Factors associated with high and low mental well-being in Spanish university students

BACKGROUND

Previous studies conducted in various nationally representative samples of the general population show that positive mental health is related to social prosperity. However, specific studies in university populations are scarce. In this study, we set out to explore factors associated with mental well-being (MWB) in a representative sample of first-year university students in Spain.

METHODS

MWB was assessed with the short version of the Warwick-Edinburgh Mental Well-Being Scale. Multinomial logistic regressions were performed to explore the association between different blocks of factors, including relational, adversity, stress, lifestyle, spiritual, health, and self-perceived health variables with high and low MWB, controlling for sociodemographic and university-related variables.

RESULTS

Data from 2082 students (18.6 ± 1.2 years; 56.6 % females) were analysed. Being male, being born in a foreign country, "high" self-perceived support, and "high" self-perceived mental health increased the odds of high MWB. Growing up in the suburbs, stressful experiences, and anxiety disorders reduced the odds of high MWB. Mood and anxiety disorders increased the odds of low MWB. "Middle" self-perceived support, sleeping ≥8 h per day, and "high" self-perceived mental health reduced the odds of low MWB.

LIMITATIONS

The cross-sectional design precludes establishing causal relationships. Data were collected in the 2014-15 academic year using self-reported online surveys.

CONCLUSION

The factors associated with high and low MWB do not always mirror each other, so specific plans are needed to successfully address each of the two poles. Interventions and policies targeting these factors for health promotion and disease prevention would improve the MWB of university students.

Experience sampling methods for the personalised prediction of mental health problems in Spanish university students: protocol for a survey-based observational study within the PROMES-U project

INTRODUCTION

There is a high prevalence of mental health problems among university students. Better prediction and treatment access for this population is needed. In recent years, short-term dynamic factors, which can be assessed using experience sampling methods (ESM), have presented promising results for predicting mental health problems.

METHODS AND ANALYSIS

Undergraduate students from five public universities in Spain are recruited to participate in two web-based surveys (at baseline and at 12-month follow-up). A subgroup of baseline participants is recruited through quota sampling to participate in a 15-day ESM study. The baseline survey collects information regarding distal risk factors, while the ESM study collects short-term dynamic factors such as affect, company or environment. Risk factors will be identified at an individual and population level using logistic regressions and population attributable risk proportions, respectively. Machine learning techniques will be used to develop predictive models for mental health problems. Dynamic structural equation modelling and multilevel mixed-effects models will be considered to develop a series of explanatory models for the occurrence of mental health problems.

ETHICS AND DISSEMINATION

The project complies with national and international regulations, including the Declaration of Helsinki and the Code of Ethics, and has been approved by the IRB Parc de Salut Mar (2020/9198/I) and corresponding IRBs of all participating universities. All respondents are given information regarding access mental health services within their university and region. Individuals with positive responses on suicide items receive a specific alert with indications for consulting with a health professional. Participants are asked to provide informed consent separately for the web-based surveys and for the ESM study. Dissemination of results will include peer-reviewed scientific articles and participation in scientific congresses, reports with recommendations for universities' mental health policy makers, as well as a well-balanced communication strategy to the general public.

STUDY REGISTRATION

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Let's Talk About Suicide Spectrum in Spanish Adolescents. "Prefer not to say": Missing Value or Clinical Data?

BACKGROUND

Suicide is the second leading cause of death in young people aged 15-29 in Spain. It is imperative to detect cases with suicidal risk for early intervention. The purpose of the study was to examine the self-reported presence of suicide spectrum indicators using a trichotomous rating scale: no, yes, prefer not to say . This last alternative was intended to safeguard the sensitive nature of the phenomenon and explore its clinical character.

METHOD

5,528 adolescents made up the definitive sample (12-18 years; M ± SD = 14.20 ± 1.53; 50.74% female).

RESULTS

Prevalence reached 15.38% for ideation, 9.32% for planning, and 3.65% for previous suicide attempts. Girls’ rates were twice those of men. Suicidality showed a tendency to increase with age. Adolescents with the presence of suicidal indicators (yes) and omission of response (prefer not to say) both had lower levels of socioemotional strength and subjective well-being, and higher levels of psychopathology than the group with the absence of markers (no).

CONCLUSIONS

Prefer not to say is a response category that increases the sensitivity of the self-report, allowing more accurate identification of cases with a high suicidal risk that would go unnoticed by the traditional dichotomous system (no-yes).

Civic Engagement and Personality: Associations with the Big Five and the Dark Triad

Several studies have analyzed the relationship between general personality traits and attitudes and behaviors, indicating that a person is more committed to the community. After raising the question of whether malevolent traits might also be related, the aim was to analyze the relationship between civic engagement and personality, delving into the contribution of the Dark Triad (narcissism, Machiavellianism, and psychopathy) and controlling for the association with the Big Five. The Civic Engagement Questionnaire, the Short Dark Triad, and the Big Five Inventory-10 were administered to 1175 Spanish students (convenience sampling). After performing statistical analyses using SPSS statistical software, it was obtained that the three Dark Triad traits explained 11% of the total explained variance of civic engagement, while 19% was reached when the Big Five were included. Narcissism and openness were the factors most strongly associated with engagement. The positive relationship between narcissism and general personality traits could explain why narcissistic people have more favorable attitudes. Furthermore, people with narcissistic traits may display these attitudes for their own benefit. This study provides further evidence of how the narcissistic personality trait differs from the other two malevolent traits. Given that these traits are also associated with maladaptive behaviors, knowing all their characteristics could facilitate the design of prevention programs aimed at reducing such maladaptive behaviors.

Intervenciones cognitivo-conductuales para reducir conductas autolesivas en niños y jóvenes con TEA: Una revisión sistemática

Cognitive-behavioural interventions to decrease self-injurious behaviours in children and young people with ASD: A Systematic Review. Self-injurious behaviours in children and young people with Autism Spectrum Disorder (ASD) imply risks to their physical integrity and affect their quality of life and that of their families. In addition, they hinder their integration into the school and social environments, this being limited by the characteristics of this type of disorder. Although there is little information about self-harm in this population, in general it has been seen that the greater the affectation and the lower the cognitive level, the more prevalent self-injurious behaviours are. The aim of this study was to review the efficacy of cognitive-behavioral interventions for the reduction of self-injurious behaviors in children and youth with ASD. For it, we searched PsycINFO, Scopus and Google Scholar. The review included studies in English or Spanish languages on cognitive-behavioral interventions to reduce self-injurious behaviors in children and youth with ASD; with samples consisting of individuals with ASD between 1 and 30 years of age presenting self-injurious behaviors; and conducted between 1970 and 2022. Of the 228 studies identified, only 7 met the inclusion criteria. The included studies included participants between the ages of 3 and 26 years diagnosed with ASD and were published between 1974 and 2015, evidencing the efficacy of cognitive-behavioral interventions. Although these studies show positive post-intervention results, they are scarce in number. Further research is therefore needed on the effectiveness of behavioural and cognitive interventions to reduce self-injurious behaviours in children and young people with ASD

Predictive models for first-onset and persistence of depression and anxiety among university students

BACKGROUND

Depression and anxiety are both prevalent among university students. They frequently co-occur and share risk factors. Yet few studies have focused on identifying students at highest risk of first-onset and persistence of either of these conditions.

METHODS

Multicenter cohort study among Spanish first-year university students. At baseline, students were assessed for lifetime and 12-month Major Depressive Episode and/or Generalized Anxiety Disorder (MDE-GAD), other mental disorders, childhood-adolescent adversities, stressful life events, social support, socio-demographics, and psychological factors using web-based surveys; 12-month MDE-GAD was again assessed at 12-month follow-up.

RESULTS

A total of 1253 students participated in both surveys (59.2% of baseline respondents; mean age = 18.7 (SD = 1.3); 56.0% female). First-onset of MDE-GAD at follow-up was 13.3%. Also 46.7% of those with baseline MDE-GAD showed persistence at follow-up. Childhood/Adolescence emotional abuse or neglect (OR= 4.33), prior bipolar spectrum disorder (OR= 4.34), prior suicidal ideation (OR=4.85) and prior lifetime symptoms of MDE (ORs=2.33-3.63) and GAD (ORs=2.15-3.75) were strongest predictors of first-onset MDE-GAD. Prior suicidal ideation (OR=3.17) and prior lifetime GAD symptoms (ORs=2.38-4.02) were strongest predictors of MDE-GAD persistence. Multivariable predictions from baseline showed AUCs of 0.76 for first-onset and 0.81 for persistence. 74.9% of first-onset MDE-GAD cases occurred among 30% students with highest predicted risk at baseline.

LIMITATIONS

Self-report data were used; external validation of the multivariable prediction models is needed.

CONCLUSION

MDE-GAD among university students is frequent, suggesting the need to implement web-based screening at university entrance that identify those students with highest risk.

Validation of an Online Version of the Alcohol Use Disorders Identification Test (AUDIT) for Alcohol Screening in Spanish University Students

Online alcohol screening may be helpful in preventing alcohol use disorders. We assessed psychometric properties of an online version of the Alcohol Use Disorders Identification Test (AUDIT) among Spanish university students. We used a longitudinal online survey (the UNIVERSAL project) of first-year students (18-24 years old) in five universities, including the AUDIT, as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. A reappraisal interview was carried out with the Timeline Followback (TLFB) for alcohol consumption categories and the Mini International Neuropsychiatric Interview (MINI) for alcohol use disorder. Reliability, construct validity and diagnostic accuracy were assessed. Results: 287 students (75% women) completed the MINI, of whom 242 also completed the TLFB. AUDIT's Cronbach's alpha was 0.82. The confirmatory factor analysis for the one-factor solution of the AUDIT showed a good fit to the data. Significant AUDIT score differences were observed by TLFB categories and by MINI disorders. Areas under the curve (AUC) were very large for dependence (AUC = 0.96) and adequate for consumption categories (AUC > 0.7). AUDIT cut-off points of 6/8 (women/men) for moderate-risk drinking and 13 for alcohol dependence showed sensitivity/specificity of 76.2%/78.9% and 56%/97.5%, respectively. The online version of the AUDIT is useful for detecting alcohol consumption categories and alcohol dependence in Spanish university students.

Mental disorders in Spanish university students: Prevalence, age-of-onset, severe role impairment and mental health treatment

BACKGROUND

The university period carries risk for onset of common mental disorders. Epidemiological knowledge on mental disorders among Spanish university students is limited.

AIMS

To estimate lifetime and 12-month prevalence, persistence and age-of-onset of mental disorders among Spanish first-year university students, as well as associated role impairment and mental health treatment use.

METHODS

First-year university students (N=2,118; 55.4% female; mean age=18.8 years) from five Spanish universities completed a web-based survey, screening possible DSM-IV mental disorders (major depressive episode(MDE), mania/hypomania, generalized anxiety disorder(GAD), panic disorder(PD), alcohol abuse/dependence(AUD), drug abuse/dependence(DUD), and adult attention-deficit/hyperactivity disorder(ADHD)). Role impairment and treatment associated with mental disorders were assessed.

RESULTS

Lifetime and 12-month prevalence of any possible mental disorder was 41.3%(SE=1.08) and 35.7%(SE=1.05), respectively. Persistence (i.e., ratio of 12-month to lifetime prevalence) was 86.4%(SE=1.58). Median age-of-onset was 14 for adult ADHD, 15 for mood disorders and AUD, and 16 for anxiety disorders and DUD. One third (29.2%) of 12-month disorders were associated with role impairment. Twelve-month PD (OR=4.0;95%CI=1.9-8.5) had the highest odds for role impairment. Only 12.6% of students with 12-month disorder received any mental health treatment. Twelve-month treatment was the highest among those students with 12-month GAD (OR=7.4;95%CI=3.7-14.8).

LIMITATIONS

The assessment of mental disorders was based on self-reports. Cross-sectional nature of the data prevents causal associations.

CONCLUSION

One third of Spanish university students report a common mental disorder in the past year, and one third of those report severe role impairment. Only one out of eight students with 12-month mental disorders receives mental health treatment.

Strengths Against Psychopathology in Adolescents: Ratifying the Robust Buffer Role of Trait Emotional Intelligence

The aim of this study was to unravel the interrelated effects of trait emotional intelligence (Trait EI), mindfulness, and irrational beliefs on adolescent mental health. A random sample of students from three secondary schools in Spain and eight secondary schools in Portugal was recruited. We conducted four-step hierarchical regression analyses. We also conducted regression analyses to examine the role of mindfulness skills and catastrophizing as mediators of the link between emotional intelligence and psychosocial problems. Finally, the SPSS PROCESS computing tool was used to perform conditional process analysis (model 6). A total of 1370 adolescents from Spain (n = 591) and Portugal (n = 779) participated in this study (mean age = 14.97, SD = 1.50; range = 12-18). The mediation analyses confirmed that adolescent mental health was determined by Trait EI directly, and by mindfulness skills and catastrophizing thoughts in an indirect way. Together, the four variables explained 44% of psychopathology, with EI being the most powerful predictor, which ratify the robust buffer role and incremental validity of Trait EI against youth mental health. The identified pathways provide keys for emotional education interventions aimed at promoting adolescent mental health.

Self-esteem and suicidal behaviour in youth: A meta-analysis of longitudinal studies

BACKGROUND

Previous literature suggests that low self-esteem is a risk factor for suicide attempts, but no meta-analyses have been conducted to assess this association in adolescents/young adults. The present study examined the relationship between low self-esteem and suicide attempts in young people (12-26 years old).

METHOD

Meta-analyses were performed using random-effects models (ES) and odds ratio (OR). Heterogeneity and sensitivity analyses were performed.

RESULTS

From 26,883 initial titles, 22 studies met the inclusion criteria, of which 9 studies had data that could be included in the meta-analysis. The meta-analysis showed that youths with lower self-esteem were more likely to have future suicide attempts, with an effect size (self-esteem as continuous variable) of d = .58 (95% CI = .44 - .73) and, for low self-esteem (categorical variable) an OR = 1.99 (95% CI = 1.39-2.86; p < .001).

CONCLUSION

A low level of self-esteem is a risk factor for suicide attempts in adolescents/young adults.

Gender commonalities and differences in risk and protective factors of suicidal thoughts and behaviors: A cross-sectional study of Spanish university students

AIM

To assess gender differences in the association between risk/protective factors and suicidal thoughts and behaviors (STB); and whether there is any gender-interaction with those factors and STB; among Spanish university students.

METHODS

Data from baseline online survey of UNIVERSAL project, a multicenter, observational study of first-year Spanish university students (18-24 years). We assessed STB; lifetime and 12-month negative life-events and family adversities; mental disorders; personal and community factors. Gender-specific regression models and gender-interactions were also analyzed.

RESULTS

We included 2,105 students, 55.4% women. Twelve-month prevalence of suicidal ideation (SI) was 10%, plans 5.7%, attempts 0.6%. Statistically significant gender-interactions were found for lifetime anxiety disorder, hopelessness, violence between parents, chronic health conditions and family support. Lifetime mood disorder was a common risk factor of SI for both genders (Females: OR= 5.5; 95%CI 3.3-9.3; Males: OR= 4.4; 95%CI 2.0-9.7). For females, exposure to violence between parents (OR= 3.5; 95%CI 1.7-7.2), anxiety disorder (OR= 2.7; 95%CI 1.6-4.6), and alcohol/substance disorder (OR= 2.1; 95%CI 1.1-4.3); and for males, physical childhood maltreatment (OR= 3.6; 95%CI 1.4-9.2), deceased parents (OR= 4.6; 95%CI 1.2-17.7), and hopelessness (OR= 7.7; 95%CI 2.8-21.2), increased SI risk. Family support (OR= 0.5; 95%CI 0.2-0.9) and peers/others support (OR= 0.4; 95%CI 0.2-0.8) were associated to a lower SI risk only among females.

CONCLUSIONS

Only mood disorder was a common risk factor of SI for both genders, whereas important gender-differences were observed regarding the other factors assessed. The protective effect from family and peers/others support was observed only among females. Further research assessing underlying mechanisms and pathways of gender-differences is needed.

Accuracy of online survey assessment of mental disorders and suicidal thoughts and behaviors in Spanish university students. Results of the WHO World Mental Health- International College Student initiative

Objective

To assess the accuracy of WMH-ICS online screening scales for evaluating four common mental disorders (Major Depressive Episode[MDE], Mania/Hypomania[M/H], Panic Disorder[PD], Generalized Anxiety Disorder[GAD]) and suicidal thoughts and behaviors[STB] used in the UNIVERSAL project.

Methods

Clinical diagnostic reappraisal was carried out on a subsample of the UNIVERSAL project, a longitudinal online survey of first year Spanish students (18–24 years old), part of the WHO World Mental Health-International College Student (WMH-ICS) initiative. Lifetime and 12-month prevalence of MDE, M/H, PD, GAD and STB were assessed with the Composite International Diagnostic Interview-Screening Scales [CIDI-SC], the Self-Injurious Thoughts and Behaviors Interview [SITBI] and the Columbia-Suicide Severity Rating Scale [C-SSRS]. Trained clinical psychologists, blinded to responses in the initial survey, administered via telephone the Mini-International Neuropsychiatric Interview [MINI]. Measures of diagnostic accuracy and McNemar χ² test were calculated. Sensitivity analyses were conducted to maximize diagnostic capacity.

Results

A total of 287 students were included in the clinical reappraisal study. For 12-month and lifetime mood disorders, sensitivity/specificity were 67%/88.6% and 65%/73.3%, respectively. For 12-month and lifetime anxiety disorders, these were 76.8%/86.5% and 59.6%/71.1%, and for 12-month and lifetime STB, 75.9%/94.8% and 87.2%/86.3%. For 12-month and lifetime mood disorders, anxiety disorders and STB, positive predictive values were in the range of 18.1–55.1% and negative predictive values 90.2–99.0%; likelihood ratios positive were in the range of 2.1–14.6 and likelihood ratios negative 0.1–0.6. All outcomes showed adequate areas under the curve [AUCs] (AUC>0.7), except M/H and PD (AUC = 0.6). Post hoc analyses to select optimal diagnostic thresholds led to improved concordance for all diagnoses (AUCs>0.8).

Conclusion

The WMS-ICS survey showed reasonable concordance with the MINI telephone interviews performed by mental health professionals, when utilizing optimized cut-off scores. The current study provides initial evidence that the WMS-ICS survey might be useful for screening purposes.

What is the Role of Internalizing and Externalizing Symptoms in Adolescent Suicide Behaviors?

Suicide is the second leading cause of death in adolescents and young adults aged 15 to 29 years. Specifically, the presence of internalizing and externalizing symptomatology is related to increased risk for suicide at these ages. Few studies have analyzed the relations between these symptoms and their role as mediators in predicting suicide behavior. This study aimed to examine the relation between internalizing and externalizing symptomatology and suicide behaviors through a longitudinal study. The sample consisted of 238 adolescents aged 12 to 18 years. The data were analyzed via the PROCESS Statistical Package. The main results showed that previous depression symptoms had a significant indirect effect, through previous suicide behaviors and current depression symptoms, on current suicide behaviors, accounting for 61% of the total variance explained. Additionally, being a girl increased this risk. Therefore, the implementation of early identification and intervention programs to address youth symptoms of depression and suicidal behaviors could significantly reduce the risk for future suicidal behaviors in adolescence.

Internalizing and externalizing symptoms and suicidal behaviour in young people: a systematic review and meta-analysis of longitudinal studies

OBJECTIVE

To assess internalizing and externalizing symptoms as risk factors for suicidal behaviour and suicide among adolescents and young adults.

METHOD

We conducted a systematic review of articles published until January 2017. We identified 26 883 potential papers; 1701 full-text articles were assessed for eligibility, of which 1479 were excluded because of methodological reasons. Diverse meta-analyses were performed for each group of symptoms. Odds ratios (ORs) and 95% confidence intervals (95% CI) or beta coefficients for categorical variables, and effect size (ES) were calculated for continuous variables.

RESULTS

Finally, 41 studies were included, involving participants aged 12-26 years for a systematic review, and 24 articles were included for meta-analysis. The meta-analysis showed that youths with any internalizing (ES = 0.93) or externalizing symptoms (ES = 0.76 and OR = 2.59) were more likely to attempt suicide in future. This effect was also seen in depression symptoms (OR = 6.58 and ES = 1.00), legal problems (OR = 3.36), and anxiety (ES = 0.65).

CONCLUSION

Reported internalizing and externalizing symptoms are predictors of suicide behaviour in young people; therefore, the detection and management of these symptoms in young populations could be a crucial strategy for preventing suicidality in this group.

Suicidal Thoughts and Behaviors: Prevalence and Association with Distal and Proximal Factors in Spanish University Students

OBJECTIVE

We report on the prevalence of suicidal thoughts and behaviors in Spanish university students and their risk and protective factors (distal/proximal; individual/environmental).

METHODS

First-year university students completed an online survey including Self-Injurious Thoughts and Behaviors Interview (SITBI) items, the screening version of the Columbia-Suicide Severity Rating Scale (C-SSRS) along with adversities and positive relationships during childhood/adolescence, recent stressful experiences, and lifetime mental disorders. Nested logistic regression models were estimated and areas under the curve (AUC) compared.

RESULTS

A total of 2,118 students completed the survey (mean age = 18.8 [SD = 1.4] years; 55.4% female). Twelve-month prevalence of suicide ideation (SI) was 9.9%, plans, 5.6%, and attempts, 0.6%. Risk factors of 12-month SI were as follows: parental psychopathology (OR = 1.7, 95% CI 1.2-2.5); sexual assault (OR = 5.6, 95% CI 1.4-22.1); lifetime mood disorder (OR = 5.2, 95% CI 3.5-7.7); and lifetime anxiety disorder (OR = 1.7, 95% CI: 1.1-2.5). Childhood positive relationships protected from SI were as follows: peers/others (OR = 0.6, 95% CI 0.4-0.9 for the second highest tertile) and family (OR = 0.4, 95% CI 0.3-0.7 for the highest tertile). AUC of the final model was 0.82 (SE = 0.015).

CONCLUSION

Our results indicate a high prevalence of SI among Spanish university students and identify protective and risk factors from a comprehensive conceptual model.

Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies

OBJECTIVES

To assess the association between gender and suicide attempt/death and identify gender-specific risk/protective factors in adolescents/young adults.

METHODS

Systematic review (5 databases until January 2017). Population-based longitudinal studies considering non-clinical populations, aged 12-26 years, assessing associations between gender and suicide attempts/death, or evaluating their gender risk/protective factors, were included. Random effect meta-analyses were performed.

RESULTS

Sixty-seven studies were included. Females presented higher risk of suicide attempt (OR 1.96, 95% CI 1.54-2.50), and males for suicide death (HR 2.50, 95% CI 1.8-3.6). Common risk factors of suicidal behaviors for both genders are previous mental or substance abuse disorder and exposure to interpersonal violence. Female-specific risk factors for suicide attempts are eating disorder, posttraumatic stress disorder, bipolar disorder, being victim of dating violence, depressive symptoms, interpersonal problems and previous abortion. Male-specific risk factors for suicide attempt are disruptive behavior/conduct problems, hopelessness, parental separation/divorce, friend's suicidal behavior, and access to means. Male-specific risk factors for suicide death are drug abuse, externalizing disorders, and access to means. For females, no risk factors for suicide death were studied.

CONCLUSIONS

More evidence about female-specific risk/protective factors of suicide death, for adolescent/young adults, is needed.

Sexual orientation and suicidal behaviour in adolescents and young adults: systematic review and meta-analysis

BackgroundResearch suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.AimsTo assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.MethodA systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.ResultsSexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.ConclusionsSexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.

Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis

BACKGROUND

Adolescents with previous self-injurious thoughts and behaviors (SITB) have over 2-fold risk of dying by suicide, higher than older ages. This meta-analysis aims to disentangle the association of each SITB with subsequent suicidal behavior in adolescence/young adulthood, the contribution of each SITB, and the proportion of suicide deaths with no previous suicide attempt.

METHODS

We searched 6 databases until June 2015.

INCLUSION CRITERIA

1. Assessment of any previous SITB [a) suicidal thoughts and behaviors (ideation; threat/gesture; plan; attempt); b) non-suicidal thoughts and behaviors (thoughts; threat/gesture; self-injury); c) self-harm] as a risk factor of suicide attempt or suicide death; 2. Case-control or cohort studies; 3. Subjects aged 12-26y. Random effect models, metaregression analyses including mental health and environmental variables, and population attributable risks (PAR)s were estimated.

RESULTS

From 23,682 potentially eligible articles, 29 were included in the meta-analysis (1,122,054 individuals). While 68% of all youth suicide deaths had no previous suicide attempt, suicide death was very strongly associated with any previous SITB (OR=22.53, 95%CI: 18.40-27.58). Suicide attempts were also associated with a history of previous SITB (OR=3.48, 95%CI: 2.71-4.43). There were no moderating effects for mental health and environmental features. The PAR of previous SITB to suicide attempts is 26%.

LIMITATIONS

There is considerable heterogeneity between the available studies. Due to limitations in the original studies, an over-estimation of the proportion dying at their first attempt cannot be ruled out, since they might have missed unrecognized previous suicide attempts.

CONCLUSIONS

Although more than two thirds of suicide deaths in adolescence/young adulthood have occurred with no previous suicidal behavior, previous SITBs have a much higher risk of dying by suicide than previously reported in this age group.

Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies

OBJECTIVE

To assess the association and magnitude of the effect of early exposure to different types of interpersonal violence (IPV) with suicide attempt and suicide death in youths and young adults.

METHOD

We searched six databases until June 2015. Inclusion criteria were as follows: (1) assessment of any type of IPV as risk factor of suicide attempt or suicide: (i) child maltreatment [childhood physical, sexual, emotional abuse, neglect], (ii) bullying, (iii) dating violence, and (iv) community violence; (2) population-based case-control or cohort studies; and (3) subjects aged 12-26 years. Random models were used for meta-analyses (Reg: CRD42013005775).

RESULTS

From 23 682 articles, 29 articles with 143 730 subjects for meta-analyses were included. For victims of any IPV, OR of subsequent suicide attempt was 1.99 (95% CI: 1.73-2.28); for child maltreatment, 2.25 (95% CI: 1.85-2.73); for bullying, 2.39 (95% CI: 1.89-3.01); for dating violence, 1.65 (95% CI: 1.40-1.94); and for community violence, 1.48 (95% CI: 1.16-1.87). Young victims of IPV had an OR of suicide death of 10.57 (95% CI: 4.46-25.07).

CONCLUSION

Early exposure to IPV confers a risk of suicide attempts and particularly suicide death in youths and young adults. Future research should address the effectiveness of preventing and detecting early any type of IPV exposure in early ages.