Dementia Prevention: Methodological Explanations for Inconsistent Results

The prevention of neurodegenerative dementias, such as Alzheimerdisease, is a growing public health concern, because of a lackof effective curative treatment options and a rising globalprevalence. Various potential risk or preventive factors havebeen suggested by epidemiologic research, including modifiablelifestyle factors, such as social contacts, leisure activities,physical exercise, and diet, as well as some preventive pharmacologicstrategies, such as hormone replacement therapy, nonsteroidalantiinflammatory drugs, and Ginkgo biloba. Some factors havebeen targeted by interventions tested in randomized controlledtrials, but many of the results are in conflict with observationalevidence. The aim of this paper is to review the epidemiologicdata linking potential protective factors to dementia or cognitivedecline and to discuss the methodological limitations that couldexplain conflicting results. A thorough review of the literaturesuggests that, even if there are consistent findings from largeobservational studies regarding preventive or risk factors fordementia, few randomized controlled trials have been designedspecifically to prove the protective effects of interventionsbased on such factors on dementia incidence. Because of themultifactorial origin of dementia, it appears that multidomaininterventions could be a suitable candidate for preventive interventions,but designing such trials remains very challenging for researchers. Alzheimer disease • bias (epidemiology) • cognition disorders • dementia • epidemiologic research design • primary prevention • randomized controlled trials as topic • risk factors     

Protecting urban American Indian young people from suicide

OBJECTIVE: To examine the likelihood of a past suicide attempt for urban American Indian boys and girls, given salient risk and protective factors. METHODS: Survey data from 569 urban American Indian, ages 9-15, in-school youths. Logistic regression determined probabilities of past suicide attempts. RESULTS: For girls, suicidal histories were associated with substance use (risk) and positive mood (protective); probabilities ranged from 6.0% to 57.0%. For boys, probabilities for models with violence perpetration (risk), parent prosocial behavior norms (protective), and positive mood (protective) ranged from 1.0% to 38.0%. CONCLUSIONS: Highlights the value of assessing both risk and protective factors for suicidal vulnerability and prioritizing prevention strategies.     

Suicidal risk factors and completed suicide: meta-analyses based on psychological autopsy studies

The purpose of the present review is to evaluate the effects of common risk factors for suicide by meta-analyses using data extracted from studies based on the psychological autopsy method. We focused on five common risk factors of suicide: substance-related disorders, mood disorders, adverse marital status, adverse employment status, and self-harm behaviors. A total of 24 articles were identified from MEDLINE in which the crude odds ratio (OR) could be calculated for the above five risk factors through 30 April 2007, using such search keywords as “suicide,” “psychological autopsy,” and “case-control study.” Overall, both substance-related disorders [OR = 5.24; 95% confidence interval (CI) = 3.30–8.31] and mood disorders [OR = 13.42; 95% CI = 8.05–22.37] were strongly associated with suicidal risk. Suicidal attempt and deliberate self-harm, which can directly lead to completed suicide, have been shown to be very strongly associated with suicidal risk [OR = 16.33; 95% CI = 7.51–35.52]. Effects of social factors such as adverse marital and employment status were relatively small. As substance-related disorders and mood disorders were strongly associated with an increased risk of completed suicide, the comorbidity of these two disorders should be paid a maximum attention. The effective prevention of suicide depends on whether we can successfully incorporate these personal factors as well as social factors into an adequate multi-factorial model. Members of the Stress Research Group of the Japanese Society for Hygiene are listed in the Appendix.     

The spreading of suicidal behavior: The contextual effect of community household poverty on adolescent suicidal behavior and the mediating role of suicide suggestion

Despite the longstanding interest of social researchers in the social factors that influence suicide and suicidal behavior, multilevel research on this topic has been limited. Using nested survey data on 5331 Icelandic adolescents (born in 1990 and 1991) in 83 school-communities, the current study examines the contextual effect of community household poverty on adolescent suicidal behavior (suicide ideation and suicide attempt). The findings show that the concentration of household poverty in the school-community has a significant, contextual effect on adolescent suicidal behavior. Furthermore, we test an “epidemic” explanation for this effect, examining the mediating role of suicide suggestion (contact with suicidal others). We find that suicide suggestion mediates a substantial part of the contextual effect of community household poverty on suicide attempt, while mediation is modest in the case of suicide ideation. The findings indicate that community household poverty increases the risk of adolescent suicidal behavior in part because communities in which household poverty is common entail a higher risk for adolescents of associating with suicidal others. The study demonstrates how the concentration of individual problems can have macrolevel implications, creating social mechanisms that cannot be reduced to the circumstances or characteristics of individuals.     

2所中专学校学生自杀行为及其人口特征学研究

目的了解中专生自杀行为的现状及其人口统计学特征,为中专学校学生心理健康教育提供依据.方法以某市2所中专学校共2 032名中专生为调查对象进行现况调查.自杀行为的定义与问卷设计与美国疾病控制中心(CDC)青年危险行为监测系统(YRBSS)相同.结果中专生总体自杀意念发生率为26.6%,自杀计划发生率为13.4%,自杀企图发生率为7.5%.各年龄分组比较,自杀意念发生率差异有显著性.17岁以下学生自杀意念发生率显著高于18岁以上组(P＜0.001),女生自杀意念发生率显著高于男生,非汉族中专生自杀意念发生率高于汉族学生.来自农村学生3种自杀行为的发生率均低于来自城市的学生.父母文化程度、是否在外工作(打工)对中专生的自杀行为无显著影响.多元非条件Logistic回归分析表明,年龄大为自杀意念的保护因素,非汉族、家住城镇和学习成绩差为自杀意念的危险因素;家庭所在地为城市、学习成绩差为自杀计划的危险因素;年级为自杀企图的保护因素,而家住城市为危险因素.结论中专生的自杀意念、自杀计划和自杀企图发生率较高,自杀行为的发生率受人口统计学特征的影响.应加强对中专生的心理健康教育.     

Alcohol and adolescent suicide

Adolescent suicide is a major public health problem. In this review, the authors discuss different aspects of the relation between alcohol abuse and suicidal behavior in adolescents, including epidemiology, role of family history, comorbidity, gender differences, neurobiology, treatment, and prevention. In the general population, about 2,000 adolescents in the United States die by suicide each year. Suicide continually ranks as the second or third leading cause of death of persons between the ages of 15 and 34 years old. The suicide rate in young people has more than doubled during the period from 1956 to 1993. This increasing suicide rate has been blamed on the increase of adolescent alcohol abuse. Availability of alcohol and guns at home may contribute to suicide risk in adolescents. Comorbid psychopathology, which is common among adolescent alcohol abusers, substantially increases risk for suicide completions and attempts. Depressed adolescents may use alcohol to self-medicate depressive symptoms. Alcohol abuse and suicidal behavior in adolescents and in adults has been found to have biochemical, genetic, and psychological correlates. Ideally, treatment of adolescents who receive a diagnosis of an alcohol use disorder and co-occurring suicidality should follow an integrated protocol that addresses both conditions. Future studies of psychological and neurobiological mechanisms of suicidality in adolescents with alcohol and/or substance abuse are merited.     

北京50家综合医院门诊患者自杀意念及自杀未遂调查

目的 了解北京市综合医院门诊患者的自杀意念和自杀未遂出现率及其危险因素.方法 采用自制量表对随机抽取的北京市50家各级综合医院2877例门诊患者进行调查,通过logistic分析筛选出其危险因素.结果 自杀意念和自杀未遂终生发生率分别为6.08%和1.18%;多因素分析显示两者的共同危险因素为近一年有绝望感、年纪轻、熟人有过自杀行为、女性.结论 北京市综合医院门诊就诊患者经常有自杀危险、抑郁等心理问题;应培养普通门诊医务人员识别、评估和处理这类问题的技能.     

重庆市大学生对自杀态度的调查

目的了解重庆市大学生对自杀的态度及其影响因素,以针对性指导心理危机干预.方法采取分层整群随机抽样方法对重庆地区11所大学9808名学生进行公众对自杀的态度量表(SPAS)问卷调查.结果高校学生对预防自杀的难度、自杀行为的自我不可控制性、自杀行为可作为影响他人的工具持否定或中立态度,其得分分别为34.28±16.44、35.64±19.14、36.94±16.05;对自杀未遂与自杀死亡的相似性、自杀的歧视、自杀的正性态度持中立观点,得分分别为47.38±22.01、51.78±17.05、37.77±18.12;对自杀问题的社会重要性条目持中立或肯定态度的得分为70.77±17.21.性别、民族、宗教以及自杀未遂和自杀暴露史对大学生自杀态度有影响.结论自杀危机干预系统需针对大众以及自杀者不同的背景制定有针对性的策略.     

Indigenous Adolescents’ Suicidal Behaviors and Risk Factors: Evidence from the National Youth Risk Behavior Survey

The study sought to examine indigenous adolescents’ suicidal behaviors and risk factors in a nationally representative sample and explore potential causes of disparities. The study analyzed the 1991–2013 Youth Risk Behavior Survey National Combined Datasets. Suicidal behavior outcomes included suicide consideration, planning, and attempts during the past 12 months. Logit regressions were used to estimate the effects of potential suicide risk factors on these suicidal behaviors. The results showed that a high percentage of indigenous adolescents exhibited suicidal behaviors (consideration: 24.6 %; planning: 20.7 %; attempts: 16.2 %). After adjusting for risk factors, indigenous adolescents were no more likely than other adolescents to consider or plan for suicide (consideration: OR 1.18, CI 0.96-1.45, p = 0.125; planning: OR 1.16, CI 0.95–1.42, p = 0.156); however, they remained significantly more likely to have made suicide attempts (OR 1.73, CI 1.32–2.26, p < 0.001). Disparities in adolescent suicidal behaviors could be explained by the heterogeneous prevalence of suicidal risk factors across different races/ethnicities.     

Suicidality

Prevention of suicidal behaviour remains difficult, despite increasing knowledge of its determinants. Health service efforts hardly affect suicide rates. Recent shifts in the epidemiology of suicidal behaviour are rising rates among the young and increasing use of violent methods; these can be linked to emerging aetiological insights. Early stages of the suicidal process often manifest themselves at an early age, as emotional and behavioural instability. Epidemiological evidence suggests that the suicidal process increasingly concentrates itself in a vulnerable minority in whom it progresses rapidly to a phase of relative unresponsiveness to environmental influences including preventive efforts. Thus, prevention should focus not only on persons in the later stages of the suicidal process like psychiatric patients, but especially on individuals who, as youngsters, show signs of entering its very first stages. Since high suicide risk implies high risk of other adverse health outcomes as well, this should, in time, yield health gains in more domains than suicide reduction only.     

Family and racial factors associated with suicide and emotional distress among latino students

Background:  Latino youth experience disproportionate rates of mental health problems including suicide and depression. Better understanding of underlying risk and protective factors on the part of school-based health professionals, teachers, and health care providers in their lives is warranted. The aims of this secondary analysis of 2004 Minnesota Student Survey data were to (1) describe the mental health status of a statewide sample of Latino 9th- and 12th-grade students; (2) explore relationships of family protective factors (communication, caring, and connection) with suicidal ideation, suicidal attempts, and emotional distress; and (3) highlight similarities and differences in family protective factors among subgroups of Latino students.
Methods:  Parallel analyses were completed for Latino-only and Latino-mixed students. Bivariate logistic regression models were used to examine associations between each family variable and each study outcome.
Results:  Nearly 1 in 5 Latino high school students have had suicidal thoughts in the past year; past year suicide attempts ranged from 6% to 18.5% across grade and gender subgroups. Most concerning are ninth-grade Latino girls, a group in which 30-40% reported suicidal thoughts and 14-19% reported attempting suicide in the past year.
Conclusions:  An important study finding is the high rate of suicidal ideation, suicide attempts, and emotional distress among students who self-identified as being of mixed ethnicity. Study findings can be used to inform mental health promotion initiatives and culturally tailor interventions with Latino students.     

Schizophrenia: A Concise Overview of Incidence, Prevalence, and Mortality

Recent systematic reviews have encouraged the psychiatric researchcommunity to reevaluate the contours of schizophrenia epidemiology.This paper provides a concise overview of three related systematicreviews on the incidence, prevalence, and mortality associatedwith schizophrenia. The reviews shared key methodological featuresregarding search strategies, analysis of the distribution ofthe frequency estimates, and exploration of the influence ofkey variables (sex, migrant status, urbanicity, secular trend,economic status, and latitude). Contrary to previous interpretations,the incidence of schizophrenia shows prominent variation betweensites. The median incidence of schizophrenia was 15.2/100,000persons, and the central 80% of estimates varied over a fivefoldrange (7.7–43.0/100,000). The rate ratio for males:femaleswas 1.4:1. Prevalence estimates also show prominent variation.The median lifetime morbid risk for schizophrenia was 7.2/1,000persons. On the basis of the standardized mortality ratio, peoplewith schizophrenia have a two- to threefold increased risk ofdying (median standardized mortality ratio = 2.6 for all-causemortality), and this differential gap in mortality has increasedover recent decades. Compared with native-born individuals,migrants have an increased incidence and prevalence of schizophrenia.Exposures related to urbanicity, economic status, and latitudeare also associated with various frequency measures. In conclusion,the epidemiology of schizophrenia is characterized by prominentvariability and gradients that can help guide future research. incidence • mortality • prevalence • review • schizophrenia     

家庭环境和应对方式对大学生自杀意念影响

目的 探讨家庭环境因素及应对方式对大学生自杀意念的影响.方法 采用随机抽样方法对某城市3所高校不同年级585名学生进行自杀意念、自伤行为、抑郁自评量表以及家庭环境和简明应对方式调查.结果 被调查者中有过自杀意念的占20.9％,5.7％有过≥1次自杀行为;11.6％的大学生有过自伤行为;自杀意念组的女生比例明显高于男生,曾经有过自杀和自伤行为的比例明显高于正常组(P＜0.001);多因素逻辑回归分析表明,女生(OR=2.391)、消极应对方式(OR =2.796)、抑郁状态(OR=1.071)、存在自伤行为(OR =4.003)以及有过≥1次自杀行为(OR =5.492)是大学生自杀意念的危险因素,而家庭环境亲密度(OR=0.879)可能是自杀意念的保护性因素;未发现童年时期父母的关系以及童年时期是否受到成年人虐待与大学生自杀意念相关.结论 大学生自杀意念较高,受性别、抑郁状态、家庭环境、消极应对以及曾经的自杀和白伤行为经验影响.     

Suicidal Behaviour on Subway Systems: A Review of the Epidemiology

Suicide on subway systems is a public health challenge that has been reported in urban centers worldwide. Our objective was to analyze studies of suicide on subway systems, develop a profile of characteristics that are suggestive of association with suicides or attempts, and show how this profile can inform prevention. A literature review involving epidemiology studies and studies relating to subway suicide was conducted. Twenty-eight studies were included in this review. Across studies, characteristics were not often assessed for risk factor status, although several characteristics were remarkably similar. Those attempting suicide on the subway appear to be affected by serious mental illness and have contact with mental health services before the suicidal behavior. Several characteristics may be shared among this population, emphasizing the potential for prevention in clinical and public health domains. Well-designed studies that utilize robust data collection and statistical methods are needed to establish the risk status associated with these characteristics.     

The role of brain-derived neurotrophic factor in the pathophysiology of adolescent suicidal behavior

Adolescent suicide research has mostly focused on demographic risk factors. Such studies focus on who is at risk, but do not explain why certain adolescents are at risk for suicide. Studies of the neurobiology of adolescent suicide could clarify why some youths are more suicidal than others and help to find biological markers of suicidal behavior in teenagers. Over the past decade the role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of suicidal behavior has attracted significant attention of scientists. BDNF is involved in the pathophysiology of many psychiatric disorders associated with suicidal behavior including depression, post-traumatic stress disorder, schizophrenia, and obsessive-compulsive disorder. BDNF dysregulation could be associated with increased suicidality independently of psychiatric diagnoses. BDNF plays an important role in the regulation and growth of neurons during childhood and adolescence. Prominent among the brain regions undergoing developmental change during adolescence are stressor-sensitive areas. The serotonin dysfunction found in adolescent and adult suicidal behavior could be related to the low level of BDNF, which impedes the normal development of serotonin neurons during brain development. BDNF dysfunction could play a more significant role in the pathophysiology of psychiatric disorders and suicidal behavior in adolescents than in adults. Treatment-induced enhancement in the BDNF function could reduce suicidal behavior secondary to the improvement in psychiatric pathology or independently of improvement in psychiatric disorders. It is interesting to hypothesize that BDNF could be a biological marker of suicidal behavior in adolescents or in certain adolescent populations.     

江西省大学生自杀意念及其影响因素

目的了解江西省大学生自杀意念现状及其影响因素，为高校进行危机干预提供依据。方法于2007年4月，自编“大学生自杀意念问卷表”，采用随机发放问卷表的方式对江西省1010名大学生进行调查。结果大学生于调查前1年内的自杀意念发生率为11．19％。不同性别学生间自杀意念发生率差异无统计学意义（P〉0．05），不同性质学校、不同学历、不同专业学生间自杀意念发生率差异有统计学意义（3c。：24．24，P〈0．01；：c。：4．58，P〈O．05；：c。：29．46，P〈O．01）。积极应对、家庭和谐、性格外向是自杀意念的保护因素，学习压力、经济压力、儿童期被忽视、人际关系紧张、记忆中有深刻的自杀印象（媒体报道或亲眼目睹）、就业压力是自杀意念的危险因素。结论江西省大学生自杀意念发生率值得关注，消除自杀意念的危险因素，提高自杀意念的保护因素，可以有效降低大学生自杀意念的发生率。     

Suicide Protective Factors Among Trans Adults

A recent study indicated a suicide attempt rate of 41 % among trans (e.g., trans, transgender, transexual/transsexual, genderqueer, two-spirit) individuals. Although this rate is alarming, there is a dearth of literature regarding suicide prevention for trans individuals. A vital step in developing suicide prevention models is the identification of protective factors. It was hypothesized that social support from friends, social support from family, optimism, reasons for living, and suicide resilience, which are known to protect cis (non-trans) individuals, also protect trans individuals. A sample of self-identified trans Canadian adults (N = 133) was recruited from LGBT and trans LISTSERVs. Data were collected online using a secure survey platform. A three block hierarchical multiple regression model was used to predict suicidal behavior from protective factors. Social support from friends, social support from family, and optimism significantly and negatively predicted 33 % of variance in participants’ suicidal behavior after controlling for age. Reasons for living and suicide resilience accounted for an additional 19 % of the variance in participants’ suicidal behavior after controlling for age, social support from friends, social support from family, and optimism. Of the factors mentioned above, perceived social support from family, one of three suicide resilience factors (emotional stability), and one of six reasons for living (child-related concerns) significantly and negatively predicted participants’ suicidal behavior. Overall, these findings can be used to inform the practices of mental health workers, medical doctors, and suicide prevention workers working with trans clients.     

合肥市451名女性流动青少年自杀行为与社会资本和社会网络的关系

目的 了解合肥市女性流动青少年的自杀行为状况,探讨其与社会资本和社会网络的关系.方法 采用横断面调查方法,对在合肥市1家工厂、6家饭店和6家娱乐场所打工的共451名16 ～24岁的未婚农村女性青少年进行问卷调查,调查内容包括自杀行为、社会资本和社会网络等.结果 调查对象最近1年自杀意念、自杀计划和自杀行为报告率分别为13.5％、4.7％和4.4％,均以娱乐场所服务员最高.社会网络大小≥4、网络密度为1.00是自杀意念的保护因素;社会支持得分≥13是自杀计划和自杀行为的保护因素,OR值分别为0.33和0.27;与生长在核心家庭或三代以上家庭者相比,生活在其他类型家庭者其自杀行为的危险性增加(OR=5.62).结论 未婚女性流动人群中自杀行为报告率较高,需采取针对性的干预措施预防该人群自杀事件的发生.     

家庭矛盾与青少年自杀行为关系的队列研究

目的 分析家庭矛盾与青少年自杀行为间的关系。方法 在山东省3个县（市）采用方便整群抽样的方法共选取8所中学作为调查学校，选取7、8和10年级的学生进行基线和随访调查，包括一般人口学、自杀行为、家庭矛盾和抑郁等信息，研究共纳入7 072名研究对象。采用多因素logistic回归模型分析家庭矛盾和自杀行为的关系。结果 7 072名研究对象的基线年龄为（14.58±1.45）岁，有任何自杀行为的有750人（10.6%），其中自杀意念、自杀计划和自杀未遂的人数（报告率）分别为707人（10.0%）、258人（3.6%）和190人（2.7%）。有自杀行为者的家庭矛盾得分高于没有自杀行为者。调整其他因素后，logistic回归结果显示，家庭矛盾与自杀行为（OR=1.05，95%CI：1.01~1.10）、自杀意念（OR=1.05，95%CI：1.00~1.09）、自杀计划（OR=1.08，95%CI：1.01~1.16）和自杀未遂（OR=1.10，95%CI：1.02~1.19）的风险增加有关。进一步对性别进行分层后，分析结果显示，女生的家庭矛盾和自杀行为无统计学关联；男生的家庭矛盾和自杀行为有统计学关联，尤其是自杀意念和自杀计划，且男生家庭矛盾对于自杀计划的预测作用大于自杀意念。敏感性分析显示该结果对于男生稳定。结论 家庭矛盾可能会增加青少年自杀行为的风险，尤其是男生。和谐的家庭环境、良好的家庭氛围对预防和控制青少年自杀行为的发生具有重要意义。