The primary aim of the current research is to gain insight into the background, and the precipitating factors of the suicides among adolescents aged, 10 to 20 years old, in 2017 in the Netherlands, by focusing on five domains and the last period…
ID
Source
Brief title
Condition
- Mood disorders and disturbances NEC
- Age related factors
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Interview
The interview instrument is partly based on existing instruments from
psychological autopsy studies of Portsky, Audenaert & van Heeringen, 2005;
2009), Rasmussen (2013) and Dyregrov (2011), supplemented with open questions
made with suicide experts from the multidisciplinary research team (see
Appendix B). Our method therefore coincides with the psychological autopsy
method that is frequently applied in other countries. By means of triangulation
of the interviews with approximately four informants, we*ll have an in-depth
overview of the life course of the adolescent, including causes, reasons,
events in the course of life, and the meanings that participants give to these
factors. This method has already been successfully applied by suicidologists
in, for example, Belgium (Portsky Audenaert & van Heeringen, 2005 & 2009),
Ireland (Arensman et al., 2016), Israel (Zilsman et al., 2016), Norway
(Rasmussen, 2013), and the United Kingdom (Hawton, Houston, Malbergand &
Simkin, 2003).
The interview instrument will consist of two components. Firstly, an open
narrative component, in which parents tell their story in their own words, on
the basis of a broad, openly formulated starting question about the onset of
suicidality in their child, as well as the (possibly) trigger factors in the
last four weeks before their death. A second component will consist of several
structured questions about the five research domains. The interviews are
digitally recorded (voice recording) and are transcribed in exactly the same
words as were used originally (verbatim) by a professional typist.
Questionnaires
The questionnaire for parents / caregivers have been developed on the basis of
the five domains and the hypotheses of experts from the multidisciplinary
research team. The questionnaire consists of structured questions from the
interview instrument, standardized questions from the health monitors for
adolescents from GGD-GHOR Netherlands and RIVM and CBS
(monitorgezondheid.nl/gezondheidsmonitor- youth) and (items from) validated
questionnaires. The standardized questions of the health monitor for
adolescents are self-report questions about, for example, alcohol and drugs.
The questions have been adapted for this study aim and to make it possible that
parents could fill in the questions. Furthermore, the validated PHQ-9 will
assess recent depressive symptoms (Kleiboer et al., 2016), the parent version
of the SDQ is used to determine psychosocial, emotional and behavioral problems
(Misterska et al., 2017), and suicidal behavior in the past will be measured by
some items from the screening instrument developed for adolescents 'Questions
about Suicide and Self-harm' (Huisman et al., 2015). Finally, childhood
life-events events and traumas are being measured (Meerdinkveldboom et al.
2016).
The questionnaire for mental health professionals has largely been derived from
the questionnaire for healthcare professionals from Aarensman et al. (2016,
2018) and adapted by experts from the research team to this study aim and the
situation in the Netherlands. For adolescents who received mental health care
the following factors will be examined: psychiatric diagnosis, physical health,
treatment, recent symptoms, medication, substance abuse and medical history.
Finally, the KEHR questionnaire is taken among the involved mental health
providers. This is a validated tool that has been specially developed to
systematically test suicide cases according to the Dutch multidisciplinary
guideline for the diagnosis and treatment of suicidal behavior (De Groot et
al., 2018). For the adolescents who were not under treatment, we*ll examine to
what extent suicidal behavior or depressive symptoms have been identified, and
whether there were any problems in the organization of health care.
Secondary outcome
Not applicable
Background summary
Rationale: Data from Statistics Netherlands showed that in 2017, 81 adolescents
aged 10 to 20 years old died by suicide, while an average of 51 adolescents
died by suicide in 2012-2016. These worrisome figures ask for a thorough
scientific research of the background and precipitating factors of these
suicides among adolescents aged 10 to 20 years old in the Netherlands (Gilissen
et al. 2018). In this study, we would like to gain insight into factors that
might have influenced the suicidality of these adolescents by means of in-depth
interviews and questionnaires with several informants, such as parents and
peers, mental health professionals and teachers. In the short term, we*ll use
these insights to make policy-related recommendations for suicide prevention.
In the long term, we*ll deliver new scientific knowledge about suicide
prevention among adolescents.
Research questions
General
1. Were there any key turning points in the life course of the adolescents
which were, according to parents and relatives, affected the suicidality of the
adolescents?
2. Were there any indications of the suicide in the last four weeks before the
death of the adolescents, as noticed by the parents, relatives and
professionals involved, and if so which indications? Were there any tipping
points?
Domain specific
1. To what extent were there suicidal clusters and did imitation effects play a
role through social media, series or games, especially in the regions of
Brabant, Gelderland, Zuid-Holland and Noord-Holland?
2. Which culture and migration factors (acculturation stress, honour-related
problems, discrimination, gap with respect to 'Western' mental health) played a
role in the death of the adolescents with a non-native background?
3. Which problems in their phase of life (educational career, performance
pressure, substance abuse) played a role in the death of the older teenagers
(16-19 years)?
4. Which factors (minority stress, stigma society) played a role in the death
of the group of *lhbtg* adolescents?
5. What health care did the adolescents receive, such as treatment and
diagnosis? Were there any problems in the organization and quality of health
care and did professionals follow the multidisciplinary guideline? Which
characteristics did adolescents have who were not under treatment and did they
show any symptoms, and if so, have these symptoms been identified?
Study objective
The primary aim of the current research is to gain insight into the background,
and the precipitating factors of the suicides among adolescents aged, 10 to 20
years old, in 2017 in the Netherlands, by focusing on five domains and the last
period before their death. A better understanding of the factors that
influenced the death of these adolescents may deliver evidence-based
(practical) recommendations to improve suicide prevention for adolescents in
the Netherlands (secondary goal).
Study design
In this research, we*ll combine qualitative and quantitative research in a
mixed-methods design (Palinkas, 2014). The emphasis is on a qualitative
research design (in-depth interviews), in addition we*ll use quantitative
components (questionnaires). The reason for this research design is that the
qualitative approach is suitable for the in-depth research questions and the
low (absolute) number of suicides. Qualitative research is also adequate for
exploring new phenomena that have scarcely been studied (such as the role of
social media) (Silverman, 2000). The research questions are mainly about
learning from patterns about the suicide of the adolescents, by closely mapping
the interplay between causes, reasons, events in the course of life, the last
phase (weeks), and the meanings that participants will give with respect to
suicide prevention (Hjelmeland, 2012). The researchers would like to understand
how and in what way we can learn from the key turning points and tipping points
from the lives of the adolescents (Rasmussen, 2013). A qualitative research
design is appropriate for research questions that are tentative, meaningful and
asked from a holistic perspective (Wengraf, 2003).
In addition, we*ll use questionnaires (with closed answer categories) from
parents and mental health professionals to efficiently gain insight into
relevant domain-specific and health care-related factors, which might have
influenced the suicide of the adolescents. These quantitative results will be
used in September 2019 for the Ministry of Health, Welfare and Sport to make
policy-related recommendations for suicide prevention, together with the first
insights from the in-depth interviews.
Study burden and risks
Parents will be screened for current suicidality prior to the interview and the
GP will be informed about their participation in the study. The interview
consists of an open and standardized section and will last 2.5 hours (maximum,
included pause). The digital questionnaire (with closed answer categories) will
be conducted at the end of the interview, will take 30 minutes to be completed,
and parents can also fill in the questions at a later time. There will be a
follow-up contact three weeks after the interview to inform whether parents
need aftercare. The interview with peers and teacher(s)/employer will take 2
hours (maximum) and will consist of the same components. The questionnaire for
mental health professionals will take 30 minutes to fill in and the telephone
interview, in which the KEHR will be conducted, will takes 1.5 hours (maximum).
There are several advantages for relatives to participate in this research,
such as being heard, to see things in perspective, and that lessons are being
learned from the suicide from their child. Relatives will also contribute to a
socially relevant and urgent goal (altruism), will have a conversation with
specially trained interviewers and extra support if needed.
Moreover, this research will lead to recommendations to improve suicide
prevention in Dutch practice, i.e. recommendations for improvement in youth
health care, public sector and in the community (regions). Results from the
in-depth research will be shared with parties in the field as quickly as
possible so that they can adapt suicide prevention policy. In addition, 113
will stimulate GGD-en to continue this research on (context-specific) causes of
suicide among adolescents at regional level.
Relatives have a higher risk of suicidal thoughts and will still have to
process the loss of their child. The interview can be stressful for them,
because of this process of grief and psychological problems,. In case of a
suicidal crisis during the interview, we will contact their GP or the GP
center.
Paasheuvelweg 25
Amsterdam 1105 BP
NL
Paasheuvelweg 25
Amsterdam 1105 BP
NL
Listed location countries
Age
Inclusion criteria
Parents / primary caregivers who had a child aged 10 to 20 years old living in
the Netherlands died in 2017, and a coroner concluded that suicide was
committed.
* Brothers / sisters and / or friends / girlfriends who knew this deceased
person well and for whom the legal representatives gave permission for
participation
* Involved teacher(s) / employer, i.e. teacher who is working in secondary
school or other education, where the deceased person followed education at the
time of death, or where the deceased person was employed at the time of death
* Mental health care professional(s) involved, i.e. mental health care
professional such as psychologist or psychiatrist by whom the deceased person
was treated at the time of death or in the year prior to their death., The
research focuses on these characteristics of participants. There are no
specific inclusion criteria. If relatives do not speak the Dutch language, the
interview will be adapted by taking a translator to the interview.
Exclusion criteria
A potential participant is excluded from participating in this study if he /
she meets the following exclusion criteria:
* Parents / caregivers and other relatives who are severely affected by
suicidal thoughts measured with the SIDAS as a screening instrument (cut-off
point total score 21 or higher, maximum total score is 50).
* Parents who are admitted to a psychiatric institution, regardless of the
psychiatric complaints they have, at the time of the examination
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL68348.029.18 |