Generational differences in mental health: are children and adolescents suffering more, or less?

Almost all of the available evidence suggests a sharp rise in anxiety, depression, and mental health issues among Western youth between the early 20th century and the early 1990s. Between the early 1990s and the present, more serious problems such as suicide and depression have receded in some data sets, whereas feeling overwhelmed and reporting psychosomatic complaints have continued to increase. Other indicators, such as anxiety, have remained at historically high levels but not continued to increase. This mixed pattern of results may be rooted in the increasing use of antidepressants and therapy and the improvement in some cultural indicators. However, the incidence of youth mental health problems remains unacceptably high.     

Can differences in stress perception and coping explain sex differences in depressive symptoms in adolescents?

A four-year longitudinal study explored the different contribution of low self-esteem, different types of stressors, conflict in close relationships and avoidant coping to the explanation of depressive symptomatology in adolescents. One hundred and ninety adolescents, 101 females and 89 males, participated in four annual assessments using diverse instruments. ANOVAs repeated measurements revealed a higher stress level, more conflicts with mothers and more avoidant coping in females as compared to males at the age of 14 years. Males showed fewer depressive symptoms and higher positive self-esteem at all times. Multiple regression analysis revealed that stress and avoidant coping in early and mid-adolescence explained a significant proportion of depressive symptoms among females in late adolescence. Among males, only the level of conflicts with friends in early adolescence contributed to their level of depressive outcome in late adolescence.     

In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies?

The purpose of this study was to ascertain whether adolescents who deliberately harmed themselves or had thoughts of self-harm differed from other adolescents in terms of help-seeking, communication and coping strategies. The participants were 6020 15-16 year-old school pupils who were surveyed using an anonymous self-report questionnaire. Adolescents with one or more episodes of deliberate self-harm (DSH) in the previous year were more likely to identify themselves as having serious problems than other adolescents. However, a substantial proportion of adolescents with either DSH or thoughts of self-harm did not identify themselves as having serious problems. Adolescents with DSH were most likely to feel the need for help but not try to get any; they were less able to talk to family members and teachers and had fewer categories of people who they were able to talk to. Like other adolescents, those with DSH or thoughts of self-harm were more likely to seek and receive help from their friends than from other sources. They differed from other adolescents in terms of coping strategies they reported employing when faced with difficulties, showing less focus on problems and more avoidant behaviours. The findings have important implications for preventive strategies, including educational programmes on emotional health and coping, and for the clinical care of adolescents identified as at risk or having self-harmed.     

Depersonalization: Physiological or pathological in adolescents?

BackgorundThis study analyzed the presence of DP symptoms in a sample of both psychiatric patients and normal subjects, addressing the issue of DP symptoms in adolescence.MethodsA total of 267 subjects (149 patients and 118 healthy controls) aged between 14 and 65 years, were assessed by means of CDS, the SCID-I and the K-SADS. The sample was then divided into two subsamples with a cut-off age of 21 years.ResultsAs expected CDS score was significantly higher in the patient group compared to the healthy control group. As for the age issue, among patients no statistical difference was found comparing subjects over and under 21 years, whereas in the sample of healthy controls, subjects under 21 years reported CDS scores significantly higher.ConclusionsWhile in adults DP symptoms are frequently associated with mental disorders, in adolescents they could be considered as a quasi-physiological phenomenon.     

Predicting inpatient suicides and suicide attempts by using clinical routine data?

OBJECTIVE: The study aimed at exploring prevalence and risk factors of inpatient suicides and attempted suicides in a psychiatric hospital. METHOD: Based on the German psychiatric basic documentation system, 20,543 patients with 40,451 episodes of inpatient care (1995-2004) in a psychiatric state hospital were included. Besides univariate analyses, multivariate logistic regression analyses and classification and regression tree analyses were performed. RESULTS: Forty-one inpatient suicides were recorded. Risk of inpatient suicide is increased for patients with resistance to psychopharmacological treatment, previous suicide attempt, severe side effects and supportive psychotherapy before admission. Two hundred fourteen inpatient suicide attempts occurred during the 10-year period. Risk factors of inpatient suicide attempt are assault, personality disorder, previous suicide attempt, psychopharmacological treatment resistance, suicidal thoughts at admission, schizophrenia, depression, female sex and length of stay. CONCLUSION: The identified risk factors underline the need for a cautious investigation of previous suicide attempts as well as for giving special attention to patients who have problems with psychopharmacotherapy during hospitalization.     

Sex differences in psychosis: normal or pathological?

BACKGROUND: Schizophrenia first appears in adolescence, in boys at an earlier age than girls. The interpretation of this key epidemiological finding crucially depends on whether similar age-related sex differences exist in the expression of associated, subclinical psychosis-like experiences. METHODS: Findings are based on a population sample of 2548 adolescents and young adults aged 17-28. Subjects were assessed with the core psychosis sections on delusions and hallucinations of the Munich-Composite International Diagnostic Interview. RESULTS: The risk of subclinical psychotic experiences was significantly higher for males in the younger half of the cohort (17-21 years), but similar in the older half (22-28 years). CONCLUSIONS: These findings suggest that normal maturational changes in adolescence with differential age of onset in boys and girls cause the expression of psychosis, the extreme of which is schizophrenia.     

Parasuicide online: Can suicide websites trigger suicidal behaviour in predisposed adolescents?

The present case report describes a 17-year-old female who explicitly visited suicide web forums, where she researched reliable suicide methods, contacted an anonymous user and purchased substances for the implementation of suicide. The risk of Internet use by vulnerable youth is discussed. Psychiatric exploration should include questions of manner and frequency of media use. The application of media guidelines for suicide prevention is demanded for websites, as are accessible self-help sites for suicidal persons targeted to youthful users.     

Geography of suicide in Japan: spatial patterning and rural–urban differences

Purpose

There are notable geographic variations in incidence rates of suicide both in Japan and globally. Previous studies have found that rurality/urbanity shapes intra-regional differences in suicide mortality, and suicide risk associated with rurality can vary significantly by gender and age. This study aimed to examine spatial patterning of and rural–urban differences in suicide mortality by gender and age group across 1887 municipalities in Japan between 2009 and 2017.

Methods

Suicide data were obtained from suicide statistics of the Ministry of Health, Labour and Welfare in Japan. We estimated smoothed standardized mortality ratios for suicide for each of the municipalities and investigated associations with level of rurality/urbanity using Bayesian hierarchical models before and after adjusting for socioeconomic characteristics.

Results

The results of the multivariate analyses showed that, for males aged 0–39 and 40–59 years, rural residents tended to have a higher suicide risk compared to urban ones. For males aged 60+ years, a distinct rural–urban gradient in suicide risk was not observed. For females aged 0–39 years, a significant association between suicide risk and rurality was not observed, while for females aged 40–59 years and females aged 60 years or above, the association was a U-shaped curve.

Conclusion

Our results showed that geographical distribution of and rural–urban differences in suicide mortality in Japan differed substantially by gender and age. These findings suggest that it is important to take demographic factors into consideration when municipalities allocate resources for suicide prevention.

     

Gender differences in a dichotic listening and movement task: lateralization or strategy?

Although the dichotic listening procedure has been used as a non-invasive neuropsychological technique for assessing laterality of speech perception, it has tended to underestimate the proportion of the right-handed population that is left-hemisphere lateralized for speech perception [Segalowitz SJ, Bryden MP. Individual differences in hemispheric representation of language. In: Segalowitz SJ (Ed.), Language Functions and Brain Organization. Toronto: Academic Press, 1983, pp. 341-72]. These underestimations may be due to traditional dichotic procedures being susceptible to attentional biases, order of report effects, and/or memory effects that obscure functional differences between the cerebral hemispheres. In the present study, we used an adaptation of the dichotic listening procedure that was designed to be less sensitive to these confounding effects. Participants were required to move as quickly as possible to one of the two color-coded targets following verbal cues presented via headphones. Conditions of cue-word presentation were monaural, (e.g. 'blue' in one ear and a blank track in the other), dichotic-same (e.g. 'blue' in both ears), and dichotic-different (e.g. 'green' in one ear and 'blue' in the other). Ninety-three percent (26 of 28) of the participants demonstrated a right ear advantage (REA) for correct responses. There was also a REA for reaction time, movement time, and the total response time. The pattern of reaction time and movement errors, however, suggest that gender differences found utilizing this dichotic procedure may be due to differences in strategic approach to the task rather than to differences in cerebral laterality. Overall, results suggest that this new adaptation of the dichotic listening procedure is very sensitive to lateralization for speech perception.     

Relatives of psychiatric inpatients--do physical violence and suicide attempts of patients influence family burden and participation in care?

A common concern of psychiatric patients' relatives is that patients might be a danger to themselves or others. The aim of this study was to investigate family burden and relatives' participation in care in relation to physical violence towards others and suicide attempts by psychiatric inpatients before admission. Information concerning violence and suicide attempts by the patients prior to admission was collected from the medical records of 155 acutely voluntarily and involuntarily admitted psychiatric inpatients. Relatives were interviewed a month after admission, using a semi-structured questionnaire. Violence towards other persons and suicide attempts were recorded in 16% and 17% of the cases, respectively. There were no differences between relatives of patients who had been violent and other relatives regarding burden and participation in care. Relatives of patients with suicide attempts more often stated they had been prevented from having own company, worried about suicide attempts by the patient, had mental health problems of their own, and had own need for care and support. It was concluded that violence of acutely admitted psychiatric patients, targeted at other people, was not associated with burden of family, but the results corroborate the need for psychiatric services to involve and support relatives of psychiatric patients with suicidal behaviour.     

The gender gap in suicide and premature death or: why are men so vulnerable?

Suicide and premature death due to coronary heart disease, violence, accidents, drug or alcohol abuse are strikingly male phenomena, particularly in the young and middle-aged groups. Rates of offending behaviour, conduct disorders, suicide and depression are even rising, and give evidence to a high gender-related vulnerability of young men. In explaining this vulnerability, the gender perspective offers an analytical tool to integrate structural and cultural factors. It is shown that traditional masculinity is a key risk factor for male vulnerability promoting maladaptive coping strategies such as emotional unexpressiveness, reluctance to seek help, or alcohol abuse. This basic male disposition is shown to increase psychosocial stress due to different societal conditions: to changes in male gender-role, to postmodern individualism and to rapid social change in Eastern Europe and Russia. Relying on empirical data and theoretical explanations, a gender model of male vulnerability is proposed. It is concluded that the gender gap in suicide and premature death can most likely be explained by perceived reduction in social role opportunities leading to social exclusion.