Factors associated with high and low mental well-being in Spanish university students.

BACKGROUND: Previous studies conducted in various nationally representative samples of the general population show that positive mental health is related to social prosperity. However, specific studies in university populations are scarce. In this study, we set out to explore factors associated with mental well-being (MWB) in a representative sample of first-year university students in Spain. METHODS: MWB was assessed with the short version of the Warwick-Edinburgh Mental Well-Being Scale. Multinomial logistic regressions were performed to explore the association between different blocks of factors, including relational, adversity, stress, lifestyle, spiritual, health, and self-perceived health variables with high and low MWB, controlling for sociodemographic and university-related variables. RESULTS: Data from 2082 students (18.6 ± 1.2 years; 56.6 % females) were analysed. Being male, being born in a foreign country, "high" self-perceived support, and "high" self-perceived mental health increased the odds of high MWB. Growing up in the suburbs, stressful experiences, and anxiety disorders reduced the odds of high MWB. Mood and anxiety disorders increased the odds of low MWB. "Middle" self-perceived support, sleeping ≥8 h per day, and "high" self-perceived mental health reduced the odds of low MWB. LIMITATIONS: The cross-sectional design precludes establishing causal relationships. Data were collected in the 2014-15 academic year using self-reported online surveys. CONCLUSION: The factors associated with high and low MWB do not always mirror each other, so specific plans are needed to successfully address each of the two poles. Interventions and policies targeting these factors for health promotion and disease prevention would improve the MWB of university students.

Experience sampling methods for the personalised prediction of mental health problems in Spanish university students: protocol for a survey-based observational study within the PROMES-U project.

INTRODUCTION: There is a high prevalence of mental health problems among university students. Better prediction and treatment access for this population is needed. In recent years, short-term dynamic factors, which can be assessed using experience sampling methods (ESM), have presented promising results for predicting mental health problems. METHODS AND ANALYSIS: Undergraduate students from five public universities in Spain are recruited to participate in two web-based surveys (at baseline and at 12-month follow-up). A subgroup of baseline participants is recruited through quota sampling to participate in a 15-day ESM study. The baseline survey collects information regarding distal risk factors, while the ESM study collects short-term dynamic factors such as affect, company or environment. Risk factors will be identified at an individual and population level using logistic regressions and population attributable risk proportions, respectively. Machine learning techniques will be used to develop predictive models for mental health problems. Dynamic structural equation modelling and multilevel mixed-effects models will be considered to develop a series of explanatory models for the occurrence of mental health problems. ETHICS AND DISSEMINATION: The project complies with national and international regulations, including the Declaration of Helsinki and the Code of Ethics, and has been approved by the IRB Parc de Salut Mar (2020/9198/I) and corresponding IRBs of all participating universities. All respondents are given information regarding access mental health services within their university and region. Individuals with positive responses on suicide items receive a specific alert with indications for consulting with a health professional. Participants are asked to provide informed consent separately for the web-based surveys and for the ESM study. Dissemination of results will include peer-reviewed scientific articles and participation in scientific congresses, reports with recommendations for universities' mental health policy makers, as well as a well-balanced communication strategy to the general public. STUDY REGISTRATION: osf.io/p7csq.

Let's Talk About Suicide Spectrum in Spanish Adolescents. "Prefer not to say": Missing Value or Clinical Data?

BACKGROUND: Suicide is the second leading cause of death in young people aged 15-29 in Spain. It is imperative to detect cases with suicidal risk for early intervention. The purpose of the study was to examine the self-reported presence of suicide spectrum indicators using a trichotomous rating scale: no, yes, prefer not to say . This last alternative was intended to safeguard the sensitive nature of the phenomenon and explore its clinical character. METHOD: 5,528 adolescents made up the definitive sample (12-18 years; M ± SD = 14.20 ± 1.53; 50.74% female). RESULTS: Prevalence reached 15.38% for ideation, 9.32% for planning, and 3.65% for previous suicide attempts. Girls' rates were twice those of men. Suicidality showed a tendency to increase with age. Adolescents with the presence of suicidal indicators (yes) and omission of response (prefer not to say) both had lower levels of socioemotional strength and subjective well-being, and higher levels of psychopathology than the group with the absence of markers (no). CONCLUSIONS: Prefer not to say is a response category that increases the sensitivity of the self-report, allowing more accurate identification of cases with a high suicidal risk that would go unnoticed by the traditional dichotomous system (no-yes).

Civic Engagement and Personality: Associations with the Big Five and the Dark Triad.

Several studies have analyzed the relationship between general personality traits and attitudes and behaviors, indicating that a person is more committed to the community. After raising the question of whether malevolent traits might also be related, the aim was to analyze the relationship between civic engagement and personality, delving into the contribution of the Dark Triad (narcissism, Machiavellianism, and psychopathy) and controlling for the association with the Big Five. The Civic Engagement Questionnaire, the Short Dark Triad, and the Big Five Inventory-10 were administered to 1175 Spanish students (convenience sampling). After performing statistical analyses using SPSS statistical software, it was obtained that the three Dark Triad traits explained 11% of the total explained variance of civic engagement, while 19% was reached when the Big Five were included. Narcissism and openness were the factors most strongly associated with engagement. The positive relationship between narcissism and general personality traits could explain why narcissistic people have more favorable attitudes. Furthermore, people with narcissistic traits may display these attitudes for their own benefit. This study provides further evidence of how the narcissistic personality trait differs from the other two malevolent traits. Given that these traits are also associated with maladaptive behaviors, knowing all their characteristics could facilitate the design of prevention programs aimed at reducing such maladaptive behaviors.

Socio-emotional strengths against psychopathology and suicidal ideation in fear of COVID-19.

Coronavirus disease (COVID-19) has caused a global health crisis. It also leads to different types of psychosocial problems in society as a result of preventive health measures and the disease itself. Among others, psychopathological symptoms and suicide behaviors have increased. The PsicorecurSOS COVID-19 online protocol was designed. At baseline, 1020 Spanish adults were assessed, during confinement, for sociodemographics, fear of COVID-19, anxious-depressive symptoms, covitality, and suicidal ideation. Reliability, descriptive, and frequency analyses were carried out, and the computer tool SPSS PROCESS was used to carry out a conditional process analysis (model 59). A total of 595 participants were included (58.30% response rate from baseline; mean age = 37.18 [SD = 13.30]; 72.44% female). Regarding suicidal ideation, 12% responded differently to "never," 19.3% exceeded the cutoff point on the anxiety scale, and 24% on the depression scale. Moderate mediation analysis explained 27% of the variance in suicidal ideation. In addition, the indirect effect of moderate mediation was significant (b = -.004, SE = .002 with the presence of covitality; and b = .01, SE = .003 absence of covitality). Sex and age did not influence the overall outcome of the model. The data from this study can serve as a starting point for generating social and health treatment initiatives based on self-examination of anxiety-depressive symptoms and increasing socio-emotional skills in order to prevent and alleviate the psychosocial effects of the pandemic.

Let’s Talk About Suicide Spectrum in Spanish Adolescents. "Prefer not to say": Missing Value or Clinical Data? / Hablemos de Espectro Suicida en Adolescentes Españoles. "No Deseo Contestar": ¿Valor Perdido o Dato Clínico?

Background: Suicide is the second leading cause of death in young people aged 15-29 in Spain. It is imperativeto detect cases with suicidal risk for early intervention. The purpose of the study was to examine the self-reportedpresence of suicide spectrum indicators using a trichotomous rating scale: no, yes, prefer not to say. This last alternativewas intended to safeguard the sensitive nature of the phenomenon and explore its clinical character. Method: 5,528adolescents made up the definitive sample (12-18 years; M ± SD = 14.20 ± 1.53; 50.74% female). Results: Prevalencereached 15.38% for ideation, 9.32% for planning, and 3.65% for previous suicide attempts. Girls’ rates were twicethose of men. Suicidality showed a tendency to increase with age. Adolescents with the presence of suicidal indicators(yes) and omission of response (prefer not to say) both had lower levels of socioemotional strength and subjective well-being, and higher levels of psychopathology than the group with the absence of markers (no). Conclusions: Prefer notto say is a response category that increases the sensitivity of the self-report, allowing more accurate identification ofcases with a high suicidal risk that would go unnoticed by the traditional dichotomous system (no-yes).(AU)

Antecedentes: En España, el suicidio constituye la segunda causa de muerte en jóvenes de 15 a 29 años. Es imperativa ladetección de casos con riesgo suicida para una intervención temprana. El objetivo del estudio fue examinar la presenciaautoinformada de indicadores del espectro suicida en adolescentes mediante una escala de respuesta tricotómica: no,sí, no deseo contestar. Incluir esta última alternativa pretendía salvaguardar la naturaleza sensible del fenómeno yexplorar su carácter clínico. Método: 5,528 adolescentes conformaron la muestra definitiva (12-18 años; M ± DT =14,20 ± 1,53; 50,74% mujeres). Resultados: Las prevalencias alcanzaron el 15.38% en ideación, 9,32% en planificacióny 3,65% en tentativas suicidas previas. Las mujeres duplicaron las cifras de los hombres. La suicidalidad mostró unatendencia a incrementar con la edad. Adolescentes con presencia de indicadores suicidas (sí) y omisión de respuesta (nodeseo contestar) obtuvieron, de forma equivalente, niveles inferiores en fortaleza socioemocional y bienestar subjetivo,y superiores en psicopatología, frente al grupo con ausencia de marcadores (no). Conclusiones: No deseo contestarconstituye una categoría de respuesta que incrementa la sensibilidad del autoinforme, permitiendo una identificación másprecisa de casos con alto riesgo suicida que pasarían desapercibidos mediante el sistema dicotómico tradicional (no-sí).(AU)

Intervenciones cognitivo-conductuales para reducir conductas autolesivas en niños y jóvenes con TEA: Una revisión sistemática / Cognitive-behavioural interventions to decrease self-injurious behaviours in children and young people with ASD: A Systematic Review

Las conductas autolesivas en niños y jóvenes con Trastorno del Espectro Autista (TEA) entrañan riesgos para su integridad física, afectan a sucalidad de vida, la de sus familias y dificultan su integración en el ámbito escolar y social, integración ya de por sí limitada por las característicaspropias de este tipo de trastornos. Aunque hay pocos estudios sobre autolesiones en esta población, en general se ha visto que, a mayor afectacióny menor nivel cognitivo, las conductas autolesivas son más frecuentes que en casos más leves. El objetivo de este trabajo fue revisar la eficaciade las intervenciones de tipo cognitivo-conductual para la reducción de conductas autolesivas en niños y jóvenes con TEA. Para ello se realizaronbúsquedas en PsycINFO, Scopus y Google Scholar. La revisión incluyó estudios en lengua inglesa o española sobre intervenciones de tipo cognitivo-conductual para reducir conductas autolesivas en niños y jóvenes con TEA; con muestras formadas por personas TEA entre 1 y 30 años quepresentaban conductas autolesivas; y realizados entre 1970 y 2022. De los 228 estudios identificados, solo 7 cumplieron los criterios de inclusión.Los estudios incluidos en la presente revisión incluyeron participantes entre los 3 y los 26 años diagnosticados con TEA y fueron publicados entre1974 y 2015, evidenciando la eficacia de las intervenciones cognitivo-conductuales. Aunque dichos estudios muestran resultados positivos tras lasintervenciones, su número es escaso, por lo que es necesario seguir investigando sobre la eficacia de las intervenciones de carácter cognitivo-conductual para reducir conductas autolesivas en niños y jóvenes con TEA. (AU)

Self-injurious behaviours in children and young people with Autism Spectrum Disorder (ASD) imply risks to their physical integrity and affect their quality of lifeand that of their families. In addition, they hinder their integration into the school and social environments, this being limited by the characteristics ofthis type of disorder. Although there is little information about self-harm in this population, in general it has been seen that the greater the affectationand the lower the cognitive level, the more prevalent self-injurious behaviours are. The aim of this study was to review the efficacy of cognitive-behavioral interventions for the reduction of self-injurious behaviors in children and youth with ASD. For it, we searched PsycINFO, Scopus and GoogleScholar. The review included studies in English or Spanish languages on cognitive-behavioral interventions to reduce self-injurious behaviors inchildren and youth with ASD; with samples consisting of individuals with ASD between 1 and 30 years of age presenting self-injurious behaviors;and conducted between 1970 and 2022. Of the 228 studies identified, only 7 met the inclusion criteria. The included studies included participantsbetween the ages of 3 and 26 years diagnosed with ASD and were published between 1974 and 2015, evidencing the efficacy of cognitive-behavioral interventions. Although these studies show positive post-intervention results, they are scarce in number. Further research is therefore neededon the effectiveness of behavioural and cognitive interventions to reduce self-injurious behaviours in children and young people with ASD. (AU)

Predictive models for first-onset and persistence of depression and anxiety among university students.

BACKGROUND: Depression and anxiety are both prevalent among university students. They frequently co-occur and share risk factors. Yet few studies have focused on identifying students at highest risk of first-onset and persistence of either of these conditions. METHODS: Multicenter cohort study among Spanish first-year university students. At baseline, students were assessed for lifetime and 12-month Major Depressive Episode and/or Generalized Anxiety Disorder (MDE-GAD), other mental disorders, childhood-adolescent adversities, stressful life events, social support, socio-demographics, and psychological factors using web-based surveys; 12-month MDE-GAD was again assessed at 12-month follow-up. RESULTS: A total of 1253 students participated in both surveys (59.2% of baseline respondents; mean age = 18.7 (SD = 1.3); 56.0% female). First-onset of MDE-GAD at follow-up was 13.3%. Also 46.7% of those with baseline MDE-GAD showed persistence at follow-up. Childhood/Adolescence emotional abuse or neglect (OR= 4.33), prior bipolar spectrum disorder (OR= 4.34), prior suicidal ideation (OR=4.85) and prior lifetime symptoms of MDE (ORs=2.33-3.63) and GAD (ORs=2.15-3.75) were strongest predictors of first-onset MDE-GAD. Prior suicidal ideation (OR=3.17) and prior lifetime GAD symptoms (ORs=2.38-4.02) were strongest predictors of MDE-GAD persistence. Multivariable predictions from baseline showed AUCs of 0.76 for first-onset and 0.81 for persistence. 74.9% of first-onset MDE-GAD cases occurred among 30% students with highest predicted risk at baseline. LIMITATIONS: Self-report data were used; external validation of the multivariable prediction models is needed. CONCLUSION: MDE-GAD among university students is frequent, suggesting the need to implement web-based screening at university entrance that identify those students with highest risk.

Validation of an Online Version of the Alcohol Use Disorders Identification Test (AUDIT) for Alcohol Screening in Spanish University Students.

Online alcohol screening may be helpful in preventing alcohol use disorders. We assessed psychometric properties of an online version of the Alcohol Use Disorders Identification Test (AUDIT) among Spanish university students. We used a longitudinal online survey (the UNIVERSAL project) of first-year students (18-24 years old) in five universities, including the AUDIT, as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. A reappraisal interview was carried out with the Timeline Followback (TLFB) for alcohol consumption categories and the Mini International Neuropsychiatric Interview (MINI) for alcohol use disorder. Reliability, construct validity and diagnostic accuracy were assessed. Results: 287 students (75% women) completed the MINI, of whom 242 also completed the TLFB. AUDIT's Cronbach's alpha was 0.82. The confirmatory factor analysis for the one-factor solution of the AUDIT showed a good fit to the data. Significant AUDIT score differences were observed by TLFB categories and by MINI disorders. Areas under the curve (AUC) were very large for dependence (AUC = 0.96) and adequate for consumption categories (AUC > 0.7). AUDIT cut-off points of 6/8 (women/men) for moderate-risk drinking and 13 for alcohol dependence showed sensitivity/specificity of 76.2%/78.9% and 56%/97.5%, respectively. The online version of the AUDIT is useful for detecting alcohol consumption categories and alcohol dependence in Spanish university students.

Mental disorders in Spanish university students: Prevalence, age-of-onset, severe role impairment and mental health treatment.

BACKGROUND: The university period carries risk for onset of common mental disorders. Epidemiological knowledge on mental disorders among Spanish university students is limited. AIMS: To estimate lifetime and 12-month prevalence, persistence and age-of-onset of mental disorders among Spanish first-year university students, as well as associated role impairment and mental health treatment use. METHODS: First-year university students (N=2,118; 55.4% female; mean age=18.8 years) from five Spanish universities completed a web-based survey, screening possible DSM-IV mental disorders (major depressive episode(MDE), mania/hypomania, generalized anxiety disorder(GAD), panic disorder(PD), alcohol abuse/dependence(AUD), drug abuse/dependence(DUD), and adult attention-deficit/hyperactivity disorder(ADHD)). Role impairment and treatment associated with mental disorders were assessed. RESULTS: Lifetime and 12-month prevalence of any possible mental disorder was 41.3%(SE=1.08) and 35.7%(SE=1.05), respectively. Persistence (i.e., ratio of 12-month to lifetime prevalence) was 86.4%(SE=1.58). Median age-of-onset was 14 for adult ADHD, 15 for mood disorders and AUD, and 16 for anxiety disorders and DUD. One third (29.2%) of 12-month disorders were associated with role impairment. Twelve-month PD (OR=4.0;95%CI=1.9-8.5) had the highest odds for role impairment. Only 12.6% of students with 12-month disorder received any mental health treatment. Twelve-month treatment was the highest among those students with 12-month GAD (OR=7.4;95%CI=3.7-14.8). LIMITATIONS: The assessment of mental disorders was based on self-reports. Cross-sectional nature of the data prevents causal associations. CONCLUSION: One third of Spanish university students report a common mental disorder in the past year, and one third of those report severe role impairment. Only one out of eight students with 12-month mental disorders receives mental health treatment.

Strengths Against Psychopathology in Adolescents: Ratifying the Robust Buffer Role of Trait Emotional Intelligence.

The aim of this study was to unravel the interrelated effects of trait emotional intelligence (Trait EI), mindfulness, and irrational beliefs on adolescent mental health. A random sample of students from three secondary schools in Spain and eight secondary schools in Portugal was recruited. We conducted four-step hierarchical regression analyses. We also conducted regression analyses to examine the role of mindfulness skills and catastrophizing as mediators of the link between emotional intelligence and psychosocial problems. Finally, the SPSS PROCESS computing tool was used to perform conditional process analysis (model 6). A total of 1370 adolescents from Spain (n = 591) and Portugal (n = 779) participated in this study (mean age = 14.97, SD = 1.50; range = 12-18). The mediation analyses confirmed that adolescent mental health was determined by Trait EI directly, and by mindfulness skills and catastrophizing thoughts in an indirect way. Together, the four variables explained 44% of psychopathology, with EI being the most powerful predictor, which ratify the robust buffer role and incremental validity of Trait EI against youth mental health. The identified pathways provide keys for emotional education interventions aimed at promoting adolescent mental health.

Medidas de frecuencia utilizadas en estudios de cohortes para evaluar el comportamiento suicida en jóvenes (12-26 años): una revisión sistemática / Measures of frequency used in cohorts studies to evaluate the suicidal behaviour in young people (12-26 years): a systematic review

Introducción: La OMS prioriza para el año 2020 reducir las tasas de suicidio señalando dificultades para dar estimaciones precisas debido a una amplia variedad de factores, entre ellos, aspectos relativos a la propia medición estadística de la conducta suicida. La proporción de muertes por suicidio es del 8,5% para los jóvenes de entre 15-29 años. Objetivo: Revisar la metodología empleada para expresar la frecuencia de la conducta suicida en población joven y describir las características metodológicas de los estudios examinados. Método: Revisión sistemática de estudios longitudinales registrada en PROSPERO. La información extraída fue: año de publicación, revista, tamaño poblacional, muestra, país, diseño, edad, porcentaje de hombres, tiempo de seguimiento y pérdidas, comportamiento suicida, factores de riesgo, aspectos éticos y evaluándose fundamentalmente las medidas de frecuencia empleadas. Resultados: Se identificaron 37.793 documentos, de los cuales fueron seleccionados 82. Ningún estudio define la medida de frecuencia empleada para la conducta suicida, encontrándose hasta 9 formas diferentes de medirla. La población son estudiantes o población general (66%), cohortes de nacimiento (16%) y colectivos específicos. El seguimiento fue de 24 semanas hasta 30 años. Solo un 24,1% de los estudios consideró los aspectos éticos. Conclusiones: Se constata que no existe una sistematización a la hora de medir la frecuencia de presentación de la conducta suicida. La variabilidad metodológica y terminológica utilizada dificulta hacer comparaciones entre los estudios y conocer la verdadera dimensión del problema. Se insta a los investigadores a realizar un esfuerzo para consensuar las medidas de frecuencia empleadas en los estudios de cohortes

Introduction: A priority for the WHO by 2020 is to have reduced the rates of suicide; they indicate difficulties in giving precise estimations due to a wide variety of factors, which include aspects related to the statistical measurements themselves of suicidal behaviour. The proportion of deaths from suicide is 8.5% among young people between 15-29 years of age. Objective: To review the methodology used to express the frequency of suicidal behaviour in young people and to describe the methodological characteristics of the studies reviewed. Method: A systematic review of longitudinal studies registered on PROSPERO. The extracted information included the following: year of publication, journal, population size, sample, country, design, age, percentage of men, follow-up time and losses, suicidal behaviour, risk factors, ethical aspects, fundamentally, evaluating the measures of frequency used. Results: Eighty-two articles were selected from 37,793 documents. None of the studies define the measure of frequency used for suicidal behaviour, there are currently up to 9 different ways of measuring it. The populations are students or the general population (66%), birth cohorts (16%) and specific groups. Follow-up was from 24 weeks to 30 years. Only 24.1% of the studies took ethical aspects into consideration. Conclusions: Researchers must make an effort to reach an agreement on the measures of frequency used in suicidal behaviour studies, as the methodological and terminological variability currently used impedes making any comparisons between different studies or understanding the real dimension of the problem

Gender commonalities and differences in risk and protective factors of suicidal thoughts and behaviors: A cross-sectional study of Spanish university students.

AIM: To assess gender differences in the association between risk/protective factors and suicidal thoughts and behaviors (STB); and whether there is any gender-interaction with those factors and STB; among Spanish university students. METHODS: Data from baseline online survey of UNIVERSAL project, a multicenter, observational study of first-year Spanish university students (18-24 years). We assessed STB; lifetime and 12-month negative life-events and family adversities; mental disorders; personal and community factors. Gender-specific regression models and gender-interactions were also analyzed. RESULTS: We included 2,105 students, 55.4% women. Twelve-month prevalence of suicidal ideation (SI) was 10%, plans 5.7%, attempts 0.6%. Statistically significant gender-interactions were found for lifetime anxiety disorder, hopelessness, violence between parents, chronic health conditions and family support. Lifetime mood disorder was a common risk factor of SI for both genders (Females: OR= 5.5; 95%CI 3.3-9.3; Males: OR= 4.4; 95%CI 2.0-9.7). For females, exposure to violence between parents (OR= 3.5; 95%CI 1.7-7.2), anxiety disorder (OR= 2.7; 95%CI 1.6-4.6), and alcohol/substance disorder (OR= 2.1; 95%CI 1.1-4.3); and for males, physical childhood maltreatment (OR= 3.6; 95%CI 1.4-9.2), deceased parents (OR= 4.6; 95%CI 1.2-17.7), and hopelessness (OR= 7.7; 95%CI 2.8-21.2), increased SI risk. Family support (OR= 0.5; 95%CI 0.2-0.9) and peers/others support (OR= 0.4; 95%CI 0.2-0.8) were associated to a lower SI risk only among females. CONCLUSIONS: Only mood disorder was a common risk factor of SI for both genders, whereas important gender-differences were observed regarding the other factors assessed. The protective effect from family and peers/others support was observed only among females. Further research assessing underlying mechanisms and pathways of gender-differences is needed.

Accuracy of online survey assessment of mental disorders and suicidal thoughts and behaviors in Spanish university students. Results of the WHO World Mental Health- International College Student initiative.

OBJECTIVE: To assess the accuracy of WMH-ICS online screening scales for evaluating four common mental disorders (Major Depressive Episode[MDE], Mania/Hypomania[M/H], Panic Disorder[PD], Generalized Anxiety Disorder[GAD]) and suicidal thoughts and behaviors[STB] used in the UNIVERSAL project. METHODS: Clinical diagnostic reappraisal was carried out on a subsample of the UNIVERSAL project, a longitudinal online survey of first year Spanish students (18-24 years old), part of the WHO World Mental Health-International College Student (WMH-ICS) initiative. Lifetime and 12-month prevalence of MDE, M/H, PD, GAD and STB were assessed with the Composite International Diagnostic Interview-Screening Scales [CIDI-SC], the Self-Injurious Thoughts and Behaviors Interview [SITBI] and the Columbia-Suicide Severity Rating Scale [C-SSRS]. Trained clinical psychologists, blinded to responses in the initial survey, administered via telephone the Mini-International Neuropsychiatric Interview [MINI]. Measures of diagnostic accuracy and McNemar χ2 test were calculated. Sensitivity analyses were conducted to maximize diagnostic capacity. RESULTS: A total of 287 students were included in the clinical reappraisal study. For 12-month and lifetime mood disorders, sensitivity/specificity were 67%/88.6% and 65%/73.3%, respectively. For 12-month and lifetime anxiety disorders, these were 76.8%/86.5% and 59.6%/71.1%, and for 12-month and lifetime STB, 75.9%/94.8% and 87.2%/86.3%. For 12-month and lifetime mood disorders, anxiety disorders and STB, positive predictive values were in the range of 18.1-55.1% and negative predictive values 90.2-99.0%; likelihood ratios positive were in the range of 2.1-14.6 and likelihood ratios negative 0.1-0.6. All outcomes showed adequate areas under the curve [AUCs] (AUC>0.7), except M/H and PD (AUC = 0.6). Post hoc analyses to select optimal diagnostic thresholds led to improved concordance for all diagnoses (AUCs>0.8). CONCLUSION: The WMS-ICS survey showed reasonable concordance with the MINI telephone interviews performed by mental health professionals, when utilizing optimized cut-off scores. The current study provides initial evidence that the WMS-ICS survey might be useful for screening purposes.

Self-esteem and suicidal behaviour in youth: a meta-analysis of longitudinal studies / Autoestima y comportamiento suicida en jóvenes: un metaanálisis de estudios longitudinales

Background: Previous literature suggests that low self-esteem is a risk factor for suicide attempts, but no meta-analyses have been conducted to assess this association in adolescents/young adults. The present study examined the relationship between low self-esteem and suicide attempts in young people (12-26 years old). Method: Meta-analyses were performed using random-effects models (ES) and odds ratio (OR). Heterogeneity and sensitivity analyses were performed. Results: From 26,883 initial titles, 22 studies met the inclusion criteria, of which 9 studies had data that could be included in the meta-analysis. The meta-analysis showed that youths with lower self-esteem were more likely to have future suicide attempts, with an effect size (self-esteem as continuous variable) of d = .58 (95% CI = .44 - .73) and, for low self-esteem (categorical variable) an OR = 1.99 (95% CI = 1.39-2.86; p < .001). Conclusion: A low level of self-esteem is a risk factor for suicide attempts in adolescents/young adults

Antecedentes: según la literatura, la baja autoestima es un factor de riesgo para los intentos de suicidio, pero no se han realizado metaanálisis para evaluar esta asociación entre los adolescentes/jóvenes. El presente estudio examinó la relación entre la baja autoestima y los intentos de suicidio entre los jóvenes (12-26 años de edad). Método: los metaanálisis se realizaron mediante modelos de efectos aleatorios, con tamaños del efecto (TE) y odds-ratio (OR). Se realizaron análisis de heterogeneidad y sensibilidad. Resultados: de 2.883 trabajos iniciales, 22 estudios cumplieron con los criterios de inclusión, de los cuales 9 estudios tenían datos que podían incluirse en el meta-análisis. El meta-análisis mostró que los jóvenes con menor autoestima eran más propensos a tener intentos futuros de suicidio, con un tamaño del efecto (autoestima como variable continua) de TE = 0,58 (IC del 95%: 0,44 a 0,73) y para la autoestima baja (variable categórica), un OR = 1,99 (IC del 95%: 1,39 a 2,86; p<0,001). Conclusión: el bajo nivel de autoestima es un factor de riesgo para los intentos de suicidio en adolescentes/jóvenes. Se necesitan programas eficaces para aumentar los niveles de autoestima y prevenir futuros comportamientos suicidas

What is the Role of Internalizing and Externalizing Symptoms in Adolescent Suicide Behaviors?

Suicide is the second leading cause of death in adolescents and young adults aged 15 to 29 years. Specifically, the presence of internalizing and externalizing symptomatology is related to increased risk for suicide at these ages. Few studies have analyzed the relations between these symptoms and their role as mediators in predicting suicide behavior. This study aimed to examine the relation between internalizing and externalizing symptomatology and suicide behaviors through a longitudinal study. The sample consisted of 238 adolescents aged 12 to 18 years. The data were analyzed via the PROCESS Statistical Package. The main results showed that previous depression symptoms had a significant indirect effect, through previous suicide behaviors and current depression symptoms, on current suicide behaviors, accounting for 61% of the total variance explained. Additionally, being a girl increased this risk. Therefore, the implementation of early identification and intervention programs to address youth symptoms of depression and suicidal behaviors could significantly reduce the risk for future suicidal behaviors in adolescence.

Self-esteem and suicidal behaviour in youth: A meta-analysis of longitudinal studies.

BACKGROUND: Previous literature suggests that low self-esteem is a risk factor for suicide attempts, but no meta-analyses have been conducted to assess this association in adolescents/young adults. The present study examined the relationship between low self-esteem and suicide attempts in young people (12-26 years old). METHOD: Meta-analyses were performed using random-effects models (ES) and odds ratio (OR). Heterogeneity and sensitivity analyses were performed. RESULTS: From 26,883 initial titles, 22 studies met the inclusion criteria, of which 9 studies had data that could be included in the meta-analysis. The meta-analysis showed that youths with lower self-esteem were more likely to have future suicide attempts, with an effect size (self-esteem as continuous variable) of d = .58 (95% CI = .44 - .73) and, for low self-esteem (categorical variable) an OR = 1.99 (95% CI = 1.39-2.86; p < .001). CONCLUSION: A low level of self-esteem is a risk factor for suicide attempts in adolescents/young adults.

First-onset and persistence of suicidal ideation in university students: A one-year follow-up study.

BACKGROUND: Longitudinal evidence about risk and protective factors for suicidal ideation among university students is limited. METHODS: 12-month first-onset and persistence of suicidal ideation (SI) among Spanish first-year university students were estimated using baseline (T1) and 12-month follow-up (T2) online surveys. Information about STBs, childhood/adolescence adversities, positive relationships, mental disorders, recent stressful experiences, and university sense of membership was assessed. Logistic regression analysis was used to study risk/protective factors of first-onset and persistence of suicidal ideation (SI). RESULTS: A total of 1,248 respondents (58.9% response) were included. Mean age at baseline was 18.7 (SD = 1.3) and 56.0% were female. 7.3% reported 12-month SI at T2. Incidence of new SI cases was 3.4% and, among students with SI at T1, 21.2% also reported SI at T2 (persistence). Risk factors of T2 SI included 12-month mood disorder at T2 both without (aOR = 12.08 95% CI 5.45-26.80) or with (aOR = 7.2 95% CI 2.91-17.80) lifetime mood at T1, past lifetime suicide attempt (aOR = 8.79 95% CI 2.37-32.64) and plan without attempt (aOR = 4.72 95% CI 2.32-9.61), and 12-month physical or sexual assault (aOR = 3.28 95% CI 1.13-9.46). Twelve-month mood at T2 withoutT1 lifetime mood (aOR = 11.27 95% CI 3.02-42.14) and childhood/adolescence emotional abuse or neglect (aOR = 3.41 95% CI 1.10-10.57) or having been bullied (aOR = 3.2 95% CI 1.08-9.53) were associated with first-onset of SI. Twelve-month mood at T2 either without (aOR = 13.92 95% CI 3.76-51.59) or with (aOR = 8.03 95% CI 2.13-30.29) were associated to T2 SI persistence. University sense of membership was protective for overall 12-month SI at T2 (aOR = 0.25 95% CI 0.12-0.53 for middle tertile), first-onset SI (aOR = 0.1 95% 0.02-0.55 for middle tertile) and persistence (aOR = 0.3 95% CI 0.11-0.81 for middle tertile). LIMITATIONS: Analysis was based on self-report data focusing on SI only, and conclusions about the direction of the associations are limited. CONCLUSIONS: High proportion of SI suggests the need of suicide prevention strategies. The potential role of university sense of membership in reducing suicidal behaviour among university students deserves further investigation.

Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies.

OBJECTIVES: To assess the association between gender and suicide attempt/death and identify gender-specific risk/protective factors in adolescents/young adults. METHODS: Systematic review (5 databases until January 2017). Population-based longitudinal studies considering non-clinical populations, aged 12-26 years, assessing associations between gender and suicide attempts/death, or evaluating their gender risk/protective factors, were included. Random effect meta-analyses were performed. RESULTS: Sixty-seven studies were included. Females presented higher risk of suicide attempt (OR 1.96, 95% CI 1.54-2.50), and males for suicide death (HR 2.50, 95% CI 1.8-3.6). Common risk factors of suicidal behaviors for both genders are previous mental or substance abuse disorder and exposure to interpersonal violence. Female-specific risk factors for suicide attempts are eating disorder, posttraumatic stress disorder, bipolar disorder, being victim of dating violence, depressive symptoms, interpersonal problems and previous abortion. Male-specific risk factors for suicide attempt are disruptive behavior/conduct problems, hopelessness, parental separation/divorce, friend's suicidal behavior, and access to means. Male-specific risk factors for suicide death are drug abuse, externalizing disorders, and access to means. For females, no risk factors for suicide death were studied. CONCLUSIONS: More evidence about female-specific risk/protective factors of suicide death, for adolescent/young adults, is needed.

Measures of frequency used in cohorts studies to evaluate the suicidal behaviour in young people (12-26 years): A systematic review. / Medidas de frecuencia utilizadas en estudios de cohortes para evaluar el comportamiento suicida en jóvenes (12-26 años): una revisión sistemática.

INTRODUCTION: A priority for the WHO by 2020 is to have reduced the rates of suicide; they indicate difficulties in giving precise estimations due to a wide variety of factors, which include aspects related to the statistical measurements themselves of suicidal behaviour. The proportion of deaths from suicide is 8.5% among young people between 15-29 years of age. OBJECTIVE: To review the methodology used to express the frequency of suicidal behaviour in young people and to describe the methodological characteristics of the studies reviewed. METHOD: A systematic review of longitudinal studies registered on PROSPERO. The extracted information included the following: year of publication, journal, population size, sample, country, design, age, percentage of men, follow-up time and losses, suicidal behaviour, risk factors, ethical aspects, fundamentally, evaluating the measures of frequency used. RESULTS: Eighty-two articles were selected from 37,793 documents. None of the studies define the measure of frequency used for suicidal behaviour, there are currently up to 9 different ways of measuring it. The populations are students or the general population (66%), birth cohorts (16%) and specific groups. Follow-up was from 24 weeks to 30 years. Only 24.1% of the studies took ethical aspects into consideration. CONCLUSIONS: Researchers must make an effort to reach an agreement on the measures of frequency used in suicidal behaviour studies, as the methodological and terminological variability currently used impedes making any comparisons between different studies or understanding the real dimension of the problem.