儿童哮喘管理与哮喘控制水平的临床研究

目的 探索家庭结构对青少年抑郁、焦虑症状的影响及其作用机制。 方法 采用整群抽样法于2021年4—5月对上海市7所中学的学生进行线上问卷调查。问卷包括自编一般情况调查表、儿童期创伤问卷、儿童抑郁量表和儿童焦虑性情绪障碍筛查表。采用单因素方差分析、卡方检验、二元logistic回归、中介效应分析等方法探讨不同家庭结构青少年的抑郁和焦虑症状发生情况、儿童期创伤的差异及其中介作用。 结果 与核心家庭青少年相比,三代直系家庭的青少年出现抑郁症状的风险较低（OR=0.794,95%CI：0.649~0.972,P<0.05）,寄宿家庭的青少年出现抑郁症状的风险较高（OR=4.548,95%CI：1.113~18.580,P<0.05）;隔代家庭和寄宿家庭的青少年在儿童期创伤问卷中情感忽视维度的得分更高（P<0.05）。情感忽视在隔代家庭和寄宿家庭对青少年抑郁症状的影响中起中介作用。 结论 父母和祖辈在家庭结构中具有一定的积极影响。与父母分离会使青少年感知到更多的情感忽视,进而增加抑郁症状的发生。     

儿童急性淋巴细胞白血病中E-钙黏蛋白甲基化对预后的影响

目的 通过Meta分析探讨在儿童及青少年成熟B细胞非霍奇金淋巴瘤治疗中应用利妥昔单抗联合化疗的疗效与安全性,为更加合理地应用利妥昔单抗提供理论依据。 方法 检索PubMed、Embase、Cochrane Library、ClinicalTrials.gov、Web of Science、中国知网、万方、维普数据库的文献,共筛选出从建库至2022年6月公开发表的利妥昔单抗治疗儿童及青少年成熟B细胞非霍奇金淋巴瘤的10篇文献,共计886例患儿。以3年无事件生存率、3年总生存率、完全缓解率、病死率和不良反应发生率作为结局指标,采用RevMan 5.4软件进行Meta分析、亚组分析、敏感性分析和发表偏倚分析。 结果 与单纯化疗组相比,利妥昔单抗联合化疗组3年无事件生存率显著提高（HR=0.38,95%CI：0.25~0.59,P<0.001）,3年总生存率显著提高（HR=0.29,95%CI：0.14~0.61,P=0.001）,完全缓解率显著提高（OR=3.72,95%CI：1.89~7.33,P<0.001）,病死率显著降低（OR=0.31,95%CI：0.17~0.57,P<0.001）。而两组的不良反应发生率差异无统计学意义（OR=1.28,95%CI：0.85~1.92,P=0.24）。 结论 在儿童及青少年成熟B细胞非霍奇金淋巴瘤治疗方案中添加利妥昔单抗可带来明显的生存益处,且不会增加不良反应的发生。     

单胎濒死儿发生的围生期危险因素分析

目的 探讨单胎濒死儿发生的围生期危险因素,为濒死儿综合诊治提供依据。 方法 该研究为病例对照研究。选取2006年1月—2015年12月在复旦大学附属妇产科医院出生的154例胎龄≥28周、1 min Apgar评分为0~1分的单胎新生儿为病例组（濒死组）,按1∶4比例随机选取616例同期出生的单胎非濒死儿（1 min Apgar评分>1分）为对照组,采用单因素分析和多因素logistic回归分析评估濒死儿发生的围生期危险因素。 结果 濒死组胎龄和出生体重均显著低于对照组（P<0.05）。濒死组胎儿水肿、脐带脱垂、羊水Ⅲ度污染、胎盘早剥、臀位、重度子痫前期、母亲产时全麻、产前胎心监护异常、产前胎动减少发生比例显著高于对照组（P<0.05）。多因素logistic回归分析显示母亲产时全麻（OR=34.520）、产前胎动减少（OR=28.168）、胎盘早剥（OR=15.641）、羊水Ⅲ度污染（OR=6.365）、产前胎心监护异常（OR=5.739）、臀位（OR=2.614）是濒死儿发生的危险因素（P<0.05）,胎龄较大（OR=0.686）是濒死儿发生的保护因素（P<0.05）。 结论 临床需对产前胎心监护异常、胎动减少、早产、胎盘早剥、臀位、羊水Ⅲ度污染、全麻手术的产妇引起重视,做好新生儿复苏准备,防范濒死儿的发生。     

儿童碳青霉烯类耐药肺炎克雷伯菌医院感染的危险因素分析：单中心配对病例-病例-对照研究

目的 调查儿童专科医院住院患儿碳青霉烯类耐药肺炎克雷伯菌（carbapenem-resistant Klebsiella pneumonia,CRKP）感染及死亡的危险因素,为该类细菌的感染防治提供参考依据。 方法 采用配对病例-病例-对照研究的方法。回顾性纳入昆明市儿童医院2019年1月至2021年10月的81例CRKP感染患儿,81例碳青霉烯类敏感肺炎克雷伯菌（carbapenem-sensitive Klebsiella pneumonia,CSKP）感染患儿,及162例对照儿童（住院期间未分离出CRKP及CSKP的患儿）,比较分析各组儿童的基础疾病、既往住院暴露及该次住院暴露情况与CRKP感染及死亡的关联性。 结果 与对照组比较,既往3个月内有住院史与CRKP、CSKP感染存在较高关联强度（分别OR=14.25、10.07,P<0.01）;CRKP感染患儿特异的危险因素包括既往3个月内有碳青霉烯药物治疗史（OR=16.54,P<0.01）及该次住院接受中心静脉置管（OR=33.03,P<0.01）。而既往3个月内有碳青霉烯药物治疗史（OR=28.33,P<0.01）及该次住院抗生素经验性用药（OR=14.50,P<0.01）是导致CRKP患儿死亡的危险因素。 结论 患儿既往3个月内有住院史、碳青霉烯类药物治疗史,以及入院后接受侵入性操作是影响CRKP感染及预后的主要原因。儿童专科医院有必要开展入院时CRKP主动筛查,规范使用抗生素,并加强医院感染监测,以控制CRKP感染的发生。 ［中国当代儿科杂志,2022,24（9）：1008-1013］     

运动康复训练对支气管哮喘儿童运动能力和生活质量干预效果的系统评价

目的 系统评价运动康复训练对支气管哮喘儿童运动能力和生活质量的干预效果。 方法 检索PubMed、Cochrane Library、Web of Science、EBSCO、中国知网、维普数据库、万方数据库等数据库从建库至2021年2月关于运动康复训练对支气管哮喘儿童影响的随机对照试验。采用RevMan 5.3软件进行Meta分析。 结果 共纳入14项研究,共计990例受试者。Meta分析结果显示：（1）运动康复组运动能力优于常规治疗组：6 min步行试验的步行距离（MD=108.13,P<0.01）、自我疲劳感觉值（MD=-2.16,P<0.001）、峰值功率（MD=0.94,P=0.001）均显著优于常规治疗组;（2）在儿科哮喘生活质量问卷中,运动康复组生活质量总评分（SMD=1.28,P=0.0002）显著高于常规治疗组,活动受限评分（SMD=1.38,P=0.0002）、症状评分（SMD=1.02,P<0.001）、情感功能评分（SMD=0.86,P<0.001）均显著高于常规治疗组。 结论 运动康复训练对支气管哮喘儿童运动能力和生活质量具有一定的改善作用,但受纳入研究数量和质量的限制,作为指导临床应用还需进一步研究和验证。     

重症监护室患儿心脏停搏后早期出现急性肾损伤的危险因素及预后分析

目的 探讨心脏停搏（cardiac arrest,CA）患儿发生急性肾损伤（acute kidney injury,AKI）的相关因素及预后的影响因素。 方法 回顾性收集2016年6月—2021年6月湖南省儿童医院儿童重症监护室发生CA患儿的病历资料。按CA恢复自发循环（return of spontaneous circulation,ROSC）48 h内是否发生AKI分为AKI组（n=50）和非AKI组（n=113）,AKI组按ROSC 7 d时预后情况分为存活组（n=21）和死亡组（n=29）。采用多因素logistic回归分析CA患儿早期发生AKI的相关因素及预后影响因素。 结果 CA后AKI发生率为30.7%（50/163）。AKI组7 d及28 d病死率分别为58.0%（29/50）、78.0%（39/50）,非AKI组为31.9%（36/113）、58.4%（66/113）。多因素logistic回归分析显示,心肺复苏时间长（OR=1.164,95%CI：1.088~1.246,P<0.001）、基线血清白蛋白低（OR=0.879,95%CI：0.806~0.958,P=0.003）、CA前应用肾上腺素（OR=2.791,95%CI：1.119~6.961,P=0.028）与CA后AKI发生密切相关;基线小儿危重病例评分低（OR=0.761,95%CI：0.612~0.945,P=0.014）、CA前应用肾上腺素（OR=7.018,95%CI：1.196~41.188,P=0.031）、CA前机械通气（OR=7.875,95%CI：1.358~45.672,P=0.021）与CA后AKI患儿死亡密切相关。 结论 CA后ROSC患儿应密切监测血清白蛋白,尤其是心肺复苏时间长、基线小儿危重病例评分低、CA前应用肾上腺素、CA前机械通气者应及早识别和干预,以降低AKI发生率和病死率。     

青少年自杀意念与家庭环境和心理弹性之间的关联研究

目的 探讨青少年自杀意念与家庭环境因素和心理弹性之间的关系。方法 采用整群抽样法,于2014年12月对河南省新乡市3 230名初高中生进行一般社会资料问卷及Kutcher青少年抑郁量表（11项）（KADS-11）、家庭环境量表中文版（FES-CV）、中文版心理弹性量表（CD-RISC）评估测评后,采用多因素logistic回归分析和病例对照研究探讨青少年家庭环境和心理弹性与自杀意念之间的关联。结果 有效问卷为2 960份,有自杀意念者247例（8.50%）,其中男性98例,女性149例。多因素logistic回归分析显示,控制了年龄和性别因素后,单亲/再婚家庭模式与青少年自杀意念风险增加有关（OR=2.655）。男性青少年的自杀意念与家庭亲密度（OR=0.750,P < 0.001）及组织性（OR=0.855,P=0.036）呈明显负关联,与家庭矛盾性呈明显正关联（OR=1.159,P=0.017）。女性青少年的自杀意念与家庭亲密度（OR=0.771,P < 0.001）、情感表达（OR=0.815,P=0.001）及知识性（OR=0.915,P=0.037）存在负性关联。CD-RISC量表评估显示,有自杀意念的青少年心理弹性总得分明显低于无自杀意念的青少年（P < 0.05）,有自杀意念青少年该量表中的能力、忍受消极情感、接受变化和控制4个维度的得分均比无自杀意念青少年低（P < 0.05）。结论 青少年家庭环境亲密度是青少年自杀意念的保护因素;男性青少年的家庭组织性和女性青少年家庭情感表达与降低自杀风险有关;增强心理弹性可能有助于降低青少年的自杀意念。     

儿童嗜酸性粒细胞性胃肠炎糖皮质激素治疗的预测因素分析

目的 分析儿童嗜酸性粒细胞性胃肠炎临床特点和治疗方案的关系，探讨糖皮质激素治疗的适用情况，为儿科医师选择治疗方案提供依据。 方法 回顾性收集广州市妇女儿童医疗中心2012年1月至2020年12月收治的182例嗜酸性粒细胞性胃肠炎患儿的临床资料。根据治疗方案中是否使用糖皮质激素分为激素组和对照组，比较分析两组患儿年龄、过敏史、临床症状、实验室检查结果、内镜下表现和胃肠黏膜病理结果，对差异有统计学意义的结果进一步行logistic回归分析。 结果 182例患儿中，36例使用糖皮质激素治疗，占总人数的19.8%。激素组患儿出现血便、贫血，内镜下出现黏膜溃疡/管腔狭窄的比例，以及黏膜嗜酸性粒细胞浸润计数均明显高于对照组（n=146，P<0.05）；激素组血清白蛋白水平明显低于对照组（P<0.05）。多因素logistic回归分析结果显示，内镜下见黏膜溃疡/管腔狭窄（OR=10.830，95%CI：3.090~37.961，P<0.001）和黏膜嗜酸性粒细胞浸润计数升高（OR=0.967，95%CI：0.941~0.993，P=0.015）可提示使用糖皮质激素治疗儿童嗜酸性粒细胞性胃肠炎。 结论 内镜下见到黏膜溃疡/管腔狭窄，病理显示黏膜嗜酸性粒细胞浸润计数明显升高，均提示儿童嗜酸性粒细胞性胃肠炎的治疗方案中可采用糖皮质激素治疗。 引用格式:     

MTHFR基因多态性与儿童支气管哮喘易感性及糖皮质激素疗效的相关性

目的 探讨亚甲基四氢叶酸还原酶（methylenetetrahydrofolate reductase,MTHFR）基因多态性与儿童支气管哮喘易感性及糖皮质激素（glucocorticoid,GC）疗效的相关性。 方法 选取2018年6月至2020年12月住院治疗的儿童支气管哮喘患儿173例为观察组,均接受GC雾化吸入治疗,连续3个月。选取同期体检的健康儿童178例为对照组。采用PCR检测两组受试儿MTHFR基因C677T位点的基因型,分析两组基因型分布差异性;比较观察组不同基因型患儿治疗前后血清免疫球蛋白E、白细胞介素-8（interleukin-8,IL-8）、白三烯B4（leukotriene B4,LTB4）水平,肺功能指标差异及临床疗效差异。 结果 与对照组相比,观察组TT基因型及T等位基因频率均显著升高（P<0.001）;TT/CT基因型及T等位基因是支气管哮喘易感性的独立危险因素（OR分别为6.615、7.055,P<0.001）。GC治疗后3种基因型患儿免疫球蛋白E、IL-8和LTB4水平较治疗前显著降低,第1秒用力呼气容积（forced expiratory volume in 1 second,FEV1）、用力肺活量（forced vital capacity,FVC）、FEV1/FVC%较治疗前显著升高（P<0.001）;TT基因型患儿IL-8和LTB4水平显著低于CC基因型患儿,LTB4水平明显低于CT基因型患儿,TT基因型患儿FVC明显高于CT基因型患儿,FEV1/FVC%显著高于CC基因型患儿（P<0.05）;治疗后3种基因型患儿临床GC治疗疗效比较差异有统计学意义,其中TT基因型患儿GC疗效良好比例显著高于CC基因型患儿（P<0.05）,且TT基因型是GC疗效良好的独立影响因素（OR=2.111,P=0.018）。 结论 MTHFR基因多态性与儿童哮喘易感性及GC疗效相关,携带TT/CT基因型儿童支气管哮喘发病风险更高,TT基因型对GC治疗具有更高的敏感性。     

人类免疫缺陷病毒暴露未感染婴幼儿的神经心理发育状况(英文翻译)

目的 研究人类免疫缺陷病毒（human immunodeficiency virus,HIV）暴露未感染（HIV-exposed uninfected,HEU）婴幼儿神经心理发育水平,探讨母亲HIV感染对HEU婴幼儿神经心理发育的影响。 方法 选取2019年6月至2020年12月在云南省4家妇幼保健院专案管理且符合纳入标准的141名0~18月龄HIV感染母亲所生未感染HIV,即HEU婴幼儿作为HEU组,以性别、年龄、出生方式、出生体重、胎龄为配对条件,按1∶1配对141名健康母亲所生婴幼儿,即无HIV暴露、无HIV感染（HIV-unexposed uninfected,HUU）婴幼儿为对照,应用Griffiths发育评估量表中文版（Griffiths Development Scales-Chinese Edition,GDS-C）评估运动、个人-社会、听力语言、手眼协调、表现（视感知空间整合能力）5个领域发育情况,同时采用问卷调查方式收集有关信息。采用多因素logistic回归分析探讨母亲HIV感染对HEU婴幼儿神经心理发育的影响。 结果 HEU组听力语言和表现2个领域迟缓检出率显著高于HUU组（P<0.05）。多因素logistic回归分析显示,HIV暴露增加了婴幼儿听力语言（OR=2.661,95%CI：1.171~6.047）和表现（OR=2.321,95%CI：1.156~4.658）2个领域迟缓发生的风险（P<0.05）。 结论 母亲感染HIV可对其分娩的未感染HIV婴幼儿听力语言和表现领域的发育产生负面影响,其机制有待进一步研究。 ［中国当代儿科杂志,2022,24（9）：967-972］     

Association between maternal job burnout and adolescent depression: the chain mediating effect of maternal depression and parenting style北大核心CSCD

目的研究母亲职业倦怠与青少年抑郁的关系,以及母亲抑郁、教养方式在其中的中介作用。方法采用横断面研究设计,于2021年4—5月在上海市7所初中进行整群随机抽样,对7所初中2572名青少年及其母亲进行问卷调查。研究工具包括一般资料调查表、职业倦怠量表、流调中心抑郁量表、简式父母教养方式问卷及儿童抑郁量表。建立结构方程模型,使用Bootstrap法进行中介效应检验。结果青少年抑郁症状检出率为12.71%(327/2572)。母亲职业倦怠得分、母亲抑郁得分、消极教养方式得分与青少年抑郁得分呈显著正相关(P<0.05),而积极教养方式得分与青少年抑郁得分呈显著负相关(P<0.05)。母亲抑郁、教养方式在职业倦怠与青少年抑郁间起中介作用,包括母亲抑郁的独立中介、积极教养方式的独立中介及抑郁-消极/积极教养方式的链式中介。结论母亲的职业倦怠可通过抑郁、教养方式、抑郁-教养方式3条中介路径影响青少年抑郁,提示降低母亲职业倦怠、改善母亲的抑郁情绪、增加积极教养行为、减少消极教养行为,有助于减少青少年抑郁症状的发生。     

Substance use and suicidal conduct: a study of adolescents hospitalized for suicide attempt and ideation

AIM: To study the prevalence of psychoactive substance use disorder (PSUD) among suicidal adolescents, psychoactive substance intoxication at the moment of the attempt, and the association between PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s). METHODS: 186 adolescents aged 16 to 21 y hospitalized for suicide attempt or overwhelming suicidal ideation were included (T0); 148 of them were traced again for evaluations after 6 mo (T1) and/or 18 mo (T2). DSM-IV diagnoses were assessed each time using the Mini International Neuropsychiatric Interview. RESULTS: At T0, 39.2% of the subjects were found to have a PSUD. Among them, a significantly higher proportion was intoxicated at the time of the attempt than those without PSUD (44.3% vs 25.4%). Among the 148 adolescents who could be traced at either T1 or T2, two died from suicide and 30 repeated suicide attempts once or more times. A marginally significant association was found between death by suicide/repetition of suicide attempt and alcohol abuse/dependence at baseline (OR=3.3, 95% CI 0.7-15.0; OR=2.6, 95% CI 0.7-9.3). More than one suicide attempt before admission to hospital at T0 (OR=3.2, 95% CI 1.1-10.0) and age over 19 y at T0 (OR=3.2, 95% CI 1.1-9.2) were independently associated with the likelihood of death by suicide or repetition of suicide attempt. CONCLUSION: Among adolescents hospitalized for suicide attempt or overwhelming suicidal ideation, the risk of death or repetition of attempt is high and is associated with previous suicide attempts--especially among older adolescents--and also marginally associated with PSUD; these adolescents should be carefully evaluated for such risks and followed up once discharged from the hospital.     

Lifetime prevalence of suicidal and self-injurious behaviors in a representative cohort of Slovenian adolescents with type 1 diabetes

Objective: To determine lifetime prevalence of suicidal and self-injurious behaviors in Slovenian adolescents with type 1 diabetes compared with healthy controls.
Research design and methods: Adolescents (14–19 yr) with type 1 diabetes were compared with a normative control group of healthy secondary school students by means of a self-reported questionnaire (according to Kienhorst) containing questions on demographic and family characteristics, suicidal ideation, intended suicide, attempted suicide, possible future suicide, and self-injurious behavior. Patients received the questionnaires at regular outpatient visits to the pediatric diabetes clinic, completed them in private, and returned them by mail. Questionnaires for control subjects were administered in classrooms.
Results: The responses of 126 eligible patients and 499 controls were analyzed. The control group trended toward higher lifetime prevalence of all suicidal behaviors and self-injurious behavior. The lowest prevalence of all suicidal behaviors and self-injurious behavior was reported by males with diabetes. Compared with male controls, the differences were statistically significant for suicidal ideation (p < 0.05) and intended suicide (p < 0.05). Compared with females with diabetes, the differences were statistically significant for suicidal ideation (p < 0.001), intended suicide (p < 0.01), attempted suicide (p < 0.05), and self-injurious behavior (p < 0.05). Females with diabetes reported highest prevalence of all suicidal but not self-injurious behaviors. More patients than controls reported receiving counseling the year preceding the study (p < 0.001).
Conclusions: In the study, type 1 diabetes showed a protective effect for suicidal behavior in adolescent males but not in adolescent females. Professionals working with adolescents with type 1 diabetes should be alert to possible suicidality, especially among females.     

Associations of body mass index and perceived weight with suicide ideation and suicide attempts among US high school students

BACKGROUND: Previous research with adolescents has shown associations of body weight and perceptions of body size with suicide ideation and suicide attempts, but it is unclear whether these associations are direct or whether a mediating effect exists. OBJECTIVES: To determine if body mass index and perceived weight are associated significantly with suicide ideation and suicide attempts, controlling for weight control practices, and if perceived weight mediates the associations of body mass index with suicide ideation and suicide attempts. DESIGN, SETTING, AND PARTICIPANTS: Data were analyzed from the 2001 Youth Risk Behavior Survey, a school-based survey administered to a nationally representative sample of students in grades 9 through 12 (N = 13 601). MAIN OUTCOME MEASURE: Self-reported past-year suicide ideation and suicide attempts, compared by perceived weight and body mass index category, calculated from self-reported height and weight. RESULTS: Body mass index category was associated significantly with suicide ideation (among all students) and suicide attempts (among white and Hispanic students) without perceived weight in the model but not with perceived weight added to the model. In contrast with those who perceive themselves as about the right weight, students who perceived themselves as very underweight (odds ratio [OR], 2.29 [95% confidence interval (CI), 1.46-3.59]), slightly underweight (OR, 1.36 [95% CI, 1.03-1.79]), slightly overweight (OR, 1.33 [95% CI, 1.12-1.58]), and very overweight (OR, 2.50 [95% CI, 1.73-3.60]) had greater adjusted odds of suicide ideation. Among white students, perceiving oneself as very underweight (OR, 3.04 [95% CI, 1.40-6.58]) or very overweight (OR, 2.74 [95% CI, 1.21-6.23]) was associated with greater odds of suicide attempts. Perceiving oneself as very underweight was associated with greater odds for suicide attempts among black (OR, 2.86 [95% CI, 1.10-7.45]) and Hispanic (OR, 3.40 [95% CI, 1.54-7.51]) students. CONCLUSIONS: How adolescents perceive their body weight may be more important than their actual weight in terms of increased likelihood of suicidal behavior. Regardless of body mass index, extreme perceptions of weight appear to be significant risk factors for suicidal behavior; important racial/ethnic differences exist.     

Hypothalamic-pituitary-adrenal axis dysfunction as a neurobiological correlate of emotion dysregulation in adolescent suicide

Background

Biological markers of vulnerability for current or future risk of suicide in adolescents could be important adjuncts to the treatment and prevention of this phenomenon.

Data sources

We conducted a PubMed search of all English-language articles published between January 1990 and June 2011 using the following search terms: (??hypothalamic-pituitary-adrenal?? OR ??HPA??) AND (??adolescence?? OR ??adolescent?? OR ??teenager??) AND (??depression?? OR ??major depressive disorder?? OR ??suicidal behavior?? OR ??suicidal ideation?? OR ??suicidal thoughts?? OR ??deliberate self-harm?? OR ??suicidal attempt?? OR ??suicide??).

Results

HPA axis activity can be examined using different methods that do not have the same biological interpretation. An abnormal HPA axis functioning together with an anomalous interaction between HPA mechanisms and other systems such as the serotonergic system may be one of the neurobiological correlates of emotion dysregulation (ED). ED may play an important role in adolescent suicidal behavior. Some psychopathological conditions such as depression or childhood psychological trauma that increase suicidal risk in adolescents are also associated with HPA axis dysregulation. ED, a personality trait, can also be viewed as a predisposing factor that augments the vulnerability to suffer from psychiatric conditions.

Conclusions

Correlating HPA axis dysfunction with psychological factors such as ED could lead to a better understanding of the role of HPA abnormalities in adolescent suicide and may enhance preventive and treatment strategies.     

Suicide and suicide attempts in adolescents

Suicide is the third-leading cause of death for adolescents 15 to 19 years old. Pediatricians can take steps to help reduce the incidence of adolescent suicide by screening for depression and suicidal ideation and behavior. This report updates the previous statement of the American Academy of Pediatrics and is intended to assist the pediatrician in the identification and management of the adolescent at risk of suicide. The extent to which pediatricians provide appropriate care for suicidal adolescents depends on their knowledge, skill, comfort with the topic, and ready access to appropriate community resources. All teenagers with suicidal thoughts or behaviors should know that their pleas for assistance are heard and that pediatricians are willing to serve as advocates to help resolve the crisis.     

Identifying Suicide Risk in Adolescents With Firearm Access: Screening in the Emergency Department

ObjectiveThis study compares current suicidal ideation, prior suicide attempt and associated self-reported risk factors in adolescents with and without access to firearms.MethodsUsing data from a clinically applied behavioral health assessment completed by adolescents presenting to a tertiary children's hospital emergency department (ED; N = 15,806), we evaluated the association between firearm access (ie, firearm in the home or ability to obtain one within 24 hours), each of the included suicide risk factors (ie, depressive symptoms, trauma victimization, bullying victimization), and our primary outcomes (ie, current suicidal ideation and prior suicide attempt). We performed regression analyses on 3 groups: 1) The overall population; 2) Only the participants with firearm access; and 3) Only the participants without firearm access.ResultsFourteen percent (2179/15,806) of the sample reported a firearm in the home or ability to access one within 24 hours. Overall, 6.8% of participants reported current suicidal ideation and 9.1% reported prior suicide attempt. Youth with firearm access had 1.52 times higher odds of current suicidal ideation and 1.61 times higher odds of prior suicide attempt compared to youth without firearm access. All included suicide risk factors were found to significantly increase the odds of current suicidal ideation and prior suicide attempt in the overall sample; this increase was similar in the groups with and without firearm access.ConclusionsAdolescents with firearm access have higher odds of suicidal ideation and prior attempt compared to those without firearm access, highlighting the need for universal ED-based screening for suicidality and lethal means.     

Disaster Related Stresses, Depressive Signs and Symptoms, and Suicidal Ideation Among a Multi-Racial/Ethnic Sample of Adolescents: A Longitudinal Analysis

Longitudinal findings are presented on the relationships between disaster related stresses, depression scores, and suicidal ideation among a multi-racial/ethnic sample of adolescents (N = 4,978) all of whom have been exposed to Hurricane Andrew. Regression analysis showed that being female, hurricane generated stresses, low levels of family support, pre-hurricane suicidal ideation, and posi-hurricane depression scores were significant predictors of post-hurricane suicidal ideation. Path analysis revealed that being female, low socioeconomic status, pre- and post-hurricane depression, high stress scores, low family support, and pre-hurricane suicidal ideation had significant direct/indirect effects on post-hurricane suicidal ideation.     

Risk factors for attempted suicide during adolescence

It is unknown whether adolescents can provide the information necessary to identify their risk for attempted suicide. The present study was designed to determine whether data collected directly from adolescents can be used to develop a simple model for differentiating suicidal from nonsuicidal adolescents. Patients aged 13 to 19 years hospitalized for medical complications of serious suicide attempts (n = 56) or for acute illnesses unrelated to injuries or ingestions (n = 248) completed self-administered questionnaires pertaining to psychosocial function, recent stress, alcohol and drug use, and health care use. Compared with ill adolescents, suicidal adolescents had poorer mental health, impulse control, family relationships, and school performance; higher 3-month stress scores and alcohol-use scores; and more use of 7 of 12 drugs (P less than .05). Compared with ill adolescents, suicidal adolescents were more likely to report previous suicide attempts (39% vs 10%, P less than .001) and previous mental health care (27% vs 8%, P less than .001) but were less likely to identify a primary care site (61% vs 87%, P less than .001). In a logistic regression model based on previous suicide attempts, previous mental health care, poor school performance, marijuana use, and dependence on the emergency room for primary care, 84% of the suicidal and 55% of the ill adolescents were correctly identified. If validated prospectively, these five self-administered questions may constitute a helpful screen for the rapid identification of suicidal adolescents.