Stephen Allison

Gender differences in the relationship between depression and suicidal ideation in young adolescents

Objective: This study examined the risk relationship between depressive symptomatology and suicidal ideation for young adolescent males and females. Method: A large cohort of students in their first year of high school completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Adolescent Suicide Questionnaire. The risk relationship between depressive symptomatology and suicidal ideation was modelled using non-parametric kernel-smoothing techniques. Results: Suicidal ideation was more frequently reported by females compared with males which was partly explained by females having higher mean depression scores. At moderate levels of depression females also had a significantly higher risk of suicidal ideation compared with males and this increased risk contributed to the overall higher levels of female ideation. Conclusions: The risk relationship between depressive symptomatology and suicidal ideation is different for young adolescent males and females. The results indicate that moderate levels of depressive symptomatology can be associated with suicidal ideation (especially among young females) and that for these young people a suicide risk assessment is required.

Does school bullying affect adult health? Population survey of health-related quality of life and past victimization

Objective: The purpose of the present study was to determine the proportion of adult South Australians who report having experienced school bullying and to examine the relationship between past victimization and adult health-related quality of life. Method: A representative sample (n=2833) of metropolitan and country South Australian adults were asked in a face-to-face interview whether they had experienced bullying when they were at school. Health-related quality of life was measured using the Medical Outcomes Study Short Form 36-item health survey questions (SF-36). Regression analyses (linear and logistic) were performed, taking into account survey weights. Results: Nearly one-fifth of adults reported having experienced bullying when they were at school. Older persons and those born overseas were less likely to report having been bullied. Those reporting that they had been bullied experienced significantly poorer mental and physical health compared to those who had not been bullied. Conclusions: Adults commonly reported experiencing bullying while at school and these reports were associated with lower health-related quality of life in adulthood. School bullying needs further investigation as a preventable cause of mental health problems across the lifespan.

Perceived academic performance as an indicator of risk of attempted suicide in young adolescents.

ABSTRACT This study investigated perceived academic performance and self-reported suicidal behavior in adolescents (n = 2,596), mean age 13 years, from 27 South Australian high schools. Groups perceiving their academic performance as failing, below average, average and above average were significantly different on measures of self-esteem, locus of control, depressive symptoms, suicidal thoughts, plans, threats, deliberate self-injury, and suicide attempts. Multivariate logistic regression analyses revealed that failing academic performance (compared to above average) is associated with a five-fold increased likelihood of a suicide attempt, controlling for self-esteem, locus of control and depressive symptoms. Teachers should note that a student presenting with low self-esteem, depressed mood and perceptions of failure may be at increased risk for suicidal thoughts and behaviors, and need referral for clinical assessment.

Correlates of firesetting in a community sample of young adolescents.

Objective: To investigate relationships between firesetting, antisocial behaviour, individual, family and parenting factors in a large community sample of adolescents. Method: A cross-sectional study of students (n = 2596) aged 13 years on average, from 27 schools in South Australia with a questionnaire on firesetting, antisocial behaviour (adapted 21-item Self Report Delinquency Scale), risk-taking, drug use, suicidality, physical and sexual abuse, depressive symptomatology, hopelessness, anxiety, locus of control, self-esteem, family functioning (McMaster Family Assessment Device) and parenting style (Influential Relationships Questionnaire). Data analysis included χ2, ANOVA and logistic regression. Results: Large significant differences are found between firesetters and non-firesetters on all measures. Among adolescents with serious levels of antisocial behaviour (7++ acts included in diagnostic guidelines for DSM-IV conduct disorder), firesetters differ from nonfiresetters in reporting more extreme antisocial behaviour (10++ acts), extreme drug use, suicidal behaviour, and perceived failure at school. Gender differences are apparent. A study limitation is the single item assessment of firesetting. Conclusions: Self-report firesetting is strongly associated with extreme antisocial behaviour in young community adolescents, in support of existing evidence from incarcerated delinquent and psychiatric populations. Early detection of community firesetters demands further assessment and intervention. Clinicians should consider its coexistence with serious drug use and high risk-taking (especially in girls), and suicidality, sexual and physical abuse (in boys).

Depression in young adolescents: Investigations using 2 and 3 factor versions of the Parental Bonding Instrument

Associations between parenting style and depressive symptomatology in a community sample of young adolescents (N = 2596) were investigated using self-report measures including the Parental Bonding Instrument and the Center for Epidemiologic Studies Depression Scale. Specifically, the 25-item 2-factor and 3-factor models by Parker et al. (1979), Kendlers (1996) 16-item 3-factor model, and Parkers (1983) quadrant model for the Parental Bonding Instrument were compared. Data analysis included analysis of variance and logistic regression. Reanalysis of Parkers original scale indicates that overprotection is composed of separate factors: intrusiveness (at the individual level) and restrictiveness (in the social context). All models reveal significant independent contributions from paternal care, maternal care, and maternal overprotection (2-factor) or intrusiveness (3-factor) to moderate and serious depressive symptomatology, controlling for sex and family living arrangement. Additive rather than multiplicative interactions between care and overprotection were found. Regardless of the level of parental care and affection, clinicians should note that maternal intrusiveness is strongly associated with adverse psychosocial health in young adolescents.

Is a history of school bullying victimization associated with adult suicidal ideation?: a South Australian population-based observational study

The objective of this research was to determine whether a history of school bullying victimization is associated with suicidal ideation in adult life. A random and representative sample of 2907 South Australian adults was surveyed in Autumn, 2008. Respondents were asked “When you were at school, did you experience traumatic bullying by peers that was particularly severe, for example, being frequently targeted or routinely harassed in any way by ‘bullies’?” Depression was determined by the mood module of the PRIME-MD which includes a suicidal ideation question; “In the last 2 weeks, have you had thoughts that you would be better off dead or hurting yourself in some way?” The overall prevalence of suicidal ideation in postschool age respondents was 3.4% (95% confidence interval: 2.8%–4.2%) in 2008. Bullying by peers was recalled by 18.7% (17.2%–20.3%). Respondents with a history of being bullied were approximately 3 times (odds ratio: 3.2) more likely to report suicidal ideation compared with those who did not. The association between being bullied and suicidal ideation remained after controlling for both depression and sociodemographic variables (odds ratio: 2.1). The results from the present research suggest that there is a strong association between a history of childhood bullying victimization and current suicidal ideation that persists across all ages. Bullying prevention programs in schools could hold the potential for longer lasting benefits in this important area of public health.

Pre-Pubertal Paediatric Bipolar Disorder: A Controversy from America

Objective: The aim of this paper was to explore the rapid rise in the diagnosis of bipolar disorder (BD) in the paediatric, particularly pre-pubertal, age group, in the USA over the past decade and to look at associated controversies. Conclusions: There has been a very marked rise in the diagnosis of BD among pre-pubertal children, and to a lesser extent adolescents, in the USA since the mid 1990s. The rise appears to have been driven by a reconceptualizing of clusters of emotional and behavioural symptoms in the paediatric age group by some academic child psychiatry departments, most notably in St Louis, Boston and Cincinnati. There is controversy in both the academic literature and public media centring on diagnostic methods, epidemiological studies, adverse effects of medication including media-reported fatalities, and pharmaceutical company influence. With some exceptions, the traditional view of BD as being very rare prior to puberty and uncommon in adolescence appears accepted beyond the USA, though whether this is changing is as yet uncertain, and thus there are implications for Australian and New Zealand child and adolescent psychiatry.

Increase in US Suicide Rates and the Critical Decline in Psychiatric Beds

he closure of most US public mental hospital beds and the reduction in acute general psychiatric beds over recent decades have led to a crisis, as overall inpatient capacity has not kept pace with the needs of patients with psychiatric disorders. Currently, state-funded psychiatric beds are almost entirely forensic (ie, allocated to people within the criminal justice system who have been charged or convicted). Very limited access to nonforensic psychiatric inpatient care is contributing to the risks of violence, incarceration, homelessness, premature mortality, and suicide among patients with psychiatric disorders. In particular, a safe minimum number of psychiatric beds is required to respond to suicide risk given the well-established and unchanging prevalence of mental illness, relapse rates, treatment resistance, nonadherence with treatment, and presentations after acute social crisis. Very limited access to inpatient care is likely a contributing factor for the increasing US suicide rate. In 2014, suicide was the second-leading cause of death for people aged between 10 and 34 years and the tenth-leading cause of death for all age groups, with firearm trauma being the leading method. Currently, the United States has a relatively low 22 psychiatric beds per 100 000 population compared with the Organisation for Economic Cooperation and Development (OECD) average of 71 beds per 100 000 population. Only 4 of the 35 OECD countries (Italy, Chile, Turkey, and Mexico) have fewer psychiatric beds per 100 000 population than the United States. Although European health systems are very different from the US health system, they provide a useful comparison. For instance, Germany, Switzerland, and France have 127, 91, and 87 psychiatric beds per 100 000 population, respectively. Furthermore, between 1998 and 2013, the total number of psychiatric beds in the United States decreased from 34 to 22 beds per 100 000 population, a 35% reduction from an already low base rate of psychiatric beds per population. This reduction in the numbers of psychiatric beds led to higher bed occupancy rates, significantly lower average inpatient length of stay, and prolonged emergency department waiting times for patients with psychiatric illness who need to be hospitalized, all of which has contributed to an increased threshold for admission and decreased threshold for discharge for patients at risk of suicide. Language: en

Is depression contagious? The importance of social networks and the implications of contagion theory

Australian & New Zealand Journal of Psychiatry, 47(4) It is well recognised that mood and behaviour are significantly influenced by social and environmental circumstances. In particular, social contagion theory hypothesises that emotions can behave like infectious diseases spreading through groups of intimates in social networks (Hill et al., 2010), leading to population clusters with higher rates of mood symptoms. Hazell (1993) used the same infectious disease model to describe the potential clustering of adolescent suicide. Until recently, the social transmission of mood and behaviour has been hard to track. The complex and dynamic nature of human relationships makes it difficult to quantify the effect of mood contagion at a population level. Using sophisticated social network analysis of large datasets, such as the Framingham Heart Study (FHS), Christakis and Fowler (2012) have examined the structural and qualitative architecture of social networks and the dynamic changes that took place over a 32-year period in the FHS. Utilising complex mathematical modelling, they were able to assess how the social architecture of a community influenced the incidence and spread of a variety of health and behavioural outcomes in Framingham, Massachusetts. Emotional contagion is often considered to be transient but the FHS studies found the effects could be long term and profound. Obesity, smoking, alcohol use, depression, loneliness and happiness spread through the web of relationships within broader social networks, with effects occurring over decades (Cacioppo et al., 2009; Christakis and Fowler, 2007, 2008; Fowler and Christakis, 2008; Rosenquist et al., 2010, 2011). Using this unique longitudinal dataset of the FHS, the studies showed that there was a social contagion component for mood including depression, loneliness and happiness (Christakis and Fowler, 2008, 2012; Hill et al., 2010; Rosenquist et al., 2011). Their model (Christakis and Fowler, 2012) specifically demonstrated that these social health effects were not just a selection effect in that ‘birds of a feather flock together’ or that there was a shared environmental exposure. Depressed people not only sought out others with depressive symptoms, but also they changed each other’s mood over extended periods of contact. Interestingly, they found that ‘friends of a friend of a friend’ (up to three degrees of separation) were influenced by the contagious spread of mood (Hill et al., 2010; Rosenquist et al., 2011). Of particular importance was the finding that friends were significantly more influential than family members in the spread of mood, especially among women (Rosenquist et al., 2011). This latter finding of the more marked influence of peers compared to family members is somewhat surprising and certainly warrants further investigation. Positive and negative emotional states behaved much like infections, gradually spreading through social networks (Hill et al., 2010). The effects were cumulative, with increased risks associated with the number of contacts with low or positive mood. Contagion of mood states likely relates to a combination of the spread of ideas, behaviours and affect. The precise mechanism is not known but it likely has both unconscious and conscious elements. The unconscious element could relate to automatic mimicry (Hatfield et al., 1993) and the mirror neuron system (Ocampo and Kritikos, 2011). Through afferent feedback, the receiver feels the sender’s expressions, and this leads towards emotional convergence (Hatfield et al., 1993). The conscious component could be due to shared communication styles such as co-rumination, especially amongst young women (van Zalk et al., 2010). Peer influence mechanisms in the adolescent literature include engaging in high-status behaviours, matching the social norms of a valued or desired group, engaging in behaviours that are reinforced by peers and engaging in behaviours that contribute to a favourable self-identity (Brechwald and Prinstein, 2011). People may also adjust their communication styles based on social comparison in order to dynamically fit the social environment (Barsade 2002; van Zalk et al., Is depression contagious? The importance of social networks and the implications of contagion theory

Anorexia nervosa and social contagion: clinical implications.

During adolescence, female friendship cliques can develop an unhealthy focus on body image, dieting and extreme weight loss (Eisenberg and NeumarkSztainer, 2010; Fletcher et al., 2011; Paxton et al., 1999). These peer group processes contribute to the prevalence of eating problems amongst young women in westernised cultures (Becker, 2004; Becker et al., 2011). Community studies provide robust evidence for peer influence as a significant mediator in harmful eating practices amongst young women (Fletcher et al., 2011; Quiles Marcos et al., 2013). Social pressures regarding body weight and shape make recovery from eating problems much more difficult (Murray et al., 1995). Anthropological studies describe how peer influence intensifies within inpatient wards, residential units and day hospitals, which can become ‘proana’, with patients actively promoting the practices of anorexia nervosa (Warin, 2006, 2010). The power of the peer group becomes greater as young people are aggregated into homogeneous groups in tertiary care. Mutual peer influence serves to intensify ‘deviant’ eating practices in a process termed peer contagion (Dishion and Tipsord, 2011). Social media and online networks greatly increase the ability of peer groups formed in tertiary care to remain in contact within larger informal pro-ana communities. There is scant literature on the clinical management of peer contagion in eating disorders (Vandereycken, 2011). This contrasts with the study of delinquency where empirical studies of peer contagion are advancing (Dishion and Tipsord, 2011). Further research is required into the peer system, especially during the adolescent phase of development when peer dynamics are crucial. Up to this point, the peer group has been a relatively neglected topic in the clinical treatment of eating disorders. The peer sub-system could usefully be added to the current discussion on the essential components of early intervention alongside individual, parent, family and multi-family therapy (Hay, 2012; Murray et al., 2012). Peer influence might play a role in the course of each of these forms of early intervention. Equally, later in the progression of the disorder, social media and online networks of pro-ana peers can influence the course of tertiary treatment. It is well recognised that the cultural context for this peer influence is the high status of thinness as sanctioned, desired and valued by western culture. It is the currency of cultural practices around food and bodies as understood by groups of young women that carry power (Warin, 2006). Moral values attributed to thinness are firmly embedded in the habitus of young people: their everyday, taken-for-granted practices. Young people (and young women in particular) learn from an early age that their bodies require constant surveillance, modification and improvement. Weight and food are the main focus of this attention, and they are important markers of competition and connection within female peer groups. Under the guide (and guise) of ‘healthy living’, attention to one’s body demonstrates a moral virtue that should be suitably rewarded. Within female peer groups, this cultural value is transmitted through a variety of processes including friends modelling dieting practices, body size comparisons, teasing about weight and ‘fat talk’ to encourage weight loss. Imitation and peer modelling tend to play the most important role (Quiles Marcos et al., 2013). Within the peer group, nothing is more contagious than a behavioural example from a popular and influential friend. Eating disorder behaviours can begin within these adolescent peer networks where friends routinely congratulate one another on weight loss or demanding physical exercise routines. Young people actively and competitively pursue crafted, thin bodies, which bestow unprecedented levels of symbolic capital in the contemporary peer group. By succeeding where many others fail (at dieting, self-discipline and thinness), the progression towards an eating disorder offers the appeal of a new adolescent identity and social distinction in the group. ‘Anorexia’ is not something a young person catches or a force that Anorexia nervosa and social contagion: Clinical implications