Abstract
Due to early detection of mental ill-health being an important suicide preventive strategy, the multi-centre EU funded “Saving and Empowering Young Lives in Europe” (SEYLE) study compared three school-based mental health promotion programs to a control group. In France, 1007 students with a mean age of 15.2 years were recruited from 20 randomly assigned schools. This paper explores the French results of the SEYLE’s two-stage screening program (ProfScreen) and of the cross-program suicidal emergency procedure. Two-hundred-thirty-five ProfScreen students were screened using 13 psychopathological and risk behaviour scales. Students considered at risk because of a positive finding on one or more scales were offered a clinical interview and, if necessary, referred for treatment. A procedure for suicidal students (emergency cases) was set up to detect emergencies in the whole cohort (n = 1007). Emergency cases were offered the same clinical interview as the ProfScreen students. The interviewers documented their reasons for referrals in a short report. 16,2% of the ProfScreen students (38/235) were referred to treatment and 2,7% of the emergency cases (27/1007) were also referred to treatment due to high suicidal risk. Frequent symptoms in those students referred for evaluation were depression, alcohol misuse, non-suicidal self-injuries (NSSI), and suicidal behaviours. According to the multivariate regression analysis of ProfScreen, the results show that the best predictors for treatment referral were NSSI (OR 2.85), alcohol misuse (OR 2.80), and depressive symptoms (OR 1.13). Analysis of the proportion for each scale of students referred to treatment showed that poor social relationships (60%), anxiety (50%), and suicidal behaviours (50%) generated the highest rate of referrals. Qualitative analysis of clinician’s motivations to refer a student to mental health services revealed that depressive symptoms (51%), anxiety (38%), suicidal behaviours (40%), and negative life events (35%) were the main reasons for referrals. Thus, not only the classical psychopathological symptoms, such as depression, anxiety, and suicidal behaviours, but also negative life events and poor social relationships (especially isolation) motivate referrals for treatment.
Highlights
There has been a general decline in global suicide rates between 2000 and 2012 [1], suicide is still a public health concern
Take into account the key role of mental disorder management: it has been calculated that if 50% of people suffering from mood disorders, schizophrenia or alcohol-related disorders were efficiently treated, suicides would decrease by 20,5%, saving 165 000 lives per year worldwide [5]
The program must achieve good acceptability with the targeted subjects. It has been reported by Miller et al [15,16], that for school psychologists, school principals, and students, school-based screening programs were the least acceptable of three types of suicide prevention programs
Summary
There has been a general decline in global suicide rates between 2000 and 2012 [1], suicide is still a public health concern. It is the second leading cause of death in young people aged. One of the oldest screenings of medical history was initiated in the United States army (1917) to detect psychologically ill-suited soldiers [8]. It included a two-stage process, with a first step identifying positive cases, followed by an individual psychological examination of the positive cases that confirmed or rejected true positivity
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