Simon Davidson

Suicidal Children and Adolescents With First Emergency Room Presentations: Predictors of Six-Month Outcome

OBJECTIVE To examine risk of future documented suicide attempts and emergency room (ER) returns among children and adolescents with first suicidal ER presentations. METHOD A total of 548 consecutive ER presentations of suicidal 5- to 19-year-olds to a Canadian center over a 1-year period (1997-1998) were reviewed. Relative risk analyses were performed on 224 first-time patients (mean age 14.6+/-2.1) to determine the strength of associations between predictors and outcomes (ER return and suicide attempts). RESULTS At 6-month follow-up, 32.6% (n = 73) had returned to the ER, 24.1% (n = 54) had a documented suicide attempt, and 14.3% (n = 32) required psychiatric hospitalization. Predictors for both ER return and future documented suicide attempts included 15- to 19-year age range, past foster/group home placement, past mental health care, a suicide plan, reported mood symptoms, sobriety at ER visit, and general substance use. Child welfare guardianship and abuse history were also predictors of ER returns. CONCLUSIONS Clinicians should be aware of these risk factors when assessing and managing suicidal youths with first ER presentations.

Identifying depressed and suicidal adolescents in a teen health clinic

PURPOSE This study examined the 6-month prevalence of depression and suicidal probability among new referrals to an adolescent health clinic. METHODS All subjects (n = 104) completed the Beck Depression Inventory (BDI) and the Suicide Probability Scale (SPS) prior to being seen by a physician and were categorized according to presenting problem (physical complaints only, psychological complaints only, and physical and psychological complaints combined). RESULTS Fifty-nine percent of the sample was depressed with 21% falling in the moderate range and 21% falling within the severe range of depression. Almost 23% of the sample demonstrated significant suicidal probability. The BDI and SPS were highly correlated (r = .73, p < .001) and 22% of the sample met criteria for both moderate to severe depression and suicidal probability. A significantly greater proportion of patients presenting with physical and psychological complaints combined (60%) met BDI criteria for depression than was found for the other two groups. Suicidal probability was most prevalent in patients presenting with psychological complaints only (26%) and moderate to severe depression and significant suicidal probability also coexisted to a greater extent within this group (26%). CONCLUSIONS Results suggest that depression and suicidal probability represent significant mental health problems within the adolescent clinic and the identification of high-risk individuals can be achieved through comprehensive screening practices.

Adolescents and young adults who are not in employment, education, or training

Their problems are more than economic

Towards a new paradigm of care: the International Declaration on Youth Mental Health

A recent and growing body of evidence on youngpeople’s mental health has pointed to the need foran international response to the increasing and con-cerning rates of mental ill-health among youngpeople.1,2The periods of adolescence and emergingadulthood3are considered the peak periods for theonset of mental ill-health4with 75% of all adult diag-noses of mental ill-health having had an onsetbefore the age of 25 years.5In an era when the physi-cal health of young people has never been better,6their psychological and mental health has neverbeen worse.7This leaves young people vulnerable todeveloping potentially intractable and enduringmental health difficulties with the inevitable per-sonal, familial, social and vocational consequencesthat accompany the experience of mentalill-health

Youth suicide: A psychological autopsy study of completers and controls

The objective of this study was to investigate risk factors that could help to differentiate between 14–25-year-old suicide attempters who survive the attempt and those who do not. Using a case–control psychological autopsy method, 29 cases (completers) and 23 controls (survivors) matched for age and sex were included. Survivors, parents and a close friend participated independently in semistructured interviews. Kiddie-Schedule for Affective Disorders and Schizophrenia Lifetime, stress scales, medical records and a sociodemographic inventory were used to reach a consensus best estimate DSM-IV five-axis diagnosis for each subject. A conditional logistic regression was used with the PHREG procedure in SAS to investigate the relationship between the binary outcome (survival/death) and the set of putative risk factors. No significant Axis I diagnostic differences were found between groups. Based on odds ratios, school suspension and irritability provide the best predictive factors for survival. Together with an Axis II cluster C diagnosis (avoidant, dependent and obsessive-compulsive personality disorder), high Global Assessment of Functioning scale, reactivity of depressed mood and level of obsessions were associated significantly with suicide completers. Cases appear to show more of an ‘internalizer’ profile, compared to controls who were more of the ‘externalizer’ profile. Dissatisfaction with physical appearance, rejection from others and feelings of isolation were highly prevalent in all subjects. Seventy-two per cent of cases died on their first attempt. The vast majority of subjects sought general medical care in the months preceding the suicidal behaviour. A mental health professional was consulted within the previous year by a greater proportion of controls, compared with cases. Our research emphasizes that the combination of psychopathology (diagnosed or not) and previous high level of functioning (in individuals who internalize their conflicts) represents an at-risk group for youth completing suicide. These findings underscore the importance of mental health evaluation as part of the general medical care assessment.

For youth by youth: innovative mental health promotion at Youth Net/Réseau Ado

Abstract Youth today are experiencing significant rates of mental illness and are generally reluctant or unable to seek out traditional mental health services. Youth Net/Réseau Ado (YN/RA) is a bilingual mental health promotion organization run by youth for youth that provides innovative, youth-friendly programming in an effort to address the distress experienced by youth. This article provides a description of the YN/RA organization which offers unique, community-based programming that includes mental health focus groups, youth initiatives (snowboarding, art and hiking programmes), and support groups for youth in need.

Trichotillomania in a Ten Year Old Boy: Gender Identity Issues Formulated in Terms of Individual and Family Factors*

The case study of a ten year old boy who presented with trichotillomania and symptoms of gender identity confusion is described and formulated in terms of the individual and family factors involved. This approach is presented as more tangible and useful than the traditional method using psychoanalytic theory.

‘Youth-friendly’ characteristics of professionals in mental health settings

Abstract Adolescents have a unique developmental vulnerability to suicide, with youth presenting as the second most vulnerable group to suicide across the lifespan. Youth have been recognized as underserved mental health service recipients, with only one in six of those in need receiving care. Calls for innovative mental health services to better serve youth have been articulated for over a decade and the adolescent health and mental health communities have responded. However, to date there has been little empirical discussion of the caregiver characteristics that would increase the likelihood of youth feeling comfortable discussing their mental health concerns. Objectives of this study were twofold: (1) to ask a large sample of Canadian youth [n = 11 171: 5146 males, 6001 females (n = 24 participants did not indicate their sex )] to identify characteristics of mental health professionals they would define as ‘youth-friendly’, and (2) to test which youth-friendly characteristics are deemed important to youth based on their circumstances, including those experiencing recent suicidality. Gender differences are also tested and explored. The absence of youth-friendly mental health service provision is proposed to be a modifiable barrier to help seeking in at-risk youth.

An In-Depth Examination of School-Based Mental Health Focus Groups with Young People: A Quality Enhancement Initiative

YouthNet/Réseau Ado (YN/RA) is a community-based, bilingual, mental health promotion and early intervention program for young people supported by a safety net of mental health professionals. The main objective of this study was to redesign an existing mental health promotion program better to engage and interest mainstream young people while enhancing the educational content. A youth-friendly methodology was used in which young people provided ideas for the redesign. The new two-session focus group format for mainstream young people met with success when pilot-tested in mainstream high schools. A majority of young people were either interested or very interested in session 1 (87.8%) as well as session 2 (94.7%) of the new model. Highlights of the new approach include an original mental health game and an open discussion geared specifically towards the needs of the young participants.

Review of arts-based therapies for Canadian youth with lived experience of mental illness

Canadian youth can experience a range of mental health problems and mental illness, many of which perpetuate into adulthood. In contrast with preventative and medical care for physical problems, youth who experience difficulties with mental health or illness meet restricted access to evaluation, diagnostic and treatment services. Obstacles vary from low funding levels for services to the fear of being stigmatised by society. Conventional therapies could be complemented by the use of arts-based therapies, which are reported to offer a tangible alternative and could relieve delays in treatment. However, research regarding the treatment options, monitoring and assessment of outcomes is based largely on narrative evidence or idiographic studies, thus constraining the dissemination of supporting evidence and limiting the range of treatments for use by practitioners. While arts-based therapies receive support from many areas, including people with lived experience of mental health problems and illness, it is argued that the development of a theoretical foundation and extensive empirical research are required to develop the potential that arts-based therapies have to offer.