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Objectives/Goals: This study’s objective was to explore how a personal cancer diagnosis impacts the social connectedness (i.e., quality, structure, and functions of social relationships) of adolescent/young adult cancer survivors (AYACS, patients diagnosed with cancer between 15 and 39 years old), to inform intervention development fostering social health. Methods/Study Population: In this qualitative study (part of larger study assessing AYACS’ psychosocial challenges), participants were 15–25 years old at the time of cancer diagnosis and within 6 years of cancer diagnosis. Participants (and consenting parents of participants 18 years old and older) had to have fluency in written and spoken English and access to a computer or smartphone. Qualitative interviewers utilized an interview guide to conduct individual participant interviews. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze data using a phenomenological approach to explore how a personal cancer diagnosis impacted social connectedness. Qualitative data related to social connectedness (corresponding to code “Relationships and Support”) are presented. Results/Anticipated Results: Three themes emerged through thematic analysis: (1) AYACS experience substantial heterogeneity related to social support needs; (2) AYACS leverage multiple relationships and resources when seeking support after a personal cancer diagnosis; (3) AYACS’ individual experiences were unique in that some noted positive changes, whereas others noted negative changes in relationships within social networks, specifically with peers. Discussion/Significance of Impact: AYACS experience various social support needs, and leverage multiple relationships when seeking social support. These translational findings create a foundation to develop AYACS social programming, foster peer relationships, and incorporate social science methods to aid intervention development to strengthen AYACS’ social connectedness.
Most evidence on suicidal thoughts, plans and attempts comes from Western countries; prevalence rates may differ in other parts of the world.
Aims
This study determined the prevalence of suicidal thoughts, plans and attempts in high school students in three different regional settings in Kenya.
Method
This was a cross-sectional study of 2652 high school students. We asked structured questions to determine the prevalence of various types of suicidality, the methods planned or effected, and participants’ gender, age and form (grade level). We provided descriptive statistics, testing significant differences by chi-squared and Fisher's exact tests, and used logistic regression to identify relationships among different variables and their associations with suicidality.
Results
The prevalence rates of suicidal thoughts, plans and attempts were 26.8, 14.9 and 15.7%, respectively. These rates are higher than those reported for Western countries. Some 6.7% of suicide attempts were not associated with plans. The most common method used in suicide attempts was drinking chemicals/poison (18.8%). Rates of suicidal thoughts and plans were higher for older students and students in urban rather than rural locations, and attempts were associated with female gender and higher grade level – especially the final year of high school, when exam performance affects future education and career prospects.
Conclusion
Suicidal thoughts, plans and attempts are prevalent in Kenyan high school students. There is a need for future studies to determine the different starting points to suicidal attempts, particularly for the significant number whose attempts are not preceded by thoughts and plans.
Nursing home residents may be particularly vulnerable to coronavirus disease 2019 (COVID-19). Therefore, a question is when and how often nursing homes should test staff for COVID-19 and how this may change as severe acute respiratory coronavirus virus 2 (SARS-CoV-2) evolves.
Design:
We developed an agent-based model representing a typical nursing home, COVID-19 spread, and its health and economic outcomes to determine the clinical and economic value of various screening and isolation strategies and how it may change under various circumstances.
Results:
Under winter 2023–2024 SARS-CoV-2 omicron variant conditions, symptom-based antigen testing averted 4.5 COVID-19 cases compared to no testing, saving $191 in direct medical costs. Testing implementation costs far outweighed these savings, resulting in net costs of $990 from the Centers for Medicare & Medicaid Services perspective, $1,545 from the third-party payer perspective, and $57,155 from the societal perspective. Testing did not return sufficient positive health effects to make it cost-effective [$50,000 per quality-adjusted life-year (QALY) threshold], but it exceeded this threshold in ≥59% of simulation trials. Testing remained cost-ineffective when routinely testing staff and varying face mask compliance, vaccine efficacy, and booster coverage. However, all antigen testing strategies became cost-effective (≤$31,906 per QALY) or cost saving (saving ≤$18,372) when the severe outcome risk was ≥3 times higher than that of current omicron variants.
Conclusions:
SARS-CoV-2 testing costs outweighed benefits under winter 2023–2024 conditions; however, testing became cost-effective with increasingly severe clinical outcomes. Cost-effectiveness can change as the epidemic evolves because it depends on clinical severity and other intervention use. Thus, nursing home administrators and policy makers should monitor and evaluate viral virulence and other interventions over time.
It is commonly thought that disability is a harm or “bad difference” because having a disability restricts valuable options in life. In his recent essay “Disability, Options and Well-Being,” Thomas Crawley offers a novel defense of this style of reasoning (formulated as the Options Argument) and argues that we and like-minded critics of this brand of argument are guilty of an inconsistency. Our aim in this article is to explain why our view avoids inconsistency, to challenge Crawley's positive defense of the Options Argument, and to suggest that this general line of reasoning employs a double standard.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
Methods.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
Results.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
Conclusions.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Suicidal behavior (SB) is a major burden in most nations world-wide and a major public health concern. The causes of SB are complex, in which both genetic set-up and exposure to overwhelming psychological stress (environmental factor) contribute to a person's final predisposition for SB. One candidate system reflecting this causal route to SB is the stress-modulating hypothalamic-pituitary-adrenal (HPA) axis, and dysregulation of HPA is considered to play a major role in depression and SB. The corticotrophin-releasing hormone and its main receptor (CRHR1) have key regulatory functions in the HPA axis, and we hypothesized that genetic variation in CRHR1 may be associated and linked with SB and related endophenotypes. We analyzed single nucleotide polymorphisms (SNPs) in an extended sample of family trios (n = 672) with suicide attempter offspring, by using family-based association tests. Results showed that the minor T-allele of exonic SNP rs12936511 was significantly transmitted to suicidal males with increased Beck Depression Inventory (BDI) scores (P = 0.0028). Analysis of haplotypes showed that risk alleles of three different SNPs segregated onto separate haplotypes, whereas a fourth ‘nonrisk’ haplotype (‘CGC’) was preferentially transmitted to suicidal males with lowered BDI scores (P = 0.0007). Conversely, the BDI scores of those who carried a homozygous combination of any of the three risk haplotypes were significantly increased (P = 0.000089). We concluded that depression intensity in male suicidal offspring was related to genetic variability in the 5’-end of CRHR1, while the characteristics of the suicide female attempters remained unknown.
Suicide is a leading cause of death in young people worldwide. Risk factors for suicidal behaviors and endophenotypes are partly heritable, and include variants in genes that drive stress diathesis in addition to, or by interaction with, certain adverse environments. Hypothalamic-Pituitary-Adrenal (HPA) axis genes are candidates for association with the dysregulated cortisol response to psychosocial stress that is observed in suicidal individuals. The role of HPA axis genetic variation will be explored in the context of varying “susceptibility” to suicidality after exposure to certain stressful life events.
Methods
A family-based association test was used on a case offspring-parent “trio” sample of 672 suicide attempt cases and their parents. Single nucleotide polymorphisms (SNP's) and/or haplotypes in CRHR1 were studied for interaction with age of exposure to physical and/or sexual assault, gender, and/or lifetime exposure to other types of stressful events.
Results
Preliminary findings show interactions of certain CRHR1 SNP's with sexual and/or physical assault that are associated with suicide attempt, possibly using a violent method. Possible associations with candidate endophenotypes such as Cluster B personalities and early-onset major depression are under investigation.
Conclusions
Interactions of HPA axis genetic variants and stressful life events are consistent with a stress diathesis model of suicidal behavior, and may additionally influence the method and medical damage outcomes of suicide attempts, which may explain part of the diversity within this phenotype.
SAYLE is a health promoting programme, funded by the EU Commission for adolescents in European schools. Its main objectives are to lead adolescents to better health through decreased risk taking and suicidal behaviours, to evaluate outcomes of different preventive programmes and to recommend effective culturally adjusted models for promoting health of adolescents in different European countries. It is developed by a consortium of 12 countries: Austria; Estonia; France; Germany; Ireland; Hungary; Italy; Israel; Romania; Slovenia; Spain and Sweden (coordinating centre). In this health promotion programme, an intervention study will be implemented to assess the effects of three different health promoting/suicide preventing programmes in comparison with control groups in 11,000 students across 12 European countries. The three interventions are:
1. A general health promotion programme targeting students awareness on healthy/unhealthy behaviors and students self-efficacy in diminishing unhealthy behaviors;
2. TeenScreen - screening by professionals of at-risk students through a questionnaire. For adolescents identified as high risk, the program includes individual assessment and referral to mental health treatment and measures ensuring compliance;
3. QPR (Question, Persuade & Refer) - a gatekeeper's program, training all adult staff at schools (teachers, counselors, nurses etc) and parents on how to recognize and refer a student with risk-taking behaviours or those suffering from mental illness to mental-health help resources.
The ultimate consequence of mental ill-health, suicidal behavior (SB), is a significant problem in most societies of the world. Suicide causes about one million deaths worldwide each year, and 10–20 times more people attempt suicide. The causes of why certain people engage in SB are complex, involving for e.g., both environmental and genetic factors, and interactions in-between. Well-established environmental risk factors are events causing significant psychological stress, which are particularly difficult to cope with, e.g. exposure to physical and sexual abuse. Excessive stress have the potential to induce unfavorable effects in a variety of higher brain-functions, incurred as side-effects to maladaptive responses in the genetically controlled stress-responsive neurosystems, e.g. the hypothalamic-pituitary-adrenal (HPA) axis; a major and systemic stress-modulator, which is mainly controlled by the regulatory corticotrophin releasing hormone receptor 1 (CRHR1) gene. Variation in-between individuals in such stress-regulatory genes such as CRHR1, may underlie the causes of the increased susceptibility of certain individuals towards SB. Here we review some of the current knowledge on what is known about the roles of the HPA axis in SB, with a focus on CRHR1.
According to a stress-vulnerability model, genetic set-up, as well as environmental exposure to psychological stress, contributes to a person's predisposition for suicidality, as well as to Major Depression (MD). The main neurochemical findings on suicidality have suggested alterations in neurosytems which are usually implicated in MD; a lowered serotonergic (5HT) activity, depletion of the noradrenergic (NA) system and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Whereas the genes of e.g. the 5HT system and of the key NA-biosynthesis enzyme, tyrosine hydroxylase, have been studied extensively in this context the genes in the HPA axis have only begun to be investigated recently.
Our group was the first to study the genetic variation in the CRHR1 gene in connection to depression and stress among suicidal individuals. We reported also findings that genetic variation in a transcription factor of the POMC gene, TBX 19, which is regulated by CRH, showed association and linkage to the anger/hostility personality trait and suicidality. Those results suggest that genetic variation in the CRH-mediated regulation of the HPA axis is a factor of importance in suicidality and, as other have shown as well, for major depression.
During symposiums the results obtained from the replication analyses of single nucleotide polymorphisms (SNPs) in candidate genes, in 1000 family trios with suicide attempter offspring, by using the transmission disequilibrium test both in a two-stages screening/replication sample design and in detailed reanalysis in the entire sample, will be discussed.
Suicide, a phenomenon characterised by heterogeneous and complex causes affects about one million people each year.
Twin studies, adoption studies and family studies indicate the role of genetic factors in suicidal behaviours. Psychobiological hypotheses regarding suicidal behaviours involve neurotransmitters such as serotonin, norepinephrine, dopamine, and their correlation to psychological functions as well as the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Whereas the genes of e.g. the 5HT system and of the key NA-biosynthesis enzyme, tyrosine hydroxylase, have been studied extensively in this context the genes in the HPA axis have only begun to be investigated.
Our novel results on the genetic variation in the CRHR1 gene in connection to depression and stress among suicidal individuals and in the TBX 19 gene, which is regulated by CRH, suggest that genetic variation in the CRH-mediated regulation of the HPA axis is a factor of importance in suicidality, especially in males with depression.
To investigate the relationship between adaptive, maladaptive, and pathological Internet use and mental health problems, in particular depression, self-harm and suicidal behavior among a representative sample of adolescents from different European countries.
Methods
A total of 7.000 students from different European countries were recruited for the SEYLE study, a European school-based intervention study, and completed a self-report questionnaire for baseline assessment. Internet behaviors were evaluated by the Young Diagnostic Questionnaire, depression by the BDI-II, self-harm by the Deliberate Self-Harm Inventory and suicidal behavior by the Paykel Suicide Scale.
Results
Pathological Internet users, who met the criteria for Internet addiction, showed significantly higher rates of depression, self-harm and suicidal behavior compared to students with adaptive Internet use. Remarkably, there were no significant differences in depression as well as self-harm and suicidal behavior between students suffering from Internet addiction and students presenting maladaptive Internet behaviors.
Conclusion
These results clearly demonstrate that students presenting either Internet addiction as well as maladaptive Internet use are more likely to suffer from depression as well as self-harm and suicidal behaviour. However, the group of students with Internet addiction and the students presenting maladaptive Internet use did not significantly differ from each other. These results suggest that not only Internet addiction, but also maladaptive Internet use, is associated with symptoms of depression, self-harm and suicidal behavior. Therefore, more attention should be paid to adolescents with maladaptive Internet use in order to early recognize depression, self-harm and suicidality in adolescence.
Suicide affects about one million people each year, a phenomenon characterized by heterogeneous and complex causes. Often environmental factors such as negative life events may act as a significant contributor to suicidal behavior. However, in many cases the exposure to the same environmental stress does not result in increased suicidality. It is now well established that there is also a substantial genetic contribution to suicidal behavior. Our novel findings which need replication will be presented. We found that genetic variation in the noradrenergic tyrosine hydroxylase gene was associated with the angry/hostility personality trait and vulnerability to stress. Similarly, we recently discovered that genetic variation in the transcription factor T-box 19, an upstream regulator of the stress-related hypothalamic pituitary adrenocortical axis, showed significant linkage to a personality characterised by high anger/hostility in suicidal offspring. Further results from our studies have revealed that genetic variation in genes with roles in basal mechanisms of neural conduction, voltage-gated sodium channel type VIII alpha and vesicle-associated membrane 4 protein, showed association and linkage among suicide attempters. Additionally, we have results which give support to the findings of others, implicating the serotonin transporter and serotonin receptor 1A in suicidal behavior. Our future studies aim at identifying and resolving complex patterns and mechanisms of neurobiological gene-environment interactions, which may contribute to suicide.
There have been only a few reports illustrating the effectiveness of mental health promotion and interventions to reduce risk behaviours, including suicidal behavior. The aim of the SEYLE project, which is funded by the European Union under the Seventh Framework Health Program, is to address these issues by collecting baseline and follow-up data on health and well-being among European adolescents and compiling an epidemiological database; testing, in a randomized controlled trial, three different suicide-preventive interventions; evaluating the outcome of each intervention in comparison with a control group from a multidisciplinary perspective; as well as recommending culturally adjusted models for promoting mental health and preventing suicidal behaviors. The study comprises 11,000 adolescents recruited from randomized schools in 11 European countries: Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden serving as the scientific coordinating center. Each country performs three active interventions and one minimal intervention as a control group. The active interventions include gatekeeper training (QPR), awareness training on mental health promotion for adolescents, and screening for at-risk adolescents by health professionals. Structured questionnaires are utilized at baseline, 3- and 12-month follow-ups in order to assess changes. During this presentation the data from the baseline evaluation of SEYLE will be described.
Trial registrationThe German Clinical Trials Register, DRKS00000214.
According to a stress diathesis model, genes and environment, as well as possible interactions in-between (GxE), may result in vulnerability towards suicidal behaviors (SB), characterized by behavioral trigger endophenotypes such as increased depression-intensity and aggression/ anger/ impulsivity. Excessive stress has the potential to induce unfavorable effects in a variety of higher brain-functions, incurred as side effects to maladaptive responses in the genetically controlled stress-responsive neurosystems e.g. in the hypothalamic- pituitary-adrenal (HPA) axis. HPA-axis dysregulation is regarded as an endophenotype of depression-, anxiety- and alcohol abuse disorders, commonly found also in suicide behaviors. Various neurobiological alterations, suggesting abnormal HPA-axis activity and reactivity, have also been demonstrated to occur in suicidal behaviors incl. completed suicides. The HPA axis is a major systemic stress-modulator being mainly controlled by the regulatory corticotrophin releasing hormone receptor 1 (CRHR1) gene. An overview will be presented of the role of the HPA axis in suicidal behaviors with a focus on CRHR1 gene.
The researches show a rapid growth of mental disorders among adolescents and young adults that often cooccurs with risk behaviours, such as suicide, which is one of the leading cause of death among young ages 15-34. Therefore it's necessary to use some tools that can promote mental health getting to young lives such as Internet and media.
Objectives
SUPREME (Suicide Prevention by Internet and Media Based Mental Health Promotion) is aimed to increasing the prevention of risk behaviours and mental health promotion through the use of mass media and Internet.
Aims
The main expected outcome is to improve mental health among European adolescents.
Method
In each European countries a sample of 300 students (average age of 15 years) will be selected. The prevention program will be a highly interactive website that which will address topics such as raising awareness about mental health and suicide, combating stigma, and stimulate peer help. The program will use different means of referral to the intervention website: “Adolescent related” and “Professional related”. A questionnaire will be administered to the pupils for require the data on lifestyles, values and attitudes, psychological well-being, familiar relationship and friendship.
Conclusion
Some web-sites, managed by mental health professionals, produced encouraging results about their use in prevention of risk behaviours and in increase well-being, especially in youth with low self-esteem and low life-satisfaction. With the implementation of the SUPREME project we will be able to identify best practices for promoting mental health through the Internet and the media.
To investigate the prevalence of pathological Internet use (PIU) among adolescents in eleven European countries in relation to demographic and health-related risk factors and Internet accessibility using homogenous methodology.
Design:
Cross-sectional analysis.
Setting:
The 7th Framework European Union funded project, Saving and Empowering Young Lives in Europe (SEYLE), is a Randomized Controlled Trial (RCT) evaluating preventive interventions for risk-behaviors among adolescents in Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain with Sweden as the coordinating site.
Participants:
11,956 adolescents (F/M: 6731/5225; mean age: 14.9 ± 0.89) recruited from randomly selected schools within the eleven study sites.
Measurements:
Internet users were classified by gender into three categories: adaptive, maladaptive and pathological, based on the Young Diagnostic Questionnaire for Internet Addiction (YDQ).
Findings:
The overall prevalence of PIU was 4.4%. the rate was higher among males than females (5.2% vs. 3.8%). Students not living with a biological parent or relative had the highest risk for both maladaptive and pathological Internet use. Low-parental involvement and parental unemployment showed high relative risk for both maladaptive and pathological Internet use. PIU significantly correlated with the average number of hours spent online. No correlation was found between national levels of Internet accessibility and pathological Internet use.
Conclusion:
Prevalence of PIU varied by gender. Youth in households without a biological parent and/or low level of parental involvement had the most significant health-related factors associated with PIU. National levels of Internet accessibility were not a risk factor for either maladaptive or pathological Internet use.
Peer relationships play a critical role in the development of adolescents, not only for the acquisition of social skills but also for the sense of personal identity and competence. Thus the quality of peer relationships influences actual and future mental health of the adolescent.
Objectives
SEYLE (Saving and Empowering Young Lives in Europe) is a randomized controlled trial, funded by the EU, evaluating interventions for mental health promotion and suicide prevention. The study comprised 12,395 high-school students from 11 European countries.
Aims
We investigated the differences on psychological problems between students with poor and good peer relationships.
Methods
1,195 adolescents (mean age 15.3 ± 0.6; 68% females) from the Molise region constituted the Italian sample. Adolescents were identified as with poor peer relationships if they never or just sometimes get along with people of their age, feel that peers like having them in the group and feel that peers were kind and helpful. Psychometric measures were used to assess mental health problems such as depression (Beck Depression Inventory II), anxiety (Zung Self-Assessment Anxiety Scale), well-being (WHO-5) and suicidal ideation (Paykel Suicide Scale).
Results
Adolescents who reported poor peer relationships scored significantly higher (p < .005) on the scales assessing depression, anxiety and suicidal ideation and significantly lower (p < .001) on the WHO-5.
Conclusions
Particularly in adolescence peer relationships may influence psychological well-being and vice versa mental health influences the openness to the others. So promoting mental health and contemporary improve social skills could lead adolescents to a better life.
Social intolerance is one major topic in every modern society, but although it receives much attention in the public space, there is relatively little information related to the behavioral correlates of such attitudes.
Aim
To investigate the relation between social intolerance and risk-taking behaviors in European adolescents.
Methods
Adolescents from the SEYLE and WE-STAY cohorts were included. The questions evaluating social intolerance, sensation-seeking and delinquent behavior, alcohol, tobacco and illegal drugs use were extracted from the baseline questionnaire.
Results
Adolescents positive for at-risk tobacco, alcohol and illegal drugs use showed significantly lower levels of social intolerance. This observation might be explained by the social factors associated with substance use at this age group. No relationship was observed with sensation-seeking and delinquent behavior.
Conclusions
Social intolerance is not associated with risk-taking behaviors in adolescents.