Background
Strengthening social integration could prevent suicidal behavior. However, minimal research has examined social integration through relationship network structure. To address this ...important gap, we tested whether structural characteristics of school networks predict school rates of ideation and attempts.
Methods
In 38 US high schools, 10,291 students nominated close friends and trusted adults to construct social networks. We used mixed‐effects logistic regression models to test individual student networks and likelihood of suicidal ideation (SI) and suicide attempts (SA); and linear regression models to estimate associations between school network characteristics and school rates of SI, SA, and SA among all with ideation.
Results
Lower peer network integration and cohesion increased likelihood of SI and SA across individual and school‐level models. Two factors increased SA: student isolation from adults and suicidal students’ popularity and clustering. A multivariable model identified higher SA in schools where youth–adult relationships were concentrated in fewer students (B = 4.95 1.46, 8.44) and suicidal students had higher relative popularity versus nonsuicidal peers (B = 0.93 0.10, 1.77). Schools had lower SA rates when more students named the same trusted adults named by friends and many students named the same trusted adults. When adjusting for depression, violence victimization and bullying, estimates for adult network characteristics were substantially unchanged whereas some peer effects decreased.
Conclusions
Schoolwide peer and youth–adult relationship patterns influence SA rates beyond individual student connections. Network characteristics associated with suicide attempts map onto three theory‐informed domains: social integration versus thwarted relational needs, group cohesion, and suicidal students’ social influence. Network interventions addressing these processes, such as maximizing youth–adult connections schoolwide and heightening influence of youth with healthy coping, could create more protective schools. Longitudinal and intervention studies are needed to determine how schools differentiate in network structure and clarify reciprocal dynamics between network characteristics and suicidal behavior.
Neuroprotection is conceived as one of the potential tool to prevent or slow neuronal death and hence a therapeutic hope to treat neurodegenerative diseases, like Parkinson’s and Alzheimer’s ...diseases. Increase of oxidative stress, mitochondrial dysfunction, excitotoxicity, inflammatory changes, iron accumulation, and protein aggregation have been identified as main causes of neuronal death and adopted as targets to test experimentally the putative neuroprotective effects of various classes of drugs. Among these agents, antiepileptic drugs (AEDs), both the old and the newer generations, have shown to exert protective effects in different experimental models. Their mechanism of action is mediated mainly by modulating the activity of sodium, calcium and potassium channels as well as the glutamatergic and GABAergic (gamma-aminobutyric acid) synapses. Neurological pathologies in which a neuroprotective action of AEDs has been demonstrated in specific experimental models include: cerebral ischemia, Parkinson’s disease, and Alzheimer’s disease. Although the whole of experimental data indicating that neuroprotection can be achieved is remarkable and encouraging, no firm data have been produced in humans so far and, at the present time, neuroprotection still remains a challenge for the future.
Secondary analysis of digital psychological data (DPD) is an increasingly popular method for behavioral health research. Under current practices, secondary research does not require human subjects ...research review so long as data are de-identified. We argue that this standard approach to the ethics of secondary research (i.e., de-identification) does not address a range of ethical risks and that greater emphasis should be placed on the ethical principle of justice. We outline the inadequacy of an individually focused research ethic for DPD and describe unaddressed "social risks" generated by secondary research of DPD. These risks exist in the "circumstances of justice": that is, a circumstance where individuals must cooperate to create a public good (e.g., research knowledge), and where it is impractical to individually exempt individuals. This requires researchers to emphasize the just allocation of benefits and burdens against a background of social cooperation. We explore six considerations for researchers who wish to conduct research with DPD without explicit consent: (a) create socially valuable knowledge, (b) fairly share the benefits and burdens of research, (c) be transparent about data use, (d) create mechanisms for withdrawal of data, (e) ensure that stakeholders can provide input into the design and implementation of the research, and (f) responsibly report results.
Public Significance Statement
Existing ethical rules for secondary research with de-identified, digitally collected psychological data should be modified. In addition to protecting individual privacy, research ethics rules should focus on the fair allocation of the benefits and burdens of research.
Suicide in children is a significant and growing problem. The "zero suicide" framework (ZSF) is one approach to suicide prevention used in health services for adults and children. This paper reports ...on the introduction of the first suicide prevention pathway (SPP) based on ZSF at a Child and Youth Mental Health Service (CYMHS) in Australia. It begins by describing the adaptations made to elements of the SPP originally designed for adults to meet the needs of children. Lessons learned in applying the SPP in the service are then discussed. The aim is to inform and improve practice in the use of zero suicide approaches in child and youth mental health settings in Australia and worldwide.
Summary
Purpose: Older enzyme‐inducing antiepileptic drugs (AEDs) may induce supraphysiologic plasma concentrations of total (t) homocysteine (Hcy). The aim of the present study was to investigate ...the effect of new AEDs on plasma tHcy levels.
Methods: Patients 18–50 years of age, on AEDs monotherapy, with no other known cause of hyper‐tHcy were enrolled. Plasma tHcy, folate, vitamin B12, and AEDs levels were determined by standard high‐performance liquid chromatography (HPLC) methods. Methylenetetrahydrofolate‐reductase (MTHFR) polymorphisms were checked using Puregene genomic DNA purification system (Gentra, Celbio, Italy). A group of healthy volunteers matched for age and sex was taken as control.
Results: Two hundred fifty‐nine patients (151 on newer and 108 on older AEDs) and 231 controls were enrolled. Plasma tHcy levels were significantly higher mean values, standard error (SE) 16.8, 0.4 vs. 9.1, 0.2 μm; physiologic range 5–13 μm and folate lower (6.3, 0.1 vs. 9.3, 0.1 nm; normal > 6.8 nm) in patients compared to controls. Patients treated with oxcarbazepine, topiramate, carbamazepine, and phenobarbital exhibited mean plasma tHcy levels above the physiologic range mean values (SE) 16 (0.8), 19.1 (0.8), 20.5 (1.0), and 18.5 (1.5) μm, respectively. Conversely, normal tHcy concentrations were observed in the lamotrigine and levetiracetam groups both 11.1 (0.5) μm.
Discussion: Oxcarbazepine and topiramate might cause hyper‐tHcy, most likely because of the capacity of these agents to induce the hepatic enzymes. Because literature data suggest that hyper‐tHcy may contribute to the development of cerebrovascular diseases and brain atrophy, a supplement of folate can be considered in these patients to normalize plasma tHcy.
A systematic search of popular and scholarly databases identified workshops that addressed general clinical competence in the assessment or management of suicide risk, targeted mental health ...professionals, and had at least one peer‐reviewed publication. We surveyed workshop developers and examined empirical articles associated with each workshop. The state of workshop education is characterized by presenting the learning objectives, educational formats, instructor factors, and evaluation studies. Workshops are efficacious for transferring knowledge and shifting attitudes; however, their role in improving clinical care and outcomes of suicidal patients has yet to be determined.
Peer-led interventions have been applied to prevent various health behavior problems and may be an important complement to individual-level suicide prevention approaches. Sources of Strength trains ...student "peer leaders" in secondary schools to conduct prevention activities that encourage other students to build healthy social bonds and strengthen help-seeking norms. Prior work examining diffusion of peer-led programs has focused on youths' closeness to peer leaders but minimally on other factors such as connections to adults and suicidal behavior.
We examined implementation and dissemination of Sources of Strength in 20 schools. Over 1 year 533 students were trained as peer leaders and 3,730 9th-12th graders completed baseline surveys assessing friendships and adults at school, and suicidal thoughts/behaviors; and end-of-year surveys reporting intervention exposure: viewed poster/video, attended presentation, direct peer communication, and activity participation. Chi-square tests compared exposure rates by student and network characteristics. Multi-level logistic regression models tested predictors of exposure across individual and school-level characteristics.
Exposure to the intervention varied greatly by school and by individual student characteristics and network position. Training more peer leaders increased school-wide exposure for all modalities except presentation (Bs 0.06-0.10,
< 0.05). In multivariate models, exposure was consistently higher for students closer to peer leaders in the friendship network (ORs 1.13-1.54,
< 0.05) and students who named more trusted adults (ORs 1.08-1.16,
< 0.001); and lower for males (ORs 0.56-0.83,
< 0.05). In multivariate models, training more students as peer leaders predicted exposure to poster-video and direct peer communication in larger schools (OR = 3.34 and 2.87, respectively). Network characteristics influenced exposure similarly for students with suicidal thoughts and behaviors.
Our findings confirm prior work showing the importance of personal affiliations to peer leaders and natural networks as a medium for diffusion of peer-led prevention efforts. We build on that work by showing independent effects of closeness to adults at school and number of peer leaders trained. There is a need to strategically select peer leaders to maximize closeness to students school-wide, particularly in larger schools. Additional work is required for Sources of Strength to devise messaging strategies to engage males and students isolated from adults at school.
A Hadron Blind Detector (HBD) has been developed, constructed and successfully operated within the PHENIX detector at RHIC. The HBD is a Cherenkov detector operated with pure
CF
4
. It has a 50
cm ...long radiator directly coupled in a windowless configuration to a readout element consisting of a triple GEM stack, with a CsI photocathode evaporated on the top surface of the top GEM and pad readout at the bottom of the stack. This paper gives a comprehensive account of the construction, operation and in-beam performance of the detector.
Suicide is a national public health crisis and a critical patient safety issue. It is the 10th leading cause of death overall and the second leading cause of death among adolescents and young adults ...(15-34 years old). Research shows 80% of youth who died by suicide saw their primary care provider within the year of their death. It is imperative that primary care providers develop the knowledge and skills to talk with patients about distress and suicidal thoughts, and to assess and respond in the context of the ongoing patient - primary care provider relationship.
This study examines the effectiveness of simulation on suicide prevention training for providers-in-training by comparing two conditions: 1) a control group that receives online teaching on suicide prevention in primary care via brief online videos and 2) an experimental group that includes the same online teaching videos plus two standardized patient (SP) interactions (face-to-face and telehealth, presentation randomized). All SP interactions are video-recorded. The primary analysis is a comparison of the two groups' suicide prevention skills using an SP "test case" at 6-month follow-up.
The primary research question examines the impact of practice (through SP simulation) over and above online teaching alone on suicide prevention skills demonstrated at follow-up. We will assess moderators of outcomes, differences among SP simulations (i.e., face-to-face vs. telehealth modalities), and whether the experimental group's suicide prevention skills improve over the three SP experiences.
The study was registered on Clinical Trials Registry ( clinicaltrials.gov ) on December 14, 2016. The Trial Registration Number is NCT02996344 .
Abstract
Background
Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and ...this presents as a critical risk factor for suicide. Currently, there are limited treatment options with limited underpinning research for those who present to emergency departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide-specific psychological interventions (Attempted Suicide Short Intervention Program ASSIP or Brief Cognitive Behavioural Therapy CBT for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway SPP) improves the outcomes for consumers presenting to a Mental Health Service with a suicide attempt.
Methods
This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP), and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospitals with suicide attempts. Presentations with suicidal ideation will also be examined (in a descriptive analysis) to ascertain whether a rise in suicidal ideation is commensurate with a fall in suicide attempts (which might indicate an increase in help-seeking behaviours). Death by suicide rates will also be examined to ensure that representations with a suicide attempt are not due to participants dying, but due to a potential improvement in mental health. For participants without a subsequent suicide attempt, the total number of days from enrolment to the last assessment (24 months) will be calculated. Self-reported levels of suicidality, depression, anxiety, stress, resilience, problem-solving skills, and self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, and 6,12, and 24 months.
Discussion
This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions.
Trials registration
ClinicalTrials.gov
NCT04072666
. Registered on 28 August 2019
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