Comparing frequencies of adolescent suicide attempters pre- and during COVID-19 pandemic school terms.

BACKGROUND: The COVID-19 pandemic had and still have a major impact on adolescent mental health and consequently on suicidal behavior. However, few studies have investigated whether the pandemic has changed the patterns and the triggers of suicidality peaks in adolescents, e.g., seasonal patterns or family conflicts. We hypothesized that the pandemic modified suicidality rates: an increment of suicide attempts would be observed in the first semester of the academic year during COVID-19 pandemic compared to the same period of previous academic year; and the precipitating factors would be more related to social stressors during the pandemic school year. METHODS: A retrospective cross-sectional study was conducted to assess the precipitating factors, also including school-related factors and cognitive skills, of adolescent suicide attempters occurred in the first and second semesters of the year before the pandemic lockdown (study periods 1 and 2) and the year after (study periods 3 and 4). RESULTS: The sample consisted of 85 adolescents aged between 12 and 17 recruited consecutively from March 2019 to March 2021 at emergency ward because of suicide attempt. Forty-eight adolescents (55.3% of the sample) were attended before the lockdown (pre-pandemic group) and 38 (44.7%) the year after. The results showed a higher proportion of female suicide attempters in period 4 (Sept 2020-Feb 2021) respect to period 3 (Mar 2020-Aug 2020), i.e., pandemic semesters compared with the increment observed between period 2 and 1 (prepandemic semesters; Fisher's exact test = 4.73; p = 0.026). The multinomial regression models showed a significant effect in the frequency of adolescents who attempted suicide (ratio χ2 = 15.19, p = 0.019), accounted by the differences between period 4 (Sept 2020-Feb 2021) and period 1 (Mar 2019-Aug 2019), with depressive symptoms being a significant contributing factor (Exp(b) = 0.93; p = 0.04). Additionally, social triggers and age were found to be significant risk factors for suicide attempts in the first semester of the pandemic academic year (period 4) compared to the same semester of the pre-pandemic year (period 2; Exp(b) = 0.16, p = 0.01, and Exp(b) = 1.88, p = 0.006, respectively). CONCLUSIONS: During the pandemic, the decrement between first and second semester of the number of females attempting suicide was more pronounced than in the prepandemic school year -though this findings lacked statistical power due to very limited sample size-. Change in the frequency of adolescent attempting suicide in the different school periods was associated with greater severity of depressive symptoms. Social relations in back-to-school after the lockdown were also associated with the number of adolescents attempting suicide.

COVID-19 Pandemic Has Changed the Psychiatric Profile of Adolescents Attempting Suicide: A Cross-Sectional Comparison.

The COVID-19 pandemic is having a major impact on the mental health of adolescents, leading to suicidal behaviors. However, it remains to be clarified whether the COVID-19 pandemic has changed the psychiatric profile of adolescent suicide attempters. METHODS: a retrospective observational analytical study was conducted to assess age, gender and clinical characteristics of adolescents attempting suicide during the year before and the year after the global lockdown. RESULTS: ninety adolescents (12-17 y.o.) were recruited consecutively from February 2019 to March 2021 at the emergency ward for having attempted suicide. Fifty-two (57.8%) attended before the lockdown (pre-pandemic group) and thirty-eight (42.2%) the year after (pandemic group). There were significant differences in diagnostic categories between the periods (p = 0.003). Adjustment and conduct disorders were more frequent in the pre-pandemic group, while anxiety and depressive disorders were more prevalent during the pandemic. Although the severity of suicide attempts did not show significant differences between the two study periods (0.7), the generalized linear model showed that the suicide attempt severity was significantly associated with current diagnosis (p = 0.01). CONCLUSIONS: the psychiatric profile of adolescents attempting suicide was different before and during the COVID-19 pandemic. During the pandemic, the proportion of adolescents with a prior psychiatric history was lower, and most of them were diagnosed with depressive and anxiety disorders. These diagnoses were also associated with a greater severity in the intentionality of suicide attempt, regardless of the study period.

An mHealth intervention for the treatment of patients with an eating disorder: A multicenter randomized controlled trial.

OBJECTIVE: The current multicentre randomized controlled trial assessed the clinical efficacy of a combined mHealth intervention for eating disorders (EDs) based on cognitive behavioral therapy (CBT). METHOD: A total of 106 ED patients from eight different public and private mental health services in Spain were randomly assigned to two parallel groups. Patients of the experimental group (N = 53) received standard face-to-face CBT plus a mobile intervention through an application called "TCApp," which provides self-monitoring and an online chat with the therapist. The control group (N = 53) received standard face-to-face CBT only. Patients completed self-report questionnaires on ED symptomatology, anxiety, depression, and quality of life, before and after treatment. RESULTS: Significant reductions in primary and secondary outcomes were observed for participants of both groups, with no differences between groups. Results also suggested that the frequency with which patients attended their referral mental health institution after the intervention was lower for patients in the experimental group than for those in the control group. DISCUSSION: The current study showed that CBT can help to reduce symptoms relating to ED, regardless of whether its delivery includes online components in addition to traditional face-to-face treatment. Besides, the additional component offered by the TCApp does not appear to be promising from a purely therapeutic perspective but perhaps as a cost-effective tool, reducing thus the costs and time burden associated with weekly visits to health professionals.

Validation of the Spanish and Catalan versions of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA).

Outcome measurement in outpatient and day-care mental health facilities for children and adolescents in Spain remains limited, in part due to a lack of validated scales. To address this issue, we translated HoNOSCA (glossary, score sheet, self-rated questionnaire, and parent/legal guardian questionnaire) into Spanish and Catalan using a reverse translation approach. We ascertained the validity and psychometric quality of the HoNOSCA in Spanish by assessing correlation with the Children's Global Assessment Scale (C-GAS). We recruited 64 participants 7-17 years of age in five day-care Psychiatry hospitals in Catalonia (Spain). Two evaluators administered both instruments twice, two weeks apart. Patients and parents/legal guardians completed the corresponding HoNOSCA versions. We calculated Cronbach's alpha for assessing internal consistency, intra-class correlation coefficients (ICC) for inter-rater and test-retest reliability, and Pearson's correlation coefficients for validity. We found that all HoNOSCA versions in Spanish presented satisfactory internal consistency, inter-rater and test-retest reliability. Concurrent validity for HoNOSCA-Glossary was also acceptable, with Pearson's coefficients of -0.543 and -0.519 for evaluators in the first administration, and of -0.675 and -0.685 in the second administration. HoNOSCA was also successfully translated into Catalan; acceptability was determined using cognitive interviews.

Body image dissatisfaction, physical activity and screen-time in Spanish adolescents.

This cross-sectional study contributes to the literature on whether body dissatisfaction is a barrier/facilitator to engaging in physical activity and to investigate the impact of mass-media messages via computer-time on body dissatisfaction. High-school students ( N = 1501) reported their physical activity, computer-time (homework/leisure) and body dissatisfaction. Researchers measured students' weight and height. Analyses revealed that body dissatisfaction was negatively associated with physical activity on both genders, whereas computer-time was associated only with girls' body dissatisfaction. Specifically, as computer-homework increased, body dissatisfaction decreased; as computer-leisure increased, body dissatisfaction increased. Weight-related interventions should improve body image and physical activity simultaneously, while critical consumption of mass-media interventions should include a computer component.

Fobia a tragar: plan de cuidados en la infancia y adolescencia / Choking phobia: Care plan in Children and Adolescents

Las alteraciones alimentarias son un problema frecuente en la edad pediátrica. La fobia a tragar se caracteriza por miedo a atragantarse al ingerir comida, líquidos o pastillas. Aunque es un trastorno considerado menor y de baja prevalencia, en estos últimos años se ha observado un aumento de su incidencia en la etapa infantil y juvenil. En el análisis de 4 casos atendidos en nuestro hospital de día por esta fobia específica, se establece la valoración y los cuidados necesarios para su tratamiento y solución, en colaboración con los demás profesionales implicados y la familia. Es de destacar el importante rol que posee enfermería en el tratamiento de este trastorno psicológico, en los dispositivos de hospitalización parcial, para la correcta aplicación del plan terapéutico, el establecimiento de vínculos robustos y de confianza con la familia y el propio usuario, así como en la motivación para el cambio terapéutico por parte de todo el núcleo familiar. Es indispensable la inclusión del trastorno en el diagnóstico diferencial de los trastornos de alimentación en la infancia y su conocimiento por parte de los profesionales comunitarios, con la finalidad de poder establecer un adecuado tratamiento precoz que mejore los resultados terapéuticos (AU)

Eating disorders are a common problem in childhood. Swallowing phobia is characterised by fear of choking on having consumed food, liquids or tablets. Although they are considered a minor disorder and have low prevalence, there has been an increase in its incidence in children and adolescents in the past few years. The analysis of four cases treated in our day hospital for this specific phobia provides an assessment and the care necessary for its treatment and solution, in collaboration with other professionals and the family The importance of the role that nurses have in the treatment of this psychological disorder is emphasised, as well admission to Day Units, the correct application of the treatment plan, the establishment of robust and reliable links with the family and the patient, and the motivation for therapeutic change by the whole family. It is essential to include the disorder in the differential diagnosis of eating disorders in children, as well as knowledge of this by community workers, in order to establish adequate early treatment to improve therapeutic outcomes (AU)

[Choking phobia: care plan in children and adolescents]. / Fobia a tragar: plan de cuidados en la infancia y adolescencia.

Eating disorders are a common problem in childhood. Swallowing phobia is characterised by fear of choking on having consumed food, liquids or tablets. Although they are considered a minor disorder and have low prevalence, there has been an increase in its incidence in children and adolescents in the past few years. The analysis of four cases treated in our day hospital for this specific phobia provides an assessment and the care necessary for its treatment and solution, in collaboration with other professionals and the family. The importance of the role that nurses have in the treatment of this psychological disorder is emphasised, as well admission to Day Units, the correct application of the treatment plan, the establishment of robust and reliable links with the family and the patient, and the motivation for therapeutic change by the whole family. It is essential to include the disorder in the differential diagnosis of eating disorders in children, as well as knowledge of this by community workers, in order to establish adequate early treatment to improve therapeutic outcomes.

Intervención enfermera en el plan terapéutico familiar de la anorexia nerviosa / Nursing intervention in the family treatment plan for anorexia nervosa

Una de las principales intervenciones que enfermería realiza en el tratamiento de los trastornos de conducta alimentaria se establece en la psicoeducación familiar, aspecto indispensable en la mayoría de tratamientos en Salud Mental. Este artículo describe y analiza las dificultades familiares expresadas en el cumplimiento del plan terapéutico establecido para los pacientes ingresados por anorexia nerviosa (AN) en el Hospital de Día de adolescentes de Salud Mental, de la Corporació Sanitària Parc Taulí, durante el año 2009. Así mismo, se recopilan datos sobre las intervenciones profesionales realizadas con la familia por parte de la enfermera asignada a esta unidad, con la finalidad de agruparlas y categorizarlas, para facilitar posteriormente la intervención enfermera en estos casos. Se incluyen en este plan de cuidados un total de 10 familias correspondientes a los 10 pacientes ingresados con diagnóstico de AN para el período estudiado. En todos los casos las pacientes son mujeres adolescentes que han recibido tratamiento previo, desde un dispositivo ambulatorio, con respuesta parcial o nula al tratamiento. Las dificultades familiares expresadas se han agrupado en cinco categorías a partir del análisis de su contenido: problemas para la elaboración de una dieta equilibrada, problemas para el manejo emocional/conductual de la paciente, problemas por inexistencia de hábitos alimentarios familiares previos, problemas por escaso control y supervisión familiar, y problemas por negativa/incumplimiento general de las pautas establecidas. Se proponen para estas categorías distintas intervenciones individuales específicas, desarrolladas e implementadas en el plan de cuidados de enfermería, y se evalúan los resultados de dichas intervenciones (AU)

One of the main nursing interventions in the treatment of eating disorders is family psycho-education, an essential aspect of mental health treatment. This article describes and analyses the difficulties families expressed in the performance of a treatment plan for patients hospitalised for anorexia nervosa (AN) in the adolescent Day Hospital of Mental Health, of the Corporació Sanitària Parc Taulí, during 2009. Data was also collected data on professional interventions, performed by the nurse assigned to this unit, in order to group and categorise them, and as an aid to nursing intervention. A total of 10 families of the 10 patients admitted with a diagnosis of AN were included in the study period. In all cases, the patients were young women who had received treatment before in an Outpatient Unit, with partial or no response to the treatment. The difficulties expressed by the families were grouped into five categories from content analysis: problems in preparing a balanced diet, problems as they are unable to handle the behaviour and emotions of the patient, problems because as there are no previous family eating habits, problems because there is no family control or supervision, and problems with the established guidelines. Specific individualised interventions are proposed for developing and promoting a nursing care plan, and assessing the results (AU)

[Nursing intervention in the family treatment plan for anorexia nervosa]. / Intervención enfermera en el plan terapéutico familiar de la anorexia nerviosa.

One of the main nursing interventions in the treatment of eating disorders is family psycho-education, an essential aspect of mental health treatment. This article describes and analyses the difficulties families expressed in the performance of a treatment plan for patients hospitalised for anorexia nervosa (AN) in the adolescent Day Hospital of Mental Health, of the Corporació Sanitària Parc Taulí, during 2009. Data was also collected data on professional interventions, performed by the nurse assigned to this unit, in order to group and categorise them, and as an aid to nursing intervention. A total of 10 families of the 10 patients admitted with a diagnosis of AN were included in the study period. In all cases, the patients were young women who had received treatment before in an Outpatient Unit, with partial or no response to the treatment. The difficulties expressed by the families were grouped into five categories from content analysis: problems in preparing a balanced diet, problems as they are unable to handle the behaviour and emotions of the patient, problems because as there are no previous family eating habits, problems because there is no family control or supervision, and problems with the established guidelines. Specific individualised interventions are proposed for developing and promoting a nursing care plan, and assessing the results.

[Profile of adolescents with social withdrawal admitted to a partial hospitalization unit of Mental Health]. / Perfil de los adolescentes con retraimiento social ingresados en una Unidad de Hospitalización Parcial de Salud Mental.

OBJECTIVE: To analyse the general characteristics of teenagers admitted to the Day Care Unit who fulfilled the criteria of social withdrawal, in order to implement a specific action plan within the existing resources for adolescents. METHOD: In this retrospective descriptive observational study, data were collected from withdrawal adolescent teenagers admitted to the unit over the year 2008. The data analysed were personal variables, diagnostic assessment on discharge, IQ assessment and Scale for Assessment of Communication and Interaction Skills and truancy. RESULTS: Of the 76 adolescents admitted to the unit, a total of 33 teenagers with social isolation were included in this study (43%). They had an average age of 15 years, an equal distribution between sexes and with a stay in the Unit 33 days longer than the general population studied. The average intellectual quotient of the social isolation group did not exceed the lower zone of the Weschler Scale (<80), and they scored below 50 points in the Scale for Assessment of Communication and Interaction Skills. CONCLUSIONS: The present research has enabled us to quantify the withdrawal phenomenon and some of its characteristics in a sample of adolescents admitted to the unit, in order to develop an interdisciplinary treatment program that allows us to address social withdrawal using a more holistic and effective approach.

Perfil de los adolescentes con retraimiento social ingresados en una Unidad de Hospitalización Parcial de Salud Mental / Profile of adolescents with social withdrawal admitted to a partial hospitalization unit of Mental Health

Objetivo. Analizar las características generales de los adolescentes ingresados en la unidad de hospitalización parcial que cumplan los criterios de retraimiento social, con la finalidad de establecer un plan de trabajo específico hacia los adolescentes en el dispositivo con los recursos existentes. Método. En este estudio observacional descriptivo retrospectivo, se recopilaron los datos de los adolescentes con retraimiento social ingresados en la unidad durante todo el año 2008, analizándose las variables personales, orientación diagnóstica al alta, valoración del cociente intelectual y de la escala de evaluación de las habilidades de comunicación e interacción y absentismo escolar. Resultados. De los 76 adolescentes ingresados en la unidad, un total de 33 chicos con retraimiento social fueron incluidos en el presente estudio (43%), presentando una edad media de 15 años, distribución equitativa entre sexos y con estancia en el dispositivo 33 días superior que en la población general estudiada. Todos los casos estudiados no superaban los 50 puntos en la escala escala de evaluación de las habilidades de comunicación e interacción. Conclusiones. El presente estudio nos ha permitido cuantificar el fenómeno y algunas de sus características, en una muestra de adolescentes ingresados en la unidad, con la finalidad de elaborar un programa terapéutico interdisciplinar que nos permita abordar el retraimiento social con perspectiva integral y de forma más eficaz

Objective. To analyse the general characteristics of teenagers admitted to the Day Care Unit who fulfilled the criteria of social withdrawal, in order to implement a specific action plan within the existing resources for adolescents. Method. In this retrospective descriptive observational study, data were collected from withdrawal adolescent teenagers admitted to the unit over the year 2008. The data analysed were personal variables, diagnostic assessmnet on discharge, IQ assessment and Scale for Assessment of Communication and Interaction Skills and truancy. Results. Of the 76 adolescents admitted to the unit, a total of 33 teenagers with social isolation were included in this study (43%). They had an average age of 15 years, an equal distribution between sexes and with a stay in the Unit 33 days longer than the general population studied. The average intellectual quotient of the social isolation group did not exceed the lower zone of the Weschler Scale (<80), and they scored below 50 points in the Scale for Assessment of Communication and Interaction Skills. Conclusions. The present research has enabled us to quantify the with drawal phenomenon and some of its characteristics in a sample of adolescents admitted to the unit, in order to develop an interdisciplinary treatment program that allows us to address social withdrawal using a more holistic and effective approach(AU)