A systematic review of psychosocial suicide prevention interventions for youth

Youth suicide is a significant public health problem. A systematic review was conducted to examine the effectiveness of school, community and healthcare-based interventions in reducing and preventing suicidal ideation, suicide attempts and deliberate self-harm in young people aged 12–25 years. PsycInfo, PubMed and Cochrane databases were searched to the end of December 2014 to identify randomised controlled trials evaluating the effectiveness of psychosocial interventions for youth suicide. In total, 13,747 abstracts were identified and screened for inclusion in a larger database. Of these, 29 papers describing 28 trials fulfilled the inclusion criteria for the current review. The results of the review indicated that just over half of the programs identified had a significant effect on suicidal ideation (Cohen’s d = 0.16–3.01), suicide attempts (phi = 0.04–0.38) or deliberate self-harm (phi = 0.29–0.33; d = 0.42). The current review provides preliminary support for the implementation of universal and targeted interventions in all settings, using a diverse range of psychosocial approaches. Further quality research is needed to strengthen the evidence-base for suicide prevention programs in this population. In particular, the development of universal school-based interventions is promising given the potential reach of such an approach.     

The role of randomized trials in testing interventions for the prevention of youth suicide

Epidemiological considerations point to a small handful of prevention strategies that have the potential for dramatically reducing suicide rates. Nearly all of those prevention approaches involve population-based strategies to either find an increased number of individuals at high risk for suicide or to reduce the prevalence of risk factors in members of a population that, as a whole, has a relatively low rate of suicide. Few of these approaches have been evaluated in rigorous trials. We argue that there are rigorous randomized trial designs that are both feasible and ethical and can be used to test both programmes and implementation strategies for population-based suicide prevention. We review existing suicide prevention trials and introduce two new randomized trial designs that are likely to achieve sufficient statistical power. The 'dynamic wait-listed design' randomizes across different time periods and is now being used to test a gatekeeper training programme in 32 schools. It could also be used to examine suicide prevention programmes in rural areas. The multi-trial follow-up study builds on the large number of successful population-based preventive interventions aimed at reducing known risk factors for suicide in youths to see whether these also cause a reduction in rates of completed suicide.     

The role of randomized trials in testing interventions for the prevention of youth suicide

Epidemiological considerations point to a small handful of prevention strategies that have the potential for dramatically reducing suicide rates. Nearly all of those prevention approaches involve population-based strategies to either find an increased number of individuals at high risk for suicide or to reduce the prevalence of risk factors in members of a population that, as a whole, has a relatively low rate of suicide. Few of these approaches have been evaluated in rigorous trials. We argue that there are rigorous randomized trial designs that are both feasible and ethical and can be used to test both programmes and implementation strategies for population-based suicide prevention. We review existing suicide prevention trials and introduce two new randomized trial designs that are likely to achieve sufficient statistical power. The ‘dynamic wait-listed design’ randomizes across different time periods and is now being used to test a gatekeeper training programme in 32 schools. It could also be used to examine suicide prevention programmes in rural areas. The multi-trial follow-up study builds on the large number of successful population-based preventive interventions aimed at reducing known risk factors for suicide in youths to see whether these also cause a reduction in rates of completed suicide.     

Early interventions for youths at high risk for bipolar disorder: a developmental approach

In recent decades, ongoing research programmes on primary prevention and early identification of bipolar disorder (BD) have been developed. The aim of this article is to review the principal forms of evidence that support preventive interventions for BD in children and adolescents and the main challenges associated with these programmes. We performed a literature review of the main computerised databases (MEDLINE, PUBMED) and a manual search of the literature relevant to prospective and retrospective studies of prodromal symptoms, premorbid stages, risk factors, and early intervention programmes for BD. Genetic and environmental risk factors of BD were identified. Most of the algorithms used to measure the risk of developing BD and the early interventions programmes focused on the familial risk. The prodromal signs varied greatly and were age dependent. During adolescence, depressive episodes associated with genetic or environmental risk factors predicted the onset of hypomanic/manic episodes over subsequent years. In prepubertal children, the lack of specificity of clinical markers and difficulties in mood assessment were seen as impeding preventive interventions at these ages. Despite encouraging results, biomarkers have not thus far been sufficiently validated in youth samples to serve as screening tools for prevention. Additional longitudinal studies in youths at high risk of developing BD should include repeated measures of putative biomarkers. Staging models have been developed as an integrative approach to specify the individual level of risk based on clinical (e.g. prodromal symptoms and familial history of BD) and non-clinical (e.g. biomarkers and neuroimaging) data. However, there is still a lack of empirically validated studies that measure the benefits of using these models to design preventive intervention programmes.     

Youth suicide risk and preventive interventions: a review of the past 10 years

OBJECTIVE: To review critically the past 10 years of research on youth suicide. METHOD: Research literature on youth suicide was reviewed following a systematic search of PsycINFO and Medline. The search for school-based suicide prevention programs was expanded using two education databases: ERIC and Education Full Text. Finally, manual reviews of articles' reference lists identified additional studies. The review focuses on epidemiology, risk factors, prevention strategies, and treatment protocols. RESULTS: There has been a dramatic decrease in the youth suicide rate during the past decade. Although a number of factors have been posited for the decline, one of the more plausible ones appears to be the increase in antidepressants being prescribed for adolescents during this period. Youth psychiatric disorder, a family history of suicide and psychopathology, stressful life events, and access to firearms are key risk factors for youth suicide. Exciting new findings have emerged on the biology of suicide in adults, but, while encouraging, these are yet to be replicated in youths. Promising prevention strategies, including school-based skills training for students, screening for at-risk youths, education of primary care physicians, media education, and lethal-means restriction, need continuing evaluation studies. Dialectical behavior therapy, cognitive-behavioral therapy, and treatment with antidepressants have been identified as promising treatments but have not yet been tested in a randomized clinical trial of youth suicide. CONCLUSIONS: While tremendous strides have been made in our understanding of who is at risk for suicide, it is incumbent upon future research efforts to focus on the development and evaluation of empirically based suicide prevention and treatment protocols.     

Depressive symptomatology among Hungarian youth: a risk and protective factors approach

Psychosocial risk and protective factors were examined to assess their influence on depressive symptomatology in a sample of Hungarian youth. Self-esteem and being happy with school were significant protective factors; older girls (ages 16-20) reported the highest depression scores, and these scores varied significantly by self-reported problem behavior. These findings are discussed in the context of their clinical and practical implications for understanding depressive symptomatology in this understudied population of Eastern European youth.     

A comparative assessment of suicide risk for young people in youth detention.

The aim of this study was to compare levels of agreement in the assessment of suicide risk by detention center staff procedures compared with those completed by a mental health clinician. Over a 6-month period, 64 young people (mean age 15.0 years; SD+/-1.3) assessed as being acutely suicidal were referred for a clinical mental health assessment and completion of the Adolescent Suicide Questionnaire (ASQ). Cohen's kappa statistic was used to determine inter-judgmental agreement between the detention center, a clinical assessment and ASQ scores. Weak levels of agreement existed in the assessment of suicide. We recommend further work in this area and broad discussion toward development of national guidelines to standardize the assessment of suicide risk for young people in youth detention.     

心理社会干预对中学生自杀高危人群的影响

目的:探讨心理社会干预对有自杀意念和自杀行为的中学生的影响。方法:通过流行病学调查,筛选出有自杀风险的高危中学生65人。除接受学校常规心理健康课程外,还参加团体认知行为实践辅导;对学生家长进行自杀预防宣教。并在干预前行青少年生活事件量表(ASLEC)、社会支持评定量表(SSRS)、简易应对方式问卷(SCSQ)、家庭环境问卷(FES)、Beck抑郁量表(BDI)、自杀意念自评量表(SIOSS)、和自尊量表(SES)问卷基线评估、干预后6个月及18个月后问卷随访评估效果。结果:干预后,青少年生活事件总应激量差异无统计学意义(F=1.350,P=0.264,P0.05);其他问卷在干预后6个月及18个月后随访与基线比较差异均存在统计学意义(P0.05),而干预后6个月随访与12个月后随访上述指标无统计学差异(P0.05)。结论:心理社会干预对改善中学生自杀意念及自杀行为短期内有一定的效果。     

Suicidality among Norwegian youth: Review of research on risk factors and interventions

Background and Aim: Published research on suicidality among Norwegian youth and publications describing interventions were summarized in order to access the current status of knowledge building via empirical research. Method: A systematic Medline search identified 29 studies on risk factors on the entire spectrum of suicidal phenomena from self-harm without suicidal ideation to completed suicide with the mean age at/under 25 years. A specialist Norwegian journal, Suicidologi, was searched for additional matter, especially interventions. Result: Most studies focussed on psychological and psychiatric risk factors of attempted suicide. Other suicidal phenomena, psychosocial and societal risk factors, and impact of interventions were hardly studied. Depression, previous suicidal behaviour, alcohol use and non-intact parental unit were consistent significant risk factors found in suicide and attempted suicide studies. Conclusion: Supporting non-intact parental units and the maintenance of intact parental units along with early detection and management of suicide attempts, depression and alcohol use should be targeted as suicide prevention interventions among adolescents.     

Attempted suicide and associated risk factors among youth in urban Japan

BACKGROUND: Suicide is a major social and health issue in Japan. We assessed prevalence of attempted suicide and explored individual, interpersonal, behavioral, and psychological risk factors associated with attempted suicide in a general community sample of youth in a metropolitan Japanese city. METHOD: Survey of 2,095 participants age between 15 and 24 who were recruited using street-intercept techniques. RESULTS: Overall, 6% of males and 11% of females reported a prior suicide attempt. For males, attempted suicide was independently associated with experience of school bullying, being homosexual or bisexual, history of drug use, experience of unwanted sex, history of a diagnosed sexually transmitted infection, and low self-esteem. For females, attempted suicide was independently associated with being younger (ages 15-19 compared to 20-24), experience of school bullying, history of drug use, and history of smoking. CONCLUSION: Prevention intervention programs for youth in Japan are necessary to achieve national aims to reduce attempted suicides and suicide mortality.     

Health risk behavior and cultural stress among Venezuelan youth: a person centered approach

Background

In recent years, more than 5 million Venezuelans have left their once prosperous country, with several hundred thousand settling in the United States (US). At present, our understanding of the health risk behavior profiles of Venezuelan émigré youth, and their links with cultural stress, remains limited.

Objectives

Drawing from a sample of recently-immigrated Venezuelan youth in the US, we aim to identify subtypes of youth according to their involvement in health risk behaviors (i.e., substance use, sexual risk behavior, violence) and assess the associations between class membership and key constructs related to cultural stress theory (i.e., negative context of reception, family communication/support).

Method

Latent profile analysis and multinomial regression were performed using data from a community-based convenience sample of 402 recently-arrived Venezuelan immigrant youth (ages 10–17; 56% male).

Results

We identified five subtype classes: (1) “Abstainer” (36%), (2) “Alcohol Only” (24%), (3) “Alcohol/Tobacco” (24%), (4) “Aggression” (8%), and (5) “Multidimensional Risk” (8%). Compared to Class #1, youth in Classes #3 and #5 reported significantly higher levels of negative context of reception and lower levels of family functioning while controlling for demographic factors. Youth in Class #5 reported the lowest levels of family economic hardship and the longest duration in the US.

Conclusion

It is vital that we support both Venezuelan youth who abstain from risk behavior and, at the same time, develop and implement programs that target the needs of those who are at elevated risk for serious consequences related to substance use, sexual risk behavior, and violence.

     

Rational approaches to the neurobiologic study of youth at risk for bipolar disorder and suicide

Objectives:  The aims of this paper are to provide an overview of neuroimaging findings specific to bipolar disorder and suicide, and to consider rational approaches to the design of future in vivo studies in youth at risk.
Methods:  Neuroimaging and related neurobiological literature pertaining to bipolar disorder and suicide in adult and pediatric samples was reviewed in a non-quantitative manner.
Results:  Specific structural and functional brain findings in bipolar disorder are described, where possible in the context of relevant current neurobiological theories of etiology. Diagnostic and prognostic implications are discussed.
Conclusions:  The simultaneous use of complementary neurobiological approaches may be a powerful way of identifying and validating factors reliably associated with bipolar disorder and suicide. A profile of neurobiological markers with which to screen for bipolar disorder and suicide risk may provide for earlier and more accurate diagnosis, perhaps even in the pre- or subsyndromal stages in high-risk youth.     

Familial risk factors for adolescent suicide: a case-control study

Sixty-seven adolescent suicide victims and 67 demographically matched living controls were compared as to family constellation, familial stressors and familial loading for psychopathology. Suicide victims were less likely to have lived with both biological parents, were more likely to be exposed to stressors such as parent-child discord, physical abuse and residential instability and showed greater familial loading for depression and substance abuse. Multivariate analyses showed that family history of both depression and substance abuse and lifetime history of parent-child discord were most closely associated with adolescent suicide. Children who are the offspring of parents with depression or substance abuse should be psychiatrically screened. Family interventions to decrease discord may also be helpful in decreasing the risk of adolescent suicide.