Objective:
The authors sought to identify scalable evidence-based suicide prevention strategies.
Methods:
A search of PubMed and Google Scholar identified 20,234 articles published between September ...2005 and December 2019, of which 97 were randomized controlled trials with suicidal behavior or ideation as primary outcomes or epidemiological studies of limiting access to lethal means, using educational approaches, and the impact of antidepressant treatment.
Results:
Training primary care physicians in depression recognition and treatment prevents suicide. Educating youths on depression and suicidal behavior, as well as active outreach to psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior. Meta-analyses find that antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered. Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention. Cognitive-behavioral therapy and dialectical behavior therapy prevent suicidal behavior. Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression. Education of gatekeepers about youth suicidal behavior lacks effectiveness. No randomized trials have been reported for gatekeeper training for prevention of adult suicidal behavior. Algorithm-driven electronic health record screening, Internet-based screening, and smartphone passive monitoring to identify high-risk patients are understudied. Means restriction, including of firearms, prevents suicide but is sporadically employed in the United States, even though firearms are used in half of all U.S. suicides.
Conclusions:
Training general practitioners warrants wider implementation and testing in other nonpsychiatrist physician settings. Active follow-up of patients after discharge or a suicide-related crisis should be routine, and restricting firearm access by at-risk individuals warrants wider use. Combination approaches in health care systems show promise in reducing suicide in several countries, but evaluating the benefit attributable to each component is essential. Further suicide rate reduction requires evaluating newer approaches, such as electronic health record–derived algorithms, Internet-based screening methods, ketamine’s potential benefit for preventing attempts, and passive monitoring of acute suicide risk change.
Mental health problems in college and their associations with academic performance are not well understood. The main aim of this study was to investigate to what extent mental health problems are ...associated with academic functioning.
As part of the World Mental Health Surveys International College Student project, 12-month mental health problems among freshmen (N = 4921) was assessed in an e-survey of students at KU Leuven University in Leuven, Belgium. The associations of mental health problems with academic functioning (expressed in terms of academic year percentage or AYP and grade point average GPA) were examined across academic departments.
Approximately one in three freshman reports mental health problems in the past year, with internalizing and externalizing problems both associated with reduced academic functioning (2.9–4.7% AYP reduction, corresponding to 0.2–0.3 GPA reduction). The association of externalizing problems with individual-level academic functioning was significantly higher in academic departments with comparatively low average academic functioning.
Limited sample size precluded further investigation of interactions between department-level and student-level variables. No information was available on freshman secondary school academic performance.
Mental health problems are common in college freshman, and clearly associated with lower academic functioning. Additional research is needed to examine the potentially causal nature of this association, and, if so, whether interventions aimed at treating mental health problems might improve academic performance.
•Approximately one in three freshman reports mental health problems in the past year.•12 month internalizing and externalizing mental health problems are associated with a decrease of 2.9–4.7% in AYP (or 0.2–0.3 GPA) in college.•This decrease in AYP is negatively correlated with departmental performance.
About a decade ago, the National Institute of Mental Health (NIMH) proposed an innovative framework, the Research Domain Criteria (RDoC), to classify psychiatric disorders. This complementary ...approach has been used with existing diagnostic systems to identify transdiagnostic factors that inform early detection of mental health disturbances and critically, provide novel targets for interventions. An additional goal, however, has been to clarify developmental processes and illness trajectories by operationalizing dimensional constructs during sensitive periods of neurofunctional development to capture the early emergence of behavioral alterations and impairment. As developmental factors are inherent to all RDoC systems and the units of analysis therein, NIMH shepherded developmental‐oriented research with targeted funding opportunity announcements. This resulting work has highlighted promising phenotypes and biological markers related to psychiatric illness across the lifespan.
Children of parents with depression are two to three times more likely to develop major depressive disorder than children without parental history; however, subcortical brain volume abnormalities ...characterizing major depressive disorder risk remain unclear. The Adolescent Brain and Cognitive Development (ABCD) Study provides an opportunity to identify subcortical differences associated with parental depressive history.
Structural magnetic resonance data were acquired from 9- and 10-year-old children (N = 11,876; release 1.1, n = 4,521; release 2.0.1, n = 7,355). Approximately one-third of the children had a parental depressive history, providing sufficient power to test differences in subcortical brain volume between low- and high-risk youths. Children from release 1.1 were examined as a discovery sample, and we sought to replicate effects in release 2.0.1. Secondary analyses tested group differences in the prevalence of depressive disorders and clarified whether subcortical brain differences were present in youths with a lifetime depressive disorder history.
Parental depressive history was related to smaller right putamen volume in the discovery (release 1.1; d = -0.10) and replication (release 2.0.1; d = -0.10) samples. However, in release 1.1, this effect was driven by maternal depressive history (d = -0.14), whereas in release 2.0.1, paternal depressive history showed a stronger relationship with putamen volume (d = -0.09). Furthermore, high-risk children exhibited a near twofold greater occurrence of depressive disorders relative to low-risk youths (maternal history odds ratio =1.99; paternal history odds ratio = 1.45), but youths with a lifetime depressive history did not exhibit significant subcortical abnormalities.
A parental depressive history was associated with smaller putamen volume, which may affect reward learning processes that confer increased risk for major depressive disorder.
College entrance may be a strategically well-placed "point of capture" for detecting late adolescents with suicidal thoughts and behaviors (STB). However, a clear epidemiological picture of STB among ...incoming college students is lacking. We present the first cross-national data on prevalence as well as socio-demographic and college-related correlates for STB among first-year college students.
Web-based self-report surveys were obtained from 13,984 first-year students (response rate 45.5%) across 19 colleges in 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, and the United States).
Lifetime prevalence of suicidal ideation, plans, and attempts was 32.7%, 17.5%, and 4.3%, respectively. The 12-month prevalence was 17.2%, 8.8%, and 1.0%, respectively. About three-fourths of STB cases had onset before the age of 16 years (Q3 = 15.8), with persistence figures in the range of 41% to 53%. About one-half (53.4%) of lifetime ideators transitioned to a suicide plan; 22.1% of lifetime planners transitioned to an attempt. Attempts among lifetime ideators without plan were less frequent (3.1%). Significant correlates of lifetime STB were cross-nationally consistent and generally modest in effect size (median adjusted odds ratio aOR = 1.7). Nonheterosexual orientation (aOR range 3.3-7.9) and heterosexual orientation with some same-sex attraction (aOR range 1.9-2.3) were the strongest correlates of STB, and of transitioning from ideation to plans and/or attempts (aOR range 1.6-6.1).
The distribution of STB in first-year students is widespread, and relatively independent of socio-demographic risk profile. Multivariate risk algorithms based on a high number of risk factors are indicated to efficiently link high-risk status with effective preventive interventions.
There is no definitive neural marker of suicidal thoughts and behaviors (STBs) or nonsuicidal self-injury (NSSI), and relative to adults, research in youth is more limited. This comprehensive review ...focuses on magnetic resonance imaging studies reporting structural and functional neural correlates of STBs and NSSI in youth to 1) elucidate shared and independent neural alternations, 2) clarify how developmental processes may interact with neural alterations to confer risk, and 3) provide recommendations based on convergence across studies. Forty-seven articles were reviewed (STBs = 27; NSSI = 20), and notably, 63% of STB articles and 45% of NSSI articles were published in the previous 3 years. Structural magnetic resonance imaging research suggests reduced volume in the ventral prefrontal and orbitofrontal cortices among youth reporting STBs, and there is reduced anterior cingulate cortex volume related to STBs and NSSI. With regard to functional alterations, blunted striatal activation may characterize STB and NSSI youth, and there is reduced frontolimbic task-based connectivity in suicide ideators and attempters. Resting-state functional connectivity findings highlight reduced positive connectivity between the default mode network and salience network in attempters and show that self-injurers exhibit frontolimbic alterations. Together, suicidal and nonsuicidal behaviors are related to top-down and bottom-up neural alterations, which may compromise approach, avoidance, and regulatory systems. Future longitudinal research with larger and well-characterized samples, especially those integrating ambulatory stress assessments, will be well positioned to identify novel targets that may improve early identification and treatment for youth with STBs and NSSI.
•Accurate methods for short-term prediction of suicidal risk are not yet established.•Developments in digital sensing and computational analysis provide new methodological capabilities that are ...relevant to this challenge.•Smartphone, wearable, and smart home technology have been shown to measure putative risk factors, including emotional distress, interpersonal behavior, and sleep disturbance.•Although significant ethical challenges remain, there are promising approaches to address these.•Digital sensing represents a promising agenda for future research on suicide risk.
Suicide is one of the leading causes of death among adolescents, and developing effective methods to improve short-term prediction of suicidal thoughts and behaviors (STBs) is critical. Currently, the most robust predictors of STBs are demographic or clinical indicators that have relatively weak predictive value. However, there is an emerging literature on short-term prediction of suicide risk that has identified a number of promising candidates, including (but not limited to) rapid escalation of: (a) emotional distress, (b) social dysfunction (e.g., bullying, rejection), and (c) sleep disturbance. However, these prior studies are limited in two critical ways. First, they rely almost entirely on self-report. Second, most studies have not focused on assessment of these risk factors using intensive longitudinal assessment techniques that are able to capture the dynamics of changes in risk states at the individual level.
In this paper we explore how to capitalize on recent developments in real-time monitoring methods and computational analysis in order to address these fundamental problems.
We now have the capacity to use: (a) smartphone, wearable computing, and smart home technology to conduct intensive longitudinal assessments monitoring of putative risk factors with minimal participant burden and (b) modern computational techniques to develop predictive algorithms for STBs. Current research and theory on short-term risk processes for STBs, combined with the emergent capabilities of new technologies, suggest that this is an important research agenda for the future.
Although these approaches have enormous potential to create new knowledge, the current empirical literature is limited. Moreover, passive monitoring of risk for STBs raises complex ethical issues that will need to be resolved before large scale clinical applications are feasible.
Smartphone, wearable, and smart home technology may provide one point of access that might facilitate both early identification and intervention implementation, and thus, represents a key area for future STB research.
Objectives
Mental health disorders are highly prevalent among university students. Universities could be an optimal setting to provide evidence‐based care through the Internet. As part of the World ...Mental Health International College Student initiative, this systematic review and meta‐analysis synthesizes data on the efficacy of Internet‐based interventions for university students' mental health.
Method
A systematic literature search of bibliographical databases (CENTRAL, MEDLINE, and PsycINFO) for randomized trials examining psychological interventions for the mental health (depression, anxiety, stress, sleep problems, and eating disorder symptoms), well‐being, and functioning of university students was performed through April 30, 2018.
Results
Forty‐eight studies were included. Twenty‐three studies (48%) were rated to have low risk of bias. Small intervention effects were found on depression (g = 0.18, 95% confidence interval CI; 0.08, 0.27), anxiety (g = 0.27, 95% CI 0.13, 0.40), and stress (g = 0.20, 95% CI 0.02, 0.38). Moderate effects were found on eating disorder symptoms (g = 0.52, 95% CI 0.22–0.83) and role functioning (g = 0.41, 95% CI 0.26, 0.56). Effects on well‐being were non‐significant (g = 0.15, 95% CI −0.20, 0.50). Heterogeneity was moderate to substantial in many analyses. After adjusting for publication bias, effects on anxiety were not significant anymore.
Discussion
Internet interventions for university students' mental health can have significant small‐to‐moderate effects on a range of conditions. However, more research is needed to determine student subsets for which Internet‐based interventions are most effective and to explore ways to increase treatment effectiveness.
Background
Eating problems are highly prevalent among young adults. Universities could be an optimal setting to prevent the onset of eating disorders through psychological intervention. As part of ...the World Mental Health‐International College Student initiative, this systematic review and meta‐analysis synthesizes data on the efficacy of eating disorder prevention programs targeting university students.
Method
A systematic literature search of bibliographical databases (CENTRAL, MEDLINE, PsycINFO) for randomized trials comparing psychological preventive interventions for eating disorders targeting university students with psychoeducation or inactive controls was performed on October 22, 2019.
Results
Twenty‐seven studies were included. Thirteen (48.1%) were rated to have a low risk of bias. The relative risk of developing a subthreshold or full‐blown eating disorder was incidence rate ratio = 0.62 (95% CI 0.44, 0.87, n
c = 8, numbers‐needed‐to‐treat NNT = 26.08; standardized clinical interviews only), indicating a 38% decrease in incidence in the intervention groups compared to controls. Small to moderate between‐group effects at posttest were found on eating disorder symptoms (g = 0.35, 95% CI 0.24, 0.46, NNT = 5.10, n
c = 26), dieting (g = 0.43, 95% CI 0.29, 0.57, NNT = 4.17, n
c = 21), body dissatisfaction (g = 0.40, 95% CI 0.27, 0.53, NNT = 4.48, n
c = 25), drive for thinness (g = 0.43, 95% CI 0.27, 0.59, NNT = 4.23, n
c = 12), weight concerns (g = 0.33, 95% CI 0.10, 0.57, NNT = 5.35, n
c = 13), and affective symptoms (g = 0.27, 95% CI 0.15, 0.38, NNT = 6.70, n
c = 18). The effects on bulimia nervosa symptoms were not significant. Heterogeneity was moderate across comparisons.
Discussion
Eating disorder prevention on campus can have significant, small‐to‐moderate effects on eating disorder symptoms and risk factors. Results also suggest that the prevention of subthreshold and full‐syndrome eating disorders is feasible using such interventions. More research is needed to identify ways to motivate students to use preventive eating disorder interventions.
Antecedentes
Los trastornos de la conducta alimentaria son altamente prevalentes entre los adultos jóvenes. Las universidades podrían ser un entorno óptimo para prevenir la aparición de trastornos alimentarios a través de la intervención psicológica. Como parte de la iniciativa World Mental Health‐International College Student, esta revisión sistemática y meta‐análisis sintetiza datos sobre la eficacia de los programas de prevención de trastornos alimentarios dirigidos a estudiantes universitarios.
Método
Una búsqueda bibliográfica sistemática de datos bibliográficas (CENTRAL, MEDLINE, PsycINFO) para ensayos aleatorios que comparaban intervenciones preventivas psicológicas para trastornos alimentarios dirigidos a estudiantes universitarios con psicoeducación o controles inactivos fue realizada hasta el 22 de octubre de 2019.
Resultados
Se incluyeron 27 estudios. Trece (48,1%) fueron calificados como de bajo riesgo de sesgo. El riesgo relativo de desarrollar un trastorno de la conducta alimentaria subclínico (parcial) o completo fue IRR = 0.62 (95% CI 0.44, 0.87, nc = 8, NNT = 26.08; sólo entrevistas clínicas estandarizadas), lo que indica una disminución del 38% en la incidencia en los grupos de intervención en comparación con los controles. Se encontraron efectos pequeños a moderados entre los grupos en la post‐prueba en los síntomas del trastorno alimentario (g = 0.35, 95% CI 0.24, 0.46, NNT = 5.10, nc = 26), dieta (g = 0.43, 95% CI 0.29, 0.57, NNT = 4.17, nc = 21), insatisfacción corporal (g = 0.40, 95% CI 0.27, 0.53, NNT = 4.48, nc = 25), impulso por delgadez (g = 0.43, 95% CI 0.27, 0.59, NNT = 4.23, nc = 12), problemas de peso (g = 0.33, 95% CI 0.10, 0.57, NNT = 5.35, nc = 13) y síntomas afectivos (g = 0.27, 95% CI 0.15, 0.38, NNT = 6.70, nc = 18). Los efectos sobre los síntomas de la bulimia nervosa no fueron significativos. La heterogeneidad fue moderada en las comparaciones.
Discusión
La prevención de los trastornos de la conducta alimentaria en el campus universitario puede tener efectos significativos, de pequeños a moderados, sobre los síntomas del trastorno alimentario y los factores de riesgo. Los resultados también sugieren que la prevención de los trastornos alimentarios subclínicos o parciales y síndromes completos es factible utilizando tales intervenciones. Se necesita más investigación para identificar formas de motivar a los estudiantes a usar intervenciones preventivas para los trastornos de la conducta alimentaria.
Abstract Background Individuals with psychotic disorders experience disruptions to both the sleep and circadian components of the sleep/wake cycle. Recent evidence has supported a role of sleep ...disturbances in emerging psychosis. However, less is known about how circadian rhythm disruptions may relate to psychosis symptoms and prognosis for adolescents with clinical high-risk (CHR) syndromes. The present study examines circadian rest/activity rhythms in CHR and healthy control (HC) youth to clarify the relationships among circadian rhythm disturbance, psychosis symptoms, psychosocial functioning, and the longitudinal course of illness. Methods Thirty-four CHR and 32 HC participants were administered a baseline evaluation, which included clinical interviews, 5 days of actigraphy, and a sleep/activity diary. CHR ( n = 29) participants were re-administered clinical interviews at a 1-year follow-up assessment. Results Relative to HC, CHR youth exhibited more fragmented circadian rhythms and later onset of nocturnal rest. Circadian disturbances (fragmented rhythms, low daily activity) were associated with increased psychotic symptom severity among CHR participants at baseline. Circadian disruptions (lower daily activity, rhythms that were more fragmented and/or desynchronized with the light/dark cycle) also predicted severity of psychosis symptoms and psychosocial impairment at 1-year follow-up among CHR youth. Conclusions Circadian rhythm disturbances may represent a potential vulnerability marker for emergence of psychosis, and thus, rest/activity rhythm stabilization has promise to inform early-identification and prevention/intervention strategies for CHR youth. Future studies with longer study designs are necessary to further examine circadian rhythms in the prodromal period and rates of conversion to psychosis among CHR teens.
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