1
|
Gumber L, Agbeleye O, Inskip A, Fairbairn R, Still M, Ouma L, Lozano-Kuehne J, Bardgett M, Isaacs JD, Wason JM, Craig D, Pratt AG. Operational complexities in international clinical trials: a systematic review of challenges and proposed solutions. BMJ Open 2024; 14:e077132. [PMID: 38626966 PMCID: PMC11029458 DOI: 10.1136/bmjopen-2023-077132] [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: 06/26/2023] [Accepted: 02/27/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE International trials can be challenging to operationalise due to incompatibilities between country-specific policies and infrastructures. The aim of this systematic review was to identify the operational complexities of conducting international trials and identify potential solutions for overcoming them. DESIGN Systematic review. DATA SOURCES Medline, Embase and Health Management Information Consortium were searched from 2006 to 30 January 2023. ELIGIBILITY CRITERIA All studies reporting operational challenges (eg, site selection, trial management, intervention management, data management) of conducting international trials were included. DATA EXTRACTION AND SYNTHESIS Search results were independently screened by at least two reviewers and data were extracted into a proforma. RESULTS 38 studies (35 RCTs, 2 reports and 1 qualitative study) fulfilled the inclusion criteria. The median sample size was 1202 (IQR 332-4056) and median number of sites was 40 (IQR 13-78). 88.6% of studies had an academic sponsor and 80% were funded through government sources. Operational complexities were particularly reported during trial set-up due to lack of harmonisation in regulatory approvals and in relation to sponsorship structure, with associated budgetary impacts. Additional challenges included site selection, staff training, lengthy contract negotiations, site monitoring, communication, trial oversight, recruitment, data management, drug procurement and distribution, pharmacy involvement and biospecimen processing and transport. CONCLUSIONS International collaborative trials are valuable in cases where recruitment may be difficult, diversifying participation and applicability. However, multiple operational and regulatory challenges are encountered when implementing a trial in multiple countries. Careful planning and communication between trials units and investigators, with an emphasis on establishing adequately resourced cross-border sponsorship structures and regulatory approvals, may help to overcome these barriers and realise the benefits of the approach. OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER: osf-registrations-yvtjb-v1.
Collapse
Affiliation(s)
- Leher Gumber
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, Northumbria, UK
| | - Opeyemi Agbeleye
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Inskip
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ross Fairbairn
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Madeleine Still
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Ouma
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jingky Lozano-Kuehne
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michelle Bardgett
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - James Ms Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Arthur G Pratt
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| |
Collapse
|
2
|
Lustig S, Kaess M, Schnyder N, Michel C, Brunner R, Tubiana A, Kahn JP, Sarchiapone M, Hoven CW, Barzilay S, Apter A, Balazs J, Bobes J, Saiz PA, Cozman D, Cotter P, Kereszteny A, Podlogar T, Postuvan V, Värnik A, Resch F, Carli V, Wasserman D. The impact of school-based screening on service use in adolescents at risk for mental health problems and risk-behaviour. Eur Child Adolesc Psychiatry 2023; 32:1745-1754. [PMID: 35488938 PMCID: PMC10460322 DOI: 10.1007/s00787-022-01990-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
Early detection and intervention can counteract mental disorders and risk behaviours among adolescents. However, help-seeking rates are low. School-based screenings are a promising tool to detect adolescents at risk for mental problems and to improve help-seeking behaviour. We assessed associations between the intervention "Screening by Professionals" (ProfScreen) and the use of mental health services and at-risk state at 12 month follow-up compared to a control group. School students (aged 15 ± 0.9 years) from 11 European countries participating in the "Saving and Empowering Young Lives in Europe" (SEYLE) study completed a self-report questionnaire on mental health problems and risk behaviours. ProfScreen students considered "at-risk" for mental illness or risk behaviour based on the screening were invited for a clinical interview with a mental health professional and, if necessary, referred for subsequent treatment. At follow-up, students completed another self-report, additionally reporting on service use. Of the total sample (N = 4,172), 61.9% were considered at-risk. 40.7% of the ProfScreen at-risk participants invited for the clinical interview attended the interview, and 10.1% of subsequently referred ProfScreen participants engaged in professional treatment. There were no differences between the ProfScreen and control group regarding follow-up service use and at-risk state. Attending the ProfScreen interview was positively associated with follow-up service use (OR = 1.783, 95% CI = 1.038-3.064), but had no effect on follow-up at-risk state. Service use rates of professional care as well as of the ProfScreen intervention itself were low. Future school-based interventions targeting help-seeking need to address barriers to intervention adherence.Clinical Trials Registration: The trial is registered at the US National Institute of Health (NIH) clinical trial registry (NCT00906620, registered on 21 May, 2009), and the German Clinical Trials Register (DRKS00000214, registered on 27 October, 2009).
Collapse
Affiliation(s)
- Sophia Lustig
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Nina Schnyder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- School of Public Health, The University of Queensland, Brisbane, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
- Clinic of Child and Adolescents Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Alexandra Tubiana
- Department of Psychiatry and Clinical Psychology, Centre Psychothérapique de Nancy, Nancy, France
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Psychothérapique de Nancy, Nancy, France
- Université de Lorraine, Nancy, France
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Christina W Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Shira Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
- Department of Community Health, University of Haifa, Haifa, Israel
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Bjørknes University College, Oslo, Norway
| | - Julio Bobes
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Pilar Alejandra Saiz
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Doina Cozman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Padraig Cotter
- Child and Adolescent Mental Health Services North Cork Area, HSE South, Mallow, Ireland
| | - Agnes Kereszteny
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Tina Podlogar
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Vita Postuvan
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Airi Värnik
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia
- Tallinn University School of Natural Science and Health, Tallinn, Estonia
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Vladimir Carli
- Department of Public Health Sciences, Methods Development and Training in Suicide Prevention, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)WHO Collaborating Centre for ResearchKarolinska Institute, Stockholm, Sweden
| | - Danuta Wasserman
- National Institute for Health, Migration and Poverty, Rome, Italy
- Department of Public Health Sciences, Methods Development and Training in Suicide Prevention, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)WHO Collaborating Centre for ResearchKarolinska Institute, Stockholm, Sweden
| |
Collapse
|
3
|
Staines L, Healy C, Corcoran P, Keeley H, Coughlan H, McMahon E, Cotter P, Cotter D, Kelleher I, Wasserman C, Brunner R, Kaess M, Sarchiapone M, Hoven CW, Carli V, Wasserman D, Cannon M. Investigating the effectiveness of three school based interventions for preventing psychotic experiences over a year period - a secondary data analysis study of a randomized control trial. BMC Public Health 2023; 23:219. [PMID: 36726107 PMCID: PMC9890687 DOI: 10.1186/s12889-023-15107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Psychotic experiences (PEs) are associated with increased risk of later mental disorders and so could be valuable in prevention studies. However, to date few intervention studies have examined PEs. Given this lack of evidence, in the current study a secondary data analysis was conducted on a clustered-randomized control trial (RCT) of 3 school based interventions to reduce suicidal behaviour, to investigate if these may reduce rates of PEs, and prevent PE, at 3-month and 1-year follow-up. METHODS The Irish site of the Saving and Empowering Young Lives in Europe study, trial registration (DRKS00000214), a cluster-RCT designed to examine the effect of school-based interventions on suicidal thoughts and behaviour. Seventeen schools (n = 1096) were randomly assigned to one of three intervention arms or a control arm. The interventions included a teacher training (gate-keeper) intervention, an interactive educational (universal-education) intervention, and a screening and integrated referral (selective-indicative) intervention. The primary outcome of this secondary data-analysis was reduction in point-prevalence of PEs at 12 months. A second analysis excluding those with PEs at baseline was conducted to examine prevention of PEs. Additional analysis was conducted of change in depression and anxiety scores (comparing those with/without PEs) in each arm of the intervention. Statistical analyses were conducted using mixed-effects modelling. RESULTS At 12-months, the screening and referral intervention was associated with a significant reduction in PEs (OR:0.12,95%CI[0.02-0.62]) compared to the control arm. The teacher training and education intervention did not show this effect. Prevention was also observed only in the screening and referral arm (OR:0.30,95%CI[0.09-0.97]). Participants with PEs showed higher levels of depression and anxiety symptoms, compared to those without, and different responses to the screening and referral intervention & universal-education intervention. CONCLUSIONS This study provides the first evidence for a school based intervention that reduce & prevent PEs in adolescence. This intervention is a combination of a school-based screening for psychopathology and subsequent referral intervention significantly reduced PEs in adolescents. Although further research is needed, our findings point to the effectiveness of school-based programmes for prevention of future mental health problems.
Collapse
Affiliation(s)
- Lorna Staines
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland.
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Helen Keeley
- Child and Adolescent Mental Health Services North Cork, Health Service Executive, Cork, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
| | - Elaine McMahon
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Padraig Cotter
- Research Society of Process Oriented Psychology United Kingdom (RSPOPUK), Old Hampstead Townhall 213 Haverstock Hill, NW3 4QP, London, UK
- Park Royal Centre for Mental Health, Central and North West London (CNWL) NHS Trust, Central Way, Off Acton Lane, NW10 7NS, London, UK
| | - David Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, EH10 5HF, Edinburgh, UK
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Romuald Brunner
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| |
Collapse
|
4
|
Walsh EH, Herring MP, McMahon J. A Systematic Review of School-Based Suicide Prevention Interventions for Adolescents, and Intervention and Contextual Factors in Prevention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:365-381. [PMID: 36301381 DOI: 10.1007/s11121-022-01449-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/26/2022]
Abstract
Suicide is the fourth leading cause of death among adolescents, globally. Though post-primary, school-based suicide prevention (PSSP) has the potential to be a key strategy for preventing adolescent suicidal thoughts and behaviours (STBs), there are persisting challenges to translating PSSP research to practice. Intervention and contextual factors relevant to PSSP are likely key to both PSSP effectiveness and implementation. As such, this systematic review aimed to summarise the effectiveness of PSSP for adolescent STBs and highlight important intervention and contextual factors with respect to PSSP. PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials were searched to identify randomised and non-randomised studies evaluating the effectiveness of interventions located in post-primary, school-based settings targeting adolescent STBs. PSSP effectiveness and intervention and contextual factors were synthesised narratively. Twenty-eight studies were retained, containing nearly 47,000 participants. Twelve out of twenty-nine trials comparing intervention and independent control comparators reported statistically significant reductions in STBs postintervention, and 5/7 trials comparing preintervention and postintervention scores demonstrated significant reductions in STBs over time. Reporting and analysis of intervention and contextual factors were lacking across studies, but PSSP effectiveness and intervention acceptability varied across type of school. Although school personnel commonly delivered PSSP interventions, their input and perspectives on PSSP interventions were lacking. Notably, adolescents had little involvement in designing, inputting on, delivering and sharing their perspectives on PSSP interventions. Twenty out of twenty-eight studies were rated as moderate/high risk of bias, with non-randomised trials demonstrating greater risks of bias and trial effectiveness, in comparison to cluster randomised trials. Future research should prioritise complete reporting and analysis of intervention and contextual factors with respect to PSSP, involving key stakeholders (including adolescents and school personnel) in PSSP, and investigating key stakeholders' perspectives on PSSP. Given the inverse associations between both study quality and study design with PSSP effectiveness, particular consideration to study quality and design in PSSP research is needed. Future practice should consider PSSP interventions with universal components and PSSP which supports and involves key stakeholders in engaging with PSSP.
Collapse
Affiliation(s)
- Eibhlin H Walsh
- School, Child & Youth (SCY) Mental Health and Wellbeing Research Lab, Department of Psychology, University of Limerick, Limerick, Ireland.
- National Institute of Studies in Education, University of Limerick, Limerick, Ireland.
- Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Matthew P Herring
- Physical Activity for Health Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sports Sciences, University of Limerick, Limerick, Ireland
| | - Jennifer McMahon
- School, Child & Youth (SCY) Mental Health and Wellbeing Research Lab, Department of Psychology, University of Limerick, Limerick, Ireland
- National Institute of Studies in Education, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
5
|
Pérez V, Elices M, Toll A, Bobes J, López-Solà C, Díaz-Marsá M, Grande I, López-Peña P, Rodríguez-Vega B, Ruiz-Veguilla M, de la Torre-Luque A. The Suicide Prevention and Intervention Study (SURVIVE): Study protocol for a multisite cohort study with nested randomized-controlled trials. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:16-23. [PMID: 33301997 DOI: 10.1016/j.rpsm.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Suicide is one of the leading causes of avoidable death. Gathering national data on suicidal behaviour incidence is crucial to develop evidence-based public policies. The study has two primary objectives: (1) to determine the incidence of suicide attempts in Spain and related risk factors, and (2) to analyze the efficacy of secondary prevention programmes to prevent suicide re-attempting in comparison to treatment as usual (TAU). MATERIALS AND METHODS Multisite, coordinated, cohort study with three nested randomized controlled trials. A cohort of 2000 individuals (age >=12) with suicidal behaviour will be recruited at ten sites distributed across Spain. Assessments will be conducted within 10 days of the suicide attempt (V0-baseline visit) and after 12 months (V4-last visit) and will include clinician reported and participant reported outcomes (PROs). Between V0 and V4, PROs will be collected remotely every three months (V1, V2 and V3). Optatively, cohort participants will participate in three nested randomized-controlled-trials (RCTs) evaluating different secondary prevention interventions: Participants aged 18 years and older will be randomly allocated to: Telephone-based Management+TAU vs. TAU or iFightDepression-Survive+TAU vs. TAU. Participants aged between 12 and 18 years will be allocated to a specific intervention for youths: Self Awareness of Mental Health+TAU vs. TAU. RESULTS This study will provide interesting data to estimate suicide attempt incidence in Spain. and will provide evidence on three. CONCLUSIONS Evidence on three potentially efficacious interventions for individuals at high risk of suicide will be obtained, and this could improve the treatment given to these individuals. TRIAL REGISTRATION NCT04343703.
Collapse
Affiliation(s)
- Víctor Pérez
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Matilde Elices
- Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
| | - Alba Toll
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Julio Bobes
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain; Department of Psychology, Universidad de Oviedo, Oviedo, Spain
| | - Clara López-Solà
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Mental Health Department, Parc Taulí Hospital Universitari, Neuroscience and Mental Health Research Area, Institut d' Investigació I Innovació ParcTaulí (I3PT), Sabadell, Spain; Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marina Díaz-Marsá
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Hospital Clínico San Carlos, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Iria Grande
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, Spain
| | - Purificación López-Peña
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Hospital Universitario Araba-Santiago, Instituto de Investigación Sanitaria Bioaraba, Universidad del País Vasco, Spain
| | - Beatriz Rodríguez-Vega
- La Paz University Hospital, Madrid, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Autonomous University of Madrid (UAM), Madrid, Spain
| | - Miguel Ruiz-Veguilla
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Hospital Virgen del Rocio de Sevilla, Spain; IBIS, Universidad de Sevilla, Spain
| | - Alejandro de la Torre-Luque
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
6
|
Orth Z, Moosajee F, Van Wyk B. Measuring Mental Wellness of Adolescents: A Systematic Review of Instruments. Front Psychol 2022; 13:835601. [PMID: 35356328 PMCID: PMC8959676 DOI: 10.3389/fpsyg.2022.835601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 12/26/2022] Open
Abstract
Objective Mental health is critical to the healthy development of adolescents. However, mental health encompasses more than the absence of mental illness; and should include indicators of mental wellness. A critical review of available mental wellness instruments for adolescents were conducted to identify operational definitions of mental wellness concepts for this population group. Method A systematic review of literature published between 2000 and 2020 was done to identify mental wellness instruments for adolescent populations. The review followed the PRISMA operational steps. Results We identified 2,543 articles from the search strategy and screened titles and abstracts for eligibility. After appraisal, 97 studies were included in the qualitative synthesis; of which, 79 mental wellness instruments were identified. Most studies did not provide a definition for mental wellness. We identified thirteen mental wellness concepts from 97 studies, namely: life satisfaction, mental wellbeing [general], resilience, self-efficacy, self- esteem, connectedness, coping, self-control, mindfulness/spiritual, hope, sense of coherence, happiness, and life purpose. Conclusion The review reflected previous research identifying a lack of consensus around the definitions of mental health, mental wellness, and mental wellbeing. This has implications for developing instruments for adolescents that adequately measure these constructs. Most of the instruments identified in the review were predominantly English and from developed countries. This indicates a need for instrument that are explicitly conceptualised and operationalised for adolescents in all their varied contexts.
Collapse
Affiliation(s)
- Zaida Orth
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Faranha Moosajee
- Division for Postgraduate Studies, University of the Western Cape, Bellville, South Africa
| | - Brian Van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| |
Collapse
|
7
|
Kaess M, Schnyder N, Michel C, Brunner R, Carli V, Sarchiapone M, Hoven CW, Wasserman C, Apter A, Balazs J, Bobes J, Cosman D, Haring C, Kahn JP, Keeley H, Kereszteny A, Podlogar T, Postuvan V, Varnik A, Resch F, Wasserman D. Twelve-month service use, suicidality and mental health problems of European adolescents after a school-based screening for current suicidality. Eur Child Adolesc Psychiatry 2022; 31:229-238. [PMID: 33320300 PMCID: PMC8837507 DOI: 10.1007/s00787-020-01681-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
Suicide is one of the leading causes of death in adolescents and help-seeking behaviour for suicidal behaviour is low. School-based screenings can identify adolescents at risk for suicidal behaviour and might have the potential to facilitate service use and reduce suicidal behaviour. The aim of this study was to assess associations of a two-stage school-based screening with service use and suicidality in adolescents (aged 15 ± 0.9 years) from 11 European countries after one year. Students participating in the 'Saving and Empowering Young Lives in Europe' (SEYLE) study completed a self-report questionnaire including items on suicidal behaviour. Those screening positive for current suicidality (first screening stage) were invited to an interview with a mental health professional (second stage) who referred them for treatment, if necessary. At 12-month follow-up, students completed the same self-report questionnaire including questions on service use within the past year. Of the N = 12,395 SEYLE participants, 516 (4.2%) screened positive for current suicidality and were invited to the interview. Of these, 362 completed the 12-month follow-up with 136 (37.6%) self-selecting to attend the interview (screening completers). The majority of both screening completers (81.9%) and non-completers (91.6%) had not received professional treatment within one year, with completers being slightly more likely to receive it (χ2(1) = 8.948, V = 0.157, p ≤ 0.01). Screening completion was associated with higher service use (OR 2.695, se 1.017, p ≤ 0.01) and lower suicidality at follow-up (OR 0.505, se 0.114, p ≤ 0.01) after controlling for potential confounders. This school-based screening offered limited evidence for the improvement of service use for suicidality. Similar future programmes might improve interview attendance rate and address adolescents' barriers to care.
Collapse
Affiliation(s)
- Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Stöckli, 3000, Bern 60, Switzerland.
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany.
| | - N Schnyder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Stöckli, 3000, Bern 60, Switzerland
- School of Public Health, The University of Queensland, Brisbane, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Australia
| | - C Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Stöckli, 3000, Bern 60, Switzerland
| | - R Brunner
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - V Carli
- Department of Learning, Informatics , Management and Ethics, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm, Sweden
| | - M Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - C W Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - C Wasserman
- Department of Learning, Informatics , Management and Ethics, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm, Sweden
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - A Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - J Balazs
- Bjørknes University College, Oslo, Norway
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - J Bobes
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - D Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - C Haring
- Institute for Clinical Evaluation, Department for Psychiatry and Psychotherapy B, State Hospital Hall, Tyrol, Austria
| | - J-P Kahn
- Department of Psychiatry and Clinical Psychology, CHRU de Nancy and Centre Psychothérapique de Nancy, Université de Lorraine, Nancy, France
| | - H Keeley
- North Cork Child and Adolescent Services, Health Service Executive South, Mallow Primary Healthcare Service, Gouldshill, Mallow Co Cork, Ireland
| | - A Kereszteny
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - T Podlogar
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - V Postuvan
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - A Varnik
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia
- Tallinn University School of Natural Science and Health, Tallinn, Estonia
| | - F Resch
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - D Wasserman
- Department of Learning, Informatics , Management and Ethics, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
8
|
Kaess M, Klar J, Kindler J, Parzer P, Brunner R, Carli V, Sarchiapone M, Hoven CW, Apter A, Balazs J, Barzilay S, Bobes J, Cozman D, Gomboc V, Haring C, Kahn JP, Keeley H, Meszaros G, Musa GJ, Postuvan V, Saiz P, Sisask M, Varnik P, Resch F, Wasserman D. Excessive and pathological Internet use - Risk-behavior or psychopathology? Addict Behav 2021; 123:107045. [PMID: 34332272 DOI: 10.1016/j.addbeh.2021.107045] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/10/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Abstract
Pathological Internet use (but only with respect to gaming) is classified as mental disorder in the ICD-11. However, there is a large group of adolescents showing excessive Internet use, which may rather be considered adolescent risk-behavior. The aim was to test whether pathological and excessive Internet use should be considered as "psychopathology" or "risk-behavior". A representative, cross-sectional sample of 11.110 students from 10 European Union countries was analyzed. Structural equation models, including the factors "risk-behavior" and "psychopathology" and the variables excessive and pathological Internet use, were tested against each other. "Risk-behavior" was operationalized by several risk-behaviors (e.g. drug abuse, truancy, etc). "Psychopathology" included measures of several mental disorders (e.g. depression, hyperactivity, etc). Excessive Internet use was assessed as the duration and frequency of Internet use. Pathological Internet use was assessed with the Young Diagnostic Questionnaire (i.e., presence of addiction criteria). Excessive Internet use loaded on "risk-behavior" (λ = 0.484, p < .001) and on "psychopathology" (λ = 0.071, p < .007). Pathological Internet use loaded on "risk-behavior" (λ = 0.333, p < .001) and on "psychopathology" (λ = 0.852, p < .001). Chi-square tests determined that the loadings of excessive Internet use (χ2 (1) = 81.98, p < .001) were significantly stronger on "risk-behavior" than "psychopathology". Vice versa, pathological Internet use loaded significantly stronger on "psychopathology" (χ2 (1) = 107.10, p < .001). The results indicate that pathological Internet use should rather be considered as psychopathology. Excessive Internet use on the other hand, should be classified as adolescent risk-behavior.
Collapse
|
9
|
Zhang M, Zhang W, Liu Y, Wu M, Zhou J, Mao Z. Relationship between Family Function, Anxiety, and Quality of Life for Older Adults with Hypertension in Low-Income Communities. Int J Hypertens 2021; 2021:5547190. [PMID: 34616569 PMCID: PMC8490058 DOI: 10.1155/2021/5547190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 09/14/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Effective functional family was beneficial for older adults' health, which may affect the quality of life (QoL) in hypertension patients. This study aimed to clarify the association between family function, anxiety, and QoL for older adults with hypertension in low-income communities. METHODS A questionnaire survey was conducted on 363 older adults with hypertension in low-income communities in Wuhan from September 2019 to November 2019. The relationships among the variables were examined by Pearson's correlation analysis. Predictor effects were tested using hierarchical multiple regressions, controlling for demographic characteristics. The structural equation model (SEM) was used to test the mediation effects of anxiety on the pathway from family function to QoL. RESULTS Family function was negatively correlated with the self-rating anxiety scale (SAS) score and positively correlated with the mental component score (MCS), but had no influence on the physical component score (PCS). Both PCS and MCS were negatively correlated with SAS. Anxiety was the negative predictor of MCS and PCS. Family function was the positive predictor of MCS, but had no influence on PCS. The path model indicated that anxiety significantly mediated the link between family function and QoL (R 2 = 32.8%), but only partially. CONCLUSION A significant correlation between anxiety, family function, and QoL was found. Anxiety had a partial mediating effect on the relationship between family function and QoL. Further research should focus on increasing the level of family function and reducing the perceived anxiety of older adults with hypertension to improve their QoL level.
Collapse
Affiliation(s)
- Meng Zhang
- Nursing Department, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenyan Zhang
- Nursing Department, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Liu
- Nursing Department, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meiliyang Wu
- Nursing Department, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Zhou
- Hanshui Bridge Street Community Health Center, Qiaokou District, Wuhan, China
| | - Zhongmin Mao
- Gutian Street Community Health Center, Qiaokou District, Wuhan, China
| |
Collapse
|
10
|
McMahon EM, Corcoran P, Keeley H, Clarke M, Coughlan H, Wasserman D, Hoven CW, Carli V, Sarchiapone M, Healy C, Cannon M. Risk and protective factors for psychotic experiences in adolescence: a population-based study. Psychol Med 2021; 51:1220-1228. [PMID: 32026792 DOI: 10.1017/s0033291719004136] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Psychotic experiences (PEs) are reported by a significant minority of adolescents and are associated with the development of psychiatric disorders. The aims of this study were to examine associations between PEs and a range of factors including psychopathology, adversity and lifestyle, and to investigate mediating effects of coping style and parental support on associations between adversity and PEs in a general population adolescent sample. METHOD Cross-sectional data were drawn from the Irish centre of the Saving and Empowering Young Lives in Europe study. Students completed a self-report questionnaire and 973 adolescents, of whom 522 (53.6%) were boys, participated. PEs were assessed using the 7-item Adolescent Psychotic Symptom Screener. RESULTS Of the total sample, 81 (8.7%) of the sample were found to be at risk of PEs. In multivariate analysis, associations were found between PEs and number of adverse events reported (OR 4.48, CI 1.41-14.25; p < 0.011), maladaptive/pathological internet use (OR 2.70, CI 1.30-5.58; p = 0.007), alcohol intoxication (OR 2.12, CI 1.10-4.12; p = 0.025) and anxiety symptoms (OR 4.03, CI 1.57-10.33; p = 0.004). There were small mediating effects of parental supervision, parental support and maladaptive coping on associations between adversity and PEs. CONCLUSION We have identified potential risk factors for PEs from multiple domains including adversity, mental health and lifestyle factors. The mediating effect of parental support on associations between adversity and PEs suggests that poor family relationships may account for some of this mechanism. These findings can inform the development of interventions for adolescents at risk.
Collapse
Affiliation(s)
- Elaine M McMahon
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University CollegeCork, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University CollegeCork, Ireland
| | - Helen Keeley
- Child and Adolescent Mental Health Services North Cork, Health Service Executive, Ireland
| | - Mary Clarke
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Dept of Child and Adolescent Psychiatry, New York State Psychiatric Institute; Dept of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Institute of Neuroscience, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
11
|
Influence of coping strategies on the efficacy of YAM (Youth Aware of Mental Health): a universal school-based suicide preventive program. Eur Child Adolesc Psychiatry 2020; 29:1671-1681. [PMID: 32025960 DOI: 10.1007/s00787-020-01476-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
The school-based mental health promotion and suicide prevention universal program Youth Aware of Mental Health (YAM) significantly reduces incident suicide attempts and severe suicidal ideation. This paper aims at elucidating psychological mechanisms underlying YAM's efficacy. Our hypothesis is that YAM operates through interactions with coping strategies (CS) on the reduction of suicidal ideation (SI). In the Saving and Empowering Young Lives in Europe (SEYLE) study, five coping strategies were assessed at baseline (T0) and 12-month follow-up (T12): "learning", "help-seeking", "arts", "sports" and "fight". We analyzed interactions between the YAM intervention, coping strategies and SI in the YAM group (N = 1693) and the minimal intervention group (N = 1909), after excluding prevalent cases with SI and previous suicide attempts from our total sample (N = 5654). General Linear Mixed Model regressions were performed. The present study confirms that coping strategies play an influential role on suicidal ideation. Our results showed that YAM acts whatever the prevailing coping strategies used. It is particularly efficient for pupils insufficiently using adaptive coping strategies such as LEARN and HELP-SEEKING or using maladaptive coping strategies, such as ARTS and FIGHT. The socialization induced by the YAM intervention seems to be a strong component of its efficiency.
Collapse
|
12
|
Lindow JC, Hughes JL, South C, Gutierrez L, Bannister E, Trivedi MH, Byerly MJ. Feasibility and Acceptability of the Youth Aware of Mental Health (YAM) Intervention in US Adolescents. Arch Suicide Res 2020; 24:269-284. [PMID: 31159674 PMCID: PMC6942243 DOI: 10.1080/13811118.2019.1624667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Suicide is the second leading cause of death among US adolescents, and rates of suicide among youth have been increasing for the past decade. This study assessed the feasibility and acceptability of the universal, school-based Youth Aware of Mental Health (YAM) program, a promising mental health promotion and suicide primary prevention intervention, in US youth. Using an uncontrolled design, the feasibility and acceptability of delivering and studying YAM were assessed in Montana and Texas schools. Thirteen of 16 (81.3%) schools agreed to support YAM delivery, and five Montana and 6 Texas schools were included in analyses. Facilitators delivered YAM in 78 classes (1,878 students) as regular high school curriculum. Of the total number of students who received YAM, 519 (27.6%) provided parental consent and assent. 436 (84.0%) consented students participated in pre- and post-surveys. Students, parents, and school staff found YAM highly acceptable based on satisfaction surveys. In summary, this study found YAM feasible to implement in US schools. Results also suggest students, parents, and school staff supported school-based programs and were highly satisfied with the YAM program. A randomized controlled trial is warranted to test the efficacy of YAM in promoting mental health and preventing suicidal thoughts and behaviors in US adolescents.
Collapse
|
13
|
Life Events Predicting the First Onset of Adolescent Direct Self-Injurious Behavior-A Prospective Multicenter Study. J Adolesc Health 2020; 66:195-201. [PMID: 31677986 DOI: 10.1016/j.jadohealth.2019.08.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Self-injurious behavior is a frequent phenomenon in adolescence. The present study prospectively examined life events as risk factors for the first onset of direct self-injurious behavior (D-SIB) in the Saving and Empowering Young Lives in Europe school-based multicenter sample. METHODS Longitudinal assessments with an interval of 1 year were performed within a sample of 1,933 adolescents (51.47% females; mean age 14.84 ± .9 years) from 10 European countries and Israel. RESULTS The number of life events during the past 6 months predicted the first onset of D-SIB in the following year. Gender neither predicted the onset of D-SIB nor moderated the association with life events. Moreover, analyses of individual events identified a range of mainly interpersonal events within both family and peer group as proximal risk factors for first episode D-SIB. CONCLUSIONS The results support the critical role of interpersonal life events in the development of D-SIB for both genders and refine the conceptualization of proximal risk factors in terms of accumulated stressors and interpersonal events.
Collapse
|
14
|
Roškar S, Berlot L, Malovrh J, Jurjević S, Podlesek A. Writing about suicide in graduation exam essays in Slovenia. DEATH STUDIES 2019; 45:669-676. [PMID: 31584352 DOI: 10.1080/07481187.2019.1671548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In 2017, senior year high school students in Slovenia wrote a graduation exam essay entitled "Suicide as an exit from the wheels of the system". Students had to explain the motives for suicide of the protagonists of two novels and take a stand on this action. We examined the relevant paragraphs of 142 essays. Negative attitudes prevailed towards suicide in general, but one quarter of students showed positive attitudes towards the protagonists' suicidal actions. A few students communicated their personal experience of hopelessness and revealed that they identified with the protagonists' suicidal behavior. Discussing suicide requires alertness for vulnerable individuals who should be offered help if needed.
Collapse
Affiliation(s)
- Saška Roškar
- Center for Health Research and Development, National Institute of Public Health, Ljubljana, Slovenia
| | - Lina Berlot
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Jana Malovrh
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Sanja Jurjević
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Anja Podlesek
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
15
|
Barzilay S, Apter A, Snir A, Carli V, Hoven CW, Sarchiapone M, Hadlaczky G, Balazs J, Kereszteny A, Brunner R, Kaess M, Bobes J, Saiz PA, Cosman D, Haring C, Banzer R, McMahon E, Keeley H, Kahn JP, Postuvan V, Podlogar T, Sisask M, Varnik A, Wasserman D. A longitudinal examination of the interpersonal theory of suicide and effects of school-based suicide prevention interventions in a multinational study of adolescents. J Child Psychol Psychiatry 2019; 60:1104-1111. [PMID: 31512239 DOI: 10.1111/jcpp.13119] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Predictions of two different models for suicide attempts (SA) over 12 months, as differentially impacted by specific school-based suicide prevention interventions, were compared. These were as follows: (a) interpersonal theory (IPTS) and (b) a two-pathway model, one path associated with externalizing symptoms and continuum of self-harm behaviors, and the other with internalizing symptoms. METHODS Self-report questionnaires were completed by 11,110 high school students from ten EU countries enrolled in the Saving and Empowering Young Lives in Europe (SEYLE) study. Baseline measures included perceived burdensomeness, thwarted belongingness from parents and peers, health risk behaviors, self-injury, suicide ideation (SI), and attempts (SA). SI and SA were reassessed at 12-month follow-up. Each model's predictions of SI and SA groups over time (i.e., repeated SA, remitted SA, SA onset, and no SA) were estimated in the no intervention/control group. The superior model was estimated across intervention groups. RESULTS Interpersonal theory showed better fit compared to the two-pathway model. In partial agreement with IPTS predictions, parental low belongingness but not peer belongingness or burdensomeness predicted greater likelihood of SI. The likelihood of repeated SA versus no SA was higher among adolescents who reported SI, self-injury, risk behaviors, and particularly both SI and self-injury. All three interventions attenuated the combined effect of SI and self-injury. Youth Aware of Mental Health Program (YAM) additionally decreased the effect of risk behaviors on the likelihood of repeated SA. CONCLUSIONS Interpersonal theory assumptions were partially supported. Perceived interpersonal difficulties with parents were primarily related with SI, and risk behaviors and self-injury were important predictors of SA. Suicide prevention interventions may be effective by mitigating the hazardous effect of varying self-harm behaviors and may be further advanced by increasing parental involvement.
Collapse
Affiliation(s)
- Shira Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Avigal Snir
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy.,National Institute for Health, Migration and Poverty, Rome, Italy.,Kazakh National Medical University, Almaty, Kazakhstan
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary.,Bjørknes University College, Oslo, Norway
| | - Agnes Kereszteny
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - Romuald Brunner
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Pilar A Saiz
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Research Division for Mental Health, University for Medical Information Technology (UMIT), Hall in Tirol, Austria
| | | | | | - Helen Keeley
- National Suicide Research Foundation, Cork, Ireland
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France
| | - Vita Postuvan
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Tina Podlogar
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Airi Varnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
16
|
Levi-Belz Y, Gavish-Marom T, Barzilay S, Apter A, Carli V, Hoven C, Sarchiapone M, Wasserman D. Psychosocial Factors Correlated with Undisclosed Suicide Attempts to Significant Others: Findings from the Adolescence SEYLE Study. Suicide Life Threat Behav 2019; 49:759-773. [PMID: 29851140 DOI: 10.1111/sltb.12475] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/06/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Suicide attempt (SA) is recognized as one of the risk factors for completed suicides. The concealment of this behavior often hinders detection and management of suicide risk. Thus, in this study, we sought to shed light on adolescents' psychosocial processes that could facilitate disclosure of SAs. Specifically, we sought to identify antecedents of adolescent SAs that had not been revealed to significant others. METHOD A high school sample) N = 990 (completed a self-report questionnaire tapping psychiatric, personal, and interpersonal characteristics, as well as suicidality, as part of the SEYLE project. Twenty-seven adolescents acknowledged having made an SA without disclosing it to parents or to other significant others. They were compared with 47 adolescents who made SAs that were communicated to others and with a control group of 916 adolescents having no history of suicidal behavior. RESULTS Compared with disclosures and controls, non-disclosing suicide attempters were characterized by higher levels of suicide ideation, distress, and victimization. Low levels of self-disclosure and parental support were significantly associated with undisclosed SAs. CONCLUSIONS Interpersonal difficulties may be related to loneliness and a thwarted sense of belongingness, which may explain the failure to disclose SAs. Implications related to assessment and prevention are discussed.
Collapse
Affiliation(s)
- Yossi Levi-Belz
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.,The Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Timor Gavish-Marom
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Shira Barzilay
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan Apter
- The Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.,The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Cristina Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mario Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Dnuta Wasserman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
17
|
Ghinea D, Koenig J, Parzer P, Brunner R, Carli V, Hoven CW, Sarchiapone M, Wasserman D, Resch F, Kaess M. Longitudinal development of risk-taking and self-injurious behavior in association with late adolescent borderline personality disorder symptoms. Psychiatry Res 2019; 273:127-133. [PMID: 30641342 DOI: 10.1016/j.psychres.2019.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/31/2022]
Abstract
Self-injurious behavior and risk-taking behaviors are associated with adolescent borderline personality disorder (BPD). Developmental trajectories of self-injurious and risk-taking behavior in predicting BPD have not been fully understood. The aim of the present study was to examine self-injurious and risk-taking behavior development and their prospective influence on BPD symptoms in adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the German Saving and Empowering Young Lives in Europe cohort were analyzed. Self-injurious and risk-taking behaviors were assessed at baseline and one-year follow-up. BPD symptoms were assessed at two-year follow-up. In fully adjusted stepwise binominal regression analyses, recent onset, termination and maintenance of risky alcohol use and self-injurious behavior remained as significant predictors of BPD. Highest ORs were found for alcohol termination and maintenance of self-injurious behavior. Other facets of risk-taking behavior were not associated with increased ORs of BPD symptoms at two-year follow-up. These findings highlight the importance of self-injurious behavior and specific facets of risk-taking behavior in the development of adolescent BPD. Clinicians should focus on efforts in preventing adolescents from risk-taking and self-injurious behavior, since engaging in young age and therefore in potentially longer periods of these behaviors is associated with the highest risk of BPD.
Collapse
Affiliation(s)
- Denisa Ghinea
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Peter Parzer
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; Clinic and Policlinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg District Hospital, Regensburg, Germany
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Marco Sarchiapone
- Department of Medical and Health Sciences, University of Molise, Campobasso, Italy
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| |
Collapse
|
18
|
Brunstein Klomek A, Barzilay S, Apter A, Carli V, Hoven CW, Sarchiapone M, Hadlaczky G, Balazs J, Kereszteny A, Brunner R, Kaess M, Bobes J, Saiz PA, Cosman D, Haring C, Banzer R, McMahon E, Keeley H, Kahn JP, Postuvan V, Podlogar T, Sisask M, Varnik A, Wasserman D. Bi-directional longitudinal associations between different types of bullying victimization, suicide ideation/attempts, and depression among a large sample of European adolescents. J Child Psychol Psychiatry 2019; 60:209-215. [PMID: 30024024 DOI: 10.1111/jcpp.12951] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The association between bullying victimization and depression, suicide ideation and suicide attempts has been studied mainly in cross-sectional studies. This study aims to test the bidirectional effect and the chronicity versus sporadic effect of physical, verbal, and relational bullying victimization on suicidal ideation/attempts and depression. METHODS Longitudinal assessments with an interval of 3- and 12-months were performed within a sample of 2,933 adolescents (56.1% females; mean age 14.78, SD = .89) from 10 European countries, participating in the Saving and Empowering Young Lives in Europe (SEYLE) school-based multicenter control sample. Multilevel Structural Equation Models were used, controlling for sociodemographic variables. Victimization was considered chronic when a student was victimized in the first two time points and sporadic when it was reported only at one point but not in another. RESULTS Bidirectional prospective association between all types of victimization and depression were found. Among participants, who reported victimization once (but not twice), physical victimization, but not verbal and relational, was associated with later suicidal ideation and attempts. Chronic victimization of any type increased likelihood for later depression compared with sporadic and no-victimization. Chronic relational victimization increased the likelihood of later suicidal ideation, and chronic physical victimization increased the likelihood for suicidal attempts. CONCLUSIONS The results support the bidirectional effect of victimization and depression and indicate that there are complex longitudinal associations between victimization and suicidal ideation/attempts. Physical victimization may especially carry effect on suicidal risk over time. Interventions should focus on victimization as a cause of distress but also aim to prevent vulnerable adolescents from becoming targets of victimization.
Collapse
Affiliation(s)
- Anat Brunstein Klomek
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel.,Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzlyia, Israel
| | - Shira Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy.,National Institute for Health, Migration and Poverty, Rome, Italy.,Kazakh National Medical University, Almaty, Kazakhstan
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Judit Balazs
- Vadaskert Child Psychiatry Hospital, Budapest, Hungary.,Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - Agnes Kereszteny
- Vadaskert Child Psychiatry Hospital, Budapest, Hungary.,Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Pilar A Saiz
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Department Psychiatry and Psychotherapy, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | | | | | - Helen Keeley
- National Suicide Research Foundation, Cork, Ireland
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France
| | - Vita Postuvan
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Tina Podlogar
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Airi Varnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
19
|
Gambadauro P, Carli V, Wasserman C, Hadlaczky G, Sarchiapone M, Apter A, Balazs J, Bobes J, Brunner R, Cosman D, Haring C, Hoven CW, Iosue M, Kaess M, Kahn JP, McMahon E, Postuvan V, Värnik A, Wasserman D. Psychopathology is associated with reproductive health risk in European adolescents. Reprod Health 2018; 15:186. [PMID: 30400907 PMCID: PMC6220505 DOI: 10.1186/s12978-018-0618-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/01/2018] [Indexed: 01/21/2023] Open
Abstract
Background Reproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood. This cross-sectional study evaluated the association between psychopathology and reproductive health risk among European adolescents. Methods A structured self-report questionnaire was delivered to 12,395 pupils of 179 randomly selected schools in 11 European countries within the EU funded “Saving and Empowering Young Lives in Europe” (SEYLE) project. The questionnaire included items about sexual initiation and reproductive health risk factors, such as number of sexual partners, frequency of condom use, and pregnancy involvement. Psychopathology was evaluated with validated instruments and/or ad-hoc questions. Results Of 11,406 respondents (median age 15; interquartile range [IQR] 14–15; 57% females), 18.8% reported sexual initiation. Sixty percent of them also reported at least one reproductive risk factor. Sexual initiation was significantly more common among pupils older than 15 years (38% versus 13.2% younger pupils) and males (21.3% versus 16.9% females). It was also more common among pupils with depression (age/sex-adjusted odds ratio [aOR] 1.871), anxiety (aOR 2.190), severe suicidal ideation (aOR 2.259), self-injurious behaviour (aOR 2.892), and suicide attempts (aOR 3.091). These associations were particularly strong among pupils ≤15 years old and, for overt psychopathology, among pupils with low non-sexual risk behaviour profile and females. Depression (aOR 1.937), anxiety (aOR 2.282), severe suicidal ideation (aOR 2.354), self-injurious behaviour (aOR 3.022), and suicide attempts (aOR 3.284) were associated with higher reproductive health risk, defined by an increasing number of coexisting reproductive risk factors. Conclusions These findings suggest an alignment between mental and reproductive health risk and support the value of cross-domain collaboration in adolescent health. The association between psychopathology and reproductive health risk, as well as its variations with age, sex, and associated risk behaviours, should be considered when designing health-promoting or disease-preventing interventions for adolescents.
Collapse
Affiliation(s)
- Pietro Gambadauro
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden. .,Res Medica Sweden, Gynaecology and Reproductive Medicine, 75224, Uppsala, Sweden.
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Camilla Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, USA
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, 86100, Campobasso, Italy.,National Institute of Health for Migration and Poverty, Via di San Gallicano 25/a, 00100, Rome, Italy
| | - Alan Apter
- Schneider Children's Medical Center of Israel, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, 1021, Hungary.,Institute of Psychology, Eötvös Loránd University, Izabella u. 46, Budapest, 1064, Hungary
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, CIBERSAM School of Medicine, Julian Claveria 6 - 3°, 33006, Oviedo, Spain
| | - Romuald Brunner
- Department of Child & Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, D-69115, Heidelberg, Germany
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Department for Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Tirol-kliniken, Milser Straße 10, A- 6060, Hall, Austria
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Miriam Iosue
- Department of Medicine and Health Science, University of Molise, 86100, Campobasso, Italy
| | - Michael Kaess
- Department of Child & Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, D-69115, Heidelberg, Germany
| | - Jean Pierre Kahn
- Department of Psychiatry and Clinical Psychology, CHRU de NANCY and Pôle 6, Centre Psychothérapique de Nancy-Laxou, Université de Lorraine, NANCY, France
| | - Elaine McMahon
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Vita Postuvan
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Muzejski trg 2, 6000, Koper, Slovenia
| | - Airi Värnik
- Estonian-Swedish Mental Health & Suicidology Institute, Ctr. Behav. & Hlth. Sci, Tallinn University, Tallinn, Estonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| |
Collapse
|
20
|
Horváth LO, Balint M, Ferenczi-Dallos G, Farkas L, Gadoros J, Gyori D, Kereszteny A, Meszaros G, Szentivanyi D, Velo S, Sarchiapone M, Carli V, Wasserman C, Hoven CW, Wasserman D, Balazs J. Direct Self-Injurious Behavior (D-SIB) and Life Events among Vocational School and High School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1068. [PMID: 29795028 PMCID: PMC6025121 DOI: 10.3390/ijerph15061068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/28/2018] [Accepted: 05/19/2018] [Indexed: 01/21/2023]
Abstract
Although several studies have recently assessed direct self-injurious behavior (D-SIB) among adolescents, it is still understudied in adolescents attending vocational schools: an educational setting generally associated with lower socioeconomic status. After extending the "Saving and Empowering Young Lives in Europe" (SEYLE) project to a vocational school population, we examined their D-SIB and life event characteristics compared to the high school population. SEYLE's Hungarian randomly selected high school sample (N = 995) was completed with a randomly selected vocational school sample (N = 140) in Budapest, Hungary. Participants aged 14⁻17 years completed the SEYLE project's self-administered questionnaires. D-SIB lifetime prevalence was significantly higher (29.4%) in the vocational school group compared to the high school group (17.2%) (Χ²(1) = 12.231, p< 0.001). D-SIB was associated with suicidal ideation in the vocational school group. Different life events were more frequent in the high school than in the vocational school group, and associations between D-SIB and life events differed in the vocational school group compared to the high school group. In conclusion, vocational school students are a vulnerable population with a higher prevalence of D-SIB compared to high school students. Life events and their association with D-SIB also differ in vocational school students compared to high school students. Taking all these into account might contribute to prevention/intervention designed for this population.
Collapse
Affiliation(s)
- Lili O Horváth
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Maria Balint
- Pedagogical Services, Budapest District 12, 1126 Budapest, Hungary.
| | | | - Luca Farkas
- West Hertfordshire Specialist CAMHS St Albans Clinic, AL3 5TL St Albans, UK.
| | - Julia Gadoros
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
| | - Dora Gyori
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Agnes Kereszteny
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Semmelweis University, Mental Health Sciences Doctoral School, 1083 Budapest, Hungary.
| | - Gergely Meszaros
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
- Semmelweis University, Mental Health Sciences Doctoral School, 1083 Budapest, Hungary.
| | - Dora Szentivanyi
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Szabina Velo
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, 86100 Molise, Italy.
| | - Vladimir Carli
- Department of Health Sciences, University of Molise, 86100 Molise, Italy.
- Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Camilla Wasserman
- Global Psychiatric Epidemiology, Columbia University-New York State Psychiatric Institute, New York, NY 10032, USA.
| | - Christina W Hoven
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | | | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
| |
Collapse
|
21
|
Wasserman C, Postuvan V, Herta D, Iosue M, Värnik P, Carli V. Interactions between youth and mental health professionals: The Youth Aware of Mental health (YAM) program experience. PLoS One 2018; 13:e0191843. [PMID: 29420556 PMCID: PMC5805239 DOI: 10.1371/journal.pone.0191843] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/12/2018] [Indexed: 12/13/2022] Open
Abstract
THE YOUTH AWARE OF MENTAL HEALTH (YAM) EXPERIENCE Youth stand at the core of much mental health promotion, yet little is written about their experiences of such efforts. We aimed to take this on by interviewing youth after they participated in Youth Aware of Mental Health (YAM), a universal mental health promotion program. YAM has a non-anticipatory methodology that provides youth with a safe space for reflection, role-play, and discussion. Addressing everyday mental health, YAM invites the experiences and issues relevant to the youth present to influence the program in a slightly different direction every time. The YAM instructor guides the participants but does not present the youth with given formulas on how to solve their problems. Like any mental health promotion, YAM appeals to some more than others in its intended audience and individuals engage with the program in many different ways. We set out to learn more about these experiences. CONVERSATIONS ABOUT MENTAL HEALTH Thirty-two semi-structured interviews were conducted with 15-17 year olds in Estonia, Italy, Romania and Spain. In these interviews, the researchers made an effort to discuss mental health in terms relevant to youth. Still, wide-ranging levels of motivation, ease with engaging in dialogue with mental health professionals, and comfort with the format and content of YAM were detected. The youth were clustered in five different groups relating to their positioning vis-à-vis the researcher during the interview. The following evocative labels were used: "interested", "foot in the door", "respect for authority", "careful", and "not my topic". Corresponding labels were devised for their YAM experience: "engaged", "initially hesitant", "cautious", "eager to please", or "disengaged". We also observed that the researchers brought their own expectations and employed a variety of approaches that led to anticipating answers, stating the obvious, or getting along better with some of the youth. These modes of interaction were categorized under: "favoritism", "familiarity", "frustration", "out of sync", and "insecurity". Similar power dynamics likely transpire in other encounters between youth and researchers, including interventions such as YAM. YOUTH AND MENTAL HEALTH PROFESSIONALS: NOTICING THE DYNAMICS AT PLAY As mental health professionals, we need to be aware of the professional habits and biases that sometimes obstruct us in understanding the experiences of youth. By initiating dialogue and listening closely to youth we can find a way to those experiences. Qualitative research can help bring the underlying interplay between mental health professionals and youth to the surface while also orienting the conversation towards topics that matter to youth. Some youth are more interested or feel more at ease in speaking openly with mental health professionals, while others find such exchanges less appealing or almost intolerable. Future mental health promotion initiatives would benefit from involving youth in the design of interventions to create an inclusive atmosphere and engage with topics that appeal to youth with diverse experiences of mental health.
Collapse
Affiliation(s)
- Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, United States of America
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Vita Postuvan
- Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Dana Herta
- Medical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Miriam Iosue
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Peeter Värnik
- Estonian-Swedish Mental Health & Suicidology Institute, Tallinn, Estonia
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
- WHO Collaborating Centre for Research, Training and Methods Development at Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
22
|
Gambadauro P, Carli V, Hadlaczky G, Sarchiapone M, Apter A, Balazs J, Banzer R, Bobes J, Brunner R, Cosman D, Farkas L, Haring C, Hoven CW, Kaess M, Kahn JP, McMahon E, Postuvan V, Sisask M, Värnik A, Zadravec Sedivy N, Wasserman D. Correlates of sexual initiation among European adolescents. PLoS One 2018; 13:e0191451. [PMID: 29420612 PMCID: PMC5805230 DOI: 10.1371/journal.pone.0191451] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/04/2018] [Indexed: 11/18/2022] Open
Abstract
Background Sexuality is a physiological component of adolescent development, though early initiation is associated with reproductive health risk. This study aimed at identifying correlates and predictors of sexual initiation in a large multinational cohort of European adolescents. Methods A questionnaire addressing socio-demographics, behaviours, mental health and sexual activity, was delivered to 11,110 adolescents recruited from 168 randomly selected schools in 10 European countries between 2009 and 2011. A follow-up questionnaire was delivered after 12 months. The longitudinal association of baseline risk behaviors, psychological attributes and contextual vulnerabilities, with sexual initiation during follow-up was evaluated through simple and multivariable age/sex stratified logistic regression. Multinomial logistic regression measured the association between predictors and sexual initiation with or without coexisting reproductive risk factors, such as multiple partners or infrequent condom use. Results Baseline sexual experience was reported by 19.2% of 10,757 respondents (median age 15; IQR 14–15; females 59.6%). This was significantly more frequent among pupils older than 15 (41%) and males (20.8%). Of 7,111 pupils without previous experience who were available at follow-up (response rate 81.8%), 17% reported sexual initiation, without differences between females and males. Baseline smoking (age/sex adjusted odds ratio [aOR] 3.63), alcohol use (aOR 2.95), illegal drugs use (aOR 2.72), and poor sleep (aOR 1.71) predicted sexual initiation. Stratified analyses showed a particularly strong association in case of younger and female pupils, and, among girls, when initiation was reported together with multiple partners and/or infrequent condom use. Externalizing (i.e. conduct and hyperactivity) symptoms independently predicted sexual initiation. Internalizing difficulties (i.e. emotional and peer problems) were negatively associated with early and risky sexual initiation among boys. Significant predictors included also being bullied, fighting, truancy, and low parental involvement. Conclusions Adolescent sexual behaviours are related to non-sexual risk behaviours, psychological difficulties and contextual vulnerabilities. While gateway effects explain some associations, a comprehensive model is needed to understand adolescent sexual behaviours, their physical, mental, and social health outcomes, and their potential positive effects on wellbeing. Tailored interventions may need to consider younger girls as a particularly vulnerable group in view of a strong association between non-sexual and sexual behaviors.
Collapse
Affiliation(s)
- Pietro Gambadauro
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Res Medica Sweden, Gynaecology and Reproductive Medicine, Uppsala, Sweden
- * E-mail:
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
- National Institute of Health for Migration and Poverty, Rome, Italy
| | - Alan Apter
- Schneider’s Children Medical Center of Israel, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Raphaela Banzer
- Addiction Help Services BIN, Innsbruck, Austria
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, CIBERSAM School of Medicine, Oviedo, Spain
| | - Romuald Brunner
- Department of Child & Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luca Farkas
- Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary
| | - Christian Haring
- Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall, Austria
| | - Christina W. Hoven
- Department of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States of America
| | - Michael Kaess
- Department of Child & Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jean Pierre Kahn
- Department of Psychiatry and Clinical Psychology, CHRU de NANCY and Pôle 6, Centre Psychothérapique de Nancy-Laxou, Université de Lorraine, Nancy, France
| | - Elaine McMahon
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Vita Postuvan
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Merike Sisask
- Estonian-Swedish Mental Health & Suicidology Institute, Tallinn, Estonia
- School of Governance, Law and Society (SOGOLAS), Tallinn University, Tallinn, Estonia
| | - Airi Värnik
- Estonian-Swedish Mental Health & Suicidology Institute, Tallinn, Estonia
- School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Nusa Zadravec Sedivy
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
23
|
Dunstan DA, Scott N. Assigning Clinical Significance and Symptom Severity Using the Zung Scales: Levels of Misclassification Arising from Confusion between Index and Raw Scores. DEPRESSION RESEARCH AND TREATMENT 2018; 2018:9250972. [PMID: 29610683 PMCID: PMC5828114 DOI: 10.1155/2018/9250972] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 12/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Zung Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) are two norm-referenced scales commonly used to identify the presence of depression and anxiety in clinical research. Unfortunately, several researchers have mistakenly applied index score criteria to raw scores when assigning clinical significance and symptom severity ratings. This study examined the extent of this problem. METHOD 102 papers published over the six-year period from 2010 to 2015 were used to establish two convenience samples of 60 usages of each Zung scale. RESULTS In those papers where cut-off scores were used (i.e., 45/60 for SDS and 40/60 for SAS), up to 51% of SDS and 45% of SAS papers involved the incorrect application of index score criteria to raw scores. Inconsistencies were also noted in the severity ranges and cut-off scores used. CONCLUSIONS A large percentage of publications involving the Zung SDS and SAS scales are using incorrect criteria for the classification of clinically significant symptoms of depression and anxiety. The most common error-applying index score criteria to raw scores-produces a substantial elevation of the cut-off points for significance. Given the continuing usage of these scales, it is important that these inconsistencies be highlighted and resolved.
Collapse
Affiliation(s)
- Debra A. Dunstan
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW 2351, Australia
| | - Ned Scott
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW 2351, Australia
| |
Collapse
|
24
|
Pereira Simões R, Santos J, Façanha J, Erse M, Loureiro C, Marques L, Quaresma H, Matos E. Promoção do bem-estar em adolescentes: contributos do projeto +Contigo. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2018. [DOI: 10.1159/000486468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objetivos:</i></b> O projeto +Contigo insere-se no âmbito da promoção da saúde mental e bem-estar e da prevenção de comportamentos autolesivos e enquanto projeto de investigação longitudinal é baseado numa intervenção multinível em rede. Tem como um dos objetivos gerais promover o bem-estar em adolescentes do 3º ciclo e do ensino secundário. <b><i>Métodos:</i></b> Estudo de natureza quasi-experimental, com grupo de controlo, avaliado no início, no final e seis meses após intervenção ao longo do ano letivo. A intervenção dirigida aos adolescentes é composta por 7 sessões em sala de aula, abordando o estigma, a adolescência, o autoconceito, a resolução de problemas, a depressão e o bem-estar. O instrumento de recolha de dados, aplicado sob a forma de questionário é constituído por vários instrumentos de medida entre os quais o índice de bem-estar (OMS, 1998). Foi autoadministrado a 2.105 adolescentes, de escolas da região centro de Portugal com adesão ao projeto +Contigo, durante os anos letivos de 2011/2012 e 2012/2013. <b><i>Resultados:</i></b> A amostra é constituída por 2.105 adolescentes, maioritariamente do género masculino, com idade entre os 13 e os 14 anos, pertencentes maioritariamente a turmas do 8º ano. O índice de bem-estar demonstra um aumento ao longo das três fases, no grupo alvo de intervenção, com diferença estatisticamente significativa para o grupo de controlo. Os adolescentes do género masculino apresentam melhores índices de bem-estar, existindo no decorrer do projeto aumento deste índice para ambos os géneros, com diferenças estatisticamente significativas no género masculino. Os adolescentes do 7º, 8º e 9º ano evoluíram favoravelmente no índice de bem-estar em todas as fases de avaliação. <b><i>Conclusão:</i></b> A intervenção produz resultados positivos a curto e a médio prazo para o índice de bem-estar, com resultados estatisticamente significativos para o grupo de intervenção comparativamente ao grupo de controlo. Estas repercussões ao nível do bem-estar dos adolescentes reforçam a estratégia preventiva de comportamentos suicidários adotada, já que, sendo o bem-estar um indicador de saúde mental acredita-se que poderá ajudar a prevenir os comportamentos autolesivos nos adolescentes.
Collapse
|
25
|
McMahon EM, Corcoran P, Keeley H, Cannon M, Carli V, Wasserman C, Sarchiapone M, Apter A, Balazs J, Banzer R, Bobes J, Brunner R, Cozman D, Haring C, Kaess M, Kahn JP, Kereszteny A, Bitenc UM, Nemes B, Poštuvan V, Sáiz PA, Sisask M, Tubiana A, Värnik P, Hoven CW, Wasserman D. Mental health difficulties and suicidal behaviours among young migrants: multicentre study of European adolescents. BJPsych Open 2017; 3:291-299. [PMID: 29234521 PMCID: PMC5707442 DOI: 10.1192/bjpo.bp.117.005322] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/11/2017] [Accepted: 10/19/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Migration has been reported to be associated with higher prevalence of mental disorders and suicidal behaviour. AIMS To examine the prevalence of emotional and behavioural difficulties, suicidal ideation and suicide attempts among migrant adolescents and their non-migrant peers. METHOD A school-based survey was completed by 11 057 European adolescents as part of the Saving and Empowering Young Lives in Europe (SEYLE) study. RESULTS A previous suicide attempt was reported by 386 (3.6%) adolescents. Compared with non-migrants, first-generation migrants had an elevated prevalence of suicide attempts (odds ratio (OR) 2.08; 95% CI 1.32-3.26; P=0.001 for European migrants and OR 1.86; 95% CI 1.06-3.27; P=0.031 for non-European migrants) and significantly higher levels of peer difficulties. Highest levels of conduct and hyperactivity problems were found among migrants of non-European origin. CONCLUSIONS Appropriate mental health services and school-based supports are required to meet the complex needs of migrant adolescents. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
Collapse
Affiliation(s)
- Elaine M McMahon
- , PhD, National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Paul Corcoran
- , PhD, National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Helen Keeley
- , MD, MRCPsych, Child and Adolescent Psychiatry, Health Service Executive, Cork, Ireland
| | - Mary Cannon
- , PhD, FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Vladimir Carli
- , MD, PhD, National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Camilla Wasserman
- , PhD, National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden; Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Marco Sarchiapone
- , MD, PhD, Department of Medicine and Health Science, University of Molise, Campobasso, Italy; National Institute for Health, Migration and Poverty, Rome, Italy
| | - Alan Apter
- , MD, Schneider Children's Medical Centre of Israel, Tel-Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- , MD, PhD, Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary; Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | | | - Julio Bobes
- , MD, PhD, Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Romuald Brunner
- , MD, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Doina Cozman
- , MD, PhD, Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- , MD, MSc, Department Psychiatry and Psychotherapy, Tirol Kliniken, Hospital Hall in Tyrol, Innsbruck, Austria
| | - Michael Kaess
- , MD, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jean-Pierre Kahn
- , MD, PhD, University of Lorraine, Nancy, France and Centre Hospitalier Régional Universitaire de Nancy, Nancy, France; Department of Psychiatry and Clinical Psychology, Centre Psychothérapique de Nancy, Nancy, France
| | - Agnes Kereszteny
- , MA, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary; Doctoral School of Semmelweis University, Budapest, Hungary
| | - Ursa Mars Bitenc
- , BSc, Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Bogdan Nemes
- , MD, PhD, Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vita Poštuvan
- , PhD, Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Pilar A Sáiz
- , MD, PhD, Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Merike Sisask
- , PhD, Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia; School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Alexandra Tubiana
- , MA, Department of Psychiatry and Clinical Psychology, Centre Psychothérapique de Nancy, Nancy, France
| | - Peeter Värnik
- , PhD, Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia
| | - Christina W Hoven
- , DrPh, MPH, Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Danuta Wasserman
- , MD, PhD, National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
26
|
Barzilay S, Brunstein Klomek A, Apter A, Carli V, Wasserman C, Hadlaczky G, Hoven CW, Sarchiapone M, Balazs J, Kereszteny A, Brunner R, Kaess M, Bobes J, Saiz P, Cosman D, Haring C, Banzer R, Corcoran P, Kahn JP, Postuvan V, Podlogar T, Sisask M, Varnik A, Wasserman D. Bullying Victimization and Suicide Ideation and Behavior Among Adolescents in Europe: A 10-Country Study. J Adolesc Health 2017; 61:179-186. [PMID: 28391968 DOI: 10.1016/j.jadohealth.2017.02.002] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/08/2017] [Accepted: 02/02/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE To examine risk and protective factors moderating the associations between three types of bullying victimization (physical, verbal, and relational bullying) with suicide ideation/attempts in a large representative sample of European adolescents. METHODS We analyzed cross-sectional data on 11,110 students (mean age = 14.9, standard deviation = .89) recruited from 168 schools in 10 European Union countries involved in the Saving and Empowering Young Lives in Europe study. A self-report questionnaire was used to measure victimization types, depression, anxiety, parental and peer support, and suicide ideation and attempts. For each outcome, we applied hierarchical nonlinear models controlling for sociodemographics. RESULTS Prevalence of victimization was 9.4% physical, 36.1% verbal, and 33.0% relational. Boys were more likely to be physically and verbally victimized, whereas girls were more prone to relational victimization. Physical victimization was associated with suicide ideation, and relational victimization was associated with suicide attempts. Other associations between victimization and suicidality (ideation/attempts) were identified through analysis of interactions with additional risk and protective factors. Specifically, verbal victimization was associated with suicide ideation among adolescents with depression who perceived low parental support. Similarly, low peer support increased the associations between verbal victimization and suicide ideation. Verbal victimization was associated with suicide attempts among adolescents with anxiety who perceived low parental support. CONCLUSIONS Findings support the development of prevention strategies for adolescent victims of bullying who may be at elevated risk for suicide ideation/behavior, by taking into account gender, the type of bullying, symptomatology, and availability of interpersonal support.
Collapse
Affiliation(s)
- Shira Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel; Child and Adolescent Psychiatry, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Anat Brunstein Klomek
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel; Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel.
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Camilla Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden; Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy; National Institute for Health, Migration and Poverty, Rome, Italy
| | - Judit Balazs
- Vadaskert Child Psychiatry Hospital, Budapest, Hungary; Institute of Psychology Eotvos Lorand University, Budapest, Hungary
| | - Agnes Kereszteny
- Institute of Psychology Eotvos Lorand University, Budapest, Hungary
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Pilar Saiz
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Research Division for Mental Health, University for Medical Information Technology (UMIT), Hall in Tirol, Austria
| | | | | | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France
| | - Vita Postuvan
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Tina Podlogar
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia; School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Airi Varnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia; School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
27
|
Podlogar T, Žiberna J, Poštuvan V, C R Kerr D. Belongingness and Burdensomeness in Adolescents: Slovene Translation and Validation of the Interpersonal Needs Questionnaire. Suicide Life Threat Behav 2017; 47:336-352. [PMID: 27418450 DOI: 10.1111/sltb.12276] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 05/09/2016] [Indexed: 12/01/2022]
Abstract
The Interpersonal Needs Questionnaire (INQ) for assessing thwarted belongingness (TB) and perceived burdensomeness (PB) has not been validated with community adolescents. We translated and administered the INQ to 307 Slovenian adolescents twice over 2-3 months and found that the 15-item version (INQ-15) did not fit without modification. TB and PB scales correlated with concurrent and later suicide ideation and lifetime suicide attempt history. The latent PB factor was associated with concurrent and later ideation controlling for TB, age, gender, depressive symptoms, binge drinking, and peer victimization. Suicide ideation and binge drinking were independently related to attempt history. Assessing and intervening on PB and binge drinking may be promising approaches to suicide prevention with community adolescents.
Collapse
Affiliation(s)
- Tina Podlogar
- Andrej Marušič Institute, Slovene Centre for Suicide Research, University of Primorska, Koper, Slovenia
| | - Janina Žiberna
- Andrej Marušič Institute, Slovene Centre for Suicide Research, University of Primorska, Koper, Slovenia
| | - Vita Poštuvan
- Andrej Marušič Institute, Slovene Centre for Suicide Research, University of Primorska, Koper, Slovenia
| | - David C R Kerr
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| |
Collapse
|
28
|
Koenig J, Brunner R, Fischer-Waldschmidt G, Parzer P, Plener PL, Park J, Wasserman C, Carli V, Hoven CW, Sarchiapone M, Wasserman D, Resch F, Kaess M. Prospective risk for suicidal thoughts and behaviour in adolescents with onset, maintenance or cessation of direct self-injurious behaviour. Eur Child Adolesc Psychiatry 2017; 26:345-354. [PMID: 27558490 DOI: 10.1007/s00787-016-0896-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/16/2016] [Indexed: 11/25/2022]
Abstract
Direct self-injurious behaviour (D-SIB) is associated with suicidal behaviour and suicide risk. It is not known if D-SIB cessation reduces these risks. The aim of this study was to explore trajectories of D-SIB and their prospective influence on suicidal thoughts and behaviour during adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the Saving and Empowering Young Lives in Europe study were analysed. D-SIB and suicidal thoughts and behaviour were assessed at baseline (T0), 1- (T1) and 2-year follow-up (T2). Onset and maintenance of D-SIB between T0 and T1 were associated with a two to threefold increased odds ratio for suicidal thoughts and behaviour at T2. Suicidal thoughts and behaviour in those terminating D-SIB before T1 were similar compared to those with no life-time history of D-SIB. Late onset and maintenance of D-SIB prospectively indicate risk for suicidal thoughts and behaviour. This is the first study showing that D-SIB cessation reduces later risk for suicidal thoughts and behaviour in adolescence. Suicide prevention efforts should set one focus on reducing adolescent D-SIB.
Collapse
Affiliation(s)
- Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
| | - Romuald Brunner
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gloria Fischer-Waldschmidt
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - JiYeon Park
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
| | - Camilla Wasserman
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Franz Resch
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany.
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
| |
Collapse
|
29
|
Keller SN, Austin CG, McNeill V. A Theater Intervention to Promote Communication and Disclosure of Suicidal Ideation. JOURNAL OF APPLIED COMMUNICATION RESEARCH : JACR 2017; 45:294-312. [PMID: 28824211 PMCID: PMC5560773 DOI: 10.1080/00909882.2017.1320569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Young adults from Montana have a higher rate of suicide than their national counterparts. There is a clear need for targeted interventions to address this disparity. The authors evaluate a community-based, narrative theater project designed to increase awareness and use of suicide prevention resources among eastern Montana youth. As a first step, seven group interviews with Montana young adults (n = 27) were conducted to identify current perceptions about suicide and suicide prevention. Interviews were conducted before and after subjects were exposed to a community-based theater production about suicide. Emergent thematic categories were organized using the four main constructs of the extended parallel process model. After the performance, participants expressed increased awareness of prevention resources; perceived susceptibility to the threat of suicide and depression; and self-efficacy for accessing help and assisting others. There were mixed results for perceived response efficacy. Implications and recommendations for intervention development are discussed.
Collapse
Affiliation(s)
| | - C Graham Austin
- Jake Jabs College of Business & Entrepreneurship, Montana State University
| | | |
Collapse
|
30
|
Factors associated with different smoking status in European adolescents: results of the SEYLE study. Eur Child Adolesc Psychiatry 2017; 26:1319-1329. [PMID: 28386649 PMCID: PMC5656692 DOI: 10.1007/s00787-017-0980-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/22/2017] [Indexed: 11/17/2022]
Abstract
Early onset and long-term smoking are associated with physical and psychological health problems. The aim of the presented analysis was to investigate risk and influencing factors for different smoking status in a big sample of European adolescents. In the context of the "saving and empowering young lives in Europe" (SEYLE) study we surveyed 12,328 adolescents at the age of 13-17 from 11 countries. The survey took place in a school-based context using a questionnaire. Overall 58% reported the onset of ever-smoking under the age of 14 and 30.9% smoke on a daily basis. Multinomial logistic regression model showed significant positive associations between adolescent smoking and internalizing problems (suicidal behavior, direct self-injurious behavior, anxiety), externalizing problems (conduct problems, hyperactivity, substance consumption) and family problems (parental substance consumption, broken home). Our data show that smoking among adolescents is still a major public health problem and adolescents who smoke are at higher risk for mental problems. Further, adolescent smoking is associated with broken home families and parental behaviors. Therefore, early preventive measures are necessary not only for adolescents, but also for their parents.
Collapse
|
31
|
McMahon EM, Corcoran P, O'Regan G, Keeley H, Cannon M, Carli V, Wasserman C, Hadlaczky G, Sarchiapone M, Apter A, Balazs J, Balint M, Bobes J, Brunner R, Cozman D, Haring C, Iosue M, Kaess M, Kahn JP, Nemes B, Podlogar T, Poštuvan V, Sáiz P, Sisask M, Tubiana A, Värnik P, Hoven CW, Wasserman D. Physical activity in European adolescents and associations with anxiety, depression and well-being. Eur Child Adolesc Psychiatry 2017; 26:111-122. [PMID: 27277894 DOI: 10.1007/s00787-016-0875-9] [Citation(s) in RCA: 288] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/30/2016] [Indexed: 11/28/2022]
Abstract
In this cross-sectional study, physical activity, sport participation and associations with well-being, anxiety and depressive symptoms were examined in a large representative sample of European adolescents. A school-based survey was completed by 11,110 adolescents from ten European countries who took part in the SEYLE (Saving and Empowering Young Lives in Europe) study. The questionnaire included items assessing physical activity, sport participation and validated instruments assessing well-being (WHO-5), depressive symptoms (BDI-II) and anxiety (SAS). Multi-level mixed effects linear regression was used to examine associations between physical activity/sport participation and mental health measures. A minority of the sample (17.9 % of boys and 10.7 % of girls; p < 0.0005) reported sufficient activity based on WHO guidelines (60 min + daily). The mean number of days of at least 60 min of moderate-to-vigorous activity in the past 2 weeks was 7.5 ± 4.4 among boys and 5.9 days ± 4.3 among girls. Frequency of activity was positively correlated with well-being and negatively correlated with both anxiety and depressive symptoms, up to a threshold of moderate frequency of activity. In a multi-level mixed effects model more frequent physical activity and participation in sport were both found to independently contribute to greater well-being and lower levels of anxiety and depressive symptoms in both sexes. Increasing activity levels and sports participation among the least active young people should be a target of community and school-based interventions to promote well-being. There does not appear to be an additional benefit to mental health associated with meeting the WHO-recommended levels of activity.
Collapse
Affiliation(s)
- Elaine M McMahon
- National Suicide Research Foundation, University College Cork, Cork, Ireland.
| | - Paul Corcoran
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Grace O'Regan
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | | | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, USA.,Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.,National Institute for Health, Migration and Poverty, Rome, Italy
| | - Alan Apter
- Schneider Children's Medical Centre of Israel, Tel-Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Maria Balint
- Pedagogical Consultation Services, Budapest, Hungary
| | - Julio Bobes
- Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Doina Cozman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Department Psychiatry and Psychotherapy, Tirol Kliniken, Hospital Hall in Tyrol, Innsbruck, Austria
| | - Miriam Iosue
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, University of Lorraine, Nancy, France
| | - Bogdan Nemes
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tina Podlogar
- Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Vita Poštuvan
- Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Pilar Sáiz
- Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Alexandra Tubiana
- Department of Psychiatry and Clinical Psychology, University of Lorraine, Nancy, France
| | - Peeter Värnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
32
|
Kaess M, Parzer P, Brunner R, Koenig J, Durkee T, Carli V, Wasserman C, Hoven CW, Sarchiapone M, Bobes J, Cosman D, Värnik A, Resch F, Wasserman D. Pathological Internet Use Is on the Rise Among European Adolescents. J Adolesc Health 2016; 59:236-9. [PMID: 27267140 DOI: 10.1016/j.jadohealth.2016.04.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/11/2016] [Accepted: 04/11/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Increased Internet accessibility has been accompanied by an increased awareness of pathological Internet use (PIU). The aim of the study was to investigate a potential increase of PIU among European adolescents. METHODS Comparable data from two large cross-sectional multicentre, school-based studies conducted in 2009/2010 and 2011/2012 in five European countries (Estonia, Germany, Italy, Romania, and Spain) were used. The Young's Diagnostic Questionnaire was used to assess the prevalence of PIU. RESULTS The comparison of the two samples provides evidence that the prevalence of PIU is on the rise (4.01%-6.87%, odds ratio = 1.69, p < .001) except in Germany. Comparison with data on Internet accessibility suggests that the rise in prevalence of adolescent PIU may be a consequence of increased Internet accessibility. CONCLUSIONS Our findings are the first data to confirm the rise of PIU among European adolescents. They definitively warrant further efforts in the implementation and evaluation of preventive interventions.
Collapse
Affiliation(s)
- Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
| | - Peter Parzer
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Tony Durkee
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York; Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Doina Cosman
- Department of Clinical Psychology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Airi Värnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn University, Tallinn, Estonia
| | - Franz Resch
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
33
|
A 2-year longitudinal study of prospective predictors of pathological Internet use in adolescents. Eur Child Adolesc Psychiatry 2016; 25:725-34. [PMID: 26526444 DOI: 10.1007/s00787-015-0779-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/28/2015] [Indexed: 02/05/2023]
Abstract
Longitudinal studies of prospective predictors for pathological Internet use (PIU) in adolescents as well as its course are lacking. This three-wave longitudinal study was conducted within the framework of the European Union-funded project "Saving and Empowering Young Lives in Europe" over a 2-year period. The sample consisted of 1444 students at the baseline investigation (T0); 1202 students after 1 year (T1); and 515 students after 2 years (T2). Structured self-report questionnaires were administered at all three time points. PIU was assessed using the Young Diagnostic Questionnaire (YDQ). In addition, demographic (i.e., gender), social (i.e., parental involvement), psychological (i.e., emotional problems), and Internet use-related factors (i.e., online activities) were assessed as prospective predictors. The prevalence of PIU was 4.3 % at T0, 2.7 % at T1 and 3.1 % at T2. However, only 3 students (0.58 %) had persistent categorical PIU (YDQ score of ≥5) over the 2-year period. In univariate models, a variety of variables that have been previously identified in cross-sectional investigations predicted PIU at T2. However, multivariate regression demonstrated that only previous PIU symptoms and emotional problems were significant predictors of PIU 2 years later (adjusted R (2) 0.23). The stability of categorical PIU in adolescents over 2 years was lower than previously reported. However, current PIU symptoms were the best predictor of later PIU; emotional symptoms also predicted PIU over and above the influence of previous problematic Internet use. Both PIU symptoms and emotional problems may contribute to the vicious cycle that supports the perpetuation of PIU.
Collapse
|
34
|
Wartberg L, Brunner R, Kriston L, Durkee T, Parzer P, Fischer-Waldschmidt G, Resch F, Sarchiapone M, Wasserman C, Hoven CW, Carli V, Wasserman D, Thomasius R, Kaess M. Psychopathological factors associated with problematic alcohol and problematic Internet use in a sample of adolescents in Germany. Psychiatry Res 2016; 240:272-277. [PMID: 27138817 DOI: 10.1016/j.psychres.2016.04.057] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/17/2016] [Accepted: 04/17/2016] [Indexed: 01/07/2023]
Abstract
In Germany, high prevalence rates for problematic alcohol use and problematic Internet use in adolescents were reported. The objective of the present study was to identify psychopathological factors associated with these two behavior patterns. To our knowledge, this is the first investigation assessing psychopathological factors for both problematic alcohol and problematic Internet use in the same sample of adolescents. We surveyed a sample of 1444 adolescents in Germany regarding problematic alcohol use, problematic Internet use, psychopathology and psychological well-being. We conducted binary logistic regression analyses. 5.6% of the sample showed problematic alcohol use, 4.8% problematic Internet use, and 0.8% both problematic alcohol and problematic Internet use. Problematic alcohol use was higher in adolescents with problematic Internet use compared to those without problematic Internet use. Conduct problems and depressive symptoms were statistically significant associated with both problematic alcohol and problematic Internet use. Prosocial behavior was related to problematic Internet use. Male gender and less peer problems were associated with problematic alcohol use. For the first time associations between adolescent problematic alcohol and problematic Internet use due to common psychopathological factors were identified. However, in addition to shared factors, we found also specific psychopathological correlates associated with these two behavior patterns.
Collapse
Affiliation(s)
- Lutz Wartberg
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf, Germany.
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tony Durkee
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Peter Parzer
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Franz Resch
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Camilla Wasserman
- Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Christina W Hoven
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Rainer Thomasius
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
35
|
Durkee T, Carli V, Floderus B, Wasserman C, Sarchiapone M, Apter A, Balazs JA, Bobes J, Brunner R, Corcoran P, Cosman D, Haring C, Hoven CW, Kaess M, Kahn JP, Nemes B, Postuvan V, Saiz PA, Värnik P, Wasserman D. Pathological Internet Use and Risk-Behaviors among European Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E294. [PMID: 27005644 PMCID: PMC4808957 DOI: 10.3390/ijerph13030294] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 12/22/2022]
Abstract
Risk-behaviors are a major contributor to the leading causes of morbidity among adolescents and young people; however, their association with pathological Internet use (PIU) is relatively unexplored, particularly within the European context. The main objective of this study is to investigate the association between risk-behaviors and PIU in European adolescents. This cross-sectional study was conducted within the framework of the FP7 European Union project: Saving and Empowering Young Lives in Europe (SEYLE). Data on adolescents were collected from randomized schools within study sites across eleven European countries. PIU was measured using Young's Diagnostic Questionnaire (YDQ). Risk-behaviors were assessed using questions procured from the Global School-Based Student Health Survey (GSHS). A total of 11,931 adolescents were included in the analyses: 43.4% male and 56.6% female (M/F: 5179/6752), with a mean age of 14.89 ± 0.87 years. Adolescents reporting poor sleeping habits and risk-taking actions showed the strongest associations with PIU, followed by tobacco use, poor nutrition and physical inactivity. Among adolescents in the PIU group, 89.9% were characterized as having multiple risk-behaviors. The significant association observed between PIU and risk-behaviors, combined with a high rate of co-occurrence, underlines the importance of considering PIU when screening, treating or preventing high-risk behaviors among adolescents.
Collapse
Affiliation(s)
- Tony Durkee
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm SE-17177, Sweden.
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm SE-17177, Sweden.
| | - Birgitta Floderus
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-17177, Sweden.
| | - Camilla Wasserman
- Department of Medicine and Health Science, University of Molise, Campobasso 86100, Italy.
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso 86100, Italy.
- National Institute for Migration and Poverty, Via San Gallicano, Roma 25/A, Italy.
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv 49202, Israel.
| | - Judit A Balazs
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest 1021, Hungary.
- Institute of Psychology, Eötvös Loránd University, Budapest 1064, Hungary.
| | - Julio Bobes
- Department of Psychiatry, Center for Biomedical Research in the Mental Health Network (CIBERSAM), University of Oviedo, Oviedo 33006, Spain.
| | - Romuald Brunner
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg 69115, Germany.
| | - Paul Corcoran
- National Suicide Research Foundation, Western Rd., Cork, Ireland.
| | - Doina Cosman
- Department of Clinical Psychology, Iuliu Hatieganu University of Medicine and Pharmacy, Str. Victor Babes Nr. 8, Cluj-Napoca 400000, Romania.
| | - Christian Haring
- Research Division for Mental Health, University for Medical Information Technology (UMIT), Klagenfurt, Innsbruck 6060, Austria.
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | - Michael Kaess
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg 69115, Germany.
| | - Jean-Pierre Kahn
- Department of Psychiatry, Centre Hospitalo-Universitaire de Nancy, Université de Lorraine, Nancy, Vandoeuvre-lès-Nancy 54500, France.
| | - Bogdan Nemes
- Department of Clinical Psychology, Iuliu Hatieganu University of Medicine and Pharmacy, Str. Victor Babes Nr. 8, Cluj-Napoca 400000, Romania.
| | - Vita Postuvan
- Slovene Center for Suicide Research, Andrej Marušič Institute, University of Primorska, Koper 6000, Slovenia.
| | - Pilar A Saiz
- Department of Psychiatry, Center for Biomedical Research in the Mental Health Network (CIBERSAM), University of Oviedo, Oviedo 33006, Spain.
| | - Peeter Värnik
- Centre of Behavioral and Health Sciences, Estonian-Swedish Mental Health & Suicidology Institute, Tallinn University, Tallinn 10120, Estonia.
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm SE-17177, Sweden.
| |
Collapse
|
36
|
Kaess M, Brunner R, Parzer P, Edanackaparampil M, Schmidt J, Kirisgil M, Fischer G, Wewetzer C, Lehmkuhl G, Resch F. Association of Adolescent Dimensional Borderline Personality Pathology with Past and Current Nonsuicidal Self-Injury and Lifetime Suicidal Behavior: A Clinical Multicenter Study. Psychopathology 2016; 49:356-363. [PMID: 27614954 DOI: 10.1159/000448481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/17/2016] [Indexed: 11/19/2022]
Abstract
Descriptive diagnoses of nonsuicidal self-injury (NSSI) and suicide attempts (SAs) may detract from underlying dimensional borderline personality pathology (D-BPP). This study aimed to investigate D-BPP in adolescent inpatients with NSSI and SAs. A consecutive sample of 359 adolescent inpatients was assessed for current and past NSSI and life-time SAs. D-BPP and current mental health problems were measured using the Dimensional Assessment of Personality Pathology and the Strengths and Difficulties Questionnaire, respectively. D-BPP was significantly associated with both current (p < 0.001) and past NSSI (p = 0.025) and life-time SAs (p < 0.001) compared to their non-self-harming peers. Patients with current and past NSSI did not differ in terms of D-BPP or current mental health problems. A multivariate model did not show any additional influence of current mental health problems over and above D-BPP in predicting NSSI and SAs. It can be hypothesized that D-BPP underlies adolescent self-harm and may persist even after its termination, promoting a higher burden of mental health problems.
Collapse
Affiliation(s)
- Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Townsend E, van Heeringen K, Hazell P. Interventions for self-harm in children and adolescents. Cochrane Database Syst Rev 2015; 2021:CD012013. [PMID: 26688129 PMCID: PMC8786270 DOI: 10.1002/14651858.cd012013] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury) is common in children and adolescents, often repeated, and strongly associated with suicide. This is an update of a broader Cochrane review on psychosocial and pharmacological treatments for deliberate SH first published in 1998 and previously updated in 1999. We have now divided the review into three separate reviews; this review is focused on psychosocial and pharmacological interventions for SH in children and adolescents. OBJECTIVES To identify all randomised controlled trials of psychosocial interventions, pharmacological agents, or natural products for SH in children and adolescents, and to conduct meta-analyses (where possible) to compare the effects of specific treatments with comparison types of treatment (e.g., treatment as usual (TAU), placebo, or alternative pharmacological treatment) for children and adolescents who SH. SEARCH METHODS For this update the Cochrane Depression, Anxiety and Neurosis Group (CCDAN) Trials Search Co-ordinator searched the CCDAN Specialised Register (30 January 2015). SELECTION CRITERIA We included randomised controlled trials comparing psychosocial or pharmacological treatments with treatment as usual, alternative treatments, or placebo or alternative pharmacological treatment in children and adolescents (up to 18 years of age) with a recent (within six months) episode of SH resulting in presentation to clinical services. DATA COLLECTION AND ANALYSIS Two reviewers independently selected trials, extracted data, and appraised study quality, with consensus. For binary outcomes, we calculated odds ratios (OR) and their 95% confidence intervals (CI). For continuous outcomes measured using the same scale we calculated the mean difference (MD) and 95% CI; for those measured using different scales we calculated the standard mean difference (SMD) and 95% CI. Meta-analysis was only possible for two interventions: dialectical behaviour therapy for adolescents and group-based psychotherapy. For these analyses, we pooled data using a random-effects model. MAIN RESULTS We included 11 trials, with a total of 1,126 participants. The majority of participants were female (mean = 80.6% in 10 trials reporting gender). All trials were of psychosocial interventions; there were none of pharmacological treatments. With the exception of dialectical behaviour therapy for adolescents (DBT-A) and group-based therapy, assessments of specific interventions were based on single trials. We downgraded the quality of evidence owing to risk of bias or imprecision for many outcomes.Therapeutic assessment appeared to increase adherence with subsequent treatment compared with TAU (i.e., standard assessment; n = 70; k = 1; OR = 5.12, 95% CI 1.70 to 15.39), but this had no apparent impact on repetition of SH at either 12 (n = 69; k = 1; OR 0.75, 95% CI 0.18 to 3.06; GRADE: low quality) or 24 months (n = 69; k = 1; OR = 0.69, 05% CI 0.23 to 2.14; GRADE: low quality evidence). These results are based on a single cluster randomised trial, which may overestimate the effectiveness of the intervention.For patients with multiple episodes of SH or emerging personality problems, mentalisation therapy was associated with fewer adolescents scoring above the cut-off for repetition of SH based on the Risk-Taking and Self-Harm Inventory 12 months post-intervention (n = 71; k = 1; OR = 0.26, 95% CI 0.09 to 0.78; GRADE: moderate quality). DBT-A was not associated with a reduction in the proportion of adolescents repeating SH when compared to either TAU or enhanced usual care (n = 104; k = 2; OR 0.72, 95% CI 0.12 to 4.40; GRADE: low quality). In the latter trial, however, the authors reported a significantly greater reduction over time in frequency of repeated SH in adolescents in the DBT condition, in whom there were also significantly greater reductions in depression, hopelessness, and suicidal ideation.We found no significant treatment effects for group-based therapy on repetition of SH for individuals with multiple episodes of SH at either the six (n = 430; k = 2; OR 1.72, 95% CI 0.56 to 5.24; GRADE: low quality) or 12 month (n = 490; k = 3; OR 0.80, 95% CI 0.22 to 2.97; GRADE: low quality) assessments, although considerable heterogeneity was associated with both (I(2) = 65% and 77% respectively). We also found no significant differences between the following treatments and TAU in terms of reduced repetition of SH: compliance enhancement (three month follow-up assessment: n = 63; k = 1; OR = 0.67, 95% CI 0.15 to 3.08; GRADE: very low quality), CBT-based psychotherapy (six month follow-up assessment: n = 39; k = 1; OR = 1.88, 95% CI 0.30 to 11.73; GRADE: very low quality), home-based family intervention (six month follow-up assessment: n = 149; k = 1; OR = 1.02, 95% CI 0.41 to 2.51; GRADE: low quality), and provision of an emergency card (12 month follow-up assessment: n = 105, k = 1; OR = 0.50, 95% CI 0.12 to 2.04; GRADE: very low quality). No data on adverse effects, other than the planned outcomes relating to suicidal behaviour, were reported. AUTHORS' CONCLUSIONS There are relatively few trials of interventions for children and adolescents who have engaged in SH, and only single trials contributed to all but two comparisons in this review. The quality of evidence according to GRADE criteria was mostly very low. There is little support for the effectiveness of group-based psychotherapy for adolescents with multiple episodes of SH based on the results of three trials, the evidence from which was of very low quality according to GRADE criteria. Results for therapeutic assessment, mentalisation, and dialectical behaviour therapy indicated that these approaches warrant further evaluation. Despite the scale of the problem of SH in children and adolescents there is a paucity of evidence of effective interventions. Further large-scale trials, with a range of outcome measures including adverse events, and investigation of therapeutic mechanisms underpinning these interventions, are required. It is increasingly apparent that development of new interventions should be done in collaboration with patients to ensure that these are likely to meet their needs. Use of an agreed set of outcome measures would assist evaluation and both comparison and meta-analysis of trials.
Collapse
Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK, OX3 7JX
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Kahn JP, Tubiana A, Cohen RF, Carli V, Wasserman C, Hoven C, Sarchiapone M, Wasserman D. Important Variables When Screening for Students at Suicidal Risk: Findings from the French Cohort of the SEYLE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12277-90. [PMID: 26437422 PMCID: PMC4626968 DOI: 10.3390/ijerph121012277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/28/2015] [Accepted: 09/22/2015] [Indexed: 11/16/2022]
Abstract
Due to early detection of mental ill-health being an important suicide preventive strategy, the multi-centre EU funded "Saving and Empowering Young Lives in Europe" (SEYLE) study compared three school-based mental health promotion programs to a control group. In France, 1007 students with a mean age of 15.2 years were recruited from 20 randomly assigned schools. This paper explores the French results of the SEYLE's two-stage screening program (ProfScreen) and of the cross-program suicidal emergency procedure. Two-hundred-thirty-five ProfScreen students were screened using 13 psychopathological and risk behaviour scales. Students considered at risk because of a positive finding on one or more scales were offered a clinical interview and, if necessary, referred for treatment. A procedure for suicidal students (emergency cases) was set up to detect emergencies in the whole cohort (n = 1007). Emergency cases were offered the same clinical interview as the ProfScreen students. The interviewers documented their reasons for referrals in a short report. 16,2% of the ProfScreen students (38/235) were referred to treatment and 2,7% of the emergency cases (27/1007) were also referred to treatment due to high suicidal risk. Frequent symptoms in those students referred for evaluation were depression, alcohol misuse, non-suicidal self-injuries (NSSI), and suicidal behaviours. According to the multivariate regression analysis of ProfScreen, the results show that the best predictors for treatment referral were NSSI (OR 2.85), alcohol misuse (OR 2.80), and depressive symptoms (OR 1.13). Analysis of the proportion for each scale of students referred to treatment showed that poor social relationships (60%), anxiety (50%), and suicidal behaviours (50%) generated the highest rate of referrals. Qualitative analysis of clinician's motivations to refer a student to mental health services revealed that depressive symptoms (51%), anxiety (38%), suicidal behaviours (40%), and negative life events (35%) were the main reasons for referrals. Thus, not only the classical psychopathological symptoms, such as depression, anxiety, and suicidal behaviours, but also negative life events and poor social relationships (especially isolation) motivate referrals for treatment.
Collapse
Affiliation(s)
- Jean-Pierre Kahn
- Centre Hospitalier Universitaire de Nancy, Hôpitaux de Brabois, Vandoeuvre les Nancy 54511, France.
- Université de Lorraine, Faculté de Médecine, Vandoeuvre les Nancy 54505, France.
- Centre Psychothérapique de Nancy, Laxou 54520, France.
| | | | | | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm SE-171 77, Sweden.
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
- Department of Health Sciences, University of Molise, Campobasso 86100, Italy.
| | - Christina Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso 86100, Italy.
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm SE-171 77, Sweden.
| |
Collapse
|
39
|
Barzilay S, Feldman D, Snir A, Apter A, Carli V, Hoven CW, Wasserman C, Sarchiapone M, Wasserman D. The interpersonal theory of suicide and adolescent suicidal behavior. J Affect Disord 2015; 183:68-74. [PMID: 26001665 DOI: 10.1016/j.jad.2015.04.047] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/25/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Joiner's interpersonal theory of suicide (IPTS) proposes that suicide results from the combination of a perception of burdening others, social alienation, and the capability for self-harm. The theory gained some empirical support, however the overall model has yet to be tested. This study aimed to test the main predictions of IPTS in a large community sample of Israeli adolescents. METHOD 1196 Israeli Jewish and Arab high-school pupils participating in the SEYLE project completed a self-report questionnaire measuring perceived burdensomeness, thwarted belongingness, health risk behaviors, and non-suicidal self-injury (risk variables), and suicidal ideation and suicide attempts (outcome measures). The data were tested in cross-sectional regression models. RESULTS Consistent with IPTS, perceived burdensomeness was found to interact with thwarted belongingness, predicting suicidal ideation. Depression mediated most of the effect of thwarted belongingness and perceived burdensomeness on suicidal ideation. Acquired capability for self-harm, as measured by health risk behaviors and direct non-suicidal self-injurious behaviors, predicted suicide attempt. However, this mechanism operated independently from ideation rather than in interaction with it, at variance with IPTS-based predictions. LIMITATIONS The cross-sectional design precludes conclusions about causality and directionality. Proxy measures were used to test the interpersonal theory constructs. CONCLUSION The findings support some of the IPTS predictions but not all, and imply two separate pathways for suicidal behavior in adolescents: one related to internalizing psychopathology and the other to self-harm behaviors. This conceptualization has clinical implications for the differential identification of adolescents at risk for suicidal behavior and for the development of prevention strategies.
Collapse
Affiliation(s)
- S Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychology, Bar Ilan University, Ramat Gan, Israel.
| | - D Feldman
- Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - A Snir
- Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - A Apter
- Feinberg Child Study Centre, Schneider Children's Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - V Carli
- National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - C W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - C Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Department of Health Sciences, University of Molise, Campobasso, Italy
| | - M Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy; National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy "d'Annunzio University" Foundation, Chieti, Italy
| | - D Wasserman
- National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
40
|
Strittmatter E, Kaess M, Parzer P, Fischer G, Carli V, Hoven CW, Wasserman C, Sarchiapone M, Durkee T, Apter A, Bobes J, Brunner R, Cosman D, Sisask M, Värnik P, Wasserman D. Pathological Internet use among adolescents: Comparing gamers and non-gamers. Psychiatry Res 2015; 228:128-35. [PMID: 25959265 DOI: 10.1016/j.psychres.2015.04.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/11/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
"Internet gaming disorder" was recently included in Section 3 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Non-gaming Internet activities were not considered because of a lack of evidence. This study examined whether gamers differ from non-gamers with respect to their psychological well-being among students who show pathological Internet use (PIU). This cross-sectional study was conducted within the project "Working in Europe to Stop Truancy Among Youth (WE-STAY)". A total of 8807 European representative students from randomly selected schools were included. The Young Diagnostic Questionnaire was applied to assess PIU, and students with this condition were divided into gamers (PIU-G) and non-gamers (PIU-NG). Overall, 3.62% and 3.11% of the students were classified as having PIU-G and PIU-NG, respectively. A multinomial logistic regression revealed that students with PIU-G and those with PIU-NG showed similarly increased risks for emotional symptoms, conduct disorder, hyperactivity/inattention, self-injurious behaviors, and suicidal ideation and behaviors. Students with PIU-G were more likely to be male and have a higher risk for peer problems than those with PIU-NG. Students with PIU-NG had a higher risk of depression than those with PIU-G. The significant psychological impairment of PIU-NG suggests that it should be considered in future diagnostic criteria.
Collapse
Affiliation(s)
- Esther Strittmatter
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; University Medical Center Münster, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Münster, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.
| | - Peter Parzer
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Gloria Fischer
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA; Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Tony Durkee
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children׳s Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Doina Cosman
- Department of Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn University, Tallinn, Estonia
| | - Peeter Värnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn University, Tallinn, Estonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
41
|
Cotter P, Kaess M, Corcoran P, Parzer P, Brunner R, Keeley H, Carli V, Wasserman C, Hoven C, Sarchiapone M, Apter A, Balazs J, Bobes J, Cosman D, Haring C, Kahn JP, Resch F, Postuvan V, Värnik A, Wasserman D. Help-seeking behaviour following school-based screening for current suicidality among European adolescents. Soc Psychiatry Psychiatr Epidemiol 2015; 50:973-82. [PMID: 25656270 DOI: 10.1007/s00127-015-1016-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To screen and clinically interview European adolescents reporting current suicidality (suicidal ideation and suicide attempt) and investigate attendance at the clinical interview. METHODS The Saving and Empowering Young Lives in Europe (SEYLE) Project was carried out in 11 European countries. A baseline questionnaire was completed in school by 12,395 adolescents (mean age 14.9; SD 0.9). Those who screened positive for suicidality (attempting suicide and/or serious suicidal ideation or plans) in the past 2 weeks were invited to a clinical interview with a mental health professional. RESULTS Of the 12,395 adolescents, 4.2 % (n = 516) screened positive for current suicidality. The prevalence ranged from 1.1 % in Hungary to 7.7 % in Israel (p < 0.001). 37.6 % (n = 194) of those who screened positive subsequently attended the clinical interview. Female students were more likely to attend for interview (42.0 % versus 30.6 %, p = 0.010). The attendance rate varied considerably across countries, from 5.7 % in Italy to 96.7 % in France (p < 0.001). Improved attendance was associated with using school as the only interview setting (Mean attendance rate, MAR = 88 vs. 31 %, p = 0.006) and arranging the interview within 1 week of contacting the student (MAR = 64 vs. 23 %, p = 0.013). The greater the travel time to interview, the lower the attendance rate (Pearson's r = -0.64, p = 0.034). Independent of the variation by country, at the individual level, adolescents with more depressive symptoms and a recent suicide attempt more often attended for interview. CONCLUSION A high rate of current suicidality was found amongst European adolescents. However, the majority of these displayed limited help-seeking behaviour. Future studies should investigate ways of making screening programmes and other interventions more acceptable and accessible to young people, especially young males.
Collapse
Affiliation(s)
- Pádraig Cotter
- National Suicide Research Foundation, University College Cork, Western Gateway Building, Room 4.28, Cork, Ireland,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Rüütel E, Sisask M, Värnik A, Värnik P, Carli V, Wasserman C, Hoven CW, Sarchiapone M, Apter A, Balazs J, Bobes J, Brunner R, Corcoran P, Cosman D, Haring C, Iosue M, Kaess M, Kahn JP, Poštuvan V, Sáiz PA, Wasserman D. Alcohol consumption patterns among adolescents are related to family structure and exposure to drunkenness within the family: results from the SEYLE project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:12700-15. [PMID: 25493392 PMCID: PMC4276641 DOI: 10.3390/ijerph111212700] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/25/2014] [Accepted: 11/28/2014] [Indexed: 11/17/2022]
Abstract
There is expedient evidence showing that differences in adolescent alcohol consumption and other risk-behaviour depend on both family structure and family member drunkenness exposure. Data were obtained among adolescents (N = 12,115, mean age 14.9 ± 0.89) in Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy,Romania, Slovenia and Spain within the European Union'ss 7th Framework Programme funded project, 'Saving and Empowering Young Lives in Europe (SEYLE)’. The current study reveals how adolescents' alcohol consumption patterns are related to their family structure and having seen their family member drunk. The results revealed statistically significant differences in adolescent alcohol consumption depending on whether the adolescent lives in a family with both birth parents, in a single-parent family or in a family with one birth parent and one step-parent. The study also revealed that the abstaining from alcohol percentage among adolescents was greater in families with both birth parents compared to other family types. The study also showed that the more often adolescents see their family member drunk the more they drink themselves. There is no difference in adolescent drinking patterns whether they see their family member drunk once a month or once a week. This study gives an insight on which subgroups of adolescents are at heightened risk of alcohol abuse and that decrease of family member drunkenness may have positive effects on the drinking habits of their children.
Collapse
Affiliation(s)
- Erik Rüütel
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn University Social Work Institute, Tallinn 11615, Estonia; E-Mails: (M.S.); (A.V.); (P.V.)
- Justice College, Estonian Academy of Security Sciences, Tallinn 12012, Estonia
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn University Social Work Institute, Tallinn 11615, Estonia; E-Mails: (M.S.); (A.V.); (P.V.)
| | - Airi Värnik
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn University Social Work Institute, Tallinn 11615, Estonia; E-Mails: (M.S.); (A.V.); (P.V.)
| | - Peeter Värnik
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn University Social Work Institute, Tallinn 11615, Estonia; E-Mails: (M.S.); (A.V.); (P.V.)
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) at Karolinska Institutet, Stockholm SE-171 77, Sweden; E-Mails: (V.C.); (D.W.)
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY 10032, USA; E-Mails: (C.W.); (C.W.H.)
| | - Christina W. Hoven
- Department of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY 10032, USA; E-Mails: (C.W.); (C.W.H.)
| | - Marco Sarchiapone
- Medicine and Health Science Department, University of Molise, Via De Sanctis, 86100 Campobasso, Italy; E-Mails: (M.S.); (M.I.)
| | - Alan Apter
- Feinberg Child Study Center, Schneider Children’s Medical Center, Tel Aviv University, Tel Aviv 69978, Israel; E-Mail:
| | - Judit Balazs
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest 1021, Hungary; E-Mail:
- Institute of Psychology, Eötvös Loránd University, Budapest 1064, Hungary
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo 33003, Spain; E-Mails: (J.B.); (P.A.S.)
| | - Romuald Brunner
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg 69047, Germany; E-Mails: (R.B.); (M.K.)
| | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland; E-Mail:
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania; E-Mail:
| | - Christian Haring
- Research Division for Mental Health, University for Health Science, Medical Informatics Technology (UMIT), Hall in Tyrol 6060, Austria; E-Mail:
| | - Miriam Iosue
- Medicine and Health Science Department, University of Molise, Via De Sanctis, 86100 Campobasso, Italy; E-Mails: (M.S.); (M.I.)
| | - Michael Kaess
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg 69047, Germany; E-Mails: (R.B.); (M.K.)
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire CHU de NANCY, Université de Lorraine, Nancy 54500, France; E-Mail:
| | - Vita Poštuvan
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper SI-6000, Slovenia; E-Mail:
| | - Pilar A. Sáiz
- Department of Psychiatry, School of Medicine, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo 33003, Spain; E-Mails: (J.B.); (P.A.S.)
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) at Karolinska Institutet, Stockholm SE-171 77, Sweden; E-Mails: (V.C.); (D.W.)
| |
Collapse
|
43
|
Kahn JP. Suicide prevention and mental health promotion in adolescents: Lessons learned from the SEYLE “Saving and Empowering Young Lives in Europe” program. Eur Psychiatry 2014. [DOI: 10.1016/j.eurpsy.2014.09.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionThe “Saving and Empowering Young Lives in Europe” (SEYLE) has gathered 12,395 high school students in 10 countries (including 1007 students in the Lorraine Region). It has been funded by the FP7 European program and coordinated by the Karolinska Institute. Its main goals were to encourage teenagers to adopt healthier behaviors by reducing risk behaviors and suicidal behaviors, to assess the benefits from various prevention programs and recommend evidence based and culturally adapted mental health promotion programs for teenagers.Inclusion and methodSEYLE is a randomized control trial evaluating 3 mental health prevention programs:– a program training school staff to identify and refer students at suicidal risk (QPR);– a mental health sensibilization program, aimed at the students (the Awareness program);– a mental health professional screening program, through self-report questionnaires and clinical interview.These prevention programs were compared to a minimal intervention control group. The students (aged 14–16 years old) filled a 127 items questionnaire at Baseline, M3 and M12.ResultsThe most salient results of this research have shown:– the efficacy on suicidal behaviors of prevention programs in schools, in particular the Awareness program (the mental health sensibilization universal program);– the existence of an invisible group of students at risk (highly sedentary students with poor sleep and media overexposure);– a high prevalence of depressive (10.5%) and (5.8%) anxious symptoms as well as non-suicidal injuries (7.8%) in European adolescents.Discussion and perspectivesThis study has provided evidence of the efficiency of mental health awareness programs in schools to decrease the number of suicides and suicidal behaviors in teenagers and to better identify “at risk” students.
Collapse
|
44
|
Kaess M, Durkee T, Brunner R, Carli V, Parzer P, Wasserman C, Sarchiapone M, Hoven C, Apter A, Balazs J, Balint M, Bobes J, Cohen R, Cosman D, Cotter P, Fischer G, Floderus B, Iosue M, Haring C, Kahn JP, Musa GJ, Nemes B, Postuvan V, Resch F, Saiz PA, Sisask M, Snir A, Varnik A, Žiberna J, Wasserman D. Pathological Internet use among European adolescents: psychopathology and self-destructive behaviours. Eur Child Adolesc Psychiatry 2014; 23:1093-102. [PMID: 24888750 PMCID: PMC4229646 DOI: 10.1007/s00787-014-0562-7] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/15/2014] [Indexed: 12/13/2022]
Abstract
Rising global rates of pathological Internet use (PIU) and related psychological impairments have gained considerable attention in recent years. In an effort to acquire evidence-based knowledge of this relationship, the main objective of this study was to investigate the association between PIU, psychopathology and self-destructive behaviours among school-based adolescents in eleven European countries. This cross-sectional study was implemented within the framework of the European Union project: Saving and Empowering Young Lives in Europe. A representative sample of 11,356 school-based adolescents (M/F: 4,856/6,500; mean age: 14.9) was included in the analyses. PIU was assessed using the Young's Diagnostic Questionnaire. Psychopathology was measured using the Beck Depression Inventory-II, Zung Self-Rating Anxiety Scale and Strengths and Difficulties Questionnaire. Self-destructive behaviours were evaluated by the Deliberate Self-Harm Inventory and Paykel Suicide Scale. Results showed that suicidal behaviours (suicidal ideation and suicide attempts), depression, anxiety, conduct problems and hyperactivity/inattention were significant and independent predictors of PIU. The correlation between PIU, conduct problems and hyperactivity/inattention was stronger among females, while the link between PIU and symptoms of depression, anxiety and peer relationship problems was stronger among males. The association between PIU, psychopathology and self-destructive behaviours was stronger in countries with a higher prevalence of PIU and suicide rates. These findings ascertain that psychopathology and suicidal behaviours are strongly related to PIU. This association is significantly influenced by gender and country suggesting socio-cultural influences. At the clinical and public health levels, targeting PIU among adolescents in the early stages could potentially lead to improvements of psychological well-being and a reduction of suicidal behaviours.
Collapse
Affiliation(s)
- Michael Kaess
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Tony Durkee
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Romuald Brunner
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Peter Parzer
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY USA
- Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Christina Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY US
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children’s Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - Maria Balint
- Pedagogical and Psychological Counsel, Kobanya, Hungary
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Renaud Cohen
- Department of Psychiatry, Centre Hospitalo-Universitaire de NANCY, Université H. Poincaré, Nancy, France
| | - Doina Cosman
- Department of Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Gloria Fischer
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Birgitta Floderus
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Miriam Iosue
- Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Christian Haring
- Research Division for Mental Health, University for Medical Information Technology (UMIT), Innsbruck, Austria
| | - Jean-Pierre Kahn
- Department of Psychiatry, Centre Hospitalo-Universitaire de NANCY, Université H. Poincaré, Nancy, France
| | - George J. Musa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY US
| | - Bogdan Nemes
- Department of Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vita Postuvan
- Health Research Department, PINT, University of Primorska, Koper, Slovenia
| | - Franz Resch
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Pilar A. Saiz
- Department of Psychiatry, School of Medicine, Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute, Centre of Behavioural and Health Science, Tallinn University, Tallinn, Estonia
| | - Avigal Snir
- Feinberg Child Study Centre, Schneider Children’s Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Airi Varnik
- Estonian-Swedish Mental Health and Suicidology Institute, Centre of Behavioural and Health Science, Tallinn University, Tallinn, Estonia
| | - Janina Žiberna
- Health Research Department, PINT, University of Primorska, Koper, Slovenia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
45
|
Risk-behaviour screening for identifying adolescents with mental health problems in Europe. Eur Child Adolesc Psychiatry 2014; 23:611-20. [PMID: 24248753 DOI: 10.1007/s00787-013-0490-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 10/26/2013] [Indexed: 10/26/2022]
Abstract
Indicated prevention of mental illness is an important public health concern among youth. The aim of this study was to establish a European school-based professional screening among adolescents, which included variables on both a broad range of risk-behaviours and psychopathology; and to investigate the indicative value of adolescent risk-behaviour and self-reported psychopathology on help-seeking and psychological problems that required subsequent mental healthcare. A two-stage professional screening approach was developed and performed within the multi-centre study "Saving and Empowering Young Lives in Europe" (SEYLE). The first stage of screening comprised a self-report questionnaire on a representative sample of 3,070 adolescents from 11 European countries. In the second stage, students deemed at-risk for mental health problems were evaluated using a semi-structured clinical interview performed by healthcare professionals. 61 % of participants (n = 1,865) were identified as being at-risk in stage one. In stage two, 384 participants (12.5 % of the original sample) were found to require subsequent mental healthcare during semi-structured, clinical assessment. Among those, 18.5 % of pupils were identified due to screening for psychopathology alone; 29.4 % due to screening for risk-behaviours alone; and 52.1 % by a combination of both. Young age and peer victimization increased help-seeking, while very low body mass index, depression, suicidal behaviour and substance abuse were the best predictors of referral to mental healthcare. Screening of risk-behaviours significantly increased the number of detected students requiring subsequent mental healthcare. Screening of risk-behaviours added significant value in identifying the significant amount of European pupils with mental health problems. Therefore, attention to adolescent risk-behaviours in addition to psychopathology is critical in facilitating prevention and early intervention. Identifying factors that increase compliance to clinical interviews are crucial in improving screening procedures.
Collapse
|
46
|
Donath C, Graessel E, Baier D, Bleich S, Hillemacher T. Is parenting style a predictor of suicide attempts in a representative sample of adolescents? BMC Pediatr 2014; 14:113. [PMID: 24766881 PMCID: PMC4011834 DOI: 10.1186/1471-2431-14-113] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Suicidal ideation and suicide attempts are serious but not rare conditions in adolescents. However, there are several research and practical suicide-prevention initiatives that discuss the possibility of preventing serious self-harm. Profound knowledge about risk and protective factors is therefore necessary. The aim of this study is a) to clarify the role of parenting behavior and parenting styles in adolescents' suicide attempts and b) to identify other statistically significant and clinically relevant risk and protective factors for suicide attempts in a representative sample of German adolescents. METHODS In the years 2007/2008, a representative written survey of N = 44,610 students in the 9th grade of different school types in Germany was conducted. In this survey, the lifetime prevalence of suicide attempts was investigated as well as potential predictors including parenting behavior. A three-step statistical analysis was carried out: I) As basic model, the association between parenting and suicide attempts was explored via binary logistic regression controlled for age and sex. II) The predictive values of 13 additional potential risk/protective factors were analyzed with single binary logistic regression analyses for each predictor alone. Non-significant predictors were excluded in Step III. III) In a multivariate binary logistic regression analysis, all significant predictor variables from Step II and the parenting styles were included after testing for multicollinearity. RESULTS Three parental variables showed a relevant association with suicide attempts in adolescents - (all protective): mother's warmth and father's warmth in childhood and mother's control in adolescence (Step I). In the full model (Step III), Authoritative parenting (protective: OR: .79) and Rejecting-Neglecting parenting (risk: OR: 1.63) were identified as significant predictors (p < .001) for suicidal attempts. Seven further variables were interpreted to be statistically significant and clinically relevant: ADHD, female sex, smoking, Binge Drinking, absenteeism/truancy, migration background, and parental separation events. CONCLUSIONS Parenting style does matter. While children of Authoritative parents profit, children of Rejecting-Neglecting parents are put at risk - as we were able to show for suicide attempts in adolescence. Some of the identified risk factors contribute new knowledge and potential areas of intervention for special groups such as migrants or children diagnosed with ADHD.
Collapse
Affiliation(s)
- Carolin Donath
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, Erlangen, 91054, Germany
| | - Elmar Graessel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, Erlangen, 91054, Germany
| | - Dirk Baier
- Criminological Research Institute of Lower Saxony, Lützerodestr 9, Hannover, 30161, Germany
| | - Stefan Bleich
- Center for Addiction Research, Clinic for Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | - Thomas Hillemacher
- Center for Addiction Research, Clinic for Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| |
Collapse
|
47
|
Brunner R, Kaess M, Parzer P, Fischer G, Carli V, Hoven CW, Wasserman C, Sarchiapone M, Resch F, Apter A, Balazs J, Barzilay S, Bobes J, Corcoran P, Cosmanm D, Haring C, Iosuec M, Kahn JP, Keeley H, Meszaros G, Nemes B, Podlogar T, Postuvan V, Saiz PA, Sisask M, Tubiana A, Varnik A, Wasserman D. Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: a comparative study of findings in 11 European countries. J Child Psychol Psychiatry 2014; 55:337-48. [PMID: 24215434 DOI: 10.1111/jcpp.12166] [Citation(s) in RCA: 241] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the prevalence and associated psychosocial factors of occasional and repetitive direct self-injurious behavior (D-SIB), such as self-cutting, -burning, -biting, -hitting, and skin damage by other methods, in representative adolescent samples from 11 European countries. METHODS Cross-sectional assessment of adolescents was performed within the European Union funded project, Saving and Empowering Young Lives in Europe (SEYLE), which was conducted in 11 European countries. The representative sample comprised 12,068 adolescents (F/M: 6,717/5,351; mean age: 14.9 ± 0.89) recruited from randomly selected schools. Frequency of D-SIB was assessed by a modified 6-item questionnaire based on previously used versions of the Deliberate Self-Harm Inventory (DSHI). In addition, a broad range of demographic, social, and psychological factors was assessed. RESULTS Overall lifetime prevalence of D-SIB was 27.6%; 19.7% reported occasional D-SIB and 7.8% repetitive D-SIB. Lifetime prevalence ranged from 17.1% to 38.6% across countries. Estonia, France, Germany, and Israel had the highest lifetime rates of D-SIB, while students from Hungary, Ireland, and Italy reported low rates. Suicidality as well as anxiety and depressive symptoms had the highest odds ratios for both occasional and repetitive D-SIB. There was a strong association of D-SIB with both psychopathology and risk-behaviors, including family related neglect and peer-related rejection/victimization. Associations between psychosocial variables and D-SIB were strongly influenced by both gender and country. Only a minor proportion of the adolescents who reported D-SIB ever received medical treatment. CONCLUSION These results suggest high lifetime prevalence of D-SIB in European adolescents. Prevalence as well as psychosocial correlates seems to be significantly influenced by both gender and country. These results support the need for a multidimensional approach to better understand the development of SIB and facilitate culturally adapted prevention/intervention.
Collapse
Affiliation(s)
- Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Carli V, Hoven CW, Wasserman C, Chiesa F, Guffanti G, Sarchiapone M, Apter A, Balazs J, Brunner R, Corcoran P, Cosman D, Haring C, Iosue M, Kaess M, Kahn JP, Keeley H, Postuvan V, Saiz P, Varnik A, Wasserman D. A newly identified group of adolescents at "invisible" risk for psychopathology and suicidal behavior: findings from the SEYLE study. World Psychiatry 2014; 13:78-86. [PMID: 24497256 PMCID: PMC3918027 DOI: 10.1002/wps.20088] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This study explored the prevalence of risk behaviors (excessive alcohol use, illegal drug use, heavy smoking, reduced sleep, overweight, underweight, sedentary behavior, high use of Internet/TV/videogames for reasons not related to school or work, and truancy), and their association with psychopathology and self-destructive behaviors, in a sample of 12,395 adolescents recruited in randomly selected schools across 11 European countries. Latent class analysis identified three groups of adolescents: a low-risk group (57.8%) including pupils with low or very low frequency of risk behaviors; a high-risk group (13.2%) including pupils who scored high on all risk behaviors, and a third group ("invisible" risk, 29%) including pupils who were positive for high use of Internet/TV/videogames for reasons not related to school or work, sedentary behavior and reduced sleep. Pupils in the "invisible" risk group, compared with the high-risk group, had a similar prevalence of suicidal thoughts (42.2% vs. 44%), anxiety (8% vs. 9.2%), subthreshold depression (33.2% vs. 34%) and depression (13.4% vs. 14.7%). The prevalence of suicide attempts was 5.9% in the "invisible" group, 10.1% in the high-risk group and 1.7% in the low-risk group. The prevalence of all risk behaviors increased with age and most of them were significantly more frequent among boys. Girls were significantly more likely to experience internalizing (emotional) psychiatric symptoms. The "invisible" group may represent an important new intervention target group for potentially reducing psychopathology and other untoward outcomes in adolescence, including suicidal behavior.
Collapse
Affiliation(s)
- Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska InstitutetStockholm, Sweden
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, Columbia University – New York State Psychiatric InstituteNew York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia UniversityNew York, NY, USA
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, Columbia University – New York State Psychiatric InstituteNew York, NY, USA,Department of Health Sciences, University of MoliseCampobasso, Italy
| | - Flaminia Chiesa
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska InstitutetStockholm, Sweden
| | - Guia Guffanti
- Department of Child and Adolescent Psychiatry, Columbia University – New York State Psychiatric InstituteNew York, NY, USA
| | - Marco Sarchiapone
- Department of Health Sciences, University of MoliseCampobasso, Italy
| | - Alan Apter
- Schneider's Children's Medical Center of Israel, University of Tel AvivIsrael
| | - Judit Balazs
- Institute of Psychology, Eötvös Loránd UniversityBudapest, Hungary
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of HeidelbergGermany
| | - Paul Corcoran
- National Suicide Research Foundation (NSRF)Cork, Ireland
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and PharmacyCluj-Napoca, Romania
| | - Christian Haring
- Research Division for Mental Health, University for Medical Information Technology (UMIT)Hall in Tirol, Austria
| | - Miriam Iosue
- Department of Health Sciences, University of MoliseCampobasso, Italy
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of HeidelbergGermany
| | - Jean Pierre Kahn
- Deparment of Psychiatry and Clinical Psychology, CHU de Nancy, Hôpitaux de BraboisVandoeuvre les Nancy, France
| | | | - Vita Postuvan
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of PrimorskaKoper, Slovenia
| | - Pilar Saiz
- Department of Psychiatry, University of Oviedo, CIBERSAM School of MedicineOviedo, Spain
| | - Airi Varnik
- Estonian-Swedish Mental Health and Suicidology Institute, University of TallinnEstonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska InstitutetStockholm, Sweden
| |
Collapse
|
49
|
Sáiz PA, Bobes J. Prevención del suicidio en España: una necesidad clínica no resuelta. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2014; 7:1-4. [DOI: 10.1016/j.rpsm.2014.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
50
|
Sarchiapone M, Mandelli L, Carli V, Iosue M, Wasserman C, Hadlaczky G, Hoven CW, Apter A, Balazs J, Bobes J, Brunner R, Corcoran P, Cosman D, Haring C, Kaess M, Keeley H, Keresztény A, Kahn JP, Postuvan V, Mars U, Saiz PA, Varnik P, Sisask M, Wasserman D. Hours of sleep in adolescents and its association with anxiety, emotional concerns, and suicidal ideation. Sleep Med 2013; 15:248-54. [PMID: 24424101 DOI: 10.1016/j.sleep.2013.11.780] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 11/18/2013] [Accepted: 11/20/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Anxiety and concerns in daily life may result in sleep problems and consistent evidence suggests that inadequate sleep has several negative consequences on cognitive performance, physical activity, and health. The aim of our study was to evaluate the association between mean hours of sleep per night, psychologic distress, and behavioral concerns. METHODS A cross-sectional analysis of the correlation between the number of hours of sleep per night and the Zung Self-rating Anxiety Scale (Z-SAS), the Paykel Suicidal Scale (PSS), and the Strengths and Difficulties Questionnaire (SDQ), was performed on 11,788 pupils (mean age±standard deviation [SD], 14.9±0.9; 55.8% girls) from 11 different European countries enrolled in the SEYLE (Saving and Empowering Young Lives in Europe) project. RESULTS The mean number of reported hours of sleep per night during school days was 7.7 (SD, ±1.3), with moderate differences across countries (r=0.06; P<.001). A reduced number of sleeping hours (less than the average) was more common in girls (β=0.10 controlling for age) and older pupils (β=0.10 controlling for sex). Reduced sleep was found to be associated with increased scores on SDQ subscales of emotional (β=-0.13) and peer-related problems (β=-0.06), conduct (β=-0.07), total SDQ score (β=-0.07), anxiety (Z-SAS scores, β=-10), and suicidal ideation (PSS, β=-0.16). In a multivariate model including all significant variables, older age, emotional and peer-related problems, and suicidal ideation were the variables most strongly associated with reduced sleep hours, though female gender, conduct problems measured by the SDQ, and anxiety only showed modest effects (β=0.03-0.04). CONCLUSIONS Our study supports evidence that reduced hours of sleep are associated with potentially severe mental health problems in adolescents. Because sleep problems are common among adolescents partly due to maturational processes and changes in sleep patterns, parents, other adults, and adolescents should pay more attention to their sleep patterns and implement interventions, if needed.
Collapse
Affiliation(s)
- Marco Sarchiapone
- Department of Heath Sciences, University of Molise, Campobasso, Italy.
| | - Laura Mandelli
- Department of Heath Sciences, University of Molise, Campobasso, Italy; Department of Biomedical and Neuromotor Sciences, Psychiatric Section, University of Bologna, Italy; National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute (KI), Stockholm, Sweden
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute (KI), Stockholm, Sweden; WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Stockholm, Sweden
| | - Miriam Iosue
- Department of Heath Sciences, University of Molise, Campobasso, Italy
| | - Camilla Wasserman
- Department of Heath Sciences, University of Molise, Campobasso, Italy; Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute (KI), Stockholm, Sweden
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary; Semmelweis University, School of Ph.D. Studies, Budapest, Hungary
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Oviedo, Spain
| | - Romuald Brunner
- Section for Disorders of Personality Development, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Research Division for Mental Health, University for Medical Information Technology (UMIT), Innsbruck, Austria
| | - Michael Kaess
- Section for Disorders of Personality Development, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Orygen Youth Health, Melbourne, Australia
| | - Helen Keeley
- National Suicide Research Foundation, Cork, Ireland
| | - Agnes Keresztény
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary; Semmelweis University, School of Ph.D. Studies, Budapest, Hungary
| | - Jean-Pierre Kahn
- Department of Psychiatry, Centre Hospitalo-Universitaire CHU de NANCY, Université H. Poincaré, Nancy, France
| | - Vita Postuvan
- Slovene Centre for Suicide Research, Andrej Marušič Institute, University of Primorska Muzejski trg 2, 6000 Koper, Slovenia
| | - Urša Mars
- Slovene Centre for Suicide Research, Andrej Marušič Institute, University of Primorska Muzejski trg 2, 6000 Koper, Slovenia
| | - Pilar A Saiz
- Department of Psychiatry, School of Medicine, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Oviedo, Spain
| | - Peter Varnik
- Estonian-Swedish Mental Health & Suicidology Institute, Center for Behavioral and Health Sciences, Tallinn, Estonia; Tallinn University, Tallinn, Estonia
| | - Merike Sisask
- Estonian-Swedish Mental Health & Suicidology Institute, Center for Behavioral and Health Sciences, Tallinn, Estonia; Tallinn University, Tallinn, Estonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute (KI), Stockholm, Sweden; WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Stockholm, Sweden
| |
Collapse
|