J, Chun KH, Bahn GH, Yook KH, Shin D, Hong HJ. Characteristics of First Visit Pediatric Patients with Suicidal Ideation and Behavior: An 8-Year Retrospective Chart Review. Soa Chongsonyon Chongsin Uihak 2020; 31:185-192. [PMID: 33110355 PMCID: PMC7584277 DOI: 10.5765/jkacap.200029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives Our study aimed to analyze the demographic and clinical characteristics of children and adolescents during their first visit to psychiatric outpatient departments for the management of suicidal ideation and behavior, and to compare the changes before and in 2012 or later. Methods This multicenter study was conducted at five university hospitals in a metropolitan area in South Korea. Medical records of patients aged 6–18 years were retrospectively reviewed from January 2009 to December 2016. Patients were analyzed by classifying them into suicidal and non-suicidal groups based on their visit to the hospital for management of suicidal ideation or suicide attempt and other mental problems, respectively. Results There were differences in the year of visit, diagnosis, education level, and referral sources between patients in the suicidal and non-suicidal groups. Multiple regression analysis was conducted based on the sex, education level, referral by school, and diagnosis of depression in patients in the suicidal group, which revealed significant association. Conclusion Suicide-related problems were significantly associated with the sex, education level, referral by school, and a diagnosis of depression in the patients. A well-connected referral system would be necessary for professional mental health management of high-risk children and adolescents.
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Affiliation(s)
- Jungeun Song
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Korea.,Suicide and School Mental Health Institute, Anyang, Korea
| | - Yong-Sil Kweon
- Suicide and School Mental Health Institute, Anyang, Korea.,Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Hee Hong
- Suicide and School Mental Health Institute, Anyang, Korea
| | - Joonbeom Kim
- Suicide and School Mental Health Institute, Anyang, Korea.,Yonsei University Interdisciplinary Graduate Program in Social Welfare Policy, Seoul, Korea
| | - Ka Hye Chun
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ki-Hwan Yook
- Department of Psychiatry, Bundang CHA Hospital, School of Medicine, CHA University, Seongnam, Korea
| | - Dongwon Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Ju Hong
- Suicide and School Mental Health Institute, Anyang, Korea.,Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Korea
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Adolescent self-harm and suicidal behavior and young adult outcomes in indigenous and non-indigenous people. Eur Child Adolesc Psychiatry 2020; 29:917-927. [PMID: 31535214 DOI: 10.1007/s00787-019-01406-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to examine the associations between self-harm and suicidal behavior in indigenous Sami and non-Sami adolescents and mental health and social outcomes in young adulthood. Data were obtained by linking the Norwegian Patient Registry (2008-2012), the National Insurance Registry (2003-2013), and the Norwegian Arctic Adolescent Health Study, a school-based survey inviting all 10th grade students in North Norway (2003-2005). In total, 3987 (68%) of all 5877 invited participants consented to the registry linkage, of whom 9.2% were indigenous Sami. Multivariable logistic regression was used to explore the associations between self-harm only, suicidal ideation with and without self-harm, and suicide attempts in adolescence (≤16-year-old), and later mental health disorders, long-term medical, social welfare benefit receipt, or long-term unemployment in young adulthood. Self-harm and suicidal behavior in Sami and non-Sami adolescents were associated with increased risk of later mental health disorders, long-term welfare benefit receipt, and long-term unemployment. These associations were attenuated by adolescent psychosocial problems. No major differences between the indigenous Sami participants and their non-Sami peers were found. Young suicide attempters experienced the highest risk, with adolescent suicide attempts being significantly associated with all four adult outcomes after adjustment. Self-harm and suicidal behavior in adolescence are markers of mental health disorders and unfavorable social outcomes in young adulthood, mostly accounted for by adolescent psychosocial problems. In contrast to other indigenous peoples, no indigenous health disparities were found, indicating that the indigenous Sami adolescents were not worse off.
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Psychosocial risk factors and outcomes associated with suicide attempts in childhood: A retrospective study. J Psychiatr Res 2020; 125:129-135. [PMID: 32278224 PMCID: PMC7217666 DOI: 10.1016/j.jpsychires.2020.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/04/2020] [Accepted: 03/13/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine factors differentiating individuals whose first suicide attempt was during childhood (ages 5-12 yrs) from those who first attempted suicide during adolescence (13-19 yrs) and during adulthood (≥20 yrs). METHOD A sample of 418 participants (ages 18-64 yrs) with a mood disorder and ≥1 lifetime suicide attempt was divided into three groups according to age of first suicide attempt (childhood: N = 43, adolescent: N = 149, adulthood: N = 226) and compared on demographics, childhood adversity, parental psychopathology, comorbid lifetime axis I diagnoses, self-harm and characteristics of first attempt. RESULTS Participants in the Childhood Attempt group were more likely to report childhood adversity, parental alcohol use disorder and subsequent suicide attempts than the two other groups. They were also more likely to have a depressed mother, non-suicidal self-injury (NSSI) during childhood and adolescence, lifetime PTSD and aggressive behavior than the Adulthood Attempt group. The Adolescent Attempt group had more childhood adversity, parental suicidal behavior, lifetime PTSD and NSSI during adolescence than the Adulthood Attempt group. The groups differed on methods of first attempt, and its lethality was related to age of attempt. CONCLUSIONS Early adversity and parental psychopathology are particularly prominent in those who make childhood suicide attempts, suggesting that this group may represent a suicidal behavior subtype.
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Roche KM, White RMB, Lambert SF, Schulenberg J, Calzada EJ, Kuperminc GP, Little TD. Association of Family Member Detention or Deportation With Latino or Latina Adolescents' Later Risks of Suicidal Ideation, Alcohol Use, and Externalizing Problems. JAMA Pediatr 2020; 174:478-486. [PMID: 32176245 PMCID: PMC7076534 DOI: 10.1001/jamapediatrics.2020.0014] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Policy changes since early 2017 have resulted in a substantial expansion of Latino or Latina immigrants prioritized for deportation and detention. Professional organizations, including the American Academy of Pediatrics, American Medical Association, and Society for Research in Child Development, have raised concerns about the potentially irreversible mental health effects of deportations and detentions on Latino or Latina youths. OBJECTIVE To examine how family member detention or deportation is associated with Latino or Latina adolescents' later mental health problems and risk behaviors. DESIGN, SETTING, AND PARTICIPANTS Survey data were collected between February 14 and April 26, 2018, and between September 17, 2018, and January 13, 2019, and at a 6-month follow-up from 547 Latino or Latina adolescents who were randomly selected from grade and sex strata in middle schools in a suburban Atlanta, Georgia, school district. Prospective data were analyzed using multivariable, multivariate logistic models within a structural equation modeling framework. Models examined how family member detention or deportation within the prior 12 months was associated with later changes in suicidal ideation, alcohol use, and clinical externalizing symptoms, controlling for initial mental health and risk behaviors. EXPOSURE Past-year family member detention or deportation. MAIN OUTCOMES AND MEASURES Follow-up reports of suicidal ideation in the past 6 months, alcohol use since the prior survey, and clinical level of externalizing symptoms in the past 6 months. RESULTS A total of 547 adolescents (303 girls; mean [SD] age, 12.8 [1.0] years) participated in this prospective survey. Response rates were 65.2% (547 of 839) among contacted parents and 95.3% (547 of 574) among contacted adolescents whose parents provided permission. The 6-month follow-up retention rate was 81.5% (446 of 547). A total of 136 adolescents (24.9%) had a family member detained or deported in the prior year. Family member detention or deportation was associated with higher odds of suicidal ideation (38 of 136 [27.9%] vs 66 of 411 [16.1%]; adjusted odds ratio, 2.37; 95% CI, 1.06-5.29), alcohol use (25 of 136 [18.4%] vs 30 of 411 [7.3%]; adjusted odds ratio, 2.98; 95% CI, 1.26-7.04), and clinical externalizing behaviors (31 of 136 [22.8%] vs 47 of 411 [11.4%]; adjusted odds ratio, 2.76; 95% CI, 1.11-6.84) at follow-up, controlling for baseline variables. CONCLUSION AND RELEVANCE This study suggests that recent immigration policy changes may be associated with critical outcomes jeopardizing the health of Latino or Latina adolescents. Since 95% of US Latino or Latina adolescents are citizens, compromised mental health and risk behavior tied to family member detention or deportation raises concerns regarding the association of current immigration policies with the mental health of Latino and Latina adolescents in the United States.
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Affiliation(s)
- Kathleen M. Roche
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Rebecca M. B. White
- The T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe
| | - Sharon F. Lambert
- Department of Psychology, George Washington University, Washington, DC
| | - John Schulenberg
- Institute of Social Research, Department of Psychology, University of Michigan, Ann Arbor
| | | | | | - Todd D. Little
- Educational Psychology and Leadership Department, College of Education, Texas Tech University, Lubbock,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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Lewis CP, Port JD, Blacker CJ, Sonmez AI, Seewoo BJ, Leffler JM, Frye MA, Croarkin PE. Altered anterior cingulate glutamatergic metabolism in depressed adolescents with current suicidal ideation. Transl Psychiatry 2020; 10:119. [PMID: 32327639 PMCID: PMC7181616 DOI: 10.1038/s41398-020-0792-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/21/2020] [Accepted: 03/25/2020] [Indexed: 01/09/2023] Open
Abstract
The anterior cingulate cortex (ACC) is involved in emotion regulation and salience processing. Prior research has implicated ACC dysfunction in suicidal ideation (SI) and suicidal behavior. This study aimed to quantify ACC glutamatergic concentrations and to examine relationships with SI in a sample of healthy and depressed adolescents. Forty adolescents underwent clinical evaluation and proton magnetic resonance spectroscopy (1H-MRS) at 3 T, utilizing a 2-dimensional J-averaged PRESS sequence sampling a medial pregenual ACC voxel. Cerebrospinal fluid-corrected ACC metabolite concentrations were compared between healthy control (HC, n = 16), depressed without SI (Dep/SI-, n = 13), and depressed with SI (Dep/SI+, n = 11) youth using general linear models covarying for age, sex, and psychotropic medication use. Relationships between ACC metabolites and continuous measures of SI were examined using multiple linear regressions. ROC analysis was used to determine the ability of glutamate+glutamine (Glx) and the N-acetylaspartate (NAA)/Glx ratio to discriminate Dep/SI- and Dep/SI+ adolescents. Dep/SI+ adolescents had higher Glx than Dep/SI- participants (padj = 0.012) and had lower NAA/Glx than both Dep/SI- (padj = 0.002) and HC adolescents (padj = 0.039). There were significant relationships between SI intensity and Glx (pFDR = 0.026), SI severity and NAA/Glx (pFDR = 0.012), and SI intensity and NAA/Glx (pFDR = 0.004). ACC Glx and NAA/Glx discriminated Dep/SI- from Dep/SI+ participants. Uncoupled NAA-glutamatergic metabolism in the ACC may play a role in suicidal ideation and behavior. Longitudinal studies are needed to establish whether aberrant glutamatergic metabolism corresponds to acute or chronic suicide risk. Glutamatergic biomarkers may be promising targets for novel risk assessment and interventional strategies for suicidal ideation and behavior.
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Affiliation(s)
- Charles P Lewis
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - John D Port
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Caren J Blacker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - A Irem Sonmez
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Bhedita J Seewoo
- Experimental and Regenerative Neurosciences, School of Biological Sciences, University of Western Australia, Perth, WA, Australia
- Brain Plasticity Group, Perron Institute for Neurological and Translational Research, Perth, WA, Australia
- Centre for Microscopy, Characterisation and Analysis, Research Infrastructure Centres, University of Western Australia, Perth, WA, Australia
| | - Jarrod M Leffler
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
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Glenn CR, Kleiman EM, Kearns JC, Santee AC, Esposito EC, Conwell Y, Alpert-Gillis LJ. Feasibility and Acceptability of Ecological Momentary Assessment with High-Risk Suicidal Adolescents Following Acute Psychiatric Care. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 51:32-48. [DOI: 10.1080/15374416.2020.1741377] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Catherine R. Glenn
- Department of Psychology, University of Rochester
- Department of Psychiatry, University of Rochester Medical Center
- Department of Psychology, Old Dominion University
| | - Evan M. Kleiman
- Department of Psychology, Rutgers, The State University of New Jersey
| | | | | | | | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center
| | - Linda J. Alpert-Gillis
- Department of Psychiatry, University of Rochester Medical Center
- Department of Pediatrics, University of Rochester Medical Center
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Janiri D, Doucet GE, Pompili M, Sani G, Luna B, Brent DA, Frangou S. Risk and protective factors for childhood suicidality: a US population-based study. Lancet Psychiatry 2020; 7:317-326. [PMID: 32171431 PMCID: PMC7456815 DOI: 10.1016/s2215-0366(20)30049-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Childhood suicidal ideation and behaviours are poorly understood. We examined correlates of suicidality in a US population-based sample of children participating in the Adolescent Brain and Cognitive Development (ABCD) study. The ABCD study aims to examine trajectories of mental health from childhood to adulthood and collects information on multiple domains, including mental and physical wellbeing, brain imaging, behavioural and cognitive characteristics, and social and family environment. We sought to identify and rank risk and protective factors for childhood suicidal thoughts and behaviours across these multiple domains and evaluate their association with self-agreement and caregiver agreement in reporting suicidality. METHODS The ABCD sample comprises a cohort of 11 875 children aged 9-10 years. The sociodemographic factors on which the sample was recruited were age, sex, race, socioeconomic status, and urbanicity. Participants were enrolled at 22 sites, the catchment area of which encompassed over 20% of the entire US population in this age group. Multistage sampling was used to ensure both local randomisation and representativeness of sociodemographic variation of the ABCD sample. The data used in this study were accessed from the ABCD Study Curated Annual Release 2.0. Suicidal thoughts and behaviours (suicidality) in each child were evaluated through independent child and caregiver reports based on the computerized Kiddie Schedule for Affective Disorders and Schizophrenia for DSM-5 (KSADS-5). We used bootstrapped logistic regression to quantify the association between suicidal ideation and behaviours, with measures of mental and physical wellbeing, behaviour, cognition, and social and family environment in participants from the ABCD study. FINDINGS Our study sample comprised 7994 unrelated children (mean age 9·9 years [SD 0·5]; 4234 [53%] male participants) with complete data on child-reported and caregiver-reported suicidal ideas and behaviours. Overall, 673 (8·4%) children reported any past or current suicidal ideation, 75 (0·9%) had any past or current suicidal plans, and 107 (1·3%) had any past or current suicidal attempts. According to caregivers, 650 (8·1%) of the children reported any past or current suicidal ideation, 46 (0·6%) reported any past or current suicidal plans, and 39 (0·5%) reported past or current suicidal attempts. However, inter-informant agreement was low (Cohen's κ range 0·0-0·2). Regardless of informant, child psychopathology (odds ratio [OR] 1·7-4·8, 95% CI 1·5-7·4) and child-reported family conflict (OR 1·4-1·8, 95% CI 1·1-2·5) were the most robust risk factors for suicidality. The risk of child-reported suicidality increased with higher weekend screen use time (OR 1·3, 95% CI 1·2-1·7) and reduced with greater parental supervision and positive school involvement (for both OR 0·8, 95% CI 0·7-0·9). Additionally, caregiver-reported suicidality was positively associated with caregiver educational level (OR 1·3, 95% CI 1·1-1·5) and male sex in children (1·5, 1·1-2·0), and inversely associated with the number of household cohabitants (0·8, 0·7-1·0). INTERPRETATION We identified risk and protective factors that show robust and generalisable associations with childhood suicidality. These factors provide actionable targets for optimising prevention and intervention strategies, support the need to identify and treat psychopathology in school-age children, and underscore the importance of school and family interventions for childhood suicidality. FUNDING National Institutes of Health.
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Affiliation(s)
- Delfina Janiri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy; Centro Lucio Bini-Aretæus, Rome, Italy
| | - Gaelle E Doucet
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gabriele Sani
- Centro Lucio Bini-Aretæus, Rome, Italy; Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Beatriz Luna
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Paediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
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Neurocognitive Processes Implicated in Adolescent Suicidal Thoughts and Behaviors: Applying an RDoC Framework for Conceptualizing Risk. Curr Behav Neurosci Rep 2019; 6:188-196. [PMID: 33312840 DOI: 10.1007/s40473-019-00194-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of Review Identifying risk factors for STBs during adolescence is essential for suicide prevention. In this review, we employ the Research Domain Criteria (RDoC) framework to synthesize studies on key neurocognitive processes-cognitive control, reward responsiveness/valuation, and negative urgency-relevant to adolescent STBs. Recent Findings Within subdomains of Cognitive Control, studies of inhibition/suppression and updating/maintenance were mixed, while response selection (i.e., decision-making) deficits were consistently associated with suicide attempts. Fewer studies, by comparison, have probed the Positive Valence Systems. Relative to healthy controls, adolescents with prior STBs may show a blunted neural response to rewards and value rewards less, but findings require replication. Finally, negative urgency, which may span subdomains within both Cognitive Control and the Positive Valence Systems, was associated with recent suicide attempts in the only study to directly test this association. Summary Few studies have examined neurocognitive functioning in relation to adolescent STBs, despite the relevance of this research to detecting suicide risk. We recommend that future studies incorporate developmental contexts relevant to both neurocognitive processes and STBs.Broadly, cognitive control is associated with activation of the prefrontal cortex (PFC) and its interaction with other brain areas (e.g., reward and motor regions) [32]. Functional magnetic resonance imaging (fMRI) studies using emotional stimuli have provided evidence of abnormalities in neural regions supporting cognitive control among youth with STBs. [33] computed neural activation corresponding to viewing angry faces (relative to a fixation cross) in a sample of depressed youth. They found that, relative to non-attempters, attempters had: (a) increased activation in the right anterior gyrus and dorsolateral PFC and (b) reduced functional connectivity between the anterior cingulate gyrus and bilateral insulae. Relatedly, youth with bipolar disorder and a history of suicide attempts showed reduced functional connectivity between the amygdala and the left ventral PFC while viewing emotional (happy, fearful) and neutral faces compared to patient non-attempters [34]. The findings indicate that attempters may have problems regulating and appropriately deploying attention, as well as planning and executing behavioral responses, in emotional contexts.
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Kronström K, Tiiri E, Jokiranta-Olkoniemi E, Kaljonen A, Sourander A. Suicidality among child and adolescent psychiatric inpatients: time trend study comparing 2000 and 2011. Eur Child Adolesc Psychiatry 2019; 28:1223-1230. [PMID: 30741340 PMCID: PMC6751151 DOI: 10.1007/s00787-019-01286-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
Abstract
Child and adolescent inpatient treatment has faced major changes since the year 2000, including shorter inpatient stays and a greater use of psychotropic drugs. This study explored changes and correlates of suicidal threats and suicide acts among inpatients, by comparing Finnish cross-sectional surveys from 2000 to 2011. A questionnaire that explored the background, diagnosis and treatment characteristics of inpatients was sent to all child and psychiatric wards in Finland. The data collection was carried out on specified days in 2000 and 2011. We received comprehensive data on 504 patients from 64/69 (93%) wards in 2000 and on 412 patients from 75/79 (95%) wards in 2011. The Spectrum of Suicidal Behaviour Scale was used to explore suicidality. The prevalence of suicidality did not change in this nationwide study: suicidal threat rates were 38% in 2000 and 37% in 2011, and suicide attempts in both years were 11%. The prevalence of suicidal acts was higher among girls and teenagers, while low general functioning, defined as Children's Global Assessment Scale scores of under 30, was associated with both suicidal threats and acts. Violent acts were associated with both suicidal threats and acts in 2000, but not in 2011. Despite changes in treatment practices and shorter inpatient stays, the prevalence of suicidality in child and adolescent inpatient treatment remained unchanged in Finland in 2000 and 2011.
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Affiliation(s)
- Kim Kronström
- Department of Adolescent Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland.
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.
| | - Elina Tiiri
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
| | - Elina Jokiranta-Olkoniemi
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
| | - Anne Kaljonen
- Turku Institute for Child and Youth Research, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
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