EARLY LIFE STRESS: A KEY LINK BETWEEN CHILDHOOD ADVERSITY AND RISK OF ATTEMPTING SUICIDE

Introduction: Epidemiology shows that the major risk factors for suicide or attempting suicide are childhood adversities such as sexual and/or physical abuse, neglect, mental illness of caregiver, and family or community violence. Suicide, whether attempted or completed, is a significant social, financial and emotional burden worldwide. Identification of risk factors and antecedents predisposing individuals to increased risk of suicide is hence imperative so as to afford prompt and appropriate monitoring and intervention. Aim: Using epidemiological data from the Survey of adverse childhood experiences (ACE) among young people in the Republic of Macedonia to examine their association with suicide attempt and to discuss possible mechanisms within the \u27stress biology research\u27. Subjects and methods: A representative sample consisted of total 1277 students (58.6% female and 41.6%), aged 18 and above in year four of 664 secondary school and 613 first- and second-year university students. The data were obtained using Adverse Childhood Experiences Study Questionnaires (Family Health History Questionnaire) for collecting information on child maltreatment, household dysfunction and other socio-behavioural factors, applying WHO/CDC-recommended methodology. Statistical significance was set up at p<0.05. Results: Emotional neglect, physical abuse and physical neglect were the most frequent abusive experiences students had. Overall, suicide attempts were reported by 3.1% of respondents (4.7% by females and 0.8% by males). Those respondents who had been emotionally abused were almost three times as likely to attempt suicide, physical abuse almost doubles the chances of attempting suicide, substance abuse in the family increased the chances 2.3 times for attempting suicide, violent treatment of the mother almost quadrupled them for attempted suicide, having a family member who had been in prison increased the odds of almost 3.5 times for attempting suicide. Attempted suicide was found to be 1.5 times more likely as the number of ACEs reaches 3 and 3.4 times more likely as the number of adverse childhood experiences reached four or more. Conclusions: Identifying and treating children, adolescents and young adults who have been affected by adverse childhood experiences may have substantial value in our evolving efforts to prevent suicide

Ефективност на онлајн програма за родителство во намалување на анксиозност кај деца во Северна Македонија

Anxiety is considered a basic and adaptive emotion. However, anxiety problems are one of the most prevalent mental health problems, with multiple negative effects and a tendency to worsen with age. The high prevalence rates and their negative consequences accent the importance of developing timely and effective prevention strategies. The aim of the study was to evaluate the effectiveness of an online parenting program in reducing anxiety symptoms in young children in the Republic of North Macedonia.  Materials and methods: A controlled randomized controlled study was conducted including parents of children aged 2-9 years old in North Macedonia. Eligible parents were assessed at baseline and post-intervention, using self-report questionnaires on sociodemographic characteristics and childhood anxiety (CBCL anxiety scale, CBCL-A; CBCL anxiety/depression scale, CBCL-AD). Parents were assigned to five group sessions of a parenting program, as the intervention group, or a structured group presentation, as a control group.  Results: A total of 288 parents were included in the study. The findings showed significant reductions in childhood anxiety symptoms reported by parents in both the parenting program and the active control condition. However, between-group comparisons showed no significant differences between the two conditions. Conclusions:The study is the first to evaluate the effectiveness of an online group parenting program in reducing anxiety symptoms in young children in North Macedonia. The findings demonstrate that it is possible to achieve a significant change in child anxiety problems, using technology-assisted methods of intervention delivery in the country.Анксиозноста се смета за основна и адаптивна емоција. Но, анксиозните проблеми се едни од најзастапените ментално-здравствени проблеми, со негативно влијание врз функционирањето и со тенденција да се влошуваат со возраста. Високите стапки на застапеност и негативните последици ја истакнуваат потребата од развивање навремени и ефективни стратегии за превенција. Целта на студијата беше да ја процени ефективноста на онлајн програма за родителство во намалување на анксиозни симптоми кај мали деца во Република Северна Македонија.  Материјали и методи: рандомизирана контролирана студија беше спроведена која вклучи родители на деца од 2-9-годишна возраст во Северна Македонија. Родителите беа проценети пред и по интервенцијата, користејќи прашалници за самопроценка во однос на социодемографските карактеристики и анксиозноста (CBCL скала за анксиозност, CBCL-A; CBCL скала за анксиозност/депресија, CBCL-AD) кај деца.  Родителите беа рандомизирани во групна програма за родителство од пет сесии, како интервентна група, или еднократна презентација за родителство, како контролна група. Резултати: Вкупно 288 родители беа вклучени во студијата. Резултатите покажаа статистички значајни намалувања на анксиозните симптоми кај децата во програмата за родителство и во активната контролна група. Но, споредбата меѓу групите не покажа статистички значајни разлики.  Заклучок: Студијата е прва која ја проценува ефективноста на онлајн програмата за родителство за намалување анксиозност кај мали деца во Северна Македонија. Резултатите ја демонстрираат можноста да се достигнат значајни подобрувања во анксиозни симптоми кај деца во државата, користејќи технолошко-поддржани методи на спроведување.

Co-occurrence of intimate partner violence against mothers and maltreatment of their children with behavioral problems in Eastern Europe

This study investigates the co-occurrence of intimate partner violence (IPV) against mothers and their risk of perpetrating child maltreatment (CM) in North Macedonia, the Republic of Moldova, and Romania. Risk factors for IPV, CM, and their co-occurrence were identified. Two samples (N1 = 112, N2 = 701) of mothers with children with behavioral problems were assessed. IPV was reported by 64% of mothers, CM by 96%, and their co-occurrence by 63%. Mothers exposed to emotional IPV reported more physical and emotional CM. Mothers exposed to physical IPV reported more physical CM. Motheŕs own history of CM and offspring's behavior problems were associated with IPV and CM co-occurrence

Depression and Resilience in Breast Cancer Patients

OBJECTIVE: A significant number of breast cancer patients, during their life with the diagnosis, experience emotional distress in the form of depression and anxiety. Psychological resilience is the ability of a person to protect his/her mental health when faced with adverse circumstances such as the cancer diagnosis. This study aims to assess the resilience in breast cancer patients and to explore whether depression affects the resilience.MATERIAL AND METHODS: Two hundred eighteen (218) women, treated for early breast cancer responded to Connor - Davidson Resilience Scale and Hospital Depression and Anxiety Scale, in order to assess the level of psychological resilience and the level of depression.RESULTS: There is a significant negative correlation between depression and resilience in our sample (r = - 0.562, p &lt; 0.001). Individuals with higher levels of depression have lower levels of psychological resilience. There is no statistically significant correlation between the ages of the participants; time passed since diagnosis, cancer stage and resilience levels.CONCLUSION: This study shows that patients who are less depressed have higher levels of resilience and that psychological resilience may independently contribute to lower levels of depression among breast cancer patients. The level of psychological resilience may be a protective factor for depression and psychological distress

Mental Health Legislation and Involuntary Hospitalization in the Republic of Macedonia

As psychiatrists, we are often obliged to provide non-consensual treatment. This institute comprises the rights of the patients with mental health disorders. The aim of this paper is to explain the contemporary mental health legislation in our country the Republic of Macedonia and the problems with the implementation of involuntary hospitalisation. This could be overcome with close cooperation between the judicial and health care system

Childhood Abuse, Household Dysfunction and the Risk of Attempting Suicide in a National Sample of Secondary School and University Students

OBJECTIVES: One of the main objectives of this paper is to analyze the associations between childhood abuse, household dysfunction and the risk of attempting suicide among young adolescents in the country.METHOD: A representative sample consisted of total 1277 students (58.6% female and 41.6% male), aged 18 and above in year four of 664 secondary school and 613 first- and second-year university students. The data were obtained using Adverse Childhood Experiences Study Questionnaires (Family Health History Questionnaire) for collecting information on child maltreatment, household dysfunction and other socio-behavioural factors, applying WHO/CDC-recommended methodology. Statistical significance was set up at p&lt;0.05.RESULTS: Emotional neglect, physical abuse and physical neglect were the most frequent abusive experiences students had. Overall, suicide attempts were reported by 3.1 % of respondents (4.7% by females and 0.8% by males). Those respondents who had been emotionally abused were almost three times as likely to attempt suicide, physical abuse almost doubles the chances of attempting suicide, substance abuse in the family increased the chances 2.3 times for attempting suicide, violent treatment of the mother almost quadrupled them for attempted suicide, having a family member who had been in prison increased the odds of almost 3.5 times for attempting suicide. Attempted suicide was found to be 1.5 times more likely as the number of ACEs reached 3 and 3.4 times more likely as the number of adverse childhood experiences reached four or more. CONCLUSION: Identifying and treating children, adolescents and young adults who have been affected by adverse childhood experiences may have substantial value in our evolving efforts to prevent suicide

Relationship between Child Maltreatment and Alcohol Abuse - Findings from Adverse Childhood Experience Study in Republic of Macedonia

OBJECTIVES: The aim of the study is to determine the relationship between of the problem of alcohol abuse and child maltreatment. METHOD: The ACE study was administered by the University Clinic of Psychiatry, Department for Child and Adolescent Psychiatry. The ACE study used a representative sample of students in year four of secondary school (aged 18 and above) and first- and second-year university students. The sample consisted of 664 secondary school students (258 males and 406 females.The university student sample consisted of 613 (343 female and 270 male) students from four universities. The data were obtaining by applying ACE Study Questionnaires.RESULTS: Individuals who experience psychological abuse are more prone to develop alcoholism. One of the most serious risk factors for abuse and neglect of children was alcoholism, as a form of household dysfunction. Overall, 13.4% of students lived with someone who misused alcohol. Overall, 10.7% lived with someone who was alcoholic. The association to each ACE was highest among respondents who grew up with two alcohol-abusing parents compared with persons with no alcohol-abusing parents. The health-risk behaviours of most concern included among the others alcohol use (by 82.2% of students). Alcohol use is widespread among students and its prevalence rate is almost 28% by both sexes, and they start drinking at the age of 14–15.CONCLUSION: Among the most frequent household dysfunctions was alcohol use by a family member and about 82% of respondents had ever used alcohol

Prevention of child mental health problems in Southeastern Europe: a multicentre sequential study to adapt, optimise and test the parenting programme ‘Parenting for Lifelong Health for Young Children’, protocol for stage 1, the feasibility study

Introduction: Families in low-income and middle-income countries (LMICs) face multiple challenges (eg, poverty and adverse childhood experiences) that increase the risk for child mental health problems, while the context may provide them with few resources. Existing prevention-oriented parenting programmes have been shown to be effective in reducing child behaviour problems and associated risk factors. This project has the overall goal of adapting, implementing and testing a parenting intervention in three Southeastern European LMIC and uses the Multiphase Optimisation Strategy and dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. It is implemented over three phases: (1) preparation, (2) optimisation and (3) evaluation. The preparation phase, the subject of this paper, involves the adaptation and feasibility piloting of the parenting programme. Methods and analysis: This protocol describes the assessment of an evidence-informed indicated prevention programme for families with children aged 2–9 years (Parenting for Lifelong Health for Young Children) for implementation in FYR of Macedonia, Republic of Moldova and Romania. In this phase, officials, experts, parents and practitioners are interviewed to explore their views of suitability and needs for further adaptation. In addition, a small pre–post pilot study will test the feasibility of the programme and its implementation as well as the evaluation measures in the three countries with 40 families per country site (n=120). Quantitative data analysis will comprise a psychometric analysis of measures, testing pre–post differences using ANCOVA, χ2 tests and regression analysis. For qualitative data analysis, a thematic approach within an experiential framework will be applied. Ethics and dissemination: The ethics review board of the Alpen-Adria University Klagenfurt and ethical review boards in the three LMIC sites have approved the study.</p

Preventing child mental health problems through parenting interventions in Southeastern Europe (RISE): Protocol for a multi-country cluster randomized factorial study

Background: Child mental health problems continue to be a major global concern, especially in low- and middle-income countries (LMICs). Parenting interventions have been shown to be effective for reducing child behavior problems in high-income countries, with emerging evidence supporting similar effects in LMICs. However, there remain substantial barriers to scaling up evidence-based interventions due to limited human and financial resources in such countries. Methods: This protocol is for a multi-center cluster randomized factorial trial of an evidence-based parenting intervention, Parenting for Lifelong Health for Young Children, for families with children ages 2–9 years with subclinical levels of behavior problems in three Southeastern European countries, Republic of Moldova, North Macedonia, and Romania (8 conditions, 48 clusters, 864 families, 108 per condition). The trial will test three intervention components: length (5 vs. 10 sessions), engagement (basic vs. enhanced package), and fidelity (on-demand vs. structured supervision). Primary outcomes are child aggressive behavior, dysfunctional parenting, and positive parenting. Analyses will examine the main effect and cost-effectiveness of each component, as well as potential interaction effects between components, in order to identify the most optimal combination of program components. Discussion: This study is the first factorial experiment of a parenting program in LMICs. Findings will inform the subsequent testing of the optimized program in a multisite randomized controlled trial in 2021.</p