Depressive symptoms and suicidal behaviours in adolescent non-daily smokers compared to daily smokers and never-smokers in Korea: National cross-sectional study

Factors associated with severe depressive symptoms among Chinese secondary school students in Hong Kong: a large cross-sectional survey

Background

Many adolescents were reported to have severe depressive symptoms, and a careful assessment of its correlates is essential for prevention and intervention programs. This study aimed to gain insight into the prevalence of severe depressive symptoms and its association with factors at four levels (individual, relationship, school and society) in a large sample of Hong Kong Chinese secondary school students.

Methods

Secondary school students from Secondary 1 through 7 were selected as participants using a cluster random sampling method. A questionnaire including inventories measuring 24 factors at the four levels (six individual factors, 11 relationship factors, three school factors, and four society factors) was completed by 8,963 participants (56.3% female) with a mean age of 15.1 (SD = 1.8) years. Students with a score of ≥15 on the Patient Health Questionnaire were defined as having severe depressive symptoms. The association between severe depressive symptoms and correlates were examined by t-test and χ2 test. Logistic regression models using a hierarchical approach then examined the individual contribution of these 24 factors to severe depressive symptoms with the control of other factors in the model.

Results

7.4% of the students have severe depressive symptoms. Twenty-two of the 24 factors were significantly associated with severe depressive symptoms in bivariate analyses. In the logistic regression, 11 factors (three individual factors: age, self-esteem and self-mastery; six relationship factors: tobacco use, alcohol drinking, drug use, paternal psychological control, dinner with parents, and perceived social support from friends; one school factor: felt pressure from homework; and one society factor: number of sibling) were statistically significant. Felt pressure from homework, alcohol drinking, and perceived social support from friends were the strongest correlates of severe depressive symptoms.

Conclusion

The prevalence of self-reported severe depressive symptoms in Hong Kong Chinese secondary school students was high, and the identification of multiple associated factors at the four levels simultaneously provides a knowledge basis for the development of a comprehensive, multivariate model of factors influencing severe depressive symptoms in Chinese secondary school students. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs.

Predictors of suicide ideation among South Korean adolescents: A machine learning approach

BACKGROUND

The current study developed a predictive model for suicide ideation among South Korean (Korean) adolescents using a comprehensive set of factors across demographic, physical and mental health, academic, social, and behavioral domains. The aim of this study was to address the pressing public health concerns of adolescent suicide in Korea and the methodological limitations of suicidal research.

METHODS

This study used machine learning methods (decision tree, logistic regression, naive Bayes classifier) to improve the accuracy of predicting suicidal ideation and related factors among a nationally representative sample of Korean middle school students (N = 6666).

RESULTS

Factors within all domains, including demographic characteristics, physical and mental health, and academic, social, and behavioral, were important in predicting suicidal thoughts among Korean adolescents, with mental health being the most important factor.

LIMITATIONS

The predictive model of the current research does not infer causality, and there may have been some loss of information due to measurement issues.

CONCLUSIONS

Study results provide insights for taking a multidimensional approach when identifying adolescents at risk of suicide, which may be used to further address their needs through intervention programs within the school setting. Considering the cultural stigma attached to disclosing suicidal ideation and behavior, the current study proposes the need for a preventive screening process based on the observation and assessment of adolescents' general characteristics and experiences in everyday life.

Identifying differential trajectories and predictors for depressive symptoms in adolescents using latent class growth analysis: A population-based cohort study

INTRODUCTION

This study investigated the differential trajectories and relevant determinants of depressive symptoms in adolescents by following cohorts that included junior, senior, and vocational high school adolescents, over a 3-year period in Taiwan.

METHODS

Longitudinal data were obtained from 575 adolescents who participated in the Taiwan Adolescent to Adult Longitudinal Study. Data analysis included latent class growth with time-varying covariate, univariate, and multivariate analysis.

RESULTS

A three-class ("low but increasing trajectory," "moderate and stable trajectory," and "high but decreasing trajectory") model fit the data of the cohort. Our findings indicated that 29%, 38%, and 33% of the adolescents were in the low but increasing, moderate and stable, and high but decreasing trajectories, respectively. After confounders were controlled for, bullying experiences were identified as a risk factor for depressive symptoms. The protective factors against depressive symptoms included resilience and peer and social support.

CONCLUSIONS

The transitions between different educational stages critically influence the depressive symptoms of adolescents, and the adolescents follow different depressive trajectories, that have different etiology. Therefore, identifying adolescents at high risk for depression and designing student-centered intervention programs through individualized and multidimensional assessment of depressive symptoms are crucial for adolescents.

[What is the contribution of smoking to the increased risk of suicide in young smokers? A systematic review]

OBJECTIVES

The correlation between smoking and suicide is well documented in the general population: there is an increased risk of suicide among tobacco smokers. However, the association between smoking and suicidal behaviors (ideations, plans, attempts) in youth is poorly elucidated. This is a systematic review of the literature examined data on the relationship between active and passive smoking and suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among youth in the general population.

METHOD

Medline searches were performed for the period 1980-2020. Cross-sectional, case-control, prospective population-based studies of young people (age less than 18 years) were included in this review; studies of specific populations (patients with an identified pathology of any kind) were excluded.

RESULTS

This review included 43 studies: 23 studies on the association between active smoking and SI, SI and/or PS, TS; three studies on the association between passive smoking and suicidal behavior, three studies on the association between smoking and suicidal behavior in young people in psychiatric hospital settings, and five studies comparing the suicidal behavior of girls and boys. Analysis of the data collected lead to the conclusion that active or passive smoking is associated with suicidal behavior in young people. Smoking appears to contribute to psychopathological disorders, including depression, the use of other psychoactive substances, or psychosocial suffering which are often associated with an increased risk of suicide in young people. The correlations between smoking and the presence of mental disorders have been highlighted; tobacco use may contribute to the development of depression, anxiety and stress. Further studies are needed to verify the existence of a causal link between smoking and suicide.

CONCLUSION

Smoking is associated with the risk of suicidal behavior in young people; it should be included among the criteria for assessing suicidal risk in youth. Smoking cessation, which improves psychological well-being, should be further integrated into the prevention of suicidal behavior.

Self-reported history of intensity of smoking is associated with risk factors for suicide among high school students

OBJECTIVE

To examine the relationship between current cigarette smoking patterns and three established risk factors for suicide using nationally representative data of high school students in the United States.

METHODS

We analyzed cross-sectional data from the national Youth Risk Behavior Surveillance Survey (YRBSS)-United States, 2017. Multivariable, logistic regressions examined the association between 3 cigarette smoking behaviors [i.e., past 30-day cigarette (n = 13,731), frequent (n = 1,093) and heavy (n = 880) smoking] and 3 risk factors for suicidal outcomes [feeling sad or hopeless, suicidal ideation, suicide plan] assessed over the previous year.

RESULTS

Among high school cigarette smokers, smoking 11 or more cigarettes per day (i.e., heavy smoking) was associated with 3.43 (95% CI: 1.69, 6.94) greater odds of reporting feeling sad or hopeless, 2.97 (95% CI: 1.60, 5.51) greater odds of reporting suicidal ideations, and 2.11 (95% CI: 1.34, 3.32) greater odds of reporting having ever planned a suicide attempt, controlling for covariates.

CONCLUSIONS

Our study shows that it is not simply cigarette smoking, but heavy cigarette smoking that is a risk factor for suicidal outcomes among adolescents.

PUBLIC HEALTH IMPLICATIONS

A comprehensive plan is needed to accommodate heavy adolescent smokers who are at increased suicidal risk.

Tobacco Use and Its Association with Mental Morbidity and Health Compromising Behaviours in Adolescents in Indonesia

Background:

Limited evidence has been established on associations between tobacco use and mental morbidity and health compromising behaviours. The study aimed to investigate the associations between tobacco use, mental problems, and health risk behaviour among adolescents attending school in Indonesia. Methods: Nationally representative data were studied from 11,124 adolescents that took part in the cross-sectional “Indonesia Global School-Based Student Health Survey (GSHS) in 2015”.

Results:

The prevalence of current tobacco use was 12.8%. In adjusted logistic regression analysis, compared to non-current or never tobacco users, current tobacco use was associated with eight of eight mental problem indicators (lonely, anxiety, no close friend, suicidal ideation, suicide plan, suicide attempt and current alcohol use), two of four dietary risk behaviours (soft drink and fast food consumption) and seven of ten other health risk behaviours (in a physical fight, bullied, injury, ever sex, school truancy, and two sub-optimal hand hygiene behaviours).

Conclusion:

Compared to nontobacco users, current tobacco users had significantly higher mental problem indicators and health risk behaviours. Multiple comorbidity with tobacco use should be targeted in interventions.

Trend in the Prevalence of Non-Daily Smoking and Their Relationship with Mental Health Using the Korea Health and Nutrition Examination Survey

Introduction: Non-Daily Smoking (NDS), which is increasingly prevalent worldwide, has not yet attracted as much attention as has daily smoking in Asia. The aims of this study were to identify trends in the prevalence of NDS and to compare characteristics by age, gender, and mental health indicators such as depression, suicidality, and alcohol consumption in South Korea. Methods: We included 33,806 adults (aged ≥ 19 years) who participated in the Korean National Health and Nutrition Examination Survey (KNHNES) from 2010 to 2015. The dataset includes self-reported medical history and questionnaires that explore depression, suicidality, and alcohol use, which are known to be highly related to smoking. We divided the respondents into four groups according to smoking status: Never Smoking (NS, N = 20,270); Past Smoking (PS = 6835); Daily Smoking (DS = 5927), who reported smoking every day; and Non-Daily Smoking (NDS = 774), who reported that they sometimes smoke. Results: Increased NDS prevalence is observed in most age groups in both male and female adults despite the prevalence of total smoking and daily smoking gradually decreasing. Depression and suicidality were significantly more prevalent in the NDS than the NS group (Depression Odds ratio, OR = 1.72, 95% Confidence interval, CI = 1.31–2.26; Suicidality OR = 3.14, 95% CI = 1.40–7.02). NDS is also associated with a higher frequency of binge drinking and alcohol use disorder than NS (OR = 4.17, 95% CI = 3.49–4.99). Conclusions: This study suggests that more concern is warranted for NDS given the increasing prevalence and characteristics of poor mental health in NDS respondents.

The Neglected Role of Physical Education Participation on Suicidal Ideation and Stress in High School Adolescents from South Korea

Adolescents are at high risk of suicidal ideation and stress. This study aimed to investigate how physical education participation predicts suicidal ideation and stress in South Korean high school students. Data from the Twelfth Korea Youth Risk Behaviour Web-Based Survey 2016 (KYRBS) were used for analyses. Two multiple logistic regressions were performed to determine the influence of selected factors on suicidal ideation and stress (model 1: subjective health, social support, body mass index, academic achievement, perceived economic status of family, and physical education participation; model 2: adjusting for school type and year). Model 2 revealed negative associations between subjective health, academic achievement, perceived economic status of family, social support, physical education participation (≥2 times/weekly), and suicidal ideation for male students. Female students exhibited negative associations between subjective health, social support, and academic achievement, along with a positive association between body mass index and suicidal ideation. For both genders, stress was negatively associated with subjective health, social support, academic achievement, perceived economic status of family, and physical education participation (≥2 times/weekly). These findings suggest that participating in physical education can mitigate the risk of suicidal ideation and stress among high school students.