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Risk-behaviour screening for identifying adolescents with mental health problems in Europe

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Abstract

Indicated prevention of mental illness is an important public health concern among youth. The aim of this study was to establish a European school-based professional screening among adolescents, which included variables on both a broad range of risk-behaviours and psychopathology; and to investigate the indicative value of adolescent risk-behaviour and self-reported psychopathology on help-seeking and psychological problems that required subsequent mental healthcare. A two-stage professional screening approach was developed and performed within the multi-centre study “Saving and Empowering Young Lives in Europe” (SEYLE). The first stage of screening comprised a self-report questionnaire on a representative sample of 3,070 adolescents from 11 European countries. In the second stage, students deemed at-risk for mental health problems were evaluated using a semi-structured clinical interview performed by healthcare professionals. 61 % of participants (n = 1,865) were identified as being at-risk in stage one. In stage two, 384 participants (12.5 % of the original sample) were found to require subsequent mental healthcare during semi-structured, clinical assessment. Among those, 18.5 % of pupils were identified due to screening for psychopathology alone; 29.4 % due to screening for risk-behaviours alone; and 52.1 % by a combination of both. Young age and peer victimization increased help-seeking, while very low body mass index, depression, suicidal behaviour and substance abuse were the best predictors of referral to mental healthcare. Screening of risk-behaviours significantly increased the number of detected students requiring subsequent mental healthcare. Screening of risk-behaviours added significant value in identifying the significant amount of European pupils with mental health problems. Therefore, attention to adolescent risk-behaviours in addition to psychopathology is critical in facilitating prevention and early intervention. Identifying factors that increase compliance to clinical interviews are crucial in improving screening procedures.

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References

  1. Afifi TO, Cox BJ, Katz LY (2007) The associations between health risk behaviours and suicidal ideation and attempts in a nationally representative sample of young adolescents. Can J Psychiatry 52:666–674

    PubMed  Google Scholar 

  2. Beck AT, Steer RA, Ball R, Ranieri W (1996) Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. J Pers Assess 67:588–597

    Article  CAS  PubMed  Google Scholar 

  3. Brown MM, Grumet JG (2009) School-based suicide prevention with African American youth in an urban setting. Prof Psychol Res Pract 40:111–117

    Article  Google Scholar 

  4. Brunner R, Kaess M, Parzer P, Fischer G, Carli V, Hoven CW, Wasserman C, Sarchiapone M, Resch F, Apter A, Balazs J, Barzilay S, Bobes J, Corcoran P, Cosman D, Haring C, Iosue M, Kahn JP, Keeley H, Meszaros G, Nemes B, Podlogar T, Postuvan V, Saiz PA, Sisask M, Tubiana A, Varnik A, Wasserman D (2013) Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behaviour: a comparative study of findings in 11 European countries. J Child Psychol Psychiatr. doi:10.1111/jcpp.12166

  5. Carli V, Wasserman C, Wasserman D, Sarchiapone M, Apter A, Balazs J, Bobes J, Brunner R, Corcoran P, Cosman D, Guillemin F, Haring C, Kaess M, Kahn JP, Keeley H, Keresztény A, Iosue M, Mars U, Musa G, Nemes B, Postuvan V, Reiter-Theil S, Saiz P, Varnik P, Varnik A, Hoven C (2013) The Saving and Empowering Young Lives in Europe (SEYLE) randomized controlled trial (RCT): methodological issues and participant characteristics. BMC Public Health 13:479

    Article  PubMed Central  PubMed  Google Scholar 

  6. Deliberto TL, Nock MK (2008) An exploratory study of correlates, onset, and offset of non-suicidal self-injury. Arch Suicide Res 12:219–231

    Article  PubMed  Google Scholar 

  7. Eaton DK, Kann L, Kinchen S, Shanklin S, Ross J, Hawkins J, Harris WA, Lowry R, McManus T, Chyen D, Lim C, Whittle L, Brener ND, Wechsler H (2010) Youth risk behaviour surveillance—United States, 2009. MMWR Surveill Summ 59:1–142

    PubMed  Google Scholar 

  8. Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, Sawyer SM, Mathers CD (2011) Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 377:2093–2102

    Article  PubMed  Google Scholar 

  9. Gould MS, Marrocco FA, Hoagwood K, Kleinman M, Amakawa L, Altschuler E (2009) Service use by at-risk youths after school-based suicide screening. J Am Acad Child Adolesc Psychiatry 48:1193–1201

    Article  PubMed  Google Scholar 

  10. Gratz K (2001) Measurement of deliberate self-harm: preliminary data on the Deliberate Self-Harm Inventory. J Psychopathol Behav Assess 23:253–263

    Article  Google Scholar 

  11. Gulliver A, Griffiths KM, Christensen H (2010) Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 10:113

    Article  PubMed Central  PubMed  Google Scholar 

  12. Haller DM, Sanci LA, Sawyer SM, Patton GC (2009) The identification of young people’s emotional distress: a study in primary care. Br J Gen Pract 59:e61–e70

    Article  PubMed Central  PubMed  Google Scholar 

  13. Hallfors D, Brodish PH, Khatapoush S, Sanchez V, Cho H, Steckler A (2006) Feasibility of screening adolescents for suicide risk in “real-world” high school settings. Am J Public Health 96:282–287

    Article  PubMed Central  PubMed  Google Scholar 

  14. Husky MM, McGuire L, Flynn L, Chrostowski C, Olfson M (2009) Correlates of help-seeking behaviour among at-risk adolescents. Child Psychiatry Hum Dev 40:15–24

    Article  PubMed  Google Scholar 

  15. Husky MM, Sheridan M, McGuire L, Olfson M (2011) Mental health screening and follow-up care in public high schools. J Am Acad Child Adolesc Psychiatry 50:881–891

    Article  PubMed  Google Scholar 

  16. Jacobson CM, Muehlenkamp JJ, Miller AL, Turner JB (2008) Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. J Clin Child Adolesc Psychol 37:363–375

    Article  PubMed  Google Scholar 

  17. Jessor R (1991) Risk behaviour in adolescence: a psychosocial framework for understanding and action. J Adolesc Health 12:597–605

    Article  CAS  PubMed  Google Scholar 

  18. Jessor R (2007) Problem behaviour theory: a brief overview. http://www.colorado.edu/ibs/jessor/pb_theory.html/

  19. Katon W, Richardson L, Russo J, McCarty CA, Rockhill C, McCauley E, Richards J, Grossman DC (2010) Depressive symptoms in adolescence: the association with multiple health risk behaviours. Gen Hosp Psychiatry 32:233–239

    Article  PubMed Central  PubMed  Google Scholar 

  20. Kaufman J, Birhamer B, Brend D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) The schedule for affective disorders and schizophrenia for school-age-children—present and lifetime version (K-SADS): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988

    Article  CAS  PubMed  Google Scholar 

  21. King RA, Schwab-Stone M, Flisher AJ, Greenwald S, Kramer RA, Goodman SH, Lahey BB, Shaffer D, Gould MS (2001) Psychosocial and risk behaviour correlates of youth suicide attempts and suicidal ideation. J Am Acad Child Adolesc Psychiatry 40:837–846

    Article  CAS  PubMed  Google Scholar 

  22. Klonsky ED (2007) The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev 27:226–239

    Article  PubMed  Google Scholar 

  23. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, Hegerl U, Lonnqvist J, Malone K, Marusic A, Mehlum L, Patton G, Phillips M, Rutz W, Rihmer Z, Schmidtke A, Shaffer D, Silverman M, Takahashi Y, Varnik A, Wasserman D, Yip P, Hendin H (2005) Suicide prevention strategies: a systematic review. JAMA 294:2064–2074

    Article  CAS  PubMed  Google Scholar 

  24. McGue M, Iacono WG, Krueger R (2006) The association of early adolescent problem behaviour and adult psychopathology: a multivariate behavioural genetic perspective. Behav Genet 36:591–602

    Article  PubMed Central  PubMed  Google Scholar 

  25. Muehlenkamp JJ, Walsh BW, McDade M (2010) Preventing non-suicidal self-injury in adolescents: the signs of self-injury program. J Youth Adolesc 39:306–314

    Article  PubMed  Google Scholar 

  26. Patel V, Flisher AJ, Hetrick S, McGorry P (2007) Mental health of young people: a global public-health challenge. Lancet 369:1302–1313

    Article  PubMed  Google Scholar 

  27. Paykel, ES, Myers JK, Lindenthal JJ, Tanner J (1972) Suicidal feelings in the general population: a prevalence study. Br J Psychiatry, pp 380–406

  28. Reynolds WM (1991) A school-based procedure for the identification of adolescents at risk for suicidal behaviours. Family Community Health 14:64–75

    Google Scholar 

  29. Sanci L, Lewis D, Patton G (2010) Detecting emotional disorder in young people in primary care. Curr Opin Psychiatry 23:318–323

    Article  PubMed  Google Scholar 

  30. Schwarz G (1978) Estimating the dimension of a model. Ann Stat 6:461–464

    Article  Google Scholar 

  31. Scott MA, Wilcox HC, Schonfeld IS, Davies M, Hicks RC, Turner JB, Shaffer D (2009) School-based screening to identify at-risk students not already known to school professionals: the Columbia suicide screen. Am J Public Health 99:334–339

    Article  PubMed Central  PubMed  Google Scholar 

  32. Shaffer D, Scott M, Wilcox H, Maslow C, Hicks R, Lucas CP, Garfinkel R, Greenwald S (2004) The Columbia Suicide Screen: validity and reliability of a screen for youth suicide and depression. J Am Acad Child Adolesc Psychiatry 43:71–79

    Article  PubMed  Google Scholar 

  33. Tylee A, Haller DM, Graham T, Churchill R, Sanci LA (2007) Youth-friendly primary-care services: how are we doing and what more needs to be done? Lancet 369:1565–1573

    Article  PubMed  Google Scholar 

  34. Viglione V, Muratori F, Maestro S, Brunori E, Picchi L (2006) Denial of symptoms and psychopathology in adolescent anorexia nervosa. Psychopathology 39:255–260

    Article  PubMed  Google Scholar 

  35. Wasserman D, Carli V, Wasserman C, Apter A, Balazs J, Bobes J, Bracale R, Brunner R, Bursztein-Lipsicas C, Corcoran P, Cosman D, Durkee T, Feldman D, Gadoros J, Guillemin F, Haring C, Kahn JP, Kaess M, Keeley H, Marusic D, Nemes B, Postuvan V, Reiter-Theil S, Resch F, Saiz P, Sarchiapone M, Sisask M, Varnik A, Hoven CW (2010) Saving and empowering young lives in Europe (SEYLE): a randomized controlled trial. BMC Public Health 10:192

    Article  PubMed Central  PubMed  Google Scholar 

  36. WHO (2009) Global School-Based Student Health Survey. World Health Organisation, Geneva

    Google Scholar 

  37. Ystgaard M, Arensman E, Hawton K, Madge N, van Heeringen K, Hewitt A, de Wilde EJ, De Leo D, Fekete S (2009) Deliberate self-harm in adolescents: comparison between those who receive help following self-harm and those who do not. J Adolesc 32:875–891

    Article  PubMed  Google Scholar 

  38. Zung WW (1971) A rating instrument for anxiety disorders. Psychosomatics 12:371–379

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The SEYLE project is supported by the European Union through the Seventh Framework Program (FP7), Grant agreement number HEALTH-F2-2009-223091. SEYLE Project Leader and Principal Investigator is Professor in Psychiatry and Suicidology Danuta Wasserman, National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) at Karolinska Institutet (KI), Stockholm, Sweden. The Executive Committee comprises Professor Danuta Wasserman and Senior Lecturer Vladimir Carli, both from NASP, KI, Sweden; Professor Marco Sarchiapone from the University of Molise, Italy; Professor Christina W. Hoven, and Anthropologist Camilla Wasserman, both from the Department of Child and Adolescent Psychiatry, Columbia University and New York State Psychiatric Institute, New York, US; the SEYLE Consortium comprises sites in twelve European countries. Site leaders are Danuta Wasserman (NASP, Coordinating Centre), Christian Haring (Austria), Airi Varnik (Estonia), Jean-Pierre Kahn (France), Romuald Brunner (Germany), Judit Balazs (Hungary), Paul Corcoran (Ireland), Alan Apter (Israel), Marco Sarchiapone (Italy), Doina Cosman (Romania), Vita Postuvan (Slovenia) and Julio Bobes (Spain). Special thanks regarding this manuscript go to Katja Klug, Gloria Fischer and Lisa Göbelbecker from the University of Heidelberg, Germany, for their extensive help in the development and evaluation of the professional screening procedure during the SEYLE study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study has been approved by the appropriate ethics committee of each study centre and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany

    Michael Kaess, Romuald Brunner, Peter Parzer & Franz Resch

  2. National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden

    Vladimir Carli, Tony Durkee & Danuta Wasserman

  3. Feinberg Child Study Centre, Schneider Children’s Medical Centre, Tel Aviv University, Tel Aviv, Israel

    Alan Apter & Dana Feldman

  4. Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary

    Judit A. Balazs & Luca Farkas

  5. Institute of Psychology, Eotvos Lorand University, Budapest, Hungary

    Judit A. Balazs

  6. Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain

    Julio Bobes & Pilar A. Sáiz

  7. Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

    Horia G. Coman & Doina Cosman

  8. National Suicide Research Foundation, Cork, Ireland

    Padraig Cotter & Helen Keeley

  9. Research Division for Mental Health, University for Medical Information Technology (UMIT), Hall in Tirol, Austria

    Christian Haring

  10. Department of Health Sciences, University of Molise, Campobasso, Italy

    Miriam Iosue

  11. Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de NANCY, Université H. Poincaré, Nancy, France

    Jean-Pierre Kahn, Alexandra Tubiana & Marco Sarchiapone

  12. Mental Health Department, PINT, University of Primorska, Primorska, Slovenia

    Tina Podlogar & Vita Postuvan

  13. Estonian-Swedish Mental Health and Suicidology Institute, Est Ctr Behav & Hlth Sci, Tallinn University, Tallinn, Estonia

    Merike Sisask & Peeter Värnik

  14. Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA

    Christina W. Hoven

  15. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA

    Christina W. Hoven

Authors
  1. Michael Kaess
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  2. Romuald Brunner
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  3. Peter Parzer
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  4. Vladimir Carli
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  6. Judit A. Balazs
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  8. Horia G. Coman
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  9. Doina Cosman
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  10. Padraig Cotter
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  11. Tony Durkee
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  12. Luca Farkas
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  13. Dana Feldman
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  14. Christian Haring
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  15. Miriam Iosue
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  16. Jean-Pierre Kahn
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  17. Helen Keeley
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  18. Tina Podlogar
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  19. Vita Postuvan
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  20. Franz Resch
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  21. Pilar A. Sáiz
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  22. Merike Sisask
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  23. Alexandra Tubiana
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  24. Peeter Värnik
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  25. Marco Sarchiapone
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  26. Christina W. Hoven
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  27. Danuta Wasserman
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Corresponding author

Correspondence to Michael Kaess.

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Kaess, M., Brunner, R., Parzer, P. et al. Risk-behaviour screening for identifying adolescents with mental health problems in Europe. Eur Child Adolesc Psychiatry 23, 611–620 (2014). https://doi.org/10.1007/s00787-013-0490-y

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  • DOI: https://doi.org/10.1007/s00787-013-0490-y

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