Additional Value of Peer Informants in Psychological Autopsy Studies of Youth Suicides.

In this study, we examined the feasibility and added value of including peer informants in a psychological autopsy study of youth suicides. Peer semi-structured interview data from 16 cases were analyzed qualitatively and compared to parent data. Results show that peers added information to parents' narratives in general and particularly on social relationships, bullying, school experiences, social media, and family relations. Peers also provided additional information on the presence of certain issues (such as social media contagion) as well as on the emotional impact from certain adverse events that seemed to have functioned as precipitating factors. We conclude that including peers in psychological autopsy studies of youth suicides is feasible and of added value but that more research is desirable. The results initially can be used in the design of psychological autopsies so that the maximum amount of information about each suicide will be learned.

Addressing sickness absence among adolescents and young adults: an evaluation of the Medical Advice for Sick-reported Students intervention.

BACKGROUND: Sickness absence is associated with lower school achievements and early school leaving. The Medical Advice for Sick-reported Students (MASS) intervention is a proactive school-based intervention focused primarily on early identification and reduction of sickness absence. This study used a program evaluation framework to evaluate the MASS intervention among intermediate vocational education students and Youth Health Care professionals. Outcome indicators were primarily number of sick days, education fit, and school performance, and secondarily, seven health indicators. Process indicators were dose delivered and received, satisfaction, and experience. METHODS: The MASS intervention evaluation was conducted in ten intermediate vocational education schools. Students with extensive sickness absence from school in the past three months were included in either the intervention or control condition. Students completed a baseline and a six-month follow-up self-report questionnaire. Linear and logistic regression analyses were applied. Students and Youth Health Care professionals completed an evaluation form regarding their satisfaction and experience with the intervention. RESULTS: Participants (n = 200) had a mean age of 18.6 years (SD = 2.02) and 78.5% were female. The MASS intervention showed positive results on decreasing sickness absence in days (ß = -1.13, 95% CI = -2.22;-0.05, p < 0.05) and on decreasing depressive symptoms (ß = -4.11, 95% CI = -7.06;-1.17, p < 0.05). No effects were found for other health indicators (p > 0.05). A significant interaction revealed a decline in sickness absence in males (p < 0.05) but not in females (p > 0.05). Youth Health Care professionals found the application of the MASS intervention useful (n = 35 forms). The mean rating of students for the consultation within the MASS intervention was an 8.3 (SD = 1.3) out of 10 (n = 14 forms). CONCLUSIONS: Our study provides some indication that the MASS intervention has positive effects on decreasing both sickness absence and depressive symptoms among intermediate vocational education students. The Youth Health Care professionals who provided the consultation as part of the MASS intervention considered the intervention to be useful and stated that the consultation was delivered as intended in almost all cases. Students were generally satisfied with the intervention. We recommend that future research evaluates the MASS intervention in a large randomized controlled trial with a longer follow-up. TRIAL REGISTRATION: This study was prospectively registered in the Netherlands Trial Register under number NTR5556 , in October 2015.

Medical Advice for Sick-reported Students (MASS) in intermediate vocational education schools: design of a controlled before-and-after study.

BACKGROUND: School absenteeism, including medical absenteeism, is associated with early school dropout and may result in physical, mental, social and work-related problems in later life. Especially at intermediate vocational education schools, high rates of medical absenteeism are found. In 2012 the Dutch intervention 'Medical Advice for Sick-reported Students' (MASS), previously developed for pre-vocational secondary education, was adjusted for intermediate vocational education schools. The aim of the study outlined in this paper is to evaluate the effectiveness of the MASS intervention at intermediate vocational education schools in terms of reducing students' medical absenteeism and early dropping out of school. Additionally, the extent to which biopsychosocial and other factors moderate the effectiveness of the intervention will be assessed. METHODS: A controlled before-and-after study will be conducted within Intermediate Vocational Education schools. Schools are allocated to be an intervention or control school based on whether the schools have implemented the MASS intervention (intervention schools) or not (control schools). Intervention schools apply the MASS intervention consisting of active support for students with medical absenteeism provided by the school including a consultation with the Youth Health Care (YHC) professional if needed. Control schools provide care as usual. Data will be collected by questionnaires among students in both groups meeting the criteria for extensive medical absenteeism (i.e. 'reported sick four times in 12 school weeks or for more than six consecutive school days' at baseline and at 6 months follow-up). Additionally, in the intervention group a questionnaire is completed after each consultation with a YHC professional, by both the student and the YHC professional. Primary outcome measures are duration and cumulative incidence of absenteeism and academic performances. Secondary outcome measures are biopsychosocial outcomes of the students. DISCUSSION: It is hypothesized that implementing the MASS intervention including a referral to a YHC professional on indication, will result in a lower level of medical absenteeism and a lower level of school drop outs among intermediate vocational education students compared to students receiving usual care. The study will provide insight in the effectiveness of the intervention as well as in factors moderating the intervention's effectiveness. TRIAL REGISTRATION: Nederlands Trial Register NTR5556. Date of clinical trial registration: 29-Oct-2015.

Social media use of adolescents who died by suicide: lessons from a psychological autopsy study.

BACKGROUND: while there are many benefits for young people to use social media, adverse effects such as cyberbullying, online challenges, social comparison and imitation may provoke and aggravate suicidal thoughts and behaviors. The influence of social media on mental health and suicidal thoughts and behaviours has been amply studied, but there is little empirical evidence for its potential role in adolescent suicides. The current study aimed to inform digital suicide prevention strategies by examining the meaning of social media in the lives of young suicide victims and elucidating the harmful and supportive effects of social media use on their wellbeing and distress. METHODS: data were analyzed from a psychological autopsy study of 35 adolescents who died by suicide in the Netherlands (43% of all adolescents who died by suicide in that year). These were 18 girls and 17 boys. All were under the age of twenty years, with an average of seventeen years. Interpretative Phenomenological Analysis was performed of 55 semi structured interviews with peers and parents of the decedents. RESULTS: young people benefitted from peer support and recovery stories. However, various themes were discussed relating to the harmful effects of social media, including dependency, triggers and imitation, challenges, cybervictimization and psychological entrapment. The themes of dependency and triggers and imitation were more salient in young females. A group of girls cultivated an online identity around their suicidal thoughts and behaviours. Next-of-kin, particularly parents, faced various challenges to talk to the adolescents about social media use, including technological illiteracy, online anonymity, and the youths' closedness. CONCLUSIONS: based on the findings, we recommend education to stimulate the digital literacy of parents, health workers and educators, supporting conscientious social media use in young people, and extending the prevention of cyberbullying. We encourage future research to examine how virtual social networks may sustain suicidal thoughts and behaviour, and to further investigate the effectiveness of digital interventions, like moderated peer support and the use of positive role models.

Gender differences in suicide-related communication of young suicide victims.

OBJECTIVES: There is limited insight into gender differences in suicide-related communication (SRC) in youths. SRC is defined as "the act of conveying one's own suicide ideation, intent or behaviours to another person". Increasing our understanding of SRC in youths will enable us to recognize and specify needs of female versus male youths. The current study explores SRC in a sample of Dutch suicide victims aged under 20 and examines gender differences. METHODS: Interview data from a psychological autopsy study of 35 youths who died by suicide in the Netherlands in 2017 were analysed. Qualitative analyses were performed to examine explicit SRC throughout the youths' lives and implicit SRC during the last months prior to suicide. We employed the Constant Comparative Method to explore patterns in the debut, form, frequency, medium, content, type of recipient, and SRC in the last months prior to suicide death. RESULTS: We identified commonalities in the SRC of youths, including the content of suicide notes and an emphasis on suicide method and preparation in the last months. Girls, however, had an earlier debut of SRC, a higher frequency of explicit SRC, and more often directed SRC towards varied types of recipients compared to boys. Moreover, SRC of girls seemed focused on coping and achieving support from others more than SRC of boys. The SRC of boys in comparison to girls was often ambiguous or diluted by "humorous" connotations. CONCLUSION: Unique patterns in SRC of boys and girls posed corresponding challenges for next of kin to interpret communications and respond adequately to SRC. The early debut of girls' SRC highlights the importance of early screening and prevention efforts in girls, while the late debut and ambiguity in boys' SRC implores professionals and next of kin to encourage young males to be unequivocal about suicide ideation or intent.

A multi-method psychological autopsy study on youth suicides in the Netherlands in 2017: Feasibility, main outcomes, and recommendations.

OBJECTIVES: In the Netherlands, there was a sharp increase in the number of suicides among 10- to 19-year-olds in 2017. A multi-method psychological autopsy study (PA) was conducted to assess feasibility, identify related factors, and study the interplay of these factors to inform suicide prevention strategies. METHODS: Coroners identified youth suicides in 2017 in their records and then general practitioners (GPs) contacted the parents of these youths. Over a period of 7 months, 66 qualitative interviews were held with the parents, peers, and teachers, providing information on precipitating factors and five topics involving 35 cases (17 boys and 18 girls, mean age 17 years). Furthermore, 43 parents and care professionals filled in questionnaires to examine risk and care-related factors. Qualitative and quantitative analyses were performed. RESULTS: Although registration problems faced by coroners and resistance to contacting bereaved families by GPs hampered the recruitment, most parents highly appreciated being interviewed. Several adverse childhood experiences played a role at an individual level, such as (cyber) bullying, parental divorce, sexual abuse, as well as complex mental disorders, and previous suicide attempts. Two specific patterns stood out: (1) girls characterized by insecurity and a perfectionist attitude, who developed psychopathology and dropped out of school, and (2) boys with a developmental disorder, such as autism, who were transferred to special needs education and therefore felt rejected. In addition, adolescents with complex problems had difficulty finding appropriate formal care. Regarding potential new trends, contagion effects of social media use in a clinical setting and internet use for searching lethal methods were found. CONCLUSION: This first national PA study showed that, as expected, a variety of mostly complex clusters of problems played a role in youth suicides. An infrastructure is needed to continuously monitor, evaluate, and support families after each youth suicide and thereby improve prevention strategies.

Young adults' self-sufficiency in daily life: the relationship with contextual factors and health indicators.

BACKGROUND: Certain factors, such as depressive symptoms and binge drinking, may be linked to young adults' ability to attain an acceptable level of functioning on specific life-domains (i.e. self-sufficiency). We studied the association of contextual factors and health indicators with self-sufficiency in young adults. METHODS: We used both baseline (n = 755) and 6-months follow-up (n = 200) self-reported questionnaire data of intermediate vocational education students (16-26 years). The questionnaire included the adapted Dutch self-sufficiency matrix (SSM-D), which addresses self-sufficiency regarding 11 life-domains (e.g. finances and housing). The questionnaire also included potentially associated contextual factors (e.g. socio-demographic characteristics) and health indicators (e.g. sickness absence from school). Ordinal (overall self-sufficiency: self-sufficient on 11, 10, 9 or ≤ 8 life-domains), and logistic (self-sufficiency per life-domain: self-sufficient yes/no) regression models were applied. RESULTS: The studied population was 18.6 years on average (SD 2.04), and 73.6% were female. Cannabis use was associated with a lower overall self-sufficiency category at baseline (OR = 0.57, 95% CI = 0.33-0.99), as were an increase in sick days (OR = 0.94, 95% CI = 0.91-0.98) and an increase on the scale of depressive symptoms (OR = 0.87, 95% CI = 0.85-0.89). An increase in sick days and an increase on the scale of depressive symptoms were associated with lower odds of being self-sufficient on three and ten life-domains, respectively (p < 0.05). An increase on the scale of depressive symptoms was associated with a lower overall self-sufficiency category 6-months post-baseline (OR = 0.90, 95% CI = 0.86-0.93). CONCLUSIONS: Our findings underline the importance of addressing self-sufficiency, sickness absence, and depressive symptoms, preferably before the transition from adolescence to young adulthood has begun.

School Absenteeism, Health-Related Quality of Life [HRQOL] and Happiness among Young Adults Aged 16-26 Years.

This study examines the association between school absenteeism, health-related quality of life (HRQOL) and happiness among young adults aged 16-26 years attending vocational education. Cross-sectional data from a survey among 676 young adults were analyzed. School absenteeism was measured by the self-reported number of sick days in the past eight weeks and hours of truancy in the past four weeks. HRQOL was measured by the 12-item Short Form Health Survey; physical and mental component summary scores were calculated. General happiness was assessed on a scale of 0-10, higher scores indicating greater happiness. Linear regression analyses were performed. The study population had a mean age of 18.5 years (SD 2.2); 26.1% were boys. Young adults with ≥5 sick days or ≥6 h of truancy reported lower mental HRQOL compared to young adults without sickness absence or truancy (p < 0.05). Young adults with 1-4 and ≥5 sick days reported lower physical HRQOL compared to young adults who had not reported to be sick (p < 0.05). Young adults with 1-5 h and ≥6 h of truancy reported higher physical HRQOL compared to young adults who were not truant (p < 0.05). No associations were observed between school absence and happiness. Lower self-reported mental HRQOL was observed among young adults with more school absenteeism due to sickness or truancy. Sickness absence was additionally associated with lower physical HRQOL.

Reducing sick leave of Dutch vocational school students: adaptation of a sick leave protocol using the intervention mapping process.

OBJECTIVES: Since the extent of sick leave and the problems of vocational school students are relatively large, we aimed to tailor a sick leave protocol at Dutch lower secondary education schools to the particular context of vocational schools. METHODS: Four steps of the iterative process of Intervention Mapping (IM) to adapt this protocol were carried out: (1) performing a needs assessment and defining a program objective, (2) determining the performance and change objectives, (3) identifying theory-based methods and practical strategies and (4) developing a program plan. Interviews with students using structured questionnaires, in-depth interviews with relevant stakeholders, a literature research and, finally, a pilot implementation were carried out. RESULTS: A sick leave protocol was developed that was feasible and acceptable for all stakeholders. The main barriers for widespread implementation are time constraints in both monitoring and acting upon sick leave by school and youth health care. CONCLUSIONS: The iterative process of IM has shown its merits in the adaptation of the manual 'A quick return to school is much better' to a sick leave protocol for vocational school students.