Cause Of Mortality In Adolescents Research Articles

The patterns, trends and major risk factors of suicide among Indian adolescents – a scoping review

BackgroundAdolescence is an essential stage for the development of mental health, and suicide is among the leading cause of mortality for adolescents around the world. In India, the suicide rate among adolescents has been increasing in recent years. The scoping review was conducted to map the evidence and address gaps by examining the existing pattern, and trends, and identify the major risk factors of suicide among Indian adolescents.MethodsThe study was conducted as per the Arksey and O’Malley scoping review framework and the Joanna Briggs Institute Reviewers’ manual. The systematic search was performed using electronic databases such as PubMed, Google Scholar, EMBASE, and PsycINFO, by using specific keywords. After the screening, 35 articles were identified according to the inclusion criteria.ResultsThe evidence on the trends of suicide among adolescents showed that the suicide rate has shown an alarming increase in recent years. The evidence pattern showed that hanging and poisoning were the commonly selected methods used by adolescents. The most commonly reported risk factors were mental health problems (54.28%), negative or traumatic familiar issues (34.28%), academic stress (22.85%), social/lifestyle factors (20%), violence (22.85%), economic distresses (8.75%), relationship factor (8.75%).ConclusionBy synthesizing and summarising the patterns, trends, and key risk factors of suicide among Indian adolescents, this scoping review provides a broad understanding of the literature already in existence. In order to effectively tackle these issues, the finding highlights the urgent need for extensive and targeted suicide prevention measures.

Cannabis use disorder, suicide attempts, and self-harm among adolescents: A national inpatient study across the United States.

Suicide is among the top three causes of adolescent mortality. There is a scarcity of research examining cannabis use and suicidal behavior in adolescents. To determine the association between cannabis use disorder (CUD) and suicide attempt/self-harm in a hospitalized sample of adolescents. We conducted a cross-sectional observation study using data from the Nationwide Inpatient Sample collected over four years from January 1, 2016, through December 31, 2019. We included adolescents aged 10-19 hospitalized during the above period (N = 807,105). The primary outcome was suicide attempt/self-harm and the main predictor was CUD. The International Classification of Diseases Tenth Revision (ICD 10) diagnostic codes was used to identify a diagnosis of CUD, suicide attempt/self-harm, and other diagnoses included in the analyses. Adolescents diagnosed with CUD (n = 53,751) were compared to adolescents without CUD (n = 753,354). Univariate and multivariate logistic regressions were conducted to determine the association between CUD and suicide attempts/self-harm. 807,105 adolescent hospitalizations were analyzed, of which 6.9% had CUD. Adolescents with CUD were more likely to be older (17 years vs. 15 years), female (52% vs. 48%), have depression (44% vs. 17%), anxiety (32% vs. 13%), an eating disorder (1.9% vs. 1.2%), ADHD (16.3% vs. 9.1%), Conduct Disorder (4.1% vs. 1.3%), Alcohol Use Disorder (11.9% vs. 0.8%), Nicotine Use Disorder (31.1% vs. 4.1%), Cocaine Use Disorder (5.4% vs. 0.2%), Stimulant Use Disorder (0.8% vs. 0.4%) and report suicide attempts/self-harm (2.8% vs. 0.9%) [all ps<0.001]. After adjusting for potential confounders, CUD was associated with a higher risk of suicide attempts/self-harm (OR = 1.4, 95% CI 1.3-1.6, p <0.001). Post-hoc analyses showed the presence of depression moderated the association between CUD and suicide attempts/self-harm in that adolescents with CUD and depression had 2.4 times the odds of suicide attempt/self-harm compared to those with CUD but no depression after controlling for potential confounders (p<0.001). Our study provides evidence for the association between CUD and suicide risk among hospitalized adolescents and underscores the importance of recognizing and addressing co-occurring mental and substance use disorders along with CUD to mitigate suicide risk. Identifying high-risk adolescents in inpatient settings provides an opportunity for intervention.

Exploring adolescents’ perspectives on and experiences with post-primary school-based suicide prevention: a meta-ethnography protocol

BackgroundGlobally, suicide is the fourth leading cause of adolescent mortality. Although post-primary school-based suicide prevention (PSSP) interventions are an evidence-based strategy for targeting adolescent suicidal thoughts and behaviors (STBs), PSSP effectiveness does not easily translate to school settings. Adolescents’ perspectives on PSSP are particularly important for (1) intervention effectiveness and implementation in both research and practice, (2) addressing PSSP evidence-practice gaps, and (3) enhancing meaningful adolescent involvement in PSSP, yet there is a gap in understanding adolescents’ experiences of engaging with PSSP. As such, this protocol outlines a meta-ethnography which will explore and synthesize adolescents’ perspectives on engaging with PSSP interventions, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers.MethodsThe meta-ethnography protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The protocol was guided by the seven-stage process for meta-ethnography proposed by Noblit and Hare. Searches of PsycINFO, MEDLINE, Web of Science, CINAHL, ERIC, Scopus, and study reference lists will identify peer-reviewed studies. Gray literature will be identified by searches in ProQuest, British Library EThOS, and DART-Europe E-theses Portal. The main reviewer will initially assess the eligibility of studies based on title and abstract, with full texts reviewed by at least two reviewers. Findings of the included studies will be synthesized in line with Noblit and Hare’s stages and evaluated using the Critical Appraisal Skills Program (CASP) checklist.DiscussionTo our knowledge, this is the first proposed meta-ethnography to explore and integrate the findings of qualitative studies exploring adolescents’ perspectives on engaging with PSSP interventions. Understanding adolescents’ experiences of engaging with PSSP will impact the field of PSSP in several ways by (1) enhancing research processes and intervention effectiveness and implementation, (2) informing decision-making and policymaking relevant to practice, (3) guiding meaningful adolescent involvement in PSSP, and (4) contributing to knowledge on the safety implications of engaging adolescents in PSSP. Finally, it is expected that the insights from this meta-ethnography will be widely applicable, given the growing demand for meaningful youth involvement in health-related fields.Systematic review registrationPROSPERO CRD42022319424.

Influence of Gender on Stress among School Children: A Cross-sectional Study

Introduction: The perception of stress by students affects their academic performance significantly. Continuous exposure to stress for a long time can cause both physical illnesses (including heart disease), and mental illnesses (e.g., anxiety disorders). Furthermore, stress increases the risk of suicide in students which is an important cause of adolescent mortality. Perception of stressors depends upon the biological, social, and psychological factors of students. Moreover, biological differences between male and female students attributed to the significant difference in experiencing stress among them. Aim: To study the gender difference and stress levels among adolescent school students. Materials and Methods: A cross-sectional study was conducted in Government boys higher secondary school and Government girls higher secondary school Mauganj, a town of Madhya Pradesh, India, between August 2016 to September 2016. The state board of examinations and the Hindi medium of instruction were followed in the school. Total 40 study subjects, 24 males and 16 females were recruited for study after obtaining written informed consent from participants by simple random sampling method. The self-administered student stress scale was used to measure participants’ levels of stress and socio-demographic information, including age, sex, education, was recorded in semistructured data entry proforma. The data were summarised using means with standard deviations and frequencies with percentages. Comparative analyses between the genders were conducted using the Student’s t-test (for continuous variables). The p-value ≤0.05 was considered level of significance. Results: Total of 40 study participants included, mean age 16.2±2.2 years. A total of 24 were male students and 16 were female students, amongst included subjects. Majority of student’s family practiced Hindu religion. Total stress score was 84.3±7.5 for male and 96.2±5.5 for female students (p=0.001). Conclusion: Significant amounts of stress were felt by students in high school. Male and female students perceived similar levels of stress in their academic and vocational domains, but female students felt significantly more stress in their financial, emotional, familial, and social domain. Student total stress levels were significantly higher for female students than male students.

Correlates of suicidal ideation in rural Chinese junior high school left-behind children: A socioecological resilience framework.

IntroductionSuicide is one of the top five causes of adolescent mortality around the world. The socioecological resilience framework in explaining the risk factors and protective factors for suicidal ideation in left-behind children (LBC) has not been well explored. The current study aims to compare the prevalence of suicidal ideation in LBC and non-LBC, and explore its correlations with resilience factors among LBC.MethodologyThis study was part of an epidemiological survey conducted by UNICEF exploring mental health outcomes in left-behind children. We implemented a cross-sectional study collecting data from 11 provinces and 1 municipal, with 5,026 participants (3,359 LBC, 1,667 controls) in year one junior high school living in impoverished areas of rural China. Data on suicidal ideation, self-harm, resilience factors including health-risk behaviors, psychological wellbeing as it was measured by the Strengths and Difficulties Questionnaire, peer relationship within the school environment, and family support were collected.ResultsOverall prevalence of suicidal ideation among LBC was 7.2% which is significantly different from 5.5% reported by NLBC (χ2 = 4.854, p = 0.028). LBC reported a higher prevalence of self-harm (16.4%) than NLBC (13.0%; χ2 = 10.232, p = 0.001), but there was no difference in the prevalence of suicide plan, suicide attempt or help-seeking. LBC had significantly poorer psychological feeling, and greater emotional and behavioral difficulties peer relationship in the school environment than controls. In the multiple logistic regression, history of self-harm was the greatest predictor for suicidal ideation among LBC (OR = 2.078, 95% CI: 1.394–3.100, p < 0.001). Health risk behavior including previous smoking attempt, poor psychological feeling, and emotional and behavior difficulties, and poor peer relationship within school environment, were also significant risk factors for suicidal ideation among LBC.ConclusionThe prevalence of suicidal ideation and self-harm was greater among left-behind than non-left-behind children. Our results show resilience factors including previous self-harm, emotional and behavioral problems, smoking, and poor peer relationship are significantly associated with suicidal ideation in left-behind adolescents.

Indian Academy of Pediatrics Consensus Guidelines on Prevention and Management of Suicidal Behavior in Adolescents

Suicide is an important cause of adolescent mortality and morbidity in India. As pediatricians are often the first point of contact for adolescents and their families in the healthcare system, they need guidelines to screen, assess, manage and prevent adolescent suicidal behavior to ensure survival, health and mental well-being of this vulnerable population. To formulate guidelines to aid pediatricians for prevention and management of adolescent suicidal behavior. Indian Academy of Pediatrics, in association with Adolescent Health Academy, formed a multidisciplinary committee of subject experts in June, 2019 to formulate guidelines for adolescent suicide prevention and management. After a review of current scientific literature and preparation of draft guidelines, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by refining of draft guidelines, and discussions over e-mail where suggestions were incorporated and the final document was approved. Pediatricians should screen for mental distress, mental disorders and suicidal and para-suicidal (non-suicidal self-injury) behavior during adolescent health visits. Those with suicidal behavior should be referred to a psychiatrist after providing emergency healthcare, risk assessment, immediate counselling and formulation of a safety plan. Pediatricians should partner with the community and policymakers for primary and secondary prevention of adolescent suicide.

Research Review: The effect of school-based suicide prevention on suicidal ideation and suicide attempts and the role of intervention and contextual factors among adolescents: a meta-analysis and meta-regression.

BackgroundGlobally, suicide is the fourth highest cause of adolescent mortality (Suicide: https://www.who.int/news‐room/fact‐sheets/detail/suicide). The effects of post‐primary school‐based suicide prevention (PSSP) on adolescent suicidal thoughts and behaviours (STBs) have not been comprehensively synthesised. We aim to estimate the population effect for PSSP interventions on adolescent STBs and explore how intervention effects vary based on intervention and contextual moderators.MethodsSearches of PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials identified cluster randomised trials examining the effectiveness of PSSP on adolescent STBs. The Cochrane Risk of Bias tool assessed bias. Crude and adjusted back‐transformed odds ratios (ORs) were calculated. Multilevel random‐effects models accounted for dependencies of effects. Univariate meta‐regression explored variability of intervention and contextual moderators on pooled effects.ResultsThere were 19 and 12 effects for suicidal ideation (SI) and suicide attempts (SA). Compared with controls, interventions were associated with 13% (OR = 0.87, 95%CI [0.78, 0.96]) and 34% (OR = 0.66, 95%CI [0.47, 0.91]) lower crude odds reductions for SI and SA, respectively. Effects were similar for adjusted SI (OR = 0.85, 95%CI [0.75, 0.95]) and SA (OR = 0.72, 95%CI [0.59, 0.87]) models. Within‐study (0.20–9.10%) and between‐study (0–51.20%) heterogeneity ranged for crude and adjusted SA models and SI heterogeneity was 0%. Moderator analyses did not vary SA effects (ps > .05).ConclusionsThis meta‐analysis contributes to the PSSP evidence‐base by demonstrating that PSSP targeting STBs as both primary intervention outcomes and with other health and well‐being outcomes reduced SI and SA among 33,155 adolescents attending 329 schools, compared to controls. The number needed to treat estimates suggests the potential of reducing the incidence of SA and SI in one adolescent by implementing PSSP in 1–2 classrooms, supporting PSSP as a clinically relevant suicide prevention strategy. Although moderator analyses were nonsignificant and contained a small number of trials, larger SA effect sizes support particular effectiveness for interventions of a duration of ≤1 week, involving multiple stakeholders and with a 12‐month follow‐up.

Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department.

Youth violence is a leading cause of adolescent mortality, underscoring the need to integrate evidence-based violence prevention programs into routine emergency department (ED) care. To examine the translation of the SafERteens program into clinical care. Hospital staff provided input on implementation facilitators/barriers to inform toolkit development. Implementation was piloted in a four-arm effectiveness-implementation trial, with youth (ages 14-18 years) screening positive for past 3-month aggression randomized to either SafERteens (delivered remotely or in-person) or enhanced usual care (EUC; remote or in-person), with follow-up at post-test and 3 months. During maintenance, ED staff continued in-person SafERteens delivery and external facilitation was provided. Outcomes were measured using the RE-AIM implementation framework. SafERteens completion rates were 77.6% (52/67) for remote and 49.1% (27/55) for in-person delivery. In addition to high acceptability ratings (e.g., helpfulness), post-test data demonstrated increased self-efficacy to avoid fighting among patients receiving remote (incidence rate ratio [IRR] 1.22, 95% confidence interval [CI] 1.09-1.36) and in-person (IRR 1.23, 95% CI 1.12-1.36) SafERteens, as well as decreased pro-violence attitudes among patients receiving remote (IRR 0.83, 95% CI 0.75-0.91) and in-person (IRR 0.87, 95% CI 0.77-0.99) SafERteens when compared with their respective EUC groups. At 3 months, youth receiving remote SafERteens reported less non-partner aggression (IRR 0.52, 95% CI 0.31-0.87, Cohen's d -0.39) and violence consequences (IRR 0.47, 95% CI 0.22-1.00, Cohen's d -0.49) compared with remote EUC; no differences were noted for in-person SafERteens delivery. Barriers to implementation maintenance included limited staff availability and a lack of reimbursement codes. Implementing behavioral interventions such as SafERteens into routine ED care is feasible using remote delivery. Policymakers should consider reimbursement for violence prevention services to sustain long-term implementation.

The secret life of young adolescents living with HIV in northern Mozambique - a mixed methods study

BackgroundIn Mozambique, HIV infection remains a leading cause of adolescent mortality. With advances in antiretroviral treatment (ART), the population of adolescents living with vertically-acquired HIV is growing. Most studies of adolescents living with HIV (ALHIV) focus on older youth with horizontal infection. As part of a larger study, we examined the characteristics and health care needs of younger ALHIV, including those with vertically-acquired infection to inform preventive interventions.MethodsWe used a convergent mixed-methods design and recruited ALHIV aged 12–14 years who were enrolled in HIV care in three health clinics in Nampula, Mozambique. From 11/2019–3/2020, we conducted 61 quantitative surveys and 14 in-depth interviews with a purposively selected subset of ALHIV who were aware of their HIV status. Descriptive statistical analysis was conducted for quantitative data. Qualitative data were transcribed and analyzed using thematic analysis.ResultsThe median age of ALHIV was 13 years, 50% were female, 67% lived with ≥1 parent, 70% had lost a parent, 100% were in school; 10% were in a relationship, and 3% had initiated sexual activity. Among 31 ALHIV aware of their serostatus, the median age of antiretroviral treatment (ART) initiation was 8 years (IQR: 6–11); 55% received caregiver support for ART management; 35% reported missing ≥1 ART dose in the last 30 days; 6% had disclosed their HIV-status to friends and 48% reported no one to talk to about HIV-specific issues. Four main themes emerged from the qualitative interviews with ALHIV: a) learning one’s HIV-positive status as the beginning of a secret life; b) importance of caregivers’ support for ART management; c) high value of ALHIV peer support to overcome isolation, increase HIV literacy, and support adherence; and d) unmet needs for sexual and reproductive health education.ConclusionHIV-related secrecy prevails among ALHIV, a situation exacerbated by caregivers and healthcare providers. Caregivers play a major role in supporting adherence among young ALHIV, yet ALHIV could also benefit from adolescent-friendly services, including peer support, sexual and reproductive health services and preparation for independent health management. Integrating such programs into ART services in Mozambique may be critical to promoting ALHIV health.

Associations Between Parental Monitoring and Multiple Types of Youth Violence Victimization: A Brief Report.

Youth violence victimization continues to be pervasive and a significant cause of adolescent mortality. Since their 2014 "Connecting the Dots" report, the Centers for Disease Control and Prevention have encouraged researchers to identify shared protective factors that prevent multiple forms of youth violence. Parental monitoring, a bidirectional construct encompassing parental knowledge and regulation of their child's activities with children's concurrent perception of their parent's awareness of such activities, could be such a cross-cutting protective factor. In this study, we examined associations between parental monitoring and multiple types of violence victimization among a school-based sample of adolescents. We conducted a cross-sectional analysis of an anonymous survey of health risk and protective behaviors completed by students across Pittsburgh Public Schools (N = 2,426). In separate analyses, we used logistic regression to examine associations between youth-reported parental monitoring and multiple experiences of youth violence victimization, ranging from school- and electronic-based bullying to different forms of sexual and physical violence. We found that many experiences of youth violence victimization were consistent with nationally representative data. In addition, we determined that higher parental monitoring was significantly and inversely associated with all violence victimization outcomes examined (school-based bullying, electronic-based bullying, threatening someone with a weapon, adolescent relationship abuse, sexual assault, and exchange sex) at the p < .05 threshold. Overall, this study is one of the first that examines how parental monitoring relates to multiple forms of youth violence victimization, including exchange sex, which is a critical but less-studied violence experience. This work adds to the growing literature on how parental monitoring may serve as a shared protective factor for multiple forms of violence victimization.

Forensic data on adolescents who died by suicide in Greece

IntroductionSuicide is the second most common cause of adolescent mortality worldwide.ObjectivesTo study the characteristics of a sample of adolescents (&lt;18years of age) who died by suicide in Greece.MethodsWe investigated all suicides that took place within the area of the Piraeus Department of Forensic Medicine (population covered ~700,000) for the period 1992-2016, based on the victims’ forensic records.ResultsDuring the 25-year period, 16 adolescents (and 1162 adults) died by suicide. They were mostly males (11/68.75%) and of Greek Nationality (14/87.5%). The mean age was 15.56 years (range: 12-17, standard deviation: 1.46). Two (12.5%) were under psychiatric medication (an antipsychotic and an antidepressant, respectively); none was receiving a benzodiazepine or a mood-stabilizing antiepileptic. None had used amphetamine, cannabis, cocaine or heroin. Two (12.5%) -one girl one boy- had consumed alcohol. The suicides took place primarily at home (12/75%), followed by outdoors (3/18.75%); one (6.25%) took place in a correctional facility. Hanging was the most prevalent method (6/37.5), followed by jumping (5/31.25%), shooting by a firearm (2/12.5%), drowning (1/6.25%), medication overdose (1/6.25% -amitriptyline poisoning) and a case of suffocating death (1/6.25%). Most suicides happened in September (5/31.25%) and April (3/18.75%). No significant differences were noted with the adult sample.ConclusionsThe methods chosen by the adolescents who died by suicide in our sample differ strikingly from those of usual suicide attempts at that age (medication overdose/self-cutting). The periods when the suicides took place may imply a role for school stress. Our study was retrospective and focused primarily on a large urban area.

A Novel Health-Transportation Partnership Paves The Road For Young Driver SafetyThrough Virtual Assessment.

Motor vehicle crashes remain the leading cause of adolescent mortality and injury in the United States. For young drivers, crash risk peaks immediately after licensure and declines during the next two years, making the point of licensure an important safety intervention opportunity. Legislation in Ohio established a unique health-transportation partnership among the State of Ohio, Children's Hospital of Philadelphia, and Diagnostic Driving, Inc., to identify underprepared driver license applicants through a virtual driving assessment system. The system, a computer-based virtual driving test, exposes drivers to common serious crash scenarios to identify critical skill deficits and is delivered in testing centers immediately before the on-road examination. A pilot study of license applicants who completed it showed that the virtual driving assessment system accurately predicted which drivers would fail the on-road examination and provided automated feedback that informed drivers on their skill deficits. At this time, the partnership's work is informing policy changes around integrating the virtual driving assessment system into licensing and driver training with the aim of reducing crashes in the first months of independent driving. The system can be developed to identify deficits in safety-critical skills that lead to crashes in new drivers and to address challenges that the coronavirus disease 2019 pandemic has introduced to driver testing and training.

Being bullied, psychological pain and suicidal ideation among Chinese adolescents: A moderated mediation model

BackgroundSchool bullying has become a serious social problem that is closely associated with suicidal ideation for bullying victims among adolescents. Suicide is the leading cause of mortality in adolescents in China. Our previous work proposed that the three-dimensional psychological pain, especially pain avoidance, is the robust predictor for suicide. The relationships among being bullied, suicidal ideation, and psychological pain remain unclear. ObjectiveThe aim of the present study is to examine whether psychological pain mediates the association between being bullied and suicidal ideation, and whether such mediation is moderated by family togetherness and peer support. Participants and SettingUsing cluster sampling, 2360 adolescents were recruited from two middle schools and two high schools in China. MethodsThe adolescents completed questionnaires regarding their being bullied, suicidal ideation, psychological pain, family togetherness, and peer support. Structural equation modeling was used to explore the interactive effects of being bullied, psychological pain, family togetherness, and peer support on suicidal ideation. ResultsOf the 2360 participants in the sample, 48 (2.03%) were identified as bullying victims. The association between being bullied and suicidal ideation was fully mediated by psychological pain among middle school students and partially mediated by psychological pain among high school students. Family togetherness moderated the indirect effect of being bullied on suicidal ideation via psychological pain among middle school students, whereas peer support moderated that effect among high school students. ConclusionsInterventions aimed at diminishing the negative effects of being bullied may start by increasing family togetherness or peer support and decreasing individuals’ psychological pain.

Suicidal ideation in a community-derived sample of Spanish adolescents

IntroductionSuicide is a current public health problem and among the main causes of mortality in adolescents and young adults. The main goal of this study was to analyse suicidal ideation in a representative sample of Spanish adolescents. Specifically, the prevalence rates of suicide ideation, the psychometric properties of the Paykel Suicide Scale (PSS) scores, and the socio-emotional adjustment of adolescents at risk for suicide were analysed. Material and methodsThe sample consisted of 1664 participants (M=16.12 years, SD=1.36, range 14–19 years), selected by stratified sampling by clusters. The instruments used were the PSS, the Strengths and Difficulties Questionnaire, the Personal Wellbeing Index-School Children, and the Oviedo Infrequency Scale. ResultsThe results showed that 4.1% of the sample indicated that they had tried to commit suicide in the previous year. Statistically significant differences were found according to gender but not according to age in the PSS mean scores. The analysis of the internal structure of the PSS showed that the one-dimensional model presented excellent goodness of fit indexes. This model showed measurement invariance across gender. The reliability of the scores, estimated with ordinal alpha, was 0.93. Participants who reported suicide ideation showed poorer mental health status and lower life satisfaction compared to the non-suicide ideation group. ConclusionsSuicidal ideation is present during adolescence and is associated with poor subjective well-being and increased emotional and behavioural problems. PSS seems to show adequate psychometric behaviour to assess suicidal ideation in adolescents. These findings have clear implications, both in health and education systems, to improve the promotion of emotional well-being and prevention of psychological and psychiatric problems in this sector of the population.

Suicidal ideation in a community-derived sample of Spanish adolescents.

Suicide is a current public health problem and among the main causes of mortality in adolescents and young adults. The main goal of this study was to analyse suicidal ideation in a representative sample of Spanish adolescents. Specifically, the prevalence rates of suicide ideation, the psychometric properties of the Paykel Suicide Scale (PSS) scores, and the socio-emotional adjustment of adolescents at risk for suicide were analysed. The sample consisted of 1,664 participants (M=16.12 years, SD=1.36, range 14-19 years), selected by stratified sampling by clusters. The instruments used were the PSS, the Strengths and Difficulties Questionnaire, the Personal Wellbeing Index-School Children, and the Oviedo Infrequency Scale. The results showed that 4.1% of the sample indicated that they had tried to commit suicide in the previous year. Statistically significant differences were found according to gender but not according to age in the PSS mean scores. The analysis of the internal structure of the PSS showed that the one-dimensional model presented excellent goodness of fit indexes. This model showed measurement invariance across gender. The reliability of the scores, estimated with ordinal alpha, was 0.93. Participants who reported suicide ideation showed poorer mental health status and lower life satisfaction compared to the non-suicide ideation group. Suicidal ideation is present during adolescence and is associated with poor subjective well-being and increased emotional and behavioural problems. PSS seems to show adequate psychometric behaviour to assess suicidal ideation in adolescents. These findings have clear implications, both in health and education systems, to improve the promotion of emotional well-being and prevention of psychological and psychiatric problems in this sector of the population.

Sexual learning among East African adolescents in the context of generalized HIV epidemics: A systematic qualitative meta-synthesis.

BackgroundAIDS-related illness is the leading cause of mortality for adolescents in sub-Saharan Africa. Together, Kenya, Tanzania, and Uganda account for 21% of HIV-infected adolescents in sub-Saharan Africa. The United Nations framework for addressing the epidemic among adolescents calls for comprehensive sexual and reproductive health education. These HIV prevention efforts could be informed by a synthesis of existing research about the formal and informal sexual education of adolescents in countries experiencing generalized epidemics. The purpose of this study was to describe the process of sexual learning among East African adolescents living in the context of generalized HIV epidemics.MethodsQualitative metasynthesis, a systematic procedure for integrating the results of multiple qualitative studies addressing a similar phenomenon, was used. Thirty-two research reports met study inclusion criteria. The reports were assessed in a four-step analytic process: appraisal, classification of findings, synthesis of findings, and construction of a framework depicting the process of sexual learning in this population.ResultsThe framework includes three phases of sexual learning: 1) being primed for sex, 2) making sense of sex, and 3) having sexual experiences. Adolescents were primed for sex through gender norms, cultural practices, and economic structures as well as through conversations and formal instruction. They made sense of sex by acquiring information about sexual intercourse, reproduction and pregnancy, sexually transmitted infections, and relationships and by developing a variety of beliefs and attitudes about these topics. Some adolescents described having sexual experiences that met wants or needs, but many experienced sex that was coerced or violent. Whether sex was wanted, coerced, or violent, adolescents experienced worry about sexually transmitted infections or premarital pregnancy.ConclusionsThe three phases of sexual learning interact to shape adolescents’ sexual lives and their risk for HIV infection. This framework will contribute to the development of sexual education programs that address HIV risk within the broader context of sexual learning.

The causes of maternal mortality in adolescents in low and middle income countries: a systematic review of the literature.

BackgroundWhile the main causes of maternal mortality in low and middle income countries are well understood, less is known about whether patterns for causes of maternal deaths among adolescents are the same as for older women. This study systematically reviews the literature on cause of maternal death in adolescence. Where possible we compare the main causes for adolescents with those for older women to ascertain differences and similarity in mortality patterns.MethodsAn initial search for papers and grey literature in English, Spanish and Portuguese was carried out using a number of electronic databases based on a pre-determined search strategy. The outcome of interest was the proportion of maternal deaths amongst adolescents by cause of death. A total of 15 papers met the inclusion criteria established in the study protocol.ResultsThe main causes of maternal mortality in adolescents are similar to those of older women: hypertensive disorders, haemorrhage, abortion and sepsis. However some studies indicated country or regional differences in the relative magnitudes of specific causes of adolescent maternal mortality. When compared with causes of death for older women, hypertensive disorders were found to be a more important cause of mortality for adolescents in a number of studies in a range of settings. In terms of indirect causes of death, there are indications that malaria is a particularly important cause of adolescent maternal mortality in some countries.ConclusionThe main causes of maternal mortality in adolescents are broadly similar to those for older women, although the findings suggest some heterogeneity between countries and regions. However there is evidence that the relative importance of specific causes may differ for this younger age group compared to women over the age of 20 years. In particular hypertensive conditions make up a larger share of maternal deaths in adolescents than older women. Further, large scale studies are needed to investigate this question further.

Modifiable Neighborhood Features Associated With Adolescent Homicide.

Homicide is a leading cause of adolescent mortality. To our knowledge, relatively little has been studied in terms of the association between environmental neighborhood features, such as streets, buildings, and natural surroundings, and severe violent injury among youth. To assess associations between environmental neighborhood features and adolescent homicide in order to identify targets for future place-based interventions. Population-based case-control study conducted in Philadelphia, Pennsylvania, from April 15, 2008, to March 31, 2014. We identified adolescents who died by homicide at 13 to 20 years of age from 2010 to 2012 while residing in Philadelphia. We used incidence-density sampling and random-digit dialing to recruit control participants ages 13 to 20 years matched on sex and indoor-outdoor location at the time of each index case participant's homicide. To obtain environmental data about modifiable features that were present in the immediate surroundings of our case and control participants, blinded field researchers used standardized techniques to photograph case and control participant outdoor locations. Photographic data were stitched together to create 360° panoramic images that were coded for 60 elements of the visible environment. Adolescent homicide. We enrolled 143 homicide case participants (mean [SD] age, 18.4 [1.5] years) and 155 matched control participants (mean [SD] age, 17.2 [2.1] years) who were both outdoors at the time of the homicide. In adjusted analyses, multiple features of Philadelphia streets, buildings, and natural surroundings were associated with adolescent homicide. The presence of street lighting (odds ratio [OR], 0.24; 95% CI, 0.09-0.70), illuminated walk/don't walk signs (OR, 0.16; 95% CI, 0.03-0.92), painted marked crosswalks (OR, 0.17; 95% CI, 0.04-0.63), public transportation (OR, 0.13; 95% CI, 0.03-0.49), parks (OR, 0.09; 95% CI, 0.01-0.88), and maintained vacant lots (OR, 0.17; 95% CI, 0.03-0.81) were significantly associated with decreased odds of homicide. The odds of homicide were significantly higher in locations with stop signs (OR, 4.34; 95% CI, 1.40-13.45), security bars/gratings on houses (OR, 9.23; 95% CI, 2.45-34.80), and private bushes/plantings (OR, 3.44; 95% CI, 1.18-10.01). Using a population-based case-control design, we identified multiple modifiable environmental features that might be targeted in future randomized intervention trials designed to reduce youth violence by improving neighborhood context.

Familial pathways to early-onset suicide attempt: a 5.6-year prospective study.

Suicide attempts are strong predictors of suicide, a leading cause of adolescent mortality. Suicide attempts are highly familial, although the mechanisms of familial transmission are not understood. Better delineation of these mechanisms could help frame potential targets for prevention. To examine the mechanisms and pathways by which suicidal behavior is transmitted from parent to child. In this prospective study conducted from July 15, 1997, through June 21, 2012, a total of 701 offspring aged 10 to 50 years (mean age, 17.7 years) of 334 clinically referred probands with mood disorders, 191 (57.2%) of whom had also made a suicide attempt, were followed up for a mean of 5.6 years. The primary outcome was a suicide attempt. Variables were examined at baseline, intermediate time points, and the time point proximal to the attempt. Participants were assessed by structured psychiatric assessments and self-report and by interview measures of domains hypothesized to be related to familial transmission (eg, mood disorder and impulsive aggression). Among the 701 offspring, 44 (6.3%) had made a suicide attempt before participating in the study, and 29 (4.1%) made an attempt during study follow-up. Multivariate logistic regression revealed that proband suicide attempt was a predictor of offspring suicide attempt (odds ratio [OR], 4.79; 95% CI, 1.75-13.07), even controlling for other salient offspring variables: baseline history of mood disorder (OR, 4.20; 95% CI, 1.37-12.86), baseline history of suicide attempt (OR, 5.69; 95% CI, 1.94-16.74), and mood disorder at the time point before the attempt (OR, 11.32; 95% CI, 2.29-56.00). Path analyses were consistent with these findings, revealing a direct effect of proband attempt on offspring suicide attempt, a strong effect of offspring mood disorder at each time point, and impulsive aggression as a precursor of mood disorder. Parental history of a suicide attempt conveys a nearly 5-fold increased odds of suicide attempt in offspring at risk for mood disorder, even after adjusting for the familial transmission of mood disorder. Interventions that target mood disorder and impulsive aggression in high-risk offspring may attenuate the familial transmission of suicidal behavior.

201. Thoughtful Decision Making and High Risk Driving Among Latino Adolescents and Young Adults

In 2014, the World Health Organization reported that road traffic injuries are the leading cause of global adolescent mortality. The Pan American Health Organization reported that road traffic injuries are the second leading cause of adolescent mortality in the Americas. In Mexico and in the United State of America, motor vehicle crashes are the leading cause of death among adolescents and young adults. Can increasing thoughtful decision making decrease high risk driving? This study explores the relationship between thoughtful decision making and high risk driving among Latino middle, high, and post high school students.