Twelve-month service use, suicidality and mental health problems of European adolescents after a school-based screening for current suicidality.

Suicide is one of the leading causes of death in adolescents and help-seeking behaviour for suicidal behaviour is low. School-based screenings can identify adolescents at risk for suicidal behaviour and might have the potential to facilitate service use and reduce suicidal behaviour. The aim of this study was to assess associations of a two-stage school-based screening with service use and suicidality in adolescents (aged 15 ± 0.9 years) from 11 European countries after one year. Students participating in the 'Saving and Empowering Young Lives in Europe' (SEYLE) study completed a self-report questionnaire including items on suicidal behaviour. Those screening positive for current suicidality (first screening stage) were invited to an interview with a mental health professional (second stage) who referred them for treatment, if necessary. At 12-month follow-up, students completed the same self-report questionnaire including questions on service use within the past year. Of the N = 12,395 SEYLE participants, 516 (4.2%) screened positive for current suicidality and were invited to the interview. Of these, 362 completed the 12-month follow-up with 136 (37.6%) self-selecting to attend the interview (screening completers). The majority of both screening completers (81.9%) and non-completers (91.6%) had not received professional treatment within one year, with completers being slightly more likely to receive it (χ2(1) = 8.948, V = 0.157, p ≤ 0.01). Screening completion was associated with higher service use (OR 2.695, se 1.017, p ≤ 0.01) and lower suicidality at follow-up (OR 0.505, se 0.114, p ≤ 0.01) after controlling for potential confounders. This school-based screening offered limited evidence for the improvement of service use for suicidality. Similar future programmes might improve interview attendance rate and address adolescents' barriers to care.

Enesetappude ja enesetapukatsete epidemioloogiline ülevaade Eestis: uuringu raport

WHO on pidanud suitsiidikäitumise (enesetappude ja enesetapukatsete) registreerimise kvaliteeti, ajakohase epidemioloogilise ülevaate omamist globaalselt ning enesetappude ennetamist kõigis maailma maades väga oluliseks teemaks pika aja vältel. Suitsiidikäitumisega seonduv oli üheks oluliseks teemaks WHO vaimse tervise tegevuskavas (WHO, 2013), kus aastaks 2020 seati kaks globaalset eesmärki: (1) 80%-il maadest on olemas toimiv üleriigiline ja sektorite ülene vaimse tervise edendamise ja ennetamise programm; (2) suitsiidikordaja on riigiti vähenenud 10% võrra. Eesti pole kahjuks nende eesmärkide täitmiseni jõudnud. Käesoleva raporti eesmärk on anda epidemioloogiline ülevaade suitsiidikäitumisest (enesetapud ja enesetapukatsed) Eestis 21. sajandil rõhuasetusega viimastele aastatele, kasutades selleks Tervise Arengu Instituudi surmapõhjuste registri ja Eesti Haigekassa andmebaasi agregeeritud andmestikke. Seejuures on eraldi tähelepanu pööratud sotsiaal-demograafilistest teguritest tulenevale ebavõrdsusele ning suitsiidikäitumise registreerimise kvaliteedile. Raport on sisendiks Sotsiaalministeeriumi poolt koostatavale enesetappude ennetamise tegevuskavale.

Factors associated with different smoking status in European adolescents: results of the SEYLE study.

Early onset and long-term smoking are associated with physical and psychological health problems. The aim of the presented analysis was to investigate risk and influencing factors for different smoking status in a big sample of European adolescents. In the context of the "saving and empowering young lives in Europe" (SEYLE) study we surveyed 12,328 adolescents at the age of 13-17 from 11 countries. The survey took place in a school-based context using a questionnaire. Overall 58% reported the onset of ever-smoking under the age of 14 and 30.9% smoke on a daily basis. Multinomial logistic regression model showed significant positive associations between adolescent smoking and internalizing problems (suicidal behavior, direct self-injurious behavior, anxiety), externalizing problems (conduct problems, hyperactivity, substance consumption) and family problems (parental substance consumption, broken home). Our data show that smoking among adolescents is still a major public health problem and adolescents who smoke are at higher risk for mental problems. Further, adolescent smoking is associated with broken home families and parental behaviors. Therefore, early preventive measures are necessary not only for adolescents, but also for their parents.

Sexual behavior, depressive feelings, and suicidality among Estonian school children aged 13 to 15 years.

BACKGROUND: The present paper is based on a WHO Collaborative Cross-National Study "Health Behavior in School-Aged Children (HBSC)." AIMS: It aimed at describing and analyzing how the sexual behaviors of 13- to 15-year-old Estonian school children were associated with self-reported depressive feelings and suicidality. Distinctive behavioral traits in relation to age of first sexual intercourse were also investigated. METHODS: Self-reported questionnaires from school children (n = 3,055) were analyzed. RESULTS: In total, 15.2% of school children reported being nonvirgin. Among 13-year-olds, 2.9% of girls and 6.8% of boys were nonvirgins. Approximately 25% of the 15-year-old girls and boys were nonvirgins. The likelihood of depressive feelings and suicidal ideation increased significantly in both genders with loss of virginity. Boys who had lost their virginity at 13 years or younger were 4.2 times more likely to have suicidal thoughts; comparable girls were 7.8 times more likely to have suicidal thoughts. Compared to virgins, youths who had lost their virginity reported poor self-assessed health and more risk behaviors in themselves and their peers. CONCLUSION: Experiences of sexual intercourse increased the odds ratios for depressive feelings and suicidality. The earlier sexual intercourse was initiated, the greater were the odds of lower mental well-being. Risk behaviors emerged as a complex phenomenon requiring complex prevention.

Suicide methods in Europe: a gender-specific analysis of countries participating in the "European Alliance Against Depression".

OBJECTIVE: To identify the most frequent gender-specific suicide methods in Europe. DESIGN: Proportions of seven predominant suicide methods utilised in 16 countries participating in the European Alliance Against Depression (EAAD) were reported in total and cross-nationally. Relative risk (RR) relating to suicide methods and gender was calculated. To group countries by pattern of suicide methods, hierarchical clustering was applied. SETTING AND PARTICIPANTS: Data on suicide methods for 119,122 male and 41,338 female cases in 2000-4/5 from 16 EAAD countries, covering 52% of European population were obtained. RESULTS: Hanging was the most prevalent suicide method among both males (54.3%) and females (35.6%). For males, hanging was followed by firearms (9.7%) and poisoning by drugs (8.6%); for females, by poisoning by drugs (24.7%) and jumping from a high place (14.5%). Only in Switzerland did hanging rank as second for males after firearms. Hanging ranked first among females in eight countries, poisoning by drugs in five and jumping from a high place in three. In all countries, males had a higher risk than females of using firearms and hanging and a lower risk of poisoning by drugs, drowning and jumping. Grouping showed that countries might be divided into five main groups among males; for females, grouping did not yield clear results. CONCLUSIONS: Research on suicide methods could lead to the development of gender-specific intervention strategies. Nevertheless, other approaches, such as better identification and treatment of mental disorders and the improvement of toxicological aid should be put in place.

Registration of external causes of death in the Baltic States 1970-1997.

BACKGROUND: Trends in external causes of deaths in the Baltic States--Estonia, Latvia and Lithuania--were analysed against the background of turbulent political, social and economic changes. The reliability of mortality statistics concerning external causes of death in these countries is considered to be good. METHOD: This study is based on data published by the statistical offices of the three Baltic States and on data obtained through interviews with personnel employed at the national statistical offices. The study period was divided, by socio-political and economic factors, into a period of stagnation (1970-1984) and a period of reforms (1985-1997). RESULTS: During 1970-1984 a stable slightly upward trend of external causes of death rates was observed. The curve became S-shaped in the reform period: between 1984 and 1988 a marked decrease occurred followed by a rapid increase of rates until 1994, and then by 1997 a fall to the approximate level of 1984. The male to female ratio of external causes of death was between 3.4:1 and 4.2:1. External deaths accounted for 10% to 14% of all deaths before 1984. During the period 1984-1988 the proportion of external deaths was under 10% and peaked in 1994 at 16%. Fluctuations in the trends of external death were more pronounced among males than females in all Baltic countries. CONCLUSION: Trends in external causes of death were similar in Baltic States. High proportions of violent death decreased life-expectancy for both sexes, but markedly for males. Social stresses and alcohol consumption could be considered as factors influencing the mortality rates and specific fluctuations in trends of external death, especially among males.

Regional differences in the distribution of suicide in the former Soviet Union during perestroika, 1984-1990.

The former USSR covered 22.4 million square kilometres and had a population of 288,362,296 in 1990. During 1984-1990 the former USSR consisted of 15 republics, which formed culturally, geographically and historically different regions. Yearly, approximately 45,000-50,000 males and 14,000-15,000 females committed suicide. Suicide rates in the former USSR during 1984-1990 varied greatly between different regions, from 3.5 cases per 100,000 inhabitants in the Caucasus (Georgia, Azerbaijan and Armenia) to 11.8 in Central Asia (Kazakhstan, Kirgizia, Turkmenistan, Uzbekistan and Tajikistan), 18.1 in Moldova, 25.6 in the Slavic region (Russia, the Ukraine and Belarus) and 28.0 in the Baltic region (Latvia, Lithuania and Estonia). The same pattern of great variation between different regions was observed for both men and women in the former USSR, with suicide rates for men ranging from 4.9 in the Caucasian region to 45.9 in the Baltics, and suicide rates for women ranging from 2.1 in the Caucasus to 12.3 in the Baltics.

Marked decrease in suicide among men and women in the former USSR during perestroika.

At the same time as substantial and rapid socio-political and socio-economic changes took place during the period of perestroika, suicide rates in the former USSR decreased by approximately 32% for men and 19% for women. The decreases in the suicide rates of men in the former USSR were unlike the suicide rate decreases taking place in 22 other European countries, where rates decreased by approximately 8% for men and 17% for women during this time period. Declines in suicide rates from 1984 to 1986-1988 occurred in all republics, with the largest decreases in Russia and Belarus, at 42% for men and 20% for women. The decrease in suicide rates of men in the former USSR was most pronounced until 1986-1988, after which time an increasing trend was observed. Suicide rates for men in the former USSR decreased 3.8-fold more than they did for men in other parts of Europe, while decreases in the suicide rates for women in the former USSR were on the same level as in Europe.

Age-specific suicide rates in the Slavic and Baltic regions of the former USSR during perestroika, in comparison with 22 European countries.

Age-specific differences in suicide rates in the Baltic and Slavic regions of the former USSR were studied for the period 1984-1990, and were compared to those of 22 European countries. It was observed that suicide rates per 100,000 inhabitants in the Slavic and Baltic regions increased directly with age for women, and showed a bimodal distribution with peaks for the 45-54 and > or = 75 age groups for men. In most of the 22 European countries, the suicide rates of both men and women increased directly with age. In 1990 the suicide rates in the Slavic and Baltic regions ranged from 25.1 for the 15-24 age group to 86.9 for men aged 75 or older, and from 6.0 to 29.8 for women, while the suicide rates in Europe ranged from 13.0 to 64.8 for men and from 3.6 to 18.7 for women. Decreases in the suicide rates in the Slavic and Baltic regions during perestroika were largest for the 25-54 age group, averaging at drop of 45% for men and 33% for women between 1984 and 1986-1988. The pattern of age-specific suicide rates for women in the Slavic and Baltic regions remained similar to that in Europe throughout the period studied. This was in contrast to a distinct pattern of male suicide rates in the Slavic and Baltic regions in 1984, which converged with those found in other parts of Europe during 1986-1988. It appears that perestroika contributed to a unique pattern of male suicide mortality in the Slavic and Baltic regions, especially in the 25-54 age group.

Female suicides and alcohol consumption during perestroika in the former USSR.

During 1984-1990, a decline in suicide rates of 32% for males and 19% for females took place in the former Soviet Union. The observed annual decrease in mortality from suicide was most marked for men in 1984-1986 and for women in 1984-1988. This article illuminates the hypothesis that the restrictive anti-alcohol campaign initiated by Gorbachev on 1 June 1985, in which prices of alcoholic beverages were raised substantially, had an impact on female mortality from suicide in the former Soviet Union. Data regarding alcohol consumption, female violent death (n = 451,537), suicide (n = 94,149), death due to accidental alcohol poisoning (n = 28,078), and undetermined death, whether accidental or self-inflicted (n = 23,982) were analysed for three Slavic (Russia, Belarus and the Ukraine), three Baltic (Lithuania, Latvia and Estonia) and two Central Asian republics (Kazakhstan and Kirgizia). Regression analyses with alcohol consumption as the independent variable and female suicide rates and female violent-death rates as dependent variables showed that suicide and alcohol consumption, as well as violent death and alcohol consumption, were positively correlated. However, alcohol seems to have a lower explanatory value for female suicides and female violent deaths compared with male suicides and male violent deaths. The attributable fraction of alcohol for female suicides in the whole USSR (27%) is estimated at approximately half of that for male suicides (50%).

Reliability of statistics on violent death and suicide in the former USSR, 1970-1990.

The stability of the relationship between trends of violent deaths as a whole, suicides and death from undetermined causes was assessed by quantitative methods for the whole former USSR in the years 1970-1990 and for each of the 15 republics in the former USSR for the years 1984-1990. Semi-structured interviews during 1989-1996 were performed with 12 professionals involved in the diagnosis and coding of causes of death in the Baltic states and Russia. The quantitative analyses showed that mortality data were reliable for the Slavic (Russia, the Ukraine and Belarus) and Baltic (Estonia, Latvia and Lithuania) republics, and also for Kazakhstan, Kirgizia and Moldova. The Central Asian and Caucasian republics showed greater variation in trends and ratios, indicating a need for further investigations of the reliability of suicide statistics in these regions. It emerged from the interviews that no instructions to falsify data were given. The only instructions given were to treat the data on suicide and murder as 'top secret'. None the less, certain classification errors might arise in the statistics. The diagnosis 'undetermined cause of death' was permissible only as a preliminary diagnosis for 14 days, and there was a risk of criticism for poor-quality work if too many deaths were classified as being due to undetermined causes. Misclassifications could also occur in cases where there was a wish to conceal murder. Negative attitudes towards suicide, especially in Muslim regions, where suicide is taboo, might also have contributed to under-reporting of suicide.

Suicides in the Baltic countries, 1968-90.

Trends of male and female suicides in the Baltic countries--Estonia, Latvia and Lithuania--in the years 1968-90 were studied. As throughout the former USSR, suicide rates declined sharply from 1986, the year marking the onset of turbulent social change. During the "period of stagnation" from 1968 to 1984, the mean value of male suicide rates per 100,000 males were 55.7 in Estonia, 52.5 in Latvia and 51.7 in Lithuania. The figures for female suicide rates were 14.3, 14.3 and 10.4, respectively. Suicide rates remained consistently high in Estonia and Latvia, while in Lithuania the male suicide rate rose gradually from 33.0 to 61.3 and the female rate from 8.0 to 13.1 during the stagnation period. In conjunction with perestroika in the former USSR (including a restrictive alcohol policy and the first tentative steps towards democracy), annual male suicide rates per 100,000 in the years 1986-90 fell considerably below those in the stagnation period. Mean values of male suicide rates decreased by 26.6% in Estonia, 26.6% in Latvia and 14.4% in Lithuania in the period 1986-90 compared with the mean values for the period 1968-84. Female suicide rates were relatively stable and the male-female ratio was accordingly lower in 1986-90 (Estonia and Latvia 3.1, Lithuania 4.2) than in 1968-84 (Estonia 3.9, Latvia 3.7 and Lithuania 5.0).

Male suicides and alcohol consumption in the former USSR.

A significant decline (34.5%) in the suicide rate occurred in 1984-1988 throughout the USSR. The decline was observed shortly after the introduction of strict restrictions on the sale of alcohol. We tested the hypothesis that the restrictive alcohol policy in the first years of perestroika (June 1985) caused the fall in suicide rates in the former USSR. Data on alcohol consumption, violent death caused by external injury and poisoning (n = 916,315), death due to accidental alcohol poisoning (n = 77,837), suicide (n = 192,305) and death undetermined whether accidentally or purposely (n = 54,253) were analyzed for all former Soviet republics for 1984, 1986, 1988 and 1990. Men were chosen for the analysis, since men are more prone to abuse alcohol than women. Regression analysis with alcohol consumption as the independent variable and suicide rates and violent death rates as dependent variables shows that suicide and alcohol consumption were positively correlated as were violet death and alcohol consumption. In the republics with high alcohol consumption (Slavic and Baltic), suicide rates were also high. In the Caucasian republics, low alcohol consumption was associated with low suicide rates. For most republics, alcohol seems to explain more than 50% of suicides. Alcohol also has considerable explanatory value for violent death. Thus, a restrictive alcohol policy might be a way to reduce suicide and violent death.

Suicides in the former Soviet republics.

The suicide rate in the former Soviet Union rose from 17.1 per 100,000 inhabitants in 1965 to 29.6 in 1984. In regions of long-standing traditional lifestyles, strong religious faith and multi-generation families (the Caucasus and central Asia), the suicide rate was low, whereas in regions with sociopolitical antagonisms (Baltic States) and forced social changes (Russia), it was high. A significant decline in the suicide rate (34.5%), from 29.6 to 19.4 per 100,000 inhabitants, occurred in 1984-1988 throughout the Soviet Union, in the hopeful period of social democratization and stiff restrictions on the sale of alcohol. Rates varied widely between different republics - from 1.8 in Armenia to 26.3 in Lithuania and 24.3 in the Russian Soviet Federated Socialist Republic (RSFSR) in 1988. In contrast to the pattern in several countries in western Europe, the suicide rates in the Russian SFSR were much higher in the rural regions than in the urban ones.

Suicide in Estonia.

Data on the suicide rate from 1922 to 1935 and from 1965 to 1988 are obtained from annual journals and original documents compiled by the Estonian State Committee for Statistics. During the period of Estonian independence (1922-1935 under consideration), the suicide rate was 16.7 per 100,000 inhabitants at the beginning of the period. During the Great Depression, this figure temporarily rose to 30 and declined to 20.6 in the year 1935. From 1965 to 1985 the suicide rate remained constantly high: on average 33 per 100,000 inhabitants. A decline in the male suicide rate from 55.2 to 36.8 has occurred since 1986. The effects of sociopolitical changes and of limitations on the sale of alcohol on suicide rates are discussed.