Applying ideation-to-action theories to predict suicidal behavior among adolescents

Okado, I., Floyd, F. J. et al. (2021).

Journal of Affective Disorders, 295, 1292–1300.

https://doi.org/10.1016/j.jad.2021.08.137

Abstract

Background

Although many risk factors for adolescent suicidal behavior have been identified, less is known about distinct risk factors associated with the progression from suicide ideation to attempts. Based on theories grounded in the ideation-to-action framework, we used structural equation modeling to examine risk and protective factors associated with the escalation from suicide ideation to attempts in adolescents.

Methods

In this cross-sectional study, data from the 2013 and 2015 Hawaii High School Youth Risk Behavior Surveys (N = 8,113) were analyzed. The sample was 54.0% female and racially/ethnically diverse. Risk factors included depression, victimization, self-harm, violent behavior, disinhibition, and hard substance use, and protective factors included adult support, sports participation, academic achievement and school safety.

Results

One in 6 adolescents (16.4%) reported suicide ideation, and nearly 1 in 10 (9.8%) adolescents had made a suicide attempt. Overall, disinhibition predicted the escalation to attempts among adolescents with suicide ideation, and higher academic performance was associated with lower suicide attempt risk. Depression and victimization were associated with suicide ideation.

Limitations

This study examined data from the Youth Risk Behavior Survey, and other known risk factors such as anxiety and family history of suicide were not available in these data.

Conclusions

Findings provide guidance for targets for clinical interventions focused on suicide prevention. Programs that incorporate behavioral disinhibition may have the greatest potential for reducing suicide attempt risk in adolescents with suicidal thoughts.

Highlights

• Depression and victimization are associated with suicide ideation in adolescents.

• Disinhibition potentiates suicide attempt risk in adolescents with suicide ideation.

• Higher academic performance protects against adolescent suicide attempt.

Suicidal Ideation, Suicide Attempts, and Suicide Deaths in Adolescents and Young Adults With Type 1 Diabetes: A Systematic Review and Meta-analysis

Renaud-Charest, O., et al. (2024).

Diabetes Care, 47(7), 1227–1237.

https://doi.org/10.2337/dc24-0411

Background

Evidence is lacking on the risk of suicide-related behaviors (suicidal ideation, suicide attempt, suicide death) in youth with type 1 diabetes (T1D).

Purpose

We aimed to 1) determine the prevalence of suicidal ideation, suicide attempts, and suicide deaths in adolescents and young adults (AYA) with T1D aged 10–24 years; 2) compare suicide-related behavior prevalence in youth with and without T1D; and 3) identify factors associated with suicide-related behaviors.

Conclusions

Suicidal ideation and suicide attempts are prevalent in AYA with T1D. Current evidence does not suggest that these rates are higher among AYA with T1D than rates among those without.

Here are some thoughts:

Adolescence and young adulthood are critical periods of development, and for youth living with type 1 diabetes (T1D), these stages are further complicated by the daily demands of managing their condition. This systematic review and meta-analysis aimed to synthesize the evidence on the prevalence of and factors associated with suicide-related behaviors in adolescents and young adults (AYA) with T1D. The results showed a prevalence of suicidal ideation of 15.4% and suicide attempts of 3.5% in AYA with T1D, with depressive symptoms and difficulties with T1D self-management being associated with higher rates of suicide-related behaviors.

The findings highlight the need for mental health support and tailored interventions for AYA with T1D, considering the unique challenges they face. The association between glycemic levels and suicide-related behaviors was inconsistent, and social determinants of health were not always accounted for in the studies. The review's limitations include heterogeneity in the meta-analysis and the lack of control groups in most studies. Further research is needed to better understand the evolution of suicide-related behaviors in AYA with T1D and to develop effective prevention and intervention strategies.

As guns rise to leading cause of death among US children, research funding to help prevent and protect victims lags

Deidre McPhillips

CNN.org

Originally posted 7 Feb 24

More children die from guns than anything else in the United States, but relatively little funding is available to study how to prevent these tragedies.

From 2008 to 2017, about $12 million in federal research awards were granted to study pediatric firearm mortality each year – about $600 per life lost, according to a study published in Health Affairs. Motor vehicle crashes, the leading cause of death among children at the time, received about $26,000 of research funding per death, while funding to study pediatric cancer, the third leading cause of death, topped $195,000 per death.

By 2020, firearm deaths in the US had reached record levels and guns had surpassed car crashes to become the leading cause of death among children. More than 4,300 children and teens died from guns in 2020, according to data from the US Centers for Disease Control and Prevention – a 27% jump from 2017, and a number that has only continued to rise. But federal dollars haven’t followed proportionately.

Congress has earmarked about $25 million for firearm injury prevention research each year since 2020, split evenly between the CDC and the National Institutes of Health. Even if all of those dollars were spent on studies focused on pediatric deaths from firearm injury, it’d still be less than $6,000 per death.

The info is here.

The article highlights the critical need for increased research funding to prevent firearm-related deaths among children and teens in the U.S. Despite guns becoming the leading cause of death in this demographic, research funding remains insufficient. This lack of investment hinders the development of life-saving solutions and policies to address gun violence effectively. To protect our youth and combat this pressing issue, substantial and sustained funding for research on gun violence prevention is imperative.

Or, we could have more sensible gun laws to protect children and adolescents.

How does marijuana affect the brain?

Heather Stringer

Monitor on Psychology

Vol. 54, No. 5, p. 20

Here is an excerpt:

Mixing marijuana with mental health issues

Psychologists also share a sense of urgency to clarify how cannabis affects people who suffer from preexisting mental health conditions. Many veterans who suffer from PTSD view cannabis as a safe alternative to other drugs to alleviate their symptoms (Wilkinson, S. T., et al., Psychiatric Quarterly, Vol. 87. No. 1, 2016). To investigate whether marijuana does in fact provide relief for PTSD symptoms, Jane Metrik, PhD, a professor of behavioral and social sciences at the Brown University School of Public Health and a core faculty member at the university’s Center for Alcohol and Addiction Studies, and colleagues followed more than 350 veterans for a year. They found that more frequent cannabis use worsened trauma-related intrusion symptoms—such as upsetting memories and nightmares—over time (Psychological Medicine, Vol. 52, No. 3, 2022). A PTSD diagnosis was also strongly linked with cannabis use disorder a year later. “Cannabis may give temporary relief from PTSD because there is a numbing feeling, but this fades and then people want to use again,” Metrik said. “Cannabis seems to worsen PTSD and lead to greater dependence on the drug.”

Metrik, who also works as a psychologist at the Providence VA Medical Center, has also been studying the effects of using cannabis and alcohol at the same time. “We need to understand whether cannabis can act as a substitute for alcohol or if it leads to heavier drinking,” she said. “What should we tell patients who are in treatment for problem drinking but are unwilling to stop using cannabis? Is some mild cannabis use OK? What types of cannabis formulations are helpful or harmful for people who have alcohol use disorder?”

Though there are still many unanswered questions, Metrik has seen cases that suggest adding cannabis to heavy drinking behavior is risky. Sometimes people can successfully quit drinking but are unable to stop using cannabis, which can also intensify depression and lead to cannabis hyperemesis syndrome—repeated and severe bouts of vomiting that can occur in heavy cannabis users, she said. Cannabis withdrawal symptoms such as irritability, anxiety, increased cravings, aggression, and restlessness usually subside after 1 to 2 weeks of abstinence, but insomnia tends to persist longer than the other symptoms, she said.

Cannabis may also interfere with pharmaceutical medications patients are taking to treat mental health issues. Cannabidiol (CBD) can inhibit the liver enzymes that metabolize medications such as antidepressants and antipsychotics, said Ryan Vandrey, PhD, a professor of psychiatry and behavioral sciences at Johns Hopkins University and president of APA’s Division 28 (Psychopharmacology and Substance Abuse). “This could lead to side effects because the medication is in the body longer and at higher concentrations,” he said. In a recent study, he found that a high dose of oral CBD also inhibited the metabolism of THC, so the impairment and the subjective “high” was significantly stronger and lasted for a longer time (JAMA Network Open, Vol. 6, No. 2, 2023). This contradicts the common conception that high levels of CBD reduce the effects of THC, he said. “This interaction could lead to more adverse events, such as people feeling sedated, dizzy, [or] nervous, or experiencing low blood pressure for longer periods of time,” Vandrey said.

The interactions between CBD, THC, and pharmaceutical medications also depend on the dosing and the route of administration (oral, topical, or inhalation). Vandrey is advocating for more accurate labeling to inform the public about the health risks and benefits of different products. “Cannabis is the only drug approved for therapeutic use through legislative measures rather than clinical trials,” he said. “It’s really challenging for patients and medical providers to know what dose and frequency will be effective for a specific condition.”

The info is here.

Antipsychotics for Children With ADHD Should Be a Last Resort

Jeannette Y. Wick
pharmacytimes.com
Originally published 20 Feb 20

Here is an excerpt:

ANTIPSYCHOTICS: NOT FIRST LINE

A freestanding diagnosis of ADHD is not an indication for antipsychotic medications. Although no studies have determined which children who get an ADHD diagnosis are most likely to receive antipsychotic medications, mental health comorbidity is a possible factor.

ADHD often occurs in conjunction with other mental health conditions. Common comorbidities include conduct disorder (depression, or oppositional defiant disorder), and prescribers may use antipsychotic drugs to augment other approaches. The evidence does not support using antipsychotic medication for depression in youths, but some data support a risperidone trial for conduct disorder or oppositional defiant disorder in stimulant-resistant youths with ADHD.

A second concern is aggression. Aggression that stems from poor impulse control is common in youths who have ADHD, and it frequently occurs in children who have comorbidities. This behavior is often associated with a need for assessment, hospitalization, or urgent care and requires careful follow-up and cautious risk assessment. ADHD may not respond to stimulant medications, so prescribers may use antipsychotic drugs off-label in an effort to reduce aggressive outbursts. Research shows that antipsychotic-treated youths with ADHD often have clinical characteristics associated with aggression. However, few youths with ADHD who were treated with antipsychotics received the evidence-indicated trial doses of 2 stimulants before an antipsychotic.

The info is here.