COVID-19 Posttraumatic Stress Disorder and Mental Health among Spanish Adolescents: SESSAMO Project.

Background: Child and adolescent mental health problems have increased after the COVID-19 pandemic. The objective of this study was to establish the association of the presence and intensity of posttraumatic stress due to COVID-19 with the presence of (1) self-harm and suicide risk, (2) depressive and anxious symptoms, (3) eating disorders and (4) problematic Internet and video game use. Methods: A cross-sectional analysis was performed on a sample of second-fourth grade secondary school students (14 to 16 years old) from Navarra and the Canary Islands recruited at the SESSAMO project. Validated questionnaires were used to assess the intensity of posttraumatic stress due to COVID-19, risk of suicide and presence of self-harm, symptoms of mental disorder and problematic use of the Internet and video games. Results: Out of 1423 participants analyzed, those with the highest level of posttraumatic stress showed a significant increase in the risk of suicide (OR = 5.18; 95% CI = 2.96-9.05) and in the presence of eating disorder symptoms (OR = 3.93; 95% CI = 2.21-7.00), and higher anxiety and depression scores (b coefficient for anxiety = 11.1; CI = 9.7-12.5; for depression = 13.0; CI = 11.5-14.5) as compared to those with the lowest level. Participants with a high level of posttraumatic stress were almost 10 times more likely to present problematic video game use (OR = 9.49; 95% CI = 3.13-28.82). Conclusions: Years after the pandemic, posttraumatic stress derived from it continues to impact the mental health of adolescents. Further long-term research is needed, as well as close follow-up and intervention in this population.

SESSAMO, follow-up of secondary students to assess mental health and obesity: a cohort study.

During last decades, a departure from health-related lifestyles has been observed among adolescents. Evidence reports that healthy lifestyles could be predictors of better mental health status. The aims of the SESSAMO Project are: 1) to assess the association between lifestyles and physical and mental health; 2) to assess how self-concept and stressful life events can modulate these associations; and 3) to establish the role of social determinants in the lifestyle and in adolescents' health. The SESSAMO Project is a prospective cohort carried out in Spain. Students aged 14-16 years (2nd-4th ESO) and their parents are invited to participate. Baseline data are collected through on-line, validated, self-administered questionnaires through a digital platform. Information on lifestyles, stressful life events and self-concept are collected. Screening of depression, anxiety, eating disorders, suicide risk, psychotic experiences and COVID impact is assessed. Every three years, up to age of 25, participants will be contacted again to update relevant information.

[Intentos de suicidio en personas mayores en servicios de Urgencias psiquiátricas hospitalarias.] / Elderly people's suicide attempts in psychiatric emergency departments.

OBJECTIVE: Elderly people have a high prevalence of mental disorder, low demand for care and increased risk of suicidal behaviour. Psychiatric emergency care may be the gateway to health services. Therefore, the aims of this study were: 1) to compare the profile of people aged sixty-five years and older seen for suicide attempts (SA) and those seen for other mental health problems in hospital psychiatric emergency departments; and 2) to establish the specificity of the Columbia Screening Scale (C-SSRS) in the exploration of suicide risk. METHODS: We carried out a secondary analysis of a descriptive, multicentre, observational, descriptive study comparing all persons seen for SA (n=21) and a control group (n=27) seen for another reason, between January and October 2015. Non-parametric analyses were performed on sociodemographic and clinical variables, stressful life events experienced and C-SSRS. RESULTS: 1) Among those attending for SA, 52.4% were men while those attending for another reason accounted for 18.5%. 2) 38.1% of those attending for SA were in mental health follow-up compared to 66.7% of those attending for other reasons. 3) C-SSRS screening discriminated between those seen for SA and those seen for other reasons. CONCLUSIONS: SA in older men may be the opportunity to initiate care and continuity of care in mental health services. The use of the C-SSRS scale in hospital psychiatric emergency departments is recommended.

OBJETIVO: En las personas mayores hay una alta prevalencia de trastorno mental, baja demanda asistencial y mayor riesgo de conducta suicida. La atención en Urgencias psiquiátricas puede ser la puerta de acceso a los servicios de salud. Por lo tanto, este trabajo tuvo como objetivos: 1) comparar el perfil de las personas de sesenta y cinco o más años atendidas por intento de suicidio (IS) y las atendidas por otros problemas de salud mental en Urgencias psiquiátricas hospitalarias; y 2) establecer la especificidad de la Escala de Cribado Columbia (C-SSRS) en la exploración del riesgo de suicidio. METODOS: Se realizó un análisis secundario de un estudio observacional descriptivo, multicéntrico, en el que se compararon todas las personas atendidas por IS (n=21) y un grupo control (n=27) atendido por otro motivo, entre enero y octubre de 2015. Se realizan análisis no paramétricos en variables sociodemográficas, clínicas, acontecimientos vitales estresantes vividos y C-SSRS. RESULTADOS: 1) Entre quienes acuden por IS el 52,4% eran hombres mientras que los que acudían por otro motivo eran el 18,5%. 2) El 38,1% de quienes acudieron por IS se encontraban en seguimiento en salud mental frente al 66,7% de los atendidos por otros motivos. 3) El cribado mediante C-SSRS discriminó entre las atenciones por IS y otro motivo. CONCLUSIONES: El IS en los hombres mayores puede ser la oportunidad para iniciar la atención y continuidad de cuidados en los servicios de salud mental. Se recomienda el uso de la escala C-SSRS en Urgencias psiquiátricas hospitalarias.

Efficacy of psychotherapeutic interventions for non-suicidal self-injury in adolescent population: Systematic review and meta-analysis.

Non-suicidal self-injury (NSSI) is the deliberate and self-inflicted damage to body tissue in the absence of fatal intent, and has become a serious health problem among adolescents. The aim of this study was to evaluate the efficacy of treatment for NSSI in this population through a systematic revision and meta-analysis (PROSPERO ID: 252355). Studies with therapies that reduced NSSI were included. The search was performed in the Medline, APA PsycINFO and PubPsych databases. The synthesis of measures for the main outcome (NSSI reduction) and for secondary outcomes (global functioning change and depressive symptomatology reduction) was performed using a random effects model. The search identified a total of 1881 studies. The systematic review included five studies and the meta-analysis four studies. The summary effect estimate for the standardized mean difference in NSSI was -0.53 (95% CI: -0.82, -0.25), in global functioning it was 0.62 (95% CI: 0.34, 0.91), and in depressive symptomatology it was -0.59 (95% CI: -0.82, -0.36). The certainty of the evidence using the GRADE method is low. We conclude that therapies specifically aimed at reducing NSSI are effective in reducing both NSSI and depressive symptoms while increasing global functioning.

Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial.

BACKGROUND: Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult's population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up. METHODS: This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated. DISCUSSION: This trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes. TRIAL REGISTRATION: NCT04911179 02/06/2021.

Psychiatric Hospitalization for Attempted Suicide and Reattempt at the One-Year Follow-Up.

BACKGROUND: People hospitalized for suicide attempt (SA) have a high risk of repeating and committing suicide during the first months after discharge. The aim of this study is to compare the usual treatment (TAU) with a TAU supplemented with a telephone follow-up programme (TAU + T). METHOD: Multicentre, open-trial, ex post facto pre-post prospective study that compared two samples of 90 (TAU) and 101 (TAU + T) people admitted in 2018-2019 for attempted suicide in two psychiatry units after one-year follow-up. Repeated SAs were analysed. RESULTS: A total of 31.4% (n =60) of the sample attempted suicide at least once during follow-up, with no differences between the units. A total of 32.5% (n =62) were readmitted during the following year, 15.6% of those readmissions were due to new suicide attempts. In TAU, the highest proportion of reattempts was among those diagnosed with personality disorders (77.8%) vs. other diagnoses (28.4%). In TAU + T, the highest proportion was found among those with previous SAs (50%) vs. those admitted for the first SA (4.4%). CONCLUSIONS: People admitted to psychiatric units for a first SA seem to benefit from TAU + T as it was associated with a lower recurrence of SA after discharge.

Effectiveness of a telephone prevention programme on the recurrence of suicidal behaviour. One-year follow-up.

People who have attempted suicide are considered a risk population for repeating the behaviour. Therapeutic interventions, such as telephone follow-up programmes (TFPs), are promising but more evidence for its efficacy is needed. In this multicentre, open, ex-post-facto, pre/post, one year prospective study, a previous cohort discharged from the emergency department for a suicide attempt (SA) and given routine treatment (n=207) was compared with a similar group who received the same intervention plus a structured TFP of six calls (n=203). At one year of follow-up, the efficacy of the TFP at preventing SA was assessed. A total of 53.2% (n=108) of the patients finished the TFP. A total of 20.3% (n=42) of the routine treatment group and 23.6% (n=48) of the TFP group re-attempted at least once in the follow-up period (χ2=0.7;df=1;p=.412). However, in both groups, different subsamples of patients who presented extreme risk of SA at follow-up (0-57%) were identified. In the TFP group, the recurrence of suicidal behaviour was lower in patients admitted after the index attempt and in those who had more severe psychopathological symptoms, but not in the other profiles. Thus, this study has identified a specific profile of patients who could benefit from a brief-contact intervention.

Suicidal behaviour recurrence in psychiatric emergency departments of patients without a prior suicide attempt, index and reattempters: A prospective study. / Repetición de conductas suicidas en urgencias psiquiátricas en pacientes sin intentos previos, index y repetidores: un estudio prospectivo.

INTRODUCTION: There has been little change in the incidence of suicidal behaviour and reattempts in recent years. Evidence is needed on the incidence of suicidal behaviour in the psychiatric population and its follow-up. MATERIAL AND METHOD: A prospective multi-centre case-control study. The sample covered the cases of 440 patients seen as psychiatric emergencies. For this purpose, we used the Vital Adverse Event Scale by Brugha and screening with the Columbia Scale. The sample was divided into three groups: patients without prior suicide attempts, patients with an index attempt and patients with more than one attempt. At two years, the clinical histories of these patients were reviewed, assessing for suicidal behaviour. RESULTS: A total of 49.1% (n=216) of the patients required urgent psychiatric care during the follow-up period, and 2.7% eventually committed suicide. The data shows a differential profile between the three groups analysed. Among them, the group of reattempters required the highest number of interventions regarding suicide behaviour (11.0%; χ2=30.3; d.f.=2; P<.001). Eventually, 6.1% of the patients without prior suicide attempts tried to commit suicide for the first time, and 21.7% (n=60) of the remaining sample repeated their prior attempts. The highest risk of attempt was in the thirty days following the urgent intervention. After this period, risk distribution varied for each group. Three items from the Columbia Scale predict suicide behaviour. CONCLUSIONS: The results show the need for assessing suicidal behaviour for all patients who receive psychiatric urgent care, including during the follow-up period. A more thorough control should be performed during the first months for patients without prior suicide attempts, and longer periods for those patients who have already tried to commit suicide.

Repeated suicide attempts: a follow-up study.

INTRODUCTION: There is a strong association between those who re-attempt a suicide attempt and those who complete it. Therefore, follow-up on the interventions carried out for suicidal patients is essential. This study investigated the sociodemographic and clinical profiles of individuals admitted as psychiatric emergencies after a suicide attempt according to sex, determined the prevalence of re-attempts in a period of six months, compared the profiles of patients who engaged in repeated suicide attempts to those who did not, and evaluated predictive variables for repeated suicide attempts. METHODOLOGY: A total of 207 patients (122 women and 85 men) who went to the psychiatric emergency room for a suicide attempt (January-October 2015) were interviewed, and their clinical histories were reviewed at 6 months. RESULTS: Lethal suicidal behaviour was lower in women. Fourteen percent of the sample (n=29) repeated a suicide attempt in the following 6 months, and 2 people died by suicide; 3 died from other causes. The patients admitted to the Psychiatric Hospitalization Unit presented with more re-attempts (X2=4.1; d.f.=1; p=0.043). In the multivariate analysis, of all the variables analysed, the only one associated with repeated suicide attempts was having been in mental health treatment upon inclusion into the study (OR=3.504, p=0.009, CI95%: 1.361-9.018). In the follow-up period, the percentage of patients who engaged in mental health treatment increased 21.7%. CONCLUSIONS: The risk of recurrence after being treated for a suicide attempt psychiatric emergency is high in the months following an attempt, and it is necessary to improve prevention and intervention programmes aimed at improving these figures.

Differences between suicide attempts and other psychiatric hospital emergencies.

INTRODUCTION: In Spain, a comparative research study between those patients treated for suicide attempt and others treated by any other reason hasn't been found. The aim of this study is to describe the differences between both types of patients in relation to sociodemographic and clinic variables together with the adverse vital events and the suicidal ideation. METHODOLOGY: A descriptive, multicentric and case-controlled study carried out in psychiatric hospital emergencies where 207 patients had been evaluated for a suicidal attempt (cases) and 233 were also evaluated by any other reasons (checkings). RESULTS: The cases presented a larger percentage of previous suicide attempts (45.4% vs. 30.0%; p=0.001) and a lower rates of prior emergency care (55.6% vs. 65.7%; p=0.030) of a history of mental disorder (77.8% vs. 86.7%; p=0.014) and follow-up in mental health. The 31.8% (n=74) exhibited suicidal ideation at the time of care and the 61.4% (n=143) expressed their desire to die when questioned. CONCLUSIONS: Neither a specific sociodemographic nor clinic profile of those who try to commit suicide has been found. But a high percentage of patients with suicidal ideation were identified in people treated for other reasons. The results emphasize the need to consider and evaluate the ideation of death and the risk of suicide in all the patients treated in psychiatric hospital emergencies.

Are previous suicide attempts a risk factor for completed suicide?

BACKGROUND: A previous suicide attempt is a clinically relevant factor for completed suicide. In this paper people who committed suicide on their first attempt are compared with those who did so after previous attempts. METHOD: A review of the Computerised Clinical Histories in the Navarro Health Service-Osasunbidea (2010-2013) in Spain. RESULTS: Of the 166 cases, 31.9% (n = 53) presented at least one prior attempt. Of these 53, 65.3% modified the method of suicide. Women presented significantly more attempts (χ2 = 14.3; df = 3; p = .002). Three sub-samples were identified according to the attempts and diagnoses. The diagnoses of personality disorders (90.9%; n = 10) and women under 51 years of age with a diagnosis of affective, anxiety, or substance abuse disorders (82.4%; n = 14) presented the highest numbers of attempts. People without a psychiatric diagnosis and with psychotic or organic mental disorders presented the smallest proportion of attempts (13.2%; n = 10) together with people over 51 years of age diagnosed with affective, anxiety, or substance abuse disorders (22.5%; n = 9). CONCLUSIONS: Prior attempts are suicide risk factors only in specific clinical sub-samples. Prevention and intervention programs should consider these results.

[Concordance in diagnosis between primary care and mental health]. / Concordancia en el diagnóstico entre atención primaria y salud mental.

OBJECTIVE: To analyse the diagnostic concordance index between primary care and mental health. DESIGN: Retrospective and descriptive study. SETTING: Mental health centre, Estella, Navarra, Spain. PARTICIPANTS. New consecutive adults patients referred to mental health (n=1005) from july 2002 to march 2005. MAIN MEASUREMENTS: Analysis of diagnoses made in primary care and mental health during the time period. Calculation of kappa index for inter-observer concordance. RESULTS: General diagnostic concordance had a kappa index =0.385 (+/-0.018). High concordance index (>0.7) was obtained for alcohol and other substance use disorders and psychotic disorders. Moderate concordance index (0.4-0.7) was obtained for eating disorders and organic mental disorders. However, low concordance index (<0.3) was obtained for anxiety, adaptative, and affective disorders. CONCLUSIONS: In general, diagnostic concordance between primary care and mental health is weak. Particularly noticeable was difficulty in identifying adaptative disorders adequately. There was a strong tendency in primary care to identify these disorders as anxiety or affective disorders.