1
|
Acosta-González N, Gallegos F, Mosquera D. The relationship between online searches and suicide. Int J Soc Psychiatry 2024:207640241264674. [PMID: 39049604 DOI: 10.1177/00207640241264674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
AIMS In this study, we examined the relationship between 131 suicide related Google search terms, grouped into nine categories, and the number of suicide cases per month in Ecuador from January 2011 to December 2021. METHODS First, we applied time-series analysis to eliminate autocorrelation and seasonal patterns to prevent spurious correlations. Second, we used Pearson's correlation to assess the relationship between Google search terms and suicide rates. Third, cross-correlation analysis was used to explore the potential delayed effects between these variables. Fourth, we extended the correlation and cross-correlation analyses by three demographic characteristics - gender, age, and region. RESULTS Significant correlations were found in all categories between Google search trends and suicide rates in Ecuador, with predominantly positive and moderate correlations. The terms 'stress' (.548), 'prevention' (.438), and 'disorders' (.435) showed the strongest associations. While global trends indicated moderate correlations, sensitivity analysis revealed higher coefficients in men, young adults, and the Highlands region. Specific patterns emerged in subgroups, such as 'digital violence' showing significant correlations in certain demographics, and 'trauma' presenting a unique temporal pattern in women. In general, cross correlation analysis showed an average negative correlation of -.191 at lag 3. CONCLUSION Google search data do not provide further information about users, such as demographics or mental health records. Hence, our results are simply correlations and should not be interpreted as causal effects. Our findings highlight a need for tailored suicide prevention strategies that recognize the complex dynamics of suicide risk across demographics and time periods.
Collapse
Affiliation(s)
| | - Francisco Gallegos
- Facultad de Economía, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Diversa Studio, Quito, Ecuador
| | - Diana Mosquera
- Facultad de Economía, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Diversa Studio, Quito, Ecuador
| |
Collapse
|
2
|
Alvarez de Mon MA, Sánchez-Villegas A, Gutiérrez-Rojas L, Martinez-Gonzalez MA. Screen exposure, mental health and emotional well-being in the adolescent population: is it time for governments to take action ?. J Epidemiol Community Health 2024:jech-2023-220577. [PMID: 38964781 DOI: 10.1136/jech-2023-220577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/22/2024] [Indexed: 07/06/2024]
Abstract
During the last decade, a multitude of epidemiological studies with different designs have been published assessing the association between the use of digital media and psychological well-being, including the incidence of mental disorders and suicidal behaviours. Particularly, available research has very often focused on smartphone use in teenagers, with highly addictive potential, coining the term 'problematic smartphone use' and developing specific scales to measure the addictive or problematic use of smartphones. Available studies, despite some methodological limitations and gaps in knowledge, suggest that higher screen time is associated with impaired psychological well-being, lower self-esteem, higher levels of body dissatisfaction, higher incidence of eating disorders, poorer sleeping outcomes and higher odds of depressive symptoms in adolescents. Moreover, a significant association has also been found between screen time and higher suicide risk. Finally, problematic pornography has been shown to be highly prevalent and it is a strong cause of concern to many public health departments and national governments because it might be eventually associated with aggressive sexual behaviours.
Collapse
Affiliation(s)
- Miguel Angel Alvarez de Mon
- Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- Psychiatry, University of Alcalá, Madrid, Spain
| | - Almudena Sánchez-Villegas
- Institute for Innovation and Sustained Development in Food Chain (ISFOOD), Public University of Navarra, Pamplona, Spain
| | - Luis Gutiérrez-Rojas
- Psychiatry Service, San Cecilio University Hospital, Andalusian Health Service, Granada, Spain
| | - Miguel A Martinez-Gonzalez
- Institute for Innovation and Sustained Development in Food Chain (ISFOOD), Public University of Navarra, Pamplona, Spain
| |
Collapse
|
3
|
Brailovskaia J. The "Vicious Circle of addictive Social Media Use and Mental Health" Model. Acta Psychol (Amst) 2024; 247:104306. [PMID: 38735249 DOI: 10.1016/j.actpsy.2024.104306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024] Open
Abstract
Social media use (SMU) is a significant part of many people's everyday life. Research around the globe describes an increase of addictive SMU tendencies since the COVID-19 outbreak. The present work combines available findings in the "Vicious Circle of addictive Social Media Use and Mental Health" model to explain how social media (SM) activity can contribute to the development of addictive tendencies, which consequences they have for mental health, and how to prevent them. Following the model, the interplay between the risk factors negative experiences caused by daily hassles and by unexpected global and traumatic events, SMU (dimension "quality"), and SM flow can directly contribute to addictive SMU through the "vicious circle". Time spent on SMU (dimension "quantity"), symptoms of depression and anxiety, and the personality trait narcissism contribute to the circle as moderators. Symptoms of stress, insomnia, and suicide-related outcomes are described as potential consequences of addictive SMU. Based on longitudinal intervention studies, a conscious reduction of SMU time and an increase of physical activity, as well as positive mental health and mindfulness are identified as protective factors that reduce the risk of addictive tendencies. The model contributes to a better understanding of addictive SMU. Implications of the model for future research and praxis, specifically for mental health programs and therapeutic treatment are discussed.
Collapse
Affiliation(s)
- Julia Brailovskaia
- Mental Health Research and Treatment Center, Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Germany; DZPG (German Center for Mental Health), partner site Bochum/Marburg, Germany.
| |
Collapse
|
4
|
West M, Rice S, Vella-Brodrick D. Adolescent Social Media Use through a Self-Determination Theory Lens: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:862. [PMID: 39063439 PMCID: PMC11277189 DOI: 10.3390/ijerph21070862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Social media is an integral part of adolescents' lives and has a strong influence on development and wellbeing. Research examining adolescent social media use and wellbeing is confusing as findings are inconsistent, inconclusive and contradictory. To address this issue, digital wellbeing scholars recommend that researchers adopt a theoretical approach with the aim of increasing meaningfulness and applicability of findings. Hence, this review applies self-determination theory to investigate how adolescent social media use supports and thwarts the basic psychological needs of relatedness, autonomy and competence. Satisfaction of all three psychological needs is essential for optimal development and wellbeing. METHODS A scoping review was conducted using a systematic search of five databases relating to adolescent social media use. The preferred items for systematic review and meta-analysis protocols (extension for scoping reviews) was applied resulting in 86 included studies. RESULTS Adolescent social media use both supports and thwarts relatedness, autonomy and competence. The findings highlighted how different aspects of adolescent social media use (including intra-personal, inter-personal, situational and environmental factors) contribute to the satisfaction and frustration of basic psychological needs. CONCLUSIONS This review illustrates how social media can be both beneficial and detrimental to satisfying the basic psychological needs of relatedness, autonomy and competence. This is important when considering that if psychological needs are satisfied or frustrated in adolescence, the repercussions can have a cascading effect throughout adulthood. This review identifies gaps in the literature and provides suggestions for future research.
Collapse
Affiliation(s)
- Monique West
- Centre for Wellbeing Science, University of Melbourne, Melbourne 3010, Australia;
| | - Simon Rice
- Centre for Youth Mental Health, University of Melbourne, Melbourne 3010, Australia;
| | | |
Collapse
|
5
|
Yu Z, Zhu X, Li Y. The association between problematic short video use and suicidal ideation and self-injurious behaviors: the mediating roles of sleep disturbance and depression. BMC Public Health 2024; 24:1689. [PMID: 38915039 PMCID: PMC11197212 DOI: 10.1186/s12889-024-19191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Prior work suggests that problematic short video use was associated with adverse psychological, physiological, and educational outcomes. With the prevailing of short video platforms, the potential relationships between this problematic behavior and suicidal ideation and self-injurious behaviors have yet to be thoroughly examined. Besides, considering the potential dual nature of problematic short video use, particularly its positive aspects, a potential mechanism may exist linking such problematic behavior to SI and SIBs, ultimately driving individuals towards extreme outcomes. Nevertheless, such mediation paths have not been rigorously examined. Thus, the current study aimed to investigate their relationships and delve into the underlying mechanism, specifically identifying potential mediators between sleep disturbance and depression. METHODS A quantitative cross-sectional study design was employed to model data derived from a large sample of first- and second-year university students residing in mainland China (N = 1,099; Mage = 19.80 years; 51.7% male). RESULTS Results showed that problematic short video use has a dual impact on SI and SIBs. On the one hand, problematic short video use was directly related to the decreased risk of suicidal ideation, attempts, and NSSI. On the other hand, such problematic behavior was indirectly associated with the increased risk of NSSI through sleep disturbance, and it indirectly related to the elevated risk of suicidal ideation, attempts, and NSSI through depression. Besides, on the whole, problematic short video use was positively associated with NSSI but not suicidal ideation and attempts. CONCLUSIONS These findings indicated that problematic short video use had a dual impact on SI and SIBs. Consequently, it is paramount to comprehend the genuine magnitude of the influence that such problematic behavior holds over these intricate psychological conditions.
Collapse
Affiliation(s)
- Zhuojun Yu
- Department of Applied Psychology, Guangdong University of Foreign Studies, Guangzhou, China
| | - Xinxin Zhu
- Department of Psychology, 7 George Square, University of Edinburgh, Edinburgh, EH8 9JZ, UK.
| | - Yuanyuan Li
- Department of Psychology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
6
|
Kelly SE, Brooks SPJ, Benkhedda K, MacFarlane AJ, Greene-Finestone LS, Skidmore B, Clifford TJ, Wells GA. A scoping review shows that no single existing risk of bias assessment tool considers all sources of bias for cross-sectional studies. J Clin Epidemiol 2024; 172:111408. [PMID: 38844117 DOI: 10.1016/j.jclinepi.2024.111408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES Different tools to assess the potential risk of bias (RoB) for cross-sectional studies have been developed, but it is unclear whether all pertinent bias concepts are addressed. We aimed to identify RoB concepts applicable to cross-sectional research validity and to explore coverage for each in existing appraisal tools. STUDY DESIGN AND SETTING This scoping review followed the Joanna Briggs Institute methodology. We included records of any study design describing or reporting methods, concepts or tools used to consider RoB in health research reported to be descriptive/prevalence survey or analytic/association (cross-sectional) study designs. Synthesis included quantitative and qualitative analysis. RESULTS Of the 4556 records screened, 90 were selected for inclusion; 67 (74%) described the development of, or validation process for, appraisal tools, 15 (17%) described methodological content or theory relevant to RoB for cross-sectional studies and 8 (9%) records of methodological systematic reviews. Review of methodological reports identified important RoB concepts for both descriptive/prevalence and analytic/association studies. Tools identified (n = 64 unique tools) were either intended to appraise quality or assess RoB in multiple study designs including cross-sectional studies (n = 21; 33%) or cross-sectional designs alone (n = 43; 67%). Several existing tools were modified (n = 17; 27%) for application to cross-sectional studies. The RoB items most frequently addressed in the RoB tools were validity and reliability of the exposure (53%) or outcome (65%) measurement and representativeness of the study population (59%). Most tools did not consider nonresponse or missingness appropriately or at all. CONCLUSION Assessing cross-sectional studies involve unique RoB considerations. We identified RoB tools designed for broad applicability across various study designs as well as those specifically tailored for cross-sectional studies. However, none of the identified tools comprehensively address all potential biases pertinent to cross-sectional studies. Our findings indicate a need for continued improvement of RoB tools and suggest that the development of context-specific or more precise tools for this study design may be necessary.
Collapse
Affiliation(s)
- Shannon E Kelly
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | | | - Karima Benkhedda
- Bureau of Nutritional Sciences, Health Canada, Ottawa, Ontario, Canada
| | - Amanda J MacFarlane
- Department of Biology, Carleton University, Ottawa, Ontario, Canada; Texas A&M Agriculture, Food, and Nutrition Evidence Center, Fort Worth, Texas, USA
| | | | | | - Tammy J Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| |
Collapse
|
7
|
Peprah P, Oduro MS, Atta-Osei G, Addo IY, Morgan AK, Gyasi RM. Problematic social media use mediates the effect of cyberbullying victimisation on psychosomatic complaints in adolescents. Sci Rep 2024; 14:9773. [PMID: 38684725 PMCID: PMC11058249 DOI: 10.1038/s41598-024-59509-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Adolescent psychosomatic complaints remain a public health issue globally. Studies suggest that cyberbullying victimisation, particularly on social media, could heighten the risk of psychosomatic complaints. However, the mechanisms underlying the associations between cyberbullying victimisation and psychosomatic complaints remain unclear. This cross-cultural study examines the mediating effect of problematic social media use (PSMU) on the association between cyberbullying victimisation and psychosomatic complaints among adolescents in high income countries. We analysed data on adolescents aged 11-16.5 years (weighted N = 142,298) in 35 countries participating in the 2018 Health Behaviour in School-aged Children (HBSC) study. Path analysis using bootstrapping technique tested the hypothesised mediating role of PSMU. Results from the sequential binary mixed effects logit models showed that adolescents who were victims of cyberbullying were 2.39 times significantly more likely to report psychosomatic complaints than those who never experienced cyberbullying (AOR = 2.39; 95%CI = 2.29, 2.49). PSMU partially mediated the association between cyberbullying victimisation and psychosomatic complaints accounting for 12% ( β = 0.01162, 95%CI = 0.0110, 0.0120) of the total effect. Additional analysis revealed a moderation effect of PSMU on the association between cyberbullying victimisation and psychosomatic complaints. Our findings suggest that while cyberbullying victimisation substantially influences psychosomatic complaints, the association is partially explained by PSMU. Policy and public health interventions for cyberbullying-related psychosomatic complaints in adolescents should target safe social media use.
Collapse
Affiliation(s)
- Prince Peprah
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Michael Safo Oduro
- Pfizer Research and Development, PSSM Data Sciences, Pfizer, Inc., Connecticut, USA
| | - Godfred Atta-Osei
- Centre for Disability and Rehabilitation Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Yeboah Addo
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
| | - Anthony Kwame Morgan
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, Australia
| |
Collapse
|
8
|
Wallace E, Revie L, Schneider D, Mais D, Sharland E. Thematic analysis of Prevention of Future Death reports for suicide: January 2021 to October 2022. BMJ MENTAL HEALTH 2024; 27:1-7. [PMID: 38657975 PMCID: PMC11043700 DOI: 10.1136/bmjment-2023-300804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 03/13/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Suicide prevention remains a high priority topic across government and the National Health Service (NHS). Prevention of Future Death (PFD) reports are produced by coroners to highlight concerns that should be addressed by organisations to prevent future deaths in similar circumstances. OBJECTIVE This research aimed to understand themes from concerns raised in PFD reports for deaths from suicide to inform future policies and strategies for preventing suicide. METHODS We employed a retrospective case series design to analyse PFD reports categorised as suicide using qualitative inductive thematic analysis. Primary themes and subthemes were extracted from coroners' concerns. Following theme extraction, the number of concerns coded to these themes across reports and the frequency of recipient organisation being named as addressee on these reports were assessed as primary outcomes. FINDINGS 12 primary themes and 83 subthemes were identified from 164 reports (4% of all available reports). The NHS was the most frequent recipient of these reports, followed by government departments. Coroners raised issues around processes within or between organisations and difficulties accessing services. The most common concerns fell under the primary theme 'processes' (142 mentions), followed by 'access to services' (84 mentions). The most frequent subthemes were 'current training not adequate' (38 mentions) and 'inadequate communication between services' (35 mentions). CONCLUSIONS Our results specify areas where review, improvement and policy development are required to prevent future suicide deaths occurring in similar circumstances. CLINICAL IMPLICATIONS These themes highlight concerns across current care and service provision where reform is required for suicide prevention.
Collapse
Affiliation(s)
- Emma Wallace
- Data and Analysis for Social Care and Health Division, Office for National Statistics, Newport, UK
| | - Lauren Revie
- Data and Analysis for Social Care and Health Division, Office for National Statistics, Newport, UK
| | - Dorothee Schneider
- Data and Analysis for Social Care and Health Division, Office for National Statistics, Newport, UK
| | - David Mais
- Data and Analysis for Social Care and Health Division, Office for National Statistics, Newport, UK
| | - Emma Sharland
- Data and Analysis for Social Care and Health Division, Office for National Statistics, Newport, UK
| |
Collapse
|
9
|
Jeong HS, Kim HMS, Kim KM. Network Structure and Clustering Analysis Relating to Individual Symptoms of Problematic Internet Use in a Community Adolescent Population. Eur Addict Res 2024; 30:181-193. [PMID: 38615663 DOI: 10.1159/000535677] [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: 04/13/2023] [Accepted: 12/01/2023] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Problematic internet use (PIU) is a psychopathology that includes multiple symptoms and psychological constructs. Because no studies have considered both network structures and clusters among individual symptoms in the context of PIU in a Korean adolescent population, this study aimed to investigate network structures and clustering in relation to PIU symptoms in adolescents. METHODS Overall, 73,238 adolescents were included. PIU severity was assessed using a self-rating scale comprising 20 items and 6 subscales, namely, the Internet Addiction Proneness Scale for Youth-Short Form; KS scale. Network structures and clusters among symptoms were analyzed using a Gaussian graphical model and exploratory graph analysis, respectively. Centrality of strength, closeness, and betweenness scores was also calculated. RESULTS Our study identified four clusters: disturbance in adaptive functioning, virtual interpersonal relationships, withdrawal, and tolerance. The symptom of confidence served as a node bridging the cluster of virtual interpersonal relationships and other clusters of withdrawal and disturbances of adaptive function. The symptom of craving served as a bridge between the clusters of withdrawal and tolerance with high betweenness centrality. CONCLUSION This study identified network structures and clustering among PIU symptoms in adolescents and revealed that positive experiences derived from online interpersonal relationships were an important mechanism underlying PIU. These are novel insights concerning the interconnection among multiple symptoms and related clustering for the mechanism of adolescent PIU in terms of KS-scale PIU assessment.
Collapse
Affiliation(s)
- Hyu Seok Jeong
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hillary Mi-Sung Kim
- Department of Child Psychology and Education, Sungkyunkwan Univeristy, Seoul, Republic of Korea
| | - Kyoung Min Kim
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea
| |
Collapse
|
10
|
Landa-Blanco M, Romero K, Caballero I, Gálvez-Pineda E, Fúnes-Henríquez MJ, Romero R. Exploring suicide ideation in university students: sleep quality, social media, self-esteem, and barriers to seeking psychological help. Front Psychiatry 2024; 15:1352889. [PMID: 38645419 PMCID: PMC11027559 DOI: 10.3389/fpsyt.2024.1352889] [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: 12/15/2023] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
The purpose of the current study is to analyze how variations in suicidal ideation scores can relate to sleep quality, social media consumption, self-esteem, and perceived barriers to seeking psychological help in a sample of university students in Honduras. A quantitative cross-sectional design was used. Self-reported data was collected from a non-random sample of 910 university students in Honduras; their average age was 24.03 years (SD=6.05). Most respondents were women (67%) with men accounting for 33% of the sample. Measurements included item 9 of the Patient Health Questionnaire-9, the Single-Item Sleep Quality Scale, Rosenberg's Self-Esteem Scale, Barriers to Seeking Psychological Help Scale for College Students, and a self-reported questionnaire on social media. In response to the query, "Over the past two weeks, how frequently have you experienced thoughts that you would be better off dead or of hurting yourself?" 54% (n=495) of participants indicated "not at all" 18% (n=168) reported "several days" 14% (n=129) responded "more than half of the days" and 13% (n=118) stated "nearly every day". The results from the ordinal logistic regression model indicate that sleep quality and self-esteem serve as protective factors associated with decreased suicide ideation. At the same time, a higher number of social media platforms used per week and perceived barriers to seeking psychological help increase suicide ideation. Altogether, these variables explained 19% of the variance in suicidal ideation scores. Suicidal ideation is highly prevalent among the sampled university students.
Collapse
Affiliation(s)
- Miguel Landa-Blanco
- School of Psychological Sciences, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | | | | | | | | | | |
Collapse
|
11
|
Grimsley EA, Torikashvili JV, Janjua HM, Read MD, Kuo PC, Diaz JJ. Transition to Permitless Open Carry and Association with Firearm-Related Suicide. J Am Coll Surg 2024; 238:681-688. [PMID: 38465793 DOI: 10.1097/xcs.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND Firearm-related death rates continue to rise in the US. As some states enact more permissive firearm laws, we sought to assess the relationship between a change to permitless open carry (PLOC) and subsequent firearm-related death rates, a currently understudied topic. STUDY DESIGN Using state-level data from 2013 to 2021, we performed a linear panel analysis using a state fixed-effects model. We examined total firearm-related death, suicide, and homicide rates separately. If a significant association between OC law and death rate was found, we then performed a difference-in-difference (DID) analysis to assess for a causal relationship between changing to PLOC and increased death rate. For significant DID results, we performed confirmatory DID separating firearm and nonfirearm death rates. RESULTS Nineteen states maintained a no OC or permit-required law, whereas 5 changed to permitless and 26 had a PLOC before 2013. The fixed-effects model indicated more permissive OC law that was associated with increased total firearm-related deaths and suicides. In DID, changing law to PLOC had a significant average treatment effect on the treated of 1.57 (95% CI 1.05 to 2.09) for total suicide rate but no significant average treatment effect for the total firearm-related death rate. Confirmatory DID results found a significant average treatment effect on the treated of 1.18 (95% CI 0.90 to 1.46) for firearm suicide rate. CONCLUSIONS OC law is associated with total firearm-related death and suicide rates. Based on our DID results, changing to PLOC is indeed strongly associated with increased suicides by firearm.
Collapse
Affiliation(s)
- Emily A Grimsley
- From the Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | | | | | | | | | | |
Collapse
|
12
|
Keyes KM, Platt JM. Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century - trends, causes, consequences. J Child Psychol Psychiatry 2024; 65:384-407. [PMID: 37458091 DOI: 10.1111/jcpp.13864] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/18/2023]
Abstract
Internalizing conditions of psychopathology include depressive and anxiety disorders; they most often onset in adolescence, are relatively common, and contribute to significant population morbidity and mortality. In this research review, we present the evidence that internalizing conditions, including depression and anxiety, as well as psychological distress, suicidal thoughts and self-harm, and fatal suicide, are considerably increasing in adolescent populations across many countries. Evidence indicates that increases are currently greatest in female adolescents. We present an epidemiological framework for evaluating the causes of these increases, and synthesize research on whether several established risk factors (e.g., age of pubertal transition and stressful life events) and novel risk factors (e.g., digital technology and social media) meet conditions necessary to be plausible causes of increases in adolescent internalizing conditions. We conclude that there are a multitude of potential causes of increases in adolescent internalizing conditions, outline evidence gaps including the lack of research on nonbinary and gender nonconforming populations, and recommend necessary prevention and intervention foci from a clinical and public health perspective.
Collapse
Affiliation(s)
- Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jonathan M Platt
- College of Public Health, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
13
|
Cheng J, Peng C, Rong F, Wang Y, Tan Y, Yu Y. Mobile phone addiction and suicide behaviors among Chinese adolescents: The mediation of poor sleep quality. J Behav Addict 2024; 13:88-101. [PMID: 38224348 PMCID: PMC10988414 DOI: 10.1556/2006.2023.00078] [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: 02/08/2023] [Revised: 07/18/2023] [Accepted: 12/03/2023] [Indexed: 01/16/2024] Open
Abstract
Background and aims Mobile phone addiction (MPA) is emerging among adolescents, especially during the COVID-19 pandemic. Nevertheless, there is a dearth of knowledge regarding the correlation between MPA and suicide behaviors and its mechanism. The objective of the current study is exploring the direct effect of MPA on suicide behaviors and the indirect effect through poor sleep quality. Methods A total of 18,900 Chinese adolescents aged 12 to 18 were recruited via a multi-stage cluster sampling method. Results The prevalence of MPA and poor sleep quality was 26.2 and 23.1%, respectively. During the past year, 24.4% participants were involved in suicide behaviors. Specifically, suicide ideators, suicide planners, and suicide attempters were 10.7, 8.4, and 5.3%, respectively. Particularly, rural females had the highest prevalence of suicide behaviors, MPA, and poor sleep quality. Logistic regression analysis showed that MPA was significantly associated with suicide ideators (OR = 1.22, 95% CI: 1.09-1.37, p < 0.001) and planners (OR = 1.18, 95% CI: 1.04-1.34, p < 0.05), but not for suicide attempters (p > 0.05). Structural equation modelling demonstrated that MPA had direct effect on suicide behaviors (β = 0.145, 95% CI = 0.127-0.160), and poor sleep quality partially mediated the relationship (the mediating ratio was 46.7%). The mediating ratio of poor sleep quality was the highest in urban males. Conclusions MPA has both direct and indirect effects on suicide behaviors. For suicide prevention, limited mobile phone use and improvement sleep quality may be practical for adolescents. Additionally, more efforts of intervention could give priority to rural girls.
Collapse
Affiliation(s)
- Junhan Cheng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chang Peng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fajuan Rong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yafei Tan
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yizhen Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
14
|
Haghish EF, Nes RB, Obaidi M, Qin P, Stänicke LI, Bekkhus M, Laeng B, Czajkowski N. Unveiling Adolescent Suicidality: Holistic Analysis of Protective and Risk Factors Using Multiple Machine Learning Algorithms. J Youth Adolesc 2024; 53:507-525. [PMID: 37982927 PMCID: PMC10838236 DOI: 10.1007/s10964-023-01892-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/17/2023] [Indexed: 11/21/2023]
Abstract
Adolescent suicide attempts are on the rise, presenting a significant public health concern. Recent research aimed at improving risk assessment for adolescent suicide attempts has turned to machine learning. But no studies to date have examined the performance of stacked ensemble algorithms, which are more suitable for low-prevalence conditions. The existing machine learning-based research also lacks population-representative samples, overlooks protective factors and their interplay with risk factors, and neglects established theories on suicidal behavior in favor of purely algorithmic risk estimation. The present study overcomes these shortcomings by comparing the performance of a stacked ensemble algorithm with a diverse set of algorithms, performing a holistic item analysis to identify both risk and protective factors on a comprehensive data, and addressing the compatibility of these factors with two competing theories of suicide, namely, The Interpersonal Theory of Suicide and The Strain Theory of Suicide. A population-representative dataset of 173,664 Norwegian adolescents aged 13 to 18 years (mean = 15.14, SD = 1.58, 50.5% female) with a 4.65% rate of reported suicide attempt during the past 12 months was analyzed. Five machine learning algorithms were trained for suicide attempt risk assessment. The stacked ensemble model significantly outperformed other algorithms, achieving equal sensitivity and a specificity of 90.1%, AUC of 96.4%, and AUCPR of 67.5%. All algorithms found recent self-harm to be the most important indicator of adolescent suicide attempt. Exploratory factor analysis suggested five additional risk domains, which we labeled internalizing problems, sleep disturbance, disordered eating, lack of optimism regarding future education and career, and victimization. The identified factors provided stronger support for The Interpersonal Theory of Suicide than for The Strain Theory of Suicide. An enhancement to The Interpersonal Theory based on the risk and protective factors identified by holistic item analysis is presented.
Collapse
Affiliation(s)
- E F Haghish
- Department of Psychology, University of Oslo, Oslo, Norway.
| | - Ragnhild Bang Nes
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Milan Obaidi
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychology, Copenhagen University, Copenhagen, Denmark
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Line Indrevoll Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway
- Nic Waals Institute, Lovisenberg hospital, Oslo, Norway
| | - Mona Bekkhus
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Bruno Laeng
- Department of Psychology, University of Oslo, Oslo, Norway
- RITMO Centre for Interdisciplinary Studies in Rhythm, Time and Motion, University of Oslo, Oslo, Norway
| | - Nikolai Czajkowski
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| |
Collapse
|
15
|
Marshall RD, Bailey J, Lin A, Sheridan DC, Hendrickson RG, Hughes A, Horowitz BZ. Impact of social media "challenges" on poison center case volume for intentional ingestions among school-aged children: an observational study. Clin Toxicol (Phila) 2024; 62:183-189. [PMID: 38587109 DOI: 10.1080/15563650.2024.2331064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Mental health problems among youth have escalated over the past decade, with increased rates of self-harm, including suicide attempts by ingestion. Social media use has been linked to youth mental health, including "challenges" urging youth to ingest substances for recreational and other purposes. We hypothesized that social media challenges for particular substances would temporally correspond with increased ingestions of these substances. METHODS We identified peak Google Trends search times for social media ingestion challenges involving diphenhydramine, laundry pods, nutmeg, and cinnamon, and used data from America's Poison Centers National Poison Data System to plot reported ingestions 3 months before and after peak searches in school-aged children. RESULTS There were 2,169 individuals in the analysis. Diphenhydramine was the most frequently reported ingestion for misuse/abuse and suicidal purposes (n = 266 and 1,609, respectively). For all ingestions together, 45 percent (n = 979) had a moderate health effect, and 6.35 percent (n = 137) had a major health effect. Time of peak searches corresponded with increased ingestions for each substance. DISCUSSION We found a temporal relationship between peak Google Trends searches for ingestion challenges and ingestions of that substance reported to United States poison centers. Compared to misuse/abuse ingestions, most suicidal ingestions peaked 1-2 months later, suggesting a public health opportunity for intervention. LIMITATIONS This retrospective observational study does not establish causal effect. All data are a result of self-reporting of the exposures, which may lead to a reporting bias. Google Trends is not the only search engine and likely underestimates the true incidence of social media posts. CONCLUSIONS Additional research is needed on the relationship between social media and youth mental health, particularly around "challenges" that place youths' health at risk. There may be opportunities for intervention to decrease medical and mental health sequelae of these challenges.
Collapse
Affiliation(s)
- Rebecca D Marshall
- Department of Psychiatry, OR Health & Science University, Portland, OR, USA
| | - Jessica Bailey
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amber Lin
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - David C Sheridan
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Robert G Hendrickson
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Poison Center, Portland, OR, USA
| | - Adrienne Hughes
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Poison Center, Portland, OR, USA
| | - B Zane Horowitz
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Poison Center, Portland, OR, USA
| |
Collapse
|
16
|
Iwatate E, Atem FD, Jones EC, Hughes JL, Yokoo T, Messiah SE. Trends in the relationship between suicide behaviors and obesity among adolescents in the United States from 1999 to 2019. Eur Child Adolesc Psychiatry 2024; 33:725-737. [PMID: 36933151 DOI: 10.1007/s00787-023-02191-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
Previous studies indicate that obesity is a risk factor of suicide behaviors among adolescents. Whether this association has remained consistent during the ongoing obesity epidemic remains unknown. The time trends of the obesity-suicide association were examined using the 1999-2019 biannual Youth Risk Behavior Survey data (n = 161,606). Prevalence odds ratio of suicide behaviors among adolescents with obesity (vs. adolescents with no obesity) for each survey year and time trends using National Cancer Institute Joinpoint regression analysis was calculated. For each year post-baseline, there was a significant increase of prevalence odds ratio of 1.4 (1.2-1.6)-1.6 (1.3-2.0) for suicide ideation, 1.3 (1.1-1.7) -1.7 (1.4-2.0) for plan, and 1.3 (1.0-1.7) -1.9 (1.5-2.4) for an attempt, except for the 2013 survey for attempt (1.19 [0.9-1.6]). Significant positive trends were found from1999 to 2019 for ideation and plan, with biannual %-changes of + 0.92 and + 1.22%, respectively. Adolescents with obesity have consistently higher odds of engaging in suicide behaviors than their peers without obesity since the beginning of the United States obesity epidemic, and this association grew stronger as the obesity epidemic continued.
Collapse
Affiliation(s)
- Eriko Iwatate
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Regional Campus, Trinity Towers, 2777 N Stemmons Fwy, Dallas, TX, 75207, USA.
| | - Folefac D Atem
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth, Dallas Regional Campus, Dallas, TX, USA
- Center for Pediatric Population Health, Children's Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
| | - Eric C Jones
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, El Paso Regional Campus, El Paso, TX, USA
| | - Jennifer L Hughes
- Department of Psychiatry and Behavioral Health, College of Medicine and Division of Health Behavior and Health Promotion, College of Public Health, Big Lots Behavioral Health Services, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern, Dallas, TX, USA
| | - Sarah E Messiah
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Regional Campus, Trinity Towers, 2777 N Stemmons Fwy, Dallas, TX, 75207, USA
| |
Collapse
|
17
|
Chamarro A, Díaz-Moreno A, Bonilla I, Cladellas R, Griffiths MD, Gómez-Romero MJ, Limonero JT. Stress and suicide risk among adolescents: the role of problematic internet use, gaming disorder and emotional regulation. BMC Public Health 2024; 24:326. [PMID: 38291407 PMCID: PMC10826210 DOI: 10.1186/s12889-024-17860-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/23/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Previous studies have associated videogame playing and social media use with suicidal behaviors together with lower stress coping or poor emotion regulation strategies. Due to the inconclusive evidence regarding the factors associated with suicidal behavior, the present study aimed to overcome the limitations of previous research and explored the relationship between adolescent stress, problematic internet use (PIU), gaming disorder (GD), and emotional regulation (ER) in a cross-section design. It was hypothesized that stress would have a direct effect on suicide risk (SR) as well as being mediated by PIU, GD, and ER. METHODS The participants comprised 430 adolescents (58.4% male) aged between 16 and 19 years. They completed an online survey including the Mobile-Related Experiences Questionnaire, Internet Gaming Disorder Scale-Short Form, Meta-Mood Trait Repair Scale, and Spanish version of the Suicidal Behaviors Questionnaire. RESULTS A total of 34.2% of the adolescents (N = 147) were at risk for SR. Results also indicated that 30,7% had experienced suicidal ideation at some point in their life, 12.1% had at least one plan to die by suicide, and 5.1% had attempted suicide. Results of path analysis confirmed that stress appeared to be a risk factor for suicide, but that its effects were not mediated by PIU. However, ER and GD mediated the effect of stress on SR. The results suggest that stress is a main risk factor for suicide, especially among adolescents with poor emotional regulation or problematic gaming. CONCLUSIONS Considering the prevalence of suicide among adolescents, the results of the present study suggest that suicide prevention programs should include emotional regulation strategies, stress coping, and videogaming management skills in the early stages of high school. Providing these protective resources to adolescents will help them face the stressful and changing situations typical of adolescence and will help them to attain greater well-being and satisfaction with life.
Collapse
Affiliation(s)
- Andrés Chamarro
- Stress & Health Research Group. Faculty of Psychology, Autonomous University of Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Adrian Díaz-Moreno
- Stress & Health Research Group. Faculty of Psychology, Autonomous University of Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Ivan Bonilla
- Stress & Health Research Group. Faculty of Psychology, Autonomous University of Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Ramon Cladellas
- Stress & Health Research Group. Faculty of Psychology, Autonomous University of Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Mark D Griffiths
- International Gaming Unit, Nottingham Trent University, Nottingham, England
| | - Maria José Gómez-Romero
- Stress & Health Research Group. Faculty of Psychology, Autonomous University of Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
- Psychology Unit, Egarsat, Mutua Colaboradora con la Seguridad Social nº 276, Barcelona, Spain
| | - Joaquín T Limonero
- Stress & Health Research Group. Faculty of Psychology, Autonomous University of Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| |
Collapse
|
18
|
Chen YY, Chen F, Wu KCC, Lu TH, Chi YC, Yip PS. Dynamic reciprocal relationships between traditional media reports, social media postings, and youth suicide in Taiwan between 2012 and 2021. SSM Popul Health 2023; 24:101543. [PMID: 37965108 PMCID: PMC10641279 DOI: 10.1016/j.ssmph.2023.101543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/16/2023] Open
Abstract
Rising social media use over the past decade has been linked with increasing suicide rates among young people. Previous studies that assessed the impact of social media on suicide have typically focused on single social media platforms, such as Twitter, and assumed unidirectional associations, where social media posts leads to suicide. Our study focused on the past decade (2012-2021) which has witnessed a rapid increase of social media platforms and use. Poisson and negative binominal auto-regression models were employed to examine the dynamic reciprocity between social media, traditional media and youth suicides in Taiwan. Increased volume in suicide-related social media posts positively correlated with increased youth suicide rates (β = 2.53 × 10-5, 95% CI= (0.83 × 10-5, 4.24 × 10-5), P < 0.01), but increased rates of youth suicide was not related to an increase in suicide-related social media posts. Suicide-related posts on social media triggered reporting of suicide-related news on traditional media platforms (β = 3.35 × 10-2, 95% CI= (2.51 × 10-2, 4.19 × 10-2), P < 0.001), whilst traditional media reports of suicide led to increased suicide-related social media posts (β = 6.13 × 10-1, 95% CI = (4.58 × 10-1, 7.68 × 10-1); P < 0.001). However, suicide-related reports on traditional media platforms did not directly lead to an increase in youth suicide rates. Our findings highlight challenges for suicide prevention strategies in the 21st Century, in dealing with the increasing prominence of social media over traditional media. As social media is more difficult to regulate than traditional media, suicide prevention efforts must adapt to this new landscape by developing innovative strategies that address the unique risks and opportunities presented by social media.
Collapse
Affiliation(s)
- Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei City, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Feng Chen
- School of Mathematics and Statistics, the University of New South Wales, Sydney, Australia
- UNSW Data Science Hub (uDASH), the University of New South Wales, Sydney, Australia
| | - Kevin Chien-Chang Wu
- Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei City, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Chen Chi
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
| | - Paul S.F. Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
| |
Collapse
|
19
|
McEvoy D, Brannigan R, Cooke L, Butler E, Walsh C, Arensman E, Clarke M. Risk and protective factors for self-harm in adolescents and young adults: An umbrella review of systematic reviews. J Psychiatr Res 2023; 168:353-380. [PMID: 37972513 DOI: 10.1016/j.jpsychires.2023.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/13/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
We conducted an umbrella review to synthesise the evidence from systematic reviews and meta-analyses that examined the risk and protective factors for self-harm in young people. We searched six different databases and used the AMSTAR-2 checklist for quality assessment. The importance of each risk and protective factor was determined based on (1) the number of times it was identified by general reviews examining any risk or protective factor, and (2) the effect sizes from meta-analyses. There were 61 systematic reviews included in this review. The most frequently identified risk factors for self-harm in young people included childhood abuse, depression/anxiety, bullying, trauma, psychiatric illnesses, substance use/abuse, parental divorce, poor family relationships, lack of friends, and exposure to self-harm behaviour in others. The risk factors with the strongest evidence for an association with self-harm were behavioural disorders, personality disorders and depression or anxiety. There was a dearth of systematic reviews examining protective factors but good family/friend relationships were most frequently identified. There was also evidence to show that non-suicidal and suicidal self-harm shared many of the same risk factors. Clinicians and other professionals who work with young people should be particularly cognisant of the psychiatric and adverse life event risk factors as well as the substance use, education-related and individual-level (e.g. being LGB) risk factors for self-harm. Knowledge of risk factors for self-harm can potentially be used to inform the design and implementation of prevention measures and further research is needed on the protective factors for self-harm.
Collapse
Affiliation(s)
- David McEvoy
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland.
| | - Ross Brannigan
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland.
| | - Lorcan Cooke
- School of Medicine, Royal College of Surgeons Ireland (RCSI), Dublin, 2, Ireland.
| | - Emma Butler
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland.
| | - Cathal Walsh
- Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Ella Arensman
- School of Public Health, University College Cork, 4th Floor, Western Gateway Building, Western Road, Cork, Ireland; National Suicide Research Foundation (NSRF), Western Gateway Building, University College Cork, Ireland.
| | - Mary Clarke
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
| |
Collapse
|
20
|
Perry J, Devore SK, Pellegrino C, Salce AJ. Social Media Usage and Its Effects on the Psychological Health of Adolescents. NASN Sch Nurse 2023; 38:292-296. [PMID: 36929816 DOI: 10.1177/1942602x231159901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Social media usage is ubiquitous among adolescents. Although social media may appeal to adolescents due to the ability to connect with peers and develop relationships, many teens also report feelings of exclusion or victimization associated with their social media use. High usage of social media may act as a forum for negative behaviors and psychological detriments. Awareness and understanding of how social media affects adolescents' psychological well-being will help parents and school staff better support teenagers and develop programs to improve coping skills and self-regulation of social media for adolescents.
Collapse
Affiliation(s)
- Julie Perry
- School of Nursing, Vanderbilt University, Nashville, TN
| | | | | | | |
Collapse
|
21
|
Barclay N, Kelley KA, Brausch AM, Muehlenkamp JJ, Nadorff MR. Changes in the suicide risk behaviors of American college students over time: An analysis of three universities. Suicide Life Threat Behav 2023; 53:764-775. [PMID: 37515442 DOI: 10.1111/sltb.12981] [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: 08/30/2022] [Revised: 06/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Suicide-related behaviors are prevalent among college students, and several mental health problems associated with increased suicide risk have increased over time. Furthermore, notable cultural events (e.g., political changes, COVID-19) have occurred in the past decade, which likely impact trends in suicide-related behaviors. The current study examined how the prevalence of nonsuicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts has changed from 2012 to 2022 across three different universities. METHOD Archival datasets from multiple years of college student survey data were compiled, and different measures of NSSI, SI, and suicide attempts were dichotomized to assess prevalence. Chi-square goodness-of-fit tests were used to identify changes in suicide-related behaviors across time. RESULTS Results indicated significant increases in the prevalence of most behaviors across each university, with most increases occurring after 2018. Despite sharing a general trend of increased suicide-related behaviors, each university differed considerably in their respective trends between various timepoints, suggesting that unique factors may differentially contribute to growing risk among college students. CONCLUSION Overall, the current study identifies increasing trends in suicide-related behaviors over the past decade and highlights the value of investigating these behaviors at the university level.
Collapse
Affiliation(s)
- Nathan Barclay
- Department of Psychology, Mississippi State University, Starkville, Mississippi, USA
| | - Karen A Kelley
- Department of Psychology, Mississippi State University, Starkville, Mississippi, USA
| | - Amy M Brausch
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Jennifer J Muehlenkamp
- Department of Psychology, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Starkville, Mississippi, USA
| |
Collapse
|
22
|
Van Meter AR, Knowles EA, Mintz EH. Systematic Review and Meta-analysis: International Prevalence of Suicidal Ideation and Attempt in Youth. J Am Acad Child Adolesc Psychiatry 2023; 62:973-986. [PMID: 36563876 DOI: 10.1016/j.jaac.2022.07.867] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/22/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Globally, rates of youth suicide vary considerably. Suicidal thoughts and behaviors (STB) are consistently associated with risk of death by suicide. However, international trends in STB have not yet been compared. To address this gap, an international meta-analysis of epidemiological and school-based studies that report on STB in youth was conducted. METHOD Systematic searches were conducted in PubMed and PsycINFO through April 2022. Eligible studies included prevalence of active suicidal ideation (SI) or suicide attempts (SA) in community youth younger than age 22. All studies were coded by 2 authors. Mixed models accounting for shared methods and including hypothesized moderators were conducted using the metafor package in R. RESULTS There were 371 effect sizes for SI, 94 for SI with a plan, and 316 for SA, representing 149 regions. Year of data collection ranged from 1981 to 2021. Participants were 6 to 21 years old. The prevalence of SI ranged across regions from 14.3% to 22.6%; the prevalence of SA ranged from 4.6% to 15.8%. Year was not associated with increasing STB prevalence except for studies from the United States, which showed increasing rates of SI and SA since 2007. CONCLUSION This is the most comprehensive meta-analysis of STB in youth, providing valuable data about how risk factors most commonly associated with suicide vary internationally and over time. International rates of STB among youth are not improving and may be getting worse in the United States, despite efforts to reduce suicide risk. Most studies did not report rates of SI or SA separately for LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others) youth and youth of color. A better understanding of proximal risk at the individual level will be important to informing future prevention efforts, especially for high-risk groups.
Collapse
Affiliation(s)
- Anna R Van Meter
- New York University Grossman School of Medicine, New York; Zucker Hillside Hospital, Queens, New York; Feinstein Institutes for Medical Research, Manhasset, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York.
| | - Ellen A Knowles
- Feinstein Institutes for Medical Research, Manhasset, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York
| | | |
Collapse
|
23
|
Lee MS, Lee H. Problematic Smartphone Use and Its Relationship With Anxiety and Suicidal Ideation Among South Korean Adolescents. Psychiatry Investig 2023; 20:843-852. [PMID: 37794666 PMCID: PMC10555507 DOI: 10.30773/pi.2023.0051] [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: 02/13/2023] [Revised: 04/13/2023] [Accepted: 06/27/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the prevalence of problematic smartphone use (PSU) among adolescents and its association with anxiety and suicidal ideation. METHODS The 16th cross-sectional, population-based Korea Youth Risk Behavior Web-Based Survey was administered in 2020 and included 54,948 adolescents. We used the Korean version of the smartphone overdependence scale and the 7-item Generalized Anxiety Disorder scale to assess PSU and anxiety. Suicidal ideation was assessed through responses to the self-report question. Multiple logistic regression analyses with complex sampling were conducted to identify the association of PSU with anxiety and suicidal ideation. RESULTS In total, 25.1% of the adolescents reported PSU, 33.2% had anxiety symptoms, and 10.9% had seriously considered suicide during the past 12 months. Girls with PSU had a higher risk of anxiety (adjusted odds ratio [aOR], 2.81; 95% confidence interval [CI], 2.65 to 2.97) and suicidal ideation (aOR, 1.77; 95% CI, 1.64 to 1.91) than non-PSU girls. Boys with PSU reported more anxiety (aOR, 2.89; 95% CI, 2.72 to 3.07) and suicidal ideation (aOR, 1.82; 95% CI, 1.66 to 1.99) than the non-PSU group. In addition, girls with the lowest household income reported more suicidal ideation than girls with the highest household income (aOR, 3.40; 95% CI, 2.69 to 4.28). CONCLUSION This study demonstrated the prevalence of PSU among South Korean adolescents in 2020. The prioritization of the detection of PSU and the identification of psychological factors may help improve the diagnosis and management of mental health problems and potentially yield significant psychosocial benefits.
Collapse
Affiliation(s)
- Mi-Sun Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hooyeon Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
24
|
Ghali S, Afifi S, Suryadevara V, Habab Y, Hutcheson A, Panjiyar BK, Davydov GG, Nashat H, Nath TS. A Systematic Review of the Association of Internet Gaming Disorder and Excessive Social Media Use With Psychiatric Comorbidities in Children and Adolescents: Is It a Curse or a Blessing? Cureus 2023; 15:e43835. [PMID: 37736454 PMCID: PMC10509728 DOI: 10.7759/cureus.43835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/20/2023] [Indexed: 09/23/2023] Open
Abstract
Internet gaming and social media usage (SMU), particularly among children and teenagers, have witnessed a remarkable surge over the past decade. However, it remains uncertain whether this widespread usage has a positive or negative impact. The primary objective of this systematic review was to investigate the diverse effects of excessive video game playing and extensive SMU, both favorable and detrimental, on the psychological and mental well-being of children and adolescents. To assess the influence of internet gaming disorder (IGD) and disordered SMU on the mental health of children aged 6-12 years and adolescents aged 13-18 years, we conducted a systematic review of 20 studies on the subject. These studies utilized a substantial sample size of 48,652 participants, encompassing online and in-person questionnaires administered to children, teenagers, and their parents in educational institutions, healthcare facilities, and online platforms. Our findings suggest that multiple factors contribute to the intricate relationship between SMU, video game playing, and mental health outcomes. The majority of research indicates that excessive gaming or SMU among children and teenagers leads to adverse consequences on their mental well-being. Furthermore, certain studies have even reported fatal consequences, while others have identified a worsening of preexisting mental health issues. A few studies have explored the potential positive impacts of SMU and gaming on individuals and society at large. In light of this, we have concluded that it is inappropriate to categorize internet gaming and SMU as solely beneficial or detrimental without considering the broader context and the interplay of various factors.
Collapse
Affiliation(s)
- Sally Ghali
- Psychiatry/Neuroscience, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shadin Afifi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vineet Suryadevara
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Yaman Habab
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Alana Hutcheson
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Binay K Panjiyar
- Cardiology, Harvard Medical School, Boston, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Gershon G Davydov
- Nephrology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Soroka University Medical Center, Be'er Sheva, ISR
| | - Hiba Nashat
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | |
Collapse
|
25
|
Messias E, Salas J, Wilson L, Scherrer JF. Temporal Location of Changes in the US Suicide Rate by Age, Ethnicity, and Race: A Joinpoint Analysis 1999-2020. J Nerv Ment Dis 2023; 211:530-536. [PMID: 37040181 PMCID: PMC10309088 DOI: 10.1097/nmd.0000000000001653] [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] [Indexed: 04/12/2023]
Abstract
ABSTRACT Suicide rates differ over time. Our objective was to determine when significant changes occurred by age, race, and ethnicity in the United States between 1999 and 2020. National Center for Health Statistics WONDER data were used in joinpoint regression. The annual percent change in suicide rate increased for all race, ethnic, and age groups, except for those 65 years and older. For American Indian/Alaska Natives, the largest increase occurred between 2010 and 2020 for those with ages 25 to 34 years. For Asian/Pacific Islander, the largest increase occurred among those 15 to 24 years old between 2011 and 2016. For Black/African-Americans, the largest increases occurred between 2010 and 2020 among 15- to 34-year-olds. For Whites, the largest increase occurred between 2014 and 2017 among 15- to 24-year-olds. Between 2018 and 2020, suicide rates significantly declined among Whites 45 to 64 years of age. Among Hispanics, significant increases in suicide rate occurred between 2012 and 2020 among those with ages 15 to 44 years. Between 1999 and 2020, the contour of suicide burden varied by age groups, race, and ethnicity.
Collapse
Affiliation(s)
- Erick Messias
- Department of Psychiatry and Behavioral Neuroscience
| | - Joanne Salas
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Lauren Wilson
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Jeffrey F. Scherrer
- Department of Psychiatry and Behavioral Neuroscience
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri
| |
Collapse
|
26
|
Rodway C, Tham SG, Richards N, Ibrahim S, Turnbull P, Kapur N, Appleby L. Online harms? Suicide-related online experience: a UK-wide case series study of young people who die by suicide. Psychol Med 2023; 53:4434-4445. [PMID: 35587034 PMCID: PMC10388316 DOI: 10.1017/s0033291722001258] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/22/2022] [Accepted: 04/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Few studies have examined online experience by young people who die by suicide. METHODS A 3-year UK-wide consecutive case series of all young people aged 10-19 who died by suicide, based on national mortality data. We extracted information on the antecedents of suicide of 544 of these 595 deaths (91%) from official investigations, mainly inquests. RESULTS Suicide-related online experience was reported in 24% (n = 128/544) of suicide deaths in young people between 2014 and 2016, equivalent to 43 deaths per year, and was more common in girls than boys (OR 1.87, 95% CI 1.23-2.85, p = 0.003) and those identifying as LGBT (OR 2.35, 95% CI 1.10-5.05, p = 0.028). Searching for information about method was most common (n = 68, 13%), followed by posting suicidal ideas online (n = 57, 10%). Self-harm, bereavement (especially by suicide), social isolation, and mental and physical ill-health were more likely in those known to have suicide-related online experience compared to those who did not. 29 (5%) were bullied online, more often girls (OR 2.84, 1.34-6.04, p = 0.007). Online bullying often accompanied face-to-face bullying (n = 16/29, 67%). CONCLUSIONS Suicide-related online experience is a common, but likely underestimated, antecedent to suicide in young people. Although its causal role is unclear, it may influence suicidality in this population. Mental health professionals should be aware that suicide-related online experience - not limited to social media - is a potential risk for young patients, and may be linked to experiences offline. For public health, wider action is required on internet regulation and support for children and their families.
Collapse
Affiliation(s)
- C. Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - S. G. Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - N. Richards
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - S. Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - P. Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - N. Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - L. Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| |
Collapse
|
27
|
O'Connor RC, Worthman CM, Abanga M, Athanassopoulou N, Boyce N, Chan LF, Christensen H, Das-Munshi J, Downs J, Koenen KC, Moutier CY, Templeton P, Batterham P, Brakspear K, Frank RG, Gilbody S, Gureje O, Henderson D, John A, Kabagambe W, Khan M, Kessler D, Kirtley OJ, Kline S, Kohrt B, Lincoln AK, Lund C, Mendenhall E, Miranda R, Mondelli V, Niederkrotenthaler T, Osborn D, Pirkis J, Pisani AR, Prawira B, Rachidi H, Seedat S, Siskind D, Vijayakumar L, Yip PSF. Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress. Lancet Psychiatry 2023; 10:452-464. [PMID: 37182526 DOI: 10.1016/s2215-0366(23)00058-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 05/16/2023]
Abstract
Globally, too many people die prematurely from suicide and the physical comorbidities associated with mental illness and mental distress. The purpose of this Review is to mobilise the translation of evidence into prioritised actions that reduce this inequity. The mental health research charity, MQ Mental Health Research, convened an international panel that used roadmapping methods and review evidence to identify key factors, mechanisms, and solutions for premature mortality across the social-ecological system. We identified 12 key overarching risk factors and mechanisms, with more commonalities than differences across the suicide and physical comorbidities domains. We also identified 18 actionable solutions across three organising principles: the integration of mental and physical health care; the prioritisation of prevention while strengthening treatment; and the optimisation of intervention synergies across social-ecological levels and the intervention cycle. These solutions included accessible, integrated high-quality primary care; early life, workplace, and community-based interventions co-designed by the people they should serve; decriminalisation of suicide and restriction of access to lethal means; stigma reduction; reduction of income, gender, and racial inequality; and increased investment. The time to act is now, to rebuild health-care systems, leverage changes in funding landscapes, and address the effects of stigma, discrimination, marginalisation, gender violence, and victimisation.
Collapse
Affiliation(s)
- Rory C O'Connor
- Suicidal Behaviour Research Laboratory, School of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | | | - Marie Abanga
- Hope for the Abused and Battered, Douala, Cameroon
| | | | | | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Helen Christensen
- Faculty of Medicine & Health, University of New South Wales, Sydney and the Black Dog Institute, Sydney, NSW, Australia
| | - Jayati Das-Munshi
- Department of Psychological Medicine, King's College London, London, UK; Institute of Psychiatry, Psychology, and Neuroscience, and Centre for Society and Mental Health, King's College London, London, UK; South London and Maudsley NHS Trust, London, UK
| | - James Downs
- Royal College of Psychiatrists, UK and Faculty of Wellbeing, Education, and Language Studies, Open University, Milton Keynes, UK
| | | | | | - Peter Templeton
- The William Templeton Foundation for Young People's Mental Health, Cambridge, UK
| | - Philip Batterham
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | | | | | - Simon Gilbody
- York Mental Health and Addictions Research Group, University of York, York, UK
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse, University of Ibadan, Ibadan, Nigeria
| | - David Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Murad Khan
- Brain & Mind Institute, Aga Khan University, Karachi, Pakistan
| | - David Kessler
- Bristol Population Health Science Institute, Centre for Academic Mental Health, Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Olivia J Kirtley
- Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Brandon Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Alisa K Lincoln
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Crick Lund
- Health Services and Population Research Department, King's College London, London, UK; Centre for Global Mental Health, King's College London, London, UK
| | - Emily Mendenhall
- Edmund A Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Regina Miranda
- Hunter College, Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA
| | - Valeria Mondelli
- Department of Psychological Medicine, King's College London, London, UK
| | - Thomas Niederkrotenthaler
- Department of Social and Preventive Medicine, Suicide Research & Mental Health Promotion Unit, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - David Osborn
- Division of Psychiatry, University College London and Camden and Islington NHS Foundation Trust, London, UK
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony R Pisani
- University of Rochester Center for the Study and Prevention of Suicide, SafeSide Prevention, Rochester, NY, USA
| | | | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, SAMRC Genomics of Brain Disorders Unit, Stellenbosch University, Cape Town, South Africa
| | - Dan Siskind
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | | | - Paul S F Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Special Administrative Region, China
| |
Collapse
|
28
|
Sedgwick R, Bittar A, Kalsi H, Barack T, Downs J, Dutta R. Investigating online activity in UK adolescent mental health patients: a feasibility study using a natural language processing approach for electronic health records. BMJ Open 2023; 13:e061640. [PMID: 37230520 PMCID: PMC10230886 DOI: 10.1136/bmjopen-2022-061640] [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: 02/10/2022] [Accepted: 04/19/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES To assess the feasibility of using a natural language processing (NLP) application for extraction of free-text online activity mentions in adolescent mental health patient electronic health records (EHRs). SETTING The Clinical Records Interactive Search system allows detailed research based on deidentified EHRs from the South London and Maudsley NHS Foundation Trust, a large south London Mental Health Trust providing secondary and tertiary mental healthcare. PARTICIPANTS AND METHODS We developed a gazetteer of online activity terms and annotation guidelines, from 5480 clinical notes (200 adolescents, aged 11-17 years) receiving specialist mental healthcare. The preprocessing and manual curation steps of this real-world data set allowed development of a rule-based NLP application to automate identification of online activity (internet, social media, online gaming) mentions in EHRs. The context of each mention was also recorded manually as: supportive, detrimental or neutral in a subset of data for additional analysis. RESULTS The NLP application performed with good precision (0.97) and recall (0.94) for identification of online activity mentions. Preliminary analyses found 34% of online activity mentions were considered to have been documented within a supportive context for the young person, 38% detrimental and 28% neutral. CONCLUSION Our results provide an important example of a rule-based NLP methodology to accurately identify online activity recording in EHRs, enabling researchers to now investigate associations with a range of adolescent mental health outcomes.
Collapse
Affiliation(s)
- Rosemary Sedgwick
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - André Bittar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Herkiran Kalsi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tamara Barack
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rina Dutta
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
29
|
Harris D, Krishnan A. Exploring the Association Between Suicide Prevention Public Service Announcements and User Comments on YouTube: A Computational Text Analysis Approach. JOURNAL OF HEALTH COMMUNICATION 2023; 28:302-311. [PMID: 37070172 DOI: 10.1080/10810730.2023.2203077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the United States, suicide rates have increased by 30% over the past few decades. Public service announcements (PSAs) are effective health promotion vehicles and social media can help spread PSAs to hard-to-engage individuals who may benefit from intervention efforts, yet the most meaningful characteristics of PSAs for influencing health promotion attitudes and behaviors are inconclusive. This study applied content and quantitative text analyses to suicide prevention PSAs and comments on YouTube to assess the relationships between message frame, message format, and the level of sentiment and help-seeking language within them. Seventy-two PSAs were analyzed for gain/loss-framing and narrative/argument-format, and 4,335 related comments were analyzed for positive/negative sentiment and frequency of help-seeking language use. Results indicate that a higher ratio of positive comments was more likely to be found on gain-framed and narrative-formatted PSAs, and a higher ratio of comments with help-seeking language was more likely to be found on narrative-formatted PSAs. Implications and future research are discussed.
Collapse
Affiliation(s)
- Donald Harris
- Information Science Department, College of Emergency Preparedness, Homeland Security and Cybersecurity, University at Albany, Albany, New York, USA
| | - Archana Krishnan
- College of Arts & Sciences, Department of Communication, University at Albany, Albany, New York, USA
| |
Collapse
|
30
|
van Schalkwyk MCI, Collin J, Eddleston M, Petticrew M, Pearson M, Schölin L, Maani N, Konradsen F, Gunnell D, Knipe D. Conceptualising the commercial determinants of suicide: broadening the lens on suicide and self-harm prevention. Lancet Psychiatry 2023; 10:363-370. [PMID: 37019125 DOI: 10.1016/s2215-0366(23)00043-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/18/2023] [Accepted: 02/03/2023] [Indexed: 04/07/2023]
Abstract
Suicide is preventable, yet, in many settings, robust suicide prevention strategies have not been implemented. Although a commercial determinants of health lens is increasingly being applied to industries important to the field of suicide prevention, the interplay between the vested interests of commercial actors and suicide has received little attention. There is a need to shift attention to the causes of the causes, directing more focus to the ways that commercial determinants influence suicide and shape suicide prevention strategies. Such a shift in perspective, with an evidence base and precedents to draw upon, has transformative potential for research and policy agendas dedicated to understanding and addressing upstream modifiable determinants of suicide and self-harm. We propose a framework intended to help guide efforts to conceptualise, research, and address the commercial determinants of suicide and their inequitable distribution. We hope these ideas and lines of inquiry help to catalyse connections between disciplines and open further debate and discussion as to how to take such an agenda forward.
Collapse
Affiliation(s)
- May C I van Schalkwyk
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Jeff Collin
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK; Prevention Research Partnership SPECTRUM Consortium, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention and Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Prevention Research Partnership SPECTRUM Consortium, UK
| | - Melissa Pearson
- Centre for Pesticide Suicide Prevention and Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Lisa Schölin
- Centre for Pesticide Suicide Prevention and Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nason Maani
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK; Prevention Research Partnership SPECTRUM Consortium, UK
| | - Flemming Konradsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - David Gunnell
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Duleeka Knipe
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| |
Collapse
|
31
|
Hughes JL, Horowitz LM, Ackerman JP, Adrian MC, Campo JV, Bridge JA. Suicide in young people: screening, risk assessment, and intervention. BMJ 2023; 381:e070630. [PMID: 37094838 DOI: 10.1136/bmj-2022-070630] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. This review outlines the epidemiology of suicide and suicidal behavior in young people. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that are prime targets for implementation of effective treatment programs and interventions aimed at rapidly reducing the suicide rate in young people. It provides an overview of current approaches to screening and assessment of suicide risk in young people and the commonly used screening tools and assessment measures. It discusses universal, selective, and indicated evidence based suicide focused interventions and highlights components of psychosocial interventions with the strongest evidence for reducing risk. Finally, the review discusses suicide prevention strategies in community settings and considers future research directions and questions challenging the field.
Collapse
Affiliation(s)
- Jennifer L Hughes
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lisa M Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institutes of Mental Health, NIH, Bethesda, MD, USA
| | - John P Ackerman
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Molly C Adrian
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - John V Campo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey A Bridge
- Departments of Pediatrics and Psychiatry and Behavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center College of Medicine, Columbus, OH, USA
| |
Collapse
|
32
|
Balt E, Mérelle S, Robinson J, Popma A, Creemers D, van den Brand I, van Bergen D, Rasing S, Mulder W, Gilissen R. Social media use of adolescents who died by suicide: lessons from a psychological autopsy study. Child Adolesc Psychiatry Ment Health 2023; 17:48. [PMID: 37029395 PMCID: PMC10082488 DOI: 10.1186/s13034-023-00597-9] [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: 01/31/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND while there are many benefits for young people to use social media, adverse effects such as cyberbullying, online challenges, social comparison and imitation may provoke and aggravate suicidal thoughts and behaviors. The influence of social media on mental health and suicidal thoughts and behaviours has been amply studied, but there is little empirical evidence for its potential role in adolescent suicides. The current study aimed to inform digital suicide prevention strategies by examining the meaning of social media in the lives of young suicide victims and elucidating the harmful and supportive effects of social media use on their wellbeing and distress. METHODS data were analyzed from a psychological autopsy study of 35 adolescents who died by suicide in the Netherlands (43% of all adolescents who died by suicide in that year). These were 18 girls and 17 boys. All were under the age of twenty years, with an average of seventeen years. Interpretative Phenomenological Analysis was performed of 55 semi structured interviews with peers and parents of the decedents. RESULTS young people benefitted from peer support and recovery stories. However, various themes were discussed relating to the harmful effects of social media, including dependency, triggers and imitation, challenges, cybervictimization and psychological entrapment. The themes of dependency and triggers and imitation were more salient in young females. A group of girls cultivated an online identity around their suicidal thoughts and behaviours. Next-of-kin, particularly parents, faced various challenges to talk to the adolescents about social media use, including technological illiteracy, online anonymity, and the youths' closedness. CONCLUSIONS based on the findings, we recommend education to stimulate the digital literacy of parents, health workers and educators, supporting conscientious social media use in young people, and extending the prevention of cyberbullying. We encourage future research to examine how virtual social networks may sustain suicidal thoughts and behaviour, and to further investigate the effectiveness of digital interventions, like moderated peer support and the use of positive role models.
Collapse
Affiliation(s)
- Elias Balt
- Research department, 113 Suicide Prevention, Amsterdam, the Netherlands.
| | - Saskia Mérelle
- Research department, 113 Suicide Prevention, Amsterdam, the Netherlands
| | - Jo Robinson
- Orygen, 35 Poplar Road, Parkville, Vic, 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Arne Popma
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam University Medical Centre (AUMC), Amsterdam, the Netherlands
| | - Daan Creemers
- Child and Adolescent Psychiatry, GGZ Oost Brabant, Boekel, the Netherlands
| | - Isa van den Brand
- Research department, 113 Suicide Prevention, Amsterdam, the Netherlands
| | - Diana van Bergen
- Department of Pedagogical and Educational Sciences, Faculty of Behavioural Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Sanne Rasing
- Child and Adolescent Psychiatry, GGZ Oost Brabant, Boekel, the Netherlands
| | - Wico Mulder
- Youth healthcare, Dutch Centre for Youth Health (NCJ), Utrecht, The Netherlands
| | - Renske Gilissen
- Research department, 113 Suicide Prevention, Amsterdam, the Netherlands
| |
Collapse
|
33
|
Chang YH, Lin CY, Liao SC, Chen YY, Shaw FFT, Hsu CY, Gunnell D, Chang SS. Societal factors and psychological distress indicators associated with the recent rise in youth suicide in Taiwan: A time trend analysis. Aust N Z J Psychiatry 2023; 57:537-549. [PMID: 35833496 DOI: 10.1177/00048674221108640] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We investigated recent trends in youth suicide and their associations with societal and psychological factors in Taiwan. METHODS Suicide data (1971-2019) for 10-24 year olds were extracted from Taiwan's national cause-of-death data files. We investigated changes in trends in youth suicide rates, societal factors (gross domestic product per capita, Gini index, overall and youth unemployment rates, divorce rates in people aged 40-59 years [i.e. the age of most 15-24 year olds' parents] and Internet use rates) and psychological distress indicators (youth self-harm rates and the prevalence of worry-related insomnia, and suicide ideation, plan and attempt) using joinpoint regression and graphic examinations. The associations of these factors with youth suicide rates were examined using Prais-Winsten regression. RESULTS Suicide rates in Taiwan's 10-24 year olds changed from a downward trend (2005-2014) to an upward trend in 2014 and increased 11.5% (95% confidence interval = [5.2%, 18.1%]) annually between 2014 and 2019. There was also an upturn in divorce rates among females aged 40-59 years in 2014 and self-harm rates among 15- to 24-year-old youth in 2013. The prevalence of self-reported insomnia and suicide ideation, plan and attempt in youth started to increase from 2013 to 2016. In the regression analysis, Internet use, female divorce rates and youth self-harm rates were positively associated with youth suicide rates. CONCLUSION Suicide rates and the prevalence of suicidal behaviors began to increase in Taiwanese youth in the 2010s. These increases may be associated with concurrent rises in parental divorce rates, Internet use and poor sleep. Further research is needed to examine the mechanisms underlying recent increases in youth suicide risk.
Collapse
Affiliation(s)
- Yi-Han Chang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Health Behaviors and Community Sciences and Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chien-Yu Lin
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Shih-Cheng Liao
- National Suicide Prevention Center, Taiwanese Society of Suicidology, Taipei, Taiwan
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health and Department of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fortune Fu-Tsung Shaw
- Department of Counseling Psychology and Human Resource Development, National Chi Nan University, Nantou, Taiwan
| | - Chia-Yueh Hsu
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - David Gunnell
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- National Institute for Health and Care Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences and Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
34
|
Rouleau RD, Beauregard C, Beaudry V. A rise in social media use in adolescents during the COVID-19 pandemic: the French validation of the Bergen Social Media Addiction Scale in a Canadian cohort. BMC Psychol 2023; 11:92. [PMID: 37004081 PMCID: PMC10063937 DOI: 10.1186/s40359-023-01141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION Social media use has grown dramatically since its inception in the early 2000s and has further increased during the COVID-19 pandemic. Problematic use of social media (PUSM) is a type of behavioural addiction which has generated increasing interest among mental health clinicians and scholars in the last decade. PUSM is associated with multiple psychiatric conditions and is known to interfere with patients' daily functioning. There is no single accepted definition of PUSM, nor means of measuring it, in the literature. The Bergen Social Media Addiction Scale (BSMAS) is a helpful tool for identifying PUSM. This paper aims to validate BSMAS and to translate it from English into French, with the goal of making this clinical screening tool for PUSM available in French-language contexts. METHOD This study explored the psychometric validity of the French version of the BSMAS in a sample of 247 adolescents, who were either psychiatric inpatients (the hospitalized group, n = 123) or recruited in local high schools (the community group, n = 124). RESULTS The adolescents in the sample reported an increase in their social media use during the COVID-19 pandemic. This increase was more pronounced in the hospitalized group. Confirmatory factorial analysis showed an excellent fit, very good internal consistency and established convergent validity for the French version of the BSMAS. A total of 15.4% of the hospitalization group and 6.5% of the community group met the recommended clinical cutoff of 24 on the BSMAS, suggesting problematic use of social media. CONCLUSIONS The French version of BSMAS is a psychometrically validated and clinically useful tool to screen for PUSM in adolescents.
Collapse
Affiliation(s)
- Raphaël Dufort Rouleau
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Carmen Beauregard
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, CIUSSS de l'Estrie-CHUS (Centre Hospitalier Universitaire de Sherbrooke), Sherbrooke, Québec, Canada
| | - Vincent Beaudry
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, CIUSSS de l'Estrie-CHUS (Centre Hospitalier Universitaire de Sherbrooke), Sherbrooke, Québec, Canada.
| |
Collapse
|
35
|
Zhao C, He J, Du M, Xu H, Lai X, Yu G, Zhang G. A cross-lagged study of the associations among problematic smartphone use, depressive symptoms, and suicidal ideation in chinese university students. CURRENT PSYCHOLOGY 2023:1-12. [PMID: 37359702 PMCID: PMC10052245 DOI: 10.1007/s12144-023-04560-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
The present study aimed to investigate the longitudinal and reciprocal relationships among problematic smartphone use (PSU), depressive symptoms (DS), and suicidal ideation (SI) in Chinese university students. Using a cross-lagged design, the Mobile Phone Addiction Inventory Scale, the Center for Epidemiologic Studies Depression Scale, and the Self-Rating Idea of Suicide Scale as research instruments, 194 university students completed a questionnaire four consecutive times. June of Year 1, December of Year 2, June of Year 2, and December of Year 3 of their college study. We refer to these as the Time 1 (T1), Time 2 (T2), Time 3 (T3), and Time 4 (T4) assessments, respectively. The levels of PSU and DS fluctuated significantly over time. DS at T1 was significantly predicted to influence SI at T2 (β = 0.17, p < .05); DS at T3 was significantly predicted by PSU and by SI at T2 (respectively, β = 0.30, p < .05; β = 0.21, p < .05); DS at T2 significantly predicted PSU at T3 (β = 0.14, p < .05); and DS at T3 significantly predicted SI at T4 (β = 0.14, p < .05) in the cross-lagged pathway. DS at T3 fully mediated the relationship between PSU at T2 and SI at T4 (indirect effect: β = 0.133, 95% CI = [0.063, 0.213]). The results suggest that there is a reciprocal relationship between PSU and DS and, furthermore, that DS plays an important mediating role between PSU and SI. Our results suggest the importance of early identification and treatment of SI. Timely reduction of PSU and improvement of DS among university students may help prevent SI.
Collapse
Affiliation(s)
- Chengjia Zhao
- School of Education, Renmin University of China, Beijing, 100872 China
- Department of Psychology, School of Mental Health, Wenzhou Medical University, Wenzhou, 325035 China
| | - Jiangkang He
- Department of Psychology, School of Mental Health, Wenzhou Medical University, Wenzhou, 325035 China
| | - Mingxuan Du
- Department of Psychology, School of Mental Health, Wenzhou Medical University, Wenzhou, 325035 China
| | - Huihui Xu
- Department of Psychology, School of Mental Health, Wenzhou Medical University, Wenzhou, 325035 China
| | - Xinyi Lai
- Department of Psychology, School of Mental Health, Wenzhou Medical University, Wenzhou, 325035 China
| | - Guoliang Yu
- Institute of Psychology, Renmin University of China, Beijing, 100872 China
| | - Guohua Zhang
- Department of Psychology, School of Mental Health, Wenzhou Medical University, Wenzhou, 325035 China
- The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, 325035 China
| |
Collapse
|
36
|
Kim D, Quan L, Seo M, Kim K, Kim JW, Zhu Y. Interpretable machine learning-based approaches for understanding suicide risk and protective factors among South Korean females using survey and social media data. Suicide Life Threat Behav 2023. [PMID: 36946602 DOI: 10.1111/sltb.12959] [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: 04/07/2022] [Revised: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE We aimed to identify and understand risk and protective factors for suicide among South Korean females by linking survey and social media data and using interpretable machine learning approaches. MATERIALS AND METHODS We collected a wide range of potential factors including the material, psychosocial, and behavioral data from a detailed survey, which we then linked to data from social media. In addition, we adopted interpretable machine learning approaches to (1) predict the suicide risk, (2) explain the relative importance of factors and their interactions regarding suicide, and (3) understand individual differences affecting suicide risk. RESULTS The best-performing machine learning model achieved an AUC of 0.737. Adverse childhood experiences, social connectedness, and mean positive sentiment score of social media posts were the three risk factors that had a monotonic or unimodal relationship with suicide, and satisfaction with life, narcissistic self-presentation, and number of close friends on social media were the three protective factors that had a monotonic or unimodal relationship with suicide. We also found several meaningful interactions between specific psychiatric symptoms and narcissistic self-presentation. CONCLUSIONS Our findings can help governmental organizations to better assess female suicide risk in South Korea and develop more informed and customized suicide prevention strategies.
Collapse
Affiliation(s)
- Donghun Kim
- Department of Library and Information Science, Yonsei University, Seoul, Republic of Korea
| | - Lihong Quan
- Department of Media and Communication, Sungkyunkwan University, Seoul, Republic of Korea
| | - Mihye Seo
- Department of Media and Communication, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kihyun Kim
- Department of Social Welfare, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jae-Won Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yongjun Zhu
- Department of Library and Information Science, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
37
|
Ilia S, Sakapeti E, Briassoulis P, Gerostergios G, Vgontzas A, Briassoulis G. Suicidality Prevalence in a Pediatric Psychiatric Clinic: Relation to Social and Environmental Risk Factors. CHILDREN 2023; 10:children10030558. [PMID: 36980115 PMCID: PMC10047874 DOI: 10.3390/children10030558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
Suicidality is a growing public health problem in children and adolescents. The aim of this retrospective data analysis study was to estimate the prevalence of suicidality in pediatric patients admitted to an academic Pediatric Psychiatric Clinic (PPC) and to analyze social and environmental risk factors associated with suicide. Suicidal ideation was assessed by the Self-Injurious Thoughts and Behaviors Interview. Using established psychometric scales, social and stressful events were analyzed. During the four-year study, 249 episodes of care were experienced by 152 individuals (mean age 15.2 ± 2 years, girls/boys 107/45). Twenty-eight patients (11.2%) were admitted from the Pediatric Intensive Care Unit and the Department of Pediatrics, 162 (65.1%) from the Pediatric Emergency Department, and 59 (23.7%) from other Hospitals (p = 0.003). A significant longitudinal increase in admissions to PPC, with increasing trends of suicidal ideation, suicide attempts, and suicidality, was recorded. Suicidal behavior, bullying, internet addiction, friends quarreling, and family problems were risk factors for suicide attempts and suicidality. Our results have implications for prevention programs, highlighting an increasing need for care for suicide attempts and suicidal ideation, related to specific stressful events and contextual socio-environmental status.
Collapse
Affiliation(s)
- Stavroula Ilia
- Postgraduate Program “Emergency and Intensive Care in Children Adolescents and Young Adults”, School of Medicine, University of Crete, 71003 Heraklion, Greece
- Pediatric Intensive Care Unit, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece
| | - Evangelia Sakapeti
- Postgraduate Program “Emergency and Intensive Care in Children Adolescents and Young Adults”, School of Medicine, University of Crete, 71003 Heraklion, Greece
- Department of Psychiatry, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece
| | - Panagiotis Briassoulis
- Pediatric Intensive Care Unit, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece
- Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - George Gerostergios
- Department of Psychiatry, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece
| | - Alexandros Vgontzas
- Department of Psychiatry, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece
| | - George Briassoulis
- Postgraduate Program “Emergency and Intensive Care in Children Adolescents and Young Adults”, School of Medicine, University of Crete, 71003 Heraklion, Greece
- Pediatric Intensive Care Unit, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece
- Correspondence: ; Tel.: +30-2810-394675
| |
Collapse
|
38
|
Szlyk HS, Li X, Kasson E, Peoples JE, Montayne M, Kaiser N, Cavazos-Rehg P. How do teens with a history of suicidal behavior and self-harm interact with social media? J Adolesc 2023. [PMID: 36864641 DOI: 10.1002/jad.12154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND This study examines how engagement with depression-related social media content varies by teens who report suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI) versus those who had not experienced each behavior. METHODS Teens aged 15-17 years old (N = 93) were recruited from social media platforms from October 2016 to August 2018. Participants were asked three open-ended questions about the advantages and disadvantages of networking about depression-related content on social media. We conducted a qualitative analysis to capture themes in responses by question item. Univariate analyses were conducted to compare differences in the frequency of themes endorsed among the behavioral groups versus their counterparts. RESULTS Among participants (female, 73%; non-White, 45%; sexual minority, 57%), most (93%, n = 87) endorsed depressive symptoms. Sixty-five percent (n = 60) endorsed suicidal ideation within the past year, who were more likely to indicate unhelpful social interactions (p = .02) as a disadvantage of following depression content than peers who did not endorse suicidal ideation within the past year. Eighty percent (n = 74) endorsed lifetime experience of NSSI, who were more likely to indicate negative impact on relationships (p = .01) from posting depression content than peers who did not experience NSSI. Fifty-eight percent (n = 54) endorsed a lifetime suicide attempt, who were more likely to mention offering solutions (p = .03) to someone posting concerning content than peers who did not endorse a lifetime suicide attempt. CONCLUSIONS This study provides diverse and unique perspectives on how engagement with depression-related social media varies by mental health behaviors and informs the use of social media for recruitment and outreach for teens.
Collapse
Affiliation(s)
- Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - JaNiene E Peoples
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mandy Montayne
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
39
|
Fekih-Romdhane F, Malaeb D, Loch AA, Farah N, Stambouli M, Cheour M, Obeid S, Hallit S. Problematic Smartphone Use Mediates the Pathway from Suicidal Ideation to Positive Psychotic Experiences: a Large Cross-Sectional, Population-Based Study. Int J Ment Health Addict 2023:1-18. [PMID: 36820017 PMCID: PMC9930705 DOI: 10.1007/s11469-023-01028-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
The present study followed the newly hypothesized "suicidal drive for psychosis" suggesting that psychosis may be consequential to suicidal ideation (SI) and behavior and attempted to explain parts of the pathway between these variables. To this end, we aimed to test whether problematic smartphone use (PSU) has an indirect mediating effect in the cross-sectional relationship between SI and positive psychotic experiences (PEs). Lebanese community young adults (N=4158; 64.4% females; mean age 21.91±3.79) have been invited to participate to a cross-sectional, web-based study in the period from June to September 2022. After adjusting for potential confounders (i.e., the living situation, marital status, household crowding index, economic pressure, cannabis use, other drugs use, and past history of mental illness other than psychosis), we found that higher levels of suicidal ideation was significantly associated with greater PSU, which was also positively and significantly associated with more positive PEs. Finally, greater suicidal ideation was significantly and directly associated with more positive PEs. Our findings suggest that SPU may be regarded as a potential target for prevention and intervention in psychosis. Clinicians, educators, and school administrators ought to give greater attention to PSU among vulnerable young people who present with SI.
Collapse
Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi Hospital, 2010 Manouba, Tunisia
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Sao Paulo, Brazil
| | - Nour Farah
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Manel Stambouli
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi Hospital, 2010 Manouba, Tunisia
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Majda Cheour
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi Hospital, 2010 Manouba, Tunisia
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Psychology Department, College of Humanities, Effat University, Jeddah, 21478 Saudi Arabia
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| |
Collapse
|
40
|
Grzejszczak J, Strzelecki D, Gabryelska A, Kotlicka-Antczak M. Affiliation to a Social Group as a Preventive Factor in Suicidal Behaviors in Children and Adolescents during the COVID-19 Pandemic. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020333. [PMID: 36832461 PMCID: PMC9955561 DOI: 10.3390/children10020333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
Suicide is one of the most common causes of death in the population of children and adolescents. Available data show the continuous growth of this phenomenon and the ineffectiveness of prevention programs. Additionally, the COVID-19 pandemic significantly affected young people's mental health, including an increased risk of suicidal behaviors due to limited direct contact with the school and peer groups in favor of the home environment. Therefore, the aim of this narrative review was to consider the risk factors and protective factors for suicidal behavior in the under-18 population, with a particular focus on the importance of belonging to a social group and building identification with it as a phenomenon protecting against suicidal behavior. Additionally, in this review, we evaluate how the COVID-19 pandemic affected these relationships. The PubMed database was used in the search with the following keywords: suicide, suicide behaviors, child and adolescent suicide behaviors, group affiliation, family affiliation, ethnicity, religious affiliation, and the COVID-19 pandemic, with articles published between 2002 and 2022 analyzed. Research conducted to date indicates that both sustained and stable family and peer relationships, as well as a sense of identification and belonging, noticeably reduce the risk of suicidal behavior. Ethnic or cultural affiliation seems to have been particularly important during the isolation in the home environment caused by the COVID-19 pandemic. Additionally, it has been shown that while in lockdown, contact through social media with individuals' identification groups was associated with a reduced chance of emotional crises. Furthermore, regardless of cultural background, attachment to a particular group correlates with enhanced psychiatric state of children and adolescents. Thus, available data highlight the need for building and maintaining affiliations with suitable groups as a protective factor against suicidal behaviors.
Collapse
Affiliation(s)
- Jagoda Grzejszczak
- Department of Child and Adolescent Psychiatry, Medical University of Lodz, 92-216 Lodz, Poland
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-216 Lodz, Poland
| | - Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland
- Correspondence:
| | | |
Collapse
|
41
|
Bye A, Carter B, Leightley D, Trevillion K, Liakata M, Branthonne-Foster S, Williamson G, Zenasni Z, Dutta R. Observational prospective study of social media, smartphone use and self-harm in a clinical sample of young people: study protocol. BMJ Open 2023; 13:e069748. [PMID: 36725102 PMCID: PMC9896249 DOI: 10.1136/bmjopen-2022-069748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Young people are the most frequent users of social media and smartphones and there has been an increasing speculation about the potential negative impacts of their use on mental health. This has coincided with a sharp increase in the levels of self-harm in young people. To date, studies researching this potential association are predominantly cross-sectional and reliant on self-report data, which precludes the ability to objectively analyse behaviour over time. This study is one of the first attempts to explore temporal patterns of real-world usage prior to self-harm, to identify whether there are usage patterns associated with an increased risk. METHODS AND ANALYSIS To study the mechanisms by which social media and smartphone use underpin self-harm in a clinical sample of young people, the Social media, Smartphone use and Self-harm in Young People (3S-YP) study uses a prospective, observational study design. Up to 600 young people aged 13-25 years old from secondary mental health services will be recruited and followed for up to 6 months. Primary analysis will compare real-world data in the 7 days leading up to a participant or clinician recorded self-harm episode, to categorise patterns of problematic usage. Secondary analyses will explore potential mediating effects of anxiety, depression, sleep disturbance, loneliness and bullying. ETHICS AND DISSEMINATION This study was approved by the National Research Ethics Service, London - Riverside, as well as by the Joint Research and Development Office of the Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Foundation Trust (SLaM), and the SLaM Clinical Research Interactive Search (CRIS) Oversight Committee. The findings from this study will be disseminated through peer-reviewed scientific journals, conferences, websites, social media and stakeholder engagement activities. TRIAL REGISTRATION NUMBER NCT04601220.
Collapse
Affiliation(s)
- Amanda Bye
- Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Ben Carter
- Biostatistics and Health Informatics, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Daniel Leightley
- Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- King's Centre for Military Health Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Kylee Trevillion
- Health Service and Population Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Maria Liakata
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
- The Alan Turing Institute, London, UK
| | | | - Grace Williamson
- Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Zohra Zenasni
- Biostatistics and Health Informatics, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Rina Dutta
- Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
42
|
Patchin JW, Hinduja S, Meldrum RC. Digital self-harm and suicidality among adolescents. Child Adolesc Ment Health 2023; 28:52-59. [PMID: 35811440 DOI: 10.1111/camh.12574] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Research on digital self-harm - the anonymous online posting, sending, or otherwise sharing of hurtful content about oneself - is still in its infancy. Yet unexplored is whether digital self-harm is related to suicidal ideation or suicide attempts. METHODS In the current study, survey data were collected in 2019 from a national sample of 4972 American middle and high school students (Mage = 14.5; 50% female). Logistic regression analysis was used to assess whether lifetime engagement in two different indicators of digital self-harm was associated with suicidal thoughts and attempts within the past year. RESULTS Logistic regression analysis showed that engagement in digital self-harm was associated with a five- to sevenfold increase in the likelihood of reporting suicidal thoughts and a nine- to 15-fold increase in the likelihood of a suicide attempt. CONCLUSIONS Results suggest a connection between digital self-harm and suicidality. As such, health professionals must screen for digital self-harm to address underlying mental health problems among youth that may occur prior to or alongside suicidality, and parents/caregivers must convey to children that they are available to dialog, support, and assist with the root issues that may eventually manifest as digital self-harm.
Collapse
Affiliation(s)
- Justin W Patchin
- Department of Political Science, University of Wisconsin-Eau Claire, Eau Claire, WI, USA
| | - Sameer Hinduja
- School of Criminology and Criminal Justice, Florida Atlantic University, Boca Raton, FL, USA
| | - Ryan C Meldrum
- Department of Criminology and Criminal Justice, Florida International University, Miami, FL, USA
| |
Collapse
|
43
|
Anthony R, Young H, Hewitt G, Sloan L, Moore G, Murphy S, Cook S. Young people's online communication and its association with mental well-being: results from the 2019 student health and well-being survey. Child Adolesc Ment Health 2023; 28:4-11. [PMID: 36385571 DOI: 10.1111/camh.12610] [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] [Accepted: 10/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Online communication has become an integral aspect of daily life for young people internationally. Very little research has examined whether the association between social media use and well-being depends on who young people engage with (i.e. real, or virtual friendships). METHODS Data were drawn from a subsample of students (N = 38,736) who took part in the School Health Research Network (SHRN) 2019 Student Health and Well-being (SHW) survey. A series of multivariable regression models were used to assess the association between who adolescents were communicating with online and well-being, controlling for confounders: passive social media use; friendship quality; and cyberbullying. We also tested whether these associations were modified based on gender. RESULTS Students are highly engaged on social networking sites, and these sites are used to communicate with existing friendship groups and develop virtual friendships. Frequent online communication with best friends (b = .340, p < .001) and bigger friendship groups (b = .397; p < .001) was associated with higher levels of well-being. However, the frequency of online contact with virtual friends made online was negatively and significantly associated with well-being (b = -.760; p < .001), with a larger negative association for girls than boys. CONCLUSIONS Online communication with virtual friendship networks were associated with lower mental well-being, with stronger associations for girls than boys; however, frequent online communication with 'real' friends was associated with better well-being. Our results indicate the importance of considering the nature of adolescent online communication, rather than just its quantity, in developing interventions to improve adolescent well-being.
Collapse
Affiliation(s)
- Rebecca Anthony
- Centre for the Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Honor Young
- Centre for the Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Gillian Hewitt
- Centre for the Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Luke Sloan
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Graham Moore
- Centre for the Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Simon Murphy
- Centre for the Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Steven Cook
- School of Social Sciences, Cardiff University, Cardiff, UK
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| |
Collapse
|
44
|
Eysenbach G, Quintana Y. Social Media is Addictive and Influences Behavior: Should it Be Regulated as a Digital Therapeutic? J Med Internet Res 2023; 25:e43174. [PMID: 36701180 PMCID: PMC9912146 DOI: 10.2196/43174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 01/27/2023] Open
Abstract
Recently, we were deeply saddened by the findings of the coroner investigating the death of 14-year-old Molly Russell. Deeply saddened and angry but not surprised. This case should be seen as a sentinel event, given that this is the first time social media was directly implicated as a cause of death. We should use this opportunity to advance proposals for the regulations of the health effects of social media.
Collapse
Affiliation(s)
| | - Yuri Quintana
- Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States.,Homewood Research Institute, Guelph, ON, Canada
| |
Collapse
|
45
|
Teng Z, Zhang Y, Wei Z, Liu M, Tang M, Deng Y, Chen Z, Wu Y, Liu R, Yang Y, Gao M, Kun J, Chen J, Wu R, Huang J. Internet addiction and suicidal behavior among vocational high school students in Hunan Province, China: A moderated mediation model. Front Public Health 2023; 10:1063605. [PMID: 36703819 PMCID: PMC9871611 DOI: 10.3389/fpubh.2022.1063605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Background Vocational education is an important part of high school education in China. However, there is little research on high school students' mental health. This study aimed to investigate the prevalence of suicidal behavior (SB) among this population and the mediating role of insomnia, depression, anxiety, and stress in the relationship between Internet addiction (IA) and SB using a structural equation model. Methods A cross-sectional questionnaire survey was conducted among several vocational high school students in Hunan Province, and 7,968 valid questionnaires were obtained. General demographic data and data from the Dual-Mode Self-Control Scale, Athens Insomnia Scale, Depression Anxiety Stress scale-21, and Revised Chen Internet Addiction Scale were collected. A structural equation model was used to explore the different pathways from IA to SB. Results Among the participants, 37.7, 15.7, and 21.8% reported suicidal ideation, plans, and attempts, respectively. The structural equation model confirmed that IA was indirectly related to SB and was mediated by insomnia and/or depression, anxiety, and stress. Limitations First, we only recruited students from vocational schools in Hunan Province, therefore, the sample may not represent the entire population of vocational students in China. Second, self-report scales were used in this study, and clinical diagnosis required professional interviews. Third, since this study had a cross-sectional design, the causal relationship between the variables could not be determined. Conclusions The prevalence of SB among vocational high school students in China was significantly high. The prevention of SB related to IA can be attributed to the improvement of insomnia and emotional problems.
Collapse
Affiliation(s)
- Ziwei Teng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yaru Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zirou Wei
- Mental Health Center, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mengdong Liu
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Meidai Tang
- Department of Psychiatry, Chenzhou No. 2 Middle School, Chenzhou, Hunan, China
| | - Yizhi Deng
- Department of Psychiatry, Chenzhou No. 2 Middle School, Chenzhou, Hunan, China
| | - Zhuohui Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ying Wu
- Department of Intensive Care Unit, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Runqi Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuanguang Yang
- Department of Psychiatry, The Third Peoples Hospital of Tongren, Tongren, China
| | - Menghui Gao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jin Kun
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jing Huang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,*Correspondence: Jing Huang ✉
| |
Collapse
|
46
|
Lyu S, Li Y. The Roles of Endorsement and Stigma in Suicidal Ideation and Behavior among Chinese College Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:877. [PMID: 36613198 PMCID: PMC9820051 DOI: 10.3390/ijerph20010877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Previous studies have suggested that stereotypes towards suicide, including endorsement of suicide and stigma toward suicide, may contribute to suicidal ideation and behaviors. However, this has not been examined directly. In this study, we examined whether endorsement of suicide and stigma toward suicide are involved in the pathway from suicidal ideation to suicide attempts among college students. To this end, we used the Suicidal Ideation Attributes Scale (SIDAS), the Suicidal Behaviors Questionnaire-Revised (SBQ-R), and the Stigma of Suicide Scale (SOSS) to assess suicidal ideation, suicide attempts, endorsement of suicide, and stigma toward suicide, respectively, in a sample of 944 Chinese college students (mean age, 20.97 years). Using mediation analysis, we found that suicidal ideation partially mediated the relationship between endorsement of suicide and suicide attempts and between stigma toward suicide and suicide attempts. These findings provide novel evidence that endorsement of suicide and stigma toward suicide are closely associated with suicide attempts, but partially through the influences of suicidal ideation. Future studies should elaborate on their longitudinal relationships. Implications of these findings for clinical practices are discussed with reference to the ideation-to-action framework of suicide, aiming to reduce suicidal behaviors.
Collapse
|
47
|
Idelji-Tehrani S, Dubicka B, Graham R. The clinical implications of digital technology. Clin Child Psychol Psychiatry 2023; 28:338-353. [PMID: 36525979 PMCID: PMC9893300 DOI: 10.1177/13591045221145400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The proliferation of digital technology within the lives of children and young people (CYP) provides arguably one of the most significant clinical and ethical paradigm shifts in Child and Adolescent Psychiatry. One can argue that mental health research has taken a myopic approach to understanding the interaction between young people's technology use and their mental health. Mental health clinicians also need a better understanding of the digital lives of CYP and how technology may be supporting or harming their mental health. Within this paper, we argue that greater longitudinal research is required, particularly in vulnerable groups, and that there is an essential need for a standardised digital use assessment (DUA) tool, which assimilates CYP use of technology and their vulnerabilities/resilience to online risks. We subsequently offer a series of questions clinicians can use to explore technology use by CYP. Such an aide memoire may empower clinicians to have wider discussions around digital technology use with CYP, while also helping to develop appropriate safety and management plans.
Collapse
Affiliation(s)
- Saam Idelji-Tehrani
- Department of Child and Adolescent Psychiatry, Institute of Child Health, 11700University College London (UCL), UK
| | - Bernadka Dubicka
- Department of Child and Adolescent Psychiatry, Hull & York Medical School, 8748University of York, UK.,Department of Child and Adolescent Psychiatry, 9022Greater Manchester Mental Health Trust, UK.,Manchester Academic Health Science Centre (MAHSC), University of Manchester, UK
| | - Richard Graham
- Department of Child and Adolescent Psychiatry, Stem4, London, UK.,Keeping Well Southeast London Community, UK.,Digital Well-Being Consultant to Own it App Project
| |
Collapse
|
48
|
Islam MR, Tushar MI, Tultul PS, Akter R, Sohan M, Anjum R, Roy A, Hossain MJ, Rahman MA, Nahar Z, Shahriar M, Bhuiyan MA. Problematic internet use and depressive symptoms among the school-going adolescents in Bangladesh during the COVID-19 pandemic: A cross-sectional study findings. Health Sci Rep 2022; 6:e1008. [PMID: 36579157 PMCID: PMC9774086 DOI: 10.1002/hsr2.1008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Aims Problematic internet use (PIU) by children and adolescents is a concern for many parents. Several factors, including students' education level, the method of instruction, the dependence on the internet, and their intended use of the internet, could all be contributing factors to PIU and depression. Disturbed mental health may be attributed to the cancellation of physical education classes because of the COVID-19 outbreak. This study aimed to assess the association of COVID-19 pandemic with PIU and depressive symptoms in adolescent students. Methods We performed this cross-sectional study among 491 school-going adolescents of 10 to 16 years. Self-administered questionnaires were applied to collect sociodemographic information and the internet usage pattern of the participants. We measured the prevalence of PIU and depressive symptoms using the PIU questionnaire (PIUQ-SF-6) and patient health questionnaire-9 (PHQ-9). Results The estimations of the risk group for PIU and depressive symptoms among school-going adolescents were 80.04% and 77.80%, respectively. The latent profiling of PIU scores for obsession, neglect, and control sub-groups were 5.82, 6.12, and 6.35, respectively. Moreover, we observed mild, moderate, and severe depressive symptoms in 48.68%, 27.70%, and 1.43% of cases. Age, education level, medium of education, financial impression, internet connection, the device used, the purpose for internet use, and the living status of respondents were significantly associated with the PIU. Reported mental health issues was associated with education level, medium of education, financial impression, and internet connection. Conclusion The present study revealed an association of PIU and depressive symptoms with sociodemographic factors and internet usage patterns. Therefore, these results might have practical implications in clinical psychology, psychiatry, and psychotherapy. The healthcare professional can develop a context-specific comprehensive clinical intervention plan for children and adolescents.
Collapse
Affiliation(s)
| | - Md. Ismail Tushar
- Department of Pharmaceutical SciencesNorth South UniversityDhakaBangladesh
| | | | - Rabeya Akter
- Department of PharmacyUniversity of Asia PacificDhakaBangladesh
| | - Md. Sohan
- Department of PharmacyUniversity of Asia PacificDhakaBangladesh
| | - Ramisa Anjum
- Department of PharmacyUniversity of Asia PacificDhakaBangladesh
| | - Arpita Roy
- Department of Biotechnology, School of Engineering & TechnologySharda UniversityGreater NoidaIndia
| | | | - Md. Ashrafur Rahman
- Department of Pharmaceutical Sciences, Jerry H. Hodge School of PharmacyTexas Tech University Health Sciences CenterAmarilloTexasUSA
| | - Zabun Nahar
- Department of PharmacyUniversity of Asia PacificDhakaBangladesh
| | | | | |
Collapse
|
49
|
Jin Z, Li R, Xu H, Rong F, Xiao W, Yu W, Sun Y, Zhang S, Tao F, Wan Y. Interaction effects of screen time and fast-food consumption on suicidal behaviours: Evidence from a nationwide survey among Chinese adolescents. J Affect Disord 2022; 319:164-171. [PMID: 36155233 DOI: 10.1016/j.jad.2022.09.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 07/29/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Although screen time and fast-food consumption have been linked to suicidal behaviours, it is unclear whether their combined effects are associated with suicidal behaviours among adolescents. METHODS A sample of 16,853 Chinese adolescents answered a standard questionnaire on screen time, fast-food consumption, and suicidal behaviours. A binomial logistic regression model was used to analyse the association between the three. An interaction model was used to examine the interaction effects of screen time and fast-food consumption on suicidal behaviours in adolescents. RESULTS There were positive correlations between screen time, fast-food consumption, and suicidal behaviours, even after adjusting for confounding factors. Interaction analyses indicated that increased screen time on weekdays and fast-food consumption were associated with suicidal ideation. The relative excess risk of interaction, attributable proportions, and synergy index of interaction were 0.41, 0.15, and 1.32, respectively. Increased screen time on weekends and fast-food consumption were associated with suicidal ideation. The relative excess risk of interaction, attributable proportions, and synergy index of interaction were 0.37, 0.14, and 1.27, respectively. Similar additive interaction effects were exhibited in increased screen time and fast-food consumption on suicidal planning. Positive additive interaction effects were observed in increased screen time on weekdays and fast-food consumption on suicide attempts. LIMITATIONS A cross-sectional study design was used; therefore, causal associations remain unclear. CONCLUSIONS Screen time and fast-food consumption are cross-sectionally associated with suicidal behaviours among Chinese adolescents. Strategies should be considered to reduce screen time and fast-food consumption among adolescents.
Collapse
Affiliation(s)
- Zhengge Jin
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Ruoyu Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Huiqiong Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Fan Rong
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Wan Xiao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Weiqiang Yu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Ying Sun
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Shichen Zhang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China.
| |
Collapse
|
50
|
Farbstein D, Lukito S, Yorke I, Wilson E, Crudgington H, El-Aalem O, Cliffe C, Bergou N, Itani L, Owusu A, Sedgwick R, Singh N, Tarasenko A, Tucker G, Woodhouse E, Suzuki M, Myerscough AL, Lopez Chemas N, Abdel-Halim N, Del Giovane C, Epstein S, Ougrin D. Risk and protective factors for self-harm and suicide in children and adolescents: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e058297. [PMID: 36428021 PMCID: PMC9703327 DOI: 10.1136/bmjopen-2021-058297] [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: 02/28/2022] [Accepted: 11/01/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Self-harm and suicide are major public health concerns among children and adolescents. Many risk and protective factors for suicide and self-harm have been identified and reported in the literature. However, the capacity of these identified risk and protective factors to guide assessment and management is limited due to their great number. This protocol describes an ongoing systematic review and meta-analysis which aims to examine longitudinal studies of risk factors for self-harm and suicide in children and adolescents, to provide a comparison of the strengths of association of the various risk factors for self-harm and suicide and to shed light on those that require further investigation. METHODS AND ANALYSIS We perform a systematic search of the literature using the databases EMBASE, PsycINFO, Medline, CINAHL and HMIC from inception up to 28 October 2020, and the search will be updated before the systematic review publication. Additionally, we will contact experts in the field, including principal investigators whose peer-reviewed publications are included in our systematic review as well as investigators from our extensive research network, and we will search the reference lists of relevant reviews to retrieve any articles that were not identified in our search. We will extract relevant data and present a narrative synthesis and combine the results in meta-analyses where there are sufficient data. We will assess the risk of bias for each study using the Newcastle-Ottawa Scale and present a summary of the quantity and the quality of the evidence for each risk or protective factor. ETHICS AND DISSEMINATION Ethical approval will not be sought as this is a systematic review of the literature. Results will be published in mental health journals and presented at conferences focused on suicide prevention. PROSPERO REGISTRATION NUMBER CRD42021228212.
Collapse
Affiliation(s)
- Dan Farbstein
- Child and Adolescent Psychiatry Unit, Psychiatric Division, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Steve Lukito
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Isabel Yorke
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Wilson
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Holly Crudgington
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Omar El-Aalem
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Charlotte Cliffe
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicol Bergou
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lynn Itani
- Emirates Health Services, Maudsley Health, Al Amal Psychiatric Hospital, Dubai, UAE
| | - Andy Owusu
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Nidhita Singh
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Gavin Tucker
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emma Woodhouse
- Compass Psychological Services Ltd, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mimi Suzuki
- Unit for Social and Community Psychiatry, Queen Mary University of London & East London NHS Foundation Trust, London, UK
| | - Anna Louise Myerscough
- Unit for Social and Community Psychiatry, Queen Mary University of London & East London NHS Foundation Trust, London, UK
| | - Natalia Lopez Chemas
- Unit for Social and Community Psychiatry, Queen Mary University of London & East London NHS Foundation Trust, London, UK
| | - Nadia Abdel-Halim
- Unit for Social and Community Psychiatry, Queen Mary University of London & East London NHS Foundation Trust, London, UK
| | - Cinzia Del Giovane
- Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Sophie Epstein
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dennis Ougrin
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Youth Resilience Research Unit, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| |
Collapse
|