Nationwide trends in sadness, suicidal ideation, and suicide attempts among multicultural and monocultural adolescents in South Korea during the COVID-19 pandemic, 2011-2022.

Researches on the mental health of Korean adolescents during COVID-19 have largely focused on those from monocultural families, but there is limited data on sadness, suicidal ideation, and suicide attempts in multicultural adolescents. This nationwide serial cross-sectional study included 688,708 adolescents aged 12-18 years who participated in the Korean Youth Risk Behavior Web-based Survey from 2011 to 2022. We compared and analyzed the prevalence of sadness, suicidal ideation, and suicide attempts among multicultural and monocultural adolescents. Multicultural adolescents were defined as those with at least one non-Korean parent. In 2021, the prevalence of sadness among multicultural adolescents was 31.86% [95% confidence interval (CI) 30.00-33.71], suicidal ideation 17.17% (15.74-18.61), and suicide attempts 4.25% (3.51-4.99). Among monocultural adolescents, the prevalence rates were 26.09% (25.50-26.69) for sadness, 12.41% (11.97-12.85) for suicidal ideation, and 1.92% (1.76-2.67) for suicide attempts. Adolescents from multicultural backgrounds were found to have higher rates of sadness, suicidal ideation, and suicide attempts. In the general population, these rates had decreased during the pre-pandemic period but increased after the onset of the pandemic then stabilized from 2020 to 2021. Female gender, smoking, alcohol use, and low school performance emerged as significant risk factors. However, no distinct risk factors specifically linked to suicide attempts were identified. Joinpoint regression analysis results aligned with the beta slope values in the main findings, reflecting a consistent pattern across both analyses. This study revealed that sadness, suicidal ideation, and suicide attempts increased during the pandemic, reversing a pre-pandemic decline. Multicultural adolescents faced these issues more than monocultural ones, underlining the need for targeted public health measures to support at-risk adolescents during pandemics.

Jo H ，Park J ，Lee H ，Lee K ，Lee H ，Son Y ，Kang J ，Lee S ，Choi Y ，Lee JH ，Fond G ，Boyer L ，Smith L ，Lee J ，López Sánchez GF ，Dragioti E ，Tully MA ，Rahmati M ，Woo HG ，Woo S ，Yon DK ... -  《-》

Prevention of self-harm and suicide in young people up to the age of 25 in education settings.

In 2016, globally, suicide was the second leading cause of death amongst those aged 15 to 29 years. Self-harm is increasingly common among young people in many countries, particularly among women and girls. The risk of suicide is elevated 30-fold in the year following hospital presentation for self-harm, and those with suicidal ideation have double the risk of suicide compared with the general population. Self-harm and suicide in young people are significant public health issues that cause distress for young people, their peers, and family, and lead to substantial healthcare costs. Educational settings are widely acknowledged as a logical and appropriate place to provide prevention and treatment. A comprehensive, high-quality systematic review of self-harm and suicide prevention programmes in all education settings is thus urgently required. This will support evidence-informed decision making to facilitate rational investment in prevention efforts in educational settings. Suicide and self-harm are distressing, and we acknowledge that the content of this review is sensitive as the data outlined below represents the lived and living experience of suicidal distress for individuals and their caregivers. To assess the effects of interventions delivered in educational settings to prevent or address self-harm and suicidal ideation in young people (up to the age of 25) and examine whether the relative effects on self-harm and suicide are modified by education setting. We searched the Cochrane Common Mental Disorders Specialised Register, CENTRAL, The Cochrane Database of Systematic Reviews, Ovid MEDLINE, PsycINFO, ERIC, Web of Science Social Science Citation Index, EBSCO host Australian Education Index, British Education Index, Educational Research Abstracts to 28 April 2023. We included trials where the primary aim was to evaluate an intervention specifically designed to reduce self-harm or prevent suicide in an education setting. Randomised controlled trials (RCTs), cluster-RCTs, cross-over trials and quasi-randomised trials were eligible for inclusion. Primary outcomes were self-harm postintervention and acceptability; secondary outcomes included suicidal ideation, hopelessness, and two outcomes co-designed with young people: better or more coping skills, and a safe environment, with more acceptance and understanding. We used standard methodological procedures as expected by Cochrane. Two review authors independently selected studies, extracted data, and assessed risk of bias. We analysed dichotomous data as odds ratios (ORs) and continuous data as standardised mean differences (SMDs) with 95% confidence intervals (CIs). We conducted random-effects meta-analyses and assessed certainty of evidence using the GRADE approach. For co-designed outcomes, we used vote counting based on the direction of effect, as there is a huge variation in the data and the effect measure used in the included studies. We included 51 trials involving 36,414 participants (minimum 23; maximum 11,100). Twenty-seven studies were conducted in secondary schools, one in middle school, one in primary school, 19 in universities, one in medical school, and one across education and community settings. Eighteen trials investigated universal interventions, 11 of which provided data for at least one meta-analysis, but no trials provided data for self-harm postintervention. Evidence on the acceptability of universal interventions is of very low certainty, and indicates little or no difference between groups (OR 0.77, 95% CI 0.36 to 1.67; 9 studies, 8528 participants). Low-certainty evidence showed little to no effect on suicidal ideation (SMD -0.02, 95% CI -0.23 to 0.20; 4 studies, 379 participants) nor on hopelessness (MD -0.01, 95% CI -1.98 to 1.96; 1 trial, 121 participants). Fifteen trials investigated selective interventions, eight of which provided data for at least one meta-analysis, but only one trial provided data for self-harm postintervention. Low-certainty evidence indicates that selective interventions may reduce self-harm postintervention slightly (OR 0.39, 95% CI 0.06 to 2.43; 1 trial, 148 participants). While no trial provided data for hopelessness, little to no effect was found on acceptability (OR 1.00, 95% CI 0.5 to 2.0; 6 studies, 10,208 participants; very low-certainty evidence) or suicidal ideation (SMD 0.04, 95% CI -0.36 to 0.43; 2 studies, 102 participants; low-certainty evidence). Seventeen trials investigated indicated interventions, 14 of which provided data for at least one meta-analysis, but only four trials provided data for self-harm postintervention and two reported no events in both groups. Low-certainty evidence suggests that indicated interventions may slightly reduce self-harm postintervention (OR 0.19, 95% CI 0.02 to 1.76; 2 studies, 76 participants). There is also low-certainty evidence indicating that these interventions may decrease the odds of non-suicidal self-injury (OR 0.65, 95% CI 0.24 to 1.79; 2 studies, 89 participants). Evidence of a slight decrease in acceptability in the intervention group is of low certainty (OR 1.44, 95% CI 0.86 to 2.42; 10 studies, 641 participants). Low-certainty evidence shows that indicated interventions may slightly reduce suicidal ideation (SMD -0.33, 95% CI -0.55 to -0.10; 10 studies, 685 participants) and may result in little to no difference in hopelessness postintervention (SMD -0.27, 95% CI -0.55 to 0.01; 6 studies, 455 participants). There were mixed findings regarding the effect of suicide prevention interventions on a range of constructs relevant to coping skills and safe environment. None of the trials, however, measured the impact of improvements in these constructs on self-harm or suicidal ideation. While this review provides an update on the evidence about interventions targeting self-harm and suicide prevention in education settings, there remains significant uncertainty about the impact of these interventions. There are some promising findings but large replication studies are needed, as are studies that examine the combination of different intervention approaches, and can be delivered in a safe environment and implemented over a long period of time. Further research is required to understand and measure outcomes that are meaningful to young people with lived experience, as they want coping skills and safety of the environment in which they conduct their everyday lives to be measured as key outcomes in future trials.

Sharma V ，Marshall D ，Fortune S ，Prescott AE ，Boggiss A ，Macleod E ，Mitchell C ，Clarke A ，Robinson J ，Witt KG ，Hawton K ，Hetrick SE ... -  《Cochrane Database of Systematic Reviews》

Factors Associated With Suicide Risk Behavior Outcomes Among Black Middle School Adolescents.

Early adolescent self-identifying Black youth present with high rates of suicidality. This study assesses associations among 7 explanatory variables (sex, weapon carrying, weight perceptions, grades, grade level, bullying at school, and cyberbullying) and suicide ideation, planning, and attempts, and identifies associations with suicidality as a composite measure among a sample of Black middle school adolescents (BMSA) in the United States. Data were extracted from the 2019 Middle School Youth Risk Behavior Survey. Descriptive statistics were calculated, and associations between suicide ideation, planning, and attempts were explored. A network graphical representation of polychoric and tetrachoric correlations across suicidality outcomes and explanatory variables was performed. A multivariable, multinomial logistic regression model estimated associations among explanatory variables and suicide ideation (with and without planning) and planning (with and without ideation). Both suicide attempt and a composite suicidality metric were explored using independent logistic models with multiple imputation. The sample included 7,643 self-identifying BMSA. Our findings indicate that approximately 28% reported suicidality. Prevalence rates were found of about 1 in 4 BMSA for suicidal ideation, 1 in 6 for suicidal planning, and 1 in 10 for attempting suicide. Female BMSA, victims of cyberbullying, and BMSA carrying a weapon experienced significantly higher odds of all suicidality outcome measures. Practical implications for identifying and screening suicidality among BMSA to guide suicide prevention efforts are necessary. Findings validate the need for informed cultural approaches to suicide screening and prevention efforts to reduce suicide risk outcomes, especially when identifiable environmental factors are strongly associated with those outcomes. Suicide rates have alarmingly increased for early adolescent Black youth, and exploring factors that inform suicide risk behavior outcomes is necessary for this population. Using responses of 7,643 Black middle school adolescents who participated in the 2019 Youth Risk Behavior Survey, the authors found that approximately 28% of Black middle school adolescents reported some form of suicidality with higher odds experienced among female participants. Other factors associated with suicidality included carrying a weapon, being bullied, being cyberbullied, and reporting lower grades in school. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.

Richardson SC ，Gunn LH 《-》

A multicomponent psychosocial intervention to reduce substance use by adolescents involved in the criminal justice system: the RISKIT-CJS RCT.

Coulton S ，Nizalova O ，Pellatt-Higgins T ，Stevens A ，Hendrie N ，Marchand C ，Vass R ，Deluca P ，Drummond C ，Ferguson J ，Waller G ，Newbury-Birch D ... -  《-》

Comparing frequencies of adolescent suicide attempters pre- and during COVID-19 pandemic school terms.

The COVID-19 pandemic had and still have a major impact on adolescent mental health and consequently on suicidal behavior. However, few studies have investigated whether the pandemic has changed the patterns and the triggers of suicidality peaks in adolescents, e.g., seasonal patterns or family conflicts. We hypothesized that the pandemic modified suicidality rates: an increment of suicide attempts would be observed in the first semester of the academic year during COVID-19 pandemic compared to the same period of previous academic year; and the precipitating factors would be more related to social stressors during the pandemic school year. A retrospective cross-sectional study was conducted to assess the precipitating factors, also including school-related factors and cognitive skills, of adolescent suicide attempters occurred in the first and second semesters of the year before the pandemic lockdown (study periods 1 and 2) and the year after (study periods 3 and 4). The sample consisted of 85 adolescents aged between 12 and 17 recruited consecutively from March 2019 to March 2021 at emergency ward because of suicide attempt. Forty-eight adolescents (55.3% of the sample) were attended before the lockdown (pre-pandemic group) and 38 (44.7%) the year after. The results showed a higher proportion of female suicide attempters in period 4 (Sept 2020-Feb 2021) respect to period 3 (Mar 2020-Aug 2020), i.e., pandemic semesters compared with the increment observed between period 2 and 1 (prepandemic semesters; Fisher's exact test = 4.73; p = 0.026). The multinomial regression models showed a significant effect in the frequency of adolescents who attempted suicide (ratio χ2 = 15.19, p = 0.019), accounted by the differences between period 4 (Sept 2020-Feb 2021) and period 1 (Mar 2019-Aug 2019), with depressive symptoms being a significant contributing factor (Exp(b) = 0.93; p = 0.04). Additionally, social triggers and age were found to be significant risk factors for suicide attempts in the first semester of the pandemic academic year (period 4) compared to the same semester of the pre-pandemic year (period 2; Exp(b) = 0.16, p = 0.01, and Exp(b) = 1.88, p = 0.006, respectively). During the pandemic, the decrement between first and second semester of the number of females attempting suicide was more pronounced than in the prepandemic school year -though this findings lacked statistical power due to very limited sample size-. Change in the frequency of adolescent attempting suicide in the different school periods was associated with greater severity of depressive symptoms. Social relations in back-to-school after the lockdown were also associated with the number of adolescents attempting suicide.

Gracia-Liso R ，Portella MJ ，Pujals-Altés E ，Puntí-Vidal J ，Llorens M ，Pàmias M ，Jiménez MF ，Aguirrezabala IM ，Palao DJ ... -  《-》