Anna Kokkevi

Adolescents’ self-reported suicide attempts, self-harm thoughts and their correlates across 17 European countries

BACKGROUND   Suicide is a leading cause of death among adolescents in Europe. Self-harm thoughts and behaviours are documented precursors of completed suicide. It is therefore of great importance to investigate the prevalence of suicide thoughts and attempts and their correlates, with the aim of preventing this major life-threatening public health problem. This study provides cross-national European data on self-reported suicidal thoughts and attempts among adolescents. METHODS   Data were obtained from 45,806 high school students aged 15-16 years from 17 countries that participated in the European School Survey Project on Alcohol and Other Drugs (ESPAD) 2007 school survey. The standardised methods of the ESPAD survey ensure comparability across countries. Students completed an anonymous questionnaire in their classrooms. The prevalences of suicidal thoughts and attempts are reported as well as their sociodemographic and psychosocial correlates identified in logistic regression. RESULTS   The median prevalence of any lifetime self-reported suicide attempt was 10.5% across the participating countries (range 4.1%-23.5%). The median of frequent self-harm thoughts (at least five times) was 7.4% (range 2.1%-15.3%). Suicidal behaviour and thoughts had significant associations with gender, substance use, family integrity and socioeconomic status. Countries with higher prevalence of substance use tended to have a weaker association between substance use and self-reported suicide attempts. CONCLUSION   Although self-reported self-harm thoughts and suicide attempts vary in prevalence within Europe, there are common correlates across countries. These have an important impact on understanding the phenomenon of suicide among young people and in guiding prevention.

The epidemiology of licit and illicit substance use among high school students in Greece.

Findings on self-reported adolescent licit and illicit substance use are presented based on a nationwide 1984 probability sample of 11,058 Greek adolescent students ages 14-18 years old. Regular smoking and use of alcohol in the 30 days prior to the survey were reported by 22.3 percent and 82.8 percent, respectively. Nearly one-third of the students (30.3 percent) reported lifetime use of psychotropic drugs without prescription, without ever having used any illicit drug. Illicit drug use is less common in Greece than in other European and North American countries with a lifetime prevalence rate of 6 percent. Regular use of tobacco, alcohol, and illicit drugs was more common in males, while unprescribed use of licit psychotropic drugs prevailed in females. Regular smoking, drinking, and illicit drug use were associated with urbanization but not socioeconomic status. Between 1984 and 1988 in an Athenian subsample of schools there was a 20 percent increase in illicit drug use among males. Use of psychotropic drugs without prescription decreased much more than use of tobacco and alcohol.

Drug abuse and psychiatric comorbidity

Psychiatric morbidity was studied in a sample of 176 opioid-dependent men recruited from prison and treatment services. The Diagnostic Interview Schedule (DIS) was used for psychiatric assessment. Lifetime and current prevalence of any mental disorder, excluding substance use disorders, reached 90.3% and 66.1%, respectively. The most prominent lifetime DSM-III axis I disorders were anxiety (31.8% lifetime and 16.5% last month) and affective (25% lifetime and 19.9% last month) disorders. Antisocial personality disorder (ASP) had a lifetime prevalence of 69.3%. Higher rates of affective and anxiety disorders were diagnosed in the treatment sample than in the imprisoned sample, whereas the inverse was observed for ASP. Results from the psychiatric interview showing a strong association between drug--opiate--dependence and DSM-III mental disorders are further supported by findings of high levels of depressive symptoms on the Center for Epidemiological Studies-Depression (CES-D) scale (71.5%) and increased rates of self-reported suicide attempts (27.4%) and psychiatric hospitalizations (26.8%). Psychiatric disorders seem to precede drug dependence in the majority of cases. Results from this study are compared and discussed with those from similar North American Studies.

Not Early Drinking but Early Drunkenness Is a Risk Factor for Problem Behaviors Among Adolescents from 38 European and North American Countries

BACKGROUND Many studies have reported that the earlier the age at first drink (AFDrink) the higher the later drinking levels and related problems. However, unless adolescents proceed into drunkenness, it is unclear why consuming small quantities at early age should lead to later problems. This study investigates the link between AFDrink and problem behaviors (smoking, cannabis use, injuries, fights, and low academic performance) among 15-year-olds who did and did not proceed into drunkenness. Among those with drunkenness experience, we tested whether AFDrink predicted problem behaviors over and above the age at first drunkenness (AFDrunk). METHODS Multilevel structural equation models were estimated based on a sample of 44,801 alcohol-experienced 15-year-olds from 38 North American and European countries and regions who participated in the Health Behaviour in School-aged Children cross-national survey. RESULTS Overall, there was a significant association between AFDrink and all 5 problem behaviors. However, this was the case only among those with drunkenness experiences but not among those never drunk. Among the former, AFDrunk was a strong predictor for all 5 problem behaviors, but time from first drink to first drunk did not predict problem behaviors. CONCLUSIONS Not early alcohol initiation but early drunkenness was a risk factor for various adolescent problem behaviors at the age of 15, that is, there was not consistent relationship for the time before the first drunkenness (i.e., since first drinking). Besides targeting early drinking, particular efforts are needed to impede early drunkenness to prevent associated harm in adolescence and beyond.

Reliability of drug dependents' self-reports

Among 936 demands for treatment by drug users in Greece in 7 months in 1994, 78 subjects making at least two demands were identified by code numbers. The median time between demands was 50 days (range 2-219). The data obtained by interview at the first two demands were compared to estimate the reliability of the interview schedule of the First Treatment Demand protocol of the Pompidou Group of the Council of Europe. Subjects were 84.6% male, with a median age of 27 years (range 14-43) and median duration of use 11 years (range 2-27). The primary substance of use was mainly heroin (88.5%). The percentage of agreement between interviews was highest for lifetime history of injecting (100%), urban residence (98.7%) and mode of use of heroin (94.3%). Percentages of agreement were close to 90% for most other items of socio-demographic data and drug use history, whether or not the correct response to the item could logically change between interviews. It is concluded that reliability of the data is around 90% and short-term behaviour in this population is rather stable. Only employment status (52.9% agreement) and secondary substance of abuse (25.5%) appeared to be exceptions. It is noteworthy that HIV and hepatitis serostatuses were reported less reliably than most other items.

Depression and Drug Use

In this paper findings from a nationwide study on adolescent student population focusing on the association of depressive disorders and drug use are presented. A progressive increase of depressive mood levels is found as we proceed from the non-users to the users of elicit (tobacco, alcohol, psychotropics used without prescription) and illicit substances. The same pattern is also observed with rates of elevated depression scores and self-reported suicide attempts. These findings are discussed in connection with the issue of possible causal relationship between depressive mood and substance dependence.

Prevalence, Patterns, and Correlates of Tranquilizer and Sedative Use Among European Adolescents

PURPOSE To examine the prevalence, patterns, and correlates of nonmedical use of tranquilizers or sedatives in 85,000 adolescent students from 31 European countries participating in the European School Survey on Alcohol and Other Drugs (ESPAD) in 2003. METHODS Surveys in each country followed a standardized protocol. Logistic regression analysis was performed to identify sociodemographic and risk behavior correlates of medical and nonmedical tranquilizer or sedative use. RESULTS Lifetime nonmedical tranquilizer or sedative use was reported by 5.6% overall. Medical tranquilizer or sedative use multiplies the odds of nonmedical use by 10.7 (95% confidence interval 9.1-12.5) for boys and 7.2 (6.3-8.3) for girls. Nonmedical tranquilizer or sedative use is also associated with the use of tobacco (odds ratio 1.3, 1.1-1.5), alcohol (1.3, 1.2-1.5), and illicit drugs (3.5, 3.1-3.9). Further correlates are truancy (1.4, 1.2-1.6), tranquilizer or sedative use by friends (6.0, 5.5-6.7) and siblings (2.7, 2.2-3.4), and dissatisfaction with relationships with parents. Medical tranquilizer or sedative use shares to a large extent the same correlates. CONCLUSIONS Findings indicate similarities in adolescent tranquilizer or sedative use between Europe and United States. The implications of the results for prevention policies are discussed.

Decrease in Adolescent Cannabis Use From 2002 to 2006 and Links to Evenings Out With Friends in 31 European and North American Countries and Regions

OBJECTIVE To compare adolescent cannabis use between 2002 and 2006 and to investigate links to the frequency of evenings spent out with friends. DESIGN The Health Behavior in School-Aged Children study, an international study carried out in collaboration with the World Health Organization/Europe. SETTING A total of 31 mostly European and North American countries and regions. PARTICIPANTS A total of 93 297 students aged 15 years. OUTCOME MEASURE Cannabis use in the last 12 months in relation to the mean frequency of evenings out with friends per week. RESULTS A decrease in the prevalence of cannabis use was found in most of the 31 participating countries and regions. The most marked decreases were found in England, Portugal, Switzerland, Slovenia, and Canada. Increases occurred only in Estonia, Lithuania, Malta, and among Russian girls. The more frequently adolescents reported going out with their friends in the evenings, the more likely they were to report using cannabis. This link was consistent for boys and girls and across survey years. Across countries, changes in the mean frequency of evenings spent out were strongly linked to changes in cannabis use. CONCLUSIONS The findings are consistent with the hypothesis that by going out less frequently in the evenings with friends, adolescents had fewer opportunities to obtain and use cannabis. Future research is needed to learn more about the nature of evenings out with friends and related factors that might explain changes in adolescent cannabis use over time.

Substance abuse patterns and their association with psychopathology and type of hostility in male patients with borderline and antisocial personality disorder

The aim of this study was to investigate the prevalence of substance use disorder in young adult patients with borderline personality disorder (BPD) and antisocial personality disorder (APD) and to ascertain the specific substances each of these groups choose to abuse. An additional aim was to assess whether alcohol and drug abuse in the patients related to their psychopathology and hostility. The study subjects were 41 hospitalized patients with BPD and 44 hospitalized patients with APD. The diagnoses of personality disorders and substance use disorders were made using DSM-III criteria. Psychopathology patterns were assessed using the Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, and State-Trait Anxiety Inventory. Hostility was assessed using the Hostility and Direction of Hostility Questionnaire. Abuse of one or more substances was reported by 76% of BPD patients and 95% of APD patients. There was no difference between the two groups in terms of alcohol abuse, but certain substances (such as benzodiazepines, anticholinergics, cannabis, and opioids) were abused more than twice as often by APD patients versus BPD patients. APD patients were more likely than BPD patients to be multiusers. In BPD patients, the number of substances abused showed a negative association with depression, while in APD patients it was positively related to state anxiety. In both patient groups, there was no correlation of the number of abused substances with the degree of extroverted or introverted hostility.

Sharp Increase in Illicit Drug Use in Greece: Trends from a General Population Survey on Licit and Illicit Drug Use

The study aims to follow trends in the prevalence of licit and illicit substance use between 1984 and 1998 in the Greek general population. Data are drawn from two nationwide cross-sectional household surveys. Probability samples consisted of 4,297 (1984) and 3,759 (1998) 12- to 64-year-old respondents. Regular tobacco smoking in the total sample increased in women and decreased in men while alcohol consumption remained at similar levels. The use of illicit drugs showed a 3-fold increase since 1984 reaching a lifetime prevalence of 19% in males and 6% in females. In contrast, a significant decrease was noted in the unprescribed use of psychoactive medicines, especially among women. Trends in licit and illicit substance use can be explained by sociocultural and policy changes in Greece in the last 15 years.