Publications by authors named "Vladimir Carli"

104 Publications

Excessive and pathological Internet use - Risk-behavior or psychopathology?

Addict Behav 2021 12 9;123:107045. Epub 2021 Jul 9.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.

Pathological Internet use (but only with respect to gaming) is classified as mental disorder in the ICD-11. However, there is a large group of adolescents showing excessive Internet use, which may rather be considered adolescent risk-behavior. The aim was to test whether pathological and excessive Internet use should be considered as "psychopathology" or "risk-behavior". A representative, cross-sectional sample of 11.110 students from 10 European Union countries was analyzed. Structural equation models, including the factors "risk-behavior" and "psychopathology" and the variables excessive and pathological Internet use, were tested against each other. "Risk-behavior" was operationalized by several risk-behaviors (e.g. drug abuse, truancy, etc). "Psychopathology" included measures of several mental disorders (e.g. depression, hyperactivity, etc). Excessive Internet use was assessed as the duration and frequency of Internet use. Pathological Internet use was assessed with the Young Diagnostic Questionnaire (i.e., presence of addiction criteria). Excessive Internet use loaded on "risk-behavior" (λ = 0.484, p < .001) and on "psychopathology" (λ = 0.071, p < .007). Pathological Internet use loaded on "risk-behavior" (λ = 0.333, p < .001) and on "psychopathology" (λ = 0.852, p < .001). Chi-square tests determined that the loadings of excessive Internet use (χ (1) = 81.98, p < .001) were significantly stronger on "risk-behavior" than "psychopathology". Vice versa, pathological Internet use loaded significantly stronger on "psychopathology" (χ (1) = 107.10, p < .001). The results indicate that pathological Internet use should rather be considered as psychopathology. Excessive Internet use on the other hand, should be classified as adolescent risk-behavior.
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http://dx.doi.org/10.1016/j.addbeh.2021.107045DOI Listing
December 2021

Excessive and pathological Internet use - Risk-behavior or psychopathology?

Addict Behav 2021 12 9;123:107045. Epub 2021 Jul 9.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.

Pathological Internet use (but only with respect to gaming) is classified as mental disorder in the ICD-11. However, there is a large group of adolescents showing excessive Internet use, which may rather be considered adolescent risk-behavior. The aim was to test whether pathological and excessive Internet use should be considered as "psychopathology" or "risk-behavior". A representative, cross-sectional sample of 11.110 students from 10 European Union countries was analyzed. Structural equation models, including the factors "risk-behavior" and "psychopathology" and the variables excessive and pathological Internet use, were tested against each other. "Risk-behavior" was operationalized by several risk-behaviors (e.g. drug abuse, truancy, etc). "Psychopathology" included measures of several mental disorders (e.g. depression, hyperactivity, etc). Excessive Internet use was assessed as the duration and frequency of Internet use. Pathological Internet use was assessed with the Young Diagnostic Questionnaire (i.e., presence of addiction criteria). Excessive Internet use loaded on "risk-behavior" (λ = 0.484, p < .001) and on "psychopathology" (λ = 0.071, p < .007). Pathological Internet use loaded on "risk-behavior" (λ = 0.333, p < .001) and on "psychopathology" (λ = 0.852, p < .001). Chi-square tests determined that the loadings of excessive Internet use (χ (1) = 81.98, p < .001) were significantly stronger on "risk-behavior" than "psychopathology". Vice versa, pathological Internet use loaded significantly stronger on "psychopathology" (χ (1) = 107.10, p < .001). The results indicate that pathological Internet use should rather be considered as psychopathology. Excessive Internet use on the other hand, should be classified as adolescent risk-behavior.
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http://dx.doi.org/10.1016/j.addbeh.2021.107045DOI Listing
December 2021

Longitudinal predictors of problematic alcohol use in adolescence: A 2-year follow-up study.

Addict Behav 2021 09 10;120:106952. Epub 2021 Apr 10.

Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.

Alcohol consumption in adolescence is widespread. Several studies have investigated alcohol use in minors and its consequences in adulthood, but prospective findings on psychosocial predictors for problematic alcohol use (PAU) already in youth are still limited. Next to genetic aspects, psychosocial predictors appear to be particularly relevant. The objective of the present longitudinal survey was to explore psychosocial influences on PAU in adolescence. At baseline, 1,444 adolescents (52.1% girls, average age: 14.65 years) were surveyed. Two years later (at follow-up), we were able to re-assess 515 adolescents (mean age: 16.60 years). Both times, a standardized questionnaire was applied to explore PAU and various psychosocial aspects. We conducted multiple imputation, created 100 datasets with a Markov Chain Monte Carlo algorithm and calculated regression analyses to identify predictors for PAU. In a multivariable analysis, we found that female gender (protective factor), school-type 'Gymnasium' (highest level of school education, protective factor), PAU, more conduct problems and lower psychological well-being (all at baseline) predicted adolescent PAU at follow-up. In supplementary analyses for frequent alcohol use (regardless of quantity) and high alcohol consumption quantity (regardless of frequency), these predictors could only partially be found again. According to the findings of the present study, psychosocial aspects are relevant for PAU in adolescence, and particularly psychological well-being should be given more attention in primary prevention measures and treatment approaches.
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http://dx.doi.org/10.1016/j.addbeh.2021.106952DOI Listing
September 2021

Longitudinal predictors of problematic alcohol use in adolescence: A 2-year follow-up study.

Addict Behav 2021 09 10;120:106952. Epub 2021 Apr 10.

Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.

Alcohol consumption in adolescence is widespread. Several studies have investigated alcohol use in minors and its consequences in adulthood, but prospective findings on psychosocial predictors for problematic alcohol use (PAU) already in youth are still limited. Next to genetic aspects, psychosocial predictors appear to be particularly relevant. The objective of the present longitudinal survey was to explore psychosocial influences on PAU in adolescence. At baseline, 1,444 adolescents (52.1% girls, average age: 14.65 years) were surveyed. Two years later (at follow-up), we were able to re-assess 515 adolescents (mean age: 16.60 years). Both times, a standardized questionnaire was applied to explore PAU and various psychosocial aspects. We conducted multiple imputation, created 100 datasets with a Markov Chain Monte Carlo algorithm and calculated regression analyses to identify predictors for PAU. In a multivariable analysis, we found that female gender (protective factor), school-type 'Gymnasium' (highest level of school education, protective factor), PAU, more conduct problems and lower psychological well-being (all at baseline) predicted adolescent PAU at follow-up. In supplementary analyses for frequent alcohol use (regardless of quantity) and high alcohol consumption quantity (regardless of frequency), these predictors could only partially be found again. According to the findings of the present study, psychosocial aspects are relevant for PAU in adolescence, and particularly psychological well-being should be given more attention in primary prevention measures and treatment approaches.
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http://dx.doi.org/10.1016/j.addbeh.2021.106952DOI Listing
September 2021

Longitudinal predictors of problematic alcohol use in adolescence: A 2-year follow-up study.

Addict Behav 2021 09 10;120:106952. Epub 2021 Apr 10.

Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.

Alcohol consumption in adolescence is widespread. Several studies have investigated alcohol use in minors and its consequences in adulthood, but prospective findings on psychosocial predictors for problematic alcohol use (PAU) already in youth are still limited. Next to genetic aspects, psychosocial predictors appear to be particularly relevant. The objective of the present longitudinal survey was to explore psychosocial influences on PAU in adolescence. At baseline, 1,444 adolescents (52.1% girls, average age: 14.65 years) were surveyed. Two years later (at follow-up), we were able to re-assess 515 adolescents (mean age: 16.60 years). Both times, a standardized questionnaire was applied to explore PAU and various psychosocial aspects. We conducted multiple imputation, created 100 datasets with a Markov Chain Monte Carlo algorithm and calculated regression analyses to identify predictors for PAU. In a multivariable analysis, we found that female gender (protective factor), school-type 'Gymnasium' (highest level of school education, protective factor), PAU, more conduct problems and lower psychological well-being (all at baseline) predicted adolescent PAU at follow-up. In supplementary analyses for frequent alcohol use (regardless of quantity) and high alcohol consumption quantity (regardless of frequency), these predictors could only partially be found again. According to the findings of the present study, psychosocial aspects are relevant for PAU in adolescence, and particularly psychological well-being should be given more attention in primary prevention measures and treatment approaches.
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http://dx.doi.org/10.1016/j.addbeh.2021.106952DOI Listing
September 2021

Longitudinal predictors of problematic alcohol use in adolescence: A 2-year follow-up study.

Addict Behav 2021 09 10;120:106952. Epub 2021 Apr 10.

Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.

Alcohol consumption in adolescence is widespread. Several studies have investigated alcohol use in minors and its consequences in adulthood, but prospective findings on psychosocial predictors for problematic alcohol use (PAU) already in youth are still limited. Next to genetic aspects, psychosocial predictors appear to be particularly relevant. The objective of the present longitudinal survey was to explore psychosocial influences on PAU in adolescence. At baseline, 1,444 adolescents (52.1% girls, average age: 14.65 years) were surveyed. Two years later (at follow-up), we were able to re-assess 515 adolescents (mean age: 16.60 years). Both times, a standardized questionnaire was applied to explore PAU and various psychosocial aspects. We conducted multiple imputation, created 100 datasets with a Markov Chain Monte Carlo algorithm and calculated regression analyses to identify predictors for PAU. In a multivariable analysis, we found that female gender (protective factor), school-type 'Gymnasium' (highest level of school education, protective factor), PAU, more conduct problems and lower psychological well-being (all at baseline) predicted adolescent PAU at follow-up. In supplementary analyses for frequent alcohol use (regardless of quantity) and high alcohol consumption quantity (regardless of frequency), these predictors could only partially be found again. According to the findings of the present study, psychosocial aspects are relevant for PAU in adolescence, and particularly psychological well-being should be given more attention in primary prevention measures and treatment approaches.
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http://dx.doi.org/10.1016/j.addbeh.2021.106952DOI Listing
September 2021

Longitudinal predictors of problematic alcohol use in adolescence: A 2-year follow-up study.

Addict Behav 2021 09 10;120:106952. Epub 2021 Apr 10.

Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.

Alcohol consumption in adolescence is widespread. Several studies have investigated alcohol use in minors and its consequences in adulthood, but prospective findings on psychosocial predictors for problematic alcohol use (PAU) already in youth are still limited. Next to genetic aspects, psychosocial predictors appear to be particularly relevant. The objective of the present longitudinal survey was to explore psychosocial influences on PAU in adolescence. At baseline, 1,444 adolescents (52.1% girls, average age: 14.65 years) were surveyed. Two years later (at follow-up), we were able to re-assess 515 adolescents (mean age: 16.60 years). Both times, a standardized questionnaire was applied to explore PAU and various psychosocial aspects. We conducted multiple imputation, created 100 datasets with a Markov Chain Monte Carlo algorithm and calculated regression analyses to identify predictors for PAU. In a multivariable analysis, we found that female gender (protective factor), school-type 'Gymnasium' (highest level of school education, protective factor), PAU, more conduct problems and lower psychological well-being (all at baseline) predicted adolescent PAU at follow-up. In supplementary analyses for frequent alcohol use (regardless of quantity) and high alcohol consumption quantity (regardless of frequency), these predictors could only partially be found again. According to the findings of the present study, psychosocial aspects are relevant for PAU in adolescence, and particularly psychological well-being should be given more attention in primary prevention measures and treatment approaches.
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http://dx.doi.org/10.1016/j.addbeh.2021.106952DOI Listing
September 2021

Longitudinal predictors of problematic alcohol use in adolescence: A 2-year follow-up study.

Addict Behav 2021 09 10;120:106952. Epub 2021 Apr 10.

Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.

Alcohol consumption in adolescence is widespread. Several studies have investigated alcohol use in minors and its consequences in adulthood, but prospective findings on psychosocial predictors for problematic alcohol use (PAU) already in youth are still limited. Next to genetic aspects, psychosocial predictors appear to be particularly relevant. The objective of the present longitudinal survey was to explore psychosocial influences on PAU in adolescence. At baseline, 1,444 adolescents (52.1% girls, average age: 14.65 years) were surveyed. Two years later (at follow-up), we were able to re-assess 515 adolescents (mean age: 16.60 years). Both times, a standardized questionnaire was applied to explore PAU and various psychosocial aspects. We conducted multiple imputation, created 100 datasets with a Markov Chain Monte Carlo algorithm and calculated regression analyses to identify predictors for PAU. In a multivariable analysis, we found that female gender (protective factor), school-type 'Gymnasium' (highest level of school education, protective factor), PAU, more conduct problems and lower psychological well-being (all at baseline) predicted adolescent PAU at follow-up. In supplementary analyses for frequent alcohol use (regardless of quantity) and high alcohol consumption quantity (regardless of frequency), these predictors could only partially be found again. According to the findings of the present study, psychosocial aspects are relevant for PAU in adolescence, and particularly psychological well-being should be given more attention in primary prevention measures and treatment approaches.
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http://dx.doi.org/10.1016/j.addbeh.2021.106952DOI Listing
September 2021

A protocol for a multicentre, parallel-group, pragmatic randomised controlled trial to evaluate the NEVERMIND system in preventing and treating depression in patients with severe somatic conditions.

BMC Psychiatry 2020 03 2;20(1):93. Epub 2020 Mar 2.

Research Center "E.Piaggio" and Department of Information Engineering, School of Engineering, University of Pisa, Pisa, Italy.

Background: Depressive symptoms are common in individuals suffering from severe somatic conditions. There is a lack of interventions and evidence-based interventions aiming to reduce depressive symptoms in patients with severe somatic conditions. The aim of the NEVERMIND project is to address these issues and provide evidence by testing the NEVERMIND system, designed to reduce and prevent depressive symptoms in comparison to treatment as usual.

Methods: The NEVERMIND study is a parallel-groups, pragmatic randomised controlled trial to assess the effectiveness of the NEVERMIND system in reducing depressive symptoms among individuals with severe somatic conditions. The NEVERMIND system comprises a smart shirt and a user interface, in the form of a mobile application. The system is a real-time decision support system, aiming to predict the severity and onset of depressive symptoms by modelling the well-being condition of patients based on physiological data, body movement, and the recurrence of social interactions. The study includes 330 patients who have a diagnosis of myocardial infarction, breast cancer, prostate cancer, kidney failure, or lower limb amputation. Participants are randomised in blocks of ten to either the NEVERMIND intervention or treatment as usual as the control group. Clinical interviews and structured questionnaires are administered at baseline, at 12 weeks, and 24 weeks to assess whether the NEVERMIND system is superior to treatment as usual. The endpoint of primary interest is Beck Depression Inventory II (BDI-II) at 12 weeks defined as (i) the severity of depressive symptoms as measured by the BDI-II. Secondary outcomes include prevention of the onset of depressive symptoms, changes in quality of life, perceived stigma, and self-efficacy.

Discussion: There is a lack of evidence-based interventions aiming to reduce and prevent depressive symptoms in patients with severe somatic conditions. If the NEVERMIND system is effective, it will provide healthcare systems with a novel and innovative method to attend to depressive symptoms in patients with severe somatic conditions.

Trial Registration: DRKS00013391. Registered 23 November 2017.
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http://dx.doi.org/10.1186/s12888-020-02494-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053064PMC
March 2020

Risk and protective factors for psychotic experiences in adolescence: a population-based study.

Psychol Med 2021 May 6;51(7):1220-1228. Epub 2020 Feb 6.

Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.

Background: Psychotic experiences (PEs) are reported by a significant minority of adolescents and are associated with the development of psychiatric disorders. The aims of this study were to examine associations between PEs and a range of factors including psychopathology, adversity and lifestyle, and to investigate mediating effects of coping style and parental support on associations between adversity and PEs in a general population adolescent sample.

Method: Cross-sectional data were drawn from the Irish centre of the Saving and Empowering Young Lives in Europe study. Students completed a self-report questionnaire and 973 adolescents, of whom 522 (53.6%) were boys, participated. PEs were assessed using the 7-item Adolescent Psychotic Symptom Screener.

Results: Of the total sample, 81 (8.7%) of the sample were found to be at risk of PEs. In multivariate analysis, associations were found between PEs and number of adverse events reported (OR 4.48, CI 1.41-14.25; p < 0.011), maladaptive/pathological internet use (OR 2.70, CI 1.30-5.58; p = 0.007), alcohol intoxication (OR 2.12, CI 1.10-4.12; p = 0.025) and anxiety symptoms (OR 4.03, CI 1.57-10.33; p = 0.004). There were small mediating effects of parental supervision, parental support and maladaptive coping on associations between adversity and PEs.

Conclusion: We have identified potential risk factors for PEs from multiple domains including adversity, mental health and lifestyle factors. The mediating effect of parental support on associations between adversity and PEs suggests that poor family relationships may account for some of this mechanism. These findings can inform the development of interventions for adolescents at risk.
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http://dx.doi.org/10.1017/S0033291719004136DOI Listing
May 2021

Risk and protective factors for psychotic experiences in adolescence: a population-based study.

Psychol Med 2021 May 6;51(7):1220-1228. Epub 2020 Feb 6.

Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.

Background: Psychotic experiences (PEs) are reported by a significant minority of adolescents and are associated with the development of psychiatric disorders. The aims of this study were to examine associations between PEs and a range of factors including psychopathology, adversity and lifestyle, and to investigate mediating effects of coping style and parental support on associations between adversity and PEs in a general population adolescent sample.

Method: Cross-sectional data were drawn from the Irish centre of the Saving and Empowering Young Lives in Europe study. Students completed a self-report questionnaire and 973 adolescents, of whom 522 (53.6%) were boys, participated. PEs were assessed using the 7-item Adolescent Psychotic Symptom Screener.

Results: Of the total sample, 81 (8.7%) of the sample were found to be at risk of PEs. In multivariate analysis, associations were found between PEs and number of adverse events reported (OR 4.48, CI 1.41-14.25; p < 0.011), maladaptive/pathological internet use (OR 2.70, CI 1.30-5.58; p = 0.007), alcohol intoxication (OR 2.12, CI 1.10-4.12; p = 0.025) and anxiety symptoms (OR 4.03, CI 1.57-10.33; p = 0.004). There were small mediating effects of parental supervision, parental support and maladaptive coping on associations between adversity and PEs.

Conclusion: We have identified potential risk factors for PEs from multiple domains including adversity, mental health and lifestyle factors. The mediating effect of parental support on associations between adversity and PEs suggests that poor family relationships may account for some of this mechanism. These findings can inform the development of interventions for adolescents at risk.
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http://dx.doi.org/10.1017/S0033291719004136DOI Listing
May 2021

Life Events Predicting the First Onset of Adolescent Direct Self-Injurious Behavior-A Prospective Multicenter Study.

J Adolesc Health 2020 02 31;66(2):195-201. Epub 2019 Oct 31.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden.

Purpose: Self-injurious behavior is a frequent phenomenon in adolescence. The present study prospectively examined life events as risk factors for the first onset of direct self-injurious behavior (D-SIB) in the Saving and Empowering Young Lives in Europe school-based multicenter sample.

Methods: Longitudinal assessments with an interval of 1 year were performed within a sample of 1,933 adolescents (51.47% females; mean age 14.84 ± .9 years) from 10 European countries and Israel.

Results: The number of life events during the past 6 months predicted the first onset of D-SIB in the following year. Gender neither predicted the onset of D-SIB nor moderated the association with life events. Moreover, analyses of individual events identified a range of mainly interpersonal events within both family and peer group as proximal risk factors for first episode D-SIB.

Conclusions: The results support the critical role of interpersonal life events in the development of D-SIB for both genders and refine the conceptualization of proximal risk factors in terms of accumulated stressors and interpersonal events.
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http://dx.doi.org/10.1016/j.jadohealth.2019.08.018DOI Listing
February 2020

Life Events Predicting the First Onset of Adolescent Direct Self-Injurious Behavior-A Prospective Multicenter Study.

J Adolesc Health 2020 02 31;66(2):195-201. Epub 2019 Oct 31.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden.

Purpose: Self-injurious behavior is a frequent phenomenon in adolescence. The present study prospectively examined life events as risk factors for the first onset of direct self-injurious behavior (D-SIB) in the Saving and Empowering Young Lives in Europe school-based multicenter sample.

Methods: Longitudinal assessments with an interval of 1 year were performed within a sample of 1,933 adolescents (51.47% females; mean age 14.84 ± .9 years) from 10 European countries and Israel.

Results: The number of life events during the past 6 months predicted the first onset of D-SIB in the following year. Gender neither predicted the onset of D-SIB nor moderated the association with life events. Moreover, analyses of individual events identified a range of mainly interpersonal events within both family and peer group as proximal risk factors for first episode D-SIB.

Conclusions: The results support the critical role of interpersonal life events in the development of D-SIB for both genders and refine the conceptualization of proximal risk factors in terms of accumulated stressors and interpersonal events.
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http://dx.doi.org/10.1016/j.jadohealth.2019.08.018DOI Listing
February 2020

Alcohol use and risk factors for self-harm behavior in Spanish adolescents.

Adicciones 2021 Jan 15;33(1):53-62. Epub 2021 Jan 15.

Universidad de Oviedo.

Self-harm behaviors in children and adolescents constitute an important public health problem with prevalence figures in the clinical population between 40 and 80%. The objectives of the study were to analyze and compare the Spanish sub-samples of two studies, SEYLE and WE-STAY to determine prevalence, self-harm patterns and factors associated with self-harm behaviors, notably the use of alcohol or drugs. The questionnaires used in both studies were the Global School Health Survey (GSHS), the Beck Depression Inventory (BDI-II), the Strengths and Difficulties Questionnaire (SDQ). The self-harm behaviors were evaluated with a modified 6-item version of s the Deliberate Self-Harm Inventory (DSHI). The independence of the study's categorical variables was assessed using the Chi-square test. The change in the relative risk of self-harm between the SEYLE study and WE-STAY was evaluated through the odds ratio (OR) calculation. Two different logistic regression models were calculated in order to establish the factors associated with self-harm behaviors in each study. In the present study, the rates of DSH vary according to study and sex, ranging from 0.58% to 2.08%, and different patterns of self-harm are evidenced by sex, with males self-injuring more frequently by self-inflicted blows and burns, while young women more often cut themselves. The presence of depressive symptoms and alcohol use were the factors most strongly associated with an increased risk of DSH.
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http://dx.doi.org/10.20882/adicciones.1239DOI Listing
January 2021

Alcohol use and risk factors for self-harm behavior in Spanish adolescents.

Adicciones 2021 Jan 15;33(1):53-62. Epub 2021 Jan 15.

Universidad de Oviedo.

Self-harm behaviors in children and adolescents constitute an important public health problem with prevalence figures in the clinical population between 40 and 80%. The objectives of the study were to analyze and compare the Spanish sub-samples of two studies, SEYLE and WE-STAY to determine prevalence, self-harm patterns and factors associated with self-harm behaviors, notably the use of alcohol or drugs. The questionnaires used in both studies were the Global School Health Survey (GSHS), the Beck Depression Inventory (BDI-II), the Strengths and Difficulties Questionnaire (SDQ). The self-harm behaviors were evaluated with a modified 6-item version of s the Deliberate Self-Harm Inventory (DSHI). The independence of the study's categorical variables was assessed using the Chi-square test. The change in the relative risk of self-harm between the SEYLE study and WE-STAY was evaluated through the odds ratio (OR) calculation. Two different logistic regression models were calculated in order to establish the factors associated with self-harm behaviors in each study. In the present study, the rates of DSH vary according to study and sex, ranging from 0.58% to 2.08%, and different patterns of self-harm are evidenced by sex, with males self-injuring more frequently by self-inflicted blows and burns, while young women more often cut themselves. The presence of depressive symptoms and alcohol use were the factors most strongly associated with an increased risk of DSH.
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http://dx.doi.org/10.20882/adicciones.1239DOI Listing
January 2021

Longitudinal development of risk-taking and self-injurious behavior in association with late adolescent borderline personality disorder symptoms.

Psychiatry Res 2019 03 3;273:127-133. Epub 2019 Jan 3.

Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland. Electronic address:

Self-injurious behavior and risk-taking behaviors are associated with adolescent borderline personality disorder (BPD). Developmental trajectories of self-injurious and risk-taking behavior in predicting BPD have not been fully understood. The aim of the present study was to examine self-injurious and risk-taking behavior development and their prospective influence on BPD symptoms in adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the German Saving and Empowering Young Lives in Europe cohort were analyzed. Self-injurious and risk-taking behaviors were assessed at baseline and one-year follow-up. BPD symptoms were assessed at two-year follow-up. In fully adjusted stepwise binominal regression analyses, recent onset, termination and maintenance of risky alcohol use and self-injurious behavior remained as significant predictors of BPD. Highest ORs were found for alcohol termination and maintenance of self-injurious behavior. Other facets of risk-taking behavior were not associated with increased ORs of BPD symptoms at two-year follow-up. These findings highlight the importance of self-injurious behavior and specific facets of risk-taking behavior in the development of adolescent BPD. Clinicians should focus on efforts in preventing adolescents from risk-taking and self-injurious behavior, since engaging in young age and therefore in potentially longer periods of these behaviors is associated with the highest risk of BPD.
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http://dx.doi.org/10.1016/j.psychres.2019.01.010DOI Listing
March 2019

Depressive symptoms among women with endometriosis: a systematic review and meta-analysis.

Am J Obstet Gynecol 2019 03 9;220(3):230-241. Epub 2018 Nov 9.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.

Objective: To evaluate whether endometriosis is associated with depressive symptoms, and whether the association is modulated by pelvic pain.

Data Sources: PubMed, Embase, PsychINFO, and the Cochrane Library, were systematically searched through September 2017.

Study Eligibility Criteria: The following eligibility criteria applied: full-text original article; quantitative data about depressive symptoms or depression; comparison of women with and without endometriosis, or women with endometriosis with and without pelvic pain. Articles reporting duplicated data were excluded.

Study Appraisal And Synthesis Methods: Two reviewers selected and reviewed the studies. Disagreements were resolved through discussion or a third opinion. Qualitative synthesis was performed through tabulation and assessment using a modified version of the Newcastle-Ottawa Scale. Effect sizes were pooled through meta-analysis, and moderator analyses were performed to identify potential confounders with several variables: region of the sample, method of ascertainment of endometriosis, method of measurement of depression, year of publication, and quality score.

Results: A meta-analysis of 24 studies (99,614 women) showed higher levels of depression among women with endometriosis compared to controls (standardized mean difference [SMD], 0.22, 95% confidence interval [CI], 0.13-0.32). The heterogeneity in this analysis (I = 68%) was not explained by any of the moderating variables. When only healthy controls were considered, a larger endometriosis-depression effect was found (11 studies, SMD, 0.49; 95% CI, 0.24-0.73; I = 69%). Endometriosis patients reporting pelvic pain had significantly higher levels of depression compared to those without pain (4 studies; SMD, 1.01; 95% CI, 0.71-1.31; I = 0%). No significant difference was found between women with pelvic pain and endometriosis and those with pelvic pain but without endometriosis (11 studies, SMD, -0.11; 95% CI, -0.25 to 0.04; I = 0%).

Conclusion: The association between endometriosis and depressive symptoms is largely determined by chronic pain but may also be modulated by individual and context vulnerabilities. Awareness of the complex relationship between endometriosis and depressive symptoms informs tailored care and patient-centered research outcomes.
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http://dx.doi.org/10.1016/j.ajog.2018.11.123DOI Listing
March 2019

Psychopathology is associated with reproductive health risk in European adolescents.

Reprod Health 2018 Nov 6;15(1):186. Epub 2018 Nov 6.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden.

Background: Reproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood. This cross-sectional study evaluated the association between psychopathology and reproductive health risk among European adolescents.

Methods: A structured self-report questionnaire was delivered to 12,395 pupils of 179 randomly selected schools in 11 European countries within the EU funded "Saving and Empowering Young Lives in Europe" (SEYLE) project. The questionnaire included items about sexual initiation and reproductive health risk factors, such as number of sexual partners, frequency of condom use, and pregnancy involvement. Psychopathology was evaluated with validated instruments and/or ad-hoc questions.

Results: Of 11,406 respondents (median age 15; interquartile range [IQR] 14-15; 57% females), 18.8% reported sexual initiation. Sixty percent of them also reported at least one reproductive risk factor. Sexual initiation was significantly more common among pupils older than 15 years (38% versus 13.2% younger pupils) and males (21.3% versus 16.9% females). It was also more common among pupils with depression (age/sex-adjusted odds ratio [aOR] 1.871), anxiety (aOR 2.190), severe suicidal ideation (aOR 2.259), self-injurious behaviour (aOR 2.892), and suicide attempts (aOR 3.091). These associations were particularly strong among pupils ≤15 years old and, for overt psychopathology, among pupils with low non-sexual risk behaviour profile and females. Depression (aOR 1.937), anxiety (aOR 2.282), severe suicidal ideation (aOR 2.354), self-injurious behaviour (aOR 3.022), and suicide attempts (aOR 3.284) were associated with higher reproductive health risk, defined by an increasing number of coexisting reproductive risk factors.

Conclusions: These findings suggest an alignment between mental and reproductive health risk and support the value of cross-domain collaboration in adolescent health. The association between psychopathology and reproductive health risk, as well as its variations with age, sex, and associated risk behaviours, should be considered when designing health-promoting or disease-preventing interventions for adolescents.
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http://dx.doi.org/10.1186/s12978-018-0618-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220505PMC
November 2018

Comorbidity of Physical and Anxiety Symptoms in Adolescent: Functional Impairment, Self-Rated Health and Subjective Well-Being.

Int J Environ Res Public Health 2018 08 9;15(8). Epub 2018 Aug 9.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, SE-171 77 Stockholm, Sweden.

Physical disorders and anxiety are frequently comorbid. This study investigates the characteristics of physical disorders, self-rated heath, subjective well-being and anxiety in adolescents. Data were drawn from the cohort study. From 11 countries 11,230 adolescents, aged 14⁻16 years were included. Zung Self-Rating Anxiety Scale (SAS), WHO-5 Well-Being Index and five questions prepared for this study to evaluate physical illnesses and self-rated heath were administered. Anxiety levels were significantly higher in adolescents who reported having physical disability ( < 0.001, Cohen's = 0.40), suffering from chronic illnesses ( < 0.001, Cohen's = 0.40), impairments associated to health conditions ( < 0.001, Cohen's = 0.61), or reported poor to very poor self-rated health ( < 0.001, Cohen's = 1.11). Mediational analyses revealed no direct effect of having a chronic illness/physical disability on subjective well-being, but the indirect effects through higher levels of anxiety were significant. Functional impairment related to health conditions was both directly and indirectly (through higher levels of anxiety) associated with lower well-being. The co-occurrence of anxiety and physical disorders may confer a greater level of disability and lower levels of subjective well-being. Clinicians have to screen anxiety, even in a subthreshold level in patients with choric physical illness or with medically unexplained physical symptoms.
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http://dx.doi.org/10.3390/ijerph15081698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121583PMC
August 2018

Predictive factors of alcohol consumption in adolescents: data from 1-year follow-up prospective study.

Adicciones 2019 Jan 1;31(1):52-63. Epub 2019 Jan 1.

Área de Psiquiatría. Universidad de Oviedo.

Alcohol use/abuse is a health problem in adolescents. The last Survey on use of drugs in Secondary Schoolers carried out in Spain (ESTUDES 2014-2015), reveals that 76.8% of adolescents aged 14 to 18 years consumed alcohol in the previous year and 68.2% in the last month. The aim of this study is to determine the medium-term factors associated with alcohol consumption in a sample of Spanish adolescents. The present study was carried out as a part of the Saving and Empowering Young Lives project in Europe (SEYLE) project. The final sample was composed of 708 students, assessed at two times [basal (T0) and one year later (T1)] [males: 51.98%, basal mean age (SD)=4.43 (0.67)]. Univariate and multivariate regression analyses were performed in order to investigate relationships between possible predictive variables found at time T0 and alcohol consumption at time T1. At basal time (T0) the prevalence of alcohol abuse was 25.56%, whereas the prevalence one year later was 49.72% (T1). Variables that significantly predict alcohol abuse within a year are: previous alcohol abuse at T0 (p<0.001), previous abuse of drugs (p=0.011), parents attending their sporting events (p=0.005), peer problems (p=0.019), and lack of prosocial behaviour (p=0.043). In the light of our results, it can be concluded that, in adolescents, externalizing disorders seem to be determining factors of medium-term alcohol consumption.
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http://dx.doi.org/10.20882/adicciones.998DOI Listing
January 2019

Predictive factors of alcohol consumption in adolescents: data from 1-year follow-up prospective study.

Adicciones 2019 Jan 1;31(1):52-63. Epub 2019 Jan 1.

Área de Psiquiatría. Universidad de Oviedo.

Alcohol use/abuse is a health problem in adolescents. The last Survey on use of drugs in Secondary Schoolers carried out in Spain (ESTUDES 2014-2015), reveals that 76.8% of adolescents aged 14 to 18 years consumed alcohol in the previous year and 68.2% in the last month. The aim of this study is to determine the medium-term factors associated with alcohol consumption in a sample of Spanish adolescents. The present study was carried out as a part of the Saving and Empowering Young Lives project in Europe (SEYLE) project. The final sample was composed of 708 students, assessed at two times [basal (T0) and one year later (T1)] [males: 51.98%, basal mean age (SD)=4.43 (0.67)]. Univariate and multivariate regression analyses were performed in order to investigate relationships between possible predictive variables found at time T0 and alcohol consumption at time T1. At basal time (T0) the prevalence of alcohol abuse was 25.56%, whereas the prevalence one year later was 49.72% (T1). Variables that significantly predict alcohol abuse within a year are: previous alcohol abuse at T0 (p<0.001), previous abuse of drugs (p=0.011), parents attending their sporting events (p=0.005), peer problems (p=0.019), and lack of prosocial behaviour (p=0.043). In the light of our results, it can be concluded that, in adolescents, externalizing disorders seem to be determining factors of medium-term alcohol consumption.
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http://dx.doi.org/10.20882/adicciones.998DOI Listing
January 2019

Predictive factors of alcohol consumption in adolescents: data from 1-year follow-up prospective study.

Adicciones 2019 Jan 1;31(1):52-63. Epub 2019 Jan 1.

Área de Psiquiatría. Universidad de Oviedo.

Alcohol use/abuse is a health problem in adolescents. The last Survey on use of drugs in Secondary Schoolers carried out in Spain (ESTUDES 2014-2015), reveals that 76.8% of adolescents aged 14 to 18 years consumed alcohol in the previous year and 68.2% in the last month. The aim of this study is to determine the medium-term factors associated with alcohol consumption in a sample of Spanish adolescents. The present study was carried out as a part of the Saving and Empowering Young Lives project in Europe (SEYLE) project. The final sample was composed of 708 students, assessed at two times [basal (T0) and one year later (T1)] [males: 51.98%, basal mean age (SD)=4.43 (0.67)]. Univariate and multivariate regression analyses were performed in order to investigate relationships between possible predictive variables found at time T0 and alcohol consumption at time T1. At basal time (T0) the prevalence of alcohol abuse was 25.56%, whereas the prevalence one year later was 49.72% (T1). Variables that significantly predict alcohol abuse within a year are: previous alcohol abuse at T0 (p<0.001), previous abuse of drugs (p=0.011), parents attending their sporting events (p=0.005), peer problems (p=0.019), and lack of prosocial behaviour (p=0.043). In the light of our results, it can be concluded that, in adolescents, externalizing disorders seem to be determining factors of medium-term alcohol consumption.
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January 2019

Direct Self-Injurious Behavior (D-SIB) and Life Events among Vocational School and High School Students.

Int J Environ Res Public Health 2018 05 24;15(6). Epub 2018 May 24.

Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.

Although several studies have recently assessed direct self-injurious behavior (D-SIB) among adolescents, it is still understudied in adolescents attending vocational schools: an educational setting generally associated with lower socioeconomic status. After extending the "Saving and Empowering Young Lives in Europe" (SEYLE) project to a vocational school population, we examined their D-SIB and life event characteristics compared to the high school population. SEYLE's Hungarian randomly selected high school sample ( = 995) was completed with a randomly selected vocational school sample ( = 140) in Budapest, Hungary. Participants aged 14⁻17 years completed the SEYLE project's self-administered questionnaires. D-SIB lifetime prevalence was significantly higher (29.4%) in the vocational school group compared to the high school group (17.2%) (Χ²(1) = 12.231, < 0.001). D-SIB was associated with suicidal ideation in the vocational school group. Different life events were more frequent in the high school than in the vocational school group, and associations between D-SIB and life events differed in the vocational school group compared to the high school group. In conclusion, vocational school students are a vulnerable population with a higher prevalence of D-SIB compared to high school students. Life events and their association with D-SIB also differ in vocational school students compared to high school students. Taking all these into account might contribute to prevention/intervention designed for this population.
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http://dx.doi.org/10.3390/ijerph15061068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025121PMC
May 2018

Direct Self-Injurious Behavior (D-SIB) and Life Events among Vocational School and High School Students.

Int J Environ Res Public Health 2018 05 24;15(6). Epub 2018 May 24.

Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.

Although several studies have recently assessed direct self-injurious behavior (D-SIB) among adolescents, it is still understudied in adolescents attending vocational schools: an educational setting generally associated with lower socioeconomic status. After extending the "Saving and Empowering Young Lives in Europe" (SEYLE) project to a vocational school population, we examined their D-SIB and life event characteristics compared to the high school population. SEYLE's Hungarian randomly selected high school sample ( = 995) was completed with a randomly selected vocational school sample ( = 140) in Budapest, Hungary. Participants aged 14⁻17 years completed the SEYLE project's self-administered questionnaires. D-SIB lifetime prevalence was significantly higher (29.4%) in the vocational school group compared to the high school group (17.2%) (Χ²(1) = 12.231, < 0.001). D-SIB was associated with suicidal ideation in the vocational school group. Different life events were more frequent in the high school than in the vocational school group, and associations between D-SIB and life events differed in the vocational school group compared to the high school group. In conclusion, vocational school students are a vulnerable population with a higher prevalence of D-SIB compared to high school students. Life events and their association with D-SIB also differ in vocational school students compared to high school students. Taking all these into account might contribute to prevention/intervention designed for this population.
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http://dx.doi.org/10.3390/ijerph15061068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025121PMC
May 2018

Direct Self-Injurious Behavior (D-SIB) and Life Events among Vocational School and High School Students.

Int J Environ Res Public Health 2018 05 24;15(6). Epub 2018 May 24.

Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.

Although several studies have recently assessed direct self-injurious behavior (D-SIB) among adolescents, it is still understudied in adolescents attending vocational schools: an educational setting generally associated with lower socioeconomic status. After extending the "Saving and Empowering Young Lives in Europe" (SEYLE) project to a vocational school population, we examined their D-SIB and life event characteristics compared to the high school population. SEYLE's Hungarian randomly selected high school sample ( = 995) was completed with a randomly selected vocational school sample ( = 140) in Budapest, Hungary. Participants aged 14⁻17 years completed the SEYLE project's self-administered questionnaires. D-SIB lifetime prevalence was significantly higher (29.4%) in the vocational school group compared to the high school group (17.2%) (Χ²(1) = 12.231, < 0.001). D-SIB was associated with suicidal ideation in the vocational school group. Different life events were more frequent in the high school than in the vocational school group, and associations between D-SIB and life events differed in the vocational school group compared to the high school group. In conclusion, vocational school students are a vulnerable population with a higher prevalence of D-SIB compared to high school students. Life events and their association with D-SIB also differ in vocational school students compared to high school students. Taking all these into account might contribute to prevention/intervention designed for this population.
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http://dx.doi.org/10.3390/ijerph15061068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025121PMC
May 2018

Correlates of sexual initiation among European adolescents.

PLoS One 2018 8;13(2):e0191451. Epub 2018 Feb 8.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.

Background: Sexuality is a physiological component of adolescent development, though early initiation is associated with reproductive health risk. This study aimed at identifying correlates and predictors of sexual initiation in a large multinational cohort of European adolescents.

Methods: A questionnaire addressing socio-demographics, behaviours, mental health and sexual activity, was delivered to 11,110 adolescents recruited from 168 randomly selected schools in 10 European countries between 2009 and 2011. A follow-up questionnaire was delivered after 12 months. The longitudinal association of baseline risk behaviors, psychological attributes and contextual vulnerabilities, with sexual initiation during follow-up was evaluated through simple and multivariable age/sex stratified logistic regression. Multinomial logistic regression measured the association between predictors and sexual initiation with or without coexisting reproductive risk factors, such as multiple partners or infrequent condom use.

Results: Baseline sexual experience was reported by 19.2% of 10,757 respondents (median age 15; IQR 14-15; females 59.6%). This was significantly more frequent among pupils older than 15 (41%) and males (20.8%). Of 7,111 pupils without previous experience who were available at follow-up (response rate 81.8%), 17% reported sexual initiation, without differences between females and males. Baseline smoking (age/sex adjusted odds ratio [aOR] 3.63), alcohol use (aOR 2.95), illegal drugs use (aOR 2.72), and poor sleep (aOR 1.71) predicted sexual initiation. Stratified analyses showed a particularly strong association in case of younger and female pupils, and, among girls, when initiation was reported together with multiple partners and/or infrequent condom use. Externalizing (i.e. conduct and hyperactivity) symptoms independently predicted sexual initiation. Internalizing difficulties (i.e. emotional and peer problems) were negatively associated with early and risky sexual initiation among boys. Significant predictors included also being bullied, fighting, truancy, and low parental involvement.

Conclusions: Adolescent sexual behaviours are related to non-sexual risk behaviours, psychological difficulties and contextual vulnerabilities. While gateway effects explain some associations, a comprehensive model is needed to understand adolescent sexual behaviours, their physical, mental, and social health outcomes, and their potential positive effects on wellbeing. Tailored interventions may need to consider younger girls as a particularly vulnerable group in view of a strong association between non-sexual and sexual behaviors.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191451PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805230PMC
March 2018

Interactions between youth and mental health professionals: The Youth Aware of Mental health (YAM) program experience.

PLoS One 2018 8;13(2):e0191843. Epub 2018 Feb 8.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden.

The Youth Aware Of Mental Health (yam) Experience: Youth stand at the core of much mental health promotion, yet little is written about their experiences of such efforts. We aimed to take this on by interviewing youth after they participated in Youth Aware of Mental Health (YAM), a universal mental health promotion program. YAM has a non-anticipatory methodology that provides youth with a safe space for reflection, role-play, and discussion. Addressing everyday mental health, YAM invites the experiences and issues relevant to the youth present to influence the program in a slightly different direction every time. The YAM instructor guides the participants but does not present the youth with given formulas on how to solve their problems. Like any mental health promotion, YAM appeals to some more than others in its intended audience and individuals engage with the program in many different ways. We set out to learn more about these experiences.

Conversations About Mental Health: Thirty-two semi-structured interviews were conducted with 15-17 year olds in Estonia, Italy, Romania and Spain. In these interviews, the researchers made an effort to discuss mental health in terms relevant to youth. Still, wide-ranging levels of motivation, ease with engaging in dialogue with mental health professionals, and comfort with the format and content of YAM were detected. The youth were clustered in five different groups relating to their positioning vis-à-vis the researcher during the interview. The following evocative labels were used: "interested", "foot in the door", "respect for authority", "careful", and "not my topic". Corresponding labels were devised for their YAM experience: "engaged", "initially hesitant", "cautious", "eager to please", or "disengaged". We also observed that the researchers brought their own expectations and employed a variety of approaches that led to anticipating answers, stating the obvious, or getting along better with some of the youth. These modes of interaction were categorized under: "favoritism", "familiarity", "frustration", "out of sync", and "insecurity". Similar power dynamics likely transpire in other encounters between youth and researchers, including interventions such as YAM.

Youth And Mental Health Professionals: Noticing The Dynamics At Play: As mental health professionals, we need to be aware of the professional habits and biases that sometimes obstruct us in understanding the experiences of youth. By initiating dialogue and listening closely to youth we can find a way to those experiences. Qualitative research can help bring the underlying interplay between mental health professionals and youth to the surface while also orienting the conversation towards topics that matter to youth. Some youth are more interested or feel more at ease in speaking openly with mental health professionals, while others find such exchanges less appealing or almost intolerable. Future mental health promotion initiatives would benefit from involving youth in the design of interventions to create an inclusive atmosphere and engage with topics that appeal to youth with diverse experiences of mental health.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191843PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805239PMC
March 2018

Interactions between youth and mental health professionals: The Youth Aware of Mental health (YAM) program experience.

PLoS One 2018 8;13(2):e0191843. Epub 2018 Feb 8.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden.

The Youth Aware Of Mental Health (yam) Experience: Youth stand at the core of much mental health promotion, yet little is written about their experiences of such efforts. We aimed to take this on by interviewing youth after they participated in Youth Aware of Mental Health (YAM), a universal mental health promotion program. YAM has a non-anticipatory methodology that provides youth with a safe space for reflection, role-play, and discussion. Addressing everyday mental health, YAM invites the experiences and issues relevant to the youth present to influence the program in a slightly different direction every time. The YAM instructor guides the participants but does not present the youth with given formulas on how to solve their problems. Like any mental health promotion, YAM appeals to some more than others in its intended audience and individuals engage with the program in many different ways. We set out to learn more about these experiences.

Conversations About Mental Health: Thirty-two semi-structured interviews were conducted with 15-17 year olds in Estonia, Italy, Romania and Spain. In these interviews, the researchers made an effort to discuss mental health in terms relevant to youth. Still, wide-ranging levels of motivation, ease with engaging in dialogue with mental health professionals, and comfort with the format and content of YAM were detected. The youth were clustered in five different groups relating to their positioning vis-à-vis the researcher during the interview. The following evocative labels were used: "interested", "foot in the door", "respect for authority", "careful", and "not my topic". Corresponding labels were devised for their YAM experience: "engaged", "initially hesitant", "cautious", "eager to please", or "disengaged". We also observed that the researchers brought their own expectations and employed a variety of approaches that led to anticipating answers, stating the obvious, or getting along better with some of the youth. These modes of interaction were categorized under: "favoritism", "familiarity", "frustration", "out of sync", and "insecurity". Similar power dynamics likely transpire in other encounters between youth and researchers, including interventions such as YAM.

Youth And Mental Health Professionals: Noticing The Dynamics At Play: As mental health professionals, we need to be aware of the professional habits and biases that sometimes obstruct us in understanding the experiences of youth. By initiating dialogue and listening closely to youth we can find a way to those experiences. Qualitative research can help bring the underlying interplay between mental health professionals and youth to the surface while also orienting the conversation towards topics that matter to youth. Some youth are more interested or feel more at ease in speaking openly with mental health professionals, while others find such exchanges less appealing or almost intolerable. Future mental health promotion initiatives would benefit from involving youth in the design of interventions to create an inclusive atmosphere and engage with topics that appeal to youth with diverse experiences of mental health.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191843PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805239PMC
March 2018

Interactions between youth and mental health professionals: The Youth Aware of Mental health (YAM) program experience.

PLoS One 2018 8;13(2):e0191843. Epub 2018 Feb 8.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden.

The Youth Aware Of Mental Health (yam) Experience: Youth stand at the core of much mental health promotion, yet little is written about their experiences of such efforts. We aimed to take this on by interviewing youth after they participated in Youth Aware of Mental Health (YAM), a universal mental health promotion program. YAM has a non-anticipatory methodology that provides youth with a safe space for reflection, role-play, and discussion. Addressing everyday mental health, YAM invites the experiences and issues relevant to the youth present to influence the program in a slightly different direction every time. The YAM instructor guides the participants but does not present the youth with given formulas on how to solve their problems. Like any mental health promotion, YAM appeals to some more than others in its intended audience and individuals engage with the program in many different ways. We set out to learn more about these experiences.

Conversations About Mental Health: Thirty-two semi-structured interviews were conducted with 15-17 year olds in Estonia, Italy, Romania and Spain. In these interviews, the researchers made an effort to discuss mental health in terms relevant to youth. Still, wide-ranging levels of motivation, ease with engaging in dialogue with mental health professionals, and comfort with the format and content of YAM were detected. The youth were clustered in five different groups relating to their positioning vis-à-vis the researcher during the interview. The following evocative labels were used: "interested", "foot in the door", "respect for authority", "careful", and "not my topic". Corresponding labels were devised for their YAM experience: "engaged", "initially hesitant", "cautious", "eager to please", or "disengaged". We also observed that the researchers brought their own expectations and employed a variety of approaches that led to anticipating answers, stating the obvious, or getting along better with some of the youth. These modes of interaction were categorized under: "favoritism", "familiarity", "frustration", "out of sync", and "insecurity". Similar power dynamics likely transpire in other encounters between youth and researchers, including interventions such as YAM.

Youth And Mental Health Professionals: Noticing The Dynamics At Play: As mental health professionals, we need to be aware of the professional habits and biases that sometimes obstruct us in understanding the experiences of youth. By initiating dialogue and listening closely to youth we can find a way to those experiences. Qualitative research can help bring the underlying interplay between mental health professionals and youth to the surface while also orienting the conversation towards topics that matter to youth. Some youth are more interested or feel more at ease in speaking openly with mental health professionals, while others find such exchanges less appealing or almost intolerable. Future mental health promotion initiatives would benefit from involving youth in the design of interventions to create an inclusive atmosphere and engage with topics that appeal to youth with diverse experiences of mental health.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191843PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805239PMC
March 2018

Explicit Motives, Antecedents, and Consequences of Direct Self-Injurious Behaviors.

Crisis 2018 Jul 8;39(4):255-266. Epub 2017 Dec 8.

3 National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden.

Background: Self-injurious behaviors in adolescence are a serious public health concern.

Aims: The current study aims to expand our understanding of motives for direct self-injurious behaviors (D-SIB). We examined the explicit motives but also the actual antecedents and consequences of D-SIB over time.

Method: As part of the Saving and Empowering Young Lives in Europe (SEYLE) study, adolescents between the ages of 14 and 18 years from Israel completed self-report questionnaires at baseline, 3-month, and 12-month follow-ups.

Results: Decreases in social support predicted later increases in D-SIB, an effect mediated by negative affect. Both peer and parental support also exerted quadratic effects on D-SIB. Thus, low as well as high support predicted subsequent D-SIB. In turn, D-SIB was followed by increased peer and parental support.

Limitations: Our methodology relies on self-reports, affected by social desirability and recall biases.

Conclusion: The findings support a causal path for the development of D-SIB: from interpersonal distress to emotional distress and then to D-SIB. They also point to interesting avenues regarding subgroupings of adolescents who self-injure depending on their motives. Finally, our results reveal that D-SIB, although of negative import, might paradoxically be effective in serving certain functions such as gaining support from parents and peers.
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http://dx.doi.org/10.1027/0227-5910/a000493DOI Listing
July 2018
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