The research output on child and adolescent suicide in Brazil : a systematic review of the literature

Objective:Suicide is the third leading cause of death among Brazilians aged 10 to 24 years.We aimed to review and describe the research output on suicide in children and adolescents in Braziland to identify strengths and gaps in this literature.Methods:PubMed/MEDLINE was searched for studies on suicide of children and adolescents (aged0-19 years) in Brazil, published from inception to December 31, 2017.Results:Our search identified 1,061 records, of which 146 were included. A large proportion (134studies; 90.4%) were original articles classified as observational epidemiological studies. Fifty-twoarticles (35.6%) used primary data. Of those, 18 (12.3%) evaluated prevalence of suicidal behaviors inpopulation-based samples. Seventy studies (47.9%) addressed death by suicide, and the remainderreported other phenomena, such as ideation, planning, or suicide attempt. Only 37 publications(25.3%) studied children and/or adolescents exclusively. Most of the studies (53.5%) were conductedwith samples from the South and Southeast regions of Brazil.Conclusion:Our findings indicate that the body of evidence on suicide among children andadolescents in Brazil is limited. The scientific output is of low quality, and there is a complete lack ofinterventional studies specifically designed for the youth population

The identifying depression early in adolescence risk stratified cohort (IDEA-RiSCo) : rationale, methods, and baseline characteristics

Background: The characterization of adolescents at high risk for developing depression has traditionally relied on the presence or absence of single risk factors. More recently, the use of composite risk scores combining information from multiple variables has gained attention in prognostic research in the field of mental health. We previously developed a sociodemographic composite score to estimate the individual level probability of depression occurrence in adolescence, the Identifying Depression Early in Adolescence Risk Score (IDEA-RS). Objectives: In this report, we present the rationale, methods, and baseline characteristics of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo), a study designed for in-depth examination of multiple neurobiological, psychological, and environmental measures associated with the risk of developing and with the presence of depression in adolescence, with a focus on immune/inflammatory and neuroimaging markers. Methods: Using the IDEA-RS as a tool for risk stratification, we recruited a new sample of adolescents enriched for low (LR) and high (HR) depression risk, as well as a group of adolescents with a currently untreated major depressive episode (MDD). Methods for phenotypic, peripheral biological samples, and neuroimaging assessments are described, as well as baseline clinical characteristics of the IDEA-RiSCo sample. Results: A total of 7,720 adolescents aged 14-16 years were screened in public state schools in Porto Alegre, Brazil. We were able to identify individuals at low and high risk for developing depression in adolescence: in each group, 50 participants (25 boys, 25 girls) were included and successfully completed the detailed phenotypic assessment with ascertainment of risk/MDD status, blood and saliva collections, and magnetic resonance imaging (MRI) scans. Across a variety of measures of psychopathology and exposure to negative events, there was a clear pattern in which either the MDD group or both the HR and the MDD groups exhibited worse indicators in comparison to the LR group. Conclusion: The use of an empirically-derived composite score to stratify risk for developing depression represents a promising strategy to establish a risk-enriched cohort that will contribute to the understanding of the neurobiological correlates of risk and onset of depression in adolescence

Prospective Follow-up of Adolescents with and at Risk for Depression::Protocol and Methods of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) Longitudinal Assessments

Objective: To present the protocol and methods for the prospective longitudinal assessments — including clinical and digital phenotyping approaches — of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) study, which comprises Brazilian adolescents stratified at baseline by risk of developing depression or presence of depression. Method: Of 7,720 screened adolescents aged 14-16, we recruited 150 participants (75 boys, 75 girls) based on a composite risk score: 50 with low risk for developing depression (LR), 50 with high risk for developing depression (HR), and 50 with an active untreated major depressive episode (MDD). Three annual follow-up assessments were conducted, involving clinical measures (parent and adolescent-reported questionnaires and psychiatrist assessments), active and passive data sensing via smartphones, and neurobiological measures (neuroimaging and biological material samples). Retention rates were 96% (Wave 1), 94% (Wave 2), and 88% (Wave 3), with no significant differences by sex or group (p &gt; 0.05). Participants highlighted their familiarity with the research team and assessment process as a motivator for sustained engagement.Discussion: This protocol relied on novel aspects, such as the use of a WhatsApp bot, which is particularly pertinent for low-to-middle-income countries, and the collection of information from diverse sources in a longitudinal design, encompassing clinical data, self-reports, parental reports, GPS data, and ecological momentary assessments. The study engaged adolescents over an extensive period and demonstrated the feasibility of conducting a prospective follow-up study with a risk-enriched cohort of adolescents in a middle-income country, integrating mobile technology with traditional methodologies to enhance longitudinal data collection. <br/

The Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo): Rationale, Methods, and Baseline Characteristics

Background: The characterization of adolescents at high risk for developing depression has traditionally relied on the presence or absence of single risk factors. More recently, the use of composite risk scores combining information from multiple variables has gained attention in prognostic research in the field of mental health. We previously developed a sociodemographic composite score to estimate the individual level probability of depression occurrence in adolescence, the Identifying Depression Early in Adolescence Risk Score (IDEA-RS).Objectives: In this report, we present the rationale, methods, and baseline characteristics of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo), a study designed for in-depth examination of multiple neurobiological, psychological, and environmental measures associated with the risk of developing and with the presence of depression in adolescence, with a focus on immune/inflammatory and neuroimaging markers.Methods: Using the IDEA-RS as a tool for risk stratification, we recruited a new sample of adolescents enriched for low (LR) and high (HR) depression risk, as well as a group of adolescents with a currently untreated major depressive episode (MDD). Methods for phenotypic, peripheral biological samples, and neuroimaging assessments are described, as well as baseline clinical characteristics of the IDEA-RiSCo sample.Results: A total of 7,720 adolescents aged 14–16 years were screened in public state schools in Porto Alegre, Brazil. We were able to identify individuals at low and high risk for developing depression in adolescence: in each group, 50 participants (25 boys, 25 girls) were included and successfully completed the detailed phenotypic assessment with ascertainment of risk/MDD status, blood and saliva collections, and magnetic resonance imaging (MRI) scans. Across a variety of measures of psychopathology and exposure to negative events, there was a clear pattern in which either the MDD group or both the HR and the MDD groups exhibited worse indicators in comparison to the LR group.Conclusion: The use of an empirically-derived composite score to stratify risk for developing depression represents a promising strategy to establish a risk-enriched cohort that will contribute to the understanding of the neurobiological correlates of risk and onset of depression in adolescence

Suicídio entre jovens : produção científica brasileira e dados mundiais de mortalidade a partir do Global Burden of Disease Study

Introdução: Comportamentos suicidas em jovens são um grande problema de saúde pública e a carga de mortalidade entre crianças e adolescentes não foi suficientemente estudada. Neste trabalho, buscamos revisar e descrever a produção científica brasileira sobre suicídio em crianças e adolescentes. Também objetivamos avaliar a distribuição global de mortes por suicídio em indivíduos com idade entre 10 e 24 anos. Métodos: Primeiramente, realizamos uma revisão sistemática da literatura indexada no PubMed/MEDLINE, buscando estudos sobre suicídio em indivíduos de 0 a 19 anos no Brasil até 31 de dezembro de 2017. Em segundo lugar, utilizamos a metodologia do Global Burden of Disease Study 2017 (GBD 2017) para estimar a carga de mortalidade por suicídio entre indivíduos de 10 a 24 anos por sexo e grupos etários específicos em 195 países e territórios até 2017. Resultados: Na primeira etapa, a revisão sistemática identificou 1.061 estudos, dos quais foram incluídos 146. A maioria dos artigos incluídos (90,4%) foi classificada como estudos epidemiológicos observacionais. Apenas 52 estudos (35,6%) utilizaram dados primários. Destes, 18 estudos (12,3%) avaliaram prevalência de comportamentos suicidas em amostras populacionais. Apenas 37 publicações (25,3%) estudaram exclusivamente crianças e/ou adolescentes. A maioria dos estudos (53,5%) foi conduzida com amostras das regiões sul e sudeste do Brasil. Na segunda etapa, a análise sistemática a partir do GBD 2017 estimou que 120.933 (intervalo de incerteza 95% [II95%], 113.263– 127.601) adolescentes morreram por suicídio em 2017, refletindo uma taxa global de 6,5 mortes (6,1-9,1) por 100.000 pessoas. Globalmente, suicídio foi a segunda principal causa de morte entre adolescentes em 2017, causando 7,8% (7,4%-8,2%) do total de mortes para aquele grupo etário. Nós identificamos uma variação de 10 vezes nas taxas de suicídio entre as regiões e de 30 vezes entre as nações. A razão das taxas de suicídio femininas e masculinas (RFM) em 2017 foi de 0,74, variando de 0,11 até 1,91. Conclusão: Nossos resultados indicaram que o suicídio entre crianças e adolescentes no Brasil é um fenômeno pouco pesquisado e que há uma escassez de estudos de intervenção desenhados para a população jovem brasileira. Nossos achados mostraram uma grande variação regional e nacional nos níveis de mortalidade por suicídio entre indivíduos de 10 a 24 anos e também enfatizaram que o suicídio tem se tornado uma das principais causas preveníveis de morte entre jovens no mundo.Introduction: Suicidal behavior in youth is a major public health problem, and mortality burden among children and adolescents has not been comprehensively studied. We aimed to review and describe the scientific output on suicide among children and adolescents in Brazil. We also aimed to assess the global distribution of suicide deaths among those aged 10-24 years. Methods: First, we conducted a systematic review of the literature indexed in PubMed/MEDLINE from inception to December 31, 2017, looking for studies on suicide among those aged 0-19 years in Brazil. Second, we used the Global Burden of Disease Study 2017 (GBD 2017) methods to estimate the burden of suicide mortality among those aged 10-24 years by sex and specific age groups for 195 countries and territories in 2017. Results: The systematic review identified 1,061 records, of which 146 studies were included. A large proportion of those studies (90.4%) was classified as observational epidemiological research. Only 52 articles (35.6%) used primary data. Of those, 18 studies (12.3%) evaluated prevalence of suicidal behaviors in population-based samples. Only 37 publications (25.3%) studied exclusively children and/or adolescents. Most of the studies (53.5%) were conducted with samples from South and Southeast regions. The GBD 2017 analysis estimated that 120,933 (95% uncertainty interval [95%UI], 113,263-127,601) adolescents (aged 10-24) died from suicide in 2017, reflecting a global rate of 6.5 deaths (6.1-9.1) per 100,000 persons. Globally, suicide was the second leading cause of death among adolescents in 2017, causing 7.8% (7.4%-8.2%) of total deaths in that age group. We identified a ten-fold variation in the youth suicide deaths rates among GBD regions and a thirty-fold variation among nations. The female to male ratio (FMR) of youth suicide rates in 2017 was 0.74, ranging from 0.11 to 1.91. Conclusion: Our results indicated that suicide among children and adolescents in Brazil is an understudied phenomenon and there was a lack of interventional studies designed for the youth population until 2017. Our findings showed large regional and national variations in levels of suicide mortality among those aged 10-24 years, and also emphasized that suicide has also become a leading cause of preventable death in youth worldwide

The research output on child and adolescent suicide in Brazil : a systematic review of the literature

Objective:Suicide is the third leading cause of death among Brazilians aged 10 to 24 years.We aimed to review and describe the research output on suicide in children and adolescents in Braziland to identify strengths and gaps in this literature.Methods:PubMed/MEDLINE was searched for studies on suicide of children and adolescents (aged0-19 years) in Brazil, published from inception to December 31, 2017.Results:Our search identified 1,061 records, of which 146 were included. A large proportion (134studies; 90.4%) were original articles classified as observational epidemiological studies. Fifty-twoarticles (35.6%) used primary data. Of those, 18 (12.3%) evaluated prevalence of suicidal behaviors inpopulation-based samples. Seventy studies (47.9%) addressed death by suicide, and the remainderreported other phenomena, such as ideation, planning, or suicide attempt. Only 37 publications(25.3%) studied children and/or adolescents exclusively. Most of the studies (53.5%) were conductedwith samples from the South and Southeast regions of Brazil.Conclusion:Our findings indicate that the body of evidence on suicide among children andadolescents in Brazil is limited. The scientific output is of low quality, and there is a complete lack ofinterventional studies specifically designed for the youth population

Assessing Mood With the Identifying Depression Early in Adolescence Chatbot (IDEABot): Development and Implementation Study

BackgroundMental health status assessment is mostly limited to clinical or research settings, but recent technological advances provide new opportunities for measurement using more ecological approaches. Leveraging apps already in use by individuals on their smartphones, such as chatbots, could be a useful approach to capture subjective reports of mood in the moment. ObjectiveThis study aimed to describe the development and implementation of the Identifying Depression Early in Adolescence Chatbot (IDEABot), a WhatsApp-based tool designed for collecting intensive longitudinal data on adolescents’ mood. MethodsThe IDEABot was developed to collect data from Brazilian adolescents via WhatsApp as part of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) study. It supports the administration and collection of self-reported structured items or questionnaires and audio responses. The development explored WhatsApp’s default features, such as emojis and recorded audio messages, and focused on scripting relevant and acceptable conversations. The IDEABot supports 5 types of interactions: textual and audio questions, administration of a version of the Short Mood and Feelings Questionnaire, unprompted interactions, and a snooze function. Six adolescents (n=4, 67% male participants and n=2, 33% female participants) aged 16 to 18 years tested the initial version of the IDEABot and were engaged to codevelop the final version of the app. The IDEABot was subsequently used for data collection in the second- and third-year follow-ups of the IDEA-RiSCo study. ResultsThe adolescents assessed the initial version of the IDEABot as enjoyable and made suggestions for improvements that were subsequently implemented. The IDEABot’s final version follows a structured script with the choice of answer based on exact text matches throughout 15 days. The implementation of the IDEABot in 2 waves of the IDEA-RiSCo sample (140 and 132 eligible adolescents in the second- and third-year follow-ups, respectively) evidenced adequate engagement indicators, with good acceptance for using the tool (113/140, 80.7% and 122/132, 92.4% for second- and third-year follow-up use, respectively), low attrition (only 1/113, 0.9% and 1/122, 0.8%, respectively, failed to engage in the protocol after initial interaction), and high compliance in terms of the proportion of responses in relation to the total number of elicited prompts (12.8, SD 3.5; 91% out of 14 possible interactions and 10.57, SD 3.4; 76% out of 14 possible interactions, respectively). ConclusionsThe IDEABot is a frugal app that leverages an existing app already in daily use by our target population. It follows a simple rule-based approach that can be easily tested and implemented in diverse settings and possibly diminishes the burden of intensive data collection for participants by repurposing WhatsApp. In this context, the IDEABot appears as an acceptable and potentially scalable tool for gathering momentary information that can enhance our understanding of mood fluctuations and development

Sex-specific inflammatory markers of risk and presence of depression in adolescents

BACKGROUND: Associations between inflammatory markers and depression are reported among adults; however, less is known in adolescent depression in particular whether these associations are sex-specific. We aimed to identify inflammatory markers of increased risk and presence of depression in adolescence and their association with severity of depressive symptoms in the entire cohort and separately in boys and girls. METHODS: We measured serum cytokines using a Meso Scale Discovery electrochemiluminescence V-PLEX assay in a cohort of 150 adolescents stratified for risk/presence of depression. Risk group and sex-specific differences in inflammatory markers were assessed with 2-way mixed ANOVA, and sex-moderated associations between inflammatory markers and the severity of depressive symptoms were assessed with moderated multiple hierarchical regression analyses. RESULTS: We found a significant interaction between biological sex and the risk group, where boys showed higher interleukin (IL)-2 levels among the depressed group compared with the low-risk group. The severity of depressive symptoms was associated with elevated levels of IL-2 in boys, and of IL-6 in girls. There was a significant moderating effect of sex on the relationship between IL-2 and the severity of depressive symptoms but not for IL-6. LIMITATIONS: The cross-sectional design means that we cannot be certain about the direction of the associations. CONCLUSIONS: Our findings suggest sex-specific associations between inflammatory markers and the development of adolescent depression, where IL-2 may increase risk for depression and severity of depressive symptoms in boys, but not in girls. However, IL-6 may increase risk for more severe depressive symptoms in girls

Sleep Disturbances, Circadian Activity and Nocturnal Light Exposure Characterize High Risk for and Current Depression in Adolescence

STUDY OBJECTIVES: Major Depressive Disorder (MDD) in adolescence is associated with irregularities in circadian rhythms and sleep. The characterization of such impairment may be critical to design effective interventions to prevent development of depression among adolescents. This study aimed to examine self-reported and actimetry-based circadian rhythms and sleep-wake behavior associated with current MDD and high-risk for MDD among adolescents. METHODS: Ninety-six adolescents who took part in the IDEA-RiSCo study were recruited using an empirically-developed depression-risk stratification method: 26 classified as low-risk (LR), 31 as high-risk (HR), and 39 as a current depressive episode (MDD). We collected self-report data on insomnia, chronotype, sleep schedule, sleep hygiene as well as objective data on sleep, rest-activity and light exposure rhythms using actimetry for 10 days. RESULTS: Adolescents with MDD exhibited more severe insomnia, shorter sleep duration, higher social jetlag (SJL), lower relative amplitude (RA) of activity and higher exposure to artificial light at night (ALAN) compared to the other groups. They also presented poorer sleep hygiene compared to the LR group. The HR group also showed higher insomnia, lower RA, higher exposure to ALAN and higher SJL compared to the LR group. CONCLUSIONS: High-risk adolescents shared sleep and rhythm alterations with the MDD group, which may constitute early signs of depression, suggesting that preventive strategies targeting sleep should be examined in future studies. Furthermore, we highlight that actimetry-based parameters of motor activity (particularly RA) and light exposure are promising constructs to be explored as tools for assessment of depression in adolescence.