Antidepressants & suicide: putting the risk in perspective

Suicidal thoughts are a symptom of depression, and completed suicide is a tragic complication of depressive illness. Although pharmacotherapy is effective for the treatment of depression, the U.S. Food and Drug Administration has ordered that all antidepressant medications carry a warning indicating that they are associated with an increased risk of suicidal thinking, feeling, and behavior in children, adolescents, and young adults. These warnings have received much attention in the general media and have caused much controversy and debate about the relative safety of these commonly used drugs and the appropriateness of their use, especially in younger patients. In this article, I will discuss this issue with the goal of putting the risk in perspective.     

An mHealth Approach to Extend a Brief Intervention for Adolescent Alcohol Use and Suicidal Behavior: Qualitative Analyses of Adolescent and Parent Feedback

Abstract

Mobile health (mHealth) tools that supplement inpatient psychiatric care can maintain and enhance intervention effects following hospitalization. Adolescents hospitalized following a suicidal event represent a vulnerable population who could greatly benefit from such an mHealth intervention. In specific, suicidal adolescents who drink alcohol are in need of robust interventions that address the bidirectional relationship between alcohol use and suicidal thoughts and behaviors, because it puts them at especially high risk for suicide upon discharge. The purpose of this study was to conduct qualitative interviews to gather feedback to improve a brief alcohol intervention provided to suicidal adolescents during psychiatric hospitalization, and to develop a mHealth tool to extend care after discharge. Participants, eight adolescents and their parents, identified the need for a smartphone application to deliver intervention content to adolescents and parents during the posthospitalization period. Adolescents sought support in meeting alcohol- and mood-related goals, while parents desired general resources as well as tips for conversations with their adolescent about mood and alcohol use.     

Reliability and validity of the Outcome Expectations for Exercise Scale-2

Development of a reliable and valid measure of outcome expectations for exercise for older adults will help establish the relationship between outcome expectations and exercise and facilitate the development of interventions to increase physical activity in older adults. The purpose of this study was to test the reliability and validity of the Outcome Expectations for Exercise-2 Scale (OEE-2), a 13-item measure with two subscales: positive OEE (POEE) and negative OEE (NOEE). The OEE-2 scale was given to 161 residents in a continuing-care retirement community. There was some evidence of validity based on confirmatory factor analysis, Rasch-analysis INFIT and OUTFIT statistics, and convergent validity and test criterion relationships. There was some evidence for reliability of the OEE-2 based on alpha coefficients, person- and item-separation reliability indexes, and R(2)values. Based on analyses, suggested revisions are provided for future use of the OEE-2. Although ongoing reliability and validity testing are needed, the OEE-2 scale can be used to identify older adults with low outcome expectations for exercise, and interventions can then be implemented to strengthen these expectations and improve exercise behavior.     

Assessment and management of hospitalized suicidal patients

Suicide in inpatient psychiatric settings is a critical problem. A comprehensive literature review was performed to determine risk factors for inpatient suicide, instruments for assessing suicide, and treatment of hospitalized suicidal patients. Findings suggested that root causes of inpatient suicide were factors related to the treatment environment, failure to assess patient behavioral characteristics, and staff reliance on no-suicide contracts. Recommendations include assessing suicide risk regularly throughout hospitalization, including on admission, during changes in a patient's mental or physical status, after a change in observation level, and before discharge. Orientation and inservice education for all staff and additional research on the psychometric properties of available suicide assessment instruments are also essential.     

A scale for the comparison of the sexual attitudes of adolescents and their parents

We developed a 14-item Attitudes Toward Sexuality Scale (ATSS) to compare the sexual attitudes of early, middle, and late adolescents and their parents. One hundred forty-one adolescents between the ages of 12 and 20 and their parents completed a questionnaire consisting of the ATSS and demographic information. The Cronbach alpha reliability coefficient for the adolescents was .75, and for the parents it was .84. A principal components analysis revealed four major dimensions of the scale: a large General factor, Legality/Morality, Alternative Modes of Sexual Expression, and Individual Rights. The correlation pattern between the ATSS and subscales of the Sex Knowledge and Attitudes Test, as well as with certain demographic variables, supports the construct validity of the ATSS. This is, therefore, a scale which may be used for research in which the sexual attitudes of adults and adolescents of various ages are to be measured and compared.     

The Assessment Checklist for Adolescents — ACA: A scale for measuring the mental health of young people in foster,kinship, residential and adoptive care

The Assessment Checklist for Adolescents — ACA is a 105-item carer-report mental health rating scale, measuring behaviours, emotional states, traits, and manners of relating to others, as manifested by adolescents (ages 12 to 17) residing in various types of alternate care, as well as those adopted from care. The ACA was designed for population and clinical research with these young people, and for use as a clinical assessment measure. The ACA's content was largely derived from the Assessment Checklist for Children (ACC). Fifteen ACC items were modified to better reflect adolescent difficulties, and 25 additional items were derived using a combination of inductive and deductive strategies. Item and factor analyses were carried out on scores from a 136-item research instrument, obtained for 230 young people residing in long-term care (as part of the NSW Children in Care study). These data were supplemented by ACC scores obtained for 142 adolescents residing in treatment foster care in Ontario, Canada. A robust 7-factor model was identified among a core of 73 clinical item scores, accounting for 51% of score variance. Four of the factors replicate ACC clinical scales (non-reciprocal interpersonal behaviour; sexual behaviour problems; food maintenance behaviour; and suicide discourse), and three are unique to the ACA (social instability/behavioural dysregulation; emotional dysregulation/distorted social cognition; and dissociation/trauma symptoms). The ACA also contains two empirically-derived low self-esteem scales (low confidence; negative self-image) that are shared with the ACC. Initial data indicate that the ACA has good content, construct and criterion-related validity, as well as high internal reliability.     

Development of the Edmonson Psychiatric Fall Risk Assessment Tool

The purpose of this study was to develop a fall risk assessment instrument for the inpatient psychiatric population. Nine risk factors were identified through a review of the literature. The instrument was applied retrospectively to patient records, and the percentage of those who fell who triggered each of the items in each domain was calculated. The expected value of the population and weighting system were established. The Morse Fall Scale and Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) were administered simultaneously to inpatient psychiatric patients. Sensitivity of the EPFRAT was 0.63, compared with 0.49 for the Morse Fall Scale; specificity of the EPFRAT was 0.86, compared with 0.85 for the Morse Fall Scale. Initial psychometric testing of the EPFRAT indicates the instrument is more sensitive in assessing fall risk in the acutely ill psychiatric population than those currently available. Additional psychometric testing is needed to determine the reliability and validity of the EPFRAT.     

The gender identity/gender dysphoria questionnaire for adolescents and adults

The present study reports on the construction of a dimensional measure of gender identity (gender dysphoria) for adolescents and adults. The 27-item gender identity/gender dysphoria questionnaire for adolescents and adults (GIDYQ-AA) was administered to 389 university students (heterosexual and nonheterosexual) and 73 clinic-referred patients with gender identity disorder. Principal axis factor analysis indicated that a one-factor solution, accounting for 61.3% of the total variance, best fits the data. Factor loadings were all >or= .30 (median, .82; range, .34-.96). A mean total score (Cronbach's alpha, .97) was computed, which showed strong evidence for discriminant validity in that the gender identity patients had significantly more gender dysphoria than both the heterosexual and nonheterosexual university students. Using a cut-point of 3.00, we found the sensitivity was 90.4% for the gender identity patients and specificity was 99.7% for the controls. The utility of the GIDYQ-AA is discussed.     

Mental health and firearms in community-based surveys: implications for suicide prevention

Suicide rates are higher among those who own a handgun and among those who [corrected] live in a household with a hand gun. This article examines the association between [corrected] gun ownership and mental health, another risk factor for suicide. Data from the General Social Survey, a series of surveys of U.S. adults, are analyzed to compare general emotional and mental health, sadness and depression, functional mental health, and mental health help seeking among gun owners, persons who do not own but live in a household with a gun, and those who do not own a gun. After taking into account a few basic demographic characteristics associated with both variables, there appears to be no association between mental health and gun ownership. Nor is there any association between mental health and living in a household with a firearm. Findings suggest that the high risk of suicide among those who own or live in a household with a gun is not related to poor mental health. Implications for prevention are discussed.     

Pediatric Emergency Department Visits for Mental Health Crisis: Prevalence of Cyber-Bullying in Suicidal Youth

The objective of this work is to (1) study the prevalence of cyber-bullying amongst adolescents referred by Pediatric Emergency Department (PED) for urgent psychiatric assessment and (2) to examine the association between cyber-bullying and suicidal behavior to assist emergency department professionals in screening for risk and triage. This is a retrospective study of patients referred by PED to an urgent psychiatric clinic. Data was extracted for those with bullying victimization. Clinical variables included demographics, reason for referral, type of bullying, substance use, abuse, past psychiatric history, diagnosis and outcome. The cyber-bullying group was compared to those with traditional bullying and a group with no-bullying. Data analysis was conducted using Chi squares, multinomial and bimodal logistic regression. The urgent psychiatric clinic assessed 805 patients in 24 months, the prevalence of bullying was 26.9 % (n = 217). The prevalence of Cyber-bullying was 13.5 % (n = 109) and traditional bullying was 13.4 % (n = 108). Cyber-bullying victims have more suicidal ideation (χ² = 7.82, p = .005; 85.3  vs. 69.4 %), more sexual abuse (χ² = 5.75, p = .02; 29.4  vs. 15.7 %), more emotional abuse (χ² = 10.8, p = .01; 30.3  vs. 12.0 %) and physical abuse (χ² = 6.13, p = .01; 27.5  vs. 13.9 %) and a higher inpatient admission rate. Suicidal ideation is the presenting problem in more than two-thirds of patients, especially females, with history of cyber-bullying who present to the PED. Screening questions about cyber-bullying could assist emergency room professionals in establishing risk and making triage decisions.     

The Social Vulnerability Scale for Older Adults: An Exploratory and Confirmatory Factor Analytic Study

The Social Vulnerability Scale (SVS), a 22-item informant report of vulnerability to exploitation and, in particular, financial exploitation of older adults, was administered to 266 respondents who assessed the social vulnerability of a significant other aged 50 years or over, either a person with dementia or other neurological condition (n?=?116), or a healthy adult (n?=?150). Exploratory factor analysis in the combined sample revealed a 15-item two-factor solution labeled gullibility and credulity. Stability in factor structure was established in an independent sample (n?=?123) using confirmatory factor analysis, and sound reliability (internal consistency) and validity (known-groups) were demonstrated. The SVS15 is a potentially useful instrument for assessing older adults' vulnerability to exploitation.     

Traumatic brain injury and suicide

A number of psychiatric and neurological problems may occur following traumatic brain injury (TBI). Anxiety and depression are common. There is evidence that there may be a correlation between TBI and increased risk of suicide. This article will explore current literature on the risk of suicidal behavior in people who have experienced TBI. Risk factors for suicide, recognition and assessment of suicidal behavior, and treatment issues will be discussed.     

Homosexuality and Risk for Psychiatric Disorders

Abstract

Social science researchers have traditionally found it difficult to obtain representative samples of gay men and lesbians. Still, this has not prevented some from making broad conclusions about the lives and mental status of homosexuals as a group. In recent months, two separate national studies have examined sexual attitudes and behaviors of adults and adolescents. Collectively, the sample size of males and females surveyed in these studies is in the thousands. Because the subjects in both studies were randomly selected, the findings were based on persons with a wide spectrum of sexual attitudes and behaviors. In many respects, these studies confirm some of the data from smaller studies. That is, homosexual orientation can be a risk factor for psychiatric disturbance for some men and women. In addition, adolescents struggling with issues related to sexual orientation are two times more likely than their peers to consider or attempt suicide.     

Introduction

SUMMARY

The purpose of this study was to evaluate the reliability and validity of selected modules of the Structured Clinical Interview for DSM-IV (KID-SCID, Version 1.0). The Disruptive Behavior Disorders (i.e., ADHD, ODD, CD) and Substance Related Disorders modules of the KID-SCID were administered to 50 adolescents receiving residential treatment for substance abuse and severe behavioral problems. This study examined available evidence for inter-rater reliability and convergent validity. Convergent validity was demonstrated for the Disruptive Behavior Disorders module, however, the Substance Abuse Disorders module failed to converge with frequency of use for most substances. Inter-rater reliability was generally high. This research provides initial evidence for both the reliability and validity of the Disruptive Behavior and Substance Abuse Disorders modules of the KID-SCID, making these modules useful in clinical practice with adolescents in treatment for substance abuse and conduct disorder.     

Lesbian,Gay, Bisexual,Sexual-Orientation Questioning Adolescents Seeking Mental Health Services

Summary

Lesbian, gay, bisexual, and sexual-orientation questioning (LGBQ) adolescents have many of the same health needs as straight adolescents. In addition, they must learn to manage a stigmatized identity that may create confusion, anxiety, and emotional turbulence for them. Beyond stigma, LGBQ youth are often found to be at higher risk for substance abuse, violence, depression, suicide, and sexual health problems. Based on responses given by urban adolescents seeking mental health services to a clinical self-assessment questionnaire (Adquest), this article examines the relationship between sexual identity and risk factors related to safety, health, sex, substance use, family and friends, worries, and their desire to talk about these in counseling. Findings indicate that LGBQ youth are at higher risk than straights, and express greater desire to talk about substance use, health, their personal lives, and their friends. Mental health practitioners working with these young persons must properly assess and address their risks by creating a sense of community and safe environment for open discussion.     

The relationship between childhood abuse and suicidality in adult bipolar disorder

This study evaluates the effect of childhood sexual and physical abuse on suicidality in adults with bipolar disorder. We conducted a retrospective chart review of adult outpatients (N= 381) with DSM-IV-TR-defined bipolar disorder seeking evaluation and treatment at an academic specialty research program (i.e., Mood Disorders Pharmacology Unit, University Health Network, University of Toronto) between October 2002 and November 2005. Eighteen percent (n = 68) of adult patients with bipolar disorder had a recorded history of childhood abuse (p = 0.009). Sixty-three percent (n = 43) of bipolar patients with a history of childhood abuse reported lifetime suicidality (chi2 = 6.885, df= 1, p = 0.009). Logistic regression analysis indicated that Childhood abuse was a significant predictor of lifetime suicidality in adult bipolar patients (OR = 2.05, CI = 1.19-3.510). Childhood abuse is associated with suicidal ideation and suicide attempts in adults with bipolar disorder. Anamnestic inquiry regarding childhood maltreatment is salient to risk assessment, illness management planning, preventative strategies, and treatment interventions in bipolar disorder.     

Parents' perspectives on young suicide

Strategies for the prevention of adolescent suicide are frequently designed to identify those young people who represent a high risk in order that services and support can be effectively targeted. This study explored the experiences of parents who had lost a child through suicide. The findings suggest that the range of behaviours perceived by parents was too broad and diverse to allow for a checklist approach to the identification of risk. The parents' responses did produce some valuable reflections on their experiences of professional support as well as some key messages on parenting which could be disseminated to all parents of adolescents.     

The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults

The present study reports on the construction of a dimensional measure of gender identity (gender dysphoria) for adolescents and adults. The 27-item gender identity/gender dysphoria questionnaire for adolescents and adults (GIDYQ-AA) was administered to 389 university students (heterosexual and nonheterosexual) and 73 clinic-referred patients with gender identity disorder. Principal axis factor analysis indicated that a one-factor solution, accounting for 61.3% of the total variance, best fits the data. Factor loadings were all ≥ .30 (median, .82; range, .34–.96). A mean total score (Cronbach's alpha, .97) was computed, which showed strong evidence for discriminant validity in that the gender identity patients had significantly more gender dysphoria than both the heterosexual and nonheterosexual university students. Using a cut-point of 3.00, we found the sensitivity was 90.4% for the gender identity patients and specificity was 99.7% for the controls. The utility of the GIDYQ-AA is discussed.     

An assessment of the validity and reliability of the SOGS-RA

The present is a validation study seeking to determine the degree of confidence that can be placed on inferences about problem gambling among adolescents in the Atlantic provinces, based on their South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA) scores. The major source of data was a 1998 survey of 13,549 students in junior and high school of the public school systems of the 4 Atlantic provinces of Canada. The SOGS-RA was found to have adequate stability and internal consistency reliability. Statistically significant gender differences were demonstrated relative to endorsement and construct validity. Regarding the latter, this study shows that the existing cut-point of the SOGS-RA score for problem gambling identifies as problem gamblers, markedly different proportions of male than female daily gamblers. Regarding construct validity in relation to the Atlantic Alcohol and Drug Risk Continua, this study suggests that while statistically highly significant, the association between problem gambling and substance-related problems may be of low clinical significance. Regarding criterion validity, there is an urgent need to perform the types of enquiry that will allow clarification about how adolescent problem gambling is conceptualized, by adults versus adolescents, by males versus females, and from a clinical versus a public or population health perspective.