Are Suicidal Thoughts and Behaviors a Temporary Phenomenon in Early Adolescence?

Background: The incidence of first suicidal thoughts and behaviors (STBs) peaks during early adolescence. After experiencing their first STBs, adolescents differ greatly in the extent to which they continue to have STBs. Aim: We determined the course of STBs in Dutch students at two ages: 13-14 years (t1) and 15-16 years (t2). Methods: Longitudinal data on STBs and sociodemographic factors were collected by self-report (n = 8,499). Associations between having STBs at t1 and t2 were determined with multinomial logistic regression analysis. Results: Students who reported suicidal thoughts at baseline (n = 1,077; 13%) reported suicidal thoughts (OR = 6.60; 95% CI [5.52, 7.88]) and suicidal attempts (OR = 6.97; 95% CI [4.20, 11.54]) at t2 more often than students with no STBs at t1. Students who reported a suicidal attempt at baseline (n = 144; 2%) also reported suicidal thoughts and suicidal attempts more often at t2 (OR = 5.98; 95% CI [3.89, 9.21]; OR = 30.00; 95% CI [15.84, 56.82], respectively). Limitations: The use of confidential self-reported data and the loss of cases after merging could have biased the results. Conclusion: For a subgroup of adolescents, STBs persisted and worsened over the 2 years. This demonstrates the importance of accurate identification of those at increased risk of suicide, in combination with personalized care.

Sociodemographic Differences in Time Trends of Suicidal Thoughts and Suicide Attempts Among Adolescents Living in Amsterdam, The Netherlands.

Background: Suicidal thoughts and suicide attempts among adolescents are major public health problems. More insight into secular changes in suicidal thoughts and suicide attempts among adolescents from various sociodemographic groups is crucial for adequate and targeted policy-making and prevention. We therefore examined 5-year time trends in suicidal thoughts and suicide attempts among adolescents and potential differences in time trends between sociodemographic groups. Methods: Logistic regression analyses were based on annually repeated cross-sectional data including 26,273 multi-ethnic students (13-14 years old) in the second year of various levels of secondary education in Amsterdam, The Netherlands. Results: Overall, the prevalence of adolescents in Amsterdam with suicidal thoughts decreased from 17.6% during 2010-2011 to 13.2% during 2014-2015. The prevalence of adolescents reporting suicide attempts decreased from 2.9% to 1.9% over the observed 5-year period. We found differences in these time trends between subgroups based on ethnicity and educational level. Limitations: The use of confidential and self-reported data could have biased the results. Conclusion: In order for prevention policy to be effective it is important to pay attention to changes in risk groups for suicidal thoughts and suicide attempts over time.

Determinants of Child Health Behaviors in a Disadvantaged Area from a Community Perspective: A Participatory Needs Assessment.

Children from disadvantaged areas are hard to reach for interventions aimed at promoting healthy lifestyles. We conducted a participatory needs assessment, in which researchers collaborated with a community in a disadvantaged area in Amsterdam to gain an understanding of the health-related issues of children within this community. Qualitative data was collected through: three to four participatory group meetings with three groups of 9-12-year-old children (n = 5-9 per group); nine interviews with professionals working with youth; two interviews with parents and their children; and informal meetings including 31 parents. All transcriptions or summaries were coded and analyzed. Childhood overweight/obesity was indicated as the main health issue. A lack of physical activity and unhealthy dietary behavior were identified as the main risk factors, with underlying determinants such as culture, habits, finances, and social norms. Identified needs included more supervised, low-priced sports activities at a nearby location and more education on adopting a healthy diet. Our participatory health needs assessment resulted in a comprehensive overview of the most relevant risk factors and determinants of childhood overweight/obesity and needs from the community's perspective. This knowledge aids in the development of better tailored, and thereby potentially more effective, interventions.

Using a Co-Creational Approach to Develop, Implement and Evaluate an Intervention to Promote Physical Activity in Adolescent Girls from Vocational and Technical Schools: A Case Control Study.

Background: As physical inactivity is particularly prevalent amongst lower-educated adolescent girls, interventions are needed. Using a co-creational approach increases their engagement and might be effective. This study aimed to: (1) describe the co-creation process, (2) evaluate how girls experienced co-creation, and (3) evaluate the effect of the co-creational interventions on physical activity, individual, sociocultural and school-based factors. Methods: Three intervention schools (n = 91) and three control schools (n = 105) across Flanders participated. A questionnaire was completed pre (September-October 2014) and post (April-May 2015). In between, sessions with a co-creation group were organised to develop and implement the intervention in each intervention school. Focus groups were conducted to evaluate the co-creational process. Results: School 1 organised sport sessions for girls, school 2 organised a fitness activity and set up a Facebook page, school 3 organised a lunch walk. Girls were positive about having a voice in developing an intervention. No significant effects were found, except for small effects on extracurricular sports participation and self-efficacy. Conclusions: Using a co-creational approach amongst adolescent girls might be a feasible approach. However, as interventions were minimal, effects were limited or undetectable. Future co-creation projects could consider the most optimal co-creation process, evaluation design and intensively test this approach.

Dutch Primary Schoolchildren's Perspectives of Activity-Friendly School Playgrounds: A Participatory Study.

School playgrounds are important physical activity (PA) environments for children, yet only a small number of children reaches the target of 40% of moderate-to-vigorous PA time during recess. The aim of this study was to explore children's perspectives (i.e., child-identified determinants) of activity-friendly school playgrounds. We conducted participatory research with children as co-researchers, framed as a project to give children the opportunity to discuss their views and ideas about their school playgrounds. At three schools, six children (9-12 years old) met over five to seven group meetings. Data analysis included children's conclusions obtained during the project and the researcher's analysis of written reports of all meetings. Children indicated a strong desire for fun and active play, with physical playground characteristics and safety, rules and supervision, peer-interactions, and variation in equipment/games as important determinants. Our results indicate that improving activity-friendliness of playgrounds requires an integrated and multi-faceted approach. It also indicates that children, as primary users, are able to identify barriers for active play that are easily overlooked, unknown or differently perceived by adults. Hence, we believe that structural involvement of children in designing, developing and improving playgrounds may increase children's' active play and consequently PA levels during recess.