Parental intoxication and adolescent suicidal behavior

Proximity of alcohol outlets and presentation to hospital by young people after self-harm: A retrospective geospatial study using the integrated data infrastructure

OBJECTIVES

There is a well-established association between alcohol use, misuse, intoxication and self-harm, the latter of which is associated with suicide. This study aimed to better understand the association between proximity to alcohol outlets and the likelihood of young people presenting to hospital following self-harm.

METHODS

This was a nationwide retrospective geospatial study using data from the New Zealand Integrated Data Infrastructure using population-level data for 10-29-year-olds for the 2018 and 2017 calendar years. Presentations to hospital following self-harm were identified using the national minimum data set. Proximity to alcohol outlets was defined in road network distance (in kilometres) and ascertained using Integrated Data Infrastructure geospatial data. Alternative measures of proximity were employed in sensitivity analyses. Complete-case two-level random intercept logistic regression models were used to estimate the relationship between alcohol outlet proximity and hospital presentation for self-harm. Adjusted models included sex, age, ethnicity, area-level deprivation, urbanicity and distance to nearest medical facility. Analyses were also stratified by urbanicity.

RESULTS

Of the 1,285,368 individuals (mean [standard deviation] age 20.0 [5.9] years), 7944 (0.6%) were admitted to hospital for self-harm. Overall, the odds of presenting to hospital for self-harm significantly decreased as the distance from the nearest alcohol outlet increased, including in adjusted models (adjusted odds ratio 0.980; 95% confidence interval = [0.969-0.992]); the association was robust to changes in the measure of alcohol proximity. The effect direction was consistent across all categorisations of urbanicity, but only statistically significant in large urban areas and rural areas.

CONCLUSIONS

The findings of this study show a clear association between young people's access to alcohol outlets and presentation to hospital for self-harm and may provide a mandate for government policies and universal interventions to reduce young people's access to alcohol outlets. Further research regarding causative mechanisms is needed.

Perceived problematic alcohol use in the family and adolescents' stress-related complaints: examining the buffering role of the school's degree of student focus as rated by its teachers

BACKGROUND

A non-negligible proportion of children grow up with problematic alcohol use in the family. Problematic familial drinking can be regarded as a stressor, and prior studies have consistently reported poorer mental health among adolescents who are exposed. However, it is also of relevance to identify modifiable protective factors which may buffer against stress-related ill-health in this group of adolescents. One context where such factors may be present is the school. The aim of this study is to examine the relationship between perceived problematic familial alcohol use and students' stress-related complaints, and specifically to explore if the school's degree of student focus can buffer against any such negative health consequences of problem drinking at home.

METHODS

Data were drawn from four separate surveys, the Stockholm School Survey (SSS) and the Stockholm Teacher Survey (STS) conducted in 2014 and 2016 among 7,944 students (~ 15-16 years) and 2,024 teachers in 147 Stockholm senior-level school units. Perceived problematic familial alcohol use was measured by one item in the SSS. Stress-related complaints were captured by co-occurring somatic complaints and psychological distress, and reported by students in the SSS. The school's student focus was measured by an index based on teachers' ratings of four items in the STS. A set of covariates at the student and the school level were also included. Two-level binary logistic and linear regression models were performed.

RESULTS

Perceived problematic familial alcohol use was linked with an increased likelihood of reporting co-occurring somatic complaints as well as psychological distress. Cross-level interactions revealed that the association between perceived problematic familial alcohol use and co-occurring somatic complaints was weaker among students attending schools with stronger teacher-rated student focus. Regarding psychological distress, the association was weaker for students attending schools with intermediate or strong teacher-rated student focus, compared with those attending schools with weaker teacher-rated student focus.

CONCLUSIONS

The findings provide support for the assumption that favourable conditions in schools can buffer against negative health consequences of problematic conditions in the family, thus serving a compensatory role.

Fathers' alcohol use and suicidal behaviour in offspring during youth and young adulthood

OBJECTIVE

To examine the association between various indicators of father's alcohol use and suicidal behaviour in offspring during youth and young adulthood.

METHODS

The study is based on a cohort of 68 910 Swedish citizens who were born between 1970 and 1985 and have fathers who participated in conscription for compulsory military training in 1969/70. Information on fathers' alcohol use was collected during conscription. Offspring was followed for suicide attempts or completed suicides (through linkage with national registers) from age 12 to end of follow-up in 2008.

RESULTS

After adjustment for confounders, the hazard ratio (HR) for offspring to fathers who were heavy drinkers was 1.4 (95% CI 1.02, 1.93) while the associations turned non-significant for offspring to fathers who often drank into intoxication, HR 1.14 (0.68, 1.90). The highest risk for suicidal behaviour was found for offspring to fathers who had been apprehended for drunkenness two times or more, or with an alcohol-related hospitalization, with adjusted HRs of 2.1 (1.4, 3,14) and 1.9 (1.27, 2,85) respectively.

CONCLUSION

Fathers' alcohol use is associated with increased risk of suicidal behaviour among offspring in youth and young adulthood.

Association Between Parental Medical Claims for Opioid Prescriptions and Risk of Suicide Attempt by Their Children

IMPORTANCE

The rate of youth suicide has increased over the past 15 years in the United States as has the rate of death due to opioid overdose in adults of parental age.

OBJECTIVE

To explore the possible connection between parental use of prescription opioids and the increasing rate of youth suicide.

DESIGN, SETTING, AND PARTICIPANTS

A pharmacoepidemiologic study was conducted from January 1, 2010, to December 31, 2016, linking medical claims for parental opioid prescriptions with medical claims for suicide attempts by their children. The study used MarketScan medical claims data covering more than 150 million privately insured people in the United States. The study included 121 306 propensity score-matched 30- to 50-year-old parents who used opioids and parents who did not use opioids and their 10- to 19-year-old children (148 395 children of parents who did not use opioids and 184 142 children of parents who used opioids). Propensity score matching was used to identify relevant control families based on demographic features and concomitant use of psychotropic medication.

EXPOSURES

Opioid use in a parent was defined as having prescription fills covering more than 365 days of an opioid between 2010 and 2016.

MAIN OUTCOMES AND MEASURES

Suicide attempt rate in the children of parents who used opioids and those who did not use opioids.

RESULTS

A total of 148 395 children (75 575 sons and 72 820 daughters; mean [SD] age, 11.5 [1.6] years at the start of follow-up) had parents who did not use opioids and 184 142 children (94 502 sons and 89 640 daughters; mean [SD] age, 11.8 [1.8] years at the start of follow-up) with parents who did use opioids. There were 100 899 children aged 10 to 14 years and 47 496 children aged 15 to 19 years with parents who did not use opioids and 96 975 children aged 10 to 14 years and 87 163 children aged 15 to 19 years with parents who did use opioids. Of the children with parents who did not use opioids, 212 (0.14%) attempted suicide; of the children with parents who did use opioids, 678 (0.37%) attempted suicide. Parental use of opioids was associated with a doubling of the risk of a suicide attempt by their offspring (odds ratio [OR], 1.99; 95% CI, 1.71-2.33). The association remained significant after adjusting for child age and sex (OR, 1.85; 95% CI, 1.58-2.17), addition of child and parental depression and diagnoses of substance use disorder (OR, 1.46; 95% CI, 1.24-1.72), and addition of parental history of suicide attempt (OR, 1.45; 95% CI, 1.23-1.71). Geographical variation in opioid use did not change the association (OR, 2.00; 95% CI, 1.71-2.34).

CONCLUSIONS AND RELEVANCE

Children of parents who use prescription opioids are at increased risk for suicide attempts, which could be a contributing factor to the time trend in adolescent suicidality. The care of families with a parent who uses opioids should include mental health screening of their children.

Exposure to parental psychopathology and offspring's risk of suicide-related thoughts and behaviours: a systematic review

AIMS

The primary objective of this systematic review was to identify and synthesise analytic studies examining the association between exposure to parental psychopathology in childhood and the nature of subsequent suicide-related thoughts (SRT) and suicide-related behaviour (SRB) (severity of ideation, planned/unplanned attempts/lethality) and to describe the direction, and magnitude of associations. The secondary objective was to determine if the associations from the primary objective differ by the type(s) and timing of parental psychopathology, sex/gender of the parent and child and is mediated by child psychiatric symptoms and family functioning.

METHODS

A systematic review was conducted using guidelines from the PRISMA statement. MEDLINE, CINAHL, EMBASE, psycINFO, Web of Science and grey literature sources were searched by two reviewers to March, 2017. Studies were included if they examined any parental psychopathology (Diagnostic and Statistical Manual of Mental Disorders criteria or equivalent) or SRT or SRB and offspring SRT or SRB occurring from birth <25 years of age.

RESULTS

Out of 10 231 studies identified, 54 were included for review. Studies were clinically and methodologically heterogeneous with none at low risk of bias (ROB). Nine studies with moderate ROB indicated a significantly increased risk of offspring SRT, suicide attempts (SA) and suicide among those exposed to maternal SA and suicide in childhood or adolescence. In the remaining 45 studies with higher ROB this association persisted. Several studies (67%) did not confirm that the exposure occurred in the offspring's childhood or adolescence. Findings were suggestive of a mediating effect of offspring psychiatric symptoms, however, few studies examined mediation and effect modification of contextual variables.

CONCLUSIONS

Offspring exposed to maternal SA are at an increased risk of these same behaviours early in life. Prospective attention to the types and timing of maternal and paternal psychopathology and the intermediate pathways to offspring SRT and SRB onset is needed and could have implications for informing modifiable targets for early intervention and prevention.

A cross-national study of the population-level association between alcohol consumption and suicide rates

INTRODUCTION

The objective of this study was to explore the association between population-level alcohol consumption and cross-national suicide rates. Suicide mortality rates vary substantially by nation, as do the level and character of alcohol consumption. Only a few prior studies examined this association, however, and they used a small number of nations and failed to test for the multiple hypothesized pathways through which any association may operate.

MATERIAL AND METHODS

We obtained data from the World Health Organization for a sample of 83 nations. Controlling for potential structural covariates, we tested four theoretical mechanisms through which population-level alcohol consumption may influence national suicide rates.

RESULTS

Results showed no evidence of threshold effects, nor were risky national drinking patterns associated with higher suicide rates. We found evidence for the most common explanation that total per capita consumption is linearly associated with suicide rates. Our other findings, however, suggested this linear association masks more complex beverage-specific effects. Per capita wine consumption was not associated with male or female suicide rates, per capita spirits consumption was associated with both male and female suicide rates, per capita beer consumption was associated with male suicide rates, and per capita consumption of "other" alcohol types was associated with female suicide rates.

DISCUSSION AND CONCLUSIONS

Testing for only a linear association between total alcohol consumption and suicide rates fails to tell the whole story. Further research requires exploration of beverage-specific effects and other potential mechanisms, and consideration of national alcohol policies to reduce suicide rates.

Child injury deaths linked with adult alcohol consumption: A time series analysis

OBJECTIVE

This paper aims to quantify the population-level associations between child injury deaths and adult (aged 15+ years) per capita alcohol consumption (PCC) and between child injury deaths and the impact of major alcohol and safety policy changes in Australia.

METHODS

All child deaths due to external causes during 1910-2013, and child deaths due specifically to road crashes, assaults, suicide and other external causes, were obtained from the Australian Institute of Health and Welfare. Child (0-14 year) mortality rates were analysed in relation to PCC using an Autoregressive Integrated Moving Average model.

RESULTS

A positive association between PCC and overall child external mortality was identified. The estimated coefficient was 0.326 (p = .002), indicating that a 10% decrease in PCC was associated with a 3.3% reduction in child injury mortality. A positive association was identified for road traffic and other child injury mortality, but not assault injuries. The introduction of compulsory seatbelt legislation in combination with random breath testing was associated with a reduction in overall injury and road traffic child mortality. Decreasing the legal drinking age was associated with an increase in the rate of other external-cause child mortality.

CONCLUSION

Reducing PCC in Australia is likely to result in a small but significant reduction in the injury mortality rate of children aged 0-14 years.

Everything in Moderation? A Mixed Methods Study on Perceptions of Parents' Drinking in the Presence of Children

Introduction

Parents are often warned about the negative consequences of drinking alcohol in the presence of their children, while surveys indicate that children fairly often see their parents drink and also being drunk. We applied a mixed method approach to explore attitudes towards parents' drinking in the presence of their children, using (1) survey and (2) focus group data. In the analysis of the focus group data, we also addressed which consequences of parents' drinking the participants emphasised, and how they reasoned for their opinions. The results were merged in order to compare, contrast and synthesise the findings from both data sets.

Methods

The data stem from a web survey among 18–69-year-old Norwegians (Study 1, N=2171) and from focus group interviews with 15–16-year-olds and parents of teenagers (Study 2, 8 groups, N=42).

Results

In both data sets, drinking moderately in the presence of children was mostly accepted, but attitudes became more restrictive with an increased drinking frequency and with visible signs of intoxication. The results from Study 2 showed also that definitions of moderation varied and that the participants used contextual factors such as atmosphere and occasion to define when drinking was acceptable and when it was not. In reflections on the importance of moderation, they emphasised parental responsibility for the family as a unit and parents' immoderate drinking as posing a risk to children's safety. The participants also underlined the importance of parental drinking in the alcohol socialisation process.

Conclusion

Parents' drinking in the presence of children was generally accepted as long as the drinking was moderate. The focus group data showed that definitions of moderation varied, and that social context also was used to define moderation.

Suicide Risk Assessment in Adolescents - C-SSRS, K10, and READ

BACKGROUND

Assessment and screening are often the first step in planning interventions to help adolescents at risk of suicide. Causes of suicidal thoughts and behavior are multifaceted and it is important for clinical work that assessment reflects this complexity.

AIMS

To investigate whether a general psychological Resilience Scale for Adolescents (READ) is associated with a validated suicide rating scale (C-SSRS).

METHOD

An observational study of self-reported suicidality (C-SSRS), psychological distress (K10), and resiliency (READ) in three adolescent samples: suicide clinic (N = 147); general psychiatric clinic (N = 85); and a nonclinical sample (N = 92).

RESULTS

Resiliency scores were significantly higher (p < .05) in the nonclinical compared with the clinic samples on all READ scales. READ scores were similar in the two clinic samples apart from the family cohesion subscale, which was significantly lower in the suicide clinic sample. READ was predictive of levels of suicidality within all samples independently of general psychological distress (K10).

LIMITATIONS

The study did not examine other early childhood factors that may contribute to individual resiliency or suicidality.

CONCLUSION

READ provides a reliable and valid assessment of individual resilience for both clinical and nonclinical settings. Evaluation of protective resources is a useful adjunct to the assessment and treatment of suicidal behavior.

Alcohol Consumption as a Risk Factor for Suicidal Behavior: A Systematic Review of Associations at the Individual and at the Population Level

The objective of this study was to provide an updated review of the magnitude of the relationship between alcohol use and suicidal behaviour at the individual and the population level. Systematic literature searches retrieved 14 reviews of individual level studies and 16 primary population level studies. Alcohol abuse and alcohol intoxication are often present in suicidal behaviour; risk of suicide is elevated in alcohol abusers and increasing population drinking tends to be associated with increase in suicide rates. Estimated magnitude of the relationship differs for men and women and it varies at the population level across cultures with different drinking pattern. These variations probably reflect gender differences and cultural variation in drinking behavior generally. Empirical evidence for a causal relationship is still urgently needed.

An investigation into the role of alcohol in self-harm in rural Sri Lanka: a protocol for a multimethod, qualitative study

INTRODUCTION

Sri Lanka has one of the highest suicide and self-harm rates in the world and although alcohol has been found to be a risk factor for self-harm in Sri Lanka, we know little about the connection between the two. This paper comprises a protocol for a qualitative study investigating alcohol's role in self-harm in rural Sri Lanka at three levels: the individual, community and policy level. The analysis will bring new understanding of the link between alcohol and self-harm in Sri Lanka, drawing on structural, cultural and social concepts. It will equip researchers, health systems and policy makers with vital information for developing strategies to address alcohol-related problems as they relate to self-harm.

METHODS AND ANALYSIS

To capture the complexity of the link between alcohol and self-harm in the Anuradhapura district in the North Central Province in Sri Lanka, qualitative methods will be utilised. Specifically, the data will consist of serial narrative life-story interviews with up to 20 individuals who have non-fatally self-harmed and where alcohol directly or indirectly was involved in the incidence as well as with their significant others; observations in communities and families; six focus group discussions with community members; and key-informant interviews with 15-25 stakeholders who have a stake in alcohol distribution, marketing, policies, prevention and treatment as they relate to self-harm.

ETHICS AND DISSEMINATION

The study has received ethical approval from the Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. A sensitive data collection technique will be used and ethical issues will be considered throughout the study.

RESULTS

The results will be disseminated in scientific peer-reviewed articles in collaboration with Sri Lankan and other international research partners.

Heavy episodic drinking and deliberate self-harm in young people: a longitudinal cohort study

AIM

To assess the association between heavy episodic drinking (HED) and deliberate self-harm (DSH) in young people in Norway.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

We analysed data on past-year HED and DSH from the second (1994) and third (1999) waves of the Young in Norway Longitudinal Study (cumulative response rate: 68.1%, n = 2647). Associations between HED and DSH were obtained as odds ratios and population-attributable fractions (PAF) applying fixed-effects modelling, which eliminates the effects of time-invariant confounders.

FINDINGS

An increase in HED was associated with an increase in risk of DSH (OR = 1.64, P = 0.013), after controlling for time-varying confounders. The estimated PAF was 28% from fixed-effects modelling and 51% from conventional modelling.

CONCLUSION

Data on Norwegian youths show a statistically significant association between heavy episodic drinking and deliberate self-harm.

Risk and protective factors that distinguish adolescents who attempt suicide from those who only consider suicide in the past year

Data from the 2010 Minnesota Student Survey was analyzed to identify risk and protective factors that distinguished adolescents across three groups: no suicidality, suicidal ideation only, and suicide attempt. The population-based sample included 70,022 students in grades 9 and 12. Hopelessness and depressive symptoms emerged as important risk factors to distinguish youth who reported suicidal ideation or behavior from those without a history of suicidality. However, these factors were not as important in differentiating adolescents who attempted suicidal from those who considered suicide but did not act on their thoughts. Instead, for both genders, self-injury represented the most important factor to distinguish these youth. Other risk factors that differentiated the latter groups, but not the former groups, for males were dating violence victimization and cigarette smoking, and for females was a same-sex sexual experience. Running away from home also seemed to increase the risk of a suicide attempt among youth in this study. Parent connectedness and academic achievement emerged as important protective factors to differentiate all the groups, yet neighborhood safety appeared to protect against the transition from suicidal thoughts to behavior. Findings from this study suggest risk and protective factors practitioners should target in clinical assessments and intervention programs to help prevent suicidal behavior among youth at greatest risk.