Associations between sleep problems and ADHD symptoms among adolescents: findings from the Shandong Adolescent Behavior and Health Cohort (SABHC).

STUDY OBJECTIVES: Sleep problems and symptoms of attention-deficit hyperactivity disorder (ADHD) in adolescence are common. Little is known about the prospective the prospective associations between sleep and subsequent ADHD symptoms in adolescents. This study examined the prospective associations between sleep problems and subsequent ADHD symptoms in a large sample of adolescents. METHODS: Participants included 7072 adolescents from the Shandong Adolescent Behavior and Health Cohort (SABHC) study in Shandong, China. Participants were initially assessed in November-December of 2015 and were reassessed 1-year later in 2016. Sleep duration, sleep problems, and psychosocial information were collected using a structured questionnaire. ADHD symptoms were measured by the Achenbach Child Behavior Checklist-Youth Self-Report. RESULTS: At baseline, 7.6% participants had clinically relevant ADHD symptoms, which were highly comorbid with sleep problems including insomnia symptoms, poor sleep quality, symptoms of restless legs syndrome (RLS), frequent snoring, and short sleep duration. Of the 6531 participants without clinically relevant ADHD symptoms at baseline, 4.5% reported clinically relevant ADHD symptoms at 1-year follow-up. After adolescent and family covariates were adjusted for, insomnia (OR = 2.09, 95% CI = 1.45-3.02), RLS (OR = 1.47, 95% CI = 1.02-2.11), and frequent snoring (OR = 2.30, 95% CI = 1.36-3.90) were all significantly associated with subsequent ADHD symptoms. CONCLUSION: ADHD symptoms and sleep problems are highly comorbid. Insomnia, RLS and frequent snoring appear to be significant predictors of subsequent ADHD symptoms. Our study highlights the importance of assessing and managing sleep problems for prevention and clinical treatment of ADHD symptoms in adolescence.

Social Psychological Factors and Suicidal Intent Among Suicide Attempters in Rural China: A Path Analysis.

This study explores the effects of social psychological factors on suicidal intent among suicide attempters in rural China. Suicide attempters were identified by the county-level Centers for Disease Control and Prevention (CDCs) and interviewed by the research team. A path analysis was conducted with physical illness, social support, and negative life events as exogenous variables, and life satisfaction, depressive emotions, and suicidal intent as endogenous variables. Beginning with a saturation model, a best model was obtained after removing the paths that were not significant. In the final model, depressive emotions and life satisfaction were directly associated with suicidal intent, and the standardized effect estimates were 0.3007 (p < 0.001) and -0.1182 (p = 0.0368). Physical illness, social support, and negative life events did not directly affect suicidal intent but had indirect effect. Depressive emotions may be the most important and direct predictor of suicidal intent; physical illness, negative life events, and social support affect suicidal intent through life satisfaction and depressive emotions.

The COMT rs4680 polymorphism and suicide attempt in rural Shandong, China.

BACKGROUND: Suicide attempt is a major public health problem and are associated with genetic factors. This paired case-control study examined the association between the COMT gene rs4680 polymorphism and suicide attempts. METHODS: A case-control study of 369 (117 men, 31.7%; mean age=44.1±13.3 years) suicide attempters and an equal number of controls without a lifetime history of suicide attempt matched on sex, age, and residence was carried out in rural Shandong, Eastern China. Demographics and psychiatric history were obtained through face-to-face interviews. Blood samples were collected during interviews and the COMT gene rs4680 polymorphism was analyzed using the ligation detection reaction method. RESULTS: The G/G genotype was significantly more prevalent in female suicide attempters than their matched controls. Conditional logistic regression showed that the G/G genotype was significantly associated with an increased risk of suicide attempts only for women (odds ratio=2.3; 95% confidence interval: 1.2-4.2). CONCLUSION: The findings support an association between the COMT gene rs4680 polymorphism and suicide attempts only in women. Further research with larger samples is needed to explore the interactions of the COMT gene rs4680 polymorphism and sex and psychiatric disorders on suicide attempts.

Association of the HTR2A 102T/C polymorphism with attempted suicide: a meta-analysis.

An association between the serotonin 2A receptor (5-HT2A receptor) gene and suicidal behavior has been reported in many studies. However, no consistent conclusion has been reached. One potential reason for this is heterogeneity in the studies analyzed, which may have been caused by the selection of different types of cases and controls. In the present study, we pooled data from the previous published papers to clarify the association between HTR2A 102T/C and attempted suicide. All case-control studies written in English and published up until 20 November 2013 were selected. The history of suicide attempts and other relevant data were extracted. According to the findings of previous studies, the recessive model was used to evaluate the role of genotype in attempted suicide. We divided the patients into three groups on the basis of the history of suicide attempts and mental disorder. Genotype distribution of the suicide attempters was compared with normal controls and patients with mental disorder, respectively. There were no significant differences in 5-HT2A receptor 102T/C genotype distributions between those who attempted suicide and the normal controls, and the results were similar for the comparisons with mental disorder patient controls. When subgroup analysis of the types of mental disorder was carried out, all heterogeneity disappeared and effect sizes increased. A significant association was observed for the schizophrenia disorder subgroup (odds ratio=1.73; 95% confidence interval: 1.11-2.69). Our meta-analysis does not support the previously suggested association between HTR2A 102T/C and attempted suicide in the general population. However, in patients with schizophrenia, the C/C genotype of 5-HT2A receptor 102T/C may increase the risk of attempted suicide. The heterogeneity in relevant studies may have been caused by the characteristic variety of mixed mental disorders.

Completed suicide with violent and non-violent methods in rural Shandong, China: a psychological autopsy study.

BACKGROUND: This study aims to describe the specific characteristics of completed suicides by violent methods and non-violent methods in rural Chinese population, and to explore the related factors for corresponding methods. METHODS: Data of this study came from investigation of 199 completed suicide cases and their paired controls of rural areas in three different counties in Shandong, China, by interviewing one informant of each subject using the method of Psychological Autopsy (PA). RESULTS: There were 78 (39.2%) suicides with violent methods and 121 (60.8%) suicides with non-violent methods. Ingesting pesticides, as a non-violent method, appeared to be the most common suicide method (103, 51.8%). Hanging (73 cases, 36.7%) and drowning (5 cases, 2.5%) were the only violent methods observed. Storage of pesticides at home and higher suicide intent score were significantly associated with choice of violent methods while committing suicide. Risk factors related to suicide death included negative life events and hopelessness. CONCLUSIONS: Suicide with violent methods has different factors from suicide with non-violent methods. Suicide methods should be considered in suicide prevention and intervention strategies.