A Youth Suicide Prevention Plan for Canada: A Systematic Review of Reviews.

OBJECTIVE: We conducted an expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based strategies and nonschool-based interventions designed to prevent repeat attempts. METHODS: Systematic review of review methods were applied. Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations derived from the findings. RESULTS: No included review addressing school-based prevention (n = 7) reported decreased suicide death rates based on randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts (n = 14) found the following: emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness. Consensus on 6 recommendations ranged from 73% to 100%. CONCLUSIONS: Our EKS facilitates decision maker access to what is known about effective youth suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention.

Tying together research and practice: using ROPE for successful partnerships in school mental health.

There is solid evidence for strategies and programs that, if implemented with fidelity in schools, will enhance the mental health of children and youth. These practices are, however, inconsistently applied and rarely evaluated programmatically in every day practice. In recent years, implementation variables that influence uptake have received attention. An emerging area of interest is the role that research partnerships might play in narrowing the gap between science and practice. Drawing on the literature and practice examples, collaborators from the United States and Canada explore the role of partnerships in bringing the worlds of research and practice closer into alignment.

Pediatric suicide-related presentations: a systematic review of mental health care in the emergency department.

STUDY OBJECTIVE: We evaluate the effectiveness of interventions for pediatric patients with suicide-related emergency department (ED) visits. METHODS: We searched of MEDLINE, EMBASE, the Cochrane Library, other electronic databases, references, and key journals/conference proceedings. We included experimental or quasiexperimental studies that evaluated psychosocial interventions for pediatric suicide-related ED visits. Inclusion screening, study selection, and methodological quality were assessed by 2 independent reviewers. One reviewer extracted the data and a second checked for completeness and accuracy. Consensus was reached by conference; disagreements were adjudicated by a third reviewer. We calculated odds ratios, relative risks (RRs), or mean differences for each study's primary outcome, with 95% confidence intervals (CIs). Meta-analysis was deferred because of clinical heterogeneity in intervention, patient population, and outcome. RESULTS: We included 7 randomized controlled trials and 3 quasiexperimental studies, grouping and reviewing them according to intervention delivery: ED-based delivery (n=1), postdischarge delivery (n=6), and ED transition interventions (n=3). An ED-based discharge planning intervention increased the number of attended post-ED treatment sessions (mean difference=2.6 sessions; 95% CI 0.05 to 5.15 sessions). Of the 6 studies of postdischarge delivery interventions, 1 found increased adherence with service referral in patients who received community nurse home visits compared with simple placement referral at discharge (RR=1.28; 95% CI 1.06 to 1.56). The 3 ED transition intervention studies reported (1) reduced risk of subsequent suicide after brief ED intervention and postdischarge contact (RR=0.10; 95% CI 0.03 to 0.41); (2) reduced suicide-related hospitalizations when ED visits were followed up with interim, psychiatric care (RR=0.41; 95% CI 0.28 to 0.60); and (3) increased likelihood of treatment completion when psychiatric evaluation in the ED was followed by attendance of outpatient sessions with a parent (odds ratio=2.78; 95% CI 1.20 to 6.67). CONCLUSION: Transition interventions appear most promising for reducing suicide-related outcomes and improving post-ED treatment adherence. Use of similar interventions and outcome measures in future studies would enhance the ability to derive strong recommendations from the clinical evidence in this area.

Factors in the psychological adjustment of homeless adolescent males: the role of coping style.

OBJECTIVE: This cross-sectional study explored differences in and the association of self-reported coping style, negative life events, self-esteem, and perceived social support with the psychological adjustment (i.e., depressive symptoms, internalizing and externalizing behavior problems) of homeless and nonhomeless adolescent males. METHOD: Data were collected from 100 youths accessing an emergency shelter and two comparison groups of nonhomeless youths: 70 youths accessing local community drop-in centers and 54 high school youths who had never accessed a shelter or drop-in. Data were collected from January 2000 to January 2001 in Ottawa. RESULTS: Homeless youths reported a higher prevalence of family dysfunction, school difficulties, suicide attempts, legal problems, and substance use than nonhomeless youths. Homeless youths differed from nonhomeless youths for each outcome measure, reporting a greater use of the disengagement coping style, higher negative life events index, less perceived parental support, and higher levels of depressive symptoms and internalizing and externalizing behavior problems. Hierarchical regression analyses indicated that disengagement coping and self-worth accounted for significant amounts of variance in depressive symptomatology, and both internalizing and externalizing behavior problems in homeless youths. CONCLUSIONS: Findings reflect the merit of considering coping style as a factor in the prevalence of psychological maladjustment among homeless youths.

Emotionally focused interventions for couples with chronically ill children: a 2-year follow-up.

Couples with chronically ill children are particularly at risk for experiencing marital distress. The study presented here is a 2-year follow-up of a randomized control trial that assessed the efficacy of Emotionally Focused Therapy (EFT) in decreasing marital distress in a sample of couples with a chronically ill child. Thirteen couples with chronically ill children who received treatment were assessed to determine if the significant improvement in relationship distress observed at posttreatment and 5-month follow-up would be maintained at 2-year follow-up. Results demonstrated that improvements in marital functioning were not only maintained but, in some cases, enhanced at the 2-year follow-up. This uncontrolled follow-up study provides initial evidence of the longer-term benefits of EFT.

Innovations in mental health promotion: Youth Net/Réseau Ado.

Today's youth are at a disturbingly high risk for mental health and illness problems and are largely dissatisfied with the existing mental health services. Youth Net/Réseau Ado (YN/RA), supported by input from mental health professionals, is a bilingual mental health promotion program that seeks out the opinions and attitudes of youth regarding mental health and illness issues, while connecting them with appropriate resources and mental health services. This paper describes the Youth Net/Réseau Ado program and provides some guidelines for the identification of mental health and illness problems, including indicators of the risk of suicide.

Les adolescents d'aujourd'hui présentent un risque inquiétant de troubles psychologiques ou affectifs et se montrent très insatisfaits face aux services existants en santé mentale. Réseau ado/Youth Net (RA/YN), soutenu par l'apport des professionnels de la santé, est un programme bilingue de promotion de la santé mentale qui cherche à solliciter les opinions et les attitudes des adolescents au sujet de la santé mentale et des maladies s'y reliant, tout en orientant ceux-ci vers les ressources et les services pertinents. Cet article décrit le programme Réseau ado/Youth Net et contient des directives pour identifier les troubles de santé et de maladie mentale, y compris les indicateurs de risque de suicide.