title: Risk for suicidal problems in poor-help-seeking adolescents with psychotic-like experiences: findings from a cross-sectional survey of 16,131 adolescents.
abstract: BACKGROUND
  Recent evidence suggests that psychotic-like experiences (PLEs) in the general population are important markers of risk of suicidal problems. However, there have been no epidemiological studies investigating help-seeking status in individuals with PLEs and elevated risk of suicide.
  
  
  METHODS
  Information on PLEs, self-awareness of mental distress (SAMD), help-seeking behaviours (HSBs), and suicidal problems was collected from 16,131 Japanese adolescents. Participants were divided into two groups, those with and without PLEs, and then both groups were further divided into three subgroups: a group without SAMD, who had no HSB by definition; a group with both SAMD and HSB; and a group with SAMD but without HSB (poor-help-seeking group), yielding a total of six groups.
  
  
  RESULTS
  Adolescents with PLEs (14.3%) had significantly higher risk of suicidal problems than those without PLEs. Among the individuals with both PLEs and SAMD, 38.1% did not seek any help (poor-help-seeking status). Among the six groups, odds of suicidal ideation was the highest among poor-help-seeking adolescents with PLEs, with a 20-fold increase compared to those without PLEs, SAMD and HSB (adjusted for age and sex), while the odds was increased 10-fold in those with PLEs, SAMD and HSB. After adjusting for anxiety/depression level, the odds ratios remained significant in both poor-help-seeking adolescents with PLEs (OR=3.8 [3.0-4.9 (95% CI)]) and those with PLEs, SAMD and HSB (OR=2.5 [2.0-3.1]).
  
  
  CONCLUSIONS
  Adolescents with PLEs and self-awareness of mental distress are at high risk for suicidal problems, particularly those without help seeking.
authors.affiliation: MRC Unit for Lifelong Health and Aging, University College London, London, UK; Department of Psychiatry and Behavioural Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan. Electronic address: nishida-at@igakuken.or.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nishida
authors.affiliation: Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Shimodera
authors.affiliation: Department of Health Education, Graduate School of Education, University of Tokyo, Tokyo, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: MRC Unit for Lifelong Health and Aging, University College London, London, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Richards
authors.affiliation: King's College London, Psychological Medicine, Institute of Psychiatry, London, UK.
authors.forename: Stephani L
authors.initials: SL
authors.lastname: Hatch
authors.affiliation: Department of Psychiatry and Behavioural Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Syudo
authors.initials: S
authors.lastname: Yamasaki
authors.affiliation: Department of Psychology, University of Southern California, Los Angeles, CA, USA; Faculty of Human Sciences, Department of Psychology, University of Tsukuba, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Usami
authors.affiliation: Department of Psychiatry and Behavioural Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Ando
authors.affiliation: Department of Psychiatry and Behavioural Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Nozomu
authors.initials: N
authors.lastname: Asukai
authors.affiliation: Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Okazaki
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology*; D012306:Risk; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology*; D013405:Suicide / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Help seeking; Psychotic-like experiences; Self-awareness of mental distress; Self-harm; Suicidal ideation