Incidence and course of suicidal ideation and suicide attempts in the general population

OBJECTIVE

Suicidal ideation and suicide attempts are important indicators of extreme emotional distress. However, little is known about predictors of onset and course of suicidality in the general population. Our study tried to fill this gap by analyzing data from a prospectively followed community sample.

METHOD

Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a 3-wave cohort study in a representative sample (n = 4848) of the Dutch adult general population.

RESULTS

The 3-year incidence of suicidal ideation and suicide attempts was 2.7% and 0.9%, respectively. Predictors of first-onset suicidal ideation and suicide attempts were sociodemographic variables (especially the negative change in situation variables), life events, personal vulnerability indicators, and emotional (mood and anxiety) disorders. Comparison of the corresponding odds ratios and confidence intervals revealed that predictors for first-onset suicidal ideation and suicide attempts did not differ significantly. One of the strongest predictors of incident suicide attempts was previous suicidal ideation. Regarding the course of suicidal ideation, it was found that 31.3% still endorsed these thoughts and 7.4% reported having made a suicide attempt 2 years later.

CONCLUSIONS

Similar predictors were found for first-onset suicidal ideation and suicide attempts. This suggests that suicidal behaviours may be ordered on a continuum and have shared risk factors. While suicidal thoughts may be necessary for, they are not sufficient predictors of, suicidal acts. The course of suicidality in the general population can be characterized by a minority of people having suicidal experiences that develop over time with progressively increasing severity.

Family interventions and their effect on adolescent alcohol use in general populations; a meta-analysis of randomized controlled trials

AIMS

In order to quantify the effectiveness of family interventions in reducing adolescent drinking, we conducted a meta-analysis of randomized controlled trials.

METHODS

We searched the Cochrane Database of Systematic Reviews, ERIC (Educational Research Information Center), Medline and PsycInfo for studies published between 1995 and September 2006. Summary estimates (OR and Cohen's d) were derived from the difference in changed alcohol consumption between family intervention and control group. Random effect models were used to estimate the overall effect and heterogeneity among studies. Eighteen papers describing nine independent trials were eligible for inclusion in this meta-analysis.

RESULTS

The overall effect of family interventions in reducing alcohol initiation (OR: 0.71; 95% CI: 0.54, 0.94) and frequency of alcohol use (d: -0.25; 95% CI: -0.37, -0.12) show the success of these programs. There was heterogeneity between studies reporting on alcohol initiation (p-heterogeneity: <0.001; I2: 78.6%). Yet, the most successful interventions continued to be effective in reducing alcohol initiation even at 48 months follow-up (pooled estimate (OR): 0.53; 95% CI: 0.38, 0.75).

CONCLUSION

The results from this meta-analysis suggest that the overall effect of family interventions on adolescent alcohol use is small, yet consistent and effective even at 48 months.

Cannabis use and mental health in secondary school children. Findings from a Dutch survey

BACKGROUND

Cannabis use is associated with mental health problems, and young people in particular are at risk.

AIMS

To investigate the association between cannabis use and mental health in adolescence.

METHOD

Data from 5551 adolescents aged 12-16 years were drawn from the Dutch Health Behaviour in School-Aged Children school survey, carried out aspart of the international 2001 World Health Organization project.

RESULTS

After adjusting for confounding factors, cannabis use was linked to externalising problems (delinquent and aggressive behaviour) but not to internalising problems (withdrawn behaviour, somatic complaints and depression). An increasing frequency of use resulted in stronger links. No significant gender or age by cannabis interaction effects were found.

CONCLUSIONS

In a country with a liberal drug policy like The Netherlands, cannabis use is associated with aggression and delinquency, just as in other countries. Cannabis use was not associated with internalising problems. Alcohol use and regular smoking were strong confounding factors.

The association between arthritis and psychiatric disorders; results from a longitudinal population-based study

BACKGROUND

To disentangle cross-sectionally and longitudinally the relationship between arthritis and psychiatric disorders, and to examine the relationship between age and incidence of (1) any psychiatric disorder among respondents with and without arthritis and (2) arthritis among respondents with and without any psychiatric disorder.

METHODS

Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a nationally representative household survey with repeated measurements in 1996, 1997 and 1999. Self-report was used to ascertain arthritis. Psychiatric and substance use disorders were diagnosed with the WHO Composite International Diagnostic Interview.

RESULTS

Regarding the cross-sectional results, it was found that the strength of the association of arthritis with mood and anxiety disorders was similar [odds ratio (OR)=1.48, 95% confidence interval (CI)=1.09-1.99 and OR=1.42, 95% CI=1.11-1.81, respectively]. The longitudinal results showed that preexisting arthritis elevated the risk of developing any mood disorder (OR=1.94, 95% CI=1.23-3.07), whereas having any mood or any anxiety disorder did not predict new-onset arthritis. The incidence of any psychiatric disorder was significantly higher among younger persons (<45 years) with arthritis, compared to others in the same age category without arthritis.

CONCLUSIONS

Arthritis is associated with psychiatric disorders. The temporal relationship points to one direction: arthritis predicts new onset of psychiatric disorder (mood disorder) instead of the reverse. Especially younger people (<45 years) with arthritis are at risk of developing a psychiatric disorder. Screening and simultaneous treatment of comorbid mood disorder and arthritis are recommended as part of routine in primary care.

Choices and motivations of infertile couples

When couples are confronted with infertility they may choose among several options: medical help, adoption, fostering, alternative medicine and focusing on other life goals. The frequency of choices and motivations for these options were investigated among 131 infertile couples. Husbands and wives answered a structured questionnaire. The medical option was chosen in more than 80% of the cases. Also, this choice is made very quickly. Other options were considered at a later time, and chosen much later than the medical option. The most frequently mentioned motive for seeking help is the desire to have a child. This motive is reported in all forms of help seeking Motives for medical consultation are often seeking information, understanding the cause of infertility and physical complaints. Altruistic motives are rather important when considering adoption, and very important when considering foster-care.

Alcohol use and mental health in adolescents: interactions with age and gender-findings from the Dutch 2001 Health Behaviour in School-Aged Children survey

OBJECTIVE

This study examines the association between alcohol use and mental health in adolescence, specifically the interaction with age and gender.

METHOD

Data were derived from the 2001 Health Behaviour in School-Aged Children (HBSC) survey--a repeated cross-sectional study with a total of 5,730 students aged 12-16 years, carried out as part of the World Health Organization cross-national HBSC Project. A two-stage random sampling procedure was used. Written questionnaires were administered in classroom settings. These contained questions about alcohol and other drug use as well as sociodemographic and behavioral variables. In addition, the Youth Self-Report was used to assess mental health.

RESULTS

Weekly alcohol use among adolescents is related to less withdrawn behavior and more delinquent, aggressive behavior. Significant interactions between weekly alcohol use and age were found on both externalizing and internalizing problems, indicating a stronger association between weekly alcohol use and problems among younger adolescents. No interactions with gender were found.

CONCLUSIONS

Particularly at a young age, the weekly use of alcohol is associated with mental health problems. Regular alcohol use should alert parents and professionals that these adolescents might experience problems in other areas.

Parenting practices and adolescent risk behavior: rules on smoking and drinking also predict cannabis use and early sexual debut

Previous research has provided considerable support for idea that increased parental support and control are strong determinants of lower prevalence levels of adolescent risk behavior. Much less is known on the association between specific parenting practices, such as concrete rules with respect to smoking and drinking and adolescent risk behavior. The present paper examined whether such concrete parental rules (1) have an effect on the targeted behaviors and (2) predict other, frequently co-occurring, risk behaviors (i.e., cannabis use and early sexual intercourse). These hypotheses were tested in a nationally representative sample of 12- to 16-year-old adolescents in the Netherlands. We found that both types of rules were associated with a lower prevalence of the targeted behaviors (i.e., smoking and drinking). In addition, independent of adolescent smoking and drinking behaviors, parental rules on smoking predicted a lower prevalence of cannabis use and early sexual intercourse, and parental rules on alcohol use also predicted a lower prevalence of early sexual intercourse. This study showed that concrete parental rule setting is more strongly related to lower levels of risk behaviors in adolescents compared to the more general parenting practices (i.e., support and control). Additionally, the effects of such rules do not only apply to the targeted behavior but extend to related behaviors as well. These findings are relevant to the public health domain and suggest that a single intervention program that addresses a limited number of concrete parenting practices, in combination with traditional support and control practices, may be effective in reducing risk behaviors in adolescence.

Ethnic composition of schools affects episodic heavy drinking only in ethnic-minority students

AIMS

To investigate if school-related contextual factors (school alcohol policy and school ethnic composition) explain episodic heavy drinking by individual students, while taking individual-level variables into account.

DESIGN AND PARTICIPANTS

Data were derived from the 2003 Dutch National School Survey on Substance Use, a nationally representative cross-sectional study with a total of 7324 respondents aged 12-16 years.

METHODS

Student-level data were collected by written questionnaire administered in classroom settings, assessing alcohol and drug use as well as socio-demographic and behavioural variables. School-level data were gathered by written questionnaire completed by the school principal, assessing school policy on substance use and school compositional factors. The data were analysed using a multi-level logistic regression model.

FINDINGS

The study revealed an association between ethnic composition of the school and episodic heavy drinking: a relatively high percentage of ethnic minorities (10-30%) at the school was associated with a lower probability of episodic heavy drinking, but only in interaction with individual-level ethnicity. Thus, ethnic-minority students attending schools of high minority density had less risk of episodic heavy drinking (OR = 0.69, 95% CI: 0.47-1.00). None of the school policy factors was associated with episodic heavy drinking.

CONCLUSIONS

Within a school context, peer modelling and reinforcement mechanisms can affect individual students' alcohol use, but a certain level of identification with the group and the resulting social control may be necessary. School policy seems to have no impact on students' alcohol use, possibly because students are faced with these only during special events, including school parties and excursions.

Perception of diagnosis and openness of patients about infertility

The perception of the diagnosis of infertility and the openness of patients about infertility was investigated among 108 infertile couples. Husbands and wives answered a structured questionnaire. The perception of diagnosis was in 38% of the cases different from the medical diagnosis. Patients perceived the diagnosis of male infertility more frequently, and the diagnosis of female infertility less frequently, than these diagnoses were made. Also there are significant differences in the perception of diagnosis between husbands and wives. Among the respondents there is a tendency to ascribe the diagnosis of infertility to themselves. It is important that physicians make sure that the patients have understood the received information. Family and friends are in almost all cases informed about the infertility problem, colleagues and acquaintances in about 60% of the cases, neighbors in about 40% of the cases. The reaction to openness is positive. Husbands are less open about male infertility than about female infertility. A selective choice of confidants and a subtle way of conveying the information generally lead to a positive reaction to the disclosure of infertility.

Home-based alcohol prevention program for parents and children: A randomized controlled trial

Objective To evaluate the effectiveness of a home-based alcohol prevention program to delay initiation of alcohol use in children. Methods In 2011, a total of 1349 sixth-grade children (M=12.15, SD=0.47) and their mothers who could read and write Dutch were recruited from primary schools in the northern part of the Netherlands. They participated in a cluster randomized controlled trial with two conditions; (1) intervention group (5 modules which families received by mail every 4weeks over 5months), (2) control group (a factsheet information brochure). An independent statistician allocated the schools to the conditions (allocation ratio (1:1)). Participants and data-analyst were blind to randomization. The primary outcome was alcohol initiation. Results Of the participants, 680 were randomized to the intervention and 669 to the control condition. In the intervention condition (N=540) 5.4% of the children drank alcohol compared to 7.1% in the control condition (N=601). The difference was not significant (OR=.99, 95% CI=.96-1.02, p=52). Conclusion The present study showed no effects of 'In control: No alcohol!' on alcohol initiation. A critical evaluation of program design and content, and future studies in different target groups, are suggested. The trial is registered at trialregister.nl, number NTR2474.