Thoughts Of Self-harm Research Articles

Mental health and lifestyle-related behaviors in medical students in a Jordanian University, and variations by clerkship status

BackgroundThe rigors of medical education often take a toll on students' mental well-being, resulting in heightened stress, anxiety, depression, somatization, and thoughts of self-harm. This study aimed to determine the prevalence of mental health problems among Jordanian medical students (Yarmouk University), explore the links between mental state and demographic and lifestyle factors, and compare mental health profiles between pre-clinical/pre-clerkship (years 1–3) and clinical/clerkship (years 4–6) students.MethodsAn online survey was distributed to undergraduate medical students at Yarmouk University. Mental health was measured using validated tools (depression: Patient Health Questionnaire, PHQ-9; eating disorders: SCOFF; Generalized Anxiety Disorder Scale, GAD-7; Somatic Symptoms: Patient Health Questionnaire, PHQ-15; overall stress (single-item measure); ability to handle stress; stressors and coping mechanisms. Data on sociodemographic factors, academic performance, and lifestyle choices, also were collected. Bivariate and multivariable analyses evaluated the associations between academic level and mental health, accounting for sociodemographic and lifestyle factors.ResultsOf the 618 medical students who responded, 48.4% screened positive for depression, 36.7% for anxiety, and 63.6% for high level of stress. Slightly over half experienced somatic symptoms, and 28.6% exhibited signs of eating disorders. Roughly, 26% had suicidal thoughts, as measured by item 9 of the PHQ-9 scale. Low reported rates of healthy behaviors were observed (e.g. balanced diets, 5.7%; vigorous physical activity, 17.0%). Smoking prevalence was 24.6%, notably higher among clinical students. At the multivariable level, stress, insomnia, eating disorders and cigarette smoking were significantly associated with depression, anxiety and somatization. Higher physical activity scores were associated with lower depression risk. Females were significantly more likely than males to fall in more severe somatization categories.ConclusionThis study highlights the need to address the alarming rates of mental health problems among Jordanian medical students. While few significant differences were observed between pre-clinical and clinical students, the high rates of depression, anxiety, stress, and negative health practices in both groups suggest the need for interventions that begin at enrollment as well as during transitions to clinical settings. Prioritizing mental health support and promoting healthier lifestyles among medical students are vital steps toward nurturing resilient, well-rounded future medical professionals.

Suicidal ideation and thoughts of self-harm during the COVID-19 pandemic among Swedish employees: a cohort study on the role of job instability and job insecurity

BackgroundSuicidal ideation may be a warning sign for suicide and previous work has indicated a higher prevalence of suicidal ideation during the COVID-19 pandemic. Job loss and job insecurity are potential risk factors for suicidal ideation, but their importance during the pandemic, and the role of organizational changes for suicidal ideation, is unclear. This study examined the association between various experiences associated with job loss and job insecurity during the pandemic and thoughts of suicide/self-harm in Sweden.MethodsThe study sample was drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH). Auxiliary data collections in February 2021 and 2022 assessed exposure to job loss/unemployment, furlough, workplace downsizing, or increased job insecurity versus stable employment and thoughts of suicide or self-harm (PHQ-9) during the pandemic. The analyses were based on 1558 individuals (2 349 observations) participating in either or both waves and who had been working before the pandemic. Logistic regression models with cluster-robust standard errors were fitted, including sociodemographic factors and prior mental health problems to control for potential confounding. Measures of personality based on a brief version of the Big-Five personality inventory were also added.ResultsThe results indicated an association between all experiences, except furlough, and thoughts of suicide/self-harm, when adjusting for sex, age, civil status, socioeconomic status and prior mental health (job loss odds ratio (OR) = 3.70, 95% confidence interval (CI) 1.79–7.63, downsizing OR = 2.41, CI 1.24–4.70, job insecurity OR = 2.77, CI 1.15–6.67). The associations for job loss and insecurity were attenuated by adjustment for personality, although it remained statistically significant for downsizing.ConclusionsThe results suggested a higher risk of suicidal ideation connected with loss of employment and survival of a downsizing, but not a forced reduction in working times/pay during the COVID-19 pandemic. The association for subjective job insecurity was less robust and may be partly explained by personality.

Edinburgh postnatal depression scale score elevation in caregivers of infants with cystic fibrosis.

The diagnosis of cystic fibrosis (CF) can impact the mental health of caregivers. This study aimed to explore prevalence of postpartum depression (PPD) symptoms in caregivers of infants with CF or CFTR-related metabolic syndrome (CRMS). This prospective, observational study was conducted in a CF clinic at a tertiary hospital over 4 years. Caregivers of infants with CF/CRMS completed serial surveys over the first year of life. Surveys included the Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). A control group of healthy infant caregivers was used for comparative analysis of EPDS scores. Analyses were conducted on 55 caregivers of 42 infants with CF/CRMS and 915 caregivers of healthy infants. Caregivers of infants with CF/CRMS had a significantly higher prevalence of elevated EPDS scores and higher mean EPDS scores for visit 1 (age 1-2mo) and visit 3 (age 6-9mo) compared to healthy controls (p < 0.001 for both). There was a higher prevalence of caregivers identifying thoughts of self-harm in the CF/CRMS cohort (8.3%) compared to caregivers of healthy controls (1.2%) at visit 1 (p = 0.015) and at visit 3 (CF/CRMS 8.8%; control 1.7%; p = 0.030). EPDS scores correlated with PHQ-9 and GAD-7 scores, particularly earlier in the infant's life. Caregivers of infants with CF/CRMS may be at higher risk of PPD and thoughts of self-harm when compared to healthy controls. Given what is known about the impact of PPD on mental and physical health of children, early identification is vital for this population.

Thoughts on Self-Harm in Polish Pregnant and Postpartum Women During the Pandemic Period.

Background: The risk of depression during pregnancy and postpartum is high and has intensified during the COVID-19 pandemic. The aim of this study was to estimate the risk of depressive disorders and self-harm thoughts in the third trimester of pregnancy and the first week postpartum in the pandemic period. Methods: This study involved a total of 317 pregnant and postpartum women. The risk and severity of depressive disorders and the prevalence of self-harm thoughts in women during the perinatal period were assessed using EPDS. Results: Pregnant women were significantly more likely to have higher EPDS scores compared to postpartum women. Mild depressive symptoms were reported by 22.08% of pregnant women and 17.18% of postpartum women, and severe symptoms were observed in 25.97% of pregnant women and 16.56% of postpartum women. Thoughts of self-harm were reported by 11.69% of pregnant women and 17.79% of postpartum women. Self-harm thoughts were significantly more common among pregnant women: multiparous women, pregnant women who received psychiatric treatment before pregnancy, those diagnosed with depressive disorders, those who suffered from prolonged periods of anxiety and sadness, and those lacking a supportive person. Among postpartum women, there were statistically significant differences in the prevalence of self-harm thoughts for place of residence, education, type of occupation, number of pregnancies, course of pregnancy, and presence of a supportive person. Conclusions: The increased prevalence of depressive symptoms and self-harm thoughts related to the COVID-19 pandemic highlights the urgent need for screening among pregnant women and the implementation of clinical interventions.

Factors predicting a decrease in suicidality among young people (0-28 years old)

Abstract Background Suicide, self-harm and suicidal thoughts (i.e., suicidality) are important public health concerns. Most youth that experience suicidality find a way to overcome these affronts. Preventative public health measures require an understanding of factors that can help youth overcome their suicidality. Methods Data come from a Dutch prospective birth-cohort study that surveyed youth from age 11 to 28 (measurements 2-3 years apart). We determined the proportion of youth that experienced suicidality across seven waves and focused on changes in suicidality, and factors associated with changes in suicidality using linear discriminant analysis. We examined a mix of individual, family, peer and socio-cultural factors in line with an ecological framework, e.g. the Interpersonal Theory of Suicide. Results Between 4-8% of youth experienced suicidal thoughts and between 2-5% experienced self-harm across time points. Most youth (89%-94% across time points) did not experience changes in suicidality, while between 3-6% experienced a decline of suicidal thoughts and between 2-4% a decline in self-harm across time points. Discriminant analyses could correctly identify ≈90% of subgroup per case (decline, increase, stable suicidality). But, the model was not very accurate in predicting which youth belonged to the declining suicidality subgroup. Functions with best predictive ability indicated the importance of interpersonal factors; belonging to peers, parents, classmates, teachers and religion. Also, overall happiness and positive changes in romantic relationships and family had predictive value. Conclusions It remains difficult to distinguish youth who experience a decrease in suicidality. Interpersonal factors may play a role in changes in suicidality, but we need to identify new factors related to declines in suicidality. Future prospective birth-cohort study should consider including factors that may be better predictors of decreases in suicidality and mental health in general. Key messages • Factors that contribute to decreases in suicidality will enrich suicide prevention strategies, which have until thusfar mostly been informed by a risk perspective. • Interpersonal factors might play an important role in changes in suicidality among youth, which indicates we need an ecological perspective on suicidality rather than an individual perspective.

Suicidal Ideation and Self-harming Thoughts With Valbenazine Use: A Case Report.

Suicidal Ideation and Self-harming Thoughts With Valbenazine Use: A Case Report.

B - 4 The Neuropsychological Impact of Myocardial Infarction Induced Cerebral Hypoxia and Acute Encephalitis Following Electrocution: a Case Study

Abstract Objective Cerebral hypoxia and acute encephalitis subsequent to myocardial infarction (MI) are often associated with a decline in cognitive functioning (Wang et al., 2022; Caplan, 2004). While this relationship is well documented in existing literature, less research has investigated the potential nuanced cognitive and behavioral impacts of hypoxia and encephalitis due to electrocution-induced atrial fibrillation (AFib). The present case study uses neuropsychological assessment to clarify further the impact of significant electrocution and subsequent morbidities on cognition. Method We present a case study of a 30-year-old right-handed transgender female with 12 years of education who was referred for neuropsychological assessment pursuant to mental status changes manifested by disorientation and amnesia (the patient believed it was ten years prior) following the MI due to electrocution complicated by an estimated period of 10–15 minutes of non-responsiveness and anoxic encephalopathy. Results Neuropsychological assessment revealed difficulties with cognitive efficiency, language functioning, sequencing, problem-solving, complex attention, and semantic fluency. Overall, performance was inconsistent with education-weighted norms and estimated premorbid functioning. An objective measure of psychological functioning reflected a negative self-evaluation, depression, thoughts of self-harm, anxiety, and personality difficulties marked by fluctuating emotions. Findings supported a diagnosis of cognitive impairment and altered mental status associated with anoxic brain injury from the above-noted MI. Conclusion This case highlights the consequences of anoxic encephalopathy from MI subsequent to electrocution on cognitive, emotional, and behavioral functioning. Neuropsychological assessment provided clear evidence of cognitive impairment beyond the initial diagnoses, and further defined cognitive and behavioral correlates not explained by other dispositional variables.

Contextualising Experiences of Co-Occurring Mental Ill-Health and Substance Use Among Trans, Non-Binary, and Gender Diverse Young People: Implications for Tailored Harm Reduction Approaches.

Though significant research highlights higher rates of mental ill-health and substance use among trans, non-binary and gender diverse (henceforth 'trans') young people, little research has considered patterns, contextual characteristics, and correlates of co-occurring experiences of mental ill-health and substance use among trans young people. Using data from the Trans Pathways study, we used prevalence ratios and age- and gender-adjusted logistic regression models to examine prevalence and differences of co-occurring substance use (past six-month cigarette use, alcohol use, and other drug use) and contextual characteristics of substance use (past six-month solitary alcohol and/or drug use, substance use for coping) by mental ill-health (depression disorder, anxiety disorder, past 12-month self-harm thoughtsand behaviours,suicidal thoughts, planning, and attempt/s). Age- and gender-adjusted models assessed associations between co-occurring depressive and anxiety disorders and recent cigarette, alcohol, and other drug use (six co-occurring items total) and 18 interpersonal stressors. Significantly increased odds of smoking or recentuse of cannabis or sedatives was observed among trans young people reporting depressive disorder, anxiety disorder (aORs ranging 1.8-3.1). Trans young people who reported recent smoking or use of cannabis, inhalants, or sedatives, had 40% to 80% reduced odds of past 12-month self-harm thoughts, self-harm behaviours,suicidal thoughts, and suicide attempt/s (aORs ranging 0.2-0.6). On the other hand, solitary alcohol and/or other drug use and substance use for coping was significantly associated with increased odds of all mental ill-health outcomes. Issues with school, secure housing, and intimate partner abuse were themost robust correlates of co-occurring mental ill-health and substance use. Trans young people using substances, especially cigarettes, cannabis, and sedatives, often so do with co-occurring experiences of depression and anxiety though limited substance use in more 'social' contexts may confer benefits for preventingself-harm and suicide thoughts and behaviours. Continued research in partnership with trans young people is warranted to conceptualise more nuanced and precise conceptualparameters of trans-affirming substance useharm reduction approaches.

Medical Chart Review to Explore Suicidal and Self-Harm Thoughts and Behavior Among Psychiatric Inpatients.

Suicide and self-harm events are elevated in psychiatric inpatient populations. In this study, health data were retrospectively collected from the medical records of 183 patients (97 civil and 86 forensic) who had resided in, or been admitted to, a public psychiatric hospital in Saskatchewan, Canada from April 1 to December 31, 2021. Descriptive and inferential analyses were conducted to estimate prevalence and correlates of (non-fatal) suicide and self-harm events, including recent and lifetime occurrences, according to patients' health information. Nearly two-thirds (62%) of patients had any record of non-fatal suicide or self-harm events, including a lifetime history of self-harm (42%) and suicidal behavior (37%) as well as recent self-harm (24%) and suicidal (31%) thoughts or behaviors. Forensic patients were significantly more likely to have a record of suicide and self-harm events. This study emphasizes the need for further research into the course of suicidality and self-harm in psychiatric inpatients.

Examination of the Potential Moderating Role of Psychological Wellbeing in the Relationship Between Depression and Thoughts of Self-Harm in Autistic Adolescents and Adults: A Two-Year Longitudinal Study.

Autistic people have a significantly increased risk of death by suicide relative to the general population. In non-autistic samples, psychological wellbeing has been shown to moderate the relationship between depression and suicidal thoughts and behavior. Thoughts of self-harm may provide a useful indicator of suicidal risk. In this longitudinal study we examined (a) the potential role for psychological wellbeing to moderate the relationship between depressive symptoms and thoughts of self-harm and (b) the contribution of autistic traits to thoughts of self-harm. Participants were 209 autistic adolescents and adults aged 15 to 80 years (Mage = 34.20, SD = 15.38 years). At both baseline and 2-year follow-up, 35% of participants reported recent thoughts of self-harm. Wellbeing was associated with autistic traits (r = - .350 to - 0.404) and depression (r = - .480 to - 0.759). Thoughts of self-harm were positively associated with autistic traits and depression (r = .242 to 0.659), and negatively associated with wellbeing (r = - .287 to - 0.609). Controlling for baseline thoughts of self-harm, depression (β = 0.254, p = .001) and autistic traits (β = 0.162, p = .007) significantly predicted thoughts of self-harm at 2-year follow-up. Despite a lack of support for the hypothesis that wellbeing would moderate the relationship between depression and thoughts of self-harm, correlational data demonstrated significant associations between wellbeing and both depression and thoughts of self-harm. Future research considering psychological wellbeing as a potential protective factor for self-harm in autistic people is warranted.

Prevalence, distribution, and inequitable co-occurrence of mental ill-health and substance use among gender and sexuality diverse young people in Australia: epidemiological findings from a population-based cohort study

PurposeTo estimate the prevalence, distribution, and co-occurrence of mental ill-health and substance use among gender and sexuality diverse young people relative to their cisgender and heterosexual peers in Australia using population-level, nationally representative data.MethodsWe utilised Wave 8 (2018) data from the Longitudinal Study of Australian Children (N = 3037, Mage = 18.4) collected via an assessment protocol comprising interviews, direct observations, and assessments (on average 60 min per survey occasion). Weighted prevalence ratios and logistic regression models adjusted for demographic confounders were used to estimate the prevalence and distribution of mental ill-health (psychological distress, past 12-month self-harm thoughts and behaviours, past 12-month suicidal ideation, planning, attempt/s) and substance use outcomes (past 12-month cigarette, alcohol, and marijuana use) across gender identity (trans vs. cisgender), sexuality (gay/lesbian, bisexual, queer [those identifying with an ‘other’ sexuality identity that is not ‘gay’, ‘lesbian’, ‘bisexual’, or ‘heterosexual’] vs. heterosexual) and sexuality diversity status (sexuality diverse vs heterosexual) subgroups. Sex-stratified prevalence rates and accompanying adjusted logistic regression models were also used to assess mental ill-health and substance use disparities by sexuality diversity status. Adjusted multinominal logistic regression models were used to test disparities in co-occurring outcomes by sexuality identity) sexuality status sub-groups, and Fisher’s Exact Test of Independence for co-occurring disparities by gender identity (due to small sample size). All analyses used Wave 8 sample weights and adjusted for postcode-level clustering.ResultsAmong gender and sexuality diverse participants, 59 − 64% reported high or very high levels of psychological distress, 28 − 46% reported past 12-month self-harm ideation or attempts, and 26 − 46% reported past 12-month suicidal ideation, planning, or behaviour. We found significant disparities in high/very high levels of psychological distress, self-harm behaviours and suicidal behaviours among trans participants (adjusted odds ratios (aORs) ranged from 3.5 to 5.5) and sexuality diverse participants (aORs ranged from 3.5 to 3.9), compared with cisgender and heterosexual participants, respectively. Highest disparities in any past 12-month self-harm and suicidal behaviours appeared most pronounced among trans participants and queer participants compared with their cisgender, heterosexual counterparts. Minor differences by sex among sexuality diverse participants were observed for select mental ill-health outcomes. Sexuality diverse participants, and particularly sexuality diverse females, were significantly more likely to report past 12-month cigarette use and past 12-month marijuana use (adjusted odds ratio (aORs) ranging 1.4–1.6). Trans young people were at significantly elevated risk of mental ill-health in co-occurrence with cigarette and marijuana use compared with their cisgender peers (Fisher’s Exact Test of Independence p < 0.05 for all), whereas sexuality diverse young people were at greater risk of co-occurring mental ill-health and cigarette co-use and marijuana co-use, compared with their non-sexuality diverse peers (adjusted multinomial odds ratios (aMORs) ranging 2.2-6.0).ConclusionMental ill-health, substance use, and their co-occurrence disproportionately affects gender and sexuality diverse young people in Australia. Further research should study the longitudinal development of these disparities through adolescence, with close attention to the social, embodied contexts of substance use among LGBTQ + young people with the view to building LGBTQ + affirming models of harm reduction.

Chronicity of self-harming behaviors among adolescent teenage girls living in refugee settlements in Northern Uganda

BackgroundSelf-harming ideations demand targeted research due to their persistent nature, especially among female adolescents within refugee populations who face unique challenges that can exacerbate self-harming tendencies. This study aimed to assess the factors associated with self-harming ideations chronicity among female teenagers living in refugee settlement in Northern Uganda.MethodThis cross-sectional study used a pretested questionnaire to assess self-harming ideations and other demographic characteristics. Ordinal logistic regression was used to determine factors associated with chronicity of self-harm ideations.ResultsOf 385 participants, the prevalence of self-harming ideations was 4.2% (n = 16) for acute, 8% (n = 31) for subacute, and 3.1% (n = 12) for chronic. The likelihood of having more chronic self-harming ideations increased with having ever been pregnant (adjusted odds ratio [aOR] = 3.78, 95% Confidence Interval [CI] = 1.57–9.08). However, having a spouse as the family head reduced the likelihood of having more chronic self-harming ideations (aOR = 0.19, 95% CI = 0.04–0.95).ConclusionsThe persistence of self-harming thoughts among female teenagers in Northern Ugandan refugee settlements varies. Pregnancy history is associated with a higher chance of prolonged self-harming thoughts while having a spouse as the family’s head is linked with a lower likelihood. Examining different demographic and familial elements when addressing the mental well-being of female teenage refugees is vital. It stresses the necessity for customized interventions and support networks targeting the reduction of self-harm behaviors among this vulnerable group.

The weight of weights: Causal impact of overweight on major depressive disorder and its disparate association with suicide attempts in over 450,000 individuals of European ancestry (AM-SRNMA 003)

AimSome studies and societal discussions have suggested a potential link between overweight and a higher risk of mental disorders and suicidal ideation. However, the causal relationships between these factors remain unclear. This study aims to assess the bidirectional causal associations between overweight and mental disorders, including suicidal attempts. MethodWe conducted a Two-Sample Mendelian Randomization study utilizing data from over 450,000 individuals of European ancestry sourced from a comprehensive Genome-Wide Association Study database. We chose single-nucleotide polymorphisms as instrumental variables. ResultsOur analyses consistently supported a unidirectional causal association of overweight with the increased risk of major depressive disorder (MDD, β = 0.152, se = 0.069, P = 0.027), bipolar affective disorders (BD, β = 0.197, se = 0.092, P = 0.033), and attention-deficit / hyperactivity disorder (ADHD, β = 0.308, se = 0.080, P = 1.366 × 10−4). We observed no significant causal relationships for the exposure of overweight to anxiety disorder (AD), manic episode (MA), panic disorder (PD), schizophrenia (SZ), substance use disorder (SUD), autism spectrum disorder (ASD), ever attempted suicide, recent thoughts of suicide or self-harm, and suicide or other intentional self-harm events. ConclusionThis study has provided evidence for the causal relationship between overweight and MDD, BD, ADHD, with no observed relationship between overweight and AD, MA, PD, SZ, SUD, ASD, ever attempted suicide, recent thoughts of suicide or self-harm, and suicide or other intentional self-harm events.

Ecological momentary assessment of self-harm thoughts and behaviors: A systematic review of constructs from the Integrated Motivational-Volitional model (Preprint)

Ecological momentary assessment of self-harm thoughts and behaviors: A systematic review of constructs from the Integrated Motivational-Volitional model (Preprint)

Prevalence of Low Mood, Thoughts of Self-Harm and Suicidal Ideation in Women Affected by the Perimenopause and Menopause

Prevalence of Low Mood, Thoughts of Self-Harm and Suicidal Ideation in Women Affected by the Perimenopause and Menopause

Predicting recurrent chat contact in a psychological intervention for the youth using natural language processing.

Chat-based counseling hotlines emerged as a promising low-threshold intervention for youth mental health. However, despite the resulting availability of large text corpora, little work has investigated Natural Language Processing (NLP) applications within this setting. Therefore, this preregistered approach (OSF: XA4PN) utilizes a sample of approximately 19,000 children and young adults that received a chat consultation from a 24/7 crisis service in Germany. Around 800,000 messages were used to predict whether chatters would contact the service again, as this would allow the provision of or redirection to additional treatment. We trained an XGBoost Classifier on the words of the anonymized conversations, using repeated cross-validation and bayesian optimization for hyperparameter search. The best model was able to achieve an AUROC score of 0.68 (p < 0.01) on the previously unseen 3942 newest consultations. A shapely-based explainability approach revealed that words indicating younger age or female gender and terms related to self-harm and suicidal thoughts were associated with a higher chance of recontacting. We conclude that NLP-based predictions of recurrent contact are a promising path toward personalized care at chat hotlines.

Adolescent Self-harm Behavior Based on Depression, Family Emotional Climate, School Identity, and Academic Performance

Background: This study investigated factors affecting self-harming behaviors and preventing self-harming thoughts and behavior in adolescent girls. Physical, cognitive, and socioemotional changes accompany adolescence. The family and school must support the adolescent in this regard. Methods: The research is a correlational study, and data collection was through the census method. All 150 girls aged between 12 and 24 years who lived in one of the villages (Benoband) of Bandar Abbas City, Iran, in 2022 were recruited. The deliberate self-harm inventory (Gratz, 2001), the Kutcher adolescent depression scale, the dual school climate, and school identification measure-student, the academic performance questionnaire (Pham &amp; Taylor, 1999), and the affective family climate were used for data collection. The collected data were analyzed using multiple linear regression analysis in SPSS software, version 26. Results: The results revealed that depression has a direct relationship with self-harm (0.30), the emotional atmosphere of the family (-0.49), and school climate and identity (-0.49). Also, the academic performance had a significant negative relationship (-0.47) with self-harm (P&lt;0.001). Regression analysis showed that these variables can explain 39% of the variance of adolescent self-harm behavior (F=25.16, P≤0.001). Conclusion: The research showed that teenagers need education and awareness in schools and families. Also, parents’ education to familiarize them with the particular characteristics of adolescents, including their emotional and social characteristics, will lead to a greater understanding of the adolescent in the family and mental and psychological peace of the adolescents. A comprehensive health education program should include coping skills, interpersonal communication, goal setting, anger management, and advocacy skills.

Adolescents Who Do Not Endorse Risk via the Patient Health Questionnaire Before Self-Harm or Suicide

Given that the Patient Health Questionnaire (PHQ) item 9 is commonly used to screen for risk of self-harm and suicide, it is important that clinicians recognize circumstances when at-risk adolescents may go undetected. To understand characteristics of adolescents with a history of depression who do not endorse the PHQ item 9 before a near-term intentional self-harm event or suicide. This was a retrospective cohort study design using electronic health record and claims data from January 2009 through September 2017. Settings included primary care and mental health specialty clinics across 7 integrated US health care systems. Included in the study were adolescents aged 13 to 17 years with history of depression who completed the PHQ item 9 within 30 or 90 days before self-harm or suicide. Study data were analyzed September 2022 to April 2023. Demographic, diagnostic, treatment, and health care utilization characteristics. Responded "not at all" (score = 0) to PHQ item 9 regarding thoughts of death or self-harm within 30 or 90 days before self-harm or suicide. The study included 691 adolescents (mean [SD] age, 15.3 [1.3] years; 541 female [78.3%]) in the 30-day cohort and 1024 adolescents (mean [SD] age, 15.3 [1.3] years; 791 female [77.2%]) in the 90-day cohort. A total of 197 of 691 adolescents (29%) and 330 of 1024 adolescents (32%), respectively, scored 0 before self-harm or suicide on the PHQ item 9 in the 30- and 90-day cohorts. Adolescents seen in primary care (odds ratio [OR], 1.5; 95% CI, 1.0-2.1; P = .03) and older adolescents (OR, 1.2; 95% CI, 1.0-1.3; P = .02) had increased odds of scoring 0 within 90 days of a self-harm event or suicide, and adolescents with a history of inpatient hospitalization and a mental health diagnosis had twice the odds (OR, 2.0; 95% CI, 1.3-3.0; P = .001) of scoring 0 within 30 days. Conversely, adolescents with diagnoses of eating disorders were significantly less likely to score 0 on item 9 (OR, 0.4; 95% CI, 0.2-0.8; P = .007) within 90 days. Study results suggest that older age, history of an inpatient mental health encounter, or being screened in primary care were associated with at-risk adolescents being less likely to endorse having thoughts of death and self-harm on the PHQ item 9 before a self-harm event or suicide death. As use of the PHQ becomes more widespread in practice, additional research is needed for understanding reasons why many at-risk adolescents do not endorse thoughts of death and self-harm.

Anxiety and depression symptoms in adolescents and young adults with juvenile idiopathic arthritis: results of an outpatient screening

BackgroundPrevious studies have shown that growing up with rheumatic conditions can fuel dissatisfaction and psychological distress, which in turn affects disease self-management and treatment adherence. Primary objective of this study was to estimate the prevalence of anxiety and depression symptoms in adolescents and young adults (AYA) with juvenile idiopathic arthritis (JIA) and to identify correlates of conspicuous screening results.MethodsInitiated as part of the COACH multicenter observational study, outpatients aged 12 to 21 years participating in the National Pediatric Rheumatological Database (NPRD) were prospectively screened for mental health using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder Scale-7 (GAD-7).ResultsData from 1,150 adolescents with JIA (mean age 15.6 ± 2.2 years; mean disease duration 7.2 ± 4.9 years, 69% female, 43% oligoarthritis, 26% polyarthritis) were analysed. Overall, 32.7% (n = 316) of AYA showed conspicuous screening results, of whom 30.4% reported clinically relevant suicidal or self-harm thoughts. About 19% of screened patients showed moderate to severe depressive or anxious symptoms. AYA with conspicuous screening results were older (15.8 vs. 15.2 years; p < 0.0001), more often female (81% vs. 64%; p < 0.0001) and more often overweight (25% vs. 17%; p = 0.006). They had higher disease activity (physician global assessment on NRS 0–10; 1.7 vs. 1.2; p < 0.0001), more functional limitations (CHAQ; 0.44 vs. 0.14; <0.0001) and rated their health status worse (NRS 0–10; 3.5 vs. 1.8; p < 0.0001) than AYA with inconspicuous screening results. Females (OR 2.33 [CI 1.53–3.56]; p < 0.0001), older age (OR 1.09 [CI 1.01–1.18]; p = 0.026), patients with more functional limitations (OR 3.36 [CI 1.98–5.72]; p < 0.0001), and patients with worse subjective health status (OR 1.17 [CI 1.07–1.27]; p < 0.0001) were more likely to have a conspicuous screening result. Regular sports participation was associated with a lower likelihood of conspicuous screening result (OR 0.69 [CI 0.49–0.98]; p = 0.039).ConclusionsA large-scale outpatient screening of AYA with JIA in Germany shows a high prevalence of anxiety and depression symptoms. The need for routine screening for early detection of mental health problems became apparent.

Investigating child sexual abuse material availability, searches, and users on the anonymous Tor network for a public health intervention strategy

Tor is widely used for staying anonymous online and accessing onion websites; unfortunately, Tor is popular for distributing and viewing illicit child sexual abuse material (CSAM). From 2018 to 2023, we analyse 176,683 onion domains and find that one-fifth share CSAM. We find that CSAM is easily available using 21 out of the 26 most-used Tor search engines. We analyse 110,133,715 search sessions from the Ahmia.fi search engine and discover that 11.1% seek CSAM. When searching CSAM by age, 40.5% search for 11-year-olds and younger; 11.0% for 12-year-olds; 8.2% for 13-year-olds; 11.6% for 14-year-olds; 10.9% for 15-year-olds; and 12.7% for 16-year-olds. We demonstrate accurate filtering for search engines, introduce intervention, show a questionnaire for CSAM users, and analyse 11,470 responses. 65.3% of CSAM users first saw the material when they were children themselves, and half of the respondents first saw the material accidentally, demonstrating the availability of CSAM. 48.1% want to stop using CSAM. Some seek help through Tor, and self-help websites are popular. Our survey finds commonalities between CSAM use and addiction. Help-seeking correlates with increasing viewing duration and frequency, depression, anxiety, self-harming thoughts, guilt, and shame. Yet, 73.9% of help seekers have not been able to receive it.