Psychological treatments for depression in pre-adolescent children (12 years and younger): systematic review and meta-analysis of randomised controlled trials.

The objective of this study was to evaluate the efficacy of psychological treatments for depression in pre-adolescent children, a disorder affecting 1-2 % of children in this age range. A systematic review of studies of psychological interventions to treat depressive disorder in pre-adolescent children (aged up to 12-years-old) was carried out. The primary outcome was level of depressive symptoms. Studies were found using Medline, PsycINFO, EMBASE and Web of Knowledge databases and selected on several criteria. Only randomised controlled trials were included. Where individual studies covered a broader age range (usually including adolescents up to age 18 years), authors of those studies were contacted and requested to provide individual patient level data for those aged 12 years and younger. 2822 abstracts were reviewed, and from these 124 full text articles were reviewed, yielding 7 studies for which we were able to access appropriate data for this review. 5 of these studies evaluated cognitive behaviour therapy (CBT). Combined results from these studies suggest that there is a lack of evidence that CBT is better than no treatment [standard mean difference -0.342 (95 % confidence interval -0.961, 0.278)], although the number of participants included in the trials was relatively small. The evidence for efficacy of family therapy and psychodynamic therapy is even more limited. The very limited number of participants in randomised controlled trials means that there is inconclusive evidence for the psychological treatment of depression in children aged 12 years and below. Given the prevalence and significant impact of this disorder, there is an urgent need to establish the effectiveness or otherwise of psychological intervention.

Trastornos psiquiátricos en los casos de suicidio consumado en un área hospitalaria entre 2007-2010 / Psychiatric disorders in cases of completed suicide in a hospital area in Spain between 2007 and 2010

Introducción: El suicidio es un importante problema de salud pública. Uno de los principales factores de riesgo conocidos para el suicidio es el padecimiento de patología psiquiátrica que se identifica en un 90-95% de suicidios consumados, incrementándose el riesgo si existe comorbilidad. Los resultados internacionales sobre la patología psiquiátrica más frecuente son dicotómicos, divididos entre los trastornos del humor y los trastornos psicóticos, si bien los datos en nuestro entorno sobre casos de suicidio consumado son muy escasos. Metodología: El presente estudio describe las características psiquiátricas y forenses de los casos de suicidio consumado (n=79) acontecidos en la región asistencial de un hospital psiquiátrico entre 2007 y 2010. Los datos forenses fueron obtenidos en el Instituto de Medicina Legal de Catalunya y los datos clínicos a partir de la revisión de las historias clínicas. Resultados: La mayoría de los sujetos fallecidos por suicidio consumado en la muestra de referencia fueron varones (78,5%) (IC 68,4%-87,3%). El 45,5% (IC 33,8%-57,1%) (35 de 77) de los fallecidos disponía de historia en el circuito de salud mental y/o toxicomanías de la zona, desconociéndose los antecedentes de dos de los fallecidos por tratarse de menores de edad. De los 35 individuos con historia en el circuito de salud mental, el 54,3% (IC 37,1%-71,4%) presentaba un trastorno afectivo; (37,1%, IC 22,9%-51,4%) trastorno depresivo; 14,3% (IC 2,9%-25,7%) trastorno bipolar y el 17,1% (IC 5,7%-31,4%) un trastorno del espectro psicótico. Además, el 48,6% presentaba comorbilidad psiquiátrica no relacionada con tóxicos y el 42,9% (IC 25,7%-60,0%) comorbilidad con trastornos relacionados con sustancias. Conclusiones: Las características psiquiátricas y forenses del fenómeno del suicidio consumado en nuestro entorno confirman los datos internacionales sobre una tasa elevada de patología psiquiátrica y un patrón característico en cuanto a metodología suicida (AU)

Introduction: Suicide is an important Public Health problem. One of the most relevant known risk factors for suicide is suffering from a mental health disorder, identified in up to 90-95% of completed suicides, with this risk being increased if comorbidity is present. Findings from international research on the most common psychiatric disorders are dichotomous, divided into mood disorders and psychotic disorders. In Spain, data of this kind are scarce. Methods: This study describes the psychiatric and forensic characteristics of completed suicide cases (n=79) ocurred in a psychiatric hospital healthcare area (in Spain), between 2007 and 2010. The forensic data were obtained from the Institute of Legal Medicine of Catalonia and the clinical data by reviewing the clinical records. Results: Most of the subjects in this sample were males (78.5%, 95% CI; 68.4%-87.3%). Almost half of the sample (45.4%, 95% CI; 33.8%-57.1%, 35/77) had records in the Mental Health Services Network (including substance misuse services). Two of the 79 were under 18, so we were not able to access the records. More than half (54.3%, 95% CI; 37.1%-71.4%) of those with psychiatric history suffered from a mood disorder; 37.1% (95% CI; 22.9%-51.4% from a depressive disorder; 14.3% (95% CI; 2.9%-25.7%) from a bipolar disorder, and 17.1% (95% CI; 5.7%-31.4%) suffered from a psychotic disorder. With regard to substance misuse, 42.9% (95% CI; 25.7%-60.0%) presented substance misuse, and 48.6% did not. Conclusions: Psychiatric and forensic characteristics of completed suicide in this Spanish sample confirm previous findings from international studies: there is a high rate of psychiatric disorders in those who complete suicide, and there is a specific pattern as regards the method used to complete it (AU)

Psychiatric disorders in cases of completed suicide in a hospital area in Spain between 2007 and 2010.

INTRODUCTION: Suicide is an important Public Health problem. One of the most relevant known risk factors for suicide is suffering from a mental health disorder, identified in up to 90-95% of completed suicides, with this risk being increased if comorbidity is present. Findings from international research on the most common psychiatric disorders are dichotomous, divided into mood disorders and psychotic disorders. In Spain, data of this kind are scarce. METHODS: This study describes the psychiatric and forensic characteristics of completed suicide cases (n=79) ocurred in a psychiatric hospital healthcare area (in Spain), between 2007 and 2010. The forensic data were obtained from the Institute of Legal Medicine of Catalonia and the clinical data by reviewing the clinical records. RESULTS: Most of the subjects in this sample were males (78.5%, 95% CI; 68.4%-87.3%). Almost half of the sample (45.4%, 95% CI; 33.8%-57.1%, 35/77) had records in the Mental Health Services Network (including substance misuse services). Two of the 79 were under 18, so we were not able to access the records. More than half (54.3%, 95% CI; 37.1%-71.4%) of those with psychiatric history suffered from a mood disorder; 37.1% (95% CI; 22.9%-51.4% from a depressive disorder; 14.3% (95% CI; 2.9%-25.7%) from a bipolar disorder, and 17.1% (95% CI; 5.7%-31.4%) suffered from a psychotic disorder. With regard to substance misuse, 42.9% (95% CI; 25.7%-60.0%) presented substance misuse, and 48.6% did not. CONCLUSIONS: Psychiatric and forensic characteristics of completed suicide in this Spanish sample confirm previous findings from international studies: there is a high rate of psychiatric disorders in those who complete suicide, and there is a specific pattern as regards the method used to complete it.