Risk factors for nonfatal self-harm and suicide among adolescents: two nested case-control studies conducted in the UK Clinical Practice Research Datalink / Lukasz CYBULSKI in Journal of Child Psychology and Psychiatry, 63-9 (September 2022)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 63-9 (September 2022) . - p.1078-1088 Titre : Risk factors for nonfatal self-harm and suicide among adolescents: two nested case-control studies conducted in the UK Clinical Practice Research Datalink Type de document : Texte imprimé et/ou numérique Auteurs : Lukasz CYBULSKI, Auteur ; Darren M. ASHCROFT, Auteur ; Matthew J. CARR, Auteur ; Shruti GARG, Auteur ; Carolyn A. CHEW-GRAHAM, Auteur ; Nav KAPUR, Auteur ; Roger T. WEBB, Auteur Article en page(s) : p.1078-1088 Langues : Anglais (eng) Mots-clés : Adolescent  Autism Spectrum Disorder  Case-Control Studies  Female  Humans  Male  Risk Factors  Self-Injurious Behavior/epidemiology/psychology  Suicide/prevention & control  United Kingdom/epidemiology  Adolescence  case-control  self-harm  suicide Index. décimale : PER Périodiques Résumé : BACKGROUND: The characteristics of adolescents who die by suicide have hitherto been examined in uncontrolled study designs, thereby precluding examination of risk factors. The degree to which antecedents of nonfatal self-harm and suicide at young age differ remains unknown. METHOD: We delineated two nested case-control studies of patients aged 10-19years using the Clinical Practice Research Datalink with interlinked hospital and national mortality records. Cases were adolescents who between 1st January 2003 and 31st December 2018 had died from suicide (N=324) - study 1; experienced their first self-harm episode (N=56,008) - study 2. In both studies, cases were matched on sex, age and practice-level deprivation quintile to 25 controls. By fitting conditional logistic regression, we examined how risks varied according to psychiatric diagnoses, prescribed psychotropic medication, patterns of clinical contact and area-level deprivation. RESULTS: Suicides occurred more often among boys (66%), but self-harm was more common in girls (68%). Most individuals who self-harmed or died from suicide presented to their GP at least once in the preceding year (85% and 75% respectively). Only a third of cases had one of the examined diagnostic categories recorded. Depression was most strongly associated with elevated risks for both outcomes (self-harm: OR 7.9; 95% CI 7.8-8.2; suicide: OR 7.4; 95% CI 5.5-9.9). Except for autism spectrum disorder, all other diagnostic categories were linked with similar risk elevations for self-harm as for suicide. Whilst self-harm risk rose incrementally with increasing levels of area-level deprivation, suicide risks did not. CONCLUSIONS: We observed few marked differences in risk factor profiles for nonfatal self-harm versus suicide. As most adolescents who had harmed themselves or died by suicide were known to services in the preceding year, their underlying pathology may not be adequately identified and treated. Our findings highlight the need for a multiagency approach to treatment and prevention. En ligne : http://dx.doi.org/10.1111/jcpp.13552 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=486 [article] Risk factors for nonfatal self-harm and suicide among adolescents: two nested case-control studies conducted in the UK Clinical Practice Research Datalink [Texte imprimé et/ou numérique] / Lukasz CYBULSKI, Auteur ; Darren M. ASHCROFT, Auteur ; Matthew J. CARR, Auteur ; Shruti GARG, Auteur ; Carolyn A. CHEW-GRAHAM, Auteur ; Nav KAPUR, Auteur ; Roger T. WEBB, Auteur . - p.1078-1088. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 63-9 (September 2022) . - p.1078-1088 Mots-clés : Adolescent  Autism Spectrum Disorder  Case-Control Studies  Female  Humans  Male  Risk Factors  Self-Injurious Behavior/epidemiology/psychology  Suicide/prevention & control  United Kingdom/epidemiology  Adolescence  case-control  self-harm  suicide Index. décimale : PER Périodiques Résumé : BACKGROUND: The characteristics of adolescents who die by suicide have hitherto been examined in uncontrolled study designs, thereby precluding examination of risk factors. The degree to which antecedents of nonfatal self-harm and suicide at young age differ remains unknown. METHOD: We delineated two nested case-control studies of patients aged 10-19years using the Clinical Practice Research Datalink with interlinked hospital and national mortality records. Cases were adolescents who between 1st January 2003 and 31st December 2018 had died from suicide (N=324) - study 1; experienced their first self-harm episode (N=56,008) - study 2. In both studies, cases were matched on sex, age and practice-level deprivation quintile to 25 controls. By fitting conditional logistic regression, we examined how risks varied according to psychiatric diagnoses, prescribed psychotropic medication, patterns of clinical contact and area-level deprivation. RESULTS: Suicides occurred more often among boys (66%), but self-harm was more common in girls (68%). Most individuals who self-harmed or died from suicide presented to their GP at least once in the preceding year (85% and 75% respectively). Only a third of cases had one of the examined diagnostic categories recorded. Depression was most strongly associated with elevated risks for both outcomes (self-harm: OR 7.9; 95% CI 7.8-8.2; suicide: OR 7.4; 95% CI 5.5-9.9). Except for autism spectrum disorder, all other diagnostic categories were linked with similar risk elevations for self-harm as for suicide. Whilst self-harm risk rose incrementally with increasing levels of area-level deprivation, suicide risks did not. CONCLUSIONS: We observed few marked differences in risk factor profiles for nonfatal self-harm versus suicide. As most adolescents who had harmed themselves or died by suicide were known to services in the preceding year, their underlying pathology may not be adequately identified and treated. Our findings highlight the need for a multiagency approach to treatment and prevention. En ligne : http://dx.doi.org/10.1111/jcpp.13552 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=486

Socio-demographic variation in diagnosis of and prescribing for common mental illnesses among children and young people during the COVID-19 pandemic: time series analysis of primary care electronic health records / Louise Jane HUSSEY in Journal of Child Psychology and Psychiatry, 66-1 (January 2025)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 66-1 (January 2025) . - p.16-29 Titre : Socio-demographic variation in diagnosis of and prescribing for common mental illnesses among children and young people during the COVID-19 pandemic: time series analysis of primary care electronic health records Type de document : Texte imprimé et/ou numérique Auteurs : Louise Jane HUSSEY, Auteur ; Evan KONTOPANTELIS, Auteur ; Pearl L. H. MOK, Auteur ; Darren M. ASHCROFT, Auteur ; Matthew J. CARR, Auteur ; Shruti GARG, Auteur ; Carolyn A. CHEW-GRAHAM, Auteur ; Nav KAPUR, Auteur ; Karina LOVELL, Auteur ; Roger T. WEBB, Auteur Article en page(s) : p.16-29 Langues : Anglais (eng) Mots-clés : Anxiety disorders  depression  COVID-19  children and young people  ethnicity  deprivation  general practice Index. décimale : PER Périodiques Résumé : Background The impact of the COVID-19 pandemic on the mental health of children and young people (CYP) has been widely reported. Primary care electronic health records were utilised to examine trends in the diagnosing, recording and treating of these common mental disorders by ethnicity and social deprivation in Greater Manchester, England. Methods Time-series analyses conducted using Greater Manchester Care Record (GMCR) data examined all diagnosed episodes of anxiety disorders and depression and prescribing of anxiolytics and antidepressants among patients aged 6?24?years. The 41-month observation period was split into three epochs: Pre-pandemic (1/2019?2/2020); Pandemic Phase 1 (3/2020?6/2021); Pandemic Phase 2 (7/2021?5/2022). Rate ratios for all CYP specific to sex, age, ethnicity, and neighbourhood-level Indices of Multiple Deprivation (IMD) quintile were modelled using negative binomial regression. Results Depression and anxiety disorder rates were highest in females, CYP aged 19?24, and White and ?Other? ethnic groups. During Pandemic Phase 1, rates for these diagnoses fell in all demographic subgroups and then rose to similar levels as those recorded pre-pandemic. In Pandemic Phase 2, rates in Black and Mixed-ethnicity females rose to a significantly greater degree (by 54% and 62%, respectively) than those in White females. Prescribing rates increased throughout the study period, with significantly greater rises observed in non-White females and males. The temporal trends were mostly homogeneous across deprivation quintiles. Conclusion The observed fluctuations in frequency of recorded common mental illness diagnoses likely reflect service accessibility and patients' differential propensities to consult as well as changing levels of distress and psychopathology in the population. However, psychotropic medication prescribing increased throughout the observation period, possibly indicating a sustained decline in mental health among CYP, and also clinicians' responses to problems presented. The comparatively greater increases in frequencies of diagnosis recording and medication prescribing among ethnic minority groups warrants further investigation. En ligne : https://dx.doi.org/10.1111/jcpp.14026 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=545 [article] Socio-demographic variation in diagnosis of and prescribing for common mental illnesses among children and young people during the COVID-19 pandemic: time series analysis of primary care electronic health records [Texte imprimé et/ou numérique] / Louise Jane HUSSEY, Auteur ; Evan KONTOPANTELIS, Auteur ; Pearl L. H. MOK, Auteur ; Darren M. ASHCROFT, Auteur ; Matthew J. CARR, Auteur ; Shruti GARG, Auteur ; Carolyn A. CHEW-GRAHAM, Auteur ; Nav KAPUR, Auteur ; Karina LOVELL, Auteur ; Roger T. WEBB, Auteur . - p.16-29. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 66-1 (January 2025) . - p.16-29 Mots-clés : Anxiety disorders  depression  COVID-19  children and young people  ethnicity  deprivation  general practice Index. décimale : PER Périodiques Résumé : Background The impact of the COVID-19 pandemic on the mental health of children and young people (CYP) has been widely reported. Primary care electronic health records were utilised to examine trends in the diagnosing, recording and treating of these common mental disorders by ethnicity and social deprivation in Greater Manchester, England. Methods Time-series analyses conducted using Greater Manchester Care Record (GMCR) data examined all diagnosed episodes of anxiety disorders and depression and prescribing of anxiolytics and antidepressants among patients aged 6?24?years. The 41-month observation period was split into three epochs: Pre-pandemic (1/2019?2/2020); Pandemic Phase 1 (3/2020?6/2021); Pandemic Phase 2 (7/2021?5/2022). Rate ratios for all CYP specific to sex, age, ethnicity, and neighbourhood-level Indices of Multiple Deprivation (IMD) quintile were modelled using negative binomial regression. Results Depression and anxiety disorder rates were highest in females, CYP aged 19?24, and White and ?Other? ethnic groups. During Pandemic Phase 1, rates for these diagnoses fell in all demographic subgroups and then rose to similar levels as those recorded pre-pandemic. In Pandemic Phase 2, rates in Black and Mixed-ethnicity females rose to a significantly greater degree (by 54% and 62%, respectively) than those in White females. Prescribing rates increased throughout the study period, with significantly greater rises observed in non-White females and males. The temporal trends were mostly homogeneous across deprivation quintiles. Conclusion The observed fluctuations in frequency of recorded common mental illness diagnoses likely reflect service accessibility and patients' differential propensities to consult as well as changing levels of distress and psychopathology in the population. However, psychotropic medication prescribing increased throughout the observation period, possibly indicating a sustained decline in mental health among CYP, and also clinicians' responses to problems presented. The comparatively greater increases in frequencies of diagnosis recording and medication prescribing among ethnic minority groups warrants further investigation. En ligne : https://dx.doi.org/10.1111/jcpp.14026 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=545

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