Shyamala Nada-Raja

Low self-esteem and hopelessness in childhood and suicidal ideation in early adulthood

This study examined the longitudinal relationship between family characteristics in early childhood, self-esteem, hopelessness and thoughts of self-harm in the midchildhood years, and suicidal ideation at ages 18 and 21. Path analysis was used to establish separate models for boys and girls. The results suggested different pathways to later suicidal ideation for boys and girls. For boys, suicidal ideation seemed to have stronger roots in childhood, with significant paths from low self-esteem and hopelessness to early thoughts of self-harm and thence to later ideation. For girls, self-esteem had a small but significant direct effect on later suicidal ideation. The findings provide support for the idea that individual characteristics such as feelings of hopelessness and low self-esteem act as “generative mechanisms,” linking early childhood family characteristics to suicidal ideation in early adulthood.

Suicide Attempt in Young People: A Signal for Long-term Health Care and Social Needs

IMPORTANCE Suicidal behavior has increased since the onset of the global recession, a trend that may have long-term health and social implications. OBJECTIVE To test whether suicide attempts among young people signal increased risk for later poor health and social functioning above and beyond a preexisting psychiatric disorder. DESIGN We followed up a cohort of young people and assessed multiple aspects of their health and social functioning as they approached midlife. Outcomes among individuals who had self-reported a suicide attempt up through age 24 years (young suicide attempters) were compared with those who reported no attempt through age 24 years (nonattempters). Psychiatric history and social class were controlled for. SETTING AND PARTICIPANTS The population-representative Dunedin Multidisciplinary Health and Development Study, which involved 1037 birth cohort members comprising 91 young suicide attempters and 946 nonattempters, 95% of whom were followed up to age 38 years. MAIN OUTCOMES AND MEASURES Outcomes were selected to represent significant individual and societal costs: mental health, physical health, harm toward others, and need for support. RESULTS As adults approaching midlife, young suicide attempters were significantly more likely to have persistent mental health problems (eg, depression, substance dependence, and additional suicide attempts) compared with nonattempters. They were also more likely to have physical health problems (eg, metabolic syndrome and elevated inflammation). They engaged in more violence (eg, violent crime and intimate partner abuse) and needed more social support (eg, long-term welfare receipt and unemployment). Furthermore, they reported being lonelier and less satisfied with their lives. These associations remained after adjustment for youth psychiatric diagnoses and social class. CONCLUSIONS AND RELEVANCE Many young suicide attempters remain vulnerable to costly health and social problems into midlife. As rates of suicidal behavior rise with the continuing global recession, additional suicide prevention efforts and long-term monitoring and after-care services are needed.

A population-based study of help-seeking for self-harm in young adults

Objective: To examine help-seeking for self-harm in a population-based sample of young adults. Method: Nine hundred and sixty-five participants aged 26 years were interviewed about help-seeking and barriers to help-seeking for a range of self-harmful behaviours. Self-harm included the traditional methods of suicide (ICD-9 self-harm) and other self-harmful behaviours such as self-battery and self-biting. Results: Just over half of the 25 in the ICD-self-harm group (based on ICD-9 self-harm criteria) and one-fifth of the 119 in the other self-harmful behaviour group had sought professional help. Counsellors, psychologists, and general practitioners were the commonest sources of help. Most participants rated help received from health services favourably, however, emergency services were rated less favourably than other health services. Among 77 self-harm participants who did not seek help, just over one-third reported attitudinal barriers. Conclusions: To encourage help-seeking by young adults who self-harm, especially young men who are at high risk for self-harm and suicide, it may be necessary to identify ways to reduce attitudinal barriers.

Models of Adolescent Psychopathology: Childhood Risk and the Transition to Adulthood

OBJECTIVE To examine the relationship between DSM-III disorder in adolescence (age 15 years) and DSM-III-R disorder in early adulthood (age 18 years), in relation to a history of behavior problems or disorder, other family and individual characteristics, and events commonly associated with the transition to adulthood. METHOD The sample came from a New Zealand birth cohort selected from the general population. Data were obtained from ages 3 to 18 years for 890 of those enrolled. RESULTS For both males and females, disorder at age 15 was strongly predicted by histories of early mental health problems. However, neither those histories, background characteristics, nor the experience of adolescent transition events modified the strength of association between disorder at ages 15 and 18 years. In childhood, after adjusting for histories of behavior problems, parental separations and (for boys) poor social competence remained independent predictors of disorder at age 15. Overall, boys appeared more vulnerable and those from socially disadvantaged backgrounds in early childhood had an elevated risk of disorder at age 18. After adjusting for disorder at age 15, adolescent unemployment remained an independent predictor of disorder at age 18 for both males and females. CONCLUSIONS This study modeled the continuity of disorder across the adolescent transition period and, after taking earlier disorder into account, identified clear predictors of later disorder. This is the first step in the process of developing more effective interventions to reduce the risk of mental health disorders.

Brief report: Text bullying and traditional bullying among New Zealand secondary school students

This descriptive study examined text and traditional bullying in New Zealand (NZ), and the relationship between text bullying and traditional bullying, and feeling unsafe at school. A self-report online survey assessed the frequency of bullying among 1169 15 year old secondary students, for five categories of bullying: text messages, rumors, exclusion, teasing, and physical bullying. Results show that in the school year assessed 47% reported having been bullied sometimes or often and 37% reported bullying others; 11% reported being text bullied, while 7% reported text bullying others. Students involved in text bullying were significantly more likely to be involved in traditional forms of bullying and were less likely to feel safe at school.

Physical Assault Among 21-Year-Olds by Partners

The authors sought to answer the following questions: Are more women than men physically assaulted by a partner? Do a disproportionate number of physical assaults against women involve a partner? Are women subjected to more physical assaults from partners than are men? Are physical assaults on women by partners more severe in terms of physical harm than physical assaults on men by partners? The sample was the Dunedin Multidisciplinary Health and Development Study, a longitudinal study of a cohort of New Zealanders. Using a semistructured face-to-face interview, information on assault was obtained from study members when they turned 21 years of age. Our results showed that more women than men reported being assaulted by a partner, assaults by men represented a greater percentage of womens assault experiences, the partner assault rate was higher for women, and the assaults against women tended to result in more serious injury.

The prevalence and correlates of psychological distress following physical and sexual assault in a young adult cohort.

Among a birth cohort of New Zealand’s 21-year-olds, 41% experienced physical or sexual assault in the previous 12 months. The level of psychological distress experienced by the 374 victims was determined in interviews assessing for symptoms indicative of posttraumatic stress disorder and ratings of impairment in activities of daily living. Of the 141 women victims, 32.6% were identified as experiencing psychological distress as were 9.9% of the 233 men. For men, bivariate analyses showed psychological distress was significantly associated with factors indicative of increased assault severity, and for women an increased likelihood of distress was associated with the location of assault and the relationship to the assailant. Positive indicators of social support were not significantly associated with less adverse psychological outcomes. However, for both men and women, resisting the assailant was associated with a reduced likelihood of psychological distress. Multivariate analyses revealed that for both women and men, unemployment uniquely predicted variance in distress, over and above that accounted for by characteristics of the assault.

A web-based intervention for abused women: the New Zealand isafe randomised controlled trial protocol

BackgroundIntimate partner violence (IPV) and its associated negative mental health consequences are significant for women in New Zealand and internationally. One of the most widely recommended interventions is safety planning. However, few women experiencing violence access specialist services for safety planning. A safety decision aid, weighing the dangers of leaving or staying in an abusive relationship, gives women the opportunity to prioritise, plan and take action to increase safety for themselves and their children. This randomised controlled trial is testing the effectiveness of an innovative, interactive web-based safety decision aid. The trial is an international collaborative concurrent replication of a USA trial (IRIS study NCT01312103), regionalised for the Aotearoa New Zealand culture and offers fully automated online trial recruitment, eligibility screening and consent.Methods/DesignIn a fully automated web-based trial (isafe) 340 abused women will be randomly assigned in equal numbers to a safety decision aid intervention or usual safety planning control website. Intervention components include: (a) safety priority setting, (b) danger assessment and (c) an individually tailored safety action plan. Self-reported outcome measures are collected at baseline and 3, 6, and 12-months post-baseline.Primary outcomes are depression (measured by Center for Epidemiologic Studies Depression Scale, Revised) and IPV exposure (measured by Severity Violence Against Women Scale) at 12 months post-baseline. Secondary outcomes include PTSD, psychological abuse, decisional conflict, safety behaviors and danger in the relationship.DiscussionThis trial will provide much-needed information on the potential relationships among safety planning, improved mental health, reduced violence as well as decreased decisional conflict related to safety in the abusive relationship. The novel web-based safety decision aid intervention may provide a cost-effective, easily accessed safety-planning resource that can be translated into clinical and community practice by multiple health disciplines and advocates. The trial will also provide information about how women in abusive relationships safely access safety information and resources through the Internet. Finally, the trial will inform other research teams on the feasibility and acceptability of fully automated recruitment, eligibility screening, consent and retention procedures.Trial registrationTrial registered on 03 July 2012 on the Australian New Zealand Clinical Trials Registry ACTRN12612000708853.

A LONGITUDINAL INVESTIGATION OF PSYCHOLOGICAL AND SOCIAL PREDICTORS OF TRAFFIC CONVICTIONS AMONG YOUNG NEW ZEALAND DRIVERS

The study aimed to determine whether young drivers with traffic conviction records differed from those without, with respect to prior personal characteristics measured around the minimum age of licensure (presently 15 years in New Zealand). From a broad range of psychological and social factors, the strongest and most stable predictors were male gender, part time work, rural residence, marijuana use, estimated driving exposure during the follow up period, and early motorcycle riding. Experiences of riding as a passenger with young drivers or with an alcohol intoxicated adult driver were also significant predictors. Some possible countermeasures are considered. (a) For the covering entry of this conference, please see IRRD abstract no. E200232.

Victimization, posttraumatic stress disorder symptomatology, and later nonsuicidal self-harm in a birth cohort.

This longitudinal population-based study examined pathways to nonsuicidal self-harm (NSSH) in relation to childhood sexual abuse (CSA), assault victimization in early adulthood, posttraumatic stress disorder symptomatology (PTSD), and other mental disorders. At age 21, 476 men and 455 women completed interviews on assault victimization, PTSD, and other mental disorders. At age 26, they completed independent interviews on self-harm and childhood sexual abuse (CSA). Multivariate logistic regression analyses were conducted to determine predictors for NSSH at age 26. For men, anxiety and depressive disorders at age 21 were the only significant predictors of NSSH at age 26. For women, victimization, PTSD, and other anxiety disorders at age 21 all significantly predicted NSSH. CSA predicted later NSSH only indirectly, by increasing the risk of anxiety disorders among men and of assault victimization among women. In conclusion, pathways to nonsuicidal self-harm differed by sex. For women there were direct links with assault victimization and PTSD in early adulthood, whereas for men only internalizing disorders predicted future NSSH.