Mental health and suicide among youth residing in frontier and remote areas.

AIMS: Examine state-level data from the National Survey of Children's Health (NSCH), Youth Risk Behavior Surveillance System (YRBSS), and frontier and remote area (FAR) codes. Compare state-level data from the NSCH and YRBSS to state's FAR codes, to explore correlations between youth mental health/suicide and geographic remoteness. METHODS: State-level data from the NSCH, YRBSS and FAR codes were organized into tables. For each variable, states were ranked from 1 to 50 and assigned a numeric value. Using this numeric ranking system, Kendall's tau-b was used to examine correlations between NSCH data and FAR codes, and YRBSS data and FAR codes. RESULTS: There were no significant correlations between any FAR level and any NSCH variable. There were significant correlations between level 1 FAR areas and suicidal ideation, suicide planning, and suicide attempt. There were also significant correlations between FAR levels 2, 3, and 4 and suicidal ideation and suicide planning. CONCLUSION: Continued surveillance of youth mental health is important in building the evidence base. However, because suicidal ideation and suicide planning appear higher across all FAR levels, there is opportunity to implement sustainable approaches to prevent suicidal behaviors among youth in FAR areas.

Sexual Identity Differences in Health Behaviors and Weight Status among Urban High School Students.

Although racial/ethnic disparities in childhood obesity are well documented in the United States (U.S.), fewer studies have investigated elevated body mass index (BMI) and related health behaviors among sexual minority youth (SMY; gay/lesbian, bisexual, not sure). We examined pooled data from the 2009-2017 Youth Risk Behavior Surveys, which included high school students from 12 urban U.S. school districts. We used sex-stratified logistic regression models to estimate the association of sexual identity with health behaviors and elevated BMI (reference = heterosexual participants). A total of 133,615 participants were included. Sexual minority boys were more likely to report physical inactivity than heterosexual boys. Gay and not sure boys were also less likely to consume the recommended daily intake of fruit. Bisexual girls were more likely than heterosexual girls to report watching television ≥ 3 hours on a school day and to consume sugar-sweetened beverages (AOR 1.30, 95% CI= 1.18-1.43). All SMY reported higher rates of current tobacco use than their heterosexual peers. Sexual minority girls and bisexual boys had significantly higher rates of obesity than their heterosexual counterparts. These findings can inform tailored health promotion initiatives to reduce obesity risk in SMY.

A Review of Psychometrically Tested Instruments Assessing Suicide Risk in Adults.

OBJECTIVE: Identify suicidal ideation and behavior screening instruments with the strongest psychometric properties, using the Interpersonal-Psychological Theory of Suicidal Behavior. METHODS: Information databases PsycINFO and PubMed were systematically searched, and articles evaluating the psychometric properties of instruments assessing suicidal ideation and behavior ( n = 2,238) were reviewed. International populations and articles with diverse methodologies were integrated. RESULTS: Review of records resulted in the inclusion of 51 articles that assessed 16 instruments. The majority of studies used the English language version (68.6%) and included U.S. populations (65.7%). However, global populations and non-English language versions were also represented. CONCLUSION: More diverse population representation, and non-English versions of instruments, is required to improve generalizability of assessment measures. Including underrepresented groups and non-English instruments will promote culturally and linguistically sensitive instruments that may better assess suicide risk in diverse populations.

Suicidality among Gender Minority Youth: Analysis of 2017 Youth Risk Behavior Survey Data.

We examined differences in suicidality based on gender identity while adjusting for known suicide risk factors in a sample of United States adolescents. Using data from the 2017 Youth Risk Behavior Survey we used logistic regression models to examine three suicide-related outcomes. Youth were categorized as transgender (1.3%), gender-questioning (1.4%), or cisgender (97.3%). In fully adjusted models, compared to cisgender youth, transgender youth had 2.71 (95% CI 1.50-4.92) higher odds of past-year suicide attempts and 2.54 (95% CI 1.05-6.15) higher odds of past-year suicide attempts requiring treatment. Gender-questioning youth had 2.31 (95% CI 1.48-3.60) higher odds of past-year suicidal ideation compared to cisgender youth. Policies and interventions are needed to reduce suicidality among gender minority youth, improve access to mental healthcare, and reduce peer victimization and substance use.

Bullying and Peer Victimization of Minority Youth: Intersections of Sexual Identity and Race/Ethnicity.

BACKGROUND: Youth with multiple minority identities, such as those who are both sexual minority (eg, lesbian, gay, bisexual) and racial/ethnic minority (eg, Black, Latino) may be at increased risk for bullying and peer victimization. METHODS: Youth Risk Behavior Surveillance data (2011-2017) were analyzed (N = 114,881; 50.8% girls; mean age = 15.7 years, SD = 0.03). We used chi-square tests and sex-stratified multiple linear regression models to examine sexual identity and racial/ethnic differences and the intersection between sexual identity and race/ethnicity across 3 forms of bullying and peer victimization, co-occurrence of traditional and electronic bullying, and any type of bullying or peer victimization. RESULTS: Sexual minority youth reported higher odds of bullying and peer victimization than heterosexual youth. White youth reported higher odds of bullying than racial/ethnic minority youth. In intersectional analyses, all sexual minority and racial/ethnic minority boys, and bisexual racial/ethnic minority girls were at higher risk for bullying and peer victimization compared to heterosexual peers of the same race/ethnicity. CONCLUSIONS: This study of a large diverse sample of youth advances our understanding of vulnerability to bullying and peer victimization among youth with multiple minority identities. This research can inform policy initiatives and interventions to prevent peer victimization of vulnerable youth.

Technology-enhanced suicide prevention interventions: A systematic review.

Objective Suicide prevention is a high priority. Scalable and sustainable interventions for suicide prevention are needed to set the stage for population-level impact. This systematic review explores how technology-enhanced interventions target suicide risk and protective factors, using the Centers for Disease Control and Prevention (CDC, 2015) Risk and Protective Factors Ecological Model. Methods Information databases (PsycINFO, PubMed and CINAHL) were systematically searched and records including technology-enhanced interventions for suicide prevention ( n = 3764) were reviewed. Records with varying technologies and diverse methodologies were integrated into the search. Results Review of the records resulted in the inclusion of 16 studies that utilized technology-enhanced interventions to address determinants of suicidal behaviour. This includes the use of standalone or, in most cases, adjunct technology-enhanced interventions for suicide prevention delivered by mobile phone application, text message, telephone, computer, web, CD-ROM and video. Conclusion Intervention effectiveness was variable, but several technology-enhanced interventions have demonstrated effectiveness in reducing suicidal ideation and mental health co-morbidities. Large-scale research and evaluation initiatives are needed to evaluate the costs and long-term population-level impact of these interventions.