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Kusuma K, Larsen M, Quiroz JC, Torok M. Age-stratified predictions of suicide attempts using machine learning in middle and late adolescence. J Affect Disord 2024; 365:126-133. [PMID: 39142588 DOI: 10.1016/j.jad.2024.08.043] [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: 02/26/2024] [Revised: 07/29/2024] [Accepted: 08/11/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Prevalence of suicidal behaviour increases rapidly in middle to late adolescence. Predicting suicide attempts across different ages would enhance our understanding of how suicidal behaviour manifests in this period of rapid development. This study aimed to develop separate models to predict suicide attempts within a cohort at middle and late adolescence. It also sought to examine differences between the models derived across both developmental stages. METHODS This study used data from the nationally representative Longitudinal Study of Australian Children (N = 2266). We selected over 700 potential suicide attempt predictors measured via self-report questionnaires, and linked healthcare and education administrative datasets. Logistic regression, random forests, and gradient boosting algorithms were developed to predict suicide attempts across two stages (mid-adolescence: 14-15 years; late adolescence: 18-19 years) using predictors sampled two years prior (mid-adolescence: 12-13 years; late adolescence: 16-17 years). RESULTS The late adolescence models (AUROC = 0.77-0.88, F1-score = 0.22-0.28, Sensitivity = 0.54-0.64) performed better than the mid-adolescence models (AUROC = 0.70-0.76, F1-score = 0.12-0.19, Sensitivity = 0.40-0.64). The most important features for predicting suicide attempts in mid-adolescence were mostly school-related, while the most important features in late adolescence included measures of prior suicidality, psychosocial health, and future plans. CONCLUSIONS To date, this is the first study to use machine learning models to predict suicide attempts at different ages. Our findings suggest that the optimal suicide risk prediction model differs by stage of adolescence. Future research and interventions should consider that risk presentations can change rapidly during adolescence.
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Affiliation(s)
- Karen Kusuma
- University of New South Wales, Sydney, NSW 2052, Australia.
| | - Mark Larsen
- University of New South Wales, Sydney, NSW 2052, Australia
| | - Juan C Quiroz
- University of New South Wales, Sydney, NSW 2052, Australia
| | - Michelle Torok
- University of New South Wales, Sydney, NSW 2052, Australia
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Simes D, Shochet I, Murray K, Gill DJ. Practice-based insights from specialized clinicians into youth suicide risk assessment and psychotherapy: A qualitative study. Psychother Res 2024; 34:972-990. [PMID: 37748115 DOI: 10.1080/10503307.2023.2253360] [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: 03/12/2023] [Revised: 08/09/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Objective: The experience of frontline clinicians is an underutilized source of knowledge about improving youth suicide intervention. This qualitative study explored the perspectives of highly experienced, specialized mental health clinicians on the practical application of risk assessment, stabilization, and treatment and their experience of working in this practice area.Method: Data were collected from seven focus groups with 28 clinicians and analyzed using consensual qualitative research methods.Results: Four domains emerged, describing 1) youth suicide intervention as relationally focused and attachment-informed, 2) the need for flexible and tailored care balancing individual and family intervention in the context of family complexity and fractured relationships, 3) a nuanced, therapeutic approach to managing the complexity and uncertainty of adolescent suicide risk, and 4) working in youth suicide intervention as emotionally demanding and facilitated or hampered by the organizational and systems context.Conclusion: The importance of harnessing family systems and attachment-informed approaches to alliance, risk assessment, and treatment was emphasized, along with the parallel need for systemic clinician support and consideration of the potential negative consequences of administrative and risk management protocols.
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Affiliation(s)
- Di Simes
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- New South Wales Health, Australia
| | - Ian Shochet
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kate Murray
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Bailey S, Newton N, Perry Y, Davies C, Lin A, Marino JL, Skinner SR, Garlick-Bock S, Nguyen H, Mitrou F, Barrett E. Prevalence, distribution, and inequitable co-occurrence of mental ill-health and substance use among gender and sexuality diverse young people in Australia: epidemiological findings from a population-based cohort study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02714-1. [PMID: 39044018 DOI: 10.1007/s00127-024-02714-1] [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: 04/04/2023] [Accepted: 06/24/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE To estimate the prevalence, distribution, and co-occurrence of mental ill-health and substance use among gender and sexuality diverse young people relative to their cisgender and heterosexual peers in Australia using population-level, nationally representative data. METHODS We utilised Wave 8 (2018) data from the Longitudinal Study of Australian Children (N = 3037, Mage = 18.4) collected via an assessment protocol comprising interviews, direct observations, and assessments (on average 60 min per survey occasion). Weighted prevalence ratios and logistic regression models adjusted for demographic confounders were used to estimate the prevalence and distribution of mental ill-health (psychological distress, past 12-month self-harm thoughts and behaviours, past 12-month suicidal ideation, planning, attempt/s) and substance use outcomes (past 12-month cigarette, alcohol, and marijuana use) across gender identity (trans vs. cisgender), sexuality (gay/lesbian, bisexual, queer [those identifying with an 'other' sexuality identity that is not 'gay', 'lesbian', 'bisexual', or 'heterosexual'] vs. heterosexual) and sexuality diversity status (sexuality diverse vs heterosexual) subgroups. Sex-stratified prevalence rates and accompanying adjusted logistic regression models were also used to assess mental ill-health and substance use disparities by sexuality diversity status. Adjusted multinominal logistic regression models were used to test disparities in co-occurring outcomes by sexuality identity) sexuality status sub-groups, and Fisher's Exact Test of Independence for co-occurring disparities by gender identity (due to small sample size). All analyses used Wave 8 sample weights and adjusted for postcode-level clustering. RESULTS Among gender and sexuality diverse participants, 59 - 64% reported high or very high levels of psychological distress, 28 - 46% reported past 12-month self-harm ideation or attempts, and 26 - 46% reported past 12-month suicidal ideation, planning, or behaviour. We found significant disparities in high/very high levels of psychological distress, self-harm behaviours and suicidal behaviours among trans participants (adjusted odds ratios (aORs) ranged from 3.5 to 5.5) and sexuality diverse participants (aORs ranged from 3.5 to 3.9), compared with cisgender and heterosexual participants, respectively. Highest disparities in any past 12-month self-harm and suicidal behaviours appeared most pronounced among trans participants and queer participants compared with their cisgender, heterosexual counterparts. Minor differences by sex among sexuality diverse participants were observed for select mental ill-health outcomes. Sexuality diverse participants, and particularly sexuality diverse females, were significantly more likely to report past 12-month cigarette use and past 12-month marijuana use (adjusted odds ratio (aORs) ranging 1.4-1.6). Trans young people were at significantly elevated risk of mental ill-health in co-occurrence with cigarette and marijuana use compared with their cisgender peers (Fisher's Exact Test of Independence p < 0.05 for all), whereas sexuality diverse young people were at greater risk of co-occurring mental ill-health and cigarette co-use and marijuana co-use, compared with their non-sexuality diverse peers (adjusted multinomial odds ratios (aMORs) ranging 2.2-6.0). CONCLUSION Mental ill-health, substance use, and their co-occurrence disproportionately affects gender and sexuality diverse young people in Australia. Further research should study the longitudinal development of these disparities through adolescence, with close attention to the social, embodied contexts of substance use among LGBTQ + young people with the view to building LGBTQ + affirming models of harm reduction.
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Affiliation(s)
- Sasha Bailey
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Yael Perry
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Cristyn Davies
- Department of Adolescent Medicine, Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - Ashleigh Lin
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Jennifer L Marino
- Department of Adolescent Medicine, Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - S R Skinner
- Department of Adolescent Medicine, Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, Sydney, Australia
| | - Sophia Garlick-Bock
- Department of Adolescent Medicine, Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - Ha Nguyen
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- The University of Western Australia, Perth, Australia
| | - Francis Mitrou
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- The University of Western Australia, Perth, Australia
| | - Emma Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Cantrell A, Sworn K, Chambers D, Booth A, Taylor Buck E, Weich S. Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-107. [PMID: 38314750 DOI: 10.3310/vkty5822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway. Aims To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment. Objectives To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: i. to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context ii. to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK. Data sources Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites. Review methods A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines. Results From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan. Limitations Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment. Conclusions No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement. Study registration This study is registered as PROSPERO CRD42021276671. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Cantrell
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Katie Sworn
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Andrew Booth
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | | | - Scott Weich
- School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
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Santosh P, Sala R, Lievesley K, Singh J, Arango C, Buitelaar JK, Castro-Fornieles J, Coghill D, Dittmann RW, Flamarique I, Hoekstra PJ, Llorente C, Purper-Ouakil D, Schulze U, Zuddas A, Parnell N, Mohan M, Fiori F. Suicidality Treatment Occurring in Paediatrics (STOP) Medication Suicidality Side Effects Scale in young people in two cohorts across Europe. BMJ Open 2023; 13:e068140. [PMID: 38097236 PMCID: PMC10728977 DOI: 10.1136/bmjopen-2022-068140] [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: 10/17/2022] [Accepted: 09/29/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES As part of the 'Suicidality: Treatment Occurring in Paediatrics (STOP)' study, we developed and performed psychometric validation of an electronic-clinical-outcome-assessment (eCOA), which included a patient-reported-outcome (ePRO), an observer-rated-outcome (eObsRO) for parents/carers and a clinician-reported-outcome (eClinRO) that allows identification and monitoring of medication-related suicidality (MRS) in adolescents. DESIGN STOP: Prospective study: A two phase validation study to assess the impact of medication on suicidal ideations. SETTING Six participating countries: Netherlands, UK, Germany, France, Spain and Italy that were part of the Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 261411. PARTICIPANTS Cohort 1 consisted of 41 adolescent-completions, 50 parent-completions and 56 clinician-completions. Cohort 2 consisted of 244 adolescent-completions, 198 parent-completions and 240 clinician-completions from across the six countries. The scale was administered only to participants who have screened positive for the STOP-Suicidality Assessment Scale (STOP-SAS). RESULTS A total of 24 items for the development of the STOP-Medication Suicidality Side Effects Scale (STOP-MS3) were identified and three versions (for patients, parents and clinicians) of the STOP-MS3 were developed and validated in two separate study cohorts comprising of adolescents, their parents and clinicians. Cronbach's α coefficients were above 0.85 for all domains. The inter-rater reliability of the STOP-MS3 was good and significant for the adolescent (ePRO), clinician (eClinRO) (r=0.613), parent (eObsRO) versions of the scale (r=0.394) and parent and clinician (r=0.347). Exploratory factor analysis identified a 3-factor model across 24 items for the adolescent and parent version of the scale: (1) Emotional Dysregulation, (2) Somatic Dysregulation and (3) Behavioural Dysregulation. For the clinician version, a 4-factor model defined the scale structure: (1) Somatic Dysregulation, (2) Emotional Dysregulation, (3) Behavioural Dysregulation and (4) Mood Dysregulation. CONCLUSION These findings suggest that the STOP-MS3 scale, a web-based eCOA, allows identification and monitoring of MRS in the adolescent population and shows good reliability and validity.
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Affiliation(s)
- Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker Limited, Gillingham, UK
| | - Regina Sala
- Centre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry Queen Mary University of London, London, UK
| | - Kate Lievesley
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jatinder Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Josefina Castro-Fornieles
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Medicine, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - David Coghill
- Departments of Paediatrics and Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Ralf W Dittmann
- Dept. of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Itziar Flamarique
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry & Accare Child Study Center, University of Groningen, Groningen, The Netherlands
| | - Cloe Llorente
- Child and Adolescent Psychiatry Department, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Diane Purper-Ouakil
- Hôpital Saint Eloi, Médecine Psychologique de l'Enfant et de l'Adolescent, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
- Psychiatry Development and Trajectories, National Institute of Health and Medical Research (Inserm) U1018 CESP, Villejuif, France
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, Universitatsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| | - Alessandro Zuddas
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatry Unit, "A.Cao" Paediatric Hospital, Cagliari, Italy
| | - Nathan Parnell
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mohapradeep Mohan
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Federico Fiori
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker Limited, Gillingham, UK
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Bullington C, Kroenke K. P4 suicidality screener: Literature synthesis and results from two randomized trials. Gen Hosp Psychiatry 2023; 85:177-184. [PMID: 37948795 DOI: 10.1016/j.genhosppsych.2023.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/05/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To synthesize the literature on use of the P4 suicidality screener since its introduction in 2010 and to summarize results from 2 randomized clinical trials. METHOD A PubMed search was conducted from 2010 to 2023 to retrieve studies reporting on use of the P4. Also, data was extracted from the CAMMPS and SCOPE trials in which the P4 was periodically administered over 12 months when the 9th item of the PHQ-9 was endorsed. RESULTS A total of 21 research studies using the P4 were found, of which 12 provided some data on P4 findings. Additionally, another 7 protocol papers reported intended use of the P4 as a study measure. In our 2 trials, the 9th item was endorsed 259 (12.5%) times in 2068 administrations of the PHQ-9. Higher risk suicidal ideation was identified in 4.1% (12/294) of CAMMPS participants and 2.8% (7/250) of SCOPE participants. No suicide attempts occurred over the 12 months in either trial. CONCLUSIONS The P4 has had moderate use as a brief suicidality screener and is an efficient way to identify the small proportion of depressed patients with higher risk suicidality. Studies comparing the P4 with other common suicidality screeners would further inform use.
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Affiliation(s)
- Craig Bullington
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kurt Kroenke
- Regenstrief Institute, Inc, Indianapolis, IN, USA.
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Su R, John JR, Lin PI. Machine learning-based prediction for self-harm and suicide attempts in adolescents. Psychiatry Res 2023; 328:115446. [PMID: 37683319 DOI: 10.1016/j.psychres.2023.115446] [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: 03/28/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
This study aimed to use machine learning (ML) models to predict the risk of self-harm and suicide attempts in adolescents. We conducted secondary analysis of cross-sectional data from the Longitudinal Study of Australian Children dataset. Several key variables at the age of 14-15 years were used to predict self-harm or suicide attempt at 16-17 years. Random forest classification models were used to select the optimal subset of predictors and subsequently make predictions. Among 2809 participants, 296 (10.54%) reported an act of self-harm and 145 (5.16%) reported attempting suicide at least once in the past 12 months. The area under the receiver operating curve was fair for self-harm (0.7397) and suicide attempt (0.7220), which outperformed the prediction strategy solely based on prior suicide or self-harm attempt (AUC: 0.6). The most important factors identified were similar, and included depressed feelings, strengths and difficulties questionnaire scores, perceptions of self, and school- and parent-related factors. The random forest classification algorithm, an ML technique, can effectively select the optimal subset of predictors from hundreds of variables to forecast the risks of suicide and self-harm among adolescents. Further research is needed to validate the utility and scalability of ML techniques in mental health research.
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Affiliation(s)
- Raymond Su
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James Rufus John
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Ping-I Lin
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Academic Unit of Child Psychiatry Services, South Western Sydney Local Health District, Liverpool, NSW, Australia; Department of Mental Health, School of Medicine, Western Sydney University, Penrith, NSW, Australia.
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8
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Saidinejad M, Duffy S, Wallin D, Hoffmann JA, Joseph MM, Schieferle Uhlenbrock J, Brown K, Waseem M, Snow S, Andrew M, Kuo AA, Sulton C, Chun T, Lee LK. The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies. Pediatrics 2023; 152:e2023063256. [PMID: 37584106 DOI: 10.1542/peds.2023-063256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/17/2023] Open
Abstract
Mental and behavioral health (MBH) visits of children and youth to emergency departments are increasing in the United States. Reasons for these visits range from suicidal ideation, self-harm, and eating and substance use disorders to behavioral outbursts, aggression, and psychosis. Despite the increase in prevalence of these conditions, the capacity of the health care system to screen, diagnose, and manage these patients continues to decline. Several social determinants also contribute to great disparities in child and adolescent (youth) health, which affect MBH outcomes. In addition, resources and space for emergency physicians, physician assistants, nurse practitioners, and prehospital practitioners to manage these patients remain limited and inconsistent throughout the United States, as is financial compensation and payment for such services. This technical report discusses the role of physicians, physician assistants, and nurse practitioners, and provides guidance for the management of acute MBH emergencies in children and youth. Unintentional ingestions and substance use disorder are not within the scope of this report and are not specifically discussed.
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Affiliation(s)
- Mohsen Saidinejad
- Department of Clinical Emergency Medicine & Pediatrics, David Geffen School of Medicine at UCLA, Institute for Health Services and Outcomes Research, The Lundquist Institute for Biomedical Innovation at Harbor UCLA, and Department of Emergency Medicine, Harbor UCLA Medical Center, Los Angeles, California
| | - Susan Duffy
- Department of Emergency Medicine, Brown University School of Medicine, Providence, Rhode Island
| | - Dina Wallin
- Department of Emergency Medicine, University of California San Francisco, UCSF Benioff Children's Hospital, San Francisco, California
| | - Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Evanston, Illinois
| | - Madeline M Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, University of Florida Health Sciences Center, Jacksonville, Jacksonville, Florida
| | | | - Kathleen Brown
- Emergency Medicine and Trauma Center, Children's National Hospital, Washington, District of Columbia
| | - Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York
| | - Sally Snow
- Independent Consultant, Pediatric Emergency and Trauma Nursing
| | | | - Alice A Kuo
- Departments of Medicine and Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Carmen Sulton
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, CPG Sedation Services, Children's Healthcare of Atlanta, Egleston, Atlanta, Georgia
| | - Thomas Chun
- Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Hasbro Children's Hospital, Warren Alpert Medical School of Medicine at Brown University, Providence, Rhode Island
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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Chen M, Zhou Y, Luo D, Yan S, Liu M, Wang M, Li X, Yang BX, Li Y, Liu LZ. Association of family function and suicide risk in teenagers with a history of self-harm behaviors: mediating role of subjective wellbeing and depression. Front Public Health 2023; 11:1164999. [PMID: 37333539 PMCID: PMC10272344 DOI: 10.3389/fpubh.2023.1164999] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background A history of self-harm behaviors is closely associated with subsequent suicide death. Although many factors associated with suicide have been identified, it remains unclear how these factors interact to influence suicide risk, especially among teenagers with a history of self-harm behaviors. Methods Data were collected from 913 teenagers with a history of self-harm behaviors through a cross-sectional study. The Family Adaptation, Partnership, Growth, Affection, and Resolve index was used to assess teenagers' family function. The Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 were used to evaluate depression and anxiety in teenagers and their parents, respectively. The Delighted Terrible Faces Scale was used to assess teenagers' perception of subjective wellbeing. The Suicidal Behaviors Questionnaire-Revised was used to evaluate teenagers' suicide risk. Student's t-test, one-way ANOVA, multivariate linear regression, Pearson's correlation, and a structural equation model (SEM) were applied to data analysis. Results Overall, 78.6% of teenagers with a history of self-harm behaviors were at risk for possible suicide. Female gender, severity of teenagers' depression, family function, and subjective wellbeing were significantly associated with suicide risk. The results of SEM suggested that there was a significant chain mediation effect of subjective wellbeing and depression between family function and suicide risk. Conclusion Family function was closely associated with suicide risk in teenagers with a history of self-harm behaviors, and depression and subjective wellbeing were sequential mediators in the association between family function and suicide risk.
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Affiliation(s)
- Mo Chen
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Yang Zhou
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Dan Luo
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Shu Yan
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Min Liu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Meng Wang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Xin Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Bing Xiang Yang
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Yi Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Lian Zhong Liu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
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10
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Groen G, Jörns-Presentati A, Dessauvagie A, Seedat S, van den Heuvel LL, Suliman S, Grobler G, Jansen R, Mwape L, Mukwato P, Chapima F, Korhonen J, Stein DJ, Jonker D, Mudenda J, Turunen T, Valtiņš K, Beinaroviča A, Grada L, Lahti M. Development of a Mobile Application for Detection of Adolescent Mental Health Problems and Feasibility Assessment with Primary Health Care Workers. Issues Ment Health Nurs 2022; 43:1046-1055. [PMID: 36205922 DOI: 10.1080/01612840.2022.2124003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Introduction: There has been a sharp increase in the use of digital health interventions in global health, particularly mobile health applications, in recent years. The extreme shortage of health care providers trained in mental health screening and intervention in low- and middle-income countries raises questions about the applicability of mobile applications to deliver these services due to their accessibility and availability. This exploratory paper describes the development and feasibility assessment of a mobile screening application for the detection of mental disorders among adolescents in Zambia and South Africa. Methods: Eighty-two health care workers (HCW) working in primary care evaluated the acceptability and practicality of the mobile screening application after receiving brief training. The evaluation included questions from the Mobile Application Rating Scale (MARS) as well as open-ended questions. Results: The acceptability of the screening app was high and study participants were positive about using the app in routine care. Problems with internet connectivity, and time and staff constraints were perceived as the main barriers to regular use. Conclusion: HCW in primary care were able and willing to use a mobile screening app for the detection of mental health problems among treatment-seeking adolescents. Implementation in clinical practice needs to be further evaluated.
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Affiliation(s)
- Gunter Groen
- Department of Social Work, Hamburg University of Applied Sciences, Hamburg, Germany
| | | | - Anja Dessauvagie
- Department of Social Work, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch, University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Leigh L van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch, University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Sharain Suliman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch, University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Gerhard Grobler
- Clinical Unit, Psychiatry, Steve Biko Academic Hospital and Department of Psychiatry, University of Pretoria, Pretoria, South Africa
| | - Ronelle Jansen
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - Lonia Mwape
- Department of Nursing, University of Zambia, Lusaka, Zambia
| | | | - Fabian Chapima
- Department of Nursing, University of Zambia, Lusaka, Zambia
| | - Joonas Korhonen
- Nursing Science Department, Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Deborah Jonker
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John Mudenda
- Medical Education, Lusaka Apex Medical University, Lusaka, Zambia
| | | | | | | | | | - Mari Lahti
- Nursing Science Department, Health and Well-being, Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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11
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Thapar A, Eyre O, Patel V, Brent D. Depression in young people. Lancet 2022; 400:617-631. [PMID: 35940184 DOI: 10.1016/s0140-6736(22)01012-1] [Citation(s) in RCA: 187] [Impact Index Per Article: 93.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023]
Abstract
Depression rates in young people have risen sharply in the past decade, especially in females, which is of concern because adolescence is a period of rapid social, emotional, and cognitive development and key life transitions. Adverse outcomes associated with depression in young people include depression recurrence; the onset of other psychiatric disorders; and wider, protracted impairments in interpersonal, social, educational, and occupational functioning. Thus, prevention and early intervention for depression in young people are priorities. Preventive and early intervention strategies typically target predisposing factors, antecedents, and symptoms of depression. Young people who have a family history of depression, exposure to social stressors (eg, bullying, discordant relationships, or stressful life events), and belong to certain subgroups (eg, having a chronic physical health problem or being a sexual minority) are at especially high risk of depression. Clinical antecedents include depressive symptoms, anxiety, and irritability. Evidence favours indicated prevention and targeted prevention to universal prevention. Emerging school-based and community-based social interventions show some promise. Depression is highly heterogeneous; therefore, a stepwise treatment approach is recommended, starting with brief psychosocial interventions, then a specific psychological therapy, and then an antidepressant medication.
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Affiliation(s)
- Anita Thapar
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK.
| | - Olga Eyre
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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12
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Moller CI, Davey CG, Badcock PB, Wrobel AL, Cao A, Murrihy S, Sharmin S, Cotton SM. Correlates of suicidality in young people with depressive disorders: A systematic review. Aust N Z J Psychiatry 2022; 56:910-948. [PMID: 35362327 DOI: 10.1177/00048674221086498] [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: 11/15/2022]
Abstract
OBJECTIVE Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders. METHOD Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15-25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines. RESULTS We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible. CONCLUSION Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.
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Affiliation(s)
- Carl I Moller
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G Davey
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Paul B Badcock
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Anna L Wrobel
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Alice Cao
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Sean Murrihy
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
| | - Sonia Sharmin
- Department of Occupational Therapy, Social Work and Social Policy, La Trobe University, Bundoora, VIC, Australia
- Research and Evaluation, Take Two, Berry Street, Eaglemont, VIC, Australia
- Department of Public Health, Torrens University Australia, Melbourne, VIC, Australia
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
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13
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El Hourani M, Zadra A, Catellanos-Ryan N, Parent S, Renaud J, R.Séguin J. Longitudinal associations throughout adolescence: Suicidal ideation, disturbing dreams, and internalizing symptoms. Sleep Med 2022; 98:89-97. [DOI: 10.1016/j.sleep.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
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14
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Sparrow-Downes VM, Trincao-Batra S, Cloutier P, Helleman AR, Salamatmanesh M, Gardner W, Baksh A, Kapur R, Sheridan N, Suntharalingam S, Currie L, Carrie LD, Hamilton A, Pajer K. Peripheral and neural correlates of self-harm in children and adolescents: a scoping review. BMC Psychiatry 2022; 22:318. [PMID: 35509053 PMCID: PMC9066835 DOI: 10.1186/s12888-022-03724-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Self-harm in children and adolescents is difficult to treat. Peripheral and neural correlates of self-harm could lead to biomarkers to guide precision care. We therefore conducted a scoping review of research on peripheral and neural correlates of self-harm in this age group. METHODS PubMed and Embase databases were searched from January 1980-May 2020, seeking English language peer-reviewed studies about peripheral and neural correlates of self-harm, defined as completed suicide, suicide attempts, suicidal ideation, or non-suicidal self-injury (NSSI) in subjects, birth to 19 years of age. Studies were excluded if only investigating self-harm in persons with intellectual or developmental disability syndromes. A blinded multi-stage assessment process by pairs of co-authors selected final studies for review. Risk of bias estimates were done on final studies. RESULTS We screened 5537 unduplicated abstracts, leading to the identification of 79 eligible studies in 76 papers. Of these, 48 investigated peripheral correlates and 31 examined neural correlates. Suicidality was the focus in 2/3 of the studies, with NSSI and any type of self-harm (subjects recruited with suicidality, NSSI, or both) investigated in the remaining studies. All studies used observational designs (primarily case-control), most used convenience samples of adolescent patients which were predominately female and half of which were recruited based on a disorder. Over a quarter of the specific correlates were investigated with only one study. Inter-study agreement on findings from specific correlates with more than one study was often low. Estimates of Good for risk of bias were assigned to 37% of the studies and the majority were rated as Fair. CONCLUSIONS Research on peripheral and neural correlates of self-harm is not sufficiently mature to identify potential biomarkers. Conflicting findings were reported for many of the correlates studied. Methodological problems may have produced biased findings and results are mainly generalizable to patients and girls. We provide recommendations to improve future peripheral and neural correlate research in children and adolescents, ages 3-19 years, with self-harm.
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Affiliation(s)
- Victoria M. Sparrow-Downes
- grid.25055.370000 0000 9130 6822Department of Family Medicine Residency Program, Memorial University of Newfoundland, NL St. John’s, Canada
| | - Sara Trincao-Batra
- grid.25055.370000 0000 9130 6822Department of Pediatrics Residency Program, Memorial University of Newfoundland, NL St. John’s, Canada
| | - Paula Cloutier
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - Amanda R. Helleman
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - Mina Salamatmanesh
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - William Gardner
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, ON Ottawa, Canada
| | - Anton Baksh
- grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada
| | - Rishi Kapur
- grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada
| | - Nicole Sheridan
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - Sinthuja Suntharalingam
- grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada
| | - Lisa Currie
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, ON Ottawa, Canada
| | - Liam D. Carrie
- Research Fellow, Harbourfront Health Group, Grand Falls, NB Canada
| | - Arthur Hamilton
- grid.34428.390000 0004 1936 893XPhD Program, Department of Cognitive Science, Carleton University, Ottawa, ON Canada
| | - Kathleen Pajer
- CHEO Research Institute, Ottawa, ON, Canada. .,Department of Psychiatry, University of Ottawa, ON, Ottawa, Canada.
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15
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Stewart I, Lees-Deutsch L. Risk Assessment of Self-Injurious Behavior and Suicide Presentation in the Emergency Department: An Integrative Review. J Emerg Nurs 2021; 48:57-73. [PMID: 34782168 DOI: 10.1016/j.jen.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 09/17/2021] [Accepted: 10/04/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Globally, there is a lack of clarity regarding the best practice to distinguish patients at the highest risk of suicide. This review explores the use of risk assessment tools in emergency departments to identify patients at high risk of repeat self-harm, suicide attempts, or death by suicide. METHODS The review question ("Does the use of risk assessment tools in emergency departments identify patients at high risk of repeat self-harm, suicide attempts, or death by suicide?") focused on exposure and outcome. Studies of any design were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used. Study characteristics and concepts were extracted, compared, and verified. An integrative approach was used for reporting through narrative synthesis. RESULTS Nine studies were identified for inclusion. Two risk assessment tools were found to have good predictive ability for suicide ideation and self-harm. Three had modest prediction of patient disposition, but in one study, the clinical impression of nurses had higher predictive ability. One tool showed modest predictive ability for patients requiring admission. DISCUSSION This review found no strong evidence to indicate that any particular risk tool has a superior predictive ability to identify repeat self-harm, suicide attempts, or death by suicide. Best practice lacks clarity to determine patients at highest risk of suicide, but the use of risk assessment tools has been recommended. Nevertheless, such tools should not be used in isolation from clinical judgment and experience to evaluate patients at risk. Education and training to augment risk assessment within the emergency department are recommended.
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16
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Liu X, Liu ZZ, Jia CX. Repeat self-harm among Chinese adolescents: 1-year incidence and psychosocial predictors. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1979-1992. [PMID: 33861354 DOI: 10.1007/s00127-021-02085-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/07/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE Self-harm in adolescents is prevalent and is the most significant predictor of future self-harm and suicide. Longitudinal data on the incidence and predictors of repeat self-harm in the general population of adolescents are limited. This study investigated 1-year incidence and psychosocial predictors of repeat self-harm in Chinese adolescents. METHODS Shandong Adolescent Behavior and Health Cohort is a longitudinal study of behavior and health in adolescents in Shandong Province, China. Of 7072 participants who were assessed in 2015 and again 1 year later in 2016, 1879 reported a history of self-harm at the baseline survey and were included for this analysis. A self-administered structured questionnaire was used to assess behavioral and emotional problems, sleep, life stress, previous history of self-harm and suicidal thought, and family factors at baseline and self-harm at 1-year follow-up. RESULTS Mean age of the sample was 14.86 (SD 1.36) years and 54.6% were female. At 1-year follow-up, 22.1% participants engaged in repeat self-harm. Multiple logistic regression analyses showed that female gender (OR 1.45, 95% CI 1.11-1.89), alcohol use (OR 1.95, 95% CI 1.48-2.57), frequent nightmares (OR 1.61, 95% CI 1.14-2.28), elevated depression score (OR 1.59, 95% CI 1.05-2.42), and prior suicidal thought (OR 1.79, 95% CI 1.37-2.34) were independently and significantly associated with an increased risk of repeat self-harm. CONCLUSION More than one in five Chinese adolescents who had a history of self-harm engaged in self-harm at 1-year follow-up. Multiple psychosocial factors including female gender, alcohol use, frequent nightmares, depression, and prior suicidal thought appeared to be significant predictors of repeat self-harm. Our findings highlight the importance of comprehensive psychosocial assessment and intervention of repeat self-harm in adolescents.
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Affiliation(s)
- Xianchen Liu
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Zhen-Zhen Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Psychology, REACH Institute, Arizona State University, Tempe, AZ, USA
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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17
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Senior M, Fanshawe T, Fazel M, Fazel S. Prediction models for child and adolescent mental health: A systematic review of methodology and reporting in recent research. JCPP ADVANCES 2021; 1:e12034. [PMID: 37431439 PMCID: PMC10242964 DOI: 10.1002/jcv2.12034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 08/25/2023] Open
Abstract
Background There has been a rapid growth in the publication of new prediction models relevant to child and adolescent mental health. However, before their implementation into clinical services, it is necessary to appraise the quality of their methods and reporting. We conducted a systematic review of new prediction models in child and adolescent mental health, and examined their development and validation. Method We searched five databases for studies developing or validating multivariable prediction models for individuals aged 18 years old or younger from 1 January 2018 to 18 February 2021. Quality of reporting was assessed using the Transparent Reporting of a multivariable prediction models for Individual Prognosis Or Diagnosis checklist, and quality of methodology using items based on expert guidance and the PROBAST tool. Results We identified 100 eligible studies: 41 developing a new prediction model, 48 validating an existing model and 11 that included both development and validation. Most publications (k = 75) reported a model discrimination measure, while 26 investigations reported calibration. Of 52 new prediction models, six (12%) were for suicidal outcomes, 18 (35%) for future diagnosis, five (10%) for child maltreatment. Other outcomes included violence, crime, and functional outcomes. Eleven new models (21%) were developed for use in high-risk populations. Of development studies, around a third were sufficiently statistically powered (k = 16%, 31%), while this was lower for validation investigations (k = 12, 25%). In terms of performance, the discrimination (as measured by the C-statistic) for new models ranged from 0.57 for a tool predicting ADHD diagnosis in an external validation sample to 0.99 for a machine learning model predicting foster care permanency. Conclusions Although some tools have recently been developed for child and adolescent mental health for prognosis and child maltreatment, none can be currently recommended for clinical practice due to a combination of methodological limitations and poor model performance. New work needs to use ensure sufficient sample sizes, representative samples, and testing of model calibration.
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Affiliation(s)
- Morwenna Senior
- Department of PsychiatryOxford Health NHS Foundation Trust, University of OxfordOxfordUK
| | - Thomas Fanshawe
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Mina Fazel
- Department of PsychiatryOxford Health NHS Foundation Trust, University of OxfordOxfordUK
| | - Seena Fazel
- Department of PsychiatryOxford Health NHS Foundation Trust, University of OxfordOxfordUK
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18
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Liu X, Liu ZZ, Yang Y, Jia CX. Prospective Associations of Frequent Pain Symptoms With Suicidal Behavior in Adolescents. THE JOURNAL OF PAIN 2021; 22:852-863. [PMID: 33636372 DOI: 10.1016/j.jpain.2021.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 01/15/2023]
Abstract
Chronic pain and suicidal behavior are prevalent in adolescents. This longitudinal study examined the associations between pain symptoms and suicidal behavior in adolescents. A total of 7,072 adolescents participated in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other nonspecific pain), insomnia, anxiety/depression, substance use, stressful life events, prior suicidal behavior, and family environment in November-December in 2015. One year later, a follow-up survey was conducted. Mean age of the sample was 14.6 years, and half were female. Of the sample, 44.8% and 8.4% reported having one or more pain symptoms "sometimes" and "often", respectively. A total of 22.4% and 10.6% reported having lifetime suicidal behavior at baseline and subsequent suicidal behavior over the 1-year follow-up, respectively. Frequent pain was significantly associated with increased risk of suicidal behavior at baseline (OR=1.64, 95%CI=1.32-2.03) and during the subsequent year (OR=1.50, 95%CI=1.17-1.93) while adjusting for adolescent individual and family covariates. Among adolescents without a history of prior suicidal behavior, frequent pain was significantly associated with an approximately 70% increased risk of incident suicidal behavior (OR= 1.69, 95%CI=1.14-2.51). In conclusion, frequent pain appears to be predictive of adolescent suicidal behavior one year later. PERSPECTIVE: This article presents the prospective associations of frequent pain symptoms with suicidal behavior in adolescents. Frequent pain was associated with a 50-70% increased risk of suicidal behavior 1 year later. The finding underscores the importance of pain assessment and treatment in comprehensive suicide prevention efforts in adolescents.
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Affiliation(s)
- Xianchen Liu
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Zhen-Zhen Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Psychology, REACH Institute, Arizona State University, Tempe, Arizona
| | - Yanyun Yang
- Department of Educational Psychology and Learning Systems, Florida State University, Tallahassee, Florida
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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19
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King CA, Brent D, Grupp-Phelan J, Casper TC, Dean JM, Chernick LS, Fein JA, Mahabee-Gittens EM, Patel SJ, Mistry RD, Duffy S, Melzer-Lange M, Rogers A, Cohen DM, Keller A, Shenoi R, Hickey RW, Rea M, Cwik M, Page K, McGuire TC, Wang J, Gibbons R. Prospective Development and Validation of the Computerized Adaptive Screen for Suicidal Youth. JAMA Psychiatry 2021; 78:540-549. [PMID: 33533908 PMCID: PMC7859874 DOI: 10.1001/jamapsychiatry.2020.4576] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The rate of suicide among adolescents is rising in the US, yet many adolescents at risk are unidentified and receive no mental health services. OBJECTIVE To develop and independently validate a novel computerized adaptive screen for suicidal youth (CASSY) for use as a universal screen for suicide risk in medical emergency departments (EDs). DESIGN, SETTING, AND PARTICIPANTS Study 1 of this prognostic study prospectively enrolled adolescent patients at 13 geographically diverse US EDs in the Pediatric Emergency Care Applied Research Network. They completed a baseline suicide risk survey and participated in 3-month telephone follow-ups. Using 3 fixed Ask Suicide-Screening Questions items as anchors and additional items that varied in number and content across individuals, we derived algorithms for the CASSY. In study 2, data were collected from patients at 14 Pediatric Emergency Care Applied Research Network EDs and 1 Indian Health Service hospital. Algorithms were independently validated in a prospective cohort of adolescent patients who also participated in 3-month telephone follow-ups. Adolescents aged 12 to 17 years were consecutively approached during randomly assigned shifts. EXPOSURES Presentation at an ED. MAIN OUTCOME AND MEASURE A suicide attempt between ED visit and 3-month follow-up, measured via patient and/or parent report. RESULTS The study 1 CASSY derivation sample included 2075 adolescents (1307 female adolescents [63.0%]; mean [SD] age, 15.1 [1.61] years) with 3-month follow-ups (72.9% retention [2075 adolescents]). The study 2 validation sample included 2754 adolescents (1711 female adolescents [62.1%]; mean [SD] age, 15.0 [1.65] years), with 3-month follow-ups (69.5% retention [2754 adolescents]). The CASSY algorithms had excellent predictive accuracy for suicide attempt (area under the curve, 0.89 [95% CI, 0.85-0.91]) in study 1. The mean number of adaptively administered items was 11 (range, 5-21). At a specificity of 80%, the CASSY had a sensitivity of 83%. It also demonstrated excellent accuracy in the study 2 validation sample (area under the curve, 0.87 [95% CI, 0.85-0.89]). In this study, the CASSY had a sensitivity of 82.4% for prediction of a suicide attempt at the 80% specificity cutoff established in study 1. CONCLUSIONS AND RELEVANCE In this study, the adaptive and personalized CASSY demonstrated excellent suicide attempt risk recognition, which has the potential to facilitate linkage to services.
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Affiliation(s)
- Cheryl A. King
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - David Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Lauren S. Chernick
- Department of Emergency Medicine and Pediatrics, Columbia University Medical Center, New York, New York
| | - Joel A. Fein
- Center for Violence Prevention, Children’s Hospital of Philadelphia, Division of Emergency Medicine, University of Pennsylvania, Philadelphia
| | | | - Shilpa J. Patel
- Division of Emergency Medicine, Children’s National Hospital, Washington, DC
| | - Rakesh D. Mistry
- Department of Pediatrics–Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Susan Duffy
- Department of Emergency Medicine, Alpert Medical School at Brown University, Providence, Rhode Island,Department of Pediatrics, Alpert Medical School at Brown University, Providence, Rhode Island
| | | | - Alexander Rogers
- Department of Emergency Medicine, University of Michigan, Ann Arbor,Department of Pediatrics, University of Michigan, Ann Arbor
| | - Daniel M. Cohen
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Allison Keller
- Department of Pediatric Emergency Medicine, The University of Utah, Salt Lake City
| | - Rohit Shenoi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Robert W. Hickey
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Margaret Rea
- Medical Center at the University of California School of Medicine, Davis, Sacramento
| | - Mary Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kent Page
- The University of Utah School of Medicine, Salt Lake City
| | | | - Jiebiao Wang
- Department of Statistics and Data Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Robert Gibbons
- Department of Medicine, The University of Chicago, Chicago, Illinois,Department of Public Health Sciences (Biostatistics), The University of Chicago, Chicago, Illinois,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois,Department of Comparative Human Development, The University of Chicago, Chicago, Illinois
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20
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Liu X, Yang Y, Liu ZZ, Jia CX. Longitudinal associations of nightmare frequency and nightmare distress with suicidal behavior in adolescents: mediating role of depressive symptoms. Sleep 2021; 44:5866620. [PMID: 32614954 DOI: 10.1093/sleep/zsaa130] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/07/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY OBJECTIVES Nightmares are a significant risk factor of suicidal behavior. This study examined the longitudinal associations of nightmare frequency and distress with suicidal thought (ST), suicide plan (SP), and suicide attempt (SA) and mediating role of depressive symptoms in adolescents. METHODS A total of 6,923 adolescents who participated in the 1-year follow-up of Shandong Adolescent Behavior & Health Cohort were included for the analysis. Participants completed a self-administered questionnaire to assess nightmares, sleep duration, insomnia, depressive symptoms, substance use, prior suicidal behavior, and family demographics in November-December in 2015. One year later, a follow-up survey was conducted to ask participants to report their depressive symptoms and suicidal behaviors. RESULTS Of the sample, 26.2% reported having frequent nightmares (at least twice/month) at baseline, and 10.0%, 3.6%, and 2.7% reported having ST, SP, and SA over 1-year follow-up. The rates of subsequent ST, SP, and SA all significantly increased with baseline nightmare frequency and distress. Path analyses showed that depressive symptoms played a significant mediating role in the associations of frequent nightmares and elevated nightmare distress with ST, SP, and SA before and after adjusting for adolescent and family covariates and prior suicidal behavior. CONCLUSIONS Suicidal risk increased with nightmare frequency and distress among adolescents. The association between nightmares and suicidal behavior was at least partially mediated by depressive symptoms. Assessing and intervening nightmares and depressive symptoms associated with nightmares may have important implications for preventing adolescent suicidal behavior.
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Affiliation(s)
- Xianchen Liu
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA
| | - Yanyun Yang
- Department of Educational Psychology and Learning Systems, Florida State University, Tallahassee, FL
| | - Zhen-Zhen Liu
- Shandong University School of Public Health, Jinan, China.,REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ
| | - Cun-Xian Jia
- Shandong University School of Public Health, Jinan, China
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21
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Arango A, Gipson PY, Votta JG, King CA. Saving Lives: Recognizing and Intervening with Youth at Risk for Suicide. Annu Rev Clin Psychol 2021; 17:259-284. [PMID: 33544628 DOI: 10.1146/annurev-clinpsy-081219-103740] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Suicide is the second leading cause of death for youth in the United States. Fortunately, substantial advances have been achieved in identifying and intervening with youth at risk. In this review, we first focus on advances in proactive suicide risk screening and psychoeducation aimed at improving the recognition of suicide risk. These strategies have the potential to improve our ability to recognize and triage youth at risk who may otherwise be missed. We then review recent research on interventions for youth at risk. We consider a broad range of psychotherapeutic interventions, including crisis interventions in emergency care settings. Though empirical support remains limited for interventions targeting suicide risk in youth, effective and promising approaches continue to be identified. We highlight evidence-based screening and intervention approaches as well as challenges in these areas and recommendations for further investigation.
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Affiliation(s)
- Alejandra Arango
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
| | - Polly Y Gipson
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
| | - Jennifer G Votta
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
| | - Cheryl A King
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
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22
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Moreno Velásquez I, Castelpietra G, Higuera G, Castro F, Gómez B, Motta J, Goti R. Suicide trends and self-harm in Panama: results from the National Mortality Registry and hospital-based data. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1513-1524. [PMID: 32556380 DOI: 10.1007/s00127-020-01895-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to (1) to investigate mortality trends due to suicide in Panama at the national and regional levels from 2001 to 2016, (2) to describe the sociodemographic and clinical characteristics of admitted patients with non-fatal self-harm from 2009 to 2017 in a regional hospital, and (3) to examine the association between mental health diagnoses and intentional self-harm, lethality, self-harm repetition and all-cause mortality within this population. METHODS Using the national mortality registry, annual percentage changes (APC) with 95% confidence intervals (CI) were estimated to evaluate suicide trends over time. Self-harm cases were assessed by trained psychiatrists at a referral hospital through interviews. Logistic regression models were used to estimate the association between mental diagnosis with intent-to-die and lethality, expressed as odds ratios (OR) and 95% CI. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% CI for self-harm repetition and all-cause mortality. RESULTS The trend of suicide in women declined, with an APC of - 4.8, 95% CI - 7.8, - 1.7, while the trend began to decline from 2006 in men; APC - 6.9, 95% CI - 8.9, - 4.9. Self-harm repetition over 12 months was 1.8%. Having a mental health diagnosis was associated with intentional self-harm (OR 1.5; 95% CI 1.0-2.4) and self-harm repetition (HR 2.7, 95% CI 1.3-5.8). Medication overdose was the preferred method for self-harm, while intentional self-harm by hanging was the preferred method for suicide. CONCLUSIONS Strategies for prevention and early intervention after self-harm deserve attention. Our findings highlight the importance of data to inform action.
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Affiliation(s)
| | - Giulio Castelpietra
- Primary Care Services Area, Central Health Directorate, Venezia Giulia, Region Friuli, Trieste, Italy
| | - Gladys Higuera
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Franz Castro
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Beatriz Gómez
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Jorge Motta
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Ricardo Goti
- Department of Mental Health, Ministry of Health, Panama City, Panama.,Centro de Salud de Curundú, Ministry of Health, Panama City, Panama
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