Pediatric suicide attempts lagged during the COVID-19 pandemic: a European multicenter study.

BACKGROUND: Elevated rates of suicidal behavior were reported during the COVID-19 pandemic. However, information is scarce on patients' profiles during this period. Studies evoke the potential adverse effects of the mandatory lockdown, but they remain relatively speculative. METHODS: We monitored fluctuations in suicide attempts (SA) in six European countries. We gathered data, retrospectively for under 18-year-old SA episodes (1 January 2018 to 31 December 2021), through records of psychiatric emergency services. We collected clinical profiles individually. We extracted environmental indicators by month, as provided by Oxford COVID-19 Government Response Tracker (OxCGRT). We used the Pruned Exact Linear Time (PELT) method to identify breakpoints in SA episodes reported for each country, and logistic regressions to estimate changes in patients' characteristics after the breakpoints. Finally, we used a univariate and multivariate negative binomial model to assess the link between SA and OxCGRT indicators, accounting for the delay (lag) between the interventions and their impact on SA. RESULTS: The study comprised 2,833 children and adolescents (mean age = 15.1 years (SD 1.6); M: F sex-ratio = 1:5.4). A significant increase in SA was found either 6 or 10 months after the beginning of the pandemic, varying by country. Patients were more likely to be girls (aOR = 1.77 [1.34; 2.34]) and used SA methods "other than self-poisoning" (aOR = 1.34 [1.05; 1.7]). In the multivariate model, an association was found between SA and the contact tracing indicator with an 11 months delay, and the number of COVID-19 deaths with a 3-months delay. CONCLUSIONS: Findings confirmed a delayed increase in SA during the COVID-19 pandemic in children and adolescents as well as changes in patients' profiles. The duration and severity of the pandemic emerged as the strongest predictor in the rise of SA. If faced with a similar pandemic in the future, the gap between the onset of pandemic and the increase in suicide attempts presents an opportunity for prevention.

Abdominal pain in British young people: associations, impairment and health care use.

OBJECTIVE: To assess the frequency and associations of abdominal pain in a sample of British secondary school young people and to examine predictors of impairment and health care use. METHODS: Cross-sectional study of young people aged 11-16 years that completed questionnaires documenting abdominal pain, related impairment and health care consultations. They also provided information detailing other physical symptoms, health problems and mental health status. RESULTS: 1173 students completed questionnaires; 598 (53%) reported abdominal pains in the previous 3 months (15% >once a week). Pains were significantly linked to reporting medical illness, to high levels of a broad range of physical symptoms and with students deeming these symptoms to be stress/mood sensitive. They were also linked to depressive and other emotional and behavioural problems and with medical help seeking (seeing a health professional in the previous year and contact ever with mental health practitioners). Considerable impairment was reported by 36%; this was independently predicted by abdominal pain frequency, higher levels of concurrent physical symptoms and symptom stress/mood sensitivity. In 18% of students the abdominal pains had led to medical consultations; this was independently predicted by pain related impairment. CONCLUSIONS: Frequent abdominal pains are common in British secondary school adolescents; they are linked to emotional symptoms and are often impairing and lead to medical consultations. Impairment was associated not only to pain frequency but also to reporting other physical symptoms and symptom stress/mood sensitivity, and impairment was a strong predictor of medical help seeking.

Therapeutic identification of depression in young people: lessons from the introduction of a new technique in general practice.

BACKGROUND: Mild-to-moderate depression in young people is associated with impaired social functioning and high rates of affective disorder in adult life. Earlier recognition of depression in young people has the potential to reduce the burden of depression in adulthood. However, depression in teenagers is underdiagnosed and undertreated. AIM: To assess the usability and usefulness of a cognitive-behavioural-therapy-based technique for Therapeutic Identification of Depression in Young people (TIDY). DESIGN AND SETTING: A qualitative study of four group practices in northwest London. METHOD: Face-to-face semi-structured interviews were conducted with practitioners who had been trained in the use of the TIDY technique. RESULTS: Twenty-five GPs and six nurses were interviewed. The key themes that emerged from the interviews were: practitioners were 'making sense of teenage depression' when interpreting signs and symptoms; the training in the technique was variable in its impact on practitioners' attitudes and practice; and time factors constrained practitioners in the application of the technique. CONCLUSION: The TIDY technique is usable in routine practice, but only if practitioners are allowed to use it selectively. This need for selectivity arises partly from concerns about time management, and partly to avoid medicalisation of psychological distress in young people. The perceived usefulness of the TIDY technique depends on the practitioner's prior knowledge, experience, and awareness.

Adolescents who are frequent attenders to primary care: contribution of psychosocial factors.

BACKGROUND: Frequent attendance to primary care services has shown an association with psychosocial factors in adult and child populations. Little is known about the psychosocial correlates of attendance in adolescents. AIMS OF THE STUDY: To study the contribution of psychosocial factors to frequent primary care attendance in a community sample of young British people. METHOD: The method used was a cross-sectional survey of 1,251 secondary school pupils, using self-report questionnaires for socio-demographic, physical and psychological health data. RESULTS: A total of 1,116 pupils [mean age 13.51 years (SD 1.5), 52% female] completed questionnaires and provided information about contact with their general practitioner (GP) in the previous year; 30% were frequent attenders (≥4 appointments). Frequent attenders were significantly younger; they were more likely to come from lower socioeconomic backgrounds, report significantly more past and current physical problems, have more hospital visits in the previous year, have more recent intense somatic symptoms made worse by stress and causing impairment, and have more days off school. Frequent attendance was also significantly associated with the presence of emotional symptoms and a history of mental health consultations. Logistic regression analysis identified seeing a hospital doctor, current illness, having days off school, a history of mental health consultations and younger age as independent predictors of frequent attendance. CONCLUSION: In addition to physical health problems, social factors and psychiatric difficulty are linked to and require attention in young people who are frequent attenders at primary care health services.

Assessment of somatic symptoms in British secondary school children using the Children's Somatization Inventory (CSI).

OBJECTIVE: To present normative and psychometric data on somatic symptoms using the Children's Somatization Inventory (CSI) in a nonclinical sample of British young people, and to assess associations with stress and functional impairment. METHODS: A total of 1,173 students (11- to 16-years old) completed the CSI and self-report psychopathology measures. RESULTS: The median CSI total score was 12 (5, 23). Headaches, feeling low in energy, sore muscles, faintness, and nausea were most frequent. Girls scored higher than boys, and respondents aged 13-14 years lower than younger children. The CSI showed good internal consistency and exploratory factor analysis yielded three factors: pain/weakness, gastrointestinal, and pseudoneurological. A quarter of respondents reported somatic symptoms were made worse by stress. CSI scores were moderately significantly correlated with impairment and emotional symptoms. CONCLUSIONS: The CSI, complemented by information on functional impairment and stress is an appropriate measure of recent somatic symptoms and somatization risk in young people for use in the UK.