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Keefner T, Minton M, Antonen K. Embracing Emotional Pain: A Case Study of Adolescent Suicidality and Spirituality. J Am Psychiatr Nurses Assoc 2024; 30:397-408. [PMID: 36016492 DOI: 10.1177/10783903221118932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Suicidality continues to be the second leading cause of adolescent death. Nurses are in a prime position to address the emotional pain associated with adolescent suicidality but report skepticism and discomfort. Moreover, spirituality is identified as a protective factor against suicidality, yet a gap exists related to exploring spirituality within the context of the emotional pain associated with adolescent suicidality. Building awareness of adolescents' spirituality and emotional pain associated with suicidality is essential to address nurse skepticism and discomfort. AIMS The purpose of this study was to explore young adults' experiences of suicide attempt(s) during adolescence in the context of spirituality using a case study application of participant narratives to Minton and Antonen's B.L.E.S.S. acronym. METHOD A multiple-case study design was used to provide an alternative perspective for understanding adolescent suicidality from a spiritual context. Reed's theory of self-transcendence and the B.L.E.S.S. acronym guided the analysis and interpretation. Convenience online sampling resulted in six adult participants who provided email narratives of their adolescent experiences. Email data collection was guided by Fritz and Vandermause. Analysis of participant narratives followed the protocol of Baxter and Jack. RESULTS Participant's narratives revealed self-transcendence that paralleled the five truths about emotional pain and spirituality inherent in the B.L.E.S.S. acronym. CONCLUSION This case study provides nurses a guide for counteracting the barriers of skepticism and stigma to promote help-seeking behavior associated with adolescent suicidality. Further research is needed for the application of the B.L.E.S.S. acronym with other population samples.
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Affiliation(s)
- Tamara Keefner
- Tamara Keefner, PhD, RN, CNE, University of South Dakota, Vermillion, SD, USA
| | - Mary Minton
- Mary Minton, PhD, RN, CHPN, South Dakota State University, Brookings, SD, USA
| | - Kathy Antonen
- Kathy Antonen, PhD, South Dakota School of Mines and Technology, Rapid City, SD, USA
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Cheng X, Chen J, Zhang X, Wang T, Sun J, Zhou Y, Yang R, Xiao Y, Chen A, Song Z, Chen P, Yang C, QiuxiaWu, Lin T, Chen Y, Cao L, Wei X. Characterizing the temporal dynamics of intrinsic brain activities in depressed adolescents with prior suicide attempts. Eur Child Adolesc Psychiatry 2024; 33:1179-1191. [PMID: 37284850 PMCID: PMC11032277 DOI: 10.1007/s00787-023-02242-4] [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: 03/09/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
Converging evidence has revealed disturbances in the corticostriatolimic system are associated with suicidal behaviors in adults with major depressive disorder. However, the neurobiological mechanism that confers suicidal vulnerability in depressed adolescents is largely unknown. A total of 86 depressed adolescents with and without prior suicide attempts (SA) and 47 healthy controls underwent resting-state functional imaging (R-fMRI) scans. The dynamic amplitude of low-frequency fluctuations (dALFF) was measured using sliding window approach. We identified SA-related alterations in dALFF variability primarily in the left middle temporal gyrus, inferior frontal gyrus, middle frontal gyrus (MFG), superior frontal gyrus (SFG), right SFG, supplementary motor area (SMA) and insula in depressed adolescents. Notably, dALFF variability in the left MFG and SMA was higher in depressed adolescents with recurrent suicide attempts than in those with a single suicide attempt. Moreover, dALFF variability was capable of generating better diagnostic and prediction models for suicidality than static ALFF. Our findings suggest that alterations in brain dynamics in regions involved in emotional processing, decision-making and response inhibition are associated with an increased risk of suicidal behaviors in depressed adolescents. Furthermore, dALFF variability could serve as a sensitive biomarker for revealing the neurobiological mechanisms underlying suicidal vulnerability.
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Affiliation(s)
- Xiaofang Cheng
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Jianshan Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Xiaofei Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Ting Wang
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Jiaqi Sun
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Ruilan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yeyu Xiao
- Guangzhou Integrated Traditional Chinese and Western Medicine, Guangzhou, 510800, Guangdong, People's Republic of China
| | - Amei Chen
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Ziyi Song
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Pinrui Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Chanjuan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - QiuxiaWu
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Taifeng Lin
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yingmei Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Liping Cao
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China.
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China.
| | - Xinhua Wei
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China.
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Zhong Y, He J, Luo J, Zhao J, Cen Y, Wu Y, Song Y, Lin C, Pan L, Luo J. The mediating role of impulsivity between sleep quality and suicidal ideation in adolescent population: a multicenter cross-sectional study in the northeastern Sichuan, China. Front Psychiatry 2024; 15:1301221. [PMID: 38347878 PMCID: PMC10859424 DOI: 10.3389/fpsyt.2024.1301221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Suicidal ideation is a critical early stage in the progression towards suicidal be havior. Prior research has established links between sleep quality, impulsivity, and suicidal tendencies, yet the interaction among these factors has been less explored. This study aims to explore the mediating role of impulsivity in the relationship between sleep quality and suicidal ideation in adolescents. Methods Employing a cross-sectional study design, 6,974 questionnaires were distributed,including the Socio-demographic Characteristics Questionnaire, Barratt Impulsiveness Scale, the Positive and Negative Suicide Ideation Inventory,and the Pittsburgh Sleep Quality Index Scale. The participants were high school and middle school students from 33 schools in northeastern Sichuan, China, selected through random cluster sampling. Results Of these 6,786 questionnaires were analyzed. The participant distribution included 47.2% male and 52.8% female students, with 68.3% from junior schools and 31.7% from senior schools. The prevalence of suicidal ideation was found to be 13.6%. The analysis, which involved correlation analysis and the construction of a structural equation model, revealed that sleep quality had a significant positive effect on impulsivity (β:0.289,p < 0.05), and impulsivity, in turn, had a positive impact on suicidal ideation (β:0.355,p < 0.05).Moreover, sleep quality was directly linked to suicidal ideation (β:0.208,p < 0.05). Thus, sleep quality affects suicidal ideation both directly and indirectly through impulsivity. Discussion The results of this study suggest that both sleep quality and impulsivity are significant direct influencers of suicidal ideation among adolescents in the region studied, with impulsivity also playing an indirect role in the relationship between sleep quality and suicidal ideation.
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Affiliation(s)
- Yunling Zhong
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jinlong He
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jing Luo
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jiayu Zhao
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yu Cen
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yuhang Wu
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yuqin Song
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Cen Lin
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Lu Pan
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jiaming Luo
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
- School of Psychiatry, North Sichuan Medical College, Nanchong, Sichuan, China
- Department of Psychiatry, Nanchong Psychosomatic Hospital, Nanchong, Sichuan, China
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Hach I, Bertsch T, Nonell P. The prevalence of off-label use and supratherapeutic blood levels of outpatient psychotropic medication in suicidal adolescents. Front Psychiatry 2024; 14:1240681. [PMID: 38298931 PMCID: PMC10827976 DOI: 10.3389/fpsyt.2023.1240681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Adolescents with mental disorders show an increased risk of suicidal phenomena. Vice versa, suicidality is a serious adverse event of psychotropic drug therapy in adolescents. There are only a few new psychotropic agents approved for this young age group. We evaluated the (pre-pandemic) prevalence of off-label use as well as detailed blood concentrations of outpatient psychotropic medication and sex differences in a clinical population of suicidal adolescents. Methods The urine presence and serum levels of psychotropic substances of adolescents hospitalized due to their acute suicidality but without a known actual suicide attempt (i.e., no acute intoxication or serious self-injuries) were investigated routinely between 01.03.2017 and 31.01.2018. Urine (N = 205) and blood samples (N = 193) were taken at the beginning of closed inpatient admission, i.e., the results of the laboratory analysis reflect outpatient drug intake. The serum levels of psychopharmacological medication and OTC medication were measured. Results Our sample consists of 231 cases (boys: N = 54; girls: N = 177, ratio: 1:3.3), aged 12-17 years (average age: 15,4 years). The most prevalent psychiatric diagnoses were depressive episodes (54%) and adjustment disorders (25%), and girls were more often diagnosed with depressive disorders than boys (boy/girl ratio: 1:9.5, p < 0.0001). More than half of adolescents (56%) used at least one prescribed psychotropic drug at admission (24.8% ≥ two psychotropic drugs). Off-label use of second-generation antipsychotics was significantly more frequent than off-label use of antidepressants (85% vs. 31%, p < 0.01). Adolescents suffering from depressive disorders were significantly more often on-label treated than adolescents with neurotic or stress-related disorders (56% vs. 10%). Female cases with prescribed psychotropic drug use showed significantly more frequent supratherapeutic drug levels than male cases (5% vs. 27%, p < 0.05). Conclusion Female adolescents may have an increased risk of supratherapeutic blood levels, especially when outpatient prescribed psychotropic drugs are off-label used. Measurement of blood levels of outpatient-prescribed psychotropic drugs could be used to enhance the safety and efficacy of the individual psychopharmacological treatment of adolescent suicidal patients. There is an urgent need for more real-world evidence on the effective treatment of adolescents with psychotropic drugs.
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Affiliation(s)
- Isabel Hach
- Department of Education and Science, Klinikum Nürnberg, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Klinikum Nürnberg, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Patrick Nonell
- Clinic of Child and Adolescent Psychiatry and Psychotherapy, Klinikum Nürnberg, Paracelsus Medical University Nürnberg, Nürnberg, Germany
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Hinojosa-Vega R, Rojas-Carrasco KE, González-Muñiz S, Jaramillo-Villanueva L, Jiménez-Márquez A. [Suicidal attempt in a school-aged patient and related factors: a case report]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:875-881. [PMID: 37995446 PMCID: PMC10727761 DOI: 10.5281/zenodo.10064736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 11/25/2023]
Abstract
Background Suicide is a public health problem, which has increased in recent years, becoming a serious cause of mortality, mostly in low- and middle-income countries. Suicidal behavior is infrequent before adolescent years, various related factors have been described. The purpose of this work is to describe the case of a patient in school age who attempted suicide and the identified factors that might have contributed. Clinical case Nine-year-old male attempted suicide by hanging in the bathroom, endangering his life. He received emergency attention and hospitalized in intensive care. During his hospitalization, the mental health service approached him. Amongst the factors previously associated with suicidal intent during school age and identifiable in the patient are family disintegration, symptoms of major depression episodes, reading-related learning difficulties and attention deficit hyperactivity disorder. The patient received treatment and follow up consultation, without showing any suicidal behavior up to this date. The patient is currently 13 years old. Conclusions It must be recognized that children of school age can present suicidal behavior. It is important to acknowledge the factors associated with this kind of behavior, to reduce risks and provide an opportune attention and handling.
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Affiliation(s)
- Rocío Hinojosa-Vega
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Servicio de Salud Mental. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Karmina Elena Rojas-Carrasco
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Servicio de Salud Mental. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Sonia González-Muñiz
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Servicio de Escolares y Adolescentes. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Leonel Jaramillo-Villanueva
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Servicio de Salud Mental. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Abigail Jiménez-Márquez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Pediatría “Dr. Silvestre Frenk Freund”, Servicio de Salud Mental. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Kayan Ocakoğlu B, Kafalı HY, Ocakoğlu FT, Kardaş B, Kardaş Ö, Işık A, Müjdecioğlu G, Akpınar S, Karakaya SEK, Balca Y, Yektaş Ç. Relations of Childhood Trauma and Emotional Dysregulation with Suicide Ideation and Suicidal Behaviour Severity in a Clinical Sample of Depressive Female Adolescents. IRANIAN JOURNAL OF PSYCHIATRY 2023; 18:443-454. [PMID: 37881414 PMCID: PMC10593995 DOI: 10.18502/ijps.v18i4.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/26/2022] [Accepted: 12/19/2022] [Indexed: 10/27/2023]
Abstract
Objective: This study aimed to explore the aspects of emotional dysregulation (ED) and childhood trauma (CT) which are associated with suicide ideation (SI) and suicidal behaviour (SB) severity in depressive female adolescents who previously attempted suicide. Method : In this cross-sectional study, we evaluated SI and SB severity. The Columbia-Suicide Severity Rating Scale (C-SSRS) was administered to 80 depressive female patients who had suicide attempts within the last month. Current suicide ideation (C-SI) and total score (C-TS), lifetime- suicide ideation (L-SI), and total score (L-TS) were obtained with the C-SSRS. Patients were recruited from five different provinces in Turkey. Additionally, the patients completed the Difficulties in Emotion Regulation Scale (DERS), Childhood Trauma Questionnaire (CTQ), and Beck Depression Inventory (BDI). The Pearson correlation test and a multiple linear regression analysis were used to determine variables predictive of suicide scores. Results: The results of multiple linear regression analysis indicated that the BDI and DERS - total scores explained 35% (adjusted R) of the variance in C-SI ((F (2;67) = 19.61, P < 0.001). C-TS was explained by 'BDI,' 'emotional neglect' and 'DERS impulse' (38% (adjusted R) (F (3;66) = 15.15, P < 0.001). L-SI was only associated with DERS strategies (explains 13% (adjusted R) of the variance in L-SI (F (1;68) = 10.411, P = 0.02). Concerning the C-SSRS L-TS, the DERS impulse and CTQ total accounted for 24% (adjusted R) of the variance (F (2;67) = 10.620, P < 0.001). Conclusion: The results of our study suggest that adolescents who have experienced emotional neglect and depressive symptoms are more at risk for suicidal ideation and behaviour. In addition, depressed adolescents who show impulsive behaviours and restricted emotional strategies are also at risk. Identifying neglected depressed adolescents and teaching impulse control and effective emotional strategies is important for the prevention of suicidal behaviours and thoughts.
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Affiliation(s)
- Binay Kayan Ocakoğlu
- Clinic of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Helin Yılmaz Kafalı
- Ministry of Health Ankara City Hospital Child and Adolescent Psychiatry Department, Ankara, Turkey
| | - Fevzi Tuna Ocakoğlu
- İstanbul Private French Lape Hospital Child and Adolescent Psychiatry Clinic, Istanbul, Turkey
| | - Burcu Kardaş
- Kocaeli University Faculty of Medicine Child and Adolescent Psychiatry Department, Kocaeli, Turkey
| | - Ömer Kardaş
- Kocaeli University Faculty of Medicine Child and Adolescent Psychiatry Department, Kocaeli, Turkey
| | - Adem Işık
- Van Regional Training and Research Hospital, Van, Turkey
| | | | - Serap Akpınar
- Ministry of Health Ankara City Hospital Child and Adolescent Psychiatry Department, Ankara, Turkey
| | | | - Yeliz Balca
- Diyarbakır Child Diseases Hospital Child and Adolescent Psychiatry Clinic, Diyarbakır, Turkey
| | - Çiğdem Yektaş
- Uskudar University Child and Adolescent Psychiatry Department, Istanbul, Turkey
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Szmajda R, Mokros Ł, Szmajda-Krygier D, Gmitrowicz A. Factors associated with suicide attempt risk in adolescent inpatient psychiatric care: toward a practical model. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02272-y. [PMID: 37668697 DOI: 10.1007/s00787-023-02272-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/29/2023] [Indexed: 09/06/2023]
Abstract
Suicide is an important social and medical problem, particularly among children and adolescents. The aim of the study was to determine the association of the psychiatric diagnosis and selected psychosocial factors with the risk of suicide attempts among patients of an adolescent psychiatric unit. A retrospective analysis was performed on a database of consecutive N = 1311 patients aged 13-18 years of the adolescent psychiatric ward. A hierarchical logistic regression analysis was performed to assess the predictive value of the main psychiatric diagnosis, for factors selected from the database to determine their influence on the relative risk of a suicide attempt. Primary diagnoses of mood disorders and emotional and behavioral disorders were associated with an increased risk of a current admission after a suicidal attempt, a history of past suicidal attempts and non-suicidal self-harm (NSSI). History of NSSI was associated with a fourfold increase probability of a suicide attempt. Truancy, sexual abuse, heartbreak and frequent conflicts were related to a rise in suicidal attempt risk. Learning difficulties were found to be linked to increased probability of suicidal attempt, but only among women. The current study confirms that the primary diagnosis, NSSI and well-recognized psychosocial factors (including family- and school-related factors) may prove useful in the assessment of suicidal risk among adolescents admitted to a psychiatric ward.
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Affiliation(s)
| | - Łukasz Mokros
- Institute of Psychiatry and Neurology, Warsaw, Poland
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Park JY, Ha J. Impact of emotional state and suicidal intentions on suicide attempts among Korean adolescents with household financial difficulties following the outbreak of COVID-19: A cross-sectional study. Medicine (Baltimore) 2023; 102:e34495. [PMID: 37565880 PMCID: PMC10419347 DOI: 10.1097/md.0000000000034495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
The recent prolonged coronavirus disease-2019 pandemic has brought an economic crisis to various households, leading to negative mental health such as depression, anxiety, traumatic distress, and suicide risk among adolescents. Adolescents with household financial difficulties due to the coronavirus disease-2019 pandemic show high suicidal tendencies and attempts such as suicidal ideation and plans, their suicidal ideation and plans increase the risk of suicide attempts in South Korea. The purpose of this study was to determine the effects of emotional state and suicidal tendencies on suicide attempts among adolescents with household financial difficulties in early pandemic. This was a secondary data analysis study using statistical data from the 16th (2020) Korea Youth Risk Behavior Web-based Survey. Among 54,948 who participated in the survey, 16,839 (30.6%) adolescents who had household financial difficulties were included in final analysis. Descriptive statistics, chi-squared test, and logistic regression analysis were conducted to analyze data. The strengthening the reporting of observational studies in epidemiology checklist was used for reporting this study. 16,839 adolescents (mean age 15.68 ± 1.76 years; 8709, 51.7% male) who experienced household financial difficulties in the prior year revealed 3 percent (508) had attempted suicide. Suicide attempts differed according to several characteristics and were significantly associated with sex, residence type, drinking experience, depressive mood, perceived happiness, suicidal ideation, and suicide planning. The findings indicate high-risk adolescents with household financial difficulties need a multi-dimensional safety network, suicide screening, and emotional interventions during the pandemic.
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Affiliation(s)
- Ju Young Park
- College of Nursing, Konyang University, Daejeon, Republic of Korea
| | - Jiyeon Ha
- College of Nursing, Research Institute of Nursing Science, Ajou University, Suwon-si, Republic of Korea
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9
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Jiang MM, Chen JN, Huang XC, Zhang YL, Zhang JB, Zhang JW. The Effect of Teacher Discrimination Behavior on Adolescent Suicidal Ideation: A Cross-Sectional Survey. Psychol Res Behav Manag 2023; 16:2667-2680. [PMID: 37485285 PMCID: PMC10361406 DOI: 10.2147/prbm.s420978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Suicidal ideation and suicidal behavior, as the most severe psychological and behavioral problems among adolescents, bring not only significant damage to individual social functioning but also cause enormous economic and social pressure, which will ultimately be detrimental to social development and social stability. This paper aimed to explore the potential relationship between teacher discrimination behavior, peer bullying victimization, anxiety disorders, and adolescent suicidal ideation based on the Vulnerability-Stress Model. Methods From September to November 2022, our research team surveyed 21,017 junior high school students from 12 secondary schools in ten cities in China. Mplus 8.3 software was used to analyze the pathways of teacher discrimination behavior on adolescent suicidal ideation. Results The results showed that teacher preference had a significant negative effect on suicidal ideation, and teacher prejudice significantly positively affected suicidal ideation. Mediation test results indicated that there were significant independent mediating effects of peer bullying victimization and anxiety disorders between teacher discrimination behavior and adolescents' suicidal ideation, as well as significant chain mediating effects. Conclusion Secondary school teachers should improve their self-quality and pay more attention to adolescents' suicidal ideation. Teachers are expected to put love into their education, respect and trust each student, and attend to their emotional needs unbiasedly. Educators should develop targeted prevention and intervention measures according to the actual situation of school bullying and also strengthen adolescents' life-value education to improve the psychological quality of adolescents and create a healthy campus atmosphere.
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Affiliation(s)
- Mao-Min Jiang
- School of Public Affairs, Xiamen University, Xiamen, People’s Republic of China
| | - Ji-Neng Chen
- Graduate School, St.Paul University Philippines, Tuguegarao, Philippines
| | - Xin-Cheng Huang
- School of Economics and Management, Beijing Institute of Graphic Communication, Beijing, People’s Republic of China
| | - Yi-Lin Zhang
- School of Humanities, Yangzhou University, Yangzhou, People’s Republic of China
| | - Jia-Bo Zhang
- School of Literature and Media, Lingnan Normal University, Zhanjiang, People’s Republic of China
| | - Jia-Wen Zhang
- School of Education, Silliman University, Dumaguete, 6200, Philippines
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10
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Wang T, Yao Z, Liu Q, Zhao J, Wang X, Wong JPH, Vahabi M, Jia C. The Mediating Effect of Stress between Extracurricular Activities and Suicidal Ideation in Chinese College Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3105. [PMID: 36833799 PMCID: PMC9963993 DOI: 10.3390/ijerph20043105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The objective of this study was to explore the relationship between extracurricular activities, stress, and suicidal ideation and to examine the mediating effect of stress between extracurricular activities and suicidal ideation in Chinese college students. METHOD A total of 6446 college students were surveyed with a web-based online data collection system using the self-made demographic questionnaire, Suicidal Behaviors Questionnaire-Revised (SBQ-R), and the 21-Item Depression Anxiety Stress Scales (DASS-21). SPSS 24.0 was used for descriptive statistics and correlation analysis, and the bootstrap method in the process procedure for SPSS Version 3.4.1 was used to construct the mediating effect model. RESULTS Gender, school grades, living area, and family income status were influencing factors for suicidal ideation, stress, and extracurricular activities. Extracurricular activities were negatively correlated with stress (r = -0.083, p < 0.001) and suicidal ideation (r = -0.039, p < 0.01). Extracurricular activities had no direct predictive effect on college students' suicidal ideation (c = -0.198, CI: -0.418, 0.023), while stress had a mediating effect between extracurricular activities and suicidal ideation; the indirect mediating effect was 0.159. CONCLUSIONS Extracurricular activities indirectly predict college students' suicidal ideation through stress. A variety of extracurricular activities can decrease the stress and suicidal ideation of college students and benefit their mental health.
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Affiliation(s)
- Tao Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University Center for Suicide Prevention Research, Shandong University, Jinan 250012, China
| | - Zhiying Yao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University Center for Suicide Prevention Research, Shandong University, Jinan 250012, China
| | - Qianqian Liu
- Student Counseling Center, Shandong University, Jinan 250012, China
| | - Jingjing Zhao
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Xinting Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University Center for Suicide Prevention Research, Shandong University, Jinan 250012, China
| | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON M5B 1Z5, Canada
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON M5B 1Z5, Canada
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University Center for Suicide Prevention Research, Shandong University, Jinan 250012, China
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11
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Yang Q, Hu YQ, Zeng ZH, Liu SJ, Wu T, Zhang GH. The Relationship of Family Functioning and Suicidal Ideation among Adolescents: The Mediating Role of Defeat and the Moderating Role of Meaning in Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15895. [PMID: 36497966 PMCID: PMC9740712 DOI: 10.3390/ijerph192315895] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To investigate the relationship between family functioning and suicidal ideation among adolescents. METHOD A total of 4515 junior and senior high school students were assessed using the Family APGAR, the Depressive Symptom Index-Suicidality Subscale, the Defeat Scale, and the Chinese Meaning in Life Questionnaire. RESULTS This study found pairwise correlations between suicidal ideation, family functioning, defeat, and meaning in life. Specifically, family functioning was an influencing factor of adolescent suicidal ideation, and defeat was a mediator of the relationship between family functioning and adolescent suicidal ideation; meaning in life was found to be a moderator of the first half of the mediation process by defeat, that is, it moderated the influence of family functioning on adolescent defeat. CONCLUSIONS This study demonstrated that the relationship between family functioning and adolescent suicidal ideation, as well as the influence of defeat and meaning in life on this relationship, constituted a moderated intermediary model. This finding has both theoretical and practical value for the implementation of a psychosocial model of adolescent suicide prevention and intervention.
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Affiliation(s)
- Qin Yang
- School of Education Science, Hunan Normal University, Changsha 410081, China
- School of Pre-School Education, Changsha Normal University, Changsha 410100, China
| | - Yi-Qiu Hu
- School of Education Science, Hunan Normal University, Changsha 410081, China
- School of Psychology, Hainan Normal University, Haikou 571158, China
| | - Zi-Hao Zeng
- School of Education Science, Hunan Normal University, Changsha 410081, China
| | - Shuang-Jin Liu
- School of Education Science, Hunan Normal University, Changsha 410081, China
| | - Tong Wu
- School of Education Science, Hunan Normal University, Changsha 410081, China
| | - Gang-Huai Zhang
- School of Pre-School Education, Changsha Normal University, Changsha 410100, China
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12
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Padovano M, Aromatario M, D’Errico S, Concato M, Manetti F, David MC, Scopetti M, Frati P, Fineschi V. Sodium Nitrite Intoxication and Death: Summarizing Evidence to Facilitate Diagnosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113996. [PMID: 36360874 PMCID: PMC9654862 DOI: 10.3390/ijerph192113996] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/16/2022] [Accepted: 10/24/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Over the years, forensic pathology has registered the spread of new methods of suicide, such as the ingestion of sodium nitrite. Sodium nitrite causes increased methemoglobin, resulting in systemic hypoxia, metabolic acidosis, and cyanosis. Since sodium nitrite is a preservative, the ingestion of foods containing an excessive amount of this substance can also cause acute intoxication up to death. The present review is aimed at guiding health professionals in the identification and management of sodium-nitrite-related intoxications and deaths. METHODS A systematic literature search was carried out on PubMed by following the PRISMA statement's criteria. A total of 35 studies with 132 cases were enrolled, and the data were cataloged in Microsoft Excel. To establish the causal correlation between sodium nitrite ingestion and death, the Naranjo Adverse Drug Reaction Probability Scale was used. RESULTS In addition to the small number of cases that have currently been published, the study demonstrated that there was a general methodological discrepancy in the diagnostic process. However, some interesting results have emerged, especially in post-mortem diagnostics. CONCLUSION Sodium-nitrite-related deaths represent a challenge for forensic pathologists; therefore, it is important to promptly recognize the essential features and perform the necessary and unrepeatable examinations for the correct diagnosis of the cause of death.
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Affiliation(s)
- Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Mariarosaria Aromatario
- Unit of Risk Management, Quality, and Accreditation, Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Stefano D’Errico
- Department of Medicine, Surgery and Health, University of Trieste, 34137 Trieste, Italy
| | - Monica Concato
- Department of Medicine, Surgery and Health, University of Trieste, 34137 Trieste, Italy
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Maria Chiara David
- Department of Public Security, Health Central Directorate, Research Center and Forensic Toxicology Laboratory, Ministry of the Interior, 00184 Rome, Italy
| | - Matteo Scopetti
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
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Khosravi M, Adibi A. STAIR Plus Narrative Therapy-Adolescent Version (SNT-A) in An 11-Year-Old Girl With PTSD and Suicidal Behaviors Following Rape/Sexual Assault: A Case Report. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:943-948. [PMID: 35958704 PMCID: PMC9360251 DOI: 10.1007/s40653-021-00430-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 06/15/2023]
Abstract
Rape/sexual assault can profoundly affect the physical, mental, and social well-being of victims. Post-traumatic stress disorder (PTSD) and suicide in rape/sexual assault survivors are significantly more frequent than the national prevalence of the condition, indicating that existing treatments require improvement. In this case report, we presented an 11-year-old Iranian girl with PTSD and suicidal behaviors following rape/sexual assault. We specifically focused on the process of helping the victim to develop effective coping skills and overcome the trauma through 16 weekly sessions of Skill Training in Affective and Interpersonal Regulation (STAIR) plus Narrative Therapy-Adolescent Version (SNT-A). During this therapeutic approach, the patient regained emotional control over the traumatic experience and made sense of the experience. Our findings revealed that SNT-A might be an effective intervention to reduce suicidal ideation among adolescent victims of rape/sexual assault. Nonetheless, further investigations in this field need to be carried out through randomized controlled trials.
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Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry and Clinical Psychology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Amir Adibi
- Department of Child and Adolescent Psychiatry, Ilam University of Medical Sciences, Ilam, Iran
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14
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洪 彬, 宋 戈, 刘 敏, 梁 楷, 沈 紫, 雷 雅, 刘 巧, 赵 莉. [Effect of Family Function on Suicide-Related Behaviors of Junior Middle School Students: The Mediating Effect of Depression]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2022; 53:866-871. [PMID: 36224690 PMCID: PMC10408806 DOI: 10.12182/20220960504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Indexed: 06/16/2023]
Abstract
Objective To examine the prevalence of suicide-related behaviors among junior middle school students, and to explore the mediating role of depression in the relationship between suicide-related behaviors and family function. Methods A total of 2572 junior middle school students from three middle schools in Chengdu were interviewed face-to-face by using suicide-related items from Youth Risk Behavior Surveillance System (YRBSS), Chinese Family Assessment Instrument (C-FAI), and Center for Epidemiologic Studies Depression Scale for Children (CES-DC). The mediating role of depression was analyzed with structural equation model. Results The prevalence of suicide-related behaviors was 26.01% among the respondents. The prevalence of suicide ideation, suicide plan and suicide attempt were 24.38%, 13.49% and 10.77%, respectively. Depression played a partial mediating role in how family function impacted on suicide-related behaviors, presenting a direct effect value of 0.170 (95% CI: 0.117-0.218, P<0.001) and an indirect effect value of 0.205 (95% CI: 0.176-0.234, P<0.001), with the mediating effect accounting for 54.67% of the total effect. Conclusion Poor family function may increase the risk of suicide-related behaviors, and this effect is produced mostly through the impact on children's mental health. Improving family function will not only improve children's psychological status, but also reduce suicide-related behaviors.
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Affiliation(s)
- 彬雪 洪
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 戈扬 宋
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 敏 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 楷利 梁
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 紫琼 沈
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 雅麟 雷
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 巧兰 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 莉 赵
- 四川大学华西公共卫生学院/四川大学华西第四医院 卫生政策与管理学系 (成都 610041)Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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15
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Schlump C, Thom J, Boender TS, Wagner B, Diercke M, Kocher T, Ullrich A, Grabenhenrich L, Greiner F, Zöllner R, Mauz E, Schranz M. [Using emergency department routine data for the surveillance of suicide attempts and psychiatric emergencies]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:30-39. [PMID: 34889967 PMCID: PMC8661829 DOI: 10.1007/s00103-021-03467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The occurrence of suicide attempts is a key indicator of the population's mental health and therefore belongs in the domain of Mental Health Surveillance at the Robert Koch Institute. No data source is currently being used systematically for the continuous observation of psychiatric emergencies (including suicide attempts) in Germany. Therefore, the use of routine data from emergency departments will be explored in this work. METHODS We included routine data from 12 emergency departments between 1 January 2018 and 28 March 2021. We developed syndrome definitions for suicide attempts, psychiatric emergencies based on combinations of chief complaints, and diagnoses from patients presenting with psychopathological symptoms. A descriptive analysis over time was presented and stratified by age and sex. RESULTS In total 1,516,883 emergency department attendances were included, among which we identified 5,133 cases (0.3%) as suicide attempts, 31,085 (2.1%) as psychiatric emergencies, and 34,230 (2.3%) as cases with psychiatric symptoms. Among psychiatric emergencies, 16.5% presented because of a suicide attempt. Of cases presenting with a suicide attempt, 53.4% were male and 20.2% were aged between 25 and 34 years. Cases identified by all 3 syndrome definitions and their temporal variations could be displayed over the entire observation period. CONCLUSION Syndromic surveillance using emergency department data indicates a potential for continuous surveillance of suicide attempts and psychiatric emergencies and provides a basis for further validation and analysis. The display of changes in real time extends the current research opportunities for psychiatric emergencies in Germany. Systematic surveillance of suicide attempts can contribute to evidence-based suicide prevention.
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Affiliation(s)
- Carmen Schlump
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Julia Thom
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - T Sonia Boender
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Birte Wagner
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Michaela Diercke
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Theresa Kocher
- Methodenentwicklung und Forschungsinfrastruktur, Robert Koch-Institut, Berlin, Deutschland
| | - Alexander Ullrich
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Linus Grabenhenrich
- Methodenentwicklung und Forschungsinfrastruktur, Robert Koch-Institut, Berlin, Deutschland
| | - Felix Greiner
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
- AKTIN-Notaufnahmeregister, Magdeburg/Aachen, Deutschland
| | | | - Elvira Mauz
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Madlen Schranz
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland.
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