Study Suggests Casting a Wider Net of Distress to Prevent Youth Suicide

A new study suggests the vast majority of young people who self-harm or experience suicidal thoughts appear to have only mild or moderate mental distress. Cambridge University researchers said young people do not display the more obvious symptoms associated with a diagnosable disorder, making detection harder and exacerbating the risk of harm.

As such, measures to reduce suicide risk in young people should focus on the whole population, not just those who are most distressed, depressed or anxious, say the investigators.

They argue that the small increases in stress across the entire population due to the coronavirus lockdown could cause far more young people to be at risk of suicide than can be detected through evidence of psychiatric disorders.

“It appears that self-harm and suicidal thinking among young people dramatically increases well within the normal or non-clinical range of mental distress,” said Professor Peter Jones, senior author of the study from Cambridge’s Department of Psychiatry.

“These findings show that public policy strategies to reduce suicide should support better mental health for all young people, not only those who are most unwell,” said Jones.

“Even modest improvements in mental health and well-being across the entire population may prevent more suicides than targeting only those who are severely depressed or anxious.”

Recent studies suggest a broad range of mental health problems such as depression, anxiety, impulsive behavior and low self-esteem can be taken as a whole to measure levels of “common mental distress.”

For the research, scientists analyzed levels of such distress in two large groups of young people through a series of questionnaires.

They also separately collected self-reported data on suicidal thinking and non-suicidal self-injury — predictive markers for increased risk of suicide — which are the second most common cause of death among 10-24 year-olds worldwide.

Both groups consisted of young people aged 14-24 from London and Cambridgeshire. The first contained 2,403 participants. The study’s methods and findings  were then reproduced with a separate group of 1,074 participants.

“Our findings are noteworthy for being replicated in the two independent samples,” said Jones.

Common mental distress scores increase in three significant increments above the population average: mild mental distress, followed by moderate, and finally severe distress and beyond. The latter often manifests as a diagnosable mental health disorder.

Those with severe mental distress were found to have the highest for risk of suicide. But the majority of all participants experiencing suicidal thoughts or self-harming — 78 percent and 76 percent respectively in the first sample, 66 percent and 71 percent in the second — ranked as having either mild or moderate levels of mental distress.

“Our findings help explain why research focusing on high-risk subjects has yet to translate into useful clinical tools for predicting suicide risk,” said Jones. “Self-harm and suicidal thoughts merit a swift response even if they occur without further evidence of a psychiatric disorder.”

The findings point to a seemingly contradictory situation, in which most of the young people who take their own life may, in fact, be from the considerably larger pool of those deemed as low- or no-risk for suicide.

“It is well known that for many physical conditions, such as diabetes and heart disease, small improvements in the risks of the overall population translate into more lives saved, rather than focusing only on those at extremely high risk,” said Jones.

“This is called the ‘prevention paradox’, and we believe our study is the first evidence that mental health could be viewed in the same way. We need both a public health and a clinical approach to suicide risk.”

Jones noted that we are surrounded by technology designed to engage the attention of children and young people, and its effect on well-being should be seen by industry as a priority beyond profit.

“At a government level, policies affecting the economy, employment, education and housing, to health, culture and sport must all take account of young people; supporting their well-being is an investment, not a cost,” he said. “This is particularly important as the widespread effects of the Covid-19 pandemic unfold.”

The Cambridge researchers conducted the study with colleagues from University College London. It was supported by the Wellcome Trust and the National Institute for Health Research, and appears in the journal BMJ Open.

Source: Cambridge University

Source: PsychCentral Study Suggests Casting a Wider Net of Distress to Prevent Youth Suicide