New research
- Childhood, teenage and adult onset depression
- Sexual attraction, depression, self harm, suicidality and help seeking behaviour
- Do schools influence student risk taking behaviors and emotional health symptoms?
- Twelve month prevalence of and risk factors for suicide attempts in WHO World Mental Health Surveys
Childhood, teenage and adult onset depression: diagnostic and individual characteristics in a clinical sample, 2011
Fernando K, Carter JD, Frampton CM, Luty SE, McKenzie J, Mulder RT, Joyce PR.
Comprehensive Psychiatry. 2011 Mar. [online, ahead of print]
Onset of depression at an early age (14 to 25 years) is associated with a number of increased risks including greater suicidality. Particular personality characteristics may also be associated with an earlier onset of depression. Also, at puberty the prevalence of depression increases, and sex differences emerge.
The research sample was 372 depressed outpatients from Christchurch (62 childhood-onset participants, 101 teenage-onset and 209 adult-onset) and this study sought to compare the three age groups.
While the researchers found fewer differences between the onset groups than expected, the results suggested childhood and teenage onset had a higher likelihood of comorbid Axis I & II diagnoses (particularly alcohol and substance abuse, OCD, social phobia) and attempted suicide.
Childhood-onset depression is associated with greater comorbidity (when two or more disorders or illnesses occur in the same person).
Sexual attraction, depression, self harm, suicidality and help seeking behaviour in New Zealand secondary school students, 2011
Lucassen MF, Merry SN, Robinson EM, Denny S, Clark T, Ameratunga S, Crengle S, Rossen FV. Australian and New Zealand Journal of Psychiatry, Mar 2. [online ahead of print]
Using data collected from Youth’07 – over 9,000 randomly selected New Zealand secondary school students – the study investigated the associations between sexual attraction and depression, self-harm, suicidality and help-seeking behaviour.
Research has confirmed that gay, lesbian and bisexual young people are at higher risk of depression and suicide, in particular because of negative and unsupportive environments. Few studies have looked at a comparison group with heterosexual young people.
The Youth2000 survey, showed almost a quarter of ‘sexual minority' students reported increased depression and suicidality. In this Youth’07 sample, about a third of gay students had come out (23 of the 73), while less than half of bisexual students had come out (111 of the 270). Most students in the sample were aged 15 years or less.
Students who were attracted to the same or both sexes consistently had higher rates of depression, suicidality and self-harming. They were also more likely to have seen a medical professional for emotional worries and to have had more problems getting this help.
“This is in line with previous research that has shown that although the majority of gay, lesbian and bisexual adolescents will grow up to lead happy, healthy, productive lives, they are at greater risk of self-harm, depression and suicide.”
Bisexual students were found to be most vulnerable, likely due to struggling to find an identity and not fitting in well with either heterosexual and gay or lesbian networks.
Do schools influence student risk taking behaviors and emotional health symptoms? (2011)
Denny SJ, Robinson EM, Utter J, Fleming TM, Grant S, Milfont TL, Crengle S, Ameratunga SN, Clark T.
Journal of Adolescent Health. 2011 Mar;48(3):259-67.
Family, peers, schools and the community are the main influences on a young adult’s risk- taking behaviours and emotional wellbeing. School-based interventions can be effective but are often poorly implemented, and effects lower than in trials. A positive school climate is associated with better student and teacher wellbeing. Whole-school health promoting programmes have been shown to be effective.
Over 9,000 New Zealand secondary school students took part in this study, most students were aged between 13 and 17 years old. Also, nearly 3,000 teachers, and 91 school administrators took part.
The most common risk taking was cigarette smoking and risky motor vehicle use, with unsafe sex and attempted suicide the least common. Sense of belonging and a supportive school environment was associated with less risk-taking behaviours for alcohol use, violence and risky motor vehicle behaviours. Teacher wellbeing was found not to be associated with student risk behaviours, but schools with higher average wellbeing of teachers had lower rates of depression among students.
The study concludes that overall school effects were modest, and questions whether health promoting programmes are achieving the desired benefits. The authors call for more rigorous best practice implementation of programmes.
Twelve month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys, 2010
Borges G, Nock MK, Haro Abad JM, Hwang I, Sampson NA, Alonso J, Andrade LH, Angermeyer MC, Beautrais A, Bromet E, Bruffaerts R, de Girolamo G, Florescu S, Gureje O, Hu C, Karam EG, Kovess-Masfety V, Lee S, Levinson D, Medina-Mora ME, Ormel J, Posada-Villa J, Sagar R, Tomov T, Uda H, Williams DR, Kessler RC.
Journal of Clinical Psychiatry, 71(12):1617-28.
Research shows some 9% of people report having serious thoughts of suicide at some stage in their life, and 3% will actually make a suicide attempt. Although most attempts do not result in suicide, this heightens further risk of chronic mental illness and suicide attempts. Trying to predict suicide attempts is of critical importance.
While many risk factors have been identified (demographic, family history, childhood adversities, psychiatric disorders, a history of attempts) applying these useful in a clinical setting has been difficult.
Obstacles include: small sample sizes, risk factors which are long-term, predicting those ideators most at risk of attempts, problems of assessing risk factors in clinical settings, and finding a way of combining risk factors to derive a single measure or level of short-term risk. This study sought to develop such a risk index.
The World Mental Health surveys were carried out in 10 developed countries (including New Zealand) and 11 developing countries between 2001 and 2007. The total sample was over 108,000, and the sample in New Zealand was 12,790. The focus was on suicidal behaviours within the past 12 months (ideation, plans, attempts).
Unplanned attempts were about one third of all attempts and the unplanned rate was higher in developed countries.Five sets of possible predictors of suicide attempts among those with ideation were examined:
- Sociodemographic characteristics (age, gender, education, family income, marital status, employment)
- Parental psychopathology (major depression, panic disorder, anxiety, substance abuse, antisocial personality disorder, past suicidal behaviour)
- Childhood adversities (loss, abuse, violence, economic adversity, chronic physical illness)
- Past suicidal behaviours
- DSM IV mental disorders (anxiety disorders, mood disorders, externalising disorders (eg, ADHD, conduct), substance disorders.
The study had three notable results.
- Estimated the 12 month prevalence of suicidal behaviours among adults (18 plus) in 21 countries: 14.6 suicide attempts for every one suicide death (ideation 2%, plans 0.6%, attempts 0.3%).
- Significant risk factors were: being female, younger age, lower education and income, unmarried status, unemployment, parental psychopathology, childhood adversities, mental disorders, and psychiatric comorbidity. Conduct disorder, anxiety and substance use disorders were the most significant predictor of attempts (ie, disorders characterised by impulse-control and anxiety). Prior attempts are affirmed as significant factors and in particular that unplanned predicted further unplanned attempts (but not planned), and planned attempts likewise. The study reports an “intriguing result” that previous ideation can be ‘protective’ for attempts as opposed to those who attempt, who have never ideated before the last 12 months.
- Risk factor indices were developed, that “might prove useful in predicting suicide attempts in clinical settings” and represents “an important initial step toward bridging the gap between the science and practice of suicide risk assessment.” Suicide prevention programmes that include a focus on screening those for elevated risk of suicide, are among those most likely to reduce the rate of suicide, but such programmes are not used in most clinical settings.
These indices may be most useful in identifying those at high risk for suicide attempt.
Contact Russell Tuffery at info "at" spinz.org.nz if you would like copies of these articles.
