Suicide among adolescents and youths during the COVID-19 pandemic lockdowns: A press media reports-based exploratory study

A Pilot Study in Adapting the Chronic Care Model to Address Shortage of Child and Adolescent Psychiatry

There is a nationwide shortage of child and adolescent psychiatrists. This, combined with the mental health crisis caused by the coronavirus 2019 pandemic has lead to low access to care for many individuals. Child Psychiatry Access Programs have been developed to address this need, but we believe they are not sufficient to care for complex cases. We propose that the Chronic Care Model can address these issues by providing, more longitudinal and and faster access to mental health care for patients. Our pilot study had 50 children and adolescent participants in our clinic model, which included the use of trainees supervised by an attending. We found that the mean wait time to appointment with a child and adolescent psychiatrist was 13.54 ± 14.8 days, which is significantly shorter by that reported by other studies. We believe our model clinic may be helpful in a variety of settings and want to share it with other psychiatrists.

Mental Health and Suicidal Behaviour in Chilean Youth during the Covid-19 Pandemic

BACKGROUND

The pandemic caused by the SARS-CoV-2 virus led to a series of containment and mitigation measures through lockdowns, social distancing, and the closure of educational establishments, which have had a profound impact on the mental health of the adolescent population.

OBJECTIVE

The main objective of the present study has been to identify the sociodemographic and mental health variables related to suicidal ideation, planning, and attempts in young people participating in outpatient intervention projects within the Chilean protection network since the onset of the pandemic and the strictest lockdowns.

METHOD

The study's sample consists of 125 young people aged 14 to 18 years (M = 15.65; SD = 1.22), participating in outpatient intervention projects within the National Service for Minors (SENAME)/Better Childhood protection network. Through a self-report survey, the young participants provided responses on sociodemographic variables and suicidal behaviour (ideation, planning, and attempts).

RESULTS

29.9% of the participants reported suicidal ideation during the onset of the pandemic and the established lockdowns; 29.2% reported having devised a plan to do so, and 18.2% indicated having attempted suicide during the evaluated period. A higher occurrence of suicidal behaviour was observed in females, sexual minorities, respondents over 15 years old, and respondents presenting depressive symptoms.

CONCLUSIONS

The Covid-19 pandemic has had a significant impact on suicidal behaviour among the adolescent population served by the protection network in Chile. The prior violation of their rights may have contributed to the issue, particularly affecting young females in late adolescence with indicators of depression, who require specialized intervention due to the high risk detected.

Improving responsible Media Reporting on Student Suicide to Reduce Negative Public Opinion: Text Mining Based on Sina Weibo in China

The aims of this study were to explore whether student suicide reporting is consistent with media recommendations for suicide reporting; analyze public opinion and sentiments toward student suicide reports. A keyword search was performed on the WeiboReach platform. This study included 113 student suicide report posts and 176,262 readers' comments on suicide news reports. Hierarchical generalized linear modeling was used to analyze the relationships between adherence to reporting recommendations and negative emotions in readers' comments. None of the media reporting of student suicide was consistent with all of the media recommendations for suicide reporting. Netizens were less likely to post negative comments when the reports describe the suicide method used (OR 1.169, 95% CI 1.022∼1.337), and not specifying the cause of suicide was a protective factor for public negative emotion (OR 0.799, 95% CI 0.707, 0.905). The findings suggest improving responsible media reporting on student suicide to reduce negative public emotion.

Self-reported suicidal behaviour among people living with disabilities: prevalence and associated factors from a cross-sectional nation-wide survey in Bangladesh

BACKGROUND

Disability marginalises a large portion of Bangladesh's population. Global pre- and post-pandemic research evidently states that, this group is more prone to develop mental health problems, which increases the risk of self-harm and suicide among them. It is crucial to comprehend and mitigate the mental health challenges among the people with disabilities which in turn can promote their greater participation in community, and in national socioeconomic development. However, currently there is limited information available, regarding the suicidal behaviour of this group in Bangladesh. Therefore, this study aimed to investigate the prevalence and contributing factors of suicidal behaviour among people with disabilities.

METHOD

A cross-sectional survey was conducted during September and October 2022, among the participants who had selected disabilities, by using probability proportional to size sampling technique across all eight divisions of Bangladesh. A semi-structured questionnaire comprising information about sociodemographic, lifestyle, health; and Suicidal Behaviour Questionnaire-Revision (SBQ-R) was used. The association between the determinants and mental health outcome was investigated using the Chi-square test, and the contributing factors were investigated using the multiple binary logistic regression.

RESULT

About 10.45% of the participants reported to have suicidal behaviour (e.g., suicidal ideation, attempts, completed suicide), considering the cut-off score as 7 for the SBQ-R in the study period. Approximately, 40% respondents mentioned suicidal ideation in their lifetime, whereas, 9.01% had suicidal ideation over the past 12 months. Additionally, 8.87% of the person with disabilities, mentioned about their suicidal intent to the family members, and 5.94% reported the likelihood of suicide in the future. Being female, having multiple disabilities, and not being connected with family and friends were found to be significantly associated with suicidal behaviour.

CONCLUSION

This research demonstrates the significance of treating mental health issues and expanding accessibility to pre-existing services to lessen the impact of the limitations generated by disabilities. Policymakers can utilize this baseline findings to design large scale research and develop measures for suicide prevention, and management for at-risk groups.

Introversion, Alexithymia, and Hostility: A Path Analysis From Personality to Suicidal Ideation Among University Students

PURPOSE

The aim of the current study was to investigate the relationship between state (i.e., hostility) and trait (i.e., social detachment, alexithymia) psychological constructs associated with suicidal ideation among university students.

METHODS

A group of 190 university students was consecutively recruited in the period between September 2022 and March 2023. After a clinical interview, a series of psychological tests were administered: the Cattell's 16-Personality Factors Questionnaire (16PF), the Toronto Alexithymia Scale (TAS-20), the Symptom Checklist-90-R (SCL-90-R), and the anamnestic form of the Cognitive Behavioral Assessment (CBA2.0), which contains a specific question regarding the suicidal ideation.

RESULTS

The analyses demonstrated that alexithymia fully mediated the relationship between a particular aspect of introversion (social detachment or low warmth) and hostility which, in turn, seemed to be a significant predictor of suicidal ideation.

CONCLUSIONS

The path analysis conducted seemed to highlight the importance of personality traits, such as social detachment and the ability to recognize and express one's internal states, on the mental health of university students in terms of hostility and suicidal ideation. Considering that the reduction of suicide mortality has been prioritized as a global target in the 15-19 age group, identifying the psychological factors associated with it is fundamental.

Suicide Attempt Violence: Gender Differences, Diagnosis and Psychiatric Care Seeking in Mexico City

BACKGROUND

Suicide cases in Mexico have increased during the last two years and are the second-leading cause of death in the young adult population.

AIM

To describe gender differences in violent suicide attempts as relates to diagnosis and the seeking of psychiatric care.

METHODS

A descriptive retrospective study was conducted. The referral forms of 241 patients who had attempted suicide were analyzed.

RESULTS

The mean age of the patients was 29.1 (SD=10.8) years, n=140 (58.1%) of the sample were women. Affective disorders were the most frequent diagnoses for both sexes. Women were more likely to delay seeking psychiatric care: 60 days versus 30 days of delay for men (p=0.009). Men were shown to more frequently resort to violent suicide methods. Both women and men who used violent suicide methods were shown to delay by more days the seeking of psychiatric care than those who were found to have used non-violent suicide methods.

CONCLUSION

We found that patients who use more violent methods of suicide took longer before seeking psychiatric care. This delay in accessing psychiatric care can be thought to contribute to the fact that completed suicides are more frequent within that category of patients. The majority of suicide attempts occurred in the 17-24 years age group; therefore, it seems reasonable to analyze the existing barriers to seeking psychiatric care, mainly in the young adult population, and to design strategies to bring mental health services closer to this population group.

COVID-19 and Mental Health: A "Pandemic Within a Pandemic"

The COVID-19 pandemic has brought significant changes in daily life for humanity and has had a profound impact on mental health. As widely acknowledged, the pandemic has led to notable increases in rates of anxiety, depression, distress, and other mental health-related issues, affecting both infected patients and non-infected individuals. COVID-19 patients and survivors face heightened risks for various neurological and psychiatric disorders and complications. Vulnerable populations, including those with pre-existing mental health conditions and individuals living in poverty or frailty, may encounter additional challenges. Tragically, suicide rates have also risen, particularly among young people, due to factors such as unemployment, financial crises, domestic violence, substance abuse, and social isolation. Efforts are underway to address these mental health issues, with healthcare professionals urged to regularly screen both COVID-19 and post-COVID-19 patients and survivors for psychological distress, ensuring rapid and appropriate interventions. Ongoing periodic follow-up and multidimensional, interdisciplinary approaches are essential for individuals experiencing long-term psychiatric sequelae. Preventive strategies must be developed to mitigate mental health problems during both the acute and recovery phases of COVID-19 infection. Vaccination efforts continue to prioritize vulnerable populations, including those with mental health conditions, to prevent future complications. Given the profound implications of mental health problems, including shorter life expectancy, diminished quality of life, heightened distress among caregivers, and substantial economic burden, it is imperative that political and health authorities prioritize the mental well-being of all individuals affected by COVID-19, including infected individuals, non-infected individuals, survivors, and caregivers.

Suicidal ideation and attempts among adolescents from a tertiary hospital in Turkey: A comparative study of pre and postpandemic periods

AIM

This study aims to compare changes in rates of suicidal ideation (SI) and attempts (SA) among adolescents during pre, mid and later periods of the pandemic.

MATERIAL AND METHOD

This study included adolescents who presented to the adolescent medicine clinic in Turkey between March-May 2019 (prepandemic = T0), March-May 2021(mid period of the pandemic = T1) and March-May 2022 (late period year of the pandemic = T2). SI and SA data were assessed through the electronic hospital records of the "HEEADSSS" inventory.

RESULTS

The charts of 2113 adolescents were evaluated. The rates of both SI (p = .015) and SA (p = .026) were determined to be higher during the pandemic (T1+T2) compared to the pre-pandemic period, with a 1.4-fold increase in SI and a 1.5-fold increase in SA. The rates of SI did not differ according to gender, (p = .090). In contrast, SA rate was significantly higher in females (7.3%) than males (3.6%) (p = .001).

CONCLUSION

This study reveals an increase in SI and SA among adolescents during the first 2 years of the pandemic. In challenging times, health professionals should prioritize the identification and treatment of mental health issues, including screening for depression and suicide risk.

Outpatient care for adolescents' and young adults' mental health: promoting self- and others' understanding through a metacognitive interpersonal therapy-informed psychological intervention

Introduction

Psychological distress may result in impairment and difficulty understanding oneself and others. Thus, addressing metacognitive issues in psychotherapy may improve psychopathology in adolescents and young adults (AYAs). We aimed to compare metacognitive interpersonal therapy (MIT)-informed psychotherapy with other treatment-as-usual (TAU) therapies.

Methods

We administered the Global Assessment of Functioning (GAF) scale, the Clinical Global Impressions-Severity (CGI-S) scale, and the Brief Psychiatric Rating Scale (BPRS) at baseline (BL) and at treatment termination (the endpoint was at 6 months and any last results obtained before that term were carried forward in analyzes). Patients received concomitant psychiatric and psychological treatment.

Results

Sixty AYAs were involved in the study. There was a significant reduction in symptomatology after the intervention. Twelve patients (17%) dropped out; treatment adherence was 83%. In the MIT group, 2 patients dropped out (11%), and in the TAU group, 9 patients dropped out (19%). All scales showed a significant reduction in symptoms between baseline (BL) and the 6-month endpoint: GAF (χ2 = 6.61, p < 0.001), BPRS (χ2 = 6.77, p < 0.001), and CGI (χ2 = 7.20, p < 0.001). There was a greater efficacy for the MIT group in terms of symptom reduction on the BPRS (t = 2.31; p < 0.05).

Conclusion

The study confirmed the efficacy of early and integrated care in adolescence and suggested greater symptom reduction for a psychotherapeutic intervention focused on stimulating mentalization skills. The study indicates the usefulness of this type of approach in the treatment of adolescent psychopathology. Due to the small sample size, the results need replication.

Youth Suicidality in the Context of Disasters

PURPOSE OF REVIEW

The purpose of this review is to summarize the current literature regarding youth suicidality (suicidal ideation, suicidal behavior, and completed suicide) in the context of disasters.

RECENT FINDINGS

There are fewer studies that examine the effect of disasters on suicidality specifically in children and youth than studies that focus on adults or general population. Numerous studies have reported on the effect of disasters on youth mental health in general without zeroing in on suicide risk. Some variables that have shown to increase suicide risk in children and youth after disasters include female gender, age at the time of disaster exposure, dependence on adults, attachments to places and caregivers, family functioning, and vulnerability to mistreatment. Several studies have demonstrated that youth suicidality fluctuates in response to disasters, at times increasing immediately post-disaster and at other times decreasing immediately post-disaster followed by an increase later. Exposure to natural disasters (e.g., earthquakes, typhoons, hurricanes, wildfires, and extremes of temperature and humidity), man-made disasters (e.g., armed conflict, global warming, and pollution), and unique disasters (e.g., the COVID-19 pandemic) have had significant impact on suicidality in children and adolescents. Although there are several promising interventions to mitigate the post-disaster suicide risk among youth, there is no consensus on a single intervention that is superior to others. More research is needed to study youth suicide risk in the context of disasters and develop culturally appropriate and evidence-based interventions.

Year 2022: exploring COVID-19 pandemic in children

COVID-19 pandemics is rapidly changing. In this article, we review progresses published in the Italian Journal of Pediatrics in 2022. More data on clinical pictures, prevention strategies and active management in children have been provided. The continued evolution of knowledge has driven transformations in the clinical approach to the disease and allowed key advancements in the care of children with COVID-19.

Relationship between self-esteem and suicidal ideation before and during COVID-19 in a non-clinical sample: mediating effects of psychological distress and hopelessness

Introduction

Several studies have highlighted the impact of the novel coronavirus disease (COVID-19) pandemic on suicide. Accordingly, investigating the risk factors of suicide during this crisis is important. Based on the escape theory of suicide, the current study examined the serial mediating roles of psychological distress and hopelessness in the relationship between self-esteem and suicidal ideation. It also aimed to explore whether or not the COVID-19 pandemic changed the mediation effect in any way.

Methods

Data were collected from 645 university students before and during the pandemic. The study employed mediation and multi-group analyses to test the hypotheses.

Results

The results demonstrated that individuals with low self-esteem reported high psychological distress, which further lead to hopelessness and eventually heightened suicidal ideation. Multi-group analysis revealed that psychological distress exerted a greater impact on suicidal ideation during COVID-19.

Discussion

The finding suggested that self-esteem, hopelessness, and psychological distress could help elucidate the development of suicidal ideation. Clinicians may target these factors in suicide prevention programs, particularly in the settings of the COVID-19 pandemic or future crisis.

Addressing mental health, misinformation, & religious tensions among South Asian students across California higher education during the COVID-19 pandemic: A qualitative research study

Background

South Asian Americans comprise one of the fastest-growing ethnic groups in the US. Nevertheless, the scientific literature on the experiences of South Asian students is lacking, where often studies focused on Asian Americans exclude South Asians altogether. South Asian students have unique experiences in California higher education, often having to cope with high pressure to perform academically and various social responsibilities associated with being first-, second-, or third-generation American.Many South Asian countries have been more severely affected by COVID-19 due to the density of people living in close proximity to one another. Students of South Asian origin worry for their families overseas, especially as the COVID-19 pandemic has impacted populations there to a more considerable extent.

Methodology

This was a qualitative research study conducted using in-depth interviews with 25 students who identified as South Asian and were currently enrolled in higher education in California at the time they were interviewed. Ads were placed on social media networks, such as Facebook and Twitter, and participation in the study was voluntary. Students were chosen randomly to avoid bias. Study participants described their experiences navigating higher education throughout the ongoing COVID-19 pandemic in relation to their social, economic, cultural, and political spheres. Interviews were mainly conducted through Zoom, some through emails or phone calls. All participants will remain anonymous to protect the identities of students.This project sought to understand the experiences of South Asian students as they navigate the new normal amidst a global crisis. Qualitative responses were indexed by themes, with South Asian students reporting a relationship between the pandemic and worsened academic experiences, issues of exacerbated mental health, the spread of misinformation, and increased religious tensions.This research reflects pragmatism, and the findings of this paper are coupled with suggested recommendations to ameliorate pandemic related issues for future South Asian students. The project was conducted through both inductive and qualitative approaches. The research strategy is action research, and the research was meant to shine a light on issues South Asian students face and help university administrations understand how to better support students during a pandemic. The time horizon is cross-sectional. The research focuses on COVID-19 in relation to South Asian students' performance and health.At 25 participants, data saturation was reached. Further participants were not needed as the qualitative research data was sufficient to draw conclusions from. The research was deemed to pose no risk to students; therefore, approval from an ethical committee was not sought. All participants signed consent forms in order to participate.Follow-up interviews were conducted to address students' experiences with family in India experiencing the B.167.2 variant and the transition back to in-person learning following virtual schooling.

Conclusions/significance

South Asian students in higher education bear a unique set of responsibilities in addition to the already rigorous coursework associated with college. However, the stresses and health of South Asian students often go understudied or overlooked. This research serves to begin to fill in the gaps in literature of South Asian experiences in higher education.The pandemic posed additional challenges for students, who lost access to their campus communities with university education going virtual, and many South Asian students had to move back home. Through this qualitative research study analyzing the experiences of South Asians enrolled in California higher education, it can be concluded that there is a relationship between the COVID-19 pandemic and students' academic performance, mental health, as well as an increase in the amount of misinformation spread regarding COVID-19 public safety guidelines.

Zero Suicide Quality Improvement: Developmental and Pandemic-Related Patterns in Youth at Risk for Suicide Attempts

The Zero Suicide (ZS) approach to health system quality improvement (QI) aspires to reduce/eliminate suicides through enhancing risk detection and suicide-prevention services. This first report from our randomized trial evaluating a stepped care for suicide prevention intervention within a health system conducting ZS-QI describes 1) our screening and case identification process, 2) variation among adolescents versus young adults; and 3) pandemic-related patterns during the first COVID-19 pandemic year. Between April 2017 and January 2021, youths aged 12-24 with elevated suicide risk were identified through an electronic health record (EHR) case-finding algorithm followed by direct assessment screening to confirm risk. Eligible/enrolled youth were evaluated for suicidality, self-harm, and risk/protective factors. Case finding, screening, and enrollment yielded 301 participants showing suicide risk-indicators: 97% past-year suicidal ideation, 83% past suicidal behavior; 90% past non-suicidal self-injury (NSSI). Compared to young adults, adolescents reported: more past-year suicide attempts (47% vs 21%, p<.001) and NSSI (past 6-months, 64% vs 39%, p<.001); less depression, anxiety, posttraumatic stress, and substance use; and greater social connectedness. Pandemic-onset was associated with lower participation of racial-ethnic minority youths (18% vs 33%, p<.015) and lower past-month suicidal ideation and behavior. Results support the value of EHR case-finding algorithms for identifying youths with potentially elevated risk who could benefit from suicide-prevention services, which merit adaptation for adolescents versus young adults. Lower racial-ethnic minority participation after the COVID-19 pandemic-onset underscores challenges for services to enhance health equity during a period with restricted in-person health care, social distancing, school closures, and diverse stresses.

Temporal and spatial trends in suicide-related visits before and during the COVID-19 pandemic in the US, 2018-2021

BACKGROUND

COVID-19 disproportionately impacted mental health in disadvantaged populations and areas. However, disparities in long-term changes in suicide-related visits across the US are unclear. This retrospective study aims to characterize temporal and spatial changes in suicide-related visits in healthcare settings from 2018 to 2021 in the U.S.

METHODS

We use electronic health records for 21,860,370 patients from Healthjump through the COVID-19 Research Database Consortium. Healthjump harmonizes EHR data from over 55 national databases across the US. Suicide ideation and suicide attempts between January 1, 2018 and December 12, 2021 were identified by the diagnosis codes in 6 periods in 2021 compared with the same periods in 2018-2020.

RESULTS

There was 30,019 suicidal ideation, and 7392 suicide attempt visits from January 2018 to November 2021. 15-20-year-olds were the most represented age group at 6302 suicide ideation visits (21.0 % of suicide ideation visits) and 1326 suicide attempt visits (17.9 % of suicide attempt visits), followed by suicide-related visits among 60+ years old. Compared with pre-pandemic periods, youth aged 15-20, females, White, non-Hispanic, and English speakers had increased suicide-related visits, especially suicidal ideation (P < 0.05). Suicide attempts with non-medical substances increased to 28.0 % in the first 6 months of the pandemic in 2020, compared with the prior year (21.5 %). COVID-19 patients had increased suicidal ideation in 2020.

LIMITATIONS

The EHR data is not nationally representative.

CONCLUSIONS

This study found significant and disproportionate increases in suicide related visits over the COVID-19 stages. To prevent the next storms of suicides, future interventions shall accommodate needs among vulnerable groups during and after periods of crisis.

Suicidal ideation in the general population in China after the COVID-19 pandemic was initially controlled

BACKGROUND

The COVID-19 pandemic increases the risk of psychological problems including suicidal ideation (SI) in the general population. In this study, we investigated the risk factors of SI after the COVID-19 pandemic was initially controlled in China.

METHODS

We conducted an online questionnaire via JD Health APP in China in June 2020. Demographic data, feelings and experiences related to the COVID-19 pandemic and psychological problems were collected. The participants (n = 14,690) were divided into the non-SI and SI groups. A binary logistic regression analysis was used to examine the correlates of SI.

RESULTS

Nine percent of the participants (1328/14690) reported SI. The regression analysis showed that SI was positively associated with ethnic minority (OR = 1.42 [1.08-1.85]), age (e.g. 18-30 years: OR = 2.31 [1.67-3.20]), having history of mental disorders (OR = 2.75 [2.27-3.35]), daily life disturbance due to health problems (OR = 1.67 [1.38-2.01]), being around someone with the COVID-19 (OR = 1.58 [1.30-1.91]), being uncertain about effective disease control (OR = 1.23 [1.03-1.46]), and having depressive symptoms (OR = 4.40 [3.59-5.39]), insomnia symptoms (OR = 2.49 [2.13-2.90]) or psychological distress (OR = 1.87 [1.59-2.18]).

LIMITATIONS

The main limitation is that the cross-sectional design of this study could not allow us to further explore the causality of SI.

CONCLUSIONS

The prevalence of SI was relatively high in general population after the COVID-19 pandemic was initially controlled in China. SI should be monitored continually after the COVID-19 pandemic.

COVID-19 Pandemic Has Changed the Psychiatric Profile of Adolescents Attempting Suicide: A Cross-Sectional Comparison

The COVID-19 pandemic is having a major impact on the mental health of adolescents, leading to suicidal behaviors. However, it remains to be clarified whether the COVID-19 pandemic has changed the psychiatric profile of adolescent suicide attempters.

METHODS

a retrospective observational analytical study was conducted to assess age, gender and clinical characteristics of adolescents attempting suicide during the year before and the year after the global lockdown.

RESULTS

ninety adolescents (12-17 y.o.) were recruited consecutively from February 2019 to March 2021 at the emergency ward for having attempted suicide. Fifty-two (57.8%) attended before the lockdown (pre-pandemic group) and thirty-eight (42.2%) the year after (pandemic group). There were significant differences in diagnostic categories between the periods (p = 0.003). Adjustment and conduct disorders were more frequent in the pre-pandemic group, while anxiety and depressive disorders were more prevalent during the pandemic. Although the severity of suicide attempts did not show significant differences between the two study periods (0.7), the generalized linear model showed that the suicide attempt severity was significantly associated with current diagnosis (p = 0.01).

CONCLUSIONS

the psychiatric profile of adolescents attempting suicide was different before and during the COVID-19 pandemic. During the pandemic, the proportion of adolescents with a prior psychiatric history was lower, and most of them were diagnosed with depressive and anxiety disorders. These diagnoses were also associated with a greater severity in the intentionality of suicide attempt, regardless of the study period.

Trend and gender-based association of the Bangladeshi student suicide during the COVID-19 pandemic: a GIS-based nationwide distribution

BACKGROUND

Students are one of the most vulnerable groups to suicide. Before the COVID-19 pandemic, a Bangladeshi study was conducted assessing their suicide patterns regarding gender-based associations. But how has the pandemic changed the Bangladeshi students' suicide patterns is not studied yet, which is investigated herein. Besides, for the first time, this study provides GIS-based distribution of suicide cases across the country's administrative district.

METHODS

As Bangladesh has no suicide surveillance system, this study utilized media reporting suicide cases following the prior studies. A total of 127 students' suicide cases from March 2020 to March 2021 were finally analyzed after eliminating the duplicate ones, and data were synthesized following the prior studies. Arc-GIS was also used to distribute the suicide cases across the administrative district.

RESULTS

Results revealed that female (72.4%; n = 92/127) was more prone to die by suicide than males. About 42.5% of the cases were aged between 14 and 18 years (mean age 16.44 ± 3.512 years). The most common method of suicide was hanging (79.5%; n = 101), whereas relationship complexities (15.7%), being emotional (12.6%), not getting the desired one (11%), conflict with a family member (9.4%), academic failure (9.4%), mental health problem (8.7%), sexual complexities (6.3%), scolded or forbidden by parents (3.9%) were the prominent suicide causalities. In respect to gender and suicide patterns, only the suicide stressor was significantly distributed, whereas the method of suicide was significantly associated with GIS-based distribution. However, a higher number of suicide cases was documented in the capital (i.e. Dhaka) and the northern region than in its surrounding districts.

CONCLUSIONS

The findings reported herein are assumed to be helpful to identify the gender-based suicide patterns and suicide-prone regions in the time of the COVID-19 pandemic to initiate suicide prevention programs of the risky students.

Suicide related to the COVID-19 pandemic in India: A systematic review

Background

The suicide rate has increased during the pandemic in India. Moreover, several studies, especially press-media reporting suicide studies have been conducted but no systematic review has been attempted in this context. Therefore, the present study systematically investigated the risk factors associated with suicidal behaviors, and the method of suicide during the COVID-19 pandemic in India.

Methods

Following the PRISMA guidelines, a systematic search was performed to include papers published up until September 30, 2022. From an initial 144 papers, 18 studies which met the inclusion criteria were included in the present review. The Pierson’s method was used for quality assessment of the included studies in the present review.

Results

The risk factors associated with suicide comprised: (i) socio-demographic factors (e.g., being aged between 31 and 50 years, male, married, unemployed), (ii) behavior and health-related factors (e.g., unavailability of alcohol and alcohol withdrawal symptoms, poor state of physical health and health issues, family disputes, relationship complexities, and sexual harassment), (iii) COVID-19-related factors (e.g., fear of COVID-19, COVID-19 test results, quarantine or isolation, financial hardship due to the pandemic, having influenza-like symptoms, experiencing stigmatization and ostracism despite testing negative, separation from family due to transport restrictions, misinterpreting other illness symptoms as COVID-19, saving the village from infection, watching COVID-19 videos on social media, online schooling, perceived stigma toward COVID-19, and being suspected of having COVID-19), and (iv) psychopathological stressors (depression, loneliness, stress, TikTok addiction, and poor mental health, suicidal tendencies, helplessness, and worrying). Hanging was the most common method of suicide. In addition, jumping from high buildings, poisoning, drowning, burning, cutting or slitting throat or wrists, self-immolation, medication overdose, electrocution, pesticide, and gun-shot were also used to carry out the suicide.

Conclusions

Findings from this research suggest multiple reasons for suicide during the COVID-19 pandemic and knowledge of such factors could aid in developing suicide prevention strategies focusing the most vulnerable cohorts inside and outside India.

The positive energy of netizens: development and application of fine-grained sentiment lexicon and emotional intensity model

The outbreak of COVID-19 has led to a global health crisis and caused huge emotional swings. However, the positive emotional expressions, like self-confidence, optimism, and praise, that appear in Chinese social networks are rarely explored by researchers. This study aims to analyze the characteristics of netizens' positive energy expressions and the impact of node events on public emotional expression during the COVID-19 pandemic. First, a total of 6,525,249 Chinese texts posted by Sina Weibo users were randomly selected through textual data cleaning and word segmentation for corpus construction. A fine-grained sentiment lexicon that contained POSITIVE ENERGY was built using Word2Vec technology; this lexicon was later used to conduct sentiment category analysis on original posts. Next, through manual labeling and multi-classification machine learning model construction, four mainstream machine learning algorithms were selected to train the emotional intensity model. Finally, the lexicon and optimized emotional intensity model were used to analyze the emotional expressions of Chinese netizens. The results show that POSITIVE ENERGY expression accounted for 40.97% during the COVID-19 pandemic. Over the course of time, POSITIVE ENERGY emotions were displayed at the highest levels and SURPRISES the lowest. The analysis results of the node events showed after the outbreak was confirmed officially, the expressions of POSITIVE ENERGY and FEAR increased simultaneously. After the initial victory in pandemic prevention and control, the expression of POSITIVE ENERGY and SAD reached a peak, while the increase of SAD was the most prominent. The fine-grained sentiment lexicon, which includes a POSITIVE ENERGY category, demonstrated reliable algorithm performance and can be used for sentiment classification of Chinese Internet context. We also found many POSITIVE ENERGY expressions in Chinese online social platforms which are proven to be significantly affected by nod events of different nature.

Suicidal ideation and behaviour in Spanish adolescents during the COVID-19 pandemic: an exploratory study

The COVID-19 pandemic and its related containment measures, mainly physical distancing and isolation, are having detrimental consequences on the mental health of the juvenile infant population worldwide.

Success4life Youth Empowerment for Promoting Well-being and Boosting Mental Health: Protocol for an Experimental Study

BACKGROUND

There is an increasingly alarming worsening of mental health among the youth. There remain significant unmet needs for developing innovative, evidence-based technology-enhanced, positive psychology interventions (PPIs) all-inclusive in targeting psychological distress and risk factors related to high-risk behavior commonly encountered in adolescents.

OBJECTIVE

We aim to assess the effectiveness of a hybrid (incorporating both synchronous and asynchronous learning) and holistic (targeting social and emotional learning and tackling risk factors unique for this age group) PPI, "success4life youth empowerment," in improving well-being in the youth.

METHODS

Students' well-being will be assessed by the 5-item World Health Organization Well-Being Index, and hope will be assessed by the 6-item Children's Hope Scale at week 0, week 8, and week 10, month 6, and month 12. Any improvement in well-being and hope will be measured, estimating the difference in postintervention (week 8 and week 10) and preintervention (week 0) scores by determining the P value and effect size using appropriate statistical tests.

RESULTS

This study includes 2 phases: pilot phase 1, delivered by the creators of the succcess4life youth empowerment modules and platform, and phase 2, which will consist of the estimation of scalability through the recruitment of trainers. We hope to start student recruitment by 2022 and aim to complete the results for phase 1 pilot testing by 2023.

CONCLUSIONS

We anticipate that a primarily web-based, 10-week holistic PPI can support improvement in the mental wellness of the youth and has the potential for effective scalability.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/38463.

Trends in suicide deaths before and after the COVID-19 outbreak in Korea

We investigated the effect of the coronavirus disease-2019 (COVID-19) pandemic on suicide trends in Korea via a time-series analysis. We used Facebook Prophet to generate forecasting models based on the monthly numbers of suicide deaths in Korea between 1997 and 2018, validated the models by comparison with the 2019 numbers, and predicted the numbers of suicides in 2020. We compared the expected and observed numbers of suicides during the COVID-19 pandemic. The total numbers of suicides during the COVID-19 pandemic did not deviate from projections based on the pre-pandemic period. However, the number of suicides among women and those under the age of 34 years significantly exceeded the expected level. The COVID-19 pandemic did not increase the overall suicide rate significantly. However, suicides among women and young people increased, suggesting that the pandemic might drive more members of these groups to suicide. Further studies are needed to verify the long-term impact of the COVID-19 pandemic on suicide.

Editorial: Schools on the frontline of suicide prevention

The world has experienced an unprecedented mental health crisis associated with the COVID-19 pandemic (Liu et al., 2020). After more than two years navigating the associated uncertainty and distress, the impact on youth mental health continues to be a pressing concern. Those in the mental health field, as well as the children and families plagued by its impact, are inundated with seeing firsthand the impact on youth's functioning. This includes increases in depression and suicide (Asarnow & Chung, 2021; Manzar et al., 2021), and having to navigate siloes in care and often even an inability when in crisis to access a continuum of services (Zhai, 2021). This has highlighted the significant issues with accessibility of mental health care and inequitable access to care for youth mental health both in the United States and globally. We continue to experience daily the impact of insufficient resources for youth behavioral health. For those in the field who prioritize the need for more robust intervention approaches, the child mental health crisis associated with the pandemic has highlighted the need for us to develop more novel and innovative interventions.

The use of TikTok among children and adolescents with Eating Disorders: experience in a third-level public Italian center during the SARS-CoV-2 pandemic

BACKGROUND

Recent research has documented the potential associations existing between the use of social media (SM) and the occurrence/development and treatment of Eating Disorders (ED). However, the literature directly addressing the use of SM TikTok among children and adolescents with ED is still scarce.

METHODS

In January-February 2021, during the second Italian national lockdown due to the SARS-CoV-2 pandemic, an anonymous paper survey was conducted in an Italian third-level center for ED in childhood and adolescence. Demographics, frequency of use of TikTok, frequently viewed topics and hashtags, experienced body-shaming, as well as the use of TikTok (active search, use of proposed contents) and perceived influences of this SM on eating attitudes and self-esteem were assessed. Groups of patients with different perceived SM-induced effects were compared to determine the frequency of their interaction with 3 specific contents (diet, Pro-Anorexia Nervosa (pro-Ana) and pro-ED recovery).

RESULTS

Seventy-eight patients (93.6% females, mean age 14.5 ± 2.1 years) were enrolled in the study. For 62.8%, TikTok represented the main SM, used for 1.4 ± 1.0 h/day, with diet (21.8%) as the most frequently used topic category. Pro-Ana and pro-ED recovery contents ("#foryou" and "#edrecovery" as the most frequent, respectively) were both actively searched by patients and proposed by the SM in a significant number of cases. For 59.0%, using TikTok reduced self-esteem, while 26.9% reported TikTok-related significant changes in their daily lives, and 3.8% reported experiences of body-shaming. Patients describing a negative effect of TikTok on their self-esteem more frequently searched and browsed "diet" (p = 0.007) and pro-ED recovery (p = 0.007) contents. Positive qualitative feedback on the SM was also reported.

CONCLUSIONS

This study documents the use of the SM TikTok among children and adolescents with ED. Individuals with a perceived negative effect of this SM on their self-esteem may show greater interaction with specific content. Further studies are needed to investigate the psychopathological factors influencing the relationship between ED and the use of SM.

Suicide Risk and Association With the Different Trauma During the COVID-19 Pandemic Period: A Cross-Sectional Study on Adolescent With Different Learning Stage in Chongqing, China

This study aimed to examine the current suicidal risk and whether the suicidal risk was associated with a wide range of trauma. The self-administered online questionnaire was adopted to collect suicide risk (SR) such as suicidal ideation, self-harm, suicide attempts, and different trauma information of the adolescents by cluster sampling in Chongqing, China. Multivariable linear regression was presented to assess the association between different risks of trauma and SR scores. Approximately 14.7% of adolescents enrolled reported suicide ideation and more than 10% of adolescents have experienced one kind of trauma during the Coronavirus disease 2019 (COVID-19) pandemic period. After adjusting for confounding variables, adolescents who suffered family hurt had a higher risk score of SR (beta coefficients (β) = 0.289, 95% confidence interval (CI) = 0.115-0.463). A positive association was found among participants from junior and senior school (β = 0.415, 95% CI = 0.152, 0.768), and the SR score was positively associated with sexism among participants from the university/college (β = 0.238, 95% CI = 0.042, 0.434). The most potentially obvious trauma that contributed to SR in junior and senior school adolescents might be cyberbullying. Family neglect or abuse might be a detrimental factor in SR for adolescents whether those in junior school or those in university school in China. More interventions, like education related to cyberbullying and family abuse, should be prioritized to reduce the risk of suicide.

Suicidal Behaviours During Covid-19 Pandemic: A Review

Objective

Novel COVID-19 disease has become a major concern worldwide, and a recent line of research warned that the context of the COVID-19 pandemic may be a major risk factor for developing severe suicidal behaviors. A broad systematic review is needed to cover the studies that have already assessed the potential underlying factors for suicidal behaviors in the context of the COVID-19 outbreak.

Method

A total of 52 studies met the inclusion criteria, and data were then described according to the subsequent categories: (1) countries where the studies were carried out; (2) factors impacting suicidal behaviors during the COVID-19 outbreak; and (3) examination of the observed populations.

Results

Findings of the current systematic review suggest that there is a certain amount of heterogeneity in factors impacting suicidal behaviors during the COVID-19 outbreak, with economic downturn, psychiatric vulnerability, isolation and quarantine, health concerns, and relational difficulties being the most prominent reasons for developing suicidal behaviors during the COVID-19 outbreak.

Conclusions

Timely interventions are needed to prevent suicidal behaviors in both the clinical and general populations, and in this regard, the creation of standard procedures may speed up the process.

Artificial intelligence and Psychiatry: An overview

The burden of mental illness both in world and India is increasing at an alarming rate. Adding to it, there has been an increase in mental health challenges during covid-19 pandemic with a rise in suicide, loneliness and substance use. Artificial intelligence can act as a potential solution to address this shortage. The use of artificial intelligence is increasingly being employed in various fields of mental health like affective disorders, psychosis, and geriatric psychiatry. The benefits are various like lower costs, wider reach but at the same time it comes with its own disadvantages. This article reviews the current understanding of artificial intelligence, the types of Artificial intelligence, its current use in various mental health disorders, current status in India, advantages, disadvantages and future potentials. With the passage of time and digitalization of the modern age, there will be an increase in the use of artificial intelligence in psychiatry hence a detailed understanding will be thoughtful. For this, we searched PubMed, Google Scholar, and Science Direct, China national Knowledge Infrastructure (CNKI), Globus Index Medicus search engines by using keywords. Initial searches involved the use of each individual keyword while the later searches involved the use of more than one word in different permutation combinations.

Suicidal behaviours among Ugandan university students: a cross-sectional study

BACKGROUND

Suicide remains the leading cause of death among university students often resulting from multiple physical and psychological challenges. Moreover, suicidal behaviours among students appear to have increased due to the COVID-19 pandemic according to some studies.

OBJECTIVE

To explore the prevalence and associated factors for suicidal ideation, suicide plans, and suicide attempts among university students in Uganda.

METHODS

Cross-sectional study data were collected from May to September 2021 from 540 undergraduate university students in south-western Uganda (363 males, mean age 23.3 years). Questions from the General Health Questionnaire (GHQ-28) were used to assess suicidal ideation, while other bespoke questions were used to assess suicide plans and attempts. The survey also investigated the suicide attempt/plan method, location of the suicidal activity, and reason for not enacting the suicide plan. Three independent regression analyses were used to determine the factors associated with different forms of suicidal behaviours.

RESULTS

The prevalence of past-year suicidal behaviours was 31.85% for suicidal ideation, 8.15% for suicide plans, and 6.11% for suicide attempts. Having a chronic physical medical condition increased the likelihood of having all forms of suicidal behaviours. Suicidal ideation was associated with having difficulty paying university tuition fees. However, being in the fifth year of university education, and feeling satisfied with current academic grades reduced the likelihood of suicidal ideation. Individuals feeling satisfied with academic performance appeared to be a protective factor against having suicide plans. Suicide attempts were associated with having a history of sexual abuse and having difficulty paying university tuition fees. The most common method used for attempted suicide was a drug overdose, and the most common location for attempted suicide was their homes.

CONCLUSION

University students have prevalent suicide behaviours especially among students with a chronic physical medical condition, a history of sexual abuse, and problems paying university tuition fees. Based on the present study, for students at risk, universities should provide appropriate interventions such as life skills education and suicide prevention techniques.

Adolescents, Suicide, and the COVID-19 Pandemic

The coronavirus disease 2019 pandemic has vastly disrupted the lives of youth. Stressors related to the pandemic and related lockdown measures have increased the prevalence of adolescent depression, suicidal ideation, and suicide attempts, with their mental and psychosocial development making them highly vulnerable to isolating restrictions. Research has demonstrated increased loneliness and decreased social support among adolescents during the pandemic. Increased social media usage has further affected depression among adolescents. Pandemic-related stressors such as fear of illness or life changes have negatively affected adolescent mental well-being. Health care use during the pandemic has involved disruption in primary care suicide screening, patterns of suicide-related presentations in emergency departments, and access to mental health services. Health care providers can support adolescent mental health through consistent screening, effectively coordinating referral for mental health evaluation, and providing family guidance on resiliency, pandemic-related mental health risks, and suicide prevention. [Pediatr Ann. 2022;51(4):e144-e149.].

Risk Behaviors, Family Support, and Emotional Health among Adolescents during the COVID-19 Pandemic in Israel

We investigated the prevalence of risk behaviors among Israeli adolescents (tobacco smoking, alcohol consumption, drug use) during the COVID-19 pandemic. Associations between different risk behaviors were examined and so was whether specific characteristics could predict risk behaviors in adolescents. The study consisted of 1020 Israeli adolescents aged 15-18. Study subjects completed an online survey between the first and second lockdowns in Israel (April 2020 to September 2020). Participants reported the frequency at which they engaged in four different risky behaviors: general risky behavior, tobacco smoking, alcohol consumption (binge drinking), and cannabis use. The most prevalent risky behavior in the sample was binge drinking (33.8%). The four measured risky behaviors were significantly correlated. Among participants who had previously engaged in a risky behavior assessed, most did not change the behavior frequency during the pandemic. All independent variables (sociodemographic characteristics, family support, and emotional, health excluding friends' support, physical activity volume, and coronavirus restrictions) were significantly different between participants engaging vs. not engaging in risky behaviors. Our findings suggest that family support is one of the most influential factors in preventing risky behavior during the pandemic, and they emphasize the importance of family-based interventions with children and adolescents from elementary to high school.

Social and environmental effects of the COVID-19 pandemic on children

OBJECTIVE

This study aimed to review the literature, summarizing the existing evidence on the effects of the pandemic on children, adolescents and parents, with an emphasis on the psychological, emotional, and sleep quality consequences.

SOURCE OF DATA

Empirical studies identified in the following databases: MEDLINE, ISI Web of Knowledge/Web of Science, and preprint servers.

SYNTHESIS OF DATA

The findings point to a wide range of consequences for children and adolescents resulting from the COVID-19 pandemic, which mainly includes an increase in depressive mood symptoms. There is also an increase in anxiety symptoms, suicidal ideation, as well as potential delays in language and motor development resulting from deprivation of social interaction and the closing of schools. These effects are more severe due to previous neuropsychiatric conditions. For parents, there is an increase in anxiety, depressive and post-traumatic symptoms, which are more accentuated in those who suffered socioeconomic damage due to the pandemic. There was an important increase in situations of violence towards children by parents and caregivers during the pandemic. Also, changes in routine and fear of the pandemic have negatively impacted sleep quality, globally.

CONCLUSIONS

It is noteworthy that most studies published to date used a cross-sectional design and applied online screening questionnaires. The few studies with a longitudinal design suggest that these changes may have been transitory and more prevalent at the beginning of the pandemic.

Foster care during the COVID-19 pandemic: A qualitative analysis of caregiver and professional experiences

BACKGROUND

Research is needed to facilitate better understanding of how different groups have been impacted by COVID-19, especially those in already strained service systems such as foster care. These inquiries will support further response, recovery and preparedness efforts.

OBJECTIVE

This qualitative study addressed how professionals and caregivers in foster care described being affected by COVID-19 in order to support future research and planning for foster care systems in this pandemic context.

PARTICIPANTS AND SETTING

A sample of foster parents and foster care professionals (N = 357) from a mostly rural, southeastern state in the U.S. participated in the study.

METHODS

Qualitative analysis was conducted of 357 open-ended responses regarding the impact of COVID-19 from a survey distributed in August 2020.

RESULTS

The coding process resulted in the identification of 15 distinct themes: Isolation & Loss of Social Support, Work Changes/Stressors, School Issues, Childcare Issues, No Impact/Positive Changes, Financial Problems, Fear of Contagion, Negative Child Welfare Impacts, Mental Health Problems/Stress, Loss of Faith/Trust & Societal Frustrations, Health & Mental Healthcare Access Issues, PPE & Testing Issues, Grief & Loss, and Marital Problems. Secondary impacts rather than direct physiologic effects of the virus were primarily reported.

CONCLUSIONS

This study underscores the various challenges facing foster care systems, and how the pandemic context is exacerbating many of these issues. Further research is needed to ensure the implementation of adequately complex and nuanced responses that target needs and avoid creating further problems for foster care.

Changes in Suicide Rate and Characteristics According to Age of Suicide Attempters before and after COVID-19

This study aims to identify age-related suicide-related factors and changes in suicide rate before and after the onset of the COVID-19 pandemic.

METHODS

From 2018 to 2020, the patients who presented to the ED of a university hospital with a suicide attempt were classified into adolescents (≤18 years), adults (19-65 years), and elderly (>65 years), and the visits were grouped into before and after COVID-19.

RESULTS

There were 853 visits before and 388 visits after COVID-19, and the results showed that the number of adolescent and adult suicide patients increased immediately after the pandemic, but the overall trend did not show a significant difference from before the pandemic. In the adolescents, the ratio of male patients increased, interpersonal and school-related motivations decreased, the poisoning and cutting methods of suicide were more common, and hospitalization admissions increased. Among the elderly, the ratio of female patients increased, the number of single patients and patients without previous psychiatric problems increased, the motives for physical illness and death of people around increased, the falling and hanging methods of suicide were more common, and hospitalization admissions and deaths increased.

CONCLUSION

The impact of COVID-19 on suicide rates and suicide-related factors varies by age group. This finding requires different approaches and methods to suicide prevention based on age.

Prevalence and factors associated with mental health problems in Saudi general population during the coronavirus disease 2019 pandemic: A systematic review and meta-analysis

This systematic review and meta-analysis generates evidence of the prevalence and associated factors of common mental disorders (i.e., depression, anxiety, and stress) related to the pandemic among the Saudi general population. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was performed in the respective databases (e.g., PubMed, Scopus, Web of Science), from 22 July to 17 August 2021, and identified a total of 220 articles. Adhering to the inclusion criteria (i.e., original research concerning the prevalence and/or associated factors of depression and/or anxiety and/or stress disorders among the general Saudi population, published in English peer-reviewed journals), 15 studies were included in this review which consisted of a total of 262,656 participants. The overall prevalence of depression, anxiety, and stress was 30% (95% confidence interval [CI]: 22% to 38%, I²  = 99.58%), 20% (95% CI: 16% to 24%, I²  = 99.32%), and 29% (95% CI: 11% to 47%, I²  = 99.76%), respectively. Risk factors of mental health problems were found to be female sex, younger age group, single/divorced marital status, lower education, lower income, non-Saudis, unemployment status, students, being in a small family and living with elderly of the sociodemographic factors. Smokers, less physical activities, lower resilience, reduced immune status, chronic health problems, and psychiatric illness history were associated with a higher degree of mental health problems. In addition, coronavirus disease 2019 (COVID-19)-related risk factors of mental illness included lack of knowledge, fear, worry and concern, family member or friends' infection or death, lockdown restrictions, quarantine, confirmed or suspected of COVID-19 infection, and even pandemic effects. In conclusion, appropriate mental health preventive approaches for the Saudi general people are highly needed, where this review can be worthy of help by providing in detailed information to the respective authorities.

Suicidal Behavior in Emergency Child and Adolescent Psychiatric Service Users Before and During the 16 Months of the COVID-19 Pandemic

BACKGROUND

Slovenia is among the countries with the highest suicide rates in the world. The COVID-19 pandemic has had a significant impact on the mental health of children and adolescents. Our hypothesis is that the school closure during the pandemic with a gradual transfer to virtual schooling had an important impact on children's and adolescents' suicidal behavior. Therefore, we aimed to determine possible changes in the frequency of assessments as well as frequency and severity of suicidal behavior in the population of Slovene children and adolescents seeking emergency psychiatric help in correlation with the progression of the pandemic and online schooling.

METHODS

We performed a retrospective observational analysis of medical records of all children and adolescents referred to the only 24-h emergency in- and outpatient child and adolescent psychiatry service in Slovenia from March 2019 through the end of July 2021. We extracted number of assessments, number of patients with suicidal ideation and with attempted suicide. A comparison between the same periods prior to the pandemic and during the pandemic was made. The months of school closure due to the COVID-19 restriction measures and the months without closures were also compared.

RESULTS

During this period, 1966 children and adolescents were assessed. There was no statistically significant difference in the observed frequency of emergency visits when we compared all the months with to all the months without school closures, or when individual corresponding months with and without school closures were compared. However, there were statistically significantly more patients with suicidal ideation [t(16) = -2.739, p = 0.015; W = 25.0, p = 0.016] and patients who had attempted suicide [t(16)= -3.412, p= 0.004; W = 14.5, p =0.006] during the pandemic as individually compared to the corresponding pre-pandemic months.

CONCLUSIONS

Our results show that the number of Slovene children and adolescents who required emergency psychiatric help with suicidality and attempted suicide increased during the COVID-19 pandemic. The increase was shown only after the first year of the pandemic. The observed increase did not appear to directly correspond to the school closures, but was more likely related to the duration of the pandemic.

The Impact of COVID on Adolescent Mental Health, Self-Harm and Suicide: How Can Primary Care Provider Respond? A Position Paper of the European Academy of Pediatrics

Adolescents aged 10 to 19 live a period of their life marked by opportunities and vulnerabilities during which the issue of mental health is of prime importance. Since several decades, and especially since the start of the COVID pandemic, mental health problems and disorders among adolescents have increased around the world. Depression, self-harm and suicidal behavior are common during this period of life, and pediatricians can play a pivotal role in identifying affected or vulnerable youngsters. This article describes risk factors for self-harm and suicidal behavior and reviews how primary care pediatricians and health professionals can respond to such situations. This scoping review is based on existing evidences as well as the authors clinical experience. It suggests concrete actions that can be taken to secure the life of at risk teenagers, and discusses how to organize the transfer to mental health professionals when needed.

Should coronavirus policies remain in place to prevent future paediatric influenza deaths?

The 2019-2020 to 2020-2021 influenza seasons in the USA saw a dramatic 99.5% decrease in paediatric mortality, with only one influenza death recorded during the latter season. This decrease has been attributed to a substantial reduction in transmission, resulting from the various restrictive measures enacted during the COVID-19 pandemic, onset March 2020. The relative disappearance of influenza raises specific policy questions, such as whether these measures should be kept in place after COVID-19 transmission reaches acceptable levels or herd immunity is achieved. Given the nature of these measures as liberty restricting, it is worth discussing their intended outcome and what values they promote. Do these measures in fact promote health, or simply give the comfort of safety while undermining long-term health and individual liberties? I argue that the year-long endurance of the pandemic well into 2021 may have flattened our value landscape into one where health reigns supreme. Discussions are underway regarding whether we should modify previously accepted health risks, such as the risk of contracting influenza. In this paper, I attempt to clarify the values that motivate our policies and discuss how our present historical context has appreciated the value of health. I also provide an analysis of various pandemic policies and their relation to influenza paediatric deaths. Ultimately, the cost of certain measures on values such as education, socialisation and liberty, among others, is too high to justify their use beyond regulating the spread of COVID-19.

The role of sociodemographics, behavioral factors, and internet use behaviors in students' psychological health amid COVID-19 pandemic in Bangladesh

BACKGROUND

The COVID-19 pandemic drastically impacted students' psychological well-being by interchanging their regular activities. Students are more engaged with online activities, which may affect their mental health. Therefore, the present study aims to investigate the magnitude of psychological health of the Bangladeshi students, where the role of online use behaviors is also investigated.

METHODS

An online-based cross-sectional survey was conducted between 7 October 2020 and 2 November, 2020 among Bangladeshi students utilizing a convenience sampling technique. The survey questionnaire included items concerning sociodemographics, behavior and health-related variables, online use behaviors, Patient Health Questionnaire (PHQ-2), and Generalized Anxiety Disorder (GAD-2). Descriptive and inferential statistics were used to present the data (i.e., binary logistic regression was performed to examine the association between variables and hierarchical regression analysis was performed to predict the variance for depression and anxiety).

RESULTS

Out of 601 included students, 260 and 196 students reported the symptoms of depression (43.3%) and anxiety (32.6%), respectively, where female students experienced a higher level of psychological problems. The psychological suffering was also significantly associated with medical college students, having an affair, less sleep time, not performing physical exercise, excessive internet use, and not watching news during online activities. After adjusting all of the studied variables in the hierarchical regression models, it explained 10% and 9.6% variance of depression and anxiety, respectively.

CONCLUSIONS

During this pandemic situation, a relatively higher level of psychological complications was observed among the Bangladeshi students. Regrettably, any specific policy was absent in the country to assuage that outcome. Therefore, based on the study finding, a few strategies and policies were recommended that may be helpful to alleviate psychological issues among the students.

Prevalence and Associated Factors of Problematic Smartphone Use During the COVID-19 Pandemic: A Bangladeshi Study

Background

Problematic smartphone use (PSU) has been increasing hastily in recent decades, and it has become inseparable during the COVID-19 pandemic, especially among the students who are at risk of problematic smartphone use. Therefore, the present study aimed to investigate the prevalence and associated factors of PSU during the COVID-19 pandemic among the Bangladeshi students.

Methods

A total of 601 Bangladeshi students were recruited through an online-based cross-sectional survey that was conducted between October 7 and November 2, 2020. The survey collected information related to socio-demographics, behavioral health, internet use behaviors, depression, anxiety, and PSU. Independent samples t-test and one-way ANOVA were performed to present the relationship between the studied variables and PSU. Multiple linear regression analysis was also used for investigating the explanatory power of the predictive models for PSU.

Results

Surprisingly, about 86.9% of the students scored to be problematic smartphone users (≥21 out of a total 36 based on the Smartphone Application-Based Addiction Scale). In addition, medical students, engaging in a relationship, performing less physical activity, longer duration of internet use, some sorts of internet use purpose (eg, messaging, watching videos, using social media), depression, and anxiety were significantly associated with higher scores of PSU. After adjusting all the studied variables, the final model explained a 31.3% variance predicting PSU.

Conclusion

The present study is one of the first approaches to assess the prevalence of PSU among the Bangladeshi students during the COVID-19 pandemic, whereas the addiction level was superfluous (and this may be due to more online engagement related to the pandemic). Thus, the study recommended strategies or policies related to the students' risk-reducing and healthy use of smartphones.

School closures were over-weighted against the mitigation of COVID-19 transmission: A literature review on the impact of school closures in the United States

BACKGROUND

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread wildly across the world. In March of 2020, almost all kindergarten through 12th grade (K-12) schools were closed in the United States in an urgent attempt to curb the pandemic in the absence of effective therapeutics or vaccination. Thirteen months since then, schools remain partially closed. Accumulated evidence suggests that children and adolescents are not the primary facilitators of transmission, limiting the restrictive effects of school closures on disease transmission. The negative effects of school closures on K-12 students need to be systematically reviewed.

METHODS

Following the guideline of Preferred Reporting Items for Systematic Reviews and Meta-analyzes, a comprehensive literature search from PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science regarding school closures and its impact on K-12 students was conducted. The primary outcomes included the impact of school closures on the mitigation of the pandemic and the resulting public health concerns of K-12 students.

RESULTS

Prolonged school closures possessed negative effects on K-12 students' physical, mental, and social well-being and reduced the number of health and social workers, hindering the reopening of the country.

CONCLUSIONS

School closures were over-weighted against the mitigation of coronavirus disease 2019 (COVID-19) transmission. A safe reopening of all K-12 schools in the United States should be of top priority.

COVID-19-Related Stressors and Mental Health Among Chinese College Students: A Moderated Mediation Model

This study aims to examine the relation between COVID-19-related stressors and mental health among Chinese college students during the pandemic outbreaks, and the possible mediator or moderator between them. Five hundred and fifty Chinese college students were invited to complete an anonymous survey, and the data were analyzed with SPSS 16.0 software. The results shows that the number of stressors has a negative direct and indirect (through risk perception of being infected with COVID-19 disease) impacts on college students' mental health. Adaptive coping is a protective factor of students' mental health, and could be regarded as a buffer that attenuates the negative effect of the COVID-19-related stressors on risk perception of being infected with COVID-19 disease (or mental health). With regard to demographic variables, females, junior and senior students, or students whose family residence was worst hit by the pandemic tend to report poorer mental health during the pandemic outbreak. These findings enrich our understanding about the impact of the COVID-19 pandemic on college population and have implications for university counseling services during times of acute, large-scale infective disease outbreaks.

How Has the COVID-19 Pandemic Changed BMI Status and Physical Activity - Its Associations with Mental Health Conditions, Suicidality: An Exploratory Study

BACKGROUND

The COVID-19 pandemic has psycho-socially impacted people of all age groups. The consequences related to this crisis may increase the suicide mortality rate as reported in prior pandemics. Although many studies have been conducted identifying suicidal behavior attributing factors, there is a lack of knowledge on the associations of body mass index (BMI) and physical activities, their changes, and suicidal behavior, which were explored herein for the first time.

METHODS

An online-based, cross-sectional study was carried out with a total of 324 Bangladeshi people (mean age = 26.99 ± 8.17 years). The measures included questions on socio-demographics, health-related variables, physical activities-related variables, and mental health problems (eg, depression, anxiety and suicidal behavior).

RESULTS

About 41.0% and 29.3% of the participants reported being depressed and anxious, respectively, whereas suicidal behavior after the pandemic's inception was found to be 6.5%. Although the role of BMI status either prior to or during the pandemic in mental health conditions was not statistically significant, the changes of BMI status were (that is, those with decreasing BMI status compared to no change in BMI status were at greater risk of depression and anxiety, which was followed by increasing BMI status). Besides having no outside space for exercise and performing more physical activities prior to the pandemic were reported to increase anxiety levels, but no significant associations between changes in physical exercise frequency and other mental health problems were observed.

CONCLUSION

In summary, the present findings showed that people with either decreased or increased BMI status after the inception of the pandemic were at greater risk of mental instabilities, which is a concern which should be considered when adopting any preventive approaches.

How Has the COVID-19 Pandemic Changed BMI Status and Physical Activity - Its Associations with Mental Health Conditions, Suicidality: An Exploratory Study

BACKGROUND

The COVID-19 pandemic has psycho-socially impacted people of all age groups. The consequences related to this crisis may increase the suicide mortality rate as reported in prior pandemics. Although many studies have been conducted identifying suicidal behavior attributing factors, there is a lack of knowledge on the associations of body mass index (BMI) and physical activities, their changes, and suicidal behavior, which were explored herein for the first time.

METHODS

An online-based, cross-sectional study was carried out with a total of 324 Bangladeshi people (mean age = 26.99 ± 8.17 years). The measures included questions on socio-demographics, health-related variables, physical activities-related variables, and mental health problems (eg, depression, anxiety and suicidal behavior).

RESULTS

About 41.0% and 29.3% of the participants reported being depressed and anxious, respectively, whereas suicidal behavior after the pandemic's inception was found to be 6.5%. Although the role of BMI status either prior to or during the pandemic in mental health conditions was not statistically significant, the changes of BMI status were (that is, those with decreasing BMI status compared to no change in BMI status were at greater risk of depression and anxiety, which was followed by increasing BMI status). Besides having no outside space for exercise and performing more physical activities prior to the pandemic were reported to increase anxiety levels, but no significant associations between changes in physical exercise frequency and other mental health problems were observed.

CONCLUSION

In summary, the present findings showed that people with either decreased or increased BMI status after the inception of the pandemic were at greater risk of mental instabilities, which is a concern which should be considered when adopting any preventive approaches.

Suicide and Suicidal Behaviors in the Context of COVID-19 Pandemic in Bangladesh: A Systematic Review

BACKGROUND

Without integration of the available information, appropriate suicide preventive actions can be hindered. Therefore, this study attempts to review the Bangladeshi COVID-19-related suicide studies for the first time.

METHODS

For conducting a systematic review, the PRISMA guideline was adhered. Bangladeshi literatures concerning the COVID-19 pandemic related to either suicide case or suicidal behavior were identified within 1 to 10 April 2021, from the databases like PubMed, Scopus, PsycINFO, Web of Science, CINAHL, etc. Finally, a total of 9 literatures were included in this review.

RESULTS

Four literatures were cross-sectional studies assessing the prevalence and risk factors of suicidal behavior, and the rest five were retrospective suicide studies concerned with either case study (n=3) or case-series study (n=2). The prevalence of suicidal ideation was identified to be ranging between 5% and 19.0%, whereas the rate increased over time of the pandemic inception. Significant risk factors concerning suicidal behavior included the factors related to (i) socio-demographic variables: female gender, being divorced or widows or widowers or single in marital status, having lower levels of education, being urban residence, belonging to higher socioeconomic class, being unemployed, and having no children, (ii) behavior and health-related variables: lack of physical exercise, cigarette smoking, alcohol consuming, abnormal sleep status, more exposure to social media, and suffering from the higher number of physical health problems; (iii) COVID-19 pandemic-related variables: lower knowledge of COVID-19, lack of preventive COVID-19 behaviors, higher levels of COVID-19 fear, living in highly COVID-19 infected area, higher economic loss due to the pandemic, and experiencing relatives or acquaintances' death by the COVID-19; (iv) psychopathological variables: depression, anxiety, stress, insomnia, suicidal thought history, suicide attempt history, and family with a history of suicide.

CONCLUSION

Implementing cost-effective mental health strategies along with social and community awareness for increasing help-seeking behaviors of suicide risky individuals is highly suggested.

Interest Consistency Can Buffer the Effect of COVID-19 Fear on Psychological Distress

In the context of a recent outbreak of the coronavirus disease (COVID-19), the present study investigated the buffering effect of grit on the relationship between fear of COVID-19 and psychological distress. The data were collected from 224 Japanese participants (98 females; mean age = 46.56, SD = 13.41) in July 2020. The measures used in this study included the Fear of COVID-19 Scale (FCV-19S), Short Grit Scale, and Depression, Anxiety, and Stress Scale 21 (DASS). The results of mediation analyses revealed significant indirect effects of consistency of interest, a major component of grit, on psychological distress (depression: estimate = .042; 95% CI: [.008, .088], anxiety: estimate = .021; 95% CI: [.001, .050], and stress: estimate = .030; 95% CI: [.004, .066]); we also found non-significant indirect effects of perseverance of effort, another major component of grit, on psychological distress. These results suggest that consistency of interest buffers the psychological distress induced by fear of COVID-19. Based on these results, it can be concluded that individuals with higher consistency of interest are less likely to experience worsening of their mental health, even if they experience fear of COVID-19 during the pandemic.

Mental Disorders of Bangladeshi Students During the COVID-19 Pandemic: A Systematic Review

Background

The unprecedented COVID-19 pandemic has become a global burden disrupting peoples’ quality of life. Students being an important cohort of a country, their mental health during this pandemic has been recognized as a concerning issue. Therefore, the prevalence and associated risk factors of Bangladeshi students’ mental health sufferings (ie, depression, anxiety, and stress) are systematically reviewed herein for the first time.

Methods

Adhering to the PRISMA guideline, a systematic search was performed from 1 to 5 April, 2021 in several databases including PubMed; and finally, a total of 7 articles were included to this review.

Results

The prevalence rates of mild to severe symptoms of depression, anxiety, and stress ranged from 46.92% to 82.4%, 26.6% to 96.82%, and 28.5% to 70.1%, respectively. The risk factors concerning mental health problems included the factors related to (i) socio-demographic (younger age, gender, lower educational grade, urban residence, family size, currently living with family/parents, and having children in the family), (ii) behavior and health (smoking status, lack of physical exercise, more internet browsing time, and dissatisfaction with sleep), (iii) COVID-19 pandemic- (COVID-19 related symptoms, COVID-19 related perceptions, and fear of COVID-19 infection), (iv) miscellaneous (losing part-time teaching job, lack of study concentration, agitation, fear of getting assaulted or humiliated on the way to the hospital or home, financial problems, academic dissatisfaction, inadequate food supply, higher exposure to COVID-19 social and mass media, engaging with more recreational activities, and performing more household chores).

Conclusion

The overall assumption of mental disorders’ prevalence rates can be regarded as problematic to this cohort. Thus, the authorities should consider setting up possible strategies to diminish the pandemic effect on students’ mental health.

Suicide among adolescents and youths during the COVID-19 pandemic lockdowns: A press media reports-based exploratory study

PROBLEM

Suicide incidences among adolescents and youths during the Coronavirus Disease 2019 (COVID-19) lockdowns have been reported across the world. However, no studies have been carried out to investigate cumulative nature, patterns, and causative factors of such suicide incidences.

METHODS

A purposive sampling of Google news between 15 February and 6 July was performed. After excluding duplicate reports, the final list comprised a total of 37-suicide cases across 11 countries.

FINDINGS

More male suicides were reported (21-cases, i.e., 56.76%), and the mean age of the total victims was 16.6 ± 2.7 years (out of a total of 29 cases). About two-thirds of the suicides were from three countries named India (11-cases), UK (8-cases), and the USA (6-cases). Out of 23-student victims, 14 were school-going students. Hanging was the most common suicide method accounting in 51.4% of cases. The most common suicide causalities were related to mental sufferings such as depression, loneliness, psychological distress, and so forth, whereas either online schooling or overwhelming academic distress was placed as the second most suicide stressors followed by TikTok addiction-related psychological distress, and tested with the COVID-19.

CONCLUSIONS

The finding of the temporal distribution of suicides concerning lockdowns may help in exploring and evolving public measures to prevent/decrease pandemic-related suicides in young people.

Suicide among Ugandan university students: evidence from media reports for 2010-2020

University students are in transition to adulthood and face multiple challenges that may lead to suicide. They are reported to have a higher risk of suicide by the World Health Organization. As there is no national suicide database in Uganda, we analysed student suicide using the press/media reports of suicides published between 2010 and 2020. A total of deaths by 23 suicide were identified: 19 were males, relationship problems were the main suicide reason (n = 6) and hanging was the most frequently used suicide method (n = 7). A strategic intervention to tackle suicide risk among university students is warranted.

Impact of COVID-19 lockdown policy on homicide, suicide, and motor vehicle deaths in Peru

Although lockdown measures to stop COVID-19 have direct effects on disease transmission, their impact on violent and accidental deaths remains unknown. Our study aims to assess the early impact of COVID-19 lockdown on violent and accidental deaths in Peru. Based on data from the Peruvian National Death Information System, an interrupted time series analysis was performed to assess the immediate impact and change in the trend of COVID-19 lockdown on external causes of death including homicide, suicide, and traffic accidents. The analysis was stratified by sex and the time unit was every 15 days. All forms of deaths examined presented a sudden drop after the lockdown. The biggest drop was in deaths related to traffic accidents, with a reduction of 12.22 deaths per million men per month (95% CI: -14.45, -9.98) and 3.55 deaths per million women per month (95% CI:-4.81, -2.30). Homicide and suicide presented similar level drop in women, while the homicide reduction was 2.5 the size of the suicide reduction in men. The slope in homicide in men during the lock-down period increased by 6.66 deaths per million men per year (95% CI:3.18, 10.15). External deaths presented a sudden drop after the lockdown was implemented and an increase in homicide in men was observed. Falls in mobility have a natural impact on traffic accidents, however, the patterns for suicide and homicide are less intuitive and reveal important characteristics of these events, although we expect all of these changes to be transient.