Evaluation of the quality of life and risk of suicide

OBJECTIVE:

To identify the socio-demographic profiles, suicidal ideation, the presence of mental disorders and the quality of life of patients using mental health services in Arapiraca, Alagoas, Brazil.

METHOD:

Interviews were conducted in family health units and the Psychosocial Attention Center. The sample included 202 mental disorder patients with a risk of suicide attempts, 207 mental disorder patients without a risk of suicide attempts and 196 controls. This study used an identification questionnaire, the abbreviated World Health Organization Quality of Life questionnaire, Beck‘s Suicidal Ideation Scale and the Mini International Neuropsychiatric Interview.

RESULTS:

Patients who had a mental disorder and a risk of suicide attempts tended to be single, had less education and lower family income, were not working and showed lower scores in quality of life domains; 73 of these patients had suicidal ideation in the previous week. Depressive disorders, manic episodes, hypomanic episodes, social phobias, obsessive compulsive disorder, post-traumatic stress disorder, psychotic syndromes and generalized anxiety disorder were more frequent and statistically significant for patients at risk for suicide attempts.

CONCLUSION:

The management of patients with a risk of suicide attempts must focus on individual patients because this risk is directly linked to changes in quality of life and the improvement of these patients'' prognosis.     

Psychosocial factors associated with suicidal ideation in clinical patients with depression

Background

Depression is a major risk factor for suicide, but few studies have examined psychosocial risk factors for suicide in clinical patients with depression. The purpose of this study was to investigate psychosocial factors which could be associated with suicidal ideation in clinical patients with depression including: sick-leave, help-seeking behavior, and reluctance to admit mental health problems.

Methods

A multi-center cross-sectional survey using self-report questionnaire was conducted at 54 outpatient psychiatric clinics in Tokyo in 2012. Adult outpatients who were diagnosed by psychiatrists as mood disorders (F30–F39) in the International Classification of Diseases-10 (ICD-10) were included in the study. Those who met the criteria for current hypomanic or manic episode were excluded from the study.

Results

A total of 189 patients with depression participated in the survey. Multivariable logistic regression analysis showed that taking sick-leave and having sought help from family were associated with decreased odds of current suicidal ideation. Moderate or more severe depression was associated with increased odds of suicidal ideation, and reluctance to admit own mental health problem tended to increase odds of suicidal ideation.

Limitations

Living status and suicidal ideation before consultation with psychiatrist were not investigated. Severity of suicidal ideation and comorbid psychiatric disorders were not assessed.

Conclusions

Importance of treatment of more severe depression for suicide prevention was confirmed. Industrial health staffs should consider the possibility of positive effect of taking sick-leave when they see employees with depression. Promoting help-seeking for family and reducing stigma of mental illness may be effective for suicide prevention.     

Suicidal behaviors in elderly Koreans: One-month-point prevalence and factors related to suicidality

Background

Suicide prevention in the elderly is a major public health priority worldwide and in Korea in particular. We investigated the one-month-point prevalence and factors related to suicidality for suicidal behaviors in elderly Koreans.

Methods

A simple random sample (N=1588) was drawn from the residential roster of 14,051 Koreans aged 60 years or older who were residents of Osan in February 2010. All subjects were invited to participate in the survey through door-to-door home visits, and the response rate was 59.8%.

Results

The age- and gender-standardized prevalence rates of lifetime suicide attempts, current suicidal ideation without a plan or attempt, and current suicidal ideation with a plan or attempt were estimated at 9.2%, 19.6%, and 2.24%. The prevalence of suicidal ideation without a plan or attempt was higher in women and less-educated individuals and increased with advancing age, whereas the prevalence of suicidal ideation with a plan or attempt was higher in more-educated individuals, was not differentiated by gender, increased until age 70, and then decreased thereafter. The factors related to suicidal ideation differed by the presence of a suicide plan or attempt.

Conclusions

Depressive elders in their 70s who have recently developed suicidal ideation would be a prime target for suicide intervention programs.

Limitations

The sample was regional, although the suicide rate in Osan was comparable to the average suicide rate in Korea.     

Early Initiation of Alcohol Drinking, Cigarette Smoking, and Sexual Intercourse Linked to Suicidal Ideation and Attempts: Findings from the 2006 Korean Youth Risk Behavior Survey

Purpose

This study examined the association between early initiation of problem behaviors (alcohol drinking, cigarette smoking, and sexual intercourse) and suicidal behaviors (suicidal ideation and suicide attempts), and explored the effect of concurrent participation in these problem behaviors on suicidal behaviors among Korean adolescent males and females.

Materials and Methods

Data were obtained from the 2006 Korean Youth Risk Behavior Survey, a nationally representative sample of middle and high school students (32,417 males and 31,467 females) in grades seven through twelve. Bivariate and multivariate logistic analyses were conducted. Several important covariates, such as age, family living structure, household economic status, academic performance, current alcohol drinking, current cigarette smoking, current butane gas or glue sniffing, perceived body weight, unhealthy weight control behaviors, subjective sleep evaluation, and depressed mood were included in the analyses.

Results

Both male and female preteen initiators of each problem behavior were at greater risk for suicidal behaviors than non-initiators, even after controlling for covariates. More numerous concurrent problematic behaviors were correlated with greater likelihood of seriously considering or attempting suicide among both males and females. This pattern was more clearly observed in preteen than in teen initiators although the former and latter were engaged in the same frequency of problem behavior.

Conclusion

Early initiation of alcohol drinking, cigarette smoking, and sexual intercourse, particularly among preteens, represented an important predictor of later suicidal ideation and suicide attempts in both genders. Thus, early preventive intervention programs should be developed and may reduce the potential risks for subsequent suicidal behaviors.     

BDNF promoter methylation and suicidal behavior in depressive patients

Introduction

Suicide is a major health problem, and depression is a major psychiatric cause of suicide. Suicide is influenced by the multifactorial interaction of many risk factors. Therefore, epigenetic research may lead to understandings that are applicable to suicide. This study investigated whether epigenetic changes are associated with suicidal behavior and evaluated the treatment outcome of suicidal ideation in depressive patients.

Methods

In 108 patients with major depression, the promoter methylation of the gene encoding brain-derived neurotrophic factor (BDNF) was measured. Sociodemographic and clinical characteristics including a history of previous depressive episodes, age at onset, duration of illnesses, family history of depression, and number of stressful life events as well as subjective perception of stress and assessment scales for depression (HAMD), anxiety (HAMA), function (SOFAS), disability (WHODAS-12), and quality of life (WHOQOL-BREF) were evaluated at baseline. Suicidal behavior was ascertained using a semistructured clinical interview with questions about severity and intent. Beck Scale for Suicide Ideation (BSS) was administered during 12 weeks of treatment with antidepressants.

Results

A higher BDNF promoter methylation status was significantly associated with a previous suicidal attempt history, suicidal ideation during treatment, and suicidal ideation at last evaluation as well as with higher BSS scores and poor treatment outcomes for suicidal ideation.

Limitations

Methylation status was investigated with limited area of the BDNF gene and sample size was relatively small.

Conclusions

BDNF methylation status could be a proxy marker for previous suicidal attempts and a clinical biomarker for poor treatment outcomes of suicidal ideation in depression.     

Factors associated with suicidal behaviour among depressed patients in Penang,Malaysia

Introduction

This study aims to highlight the factors associated with suicidal behavior among patients with depressive disorders.

Material and methods

A retrospective (Jan 2002 – Dec 2007) evaluation of medical records was done at the psychiatric clinic at the Penang (Malaysia) Public Hospital. Data was analyzed using Statistical Package for Social Science SPSS version 13^®. Chi-square (χ²) test was used to assess the association among variables. Odds ratios were calculated. Multiple logistic regression was applied to identify the predictors for suicidal behavior.

Results

Of 298 patients, 99 patients reported having thoughts of suicide. Overall, female respondents, particularly Chinese, constituted the majority reporting suicidal thoughts (p = 0.01). Cigarette (p < 0.01) and alcohol use (p < 0.01) were found to be associated with suicidal ideation. Among patients with medical comorbidities, diabetics were at a high risk for suicidal thoughts (odds ratio – OR = 1.05, 95% confidence interval – CI 0.45-2.46). In terms of social problems, marital and relationship difficulties were the main risk factors (OR = 2.03, 95% CI: 1.16-3.58). The significant predictors for suicidal behavior were found to be smoking and alcohol use (adjusted R² = 0.39, F change = 75.55, p < 0.01).

Conclusions

Chinese females were found at higher risk of suicidal ideation, as were smokers and alcohol users. The elderly aged 50 and over were also at a higher risk, followed by adolescents and youths aged 15-24 years. Comorbid medical complications and social problems were other factors that may contribute to suicidal ideation among the patients with depressive disorders.     

Suicidal behaviours in South East London: Prevalence,risk factors and the role of socio-economic status

Background

Low socio-economic status (SES) is an established risk factor of suicidal behaviours, but it is unknown to what extent its association is direct, indirect or confounded, given its strong association to mental health. We aimed to (I) estimate the prevalence of suicidal behaviours; (II) describe relevant risk factors; and (III) investigate direct and indirect effects of SES on suicidal behaviours.

Methods

We used cross-sectional community survey data of adults from randomly selected South East London households (SELCoH). Suicidal outcome measures replicated the 2007 Adult Psychiatric Morbidity Survey in England (APMS). Lifetime prevalence was described by socio-demographics, SES, mental health indicators, and life events. Structured symptom screens and a drug use questionnaire measured mental health. Structural equation models estimated direct and indirect effects of a latent SES variable on suicidal ideation and suicide attempts, adjusting for covariates.

Results

20.5% (95% CI: 18.4–22.7) reported suicidal ideation and 8.1% (95% CI: 6.8–9.7) reported suicide attempts (higher than APMS estimates: 13.7%, 4.8%, respectively). Unadjusted risk factors included poor mental health, low SES, and non-married/non-cohabitating relationship status. Black African ethnicity was protective, and women reported more suicide attempts. SES was directly associated to suicide attempts, but not suicidal ideation. SES had indirect effects on suicidal outcomes via mental health and life events.

Limitations

The cross-sectional design and application of measures for different time periods did not allow for causal inferences.

Conclusions

Suicidal behaviours were more prevalent than in the general UK population. Interventions targeting low SES individuals may prove effective in preventing suicide attempts.     

Earlier Parental Set Bedtimes as a Protective Factor Against Depression and Suicidal Ideation

Study Objectives:

To examine the relationships between parental set bedtimes, sleep duration, and depression as a quasi-experiment to explore the potentially bidirectional relationship between short sleep duration and depression. Short sleep duration has been shown to precede depression, but this could be explained as a prodromal symptom of depression. Depression in an adolescent can affect his/her chosen bedtime, but it is less likely to affect a parent''s chosen set bedtime which can establish a relatively stable upper limit that can directly affect sleep duration.

Design:

Multivariate cross-sectional analyses of the ADD Health using logistic regression.

Setting:

United States nationally representative, school-based, probability-based sample in 1994-96.

Participants:

Adolescents (n = 15,659) in grades 7 to 12.

Measurements and Results:

Adolescents with parental set bedtimes of midnight or later were 24% more likely to suffer from depression (OR = 1.24, 95% CI 1.04-1.49) and 20% more likely to have suicidal ideation (1.20, 1.01-1.41) than adolescents with parental set bedtimes of 10:00 PM or earlier, after controlling for covariates. Consistent with sleep duration and perception of getting enough sleep acting as mediators, the inclusion of these variables in the multivariate models appreciably attenuated the associations for depression (1.07, 0.88-1.30) and suicidal ideation (1.09, 0.92-1.29).

Conclusions:

The results from this study provide new evidence to strengthen the argument that short sleep duration could play a role in the etiology of depression. Earlier parental set bedtimes could therefore be protective against adolescent depression and suicidal ideation by lengthening sleep duration.

Citation:

Gangwisch JE; Babiss LA; Malaspina D; Turner JB; Zammit GK; Posner K. Earlier parental set bedtimes as a protective factor against depression and suicidal ideation. SLEEP 2010;33(1):97-106.     

Psychiatric morbidity in stroke patients attending a neurology clinic in Nigeria

Back ground

Stroke produces a wide range of mental and emotional disorders. Neuropsychiatric complications associated with stroke may have negative effects on the social functioning, overall quality of life and the recovery of motor functioning of stroke survivors.

Objective

To determine the prevalence and nature of psychiatric morbidity among stroke patients attending neurology outpatient clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin-Nigeria.

Methods

All patients with stroke aged 18 years and above at an outpatient neurology clinic in Ilorin, Nigeria were assessed for mental and emotional disorders using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) over one year (March 2009 to February 2010).

Results

Overall prevalence of psychiatric morbidity was 36.0% (30/83) among 83 patients who constituted the study population. Specific diagnoses recorded were depression (19.2%), generalised anxiety disorder (9.6%), harmful alcohol use (2.4%); dementia, somatoform disorder, phobia and delusional disorder each had a prevalence of 1.2%. Clinical and sociodemographic variables were not significantly associated with psychiatric morbidity.

Conclusion

Psychiatric disorders are often associated with stroke. Identifying and treating stroke patients with these psychiatric co-morbidities could thus help to improve the overall quality of life of these patients.     

Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help

Background

Suicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions.

Objective

To evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation.

Methods

A total of 236 adults with mild to moderate suicidal thoughts, defined as scores between 1-26 on the Beck Scale for Suicide Ideation (BSS), were recruited in the general population and randomized to the intervention (n = 116) or to a waitlist, information-only, control group (n = 120). The intervention aimed to decrease the frequency and intensity of suicidal ideation and consisted of 6 modules based on cognitive behavioral techniques. Participants in both groups had unrestricted access to care as usual. Assessments took place at baseline and 6 weeks later (post-test). All questionnaires were self-report and administered via the Internet. Treatment response was defined as a clinically significant decrease in suicidal ideation on the BSS. Total per-participant costs encompassed costs of health service uptake, participants’ out-of-pocket expenses, costs stemming from production losses, and intervention costs. These were expressed in Euros (€) for the reference year 2009.

Results

At post-test, treatment response was 35.3% and 20.8% in the experimental and control conditions, respectively. The incremental effectiveness was 0.35 − 0.21 = 0.15 (SE 0.06, P = .01). The annualized incremental costs were −€5039 per participant. Therefore, the mean incremental cost-effectiveness ratio (ICER) was estimated to be −€5039/0.15 = −€34,727 after rounding (US −$41,325) for an additional treatment response, indicating annual cost savings per treatment responder.

Conclusions

This is the first trial to indicate that online self-help to reduce suicidal ideation is feasible, effective, and cost saving. Limitations included reliance on self-report and a short timeframe (6 weeks). Therefore, replication with a longer follow-up period is recommended.     

Psychological factors associated with the incidence and persistence of suicidal ideation

Background

Suicidal ideation has been identified as both a common antecedent and a significant risk factor for suicide attempt and completed suicide. However, little is known about the incidence and persistence of suicidal ideation in the general population and the associated risk factors.

Methods

A 12-month follow-up survey investigated 997 of the respondents who participated in the baseline territory-wide survey of adult population in Hong Kong. A set of baseline psychological factors was considered as predictors of first onset and persistence of suicidal ideation.

Results

Twelve-month incidence (1.9%) and persistence (6.2%) rates were estimated. Respondents with anxiety and lack of reasons for living were more likely to report a development of suicidal thoughts in the follow-up assessment, while respondents with higher level of average life distress and lower level of hope were at increased risk of continuing to have suicidal thoughts. Depression was found to partially mediate the effect of average life distress on persistent suicidality.

Limitations

Retention rate of the follow-up sample was about 50% only. Assessments of suicidal ideation were based on retrospective reports.

Conclusions

Psychological factors differentially predict first onset and persistence of suicidal ideation. It is of clinical value that depression partially mediated the effect of life distress on persistence of suicidality.     

Differentiating army suicide attempters from psychologically treated and untreated soldiers: A demographic,psychological and stress-reaction characterization

Background

Suicide is the leading cause of death in most armies during peace-time. The recent dramatic rise in suicides in the US Army further focuses attention on the causes of suicidal behavior in the military.

Methods

This study investigated demographic characteristics, psychological profile and stress-related risk factors associated with suicide attempts in Israelis aged 18–21 years, who served in the Army in 2009. Soldiers who attempted suicide (N=60) were compared to soldiers treated by a mental health professional, but reported no suicidal behavior (N=58), and to controls (N=50).

Results

Suicide attempters had lower socioeconomic status and less cognitive ability compared with treated soldiers and untreated control soldiers. Only 25% of the suicide attempters had received mental healthcare prior to the attempt. The majority of the attempts were non-lethal (86.2%), and only 5.2% used firearms. Attempters had more previous suicide attempts (37.9%) and deliberate selfharm incidents (19.3%), compared to almost no such behaviors in the other two groups. Following the suicide attempt, 77% were diagnosed with moderate to severe mental disorders, 44.8% personality disorders and 8.6% mood disorders. Attempters reported higher levels of general stress compared to their peers in the other two groups. Being away from home and obeying authority were especially more stressful in attempters.

Conclusions

Young soldiers are less prone to seek mental health assistance, despite suffering from higher levels of stress. Screening is required to detect soldiers at risk for suicidal behavior and preventive intervention will require active outreach.     

Applying Computer Adaptive Testing to Optimize Online Assessment of Suicidal Behavior: A Simulation Study

Background

The Internet is used increasingly for both suicide research and prevention. To optimize online assessment of suicidal patients, there is a need for short, good-quality tools to assess elevated risk of future suicidal behavior. Computer adaptive testing (CAT) can be used to reduce response burden and improve accuracy, and make the available pencil-and-paper tools more appropriate for online administration.

Objective

The aim was to test whether an item response–based computer adaptive simulation can be used to reduce the length of the Beck Scale for Suicide Ideation (BSS).

Methods

The data used for our simulation was obtained from a large multicenter trial from The Netherlands: the Professionals in Training to STOP suicide (PITSTOP suicide) study. We applied a principal components analysis (PCA), confirmatory factor analysis (CFA), a graded response model (GRM), and simulated a CAT.

Results

The scores of 505 patients were analyzed. Psychometric analyses showed the questionnaire to be unidimensional with good internal consistency. The computer adaptive simulation showed that for the estimation of elevation of risk of future suicidal behavior 4 items (instead of the full 19) were sufficient, on average.

Conclusions

This study demonstrated that CAT can be applied successfully to reduce the length of the Dutch version of the BSS. We argue that the use of CAT can improve the accuracy and the response burden when assessing the risk of future suicidal behavior online. Because CAT can be daunting for clinicians and applied scientists, we offer a concrete example of our computer adaptive simulation of the Dutch version of the BSS at the end of the paper.     

Hazardous Drinking-Related Characteristics of Depressive Disorders in Korea: The CRESCEND Study

This study aimed to identify clinical correlates of hazardous drinking in a large cohort of Korean patients with depression. We recruited a total of 402 depressed patients aged > 18 yr from the Clinical Research Center for Depression (CRESCEND) study in Korea. Patients'' drinking habits were assessed using the Korean Alcohol Use Disorder Identification Test (AUDIT-K). Psychometric scales, including the HAMD, HAMA, BPRS, CGI-S, SSI-Beck, SOFAS, and WHOQOL-BREF, were used to assess depression, anxiety, overall psychiatric symptoms, global severity, suicidal ideation, social functioning, and quality of life, respectively. We compared demographic and clinical features and psychometric scores between patients with and without hazardous drinking behavior after adjusting for the effects of age and sex. We then performed binary logistic regression analysis to identify independent correlates of hazardous drinking in the study population. Our results revealed that hazardous drinking was associated with current smoking status, history of attempted suicide, greater psychomotor retardation, suicidal ideation, weight loss, and lower hypochondriasis than non-hazardous drinking. The regression model also demonstrated that more frequent smoking, higher levels of suicidal ideation, and lower levels of hypochondriasis were independently correlates for hazardous drinking in depressed patients. In conclusion, depressed patients who are hazardous drinkers experience severer symptoms and a greater burden of illness than non-hazardous drinkers. In Korea, screening depressed patients for signs of hazardous drinking could help identify subjects who may benefit from comprehensive therapeutic approaches.

Graphical Abstract

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Post traumatic stress disorder among former child soldiers attending a rehabilitative service and primary school education in northern Uganda

Background

This study was prompted by the psychiatric hospitalization of 12 former child soldiers of the Lord''s Resistance Army (LRA) at a rehabilitation school in northern Uganda with a case of mass psychotic behavior.

Objectives

To report the prevalence of post-traumatic stress disorder, depressed mood, and associated risk factors.

Methods

Data on post-traumatic stress disorder, depressed mood, physical disabilities, socio-demographic variables, and the children''s war experiences were collected in face-to-face interviews using the Harvard Trauma Questionnaire (HTQ), a modified Hopkins Symptoms Check-List (HSCL), and a 15-item War Trauma Experience Check-list (WTECL-15). Data was analyzed with SPSS version 11.0.

Results

There were 58 girls and 44 boys. Eighty nine children (87.3%) reported having experienced ten or more war-related traumatic psychological events; 55.9% of the children suffered from symptoms of post-traumatic stress disorder, 88.2%, symptoms of depressed mood and 21.6% had various forms of physical disability. Nearly half of the children (42.2%) reported a positive family history of severe mental illness; 10.8%, a family history of suicide; 22.5%, a family history of suicide attempt; and 45.1%, a family history of alcohol abuse. Children who experienced 10 or more traumatic war events were more likely than the rest to experience depressed mood. Return through a reception center or through a cleansing ritual did not protect against depression.

Discussion

Post-traumatic stress disorder among former LRA child soldiers at a rehabilitation centre in northern Uganda is presented. The report highlights the huge unmet need for psychological services among former child soldiers of the LRA.     

Risk behaviors,suicidal ideation and suicide attempts in a nationally representative French sample

Background

Data from large nationally representative samples are needed to provide the empirical foundation to inform health policies for the prevention of suicide risk and risk behaviors in men and women.

Methods

Data were extracted from the 2010 Health Barometer, a large telephone survey on a representative sample of the general population aged 15–85 years living in France (n=27,653), carried out by the National Institute for Health Promotion and Health Education. Data were collected between October 2009 and July 2010. A computer-assisted telephone interview (CATI) system was used.

Results

Overall, 3.9% of respondents aged 15 to 85 reported past year suicidal ideation, and 0.5% reported a suicide attempt in that time period. Increased rates of risky sexual behavior are associated with ideation and attempt in both men and women, after controlling for sociodemographic variables. Homosexuality or bisexuality are associated with suicidal ideation for both men and women, but not with attempts. Substance misuse, physical and sexual assaults are strongly associated with suicidal symptoms for both men and women. Early first experiences with sex, tobacco, and alcohol are associated with suicidal symptoms though somewhat differentially for men and women.

Limitations

Cross-sectional survey.

Conclusion

The findings underscore associations between suicidal thoughts and behaviors and risk behaviors such as unprotected sex and substance use in men and women throughout the lifespan. These associations highlight the need for preventive strategies such as screening for risk behaviors in order to identify men and women particularly at risk for suicidal behavior.     

Missed opportunities: mental disorder in children of parents with depression

Background

Emerging evidence suggests that early intervention and prevention programmes for mental health problems in the offspring of parents with depression are important. Such programmes are difficult to implement if children with psychiatric disorder are not identified and are not accessing services, even if their parents are known to primary care.

Aim

To investigate service use in children of parents who have recurrent depression, and factors that influence such contact.

Design and setting

A total of 333 families were recruited, mainly through primary health care, in which at least one parent had received treatment for recurrent depression and had a child aged 9–17 years.

Method

Psychiatric assessments of parents and children were completed using research diagnostic interviews. The service-use interview recorded current (in the 3 months prior to interview) and lifetime contact with health, educational, and social services due to concerns about the child’s emotions or behaviour.

Results

Only 37% of children who met criteria for psychiatric disorder were in contact with any service at the time of interview. A third, who were suicidal or self-harming and had a psychiatric disorder at that time, were not in contact with any service. Lack of parental worry predicted lower service use, with higher rates in children with comorbidity and suicidality.

Conclusion

Most children with a psychiatric disorder in this high-risk sample were not in contact with services. Improving ease of access to services, increasing parental and professional awareness that mental health problems can cluster in families, and improving links between adult and child services may help early detection and intervention strategies for the offspring of parents with depression.     

E-Mental Health Care Among Young Adults and Help-Seeking Behaviors: A Transversal Study in a Community Sample

Background

The Internet is widely used by young people and could serve to improve insufficient access to mental health care. Previous information on this topic comes from selected samples (students or self-selected individuals) and is incomplete.

Objective

In a community sample of young adults, we aimed to describe frequency of e-mental health care study-associated factors and to determine if e-mental health care was associated with the use of conventional services for mental health care.

Methods

Using data from the 2011 wave of the TEMPO cohort study of French young adults (N=1214, aged 18-37 years), we examined e-mental health care and associated factors following Andersen’s behavioral model: predisposing factors (age, sex, educational attainment, professional activity, living with a partner, children, childhood negative events, chronic somatic disease, parental history of depression), enabling factors (social support, financial difficulties, parents’ income), and needs-related factors (lifetime major depression or anxiety disorders, suicidal ideation, ADHD, cannabis use). We compared traditional service use (seeking help from a general practitioner, a psychiatrist, a psychologist; antidepressant or anxiolytics/hypnotics use) between participants who used e-mental health care versus those who did not.

Results

Overall, 8.65% (105/1214) of participants reported seeking e-mental health care in case of psychological difficulties in the preceding 12 months and 15.7% (104/664) reported psychological difficulties. Controlling for all covariates, the likelihood of e-mental health care was positively associated with 2 needs-related factors, lifetime major depression or anxiety disorder (OR 2.36, 95% CI 1.36-4.09) and lifetime suicidal ideation (OR 1.91, 95% CI 1.40-2.60), and negatively associated with a predisposing factor: childhood life events (OR 0.60, 95% CI 0.38-0.93). E-mental health care did not hinder traditional care, but was associated with face-to-face psychotherapy (66.2%, 51/77 vs 52.4%, 186/355, P=.03).

Conclusions

E-mental health care represents an important form of help-seeking behavior for young adults. Professionals and policy makers should take note of this and aim to improve the quality of online information on mental health care and to use this fact in clinical care.     

Use of the Suicide Status Form-II to investigate correlates of suicide risk factors in psychiatrically hospitalized children and adolescents

Background

Suicide is the third leading cause of death in the United States for youth 12–17 years or age. Acute psychiatric hospitalization represents a clear worst point clinically and acute suicide risk is the most common reason for psychiatric admission. We sought to determine factors associated with differences in individual suicide risk assessment for children and adolescents during acute psychiatric admission.

Methods

Study participants were 1153 youth consecutively admitted to an inpatient psychiatry unit who completed a self-administered Suicide Status Form (SSF) within 24 h of admission. Additional information on suicide risk factors was obtained through medical chart abstraction.

Results

Females reported significantly greater psychological pain, stress, hopelessness, and self-hate on the SSF and were significantly more likely to have made a suicide attempt just prior to the index hospital admission (OR=1.59, SE=0.29; CI=1.12–2.26), report a family history of suicide (OR=2.02, SE=0.33; CI=1.47–2.78), and had experienced a greater number of inpatient psychiatry admissions related to suicidal ideation (RR=1.33, SE=0.13; CI=1.10–1.61). High school aged youth and those with a primary diagnosis of depression displayed consistently elevated SSF scores and risk factors for suicide compared to comparison groups.

Limitations

Diagnosis was determined through chart abstraction. Responses to access to firearm question had missing data for 46% of the total sample.

Conclusions

Systematic administration of a suicide-specific measure at admission may help clinicians improve identification of suicide risk factors in youth in inpatient psychiatry settings.