Contents of the Standardized Suicide Prevention Program for Gatekeeper Intervention in Korea,Version 2.0

ObjectiveSuicide is a huge nationwide problem that incurs a lot of socio-economic costs. Suicide also inflicts severe distress on the people left behind. The government of the Republic of Korea has been making many policy efforts to reduce suicide rate. The gatekeeper program, ‘Suicide CARE’, is one of the meaningful modalities for preventing suicide. MethodsMultidisciplinary research team collaborated to update the ‘Suicide CARE’ to version 2.0. ResultsIn the ‘Introductory part’, the authors have the time to think about the necessity and significance of the program before conducting full-scale gatekeeper training. In the ‘Careful observation’ part, trainees learn how to understand and recognize the various linguistic, behavioral, and situational signals that a person shows before committing suicide. In the ‘Active listening’ part, trainees learn how to ask suicide with a value-neutral attitude as well listening empathetically. In the ‘Risk evaluation and Expert referral’ part, trainees learn intervening strategies to identify a person’s suicidal intention, plan, and past suicide attempts, and connect the person to appropriate institutes or services. ConclusionSubsequent studies should be conducted to verify the efficacy of the gatekeeper program.     

Suicide and external mortality pattern in a cohort of migrants from the former Soviet Union to Germany

BackgroundMental health consequences of migration are manifold. Where some migrants experience migration as liberation from life threatening conditions, others suffer from hostility and social descent in the target country. This study investigates deaths due to external causes, suicides, and events of undetermined intent in German repatriates from the Former Soviet Union. The relation between age at migration and suicide mortality is also explored.MethodsA cohort of German repatriates who migrated between 1990 and 1999 was followed-up until 2010. Each individual accumulated time at risk, expressed in person years (PY). Standardized mortality ratios (SMR) were calculated, supplemented by subgroup analyses for age and calendar year strata, and immigration period. Multivariate Poisson models were used to investigate the influence of age, sex, calendar year, number of moves, and final move distance.ResultsA total of 6378 German repatriates (3031 men, 3347 women) accumulated 92 149 PY. Median age at immigration was 30 years in women and 27 years in men. Women's all-cause mortality was significantly lower (SMR = 0.85 [0.75; 0.97]). Men more often died from external causes (SMR = 1.58 [1.09; 2.23]), intentional self-harm (SMR = 1.68 [0.90; 2.88]), and events of undetermined intent such as poisoning by drugs (SMR = 8.07 [4.02; 14.44]). External cause mortality was significantly increased after 1995 (SMR = 1.87). In particular, men who migrated when they were 11–20 years old were at strongly increased risk of committing suicide (SMR = 3.84) or dying due to events of undetermined intent (SMR = 14.75).ConclusionThe most endangered subgroup is men who migrated at teenage age. Protective factors such as strong family bounds formerly present in the FSU failed in Germany, the higher population density caused intense friction. The changes in the families' ethnical composition from mostly ethnic German members in the early 90s' towards predominantly Russian members around the turn of the millennium complicated integration. Setting-oriented prevention measures should consider the families' migration history, their link to culture and religion, and the different concepts of mental health.     

Key Indicators of the Transition from Social to Problem Gambling

At the International Gambling Conference: Policy, Practice and Research in 2004 (Clarke, eCommunity-International Journal of Mental Health and Addiction, 3:29–40, 2005), a paper was presented which proposed key indicators of the transition from social to problem gambling and to recovery, based on a review of literature on factors leading to substance abuse. They included availability of gambling activities, lack of social and cultural empowerment, low socioeconomic status, and personal loss of control. Subsequently, a multidisciplinary team collected data on why people gamble. Four New Zealand ethnic groups (Päkehä/New Zealand European, Mäori, Pacific peoples and Asians) in South Auckland were targeted for both phases of the study. Phase 1 involved qualitative analysis of data from individual interviews and focus groups. Phase 2 surveyed 345 adults using a questionnaire developed from the first phase. From both phases, key indicators for problem gambling were similar to the indicators for substance abuse. Public health interventions such as reducing access to electronic gaming machines and empowerment of cultural groups, and a longitudinal study of the development of gambling in the community are suggested.     

Youth development program participation and intentional self-regulation skills: contextual and individual bases of pathways to positive youth development

The present research used data from Grades 8, 9, and 10 of the 4-H Study of Positive Youth Development, a longitudinal study involving U.S. adolescents, in order to better elucidate the process through which the strengths of youth and the ecological resources promoting healthy development (such as out-of-school-time programs) may contribute to thriving. We examined the relationship between adolescents’ self-regulation skills (selection, optimization, and compensation) and their participation in youth development (YD) programs across Grades 8 and 9 in predicting Grade 10 PYD and Contribution. Results indicated that while self-regulation skills alone predicted PYD, self regulation and YD program participation both predicted Contribution. In addition, Grade 8 YD participation positively predicted Grade 9 self regulation, which, in turn, predicted Grade 10 PYD and Contribution. We discuss how the alignment of youth strengths and resources within the environment may promote positive youth development.     

A Survey of Autistic Adults from New Zealand on the Autism Diagnostic Process During Adolescence and Adulthood

Journal of Autism and Developmental Disorders - The diagnostic experiences of autistic adults in New Zealand have not been investigated and little is known globally about autistic adults’...     

Childhood Exposure to Psychological Trauma and the Risk of Suicide Attempts: The Modulating Effect of Psychiatric Disorders

ObjectiveWe examined whether childhood exposure to psychological trauma is associated with greater suicidality and whether specific psychiatric disorders modulate this association in a representative sample of Korean adults.MethodsThe Korean version of the Composite International Diagnostic Interview 2.1 was administered to 6,027 subjects aged 18-74 years. Subjects who experienced a traumatic event before the age of 18 years, the childhood-trauma-exposure group, were compared with controls without childhood trauma exposure.ResultsChildhood exposure to psychological trauma was associated with lifetime suicidal ideation (OR=3.19, 95% CI=2.42-4.20), suicide plans (OR=4.15, 95% CI=2.68-6.43), and suicide attempts (OR=4.52, 95% CI=2.97-6.88). These associations weakened after further adjustment for any psychiatric disorders, but they were not eliminated. The risk of suicide attempts related to childhood trauma increased with the presence of a concurrent alcohol use, depressive, or eating disorder.ConclusionIn terms of clinical implications, patients with these disorders who have a history of childhood trauma should be carefully assessed for their suicide risk and aggressively treated for psychiatric disorders.     

Adolescence as a period of vulnerability and intervention in schizophrenia: Insights from the MAM model

Adolescence is a time of extensive neuroanatomical, functional and chemical reorganization of the brain, which parallels substantial maturational changes in behavior and cognition. Environmental factors that impinge on the timing of these developmental factors, including stress and drug exposure, increase the risk for psychiatric disorders. Indeed, antecedents to affective and psychotic disorders, which have clinical and pathophysiological overlap, are commonly associated with risk factors during adolescence that predispose to these disorders. In the context of schizophrenia, psychosis typically begins in late adolescence/early adulthood, which has been replicated by animal models. Rats exposed during gestational day (GD) 17 to the mitotoxin methylazoxymethanol acetate (MAM) exhibit behavioral, pharmacological, and anatomical characteristics consistent with an animal model of schizophrenia. Here we provide an overview of adolescent changes within the dopamine system and the PFC and review recent findings regarding the effects of stress and cannabis exposure during the peripubertal period as risk factors for the emergence of schizophrenia-like deficits. Finally, we discuss peripubertal interventions appearing to circumvent the emergence of adult schizophrenia-like deficits.     

Investigating the links between adolescent sleep deprivation,fronto-limbic connectivity and the Onset of Mental Disorders: a review of the literature

The importance of sleep for mental health has been known for some time. Although it was initially suggested that mental health conditions negatively impact sleep, it is now widely understood that this association is bidirectional. Adolescence is a period where people are at an increased risk of being sleep deprived largely due to a late shift in the circadian rhythm around puberty combined with early school start times. This combination may lead to adolescents being at an increased risk of mental health problems. Adolescence is also a period of continued brain development with white matter maturation continuing in the frontal brain regions throughout adolescence and into early adulthood. White matter development involves myelination of axons that link areas of grey matter and is integral for communication speed and efficiency. Studies have demonstrated that sufficient sleep is required for myelination to occur. The uncinate fasciculus (UF) is one of the last white matter tracts to be myelinated with this process occurring throughout adolescence and running between the amygdala in the limbic system and the orbitofrontal (OFC) and medial prefrontal cortices (mPFC). Recent studies have shown that connectivity between the amygdala and OFC is important for an individual's ability to exert top-down executive control over amygdala based automatic emotional responses to experiences perceived as threatening. The current literature review provides an overview of these mechanisms and concludes by proposing a model of adolescent sleep deprivation leading to potential life-long mental health issues through the moderating impact of reduced UF development.     

Effect of Community-based Intervention Using Depression Screening on Elderly Suicide Risk: A Meta-analysis of the Evidence from Japan

A systematic review was undertaken to quantify the effect of community-based depression screening (CDS) with follow-up on the completed suicide risk for residents aged 65 and over. Five quasi-experimental studies in Japanese regions with high suicide rates were included in the meta-analysis. Combined incidence rate ratios (95% confidence intervals) by the Mantel–Haenszel method and by the DerSimonian–Laird method in two homogenous studies implementing the follow-up conducted by psychiatrists were 0.30 (0.13–0.68) and 0.33 (0.14–0.80) in men, and 0.33 (0.19–0.58) and 0.33 (0.19–0.60) in women, respectively; and those in three homogenous studies implementing the follow-up conducted by general practitioners were 0.73 (0.45–1.18) and 0.74 (0.45–1.23) in men, and 0.36 (0.21–0.60) and 0.39 (0.22–0.66) in women, respectively. There are very few studies included, however, to demonstrate an association between CDS and the reduced risk, suggesting gender difference in the effectiveness.     

Family and school influences on adolescents' adjustment: The moderating role of youth hopefulness and aspirations for the future

Using a school-based sample of 675 adolescents, this short-term longitudinal investigation examined the relationships among individual, family, and school influences on adolescent adjustment problems. Adolescents' perceptions of school climate and their sense of connectedness to school were negatively associated with conduct problems. A significant interaction between parental academic support and adolescents' academic aspirations was detected for the total sample, boys, and White youth, indicating that parental support serves a protective function against conduct problems for students with low academic expectations. Adolescents' hopefulness, parental academic aspirations, and school connectedness were negatively associated with depression. Adolescents' hopefulness and their academic aspirations moderated associations between both family and school influences on adolescent adjustment with youth gender and race qualifying these interaction effects.     

Developmental trajectories of intentional self regulation in adolescence: the role of parenting and implications for positive and problematic outcomes among diverse youth

This study assessed 1574 Grades 5 to 11 youth (63.6% female) from the 4-H Study of Positive Youth Development (PYD), a longitudinal study involving U.S. adolescents, to assess if patterns of intentional self regulation (ISR) existed; whether these trajectories differed in relation to several Grade 5 parenting characteristics; and whether ISR trajectories were linked to positive and negative developmental outcomes at Grade 11. Growth mixture modeling identified a four-group solution of ISR trajectories: Steady Decline, Elevated, Late Onset, and Pronounced Decline. Most adolescents reported an incremental decrease in ISR from Grades 5 to 11 (Steady Decline). Lower levels of parental warmth, monitoring, and school involvement at Grade 5 predicted Late-Onset ISR development while Pronounced Decline adolescents reported lower levels of PYD and Contribution at Grade 11. We discuss the finding that youth at initially similar levels of ISR diverged over adolescence, while youth at initially disparate levels converged.