History of Physical Teen Dating Violence and Its Association With Suicidal Behaviors Among Adolescent High School Students: Results From the 2015 Youth Risk Behavior Survey

Effectiveness of the myPlan Teen App, a Digital Healthy Relationship and Safety Planning Intervention With Adolescent Aged 15-17 Years

PURPOSE

To determine the effectiveness of myPlan Teen app compared to usual care on the use of helpful safety behaviors, dating violence victimization and perpetration, depression, and suicide behavior.

METHODS

A longitudinal randomized clinical trial with 617 adolescents randomized to myPlan Teen or usual care. Participants in both groups completed surveys using validated measures at baseline, 3, 6-, and 12-months post-baseline. The study analysis examined the difference between the intervention and control groups in change over time in outcomes.

RESULTS

myPlan Teen significantly increased the use and helpfulness of safety behaviors among adolescents compared to the control group. Intervention users also significantly reduced the perpetration of physical and sexual violence and suicide behaviors. Although both groups experienced decreases in victimization and depression over the 12 months, the differences were not significantly different by group.

DISCUSSION

myPlan Teen, a digitally delivered intervention, is one of the few interventions targeting dating violence in adolescence that has proven effective.

Dating Violence Victimization, Perpetration and Suicidality Among Adolescents

Few studies have focused on evaluating the relationship between dating violence (DV) and suicide during the critical period of adolescence, particularly for transgender and gender-diverse (TGD) youth. The study examined the relationship between experiencing DV victimization and perpetration in the past 6 months and suicidality (ideation and attempts) among male, female, and TGD adolescents. This study used data from a longitudinal randomized trial examining the effectiveness of myPlan, a healthy relationship and safety planning app intervention for adolescents, to a control website. Data for this study was collected virtually, in which participants completed surveys through online platforms. A convenience sample was recruited through youth organizations and posting on online platforms including social media. N = 610 adolescents age 15-17 years, who resided in the U.S. experienced DV in the past 6 months, had access to a safe device, and were able to access online surveys were included in this study. The majority were female (63.8%) with (19.5%) TGD and 16.7% male. Nearly 22% of the sample identified as Hispanic/Latino and 61.0% as white. Participants completed an online survey consisting of measures of socio demographics, DV victimization and perpetration via the Conflict of Adolescent Dating Relationships Inventory (CADRI), and suicidality. The primary outcome was the association between DV victimization and perpetration on suicidality. Different forms of DV were accounted for including emotional/relational, physical, and sexual DV. Logistic regressions determined differences in the rate of DV victimization and perpetration on suicidality between gender groups (cisgender female, cisgender male, and TGD). A stratified analysis was conducted to test if the relationship between DV and suicidality differed across gender identity. Approximately one-third (32.2%) of adolescents reported suicidality in the past 6 months. TGD adolescents were more likely to report suicidality compared to males (20.6%, p < .05) and females (32.7%, p > .05). The overall odds of suicidality increased as frequency of emotional/relational DV victimization (OR = 1.37, p < .001), physical DV victimization (OR = 1.59, p < .001) and sexual DV victimization (OR = 1.42, p < .001) increased. These relationships were not significant for DV perpetration. When stratifying findings by gender groups, all forms of DV victimization significantly increased the odds of suicidality for females as well as female perpetration of physical violence. For males, all forms of DV victimization and perpetration were associated with increased odds of suicidality, although not significant due to the smaller sample size. While DV victimization is associated with increased odds of suicidality for TGD, perpetration of DV is associated with decreased odds of suicidality, although not significant due to small sample size. The findings from this study provide further insight into experiences of DV and suicidality among gender diverse youth and can guide future interventions aimed at preventing DV and suicide among adolescents.

Attitudes Toward Unhealthy Relationship Behaviors and Boundary-Setting: Variation Among High School Students

Teen dating violence (TDV) is common during adolescence and has lasting negative impacts on those who experience it. Yet, there is limited research exploring how well teens recognize unhealthy behaviors and communicate boundaries, both crucial aspects in preventing TDV. This study aimed to investigate how demographic characteristics (i.e., gender, age, sexual identity, and race/ethnicity) relate to adolescents' abilities to recognize unhealthy relationships and willingness to communicate boundaries. Participants (N = 873) completed online surveys during school hours on demographic characteristics (e.g., gender), recognition of unhealthy relationship behaviors, communicating boundaries, and navigating breakups. We found that girls, participants who identify as a sexual minority (e.g., lesbian), and White participants demonstrated significantly higher recognition of controlling behaviors compared to boys and their heterosexual and non-White counterparts, respectively, but there was no significant difference in identifying abusive behaviors such as shouting, yelling, and insulting a partner. Older participants (i.e., ages 16-18) were significantly more likely to recognize controlling and abusive behaviors as unhealthy compared to younger participants (i.e., 13-15). Further, we found that girls and older participants were significantly more willing to communicate boundaries in relationships than boys and their younger counterparts. Our findings align with prior research emphasizing the necessity for prevention strategies that raise awareness of controlling behaviors that can escalate to more severe forms of TDV and equip adolescents with the means to establish and communicate personal boundaries.

Clinical characteristics of suicidal behavior in first hospitalization and drug-naïve patients with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) is a major and common cause of suicide. The purpose of this article is to report the clinical characteristics and patterns of co-morbid suicidal behavior (SB) in first hospitalized and drug-naïve MDD patients.

METHODS

A total of 345 patients with first hospitalization and drug-naïve MDD with SB were included in this study, while 183 patients without SB were included as a control group. We collected socio-demographic, general clinical data and common biochemical indicators of all participants and assessed their clinical symptoms.

RESULTS

Compared to patients without SB, MDD with SB had more severe clinical symptoms and worse metabolic indicators. Duration of disease, depressive symptom scores, and thyroid stimulating hormone (TSH) levels was risk factors for SB and its number.

CONCLUSIONS

MDD patients with SB suffered more severe clinical symptoms and worse metabolic indicators, and risk factors for SB in this population were identified, which may provide beneficial insight and reference for clinical prevention and intervention of SB in MDD patients.

Racial/ethnic differences in adolescents' non-response to suicide attempt: Findings from the Youth Risk Behavior Survey, 2015-2019

Racial/ethnic minority adolescents are at greater risk of attempting suicide compared to their White counterparts. Yet, racial/ethnic minority adolescents are more likely to not respond to questions on suicidal behaviors. The objective of this study was to investigate the association between race/ethnicity and missing response to suicide attempt among adolescents in the United States. Data for this study were obtained the 2015-2019 national Youth Risk Behavior Survey (n = 40,360). The outcome variable investigated in this study was missing response to suicide attempt and the main explanatory variable was race/ethnicity. Two hierarchical binary logistic regression models were fitted to examine the association between race/ethnicity and missing response to suicide attempt. Of the 40,036 adolescents, 13.4% had missing response to suicide attempt. Controlling for the effects of demographic factors and symptoms of depression, adolescents who self-identified as non-Hispanic Black had more than threefold higher odds of having missing response to suicide attempt when compared to their non-Hispanic White counterparts (AOR = 3.62, p < .001, 95% CI = 2.45-5.34). Adolescent males and adolescents questioning their sexual identity had higher odds of having missing response to suicide attempt. Adolescents with depressive symptoms had lower odds of having missing response to suicide attempt. Missing response to suicide attempt among adolescents continues to differ by race/ethnicity and other demographic factors. The use of a single item in assessing suicide attempt history may be inadequate in capturing national estimates of adolescent suicide metrics.

Interpersonal Well-Being and Suicidal Outcomes in a Nationally Representative Study of Adolescents: A Translational Study

Adolescent suicide continues to rise despite burgeoning research on interpersonal risk for suicide. This may reflect challenges in applying developmental psychopathology research into clinical settings. In response, the present study used a translational analytic plan to examine indices of social well-being most accurate and statistically fair for indexing adolescent suicide. Data from the National Comorbidity Survey Replication Adolescent Supplement were used. Adolescents aged 13-17 (N = 9,900) completed surveys on traumatic events, current relationships, and suicidal thoughts and attempts. Both frequentist (e.g., receiver operating characteristics) and Bayesian (e.g., Diagnostic Likelihood Ratios; DLRs) techniques provided insight into classification, calibration, and statistical fairness. Final algorithms were compared to a machine learning-informed algorithm. Overall, parental care and family cohesion best classified suicidal ideation, while these indices and school engagement best classified attempts. Multi-indicator algorithms suggested adolescents at high risk across these indices were approximately 3-times more likely to engage in ideation (DLR = 3.26) and 5-times more likely to engage in attempts (DLR = 4.53). Although equitable for attempts, models for ideation underperformed in non-White adolescents. Supplemental, machine learning-informed algorithms performed similarly, suggesting non-linear and interactive effects did not improve model performance. Future directions for interpersonal theories for suicide are discussed and clinical implications for suicide screening are demonstrated.

Characteristics of and Circumstances Associated With Female Intimate Partner Problem-Included Suicides: Analysis of Data From the National Violent Death Reporting System (2003-2019)

Intimate partner problems (IPP)-which include divorce, breakups, arguments, jealousy, conflict, discord, and violence-have been robust precipitating factors associated with an increased risk for suicidal thoughts and behaviors. Although research on suicide related to IPP is growing, efforts to explore the circumstances surrounding suicidality among female victims struggling with IPP remain insufficient. To address this gap, this exploratory study sought to understand the circumstances surrounding female IPP-related suicide in the United States. We conducted a secondary analysis of data from the U.S. National Violent Death Reporting System (NVDRS, 2003-2019) which includes 43 states, the District of Columbia, and Puerto Rico. Of the final analytical sample of 58,545 female suicide cases in the United States, we delineated IPP-included suicide cases (13,496, 23.1%) and non-IPP-included suicide cases (45,049, 76.9%). Two-sided Pearson chi-square tests and standardized difference (SD) tests identified significant differences in the surrounding circumstances between IPP-included suicide and non-IPP-included suicide. IPP-included female suicide was more common among younger women, those involved in an intimate relationship, and women who were pregnant or postpartum (p < .001; SD > .10). IPP-included suicide victims were more likely to have experienced depression, substance abuse, and previous interpersonal trauma than non-IPP-included suicide victims (p < .001; SD > .10). Compared to non-IPP-included suicide, IPP-included suicide was more likely to occur at the victim's house or apartment during evening and nighttime by firearm or hanging (p < .001; SD > .10). Our findings also showed that IPP-included suicide victims had previous suicidal thoughts and were more likely to have disclosed their suicidal ideation with others before committing suicide than non-IPP-included suicide victims (p < .001; SD > .10). Findings identified unique circumstances and characteristics possibly associated with IPP-included female suicide. Our understanding of suicide may be enhanced by exploring the causal pathway behind these relationships.

Comparing the Effects of Victimization, School Connectedness, and Social Support on Heterosexual and Sexual Minority Adolescent Suicidality in the United States: A Partial Test of Minority Stress Theory

In the United States, sexual minority adolescents are among the subpopulations at the highest risk for suicide; yet, predictors of suicidality among this unique group remain significantly understudied. Drawing from Meyer's minority stress theory (MST), this study examines whether general stressors act as predictors of adolescent suicidality and whether differences exist in the variation of these effects between heterosexual and sexual minority adolescents. Specifically, multivariate logistic regression models were developed to examine the impact that victimization, school connectedness, and social support have on heterosexual and sexual minority adolescent suicidality using a sample of 166,176 U.S. adolescents drawn from the 2019 Minnesota Student Survey. Participants ranged from 10 to 18 years of age and identified as heterosexual, bisexual, gay or lesbian, questioning, pansexual, queer, or as none of these. Findings highlight that sexual minorities (Exp(B) = 1.870, p < .001) were roughly twice as likely to report suicidality compared to their heterosexual peers. All victimization measures were highly predictive of suicidality among heterosexual and sexual minority adolescents. Overall, adolescents who were less connected to their school setting and more socially isolated were also more likely to experience suicidality; however, such effects were not reflected uniformly in every item measuring school connectedness and social support. Findings highlight important avenues for policies implementation aimed at mitigating the effects of multiple sources of stressors on adolescents' mental health and reducing adolescents' suicide rates. Interventions tailored to the unique needs of sexual minority adolescents are needed to address their disproportionate representation among those at risk for suicide.

Physical Dating Violence Victimization among LGBTQ Youth: Disclosure and Association with Mental Health

Youth dating violence and youth suicide are both major public health concerns. However, little research examines the intersection of these issues among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth. The current study examined the association between physical dating violence victimization and mental health using online survey data collected from 39,126 LGBTQ youth of ages 13 to 24 in the United States. Overall, 11% of LGBTQ youth who were in a relationship in the past year experienced physical dating violence victimization, with 4% having experienced it once and 7% having experienced it multiple times. Rates of experiencing physical dating violence victimization varied based on a number of youth characteristics and environmental factors. Past-year physical dating violence victimization was associated with nearly four times the odds of attempting suicide in the past year. Given the intersection of suicide risk and dating violence among LGBTQ youth, dating violence prevention organizations must be LGBTQ-inclusive, and suicide prevention must be equipped to address dating violence victimization. The higher rates of physical dating violence victimization among multiple marginalized and socioeconomically disadvantaged LGBTQ youth suggest the need for an intersectional approach that addresses the structural factors that place LGBTQ youth at risk for physical dating violence.

First and Later Dating Experiences and Dating Violence among High School Students

This study investigated early dating experiences by exploring the complex aspects of first-time and later romantic involvement as well as the surrounding circumstances. In total, 377 young people (with the median age being 17 years) were investigated in six high schools in two cities in Lithuania using a questionnaire designed for research purposes by the authors. The results from this study in Lithuania contribute to the field by showing current data on the cultural and psychosocial aspects of dating experiences in high schools. This investigation into first-time and later dating creates an appropriate window to explore and investigate the attitudes, dating habits, and experiences of late adolescents, comprising negative experiences and sexual harassment, which could be used to build preventative programmes. The obtained results provide various data that are useful for trying to better understand the current habits and experiences of young people, for public health specialists, educators, and doctors and also provide an opportunity for monitoring trends, dynamic changes over time, and cross-cultural comparisons.

Suicide attempt and suicide plan among U.S. adolescents: The role of repeated and co-occurring violence experiences

PURPOSE

This study is to measure the impact of repeated and co-occurring violence experiences on suicidal behaviors among U.S. adolescents.

METHODS

Data from a nationally representative sample (N = 13, 677) were utilized, collected by 2019 Youth Risk Behavior Survey. Association and correlation between suicidal behaviors (suicide attempt and suicide plan) and multiple violence experiences (weapon-involved violence, physical violence, and sexual violence) were examined using a series of logistic regression models and structural equation modeling (SEM).

RESULTS

In the past year, nearly one in eleven adolescents had attempted suicide, one in six planned for suicide, and one in five suffered from at least one form of violence. Adolescents experiencing high frequency of victimization were up to 12 times greater odds of attempting suicide and up to 6 times more likely to plan for suicide. Those with multiple forms of violence experiences had much greater likelihood of attempting suicide and planning for suicide. The three violence experiences were highly correlated with each other and collectively explained about 40% of variance in suicide attempt and 24% of variance in suicide plan.

CONCLUSION

Comprehensive intervention programs and mental health services are needed for adolescents with repeated and concurrent violence experiences to prevent their suicidal behaviors.

Dating violence and its relationship with anxiety, depression, and stress in young Andalusian university students

AIM

To analyze the prevalence of dating violence (DV) and its relationship with states of depression, anxiety, and stress in young Andalusian university students.

METHOD

Cross-sectional descriptive quantitative study in 8 public universities in Andalusia. Data collection was carried out from September to November 2020 through a self-administered questionnaire that included sociodemographic variables and variables related to dating violence, depression, anxiety, and stress. For the analysis of the data, descriptive and nonparametric tests were performed through the U Mann-Whitney and Spearman Rho for the relationship between variables.

RESULTS

Thousand ninety-one young university students from Andalusia participated. The most prevalent DV was psychological, including behaviors related to cyberbullying, control-surveillance and psychoemotional (68.42-42.90%), followed by sexual (16.68-3.57%) and finally physical (5.60-1.92%). Statistically significant differences were shown according to sex and DV, where girls scored higher in being victims of behaviors related to cyberbullying, control-surveillance and sexual, and boys in perpetrating psycho-emotional, physical and sexual violence. All types of DV showed significant and positive correlations with depression, anxiety, and stress, except physical DV perpetrated with stress.

CONCLUSIONS

The high prevalence of DV and its relationship with mental health show the importance of conducting research on this line in the educational field, since it is a space that guarantees egalitarian relationships and promotes health.

The Association Between Dating Violence and Student Absenteeism Among a Representative Sample of U.S. High School Students: Findings From the 2019 Youth Risk Behavior Survey Survey

Student absenteeism affects students' engagement in school and academic and professional success. While research documents a significant association between school bullying/fighting and student absenteeism due to fear of being at school or getting to school, little research has examined the association of adolescent dating violence (ADV) victimization with this type of absenteeism. This study examined the relationship between physical and/or sexual ADV victimization in the past year (dichotomized as yes or no), and number of days of student absenteeism due to feeling unsafe at school or on the way to school in the past month (dichotomized as any vs. none). We analyzed cross-sectional data from the 2019 Youth Risk Behavior Survey (YRBS), a nationally representative survey of U.S. high school students (n = 9507). We conducted crude and multivariate regression models for the total sample and stratified by sex to assess our hypothesized association of ADV victimization and absenteeism; sex, grade, race/ethnicity, and sexual identity were included as covariates in adjusted models. Findings demonstrate that students reporting past year ADV victimization had 3.69 times the odds of student absenteeism due to feeling unsafe, when compared to students who did not report ADV victimization (95% CI: 3.06-4.45, p < 0.001). Sex-stratified models reveal that this effect is significantly stronger for males than for females, as indicated by non-overlapping confidence intervals (male AOR: 5.67, 95% CI: 4.18-7.68; female AOR: 2.95, 95% CI: 2.32-3.74). The multivariate models also show that Black and Latinx compared with White students, and lesbian/gay/bisexual/unsure compared with heterosexual students, had higher odds of student absenteeism due to feeling unsafe. Findings indicate the need to address ADV victimization and student absenteeism with integrated and gender-tailored responses, and with consideration of greater vulnerabilities for queer students and students of color.

Association between use of electronic vaping products and insufficient sleep among adolescents: Findings from the 2017 and 2019 YRBS

BACKGROUND AND OBJECTIVE

Although studies have investigated the association between cigarette smoking and sleep outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) use and insufficient sleep among adolescents. The objective of this study was to investigate the cross-sectional association between the use of EVPs and insufficient sleep among adolescents.

METHODS

Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The dependent variable investigated was insufficient sleep, and the main independent variable was the use of EVPs.

RESULTS

Of the 28,135 adolescents, 22.6%, 19.2%, and 58.2% were current, former, and never users of EVPs, respectively. More than three in four adolescents (76.5%) did not obtain the recommended 8 h of sleep on an average school night. Controlling for demographic factors and other covariates, adolescents who currently used EVPs had 1.33 times higher odds of having insufficient sleep (AOR = 1.33, p < .001, 95% CI = 1.16-1.52), and adolescents who previously used EVPs had 1.29 times higher odds of having insufficient sleep (AOR = 1.29, p < .001, 95% CI = 1.15-1.44) when compared to adolescents who had never used EVPs. Adolescents were more likely to get insufficient sleep if they were older, non-Hispanic Black, had symptoms of depression, experienced suicidal ideation, engaged in excessive screen-time behaviors, or currently used alcohol. Physical activity had a protective effect on insufficient sleep.

CONCLUSION

This study found that EVPs use was associated with insufficient sleep among adolescents over and above demographic and other covariates. As EVP use increases among adolescents, it is important to consider the potential impact on multiple domains, including sleep. Future studies that employ longitudinal designs may offer additional insight into the mechanisms underlying the association between EVPs use and insufficient sleep.

Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students - Adolescent Behaviors and Experiences Survey, United States, January-June 2021

Social and educational disruptions during the COVID-19 pandemic have exacerbated concerns about adolescents' mental health and suicidal behavior. Data from the 2021 Adolescent Behaviors and Experiences Survey (ABES) indicate that 37.1% of U.S. high school students reported poor mental health during the COVID-19 pandemic, with 19.9% considering and 9.0% attempting suicide in the preceding year (1). Adverse childhood experiences (ACEs)* are associated with poor mental health and suicidal behaviors (2,3), and high prevalence of some ACEs have been documented during the pandemic (4). ACEs are preventable, potentially traumatic events that occur in childhood (ages 0-17 years) such as neglect, experiencing or witnessing violence, or having a family member attempt or die by suicide. Also included are aspects of a child's environment that can undermine their sense of safety, stability, and bonding. Associations between ACEs occurring during the pandemic and mental health or suicidal behaviors among U.S. high school students were examined using ABES data. Experience of one to two ACEs was associated with poorer mental health and increased suicidal behaviors, and these deleterious outcomes increased with additional ACE exposure. After adjusting for demographic characteristics, adolescents who reported four or more ACEs during the pandemic had a prevalence of poor current mental health four times as high as, and a prevalence of past-year suicide attempts 25 times as high as, those without ACEs during the pandemic. Experience of specific ACE types (e.g., emotional abuse) was associated with higher prevalences of poor mental health and suicidal behaviors. Prevention and intervention strategies (5), including early identification and trauma-informed mental health service and support provision, for ACEs and their acute and long-term impacts could help address the U.S. child and adolescent mental health and suicide crisis.^†.

Adolescent suicide attempts in the United States: When suicide ideation and suicide capability interact

INTRODUCTION

Guided by the interpersonal theory of suicide, this study examined whether the relationship between level of suicide ideation and attempted suicide varies as a function of suicide capability.

METHODS

Cross-sectional data were obtained from the 2017 and 2019 Youth Risk Behavior Survey in which 28,442 respondents were sampled. Confirmatory factor analysis was conducted to create a latent suicide capability variable. Structural equation modeling was used to test the moderating effects of suicide capability on the relationship between level of suicide ideation and attempted suicide, adjusting for sociodemographic characteristics, sadness/hopelessness, and the sampling design.

RESULTS

Compared to adolescent with no reported ideation, those reporting single and dual ideation experienced increased odds of attempted suicide. The relationship between level of suicide ideation and attempted suicide significantly varied as a function of capability. While adolescents with dual suicide ideation experienced higher rates of attempted suicide at increasing levels of capability, faster rates of change of attempted suicide at increasing levels of capability were observed among those with single and no reported ideation.

CONCLUSION

Capability may heighten the risk of suicide attempts among youth, suggesting that treatment efforts could be directed at reducing exposure to painful and provocative experiences associated with suicide behaviors.

Sports- and physical activity-related concussion and mental health among adolescents: Findings from the 2017 and 2019 Youth Risk Behavior Survey

This study examined the association between self-reported sports- or physical activity-related concussion and symptoms of depression and suicidal behaviors (suicidal ideation, having a suicide plan, and suicide attempts). This study used data from the 2017 and 2019 Youth Risk Behavior Survey (YRBS), a biennial, school-based, nationally representative survey of U.S. students in grade levels 9 to 12 (N = 14,496). Multivariate logistical regression models assessed the association between self-reported sports-or physical activity-related concussions and suicidal behaviors among students, controlling for a range of demographic and psychosocial variables. Altogether, 13.6% of students reported a sports-or physical activity related concussion in the past 12 months. Among youth, sports-or physical activity related concussions were significantly associated with greater odds of symptoms of depression, suicidal ideation, making a suicide plan, and suicide attempts compared to other youth who did not experience sports- or physical activity-related concussion. Findings highlight increased risk for adverse mental health outcomes among students with sports-or physical activity related concussions. Providing resources for students to engage in physical activity and sports teams may help prevent the onset of depression and suicidal behaviors; however, resources must also be available to monitor any concussions related to these activities to provide support for student emotional well-being.

A Network Analysis Investigation of Disordered Eating Across Demographic and Developmental Subpopulations Using a National Epidemiological Sample of High School Students

Disordered eating (DE) poses a large societal burden, yet limited research has examined DE from a developmental epidemiological perspective. It is important to consider how demographics influence DE symptoms to inform prevention and early intervention programs across diverse subpopulations. Therefore, we conducted network analyses using a large nationally representative epidemiological sample of high school students (Youth Risk Behavior Survey, United States; n = 59,582) to identify the most important symptoms and symptom relationships among six DE behaviors. We compared networks by sex, grade, and race to identify differences in symptom networks. Dieting for weight loss was highly central across networks. Networks significantly differed across sex, grade, and race. Our results suggest that dieting for weight loss may be an early intervention target for eating disorders, regardless of demographic and developmental factors. In addition, sex, race, and age should be accounted for when researching and developing prevention programs for DE and eating disorders. Public health officials, as well as mental health professionals, should present a more balanced message about dieting and weight loss to high school students to prevent the detrimental impact of DE on physical and mental health. Notably, this study is the first large, nationwide epidemiological sample using DE symptoms in network analysis.

Association Between Concussions and Suicidality in High School Students in the United States

Importance

Prior research has shown a statistically significant association between sustaining a concussion and suicidality in adolescents, but this prior research controlled for relatively few variables predictive of suicidality.

Objective

To examine whether sustaining a concussion remained a significant predictor of suicidality after controlling for relevant covariates (e.g., sexual abuse/assault, bullying, substance use, depression), hypothesizing that the relationship between concussion and suicidality would become non-significant after controlling for these variables.

Design

This study involved secondary data analysis of the 2019 Youth Risk Behavior Surveillance (YRBS) System, a national cross-sectional study of adolescents. Analyses were stratified by gender.

Setting

A national sampling of U.S. high school students.

Participants

Eleven thousand two hundred sixty-two students in the YRBS database, including 5,483 boys and 5,779 girls.

Exposure(s)

Participants included in the analyses reported whether, in the last year, they experienced a concussion and/or suicidality.

Main Outcomes and Measures

The main outcome was suicidality (i.e., ideation, planning, attempt), which was predicted by concussion in an unadjusted analysis and by concussion along with other risk factors in a multivariable analysis.

Results

The final sample included 11,262 participants with available data on concussion and suicidality in the last year (14–18 years-old; 51.3% girls; 49.0% White). Per unadjusted odds ratios with 95% confidence intervals, there was a relationship between concussion and suicidal ideation [girls: OR = 1.46 (1.24, 1.73); boys: OR = 1.69 (1.41, 2.03)], planning (girls: OR = 1.39 [1.16, 1.66]; boys: OR = 1.76 [1.44, 2.14]), and attempt [girls: OR = 1.70 (1.32, 2.19); boys: OR = 3.13, (2.37, 4.15)]. These relationships became mostly non-significant after controlling for relevant risk factors for suicidality. The adjusted odds ratios showed no relationship between concussion and suicidal ideation [girls: OR = 1.11 (0.86, 1.44); boys: OR = 1.24 (0.92, 1.69)] or planning (girls: OR = 1.07 [0.82, 1.40]; boys: OR = 1.12 [0.82, 1.55]); but a significant relationship with suicide attempts in boys [OR = 1.98 (1.28, 3.04)], but not girls [OR = 1.05 (0.74, 1.49)].

Conclusions and Relevance

There was an association between concussion and suicidality in U.S. high school students; however, after controlling for other variables (e.g., depression, sexual abuse/assault, illicit drug use), there was no association between concussion and suicidality aside from a significant relationship between concussion and attempts in boys.

Self-inflicted injuries among adolescents: Prevalence and associated factors, Espírito Santo, Brazil

Objective: To identify the prevalence of notified self-inflicted injuries among adolescents in Espírito Santo and to analyze the associated factors. Materials and methods: A cross-sectional and analytical study, with the notified data of self-inflicted violence among adolescents in Espírito Santo registered in the Notifiable Diseases Information System from 2011 to 2018. The bivariate analyses considered the Chi-square (χ²) and Fisher’s Exact tests. The multivariate analysis considered the log-binomial model, and the adjustment results were presented as prevalence ratio. Results: The prevalence of notified self-inflicted injuries was 33 % and, of this total, 79.8 % occurred among female adolescents. Prevalence was higher among adolescents aged from 13 to 17 years old (female gender) and from 18 to 19 years old (male gender), as well as among those with some disability or disorder. Higher prevalence values were found in the residence and in collective housing, as well as among those who did not consume alcohol at the event in question. In the female gender, there was also an association with the urban area (p < 0.05). Conclusions: High prevalence of notified self-inflicted injuries is perceived among adolescents in Espírito Santo, as well as of the factors associated to this phenomenon. The importance of adopting promotion, prevention and recovery measures for the problem is verified.

A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide

BACKGROUND

LGBTQ+ youth have higher rates of self-harm and suicide than cisgender, heterosexual peers. Less is known about prevalence of risks within these populations.

OBJECTIVES

The first systematic review and meta-analysis to investigate the prevalence of risks among young people throughout the LGBTQ+ umbrella with experiences across the dimension of self-harm, suicidal ideation and suicide behaviour; and how they may differ between LGBTQ+ umbrella groups.

DATA SOURCES

MEDLINE, Scopus, EMBASE, PsycINFO, and Web of Science searches were run to identify quantitative research papers (database inception to 31st January, 2020).

STUDY ELIGIBILITY CRITERIA

Articles included were empirical quantitative studies, which examined risks associated with self-harm, suicidal ideation or suicidal behaviour in LGBTQ+ young people (12-25 years).

SYNTHESIS METHODS

2457 articles were identified for screening which was completed by two independent reviewers. 104 studies met inclusion criteria of which 40 had data which could be meta-analysed in a meaningful way. This analysis represents victimisation and mental health difficulties as risks among LGBTQ+ youth with self-harm and suicide experiences. Random-effects modelling was used for the main analyses with planned subgroup analyses.

RESULTS

Victimisation and mental health were key risk factors across the dimension self-harm and suicide identified through all analyses. A pooled prevalence of 0.36 was indicated for victimisation and 0.39 for mental health difficulties within LGBTQ+ young people with experiences of self-harm or suicide. Odds ratios were calculated which demonstrated particularly high levels of victimisation (3.74) and mental health difficulties (2.67) when compared to cisgender, heterosexual counterparts who also had these experiences.

CONCLUSIONS

Victimisation and mental health difficulties are highly prevalent among LGBTQ+ youth with experiences of self-harm and suicide. Due to inconsistency of reporting, further risk synthesis is limited. Given the global inclusion of studies, these results can be considered across countries and inform policy and suicide prevention initiatives.

PROSPERO REGISTRATION NUMBER

CRD42019130037.

Prevalence and associated factors of suicidality in Japanese adolescents: results from a population-based questionnaire survey

Background

Suicide is the leading cause of death among Japanese adolescents. However, knowledge gaps regarding contemporary demographics and factors associated with suicidality among Japanese adolescents are a major concern. This study examined the prevalence of suicidality among Japanese adolescents and investigated associated factors.

Methods

A population-based questionnaire survey investigating general health was administered to 22,419 adolescents aged 13–18 years. The 29-item questionnaire covered emotional status, family function, cyberbullying, suicidality, and stressors (e.g., relationships with parents/friends, school performance, and sexual identity). We conducted multiple logistic regression analysis to identify factors associated with suicidality in this population.

Results

The prevalence of suicidal ideation was 21.6% in males and 28.5% in females, and that of attempted suicide was 3.5% in males and 6.6% and in females. Bullying and stress related to family relationships had the strongest associations with suicidality. Exposure to cyberbullying had the highest odds ratio for both junior high (3.1, 95% confidence interval [CI] 2.1–4.4) and high school students (3.6, 95% CI 2.5–5.3). Other factors significantly associated with suicidality were sex, emotional status, and stress about relationships with friends, sexual identity, school records, and academic course. Adolescents accessed a variety of resources to cope with stressors, with the Internet being the most common resource consulted.

Conclusions

Suicidality is commonly experienced among Japanese adolescents. Although there are many associated risk factors, cyberbullying is of particular concern. Recognition of factors associated with adolescent suicidality will inform further research and suicide prevention efforts for healthcare providers and families.

Investigating the association between bullying victimization and suicidal ideation among adolescents: Evidence from the 2017 Youth Risk Behavior Survey

BACKGROUND

Suicide among adolescents in the United States is the second leading cause of death. Bullying victimization has also been identified as a growing public health concern. Although studies have examined the association between bullying victimization and mental health outcomes, there is a dearth of research investigating the association between bullying victimization and suicidal ideation among adolescents.

OBJECTIVE

The objective of this study is to investigate the association between bullying victimization and suicidal ideation among adolescents.

PARTICIPANTS AND SETTING

Data for this study came from the 2017 National Youth Risk Behavior Survey.

METHODS

An analytic sample of 14,603 adolescents aged 14-18 years (52 % female) was analyzed using binary logistic regression.

RESULTS

About 18 % of adolescents experienced suicidal ideation during the past 12 months. About one in ten adolescents (9.1 %) were victims of both school bullying and cyberbullying. Bullying victimization was associated with suicidal ideation whereby, adolescents who experienced both school bullying and cyberbullying victimization had 3.26 times higher odds of experiencing suicidal ideation (AOR = 3.26, p < .001, 95 % CI=3.10-3.43), adolescents who experienced school bullying victimization had 2.15 times higher odds of experiencing suicidal ideation (AOR = 2.15, p < .001, 95 % CI=2.04-2.27), and adolescents who experienced cyberbullying victimization had twice the odds of experiencing suicidal ideation (AOR = 2.00, p < .001, 95 % CI=1.87-2.14). Other factors significantly associated with suicidal ideation include forced sexual intercourse, depressive symptoms, cigarette smoking, alcohol use, cannabis use, and illicit drug use.

CONCLUSION

Understanding the association between bullying victimization and suicidal ideation could contribute to early identification of adolescents who may be at risk for suicide.