Trends in Adolescent Completed Suicide in Croatia for the Period of 2000 to 2020.

BACKGROUND: Croatia belongs to the countries with a medium mortality rate due to suicide in youths. Previous epidemiological reports indicated a decreasing trend of suicide rates in adolescents. However, recent trend analysis in youth suicide rates in Croatia are missing. This study aimed to describe recent trends in child and adolescent completed suicide in Croatia and to compare the rates and methods of suicide ("means") across demographic groups. SUBJECTS AND METHODS: Data from the Croatian Committed Suicide Registry were used to calculate age-specific rates of suicide from 2000 to 2020 among 0 to 24 year olds, overall and by age, gender, and means of suicide. RESULTS: The total average suicide rate for Croatian children and adolescents during the study period was 4.12 per 100,000. The male-female ratio was 4.1:1. The total youth suicide rate and male suicide rate significantly declined from 2000 to 2020; however, the decrease in female rates did not reach statistical significance. Nearly half of all suicides among Croatian youth of both gender occurred through hanging, whereas using firearms was the second-most common suicide method in males and jumping from a height in females. CONCLUSIONS: Suicide rates among children and adolescents in Croatia continue to decrease. High-risk groups include adolescents aged 20-24 years and male youth, so these data should be considered when designing prevention programmes for youth suicide.

Challenges of assessment and treatment of ultra high risk for psychosis in an adolescent.

The onset of psychosis is typically preceded by a prodromal phase that is characterised by the emergence of "attenuated" psychotic symptoms. This phase is described as ultra-high risk (UHR) or at-risk mental state (ARMS) of psychosis. Criteria have been established for identifying these young people who are at clinical high risk. People at ultra-high risk (UHR) of psychosis have about 30% chance of developing the illness within two years. This category was introduced with the goal of developing treatments for prevention of psychotic disorders. Recent research suggests that early interventions appear to be effective in delaying and even preventing the onset of psychosis. These treatments include antipsychotic medication, nutritional supplements such as omega-3 fatty acids and psychological treatment. Cognitive behavioral therapy (CBT) has been tested as a potentially effective intervention in this group. Here we describe a case of a male adolescent with UHR psychotic symptoms with focus on challenges of assessing the UHR in adolescents and issues of providing effective age appropriate interventions.

Self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans.

The presence of posttraumatic stress disorder (PTSD) in male war veterans has been linked with family dysfunction and psychopathology in their children [1, 2]. This study aimed to evaluate self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans and determine the degree that parent-child bonding and family functioning contributed to adolescent behavior problems. Internalizing and externalizing behavior problems, parent-child bonding and family functioning were assessed in a sample of clinically referred Croatian PTSD veterans adolescent offspring (N = 122) and non-PTSD veteran adolescent offspring (N = 122) matched for age, sex, educational level, family income, parental employment status, ethnicity, and residential area. Youth Self-Report, Parental Bonding Instrument, Family Assessment Device were used. Adolescent offspring of PTSD veterans reported having significantly more internalizing and externalizing problems than non-PTSD veteran offspring, and also more difficulties in their family functioning, lower levels of maternal and paternal care, and more impaired mother-child and father-child bonding than control subjects. Internalizing symptoms were associated with family dysfunction, while externalizing symptoms were associated with paternal overcontrol/overprotection, and low maternal and paternal care. In conclusion, the increase in internalizing and externalizing symptoms as well as family and parental dysfunction among clinically referred adolescent offspring of PTSD veterans compared to their non-PTSD veteran counterparts indicates a need for early detection and interventions targeting both adolescent psychopathology and family relationships.

The prevalence and psychosocial correlates of suicide attempts among inpatient adolescent offspring of Croatian PTSD male war veterans.

Despite evidence that children of male war veterans with combat-related posttraumatic stress disorder (PTSD) are at particularly high risk for behavior problems, very little is currently known about suicidal behaviors in this population of youth. This study aimed to examine the prevalence and psychosocial correlates of suicide attempts among psychiatrically hospitalized adolescent offspring of Croatian male PTSD veterans. Participants were psychiatric inpatients, ages 12-18 years. Self-report questionnaires assessed demographics, suicide attempts, psychopathology, parenting style, and family functioning. The prevalence of suicide attempts was 61.5% (65.2% for girls and 58.0% for boys). Internalizing symptoms, family dysfunction, lower levels of maternal and paternal care, and paternal overcontrol were significantly associated with suicide attempts. Our findings suggest that suicide attempts are common among inpatient adolescent offspring of male PTSD veterans and that interventions targeting both adolescent psychopathology and family relationships are needed for adolescents who have attempted suicide.

Architecture and functioning of child and adolescent mental health services: a 28-country survey in Europe.

The WHO Child and Adolescent Mental Health Atlas, published in 2005, reported that child and adolescent mental health services (CAMHS) in Europe differed substantially in their architecture and functioning. We assessed the characteristics of national CAMHS across the European Union (EU), including legal aspects of adolescent care. Using an online mapping survey aimed at expert(s) in each country, we obtained data for all 28 countries in the EU. The characteristics and activities of CAMHS (ie, availability of services, inpatient beds, and clinicians and organisations, and delivery of specific CAMHS services and treatments) varied considerably between countries, as did funding sources and user access. Neurodevelopmental disorders were the most frequent diagnostic group (up to 81%) for people seen at CAMHS (data available from only 13 [46%] countries). 20 (70%) countries reported having an official national child and adolescent mental health policy, covering young people until their official age of transition to adulthood. The heterogeneity in resource allocation did not seem to match epidemiological burden. Substantial improvements in the planning, monitoring, and delivery of mental health services for children and adolescents are needed.

Non-suicidal self-injury among psychiatric outpatient adolescent offspring of Croatian posttraumatic stress disorder male war veterans: Prevalence and psychosocial correlates.

BACKGROUND: The children of male veterans with combat-related posttraumatic stress disorder (PTSD) are at particularly high risk of emotional and behavioral problems. However, no studies have examined non-suicidal self-injury (NSSI) in this population of youth. AIMS: To determine the prevalence and psychosocial correlates of lifetime NSSI in a sample of psychiatric outpatient adolescent offspring of Croatian PTSD male veterans. METHOD: Consecutive outpatient adolescent offspring of Croatian male PTSD veterans, aged 12 to 18 years, were assessed on the Deliberate Self Harm Inventory, the Youth Self-Report, the Family Assessment Device, the Parental Bonding Instrument and the Demographics Questionnaire. RESULTS: Of the whole sample, 52.7% of adolescents reported NSSI at least once during their lifetime. Lifetime NSSI was significantly associated with internalizing symptoms (adjusted odds ratio (OR) = 2.14; 95% confidence interval (CI): 1.04-4.42, p = .040), poor family functioning (adjusted OR = 6.54; 95% CI: 2.02-21.22, p = .002), lower maternal and paternal care (adjusted OR = 0.47; 95% CI: 0.40-0.56, p = .000 and adjusted OR = 0.82; 95% CI: 0.73-0.91, p = .000, respectively) and higher paternal control (adjusted OR = 1.84; 95% CI: 1.59-2.14, p = .000) in multivariate analysis. No association was found between lifetime NSSI and any of the socio-demographic variables. CONCLUSION: NSSI is a significant clinical problem in outpatient adolescent offspring of PTSD male veterans, which may be influenced by clinical and family factors. Interventions aimed at reducing internalizing symptoms and improving family functioning and parental behaviors are needed in the treatment of adolescent offspring of male PTSD veterans engaging in NSSI.

Harm avoidance moderates the relationship between internalized stigma and depressive symptoms in patients with schizophrenia.

This study investigated the associations between internalized stigma, depressive symptoms, and temperament dimension Harm avoidance. One hundred and seventeen stable outpatients with schizophrenia completed a battery of self-report instruments. Internalized stigma was significantly positively related to depressive symptoms, while Harm avoidance moderated the internalized stigma-depressive symptoms relationship.