The relationship between adolescent suicidal behavior and life events in childhood and adolescence.

OBJECTIVE: Although the relationship between experience of problematic life events and adolescent suicidal behavior has frequently been recognized during the past decade, few studies of life events have been initiated that discriminated between adolescent suicide attempters and depressed adolescents. Therefore, the authors compared adolescent suicide attempters with both depressed and nondepressed adolescents who never attempted suicide with respect to life events that happened in two periods: childhood (defined as the period up to age 12 years) and adolescence (age 12 and older). METHOD: Using a semistructured interview, the authors gathered life event data about childhood and adolescence from three groups of adolescents: 48 suicide attempters, 66 depressed adolescents who had never made a suicide attempt, and 43 nondepressed adolescents who had never made a suicide attempt. RESULTS: The group of adolescents who attempted suicide differed from both of the other groups in that they had experienced more turmoil in their families, starting in childhood and not stabilizing during adolescence. During adolescence, they were more often sexually abused. During the last year before the attempt, further social instability, such as changes in residence and having to repeat a class, occurred. CONCLUSIONS: For suicidal adolescents, the suicide attempt seems embedded not just in the problems every adolescent has to deal with but in greater turmoil in their families, rooted in childhood and not stabilizing during adolescence, in combination with traumatic events during adolescence and social instability in the year preceding the attempt.

Adolescents' image of their suicide attempt.

OBJECTIVE: To inventory the reasons adolescents give for their perceptions of events, thoughts, and feelings in the last days and hours before and during the attempt. METHOD: A semistructured interview also included the administration of an instrument that contained the formulation of reasons. RESULTS: The most frequently mentioned reasons for attempting suicide concerned the cessation of (an unbearable) consciousness. The motivation most frequently named for "crossing the bridge" between thinking about and attempting suicide involved an escalation of frustration and tension. CONCLUSIONS: Special emphasis should be given to family relationships, relationships with peers and friends, frustration tolerance, and the way in which adolescents handle their problems.

The specificity of psychological characteristics of adolescent suicide attempters.

Using a semistructured interview, psychological characteristics were gathered from three groups of adolescents: 48 suicide attempters, 66 depressed, and 43 nondepressed adolescents who never attempted suicide. Various characteristics reported in literature discriminated the attempters from the normal group but not from the depressed group. These characteristics probably are not specific for adolescent suicide attempters. Even when a discriminant analysis was applied, the suicide attempters showed many similarities with the depressed adolescents, although both these groups could be separated from the normal group. Using follow-up data, the quadrants created by the axes appeared to have more implications for prevention than for the a priori group membership.

Perception of risk and subjective health among victims of the Chernobyl disaster.

Several studies have demonstrated that the nuclear power plant accident at Chernobyl in 1986 had a strong impact on the subjective health of the inhabitants in the surrounding regions and that the majority of these health complaints appear to be stress-related. An epidemiological survey among the adult population of the Gomel region in Belarus near Chernobyl showed higher rates of self-reported health problems, psychological distress and medical service use in this region than in a comparable unexposed region. This paper presents an analysis of data on cognitive factors that were collected in this study. The findings support the hypothesis that cognitive variables such as risk perception and sense of control play an important role as mediating factors in the explanation of the observed health differences between the exposed and non-exposed regions. A tentative model is presented to further clarify the role of risk perception in the occurrence of non-specific health complaints after such ecological disasters.

Self-reported suicidal behavior in Dutch secondary education students.

From nearly 10,000 secondary education students in The Netherlands, aged 14-20, data were collected on the prevalence of suicide attempts and recent thoughts about suicide and death. In this sample, 3.3% of the girls and 1.3% of the boys indicated that they had attempted suicide. The youngest students already reported as many attempts as the eldest, which is remarkable. Differences between boys and girls and between various types of schools were not substantial. We also found that 5.2% of the girls and 2.2% of the boys currently had thoughts of suicide. Again, there was no substantial difference as regards sex, type of school, and age. There was, however, a (small) difference between boys and girls concerning thoughts of death--namely, 9.3% of the girls versus 4.8% of the boys.

OpenLabs services for ordering laboratory investigations.

An automated system is described that screens requests for laboratory investigations from GPs and delivers feedback with respect to the adequacy of the requests. The system has to replace and extend the current system in which feedback is provided on a manual basis each half year, based on the tests requested during a period of one month, randomly selected from the previous half year. It has been reported elsewhere that the manual system reduced the number of tests requested considerably. The criteria used by the automated system and the manual system are based on guidelines and work agreements that GPs have agreed to follow when requesting investigations. It is concluded that the automated system is very user-friendly and that in the order of 4-17% of the requested tests could be identified as unnecessary, with a false negative rate in between 4% (for hyperthyroidism) and 23% (for hypothyroidism). The achieved reduction in the number of tests is in addition to the reduction obtained in the manual system.

Social support, life events, and behavioral characteristics of psychologically distressed adolescents at high risk for attempting suicide.

Differences in social support, behavioral characteristics and life events between four groups of adolescents were investigated, one group consisting of suicide attempters and depressed adolescents showing problematic psychological scores and high risk for attempting suicide, and three other groups with lower risk and other (combinations of) psychological characteristics. The high-risk group distinguished itself from the psychologically most "normal" group by reporting less support and understanding from siblings and relations outside the family, more changes in living situation (life-time), more changes in caretaker and physical abuse during childhood, more changes in living situation and sexual abuse during adolescence, and more siblings leaving home during the preceding year. On a behavioral level, they reported consuming more alcohol and running away more often. The only exception to this was support and understanding from other relations: high-risk adolescents experienced more, especially in the last year. A possible explanation is that these subjects, due to the turmoil in their families, relied more on persons outside their families. Differences between the high-risk group and the other two groups are described in terms of the relation between the dependent variables and the psychological characteristics. Implications for assessments in emergency rooms is discussed.

Differences in measured and self-reported height and weight in Dutch adolescents.

BACKGROUND/AIMS: Monitoring overweight prevalence and its trends in Dutch youth is frequently based on self-reported data. The validity of self-reported data especially in young adolescents is not sufficiently known. The purpose of this study is to study the validity of self-reported height and weight in 12- to 13-year-olds, to identify sociodemographic correlates and to explore whether correction factors can be developed to estimate the prevalence of overweight in youth. METHODS: 5,525 12- to 13-year-old pupils in the Rotterdam area filled in a confidential questionnaire on health topics, including their height and weight. In a sub-sample of 499 pupils both self-reported and measured height and weight were available. RESULTS: Self-reported data led to a considerable underestimation of Body Mass Index and consequently the prevalence of overweight. Underestimation was higher in pupils who regarded themselves as more fat, were of non-Dutch origin and in lower education levels. CONCLUSION: Self-reported height and weight appeared to be inappropriate to estimate the overweight prevalence in 12- to 13-year-olds, unless the figures were adjusted. Using adjusted self-reported BMI on an individual level is questionable. Actual measurements of height and weight are necessary to draw up valid correction formulas in new samples.

Addiction-risk behaviours and suicide attempts in adolescents.

Data on single and multiple addiction-risk behaviours and suicidal behaviour were obtained from a large sample of Dutch secondary school students aged 16 to 19 years. Although the prevalence of hard drugs was the lowest of all addiction-risk behaviours, there was a markedly high report of suicidal behaviours in youngsters who used these drugs: one out of each five boys and one out of each three girls. The most "suicidal" combination of two addiction-risk behaviours reported by girls was that of sedatives and hard drugs: more than half of the girls who reported both these behaviours also reported a suicide attempt. In boys, 27% of those who reported sedatives and cigarettes also reported a suicide attempt. The number of addiction-risk behaviours reported by the adolescents showed an almost linear increasing relation with the percentage of suicide attempters. The results suggest that suicidal behaviour and addiction-risk behaviours both should be regarded as part of a complex interaction of multiple behavioural problems. Prevention programmes and intervention strategies should focus on multiple rather than single targets, and screening procedures to detect adolescents at-risk for suicidal behaviour should focus on patterns of multiple risk factors rather than on single behaviours.

Negative life events and depressive symptoms in the elderly: a life span perspective.

This study suggests that negative life events may have long-term consequences for people's well-being. A community sample of 194 elderly people was interviewed by means of the Geriatric Depression Scale and the Negative Life Events Questionnaire. Depressed mood at old age was related to the reporting of negative socio-economic circumstances as well as emotional abuse and neglect during childhood, and to the reporting of negative socio-economic circumstances, sexual abuse, emotional abuse and neglect, relational stress and problem behaviour of significant others during (late) adulthood. Depression scores were especially high when subjects reported the experience of many events during adulthood and late adulthood. On top of this, the interaction effect between the number of negative life events experienced in childhood and adulthood indicated that there was a much stronger association between the number of negative life events experienced in adulthood and depressive symptoms in late life, for those who experienced more negative life events in childhood, than for those who did not. It is suggested that incorporating life histories into the diagnostic interview is advisable.

Construction of an index for predicting suicide attempts in depressed adolescents.

A group of 48 adolescents who recently attempted suicide and 66 depressed adolescents were compared on sociodemographic, behavioural, psychological and relational variables. The variables which proved significant were used in different combinations in stepwise logistic regression analyses, resulting in seven variables which served as the content of an index of risk. The sensitivity of the index was 90% and the specificity 83%. At one-year follow-up the occurrence of a suicide attempt correlated with score on the instrument.

Differences between adolescent suicide attempters and depressed adolescents.

Most of the characteristics differentiating between adolescent attempters and nonattempters do not have discriminative power in comparing 48 adolescents who recently attempted suicide with 66 depressed adolescents. These characteristics may probably be attributed to an affective disorder that is present in most of the suicide attempters. However, suicide attempters, compared with the depressed group, live in more problematic circumstances (such as family disruption or sexual abuse) and have a cognitive style that promotes a more negative evaluation of events and situations. Their depressive symptoms are distinguished from the depressed group by withdrawal and isolation, besides maintaining a hopeless and negative expectation of the future. Furthermore, there are reasons to accept the idea that suicidal behavior is a serious alternative within their behavioral repertoire. Based on these findings, a psychological interpretation is given concerning the dynamics leading to a suicide attempt. Also, intervention strategies are discussed.

Suicidal behaviour and family factors among Dutch and Slovenian high school students: a comparison.

OBJECTIVE: East European countries have much higher suicide rates than West European countries. Whether this also applies for suicidal ideation and suicide attempts is not known. In addition, the role of family factors in relation to suicidal behaviour has not been investigated in East European countries. METHOD: Two representative samples of 19,250 Dutch and 4706 Slovenian high school students were compared on the basis of self-report data. RESULTS: Slovenian students report more suicidal behaviour (ideation and attempts) as well as more unfavourable family circumstances than Dutch students. This applies especially to the death of parent(s), the number of changes in their living situation, and to conflicts between or with parents. CONCLUSION: A relation between family characteristics and suicidal behaviour is established in both samples, but proved to be strongest in Slovenian girls. Complicated cultural and socioeconomic differences between the two countries may account for the reported differences.

Characteristics of suicide attempters in a population-based sample of Dutch adolescents.

The characteristics of suicide attempters were ascertained in a sample of 9393 Dutch students aged 14-20. Broken homes and use of drugs and alcohol were found more often among attempters. Attempters more frequently lived with a single parent, in children's homes or foster homes, were disproportionately of female sex, reported more deaths of friends or relatives, and more often had an unemployed father. Thoughts of suicide and of death were reported more frequently, they were more depressed and hopeless, and had less self-esteem. They were less rational and perceived relationships with parents as poor.

Musculoskeletal disorders in juvenile onset mixed connective tissue disease.

OBJECTIVE: We studied the occurrence of musculoskeletal involvement in patients with juvenile onset mixed connective tissue disease (MCTD) and their functional ability. METHODS: Thirteen patients who fulfilled the Kasukawa criteria of MCTD, were subjected to a general orthopedic assessment, as well as to a specific examination of tenderness and swelling of joints, muscle strength, joint motion and alignment, radiographical evaluation, and on disability and discomfort. RESULTS: Low indices were found on the modified Ritchie Articular Index (RI) (0.07) and the Fuchs Swelling Index (0.13). Mild to moderate indices were measured on the Joint Alignment and Motion Scale (JAM) (0.52) and on the Larsen Radiographic Evaluation Scales for the wrist, metacarpal, proximal and distal interphalangeal joints (L-RES) (1.40, 0.62, 0.31, 0.31). The mean pulp-thickness ratio was 22%, which is an indication for sclerodermic changes in the hands. Proximal muscle weakness was found in 10/13 patients (mainly in the upper extremity), distal muscle weakness was found in 12/13 patients. On the pediatric version of the Stanford Health Assessment Questionnaire (C-HAQ), pain and discomfort scored 0.04, disability scored 0.46; those scores were considered to below. Between L-RES and JAM a significant correlation was found (0.74, 0.74 and 0.73; p < 0.01). Another significant correlation was found between the RI and the disability score of the HAQ (0.58; p < 0.05). CONCLUSION: Sclerodermic changes as well as arthritic changes are of a benign character in our population of patients with juvenile onset MCTD.

Correlates of disablement in polyarticular juvenile chronic arthritis--a cross-sectional study.

To assess the impact of disease on the functional outcome of patients with polyarticular juvenile chronic arthritis (JCA), the relationship between impairments and functional limitations was studied. Therefore, variables from the impairment domain were correlated with variables of the functional limitation domain and outcome variables were analysed for differences as a result of inflammatory disease, rheumatoid factor (RF), disease duration and age at onset. Twenty-three patients with polyarticular JCA were subjected to auxologic evaluation, a laboratory check, radiographic evaluation, joint count on tenderness and swelling, joint mobility/deformity examination, functional assessment of skills, health assessment and psychosocial evaluation. Inflammatory disease parameters, like CRP, ESR, thrombocytosis and leucocytosis, were increased in 6/23 patients. The parameters of the impairment domain, like joint tenderness and swelling, showed mild outcome, while parameters of the functional limitation domain showed more severe outcome. Generally, perceived competence was found to be normal. A clinically relevant number of patients (10/13) showed low scores on the activity factor of the Child Behaviour Check List (CBCL). A significant relationship was found between inflammatory disease variables and functional limitation outcome. RF seropositivity was not a good outcome predictor. Disease duration and age of onset showed no significant difference in the outcome of the domains. Significant correlation was found between the parental report of the Childhood Health Assessment Questionnaire (CHAQ) and all impairment parameters. Joint swelling showed a significant relationship with CHAQ and Juvenile Arthritis Functional Assessment Report (JAFAR). Disability outcome did not correlate with functional limitation. In general, children with polyarticular JCA function rather well when using a multidomain evaluation approach. Compensatory and adaptational mechanisms might contribute to the poor correlation between impairment and functional limitation parameters. Laboratory evaluation of inflammatory disease, a joint count of swollen joints and parent's report of the child's health status related best in our study.

Two subtypes of adolescent suicide attempters. An empirical classification.

An empirical classification of 203 adolescent suicide attempters (mean age 17.3) was achieved using multiple correspondence analysis. The characteristics upon which the classification is based concern sociodemographic as well as psychological variables. Two groups are identified: the first is predominantly characterized by recent problematic behaviors, whereas the second group is primarily characterized by problematic circumstances. Analyzing related variables, the first group seems to have special clinical and preventive interest, because of its high risk for recidivism. The second group seems to have a satisfactory level of functioning.

Correlates of disablement in systemic onset juvenile chronic arthritis. A cross sectional study.

The impact of systemic onset JCA on functional outcome was studied in a multidimensional construct. Twenty-one patients were subjected to auxologic evaluation, a laboratory check, pulmonary and cardiac function tests, radiographic evaluation, joint count on tenderness, swelling and function, ADL, health assessment (CHAQ), and psychosocial evaluation. Six of 21 patients had active systemic disease. Restrictive pulmonary function was found in 8/17 patients, 1/21 had pericarditis. Joint impairment was moderate. Functional limitations were mild. Self-esteem was positive. Parental report on functional limitation correlated significantly with joint impairment. Performance of daily activities correlated strongly with perceived competence. Active inflammatory disease did not correlate with joint impairment and functional limitation. Patients with systemic onset JCA develop mild functional limitations, which partially correlate with the more serious impairments. Pulmonary function disorders are a common impairment. Active inflammatory disease might influence functional outcome, but there is no evidence that it influences joint impairment outcome.