Service use among Mexico City adolescents with suicidality

Suicidal thoughts and behaviors in the Kingdom of Saudi Arabia

OBJECTIVE

Suicidal thoughts and behaviors (STB) constitute an escalating public health concern globally. Despite the growing burden of suicidal ideation, plan, and attempts, national information on the trends of STB is lacking in the Kingdom of Saudi Arabia (KSA). Therefore, we aim to report on the prevalence, correlates, and treatment-seeking behaviors associated with STB in the country using nationally representative information from The Saudi National Mental Health Survey (SNMHS).

METHODS

The SNMHS is a national household survey of Saudi citizens aged 15-65 (n = 4004). The adapted Composite International Diagnostic Interview (CIDI) 3.0 was administered to produce lifetime and 12-month prevalence and treatment estimates of STB in the KSA. Associated correlates were calculated using cross tabulations and logistic regressions.

RESULTS

Suicidal ideation, plan, and attempt had respective lifetime prevalence rates of 4.90 %, 1.78 %, and 1.46 %; 12-month prevalence rates of 1.82 %, 0.89 %, and 0.63 %. Significant correlates of STB include younger age, female gender, low education, urban rearing, and singe marital status. STB were also significantly associated with the presence of prior mental disorders, childhood adversities, and low treatment-seeking.

CONCLUSIONS

High unmet need and significant sociocultural and psychological risk factors have been identified in association with STB in the KSA. Given the community-based nature of the SNMHS and the limited national data on STB in the Middle East and North Africa region, our findings can extend to inform the necessary healthcare policies, treatment plans, and prevention strategies needed to alleviate the burdens of STB in the region.

Predisposing, enabling and need factors associated with past-year health service use for mental health reasons in adults with suicidal ideation in France

BACKGROUND

We aimed to determine the prevalence of past-year health service use for mental health reasons in a French representative sample of adults overall and in those reporting suicidal ideation in the past year and assess the factors associated with health service use according Andersen's model of healthcare seeking behaviors.

METHODS

Data were drawn from the 2017 Health Barometer survey a large computer-assisted telephone survey on a representative sample of the general population aged 18-75 years living in France (n = 25,319). Logistic regression analyses were used to study past-year health service use for mental health reasons as a function of predisposing, enabling and need factors. Analyses were stratified according to suicidal ideation and sex.

RESULTS

Among individuals with suicidal ideation, 45.1 % of adults, 50.4 % of females and 37.6 % of males, reported past-year health service use for a mental health reason. Increased odds of health service use were observed regarding predisposing (female sex, younger age, higher education), enabling (income level), and need factors (prior suicide attempts, role impairment and major depression). Among males, the only significant factors included age 65-75 (aOR = 0.16, 95%CI = 0.03-0.84) and major depression (aOR = 2.79, 95%CI = 1.79-4.36).

LIMITATIONS

Self-reported service utilization. Cross-sectional survey.

CONCLUSIONS

In a country with a high level of medical coverage, further research is needed to identify sex-specific socio-demographic, economic and clinical differences in the use of different types of health services as well as perceived need for care, structural and attitudinal barriers to treatment.

Treatment compliance and risk and protective factors for suicide ideation to completed suicide in adolescents: a systematic review

OBJECTIVE

To review the literature regarding adolescent suicide risk and explore the associations between treatment compliance (expressed as a concept including measured adherence to treatment and/or mental health service utilization) and risk and protective factors for suicidal behavior (SB), as well as the association between treatment compliance and reattempts.

METHODS

PubMed, LILACS, and Google Scholar were searched using the following terms: (adolescent*) AND (suicide*) AND (risk factor OR protective factors) AND (treatment compliance OR treatment attrition OR treatment adherence OR treatment drop out OR treatment retention OR mental health utilization). We retrieved studies that focused on the relation of treatment compliance to risk and protective factors for SB and that had only adolescent samples.

RESULTS

Of 4,841 articles, 30 original articles were selected for review. Most studies indicated high mental health service (MHS) utilization and poor treatment adherence by SB patients. Social minority status and conduct disorder were associated with less treatment adherence, while female sex, parental perceived need for treatment, and major depression were associated with greater treatment adherence. Inpatient and intensive emergency care after SA and family interventions improved MHS utilization and treatment compliance. However, we found no substantial protective effect of treatment compliance against reattempts.

CONCLUSION

Effective treatment planning for compliance requires considering psychopathology, treatment planning, and social, familial, and individual factors.

Psychotherapy and youth suicide prevention: An interpretative phenomenological analysis of specialist clinicians' experiences

The study explored psychologists' experiences in delivering short-term psychotherapy for suicidal adolescents and sought to clarify how these experiences fit with empirically supported interventions and the interpersonal psychological theory of suicide. Semistructured interviews were conducted with 12 psychologists' who provided short-term psychotherapy in a suicide prevention programme for youth (12- to 25-year-olds). Interview transcripts were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: (i) understand the experience and context of the suicidality and the importance of a formulation-based approach to engagement and individualized treatment planning; (ii) involve broad support systems, and in particular families, to help the young person reduce feelings of burdensomeness and increase safety, connectedness and belonging; and (iii) improve affect regulation and reflective functioning, important not only for the young person but also for the support system to maximize the positive impact of supports via emotional coregulation and effective problem-solving. Interventions and approaches as well as the potential underlying processes of change being targeted are discussed in light of these findings. As an example, the development of a suicide safety plan was an intervention that traversed these themes. When used as a process tool, it helped foster a collaborative, formulation, dimensional and biopsychosocial approach to treat psychopathology and suicidality and extended beyond the therapist-client dyad. Moreover, treatment needs to be extended beyond the therapist-client dyad to allow therapists to facilitate a systemic treatment response, as this was seen as a major component of interventions for suicidal youth.

Living Conditions of Adolescents Who Have Attempted Suicide in Mexico

Suicidal behavior represents a complex public health problem, with a rising number of suicide attempts registered among Mexican adolescents. We undertook a qualitative study in order to understand the living conditions of adolescents who had attempted to take their lives in five Mexican states. We interviewed 37 adolescents who had engaged in suicide attempts in the year prior to our study. To code and analyze the information, we defined the following three categories of living conditions as social determinants of health for adolescents: poverty and vulnerability, education, and health care. To this end, we followed the methodology proposed by Taylor and Bogdan, and used Atlas.ti 7.5.18 software for analyses. Among our findings, we noted that poverty, manifested primarily as material deprivation, rendered the daily lives of our interviewees precarious, compromising even their basic needs. All the young people analyzed had either received medical, psychological, and/or psychiatric care as outpatients or had been hospitalized. School played a positive role in referring adolescents with suicidal behavior to health services; however, it also represented a high-risk environment. Our findings highlight the urgent need to implement a national intersectoral strategy as part of comprehensive public policy aimed at improving the health of adolescents in Mexico.

Do individuals follow up with mental health services after a suicide attempt? Findings from the assertive management of attempted suicide service, Bengaluru, India

OBJECTIVE

There is limited information from India on whether individuals follow up with mental health services after a suicide attempt. The objective of this study was to determine follow-up rates after a suicide attempt with mental health services of those individuals treated as part of the assertive management of attempted suicide service in a general hospital in Bengaluru, India.

MATERIALS AND METHODS

Records from 284 persons from January 2016 to December 2016 were analyzed to ascertain their follow-up rates with mental health services after a suicide attempt.

RESULTS

After discharge, 25% individuals followed up on a single occasion with mental health services. Individuals with a psychiatric diagnosis were significantly more likely to follow up with mental health services as compared to those without a psychiatric diagnosis (P < 0.011, odds ratio: 2.875, confidence interval at 95%: 1.276-6.481). 90.8% were contacted through telephone as part of aftercare.

CONCLUSIONS

Most individuals in India, especially those without a psychiatric diagnosis, do not follow up with mental health services after a suicide attempt. Periodic telephonic contacts are a useful aftercare strategy to reach out to this high-risk population. Limitation of this study is that findings are from an urban general hospital setting.

Predicting Suicidal Ideation in College Students with Mental Health Screening Questionnaires

OBJECTIVE

The present study aimed to identify risk factors for future SI and to predict individual-level risk for future or persistent SI among college students.

METHODS

Mental health check-up data collected over 3 years were retrospectively analyzed. Students were categorized as suicidal ideators and non-ideators at baseline. Logistic regression analyses were performed separately for each group, and the predicted probability for each student was calculated.

RESULTS

Students likely to exhibit future SI had higher levels of mental health problems, including depression and anxiety, and significant risk factors for future SI included depression, current SI, social phobia, alcohol problems, being female, low self-esteem, and number of close relationships and concerns. Logistic regression models that included current suicide ideators revealed acceptable area under the curve (AUC) values (0.7-0.8) in both the receiver operating characteristic (ROC) and precision recall (PR) curves for predicting future SI. Predictive models with current suicide non-ideators revealed an acceptable level of AUCs only for ROC curves.

CONCLUSION

Several factors such as low self-esteem and a focus on short-term rather than long-term outcomes may enhance the prediction of future SI. Because a certain range of SI clearly necessitates clinical attention, further studies differentiating significant from other types of SI are necessary.

Association between attempted suicide and academic performance indicators among middle and high school students in Mexico: results from a national survey

BACKGROUND

Students' mental health is associated to academic performance. In high income countries, higher students' grades are related to lower odds of suicidal behaviors, but studies on other indicators of academic performance are more limited, specially in middle income countries.

METHODS

Data from 28,519 middle and high school students selected with multistage clustered sampling in the Mexican National Survey of Student's Drug Use. Using a self-administered questionnaire, lifetime suicidal attempt and four indicators of academic performance were assessed: age inconsistency with grade level, not being a student in the last year, perceived academic performance and number of failed courses. Multiple logistic regression models were used to control for sociodemographic and school characteristics.

RESULTS

The lifetime prevalence of attempted suicide was 3.0% for middle school students and 4.2% for high school students. Among middle school students, statistically adjusted significant associations of suicide attempt with academic performance indicators were: not being a student the year before, worse self-perceived performance and a higher number of failed courses; among high school students, predictors were failed courses and self-perceived academic performance, with ORs of 1.65 and 1.96 for the categories of good and fair/poor respectively, compared to those who reported very good performance.

CONCLUSION

Self-perceived academic performance was the main indicator for suicide in both school levels. Suicide prevention efforts in Mexico's schools should include asking students about the perception they have about their own academic performance.

The growth of suicide ideation, plan and attempt among young adults in the Mexico City metropolitan area

AIMS

Low and middle income countries share a heavy burden of suicide with about three in every four suicides occurring in these countries. Mexico has witnessed a growing trend in suicide deaths; if this trend is not simply a reflection of better reporting of suicide on death certificates, then this increase should logically be accompanied by an increasing trend in suicide ideation, plan and attempts, but we lack information on the trends for suicide ideation, plan and attempt for this period. We therefore aim to report changes for suicidal behaviour for the period 2001-2013 in the Mexico City Metropolitan Area.

METHOD

Using two cross-sectional surveys conducted in Mexico in 2001 and 2013, we report the lifetime and 12-month prevalence of suicide ideation, plan and attempt and changes in treatment for these problems among respondents aged 19-26 living in the Mexico City Metropolitan Area 12 years apart. To estimate the changes in prevalence for each outcome, we used generalised linear models to calculate prevalence ratios (PR; the prevalence rate in the exposed (year 2013) divided by the prevalence rate in the unexposed (year 2001-2002), adjusting for sociodemographic variables.

RESULTS

While increases in the prevalence are noted everywhere, statistical comparisons only found differences for lifetime ideation (PR = 3.1; 95% CI = 1.7-5.8) and a borderline difference for suicide attempt (PR = 2.2; 95% CI = 1.0-4.9). No attempt within the last 12-months was reported in 2001, but the prevalence in 2013 reached 1.5% (18 cases). While PRs for 12-month prevalence were all above the null, none reached statistically significant differences. During this 12-year period, the distribution of mental disorders and the use of services for mental disorders among suicide ideators, planners and attempters did not change in any noticeable way.

CONCLUSIONS

The limitations of our data are the small number of participants in the 2001 survey, the low follow-up rate for the survey in 2013 and that while representative from one city it does not represent the whole country. These findings suggest that suicide ideation and attempt may have increased during this 12-year period in the Mexico City metropolitan area, but this increase did not lead to more use of mental health care services. This information, coupled with the long-term trend of increasing suicide death rates in the country, draw a worrisome and neglected scenario for our youth in this region. Urgent measures, following the recent WHO guidelines for suicide prevention, must not be postponed.

Preliminary Results From an Examination of Episodic Planning in Suicidal Behavior

Background: Prior research has reported that a substantial portion of suicidal behavior occurs impulsively. These studies, however, have been unable to assess for episodic planning. Aims: To provide preliminary support for the plausibility and utility of assessing episodic, nonlinear planning in suicidal behavior. Method: Fifty undergraduates with a prior history of suicidal behavior responded to a series of questions assessing level of attempt, method, and level of planning during their most recent self-reported suicide attempt. Results: Level of intent was positively associated with planning, and the modal individual whose most recent attempt involved clear intent to die endorsed planning for at least 1 year. Conclusion: These preliminary data support the plausibility and potential utility of assessing episodic planning and indicate that suicide attempts involving a clear intent to die typically require extensive levels of planning and rarely (if ever) emerge without forethought.

Study on genes of the serotonergic system and suicidal behavior: protocol for a case-control study in Mexican population

BACKGROUND

Suicidal behavior is a leading cause of injury and death worldwide. Several studies have provided a possible relationship between genetic factors and suicidal behavior. Also, these studies have shown evidence for altered serotonergic neural transmission in the pathogenesis of suicidal behavior. In addition, genes pertaining to the serotonergic system have been proposed as candidates to establish biological correlates between suicidal behavior and the serotonergic system. The most studied genes are SCL6A4, HTR2A, HTR2C, HTR1A, HTR1B, TPH-1, and TPH-2. To get a comprehensive understanding of the association with suicidal behavior we will conduct genotype assays studies in a Mexican population.

METHODS/DESIGN

We will conduct a case-control study. The population sample will comprise adolescent and adult patients admitted for attempted of suicide and diagnosed by a psychiatrist. A peripheral blood sample will be taken from all the subjects (cases and controls). Genomic DNA from the leukocytes blood sample will be extracted. The genotypes of interest are distributed in the following genes: SCL6A4, HTR2A, HTR1A, HTR1B, HTR2C, TPH-2 and TPH-1. All the samples will be analyzed using a polymerase chain reaction (PCR) end-point method. We will evaluate the Hardy-Weinberg Equilibrium. The chi-squared test or Fisher's exact test will be used to compare genotype and allele frequencies between control and case groups. The Quanto 1.2 software will measure the sample size of the association. For all the association analyses the level of significance will be set at p = 0.05 and the confidence interval at 95%.

DISCUSSION

Suicidal behavior has been increase in Mexico, principally in young population. Our study will demonstrate the association between serotoninergic genes and suicide behavior in Mexican population.

Twelve-month suicidal symptoms and use of services among adolescents: results from the National Comorbidity Survey

OBJECTIVE

The study assessed the prevalence of suicidal ideation, suicide plans, and suicide attempts as well as patterns of mental health service use among adolescents.

METHODS

Data came from the National Comorbidity Survey–Adolescent Supplement, a nationally representative sample of 10,123 adolescents aged 13 to 18 years who participated in computer-assisted, face-to-face interviews between February 2001 and January 2004. Prevalences of suicidal thoughts and behaviors in the past year were determined. Past-year use of any mental health treatment and receipt of four or more visits from one provider among youths with suicidal ideation, plans, or attempts were also assessed. Associations were evaluated by using logistic regression.

RESULTS

During the course of 12 months, 3.6% of adolescents reported suicidal ideation without a plan or attempt, .6% reported a suicide plan without an attempt, and 1.9% made a suicide attempt. Overall, two-thirds of adolescents with suicidal ideation (67.3%) and half of those with a plan (54.4%) or attempt (56.9%) did not have any contact with a mental health specialist in the past year. Different predictors of use of care were identified for each group.

CONCLUSIONS

Adolescent suicidality often is untreated in the United States. Increased outreach efforts to improve treatment access for youths with suicidal ideation and attempts are needed.

Prevalência e fatores associados a indicadores negativos de saúde mental em adolescentes estudantes do ensino médio em Pernambuco, Brasil

OBJETIVOS: identificar a prevalência e fatores associados a indicadores negativos de saúde mental em adolescentes. MÉTODOS: utilizou-se um questionário previamente validado para coletar dados de 4.207 adolescentes (14-19 anos) estudantes do ensino médio, selecionados através de amostragem por conglomerados em dois estágios. RESULTADOS: as prevalências de tristeza, sentimento de solidão, pensamento de suicídio, dificuldade para dormir devido à preocupação e planos de suicídio foram, respectivamente, 29,7%, 15,8%, 11,2%, 10,0% e 7,8%. A prevalência de todos os indicadores foi superior entre as moças, sendo a tristeza o indicador mais prevalente. Identificou-se que a cor da pele não foi um fator associado à ocorrência dos indicadores negativos de saúde mental, enquanto não morar com os pais apresentou associação significativa com sentimento de solidão e pensamento em suicídio. CONCLUSÕES: a prevalência de sentimento de solidão e de tristeza é alta e as moças representam um subgrupo de maior risco em relação a todos os indicadores negativos de saúde mental.

Mental health screening and follow-up care in public high schools

OBJECTIVE

Despite increased interest in screening adolescents for mental health problems and suicide risk, little is known regarding the extent to which youth are identified and connected with appropriate services.

METHOD

Between 2005 and 2009, a total of 4,509 ninth-grade students were offered screening. We reviewed the records of the 2,488 students who were screened. Students identified as being at risk were provided with a referral. Data were collected on screening results, mental health referrals, and completion of recommended treatment over approximately 90 days.

RESULTS

Among students screened, 19.6% were identified as being at risk, 73.6% of whom were not currently receiving any treatment. Students referred for school services tended to be less severely ill than those referred for community services, with lower rates of suicidal ideation, prior suicide attempts, and self-injury. Among at-risk students not currently in treatment, 76.3% of students referred received at least one mental health visit during the follow-up period. Overall, 74.0% of students were referred to school and 57.3% to community services. A great majority of school referrals (80.2%) successfully accessed services, although a smaller proportion of community services referrals successfully accessed treatment (41.9%).

CONCLUSIONS

Systematic voluntary school-based mental health screening and referral offers a feasible means of identifying and connecting high-risk adolescents to school- and community-based mental health services, although linkages to community-based services may require considerable coordination.