Exploratory Study of the Clinical Characteristics of Adolescent Girls with a History of Physical or Sexual Abuse Consulting in a Mood Disorder Clinic.

OBJECTIVE: To examine the clinical characteristics of adolescent girls consulting in a mood disorder clinic with a history of physical or sexual abuse. METHOD: A retrospective review was conducted of the charts of 55 adolescent girls consulting in a mood disorder clinic. An analysis grid was used to gather data on demographics, personal antecedents, symptoms and diagnoses. Girls with a history of physical or sexual abuse were compared with girls without such a history. Univariate analyses and a logistic regression analysis were performed. RESULTS: Adolescent girls with a history of physical or sexual abuse did not differ statistically from those without such a history in terms of depressive symptoms or type and number of diagnoses. However, proportionally more girls with a history of physical or sexual abuse presented self-harm and relational problems with their parents and peers. CONCLUSION: Both history of physical or sexual abuse and self-destructive behaviors are rooted in relational problems. The results show that these are related to one another among those adolescent girls. Clinically, these findings suggest that it is important for clinicians do a thorough exploration of self-destructive behaviors and family and peer relations when assessing depressed adolescent girls.

OBJECTIF: Examiner les caractéristiques cliniques des adolescentes consultant à une clinique des troubles de l'humeur et ayant été victime d'abus physique ou sexuel dans le passé. MÉTHODE: Une étude rétrospective de 55 dossiers d'adolescentes a été réalisée. Une grille d'analyse fut utilisée pour recueillir les données sociodémographiques, les antécédents personnels, les symptômes et les diagnostics. Les adolescentes ayant été victime d'abus physique ou sexuel dans le passé ont été comparées à d'autres adolescentes sans histoire d'abus. Une analyse univariée et une analyse de régression logistique ont été effectuées. RÉSULTATS: Les adolescentes ayant été victimes d'abus physiqueou sexuel ne différaient pas statistiquement de celles sans histoire d'abus, en ce qui a trait aux symptômes dépressifs, ou au type et au nombre de diagnostics. Toutefois, elles présentaient une proportion plus élevée d'automutilation et de problèmes relationnels avec leurs parents et leurs pairs. CONCLUSION: Un passé de victimisation physique ou sexuel et des comportements autodestructeurs traduisent des problèmes relationnels. Les résultats montrent que ces variables sont reliées l'une à l'autre chez ces adolescentes ayant été victimes d'abus physique ou sexuel. Ce résultat suggère l'importance pour le clinicien d'explorer en profondeur les comportements autodestructeurs ainsi que les relations avec la famille et les pairs lors de l'évaluation des adolescentes dépressives.

Comparison of the Effects of Telephone Suicide Prevention Help by Volunteers and Professional Paid Staff: Results from Studies in the USA and Quebec, Canada.

Research since the 1960s has consistently found that lay volunteers are better at helping suicidal callers than professionals. Yet, professional degrees are increasingly becoming requirements for helpline workers. In our first study, we conducted post hoc comparisons of U.S. helplines with all professional paid staff, all lay volunteers, and a mix of both, using silent monitoring and standardized assessments of 1,431 calls. The volunteer centers more often conducted risk assessments, had more empathy, were more respectful of callers, and had significantly better call outcome ratings. A second study of five Quebec suicide prevention centers used silent monitoring to compare telephone help in 1,206 calls answered by 90 volunteers and 39 paid staff. Results indicate no significant differences between the volunteers and paid employees on outcome variables. However, volunteers and paid staff with over 140 hours of call experience had significantly better outcomes. Unlike the United States, Quebec paid employees were not required to have advanced professional degrees. We conclude from these results and previous research that there is no justification for requiring that suicide prevention helpline workers be mental health professionals. In fact, the evidence to date indicates that professionals may be less effective in providing telephone help to suicidal individuals when compared to trained lay volunteers.

Psychometric properties of three measures of protective factors for depression and suicidal behaviour among adolescents.

OBJECTIVES: To assess the reliability of French versions of the Adolescent Coping Scale (ACS), the Reasons for Living Inventory for Adolescents (RFL-A), and the Spirituality Scale (SS); to examine the construct validity of these psychometric instruments; and to determine their convergent validity with French versions of the Life Events Questionnaire for Adolescents (LEQ-A), the Beck Depression Inventory-Second Edition (BDI-II), and the Beck Hopelessness Scale (BHS) among French-Canadian adolescents. METHODS: Participants were 429 adolescents from high schools (n = 283) and the Mood Disorder Clinic (n = 146) in Montreal. The instruments were translated into French following the back-translation method. The internal consistency was assessed through Cronbach alpha coefficients. Exploratory analyses were conducted to document the content of their dimensions. Convergent validity was examined by correlating the ACS, the RFL-A, and the SS with the French versions of the LEQ-A, the BDI-II, and the BHS. RESULTS: The findings confirm that the ACS, RFL-A, and SS are psychometric instruments well suited to assess protective factors for depression and suicidal behaviour among French-speaking adolescents in community and clinical settings. However, results must be interpreted with some circumspection as 2 SS subscales obtained reliability coefficients in the moderate range only and the instructions for the RFL-A were reframed in response to ethical considerations. CONCLUSIONS: Our results add to those already available on the original English versions of the ACS, RFL-A, and SS and advance the knowledge of the psychometric properties of protective measures.

Comparing models of helper behavior to actual practice in telephone crisis intervention: a Silent Monitoring Study of Calls to the U.S. 1-800-SUICIDE Network.

Models of telephone crisis intervention in suicide prevention and best practices were developed from a literature review and surveys of crisis centers. We monitored 2,611 calls to 14 centers using reliable behavioral ratings to compare actual interventions with the models. Active listening and collaborative problem-solving models describe help provided. Centers vary greatly in the nature of interventions and their quality according to predetermined criteria. Helpers do not systematically assess suicide risk. Some lives may have been saved but occasionally unacceptable responses occur. Recommendations include the need for quality assurance, development of standardized practices and research relating intervention processes to outcomes.

Which helper behaviors and intervention styles are related to better short-term outcomes in telephone crisis intervention? Results from a Silent Monitoring Study of Calls to the U.S. 1-800-SUICIDE Network.

A total of 2,611 calls to 14 helplines were monitored to observe helper behaviors and caller characteristics and changes during the calls. The relationship between intervention characteristics and call outcomes are reported for 1,431 crisis calls. Empathy and respect, as well as factor-analytically derived scales of supportive approach and good contact and collaborative problem solving were significantly related to positive outcomes, but not active listening. We recommend recruitment of helpers with these characteristics, development of standardized training in those methods that are empirically shown to be effective, and the need for research relating short-term outcomes to long-term effects.

Psychiatric services utilization in completed suicides of a youth centres population.

BACKGROUND: From a retrospective study of youth centres (YCs) and coroner's files, we investigated youths' history of medical service utilization who died by suicide. This is the second of two papers on YCs population, the first paper having shown that the rate of psychopathology was higher in the YCs population compared to the general adolescent population. METHODS: From 1995 to 2000, 422 youths, aged 18 years and younger, died as a result of suicide in Quebec. More than one-third received services from YCs at some point. Using the provincial physician payment and hospitalization database, we examined physical and psychiatric service utilization according to time intervals, as well as hospitalization for psychiatric reasons in the individuals' lifetime and in the year preceding suicide. Suicides were matched to living YCs youths for age, sex, and geographic area. YCs controls were then subdivided into two groups based on file information pertaining to the presence or absence of suicidal behavior or ideation. RESULTS: Compared to living YCs youths, suicides had a higher rate of psychiatric service utilization in the week, month, 90 days, and year preceding suicide, as well as higher levels of lifetime hospitalization for psychiatric reasons than controls with or without a history of suicidal behavior or ideation. We found that 28.3% YCs suicides made use of psychiatric services in the year preceding suicide. CONCLUSION: The rate of psychiatric service utilization by YCs youth suicides is substantially inferior to the needs of this population. Our study underscores the need for appropriate recognition of psychiatric and suicidal problems among YCs population by social and psycho-educational professionals. At the same time, it highlights the issues of general practitioners' risk identification, psychiatric referral and treatment. Our findings suggest the need for improved organization and coordination of psychiatric services to ameliorate treatment delivery.