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Saving and Empowering Young Lives in Europe (SEYLE) Strategies for suicide prevention

New Directions in Psychiatry A forum for European young psychiatrists Sorrento, May 23-25, 2012. Saving and Empowering Young Lives in Europe (SEYLE) Strategies for suicide prevention. Danuta Wasserman Professor in Psychiatry and Suicidology Head of the National Centre for Suicide Research and

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Saving and Empowering Young Lives in Europe (SEYLE) Strategies for suicide prevention

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  1. New Directions in PsychiatryA forum for European young psychiatristsSorrento, May 23-25, 2012 Saving and Empowering Young Lives in Europe (SEYLE)Strategies for suicide prevention Danuta Wasserman Professor in Psychiatry and Suicidology Head of the National Centre for Suicide Research and Prevention of Mental Ill-health (NASP) at Karolinska Institutet Stockholm, Sweden President-Elect of the European Psychiatric Association (EPA)

  2. Mental health problems • More than 90% of adolescents who commit suicide suffer from a psychiatric disorder at the time of their death. • Mental illness is frequently unrecognized and untreated (Shaffer et al., 2004; Brent et al., 1999) • More than half had suffered from a psychiatric disorder for at least 2 years (Shaffer et al., 2001) • The most common forms of psychiatric disorder found in young completed suicides are mood disorders and substance and/or alcohol abuse • Comorbidity between different disorders is common Danuta Wasserman

  3. Risk taking behaviours • Teens engaging in risk behaviours, such as substance abuse, violence, peer victimization, etc. are at increased risk for depression, suicidal ideation, and suicide attempts (Hallfors et al. 2004). • It is hypothesized that preventive interventions that are designed to identify and refer subjects with risk-behaviours to treatment, could have an impact on improving mental health Danuta Wasserman

  4. Projects funded by the European Union • Saving and Empowering Young Lives in Europe (SEYLE): € 3 million • Working in Europe to Stop Truancy Among Youth in Europe (WE-STAY) : € 3 million • Suicide Prevention by Internet and Media Based Mental Health Promotion (SUPREME): €800,000 Danuta Wasserman

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  6. Objectives • Gather information on health and well-being of adolescents in Europe. • Implement interventions based on different approaches. • Evaluate outcomes of three different interventionsin a randomized controlled trial (Wasserman et al 2009; BMC-Public Health). • Recommend effective culturally adjusted models for promoting health of adolescents in Europe. Danuta Wasserman

  7. Three different theoretical approaches are used in the preventive interventions to empower: -Professionals: Profscreen was designed by Heidelberg University, Germany with Karolinska Institutet, Sweden -Teachers: QPR, US gatekeeper training program -Pupils: Awareness increasing intervention, designed at Columbia University and Karolinska Institutet -Control/Minimal intervention Danuta Wasserman

  8. Baseline and Follow-up Measures (∼320 variables) • Socio-demographics • age, gender, ethnicity, migration, employment, religion • Mental Health • well-being, depression, anxiety, • hyperactivity, suicidal behaviour, DSH • Lifestyles • alcohol and substance abuse, tobacco, sexual habits, nutrition, • physical activity, sleep patterns, bullying, Internet use • Values Saving and Empowering Young Lives in Europe (SEYLE) • SEYLE is a randomized controlled trial of mental health promotion and suicide prevention interventions (http://www.seyle.eu). • 12,395 pupils have been recruited in European High Schools. • Ethical approval for the collection of DNA has been sought. • A prospective cohort of young subjects that we will be followed-up beyond the duration of the SEYLE project has been established. Danuta Wasserman 4 Wasserman D, Carli V et al. Saving and empowering young lives in Europe (SEYLE): a randomized controlled trial. BMC Public Health. 2010;10:192.

  9. ARM IIntervention by Professionals Early Detection of Psychopathology and Risk-Behaviours in Schools4-week intervention • Diagnostics • Treatment in health care services • Follow-up of adolescents with mental ill-health and suicide attempters Danuta Wasserman

  10. ARM I Professional Screening for Psychiatric Disorders and Risk-Behaviours • Positive cases identified through the baseline questionnaire • Interviews by mental health professionals to exclude false positives • Referral to the local health care system Danuta Wasserman

  11. QPR ARM II4-Week intervention Ask A Question, Save A Life Question, Persuade, Refer • QPR is not a tool for mental health professionals • QPR is not intended to be a form of counseling or treatment • QPR is intended to offer hope through positive action Danuta Wasserman

  12. ARM IIGatekeepers identify suicidal students at school (QPR) • Recognition • Communication • Referral to professionals Danuta Wasserman

  13. ARM III Awareness increasing intervention 4-week intervention • A specifically tailored pedagogical booklet about lifestyles with information about the possibility to seek help for risk-behaviours, suicidal behavior and mental health problems is provided to students and parents. • Lectures with role-play • Posters in the classroom Danuta Wasserman

  14. ARM IIIAwareness ProgramBooklet for pupils, parents & teachers (25 pages) • Part 1: Awareness of Mental Health • Part 2: Self-Help Advice • Part 3: Stress and Crisis • Part 4: Depression and Suicidal Thoughts • Part 5: Helping a troubled friend • Part 6: Getting advice – Who to contact Danuta Wasserman

  15. Design of Awareness Intervention Danuta Wasserman

  16. ARM IIIAwareness ProgamInstructions booklet for persons performing the interventions (psychologist, public health experts, social workers (31p.) • Instructions • Role-play examples • Posters Danuta Wasserman

  17. ARM IVControl/minimal Intervention4-week duration • Posters in the classroom • Contact information for healthcare services • Contact information for healthy lifestyle groups Danuta Wasserman

  18. Characteristics of the SEYLE sampleCountry differences Danuta Wasserman

  19. Risk-Behaviours Results Danuta Wasserman

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  21. Different preventive strategies are needed for boys and girls • Girls need • More sleep • Physical activity • Boys need: • No alcohol • No drugs • No cigarettes • More sleep • More physical activity Danuta Wasserman

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  23. Start prevention at an early age • Risk-behaviors increase with age • 14-year-olds already have: • High alcohol use • Drug use • Smoking • Need improvement in sleep • Need improvement in physical activity Danuta Wasserman

  24. Drink containing alcohol (at least once a month) %Country differences Females had lower rates than males (M= 65.7% vs. F= 62.5 %) Alcohol related behaviours were more frequent in Austria, Hungary, Slovenia and Germany Danuta Wasserman

  25. During the past 12 months, did you ride in a car or other vehicle driven by someone who had been drinking alcohol? YES (%)Country differences Females reported less frequently being “passenger of drinking-driving person” than males (M= 18.7% vs. F= 15.7%) Danuta Wasserman

  26. At least one time in life used drugs (%)Country differences Use of drugs significantly differs among genders (M=13.4% vs. F=9.7%) Danuta Wasserman

  27. Have you ever used hashish or marijuana? YES (%)Country differences Rate of use of hashish and marijuana was higher in males (M=11.4 vs. F=7.7%) Danuta Wasserman

  28. Have you ever smoked cigarettes? YES (%)Country differences Danuta Wasserman

  29. WE-STAY ProjectAt least one day of missed class in the past two weeks without permissionCountry differences • Females reported lower level of skipping school (M= 20.4% vs. F= 13.2%) Danuta Wasserman

  30. Psychopathology Results Danuta Wasserman

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  32. Psychopathology among gender • Females • Depression • Anxiety • NSSI • Suicidal ideation • Suicide attempts • Males • Conduct disorders • Hyperactivity Danuta Wasserman

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  34. During the pasttwoweeks... Danuta Wasserman

  35. Young’s Diagnostic Questionnaire for Internet addiction (YDQ) • Diagnosis is based on a pattern of Internet use, over the past six months, resulting in a clinical impairment or distress according to eight specific criteria: Danuta Wasserman

  36. Definitions • Based on the YDQ score, Internet users are categorized into three groups: • Adaptive users [normal use]: those scoring 0-2 on the YDQ; • Maladaptive users [risky use]: those scoring 3-4 on the YDQ; • Pathological users [addiction]: those scoring ≥5 on the YDQ. Danuta Wasserman

  37. Prevalence of Pathological Internet use Danuta Wasserman

  38. Internet use for other purposes than homework, education, research Danuta Wasserman

  39. Pathological Internet use and socio-demographics Significantly increased relative risk of Internet addiction: • Male-gender • Student does not live with biological parent or relative • Parents do not understand student’s problems • Parents do not know what student does with free time • Parents do not pay attention to student • Unemployment of student’s parent/guardian Danuta Wasserman

  40. Adolescent sub-threshold depression and depression • On the basis of the BDI-II: • 29.3% identified as sub-threshold depression (BDI<20) • 9.4% identified with depression (BDI>20) Danuta Wasserman

  41. Results • Mean scores of depressed adolescent groups were significantly correlated with poor coping, measured by the SDQ (Strengths and Difficulties Questionnaire) and to the PSS (Paykel Suicide Scale) Danuta Wasserman

  42. Results from the ProfScreen arm In the professional screening: • 3,070 students were screened • 12.4% had such a high degree of severe mental health problems that they required mental healthcare Danuta Wasserman

  43. Results • Help-seeking behaviours were increased in: • Younger students • Depressive students • Peer victimized students • Best predictors for referral to mental healthcare were: • Low Body Mass Index (BMI) • Depression • Suicidal behaviour • Substance abuse • To increase help-seeking behaviour: • Parents postive attitude • Close proximity to the school for the professional clinical interview • Short waiting time for the clinical interview Danuta Wasserman

  44. Suicide attempters (past two weeks) Danuta Wasserman

  45. The education system is a suitable arena for: • introducing program to promote mental health and prevent suicide • establishing policies and procedures that can be adopted by the whole school system and by people working at individual schools Danuta Wasserman

  46. Available from the Oxford University Press (www.oup.com) Printed in English

  47. Thank you Danuta Wasserman 24 september 2014 47

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