title: Important Variables When Screening for Students at Suicidal Risk: Findings from the French Cohort of the SEYLE Study.
abstract: Due to early detection of mental ill-health being an important suicide preventive strategy, the multi-centre EU funded "Saving and Empowering Young Lives in Europe" (SEYLE) study compared three school-based mental health promotion programs to a control group. In France, 1007 students with a mean age of 15.2 years were recruited from 20 randomly assigned schools. This paper explores the French results of the SEYLE's two-stage screening program (ProfScreen) and of the cross-program suicidal emergency procedure. Two-hundred-thirty-five ProfScreen students were screened using 13 psychopathological and risk behaviour scales. Students considered at risk because of a positive finding on one or more scales were offered a clinical interview and, if necessary, referred for treatment. A procedure for suicidal students (emergency cases) was set up to detect emergencies in the whole cohort (n = 1007). Emergency cases were offered the same clinical interview as the ProfScreen students. The interviewers documented their reasons for referrals in a short report. 16,2% of the ProfScreen students (38/235) were referred to treatment and 2,7% of the emergency cases (27/1007) were also referred to treatment due to high suicidal risk. Frequent symptoms in those students referred for evaluation were depression, alcohol misuse, non-suicidal self-injuries (NSSI), and suicidal behaviours. According to the multivariate regression analysis of ProfScreen, the results show that the best predictors for treatment referral were NSSI (OR 2.85), alcohol misuse (OR 2.80), and depressive symptoms (OR 1.13). Analysis of the proportion for each scale of students referred to treatment showed that poor social relationships (60%), anxiety (50%), and suicidal behaviours (50%) generated the highest rate of referrals. Qualitative analysis of clinician's motivations to refer a student to mental health services revealed that depressive symptoms (51%), anxiety (38%), suicidal behaviours (40%), and negative life events (35%) were the main reasons for referrals. Thus, not only the classical psychopathological symptoms, such as depression, anxiety, and suicidal behaviours, but also negative life events and poor social relationships (especially isolation) motivate referrals for treatment.
authors.affiliation: Centre Hospitalier Universitaire de Nancy, Hôpitaux de Brabois, Vandoeuvre les Nancy 54511, France. jp.kahn@chu-nancy.fr.|Université de Lorraine, Faculté de Médecine, Vandoeuvre les Nancy 54505, France. jp.kahn@chu-nancy.fr.|Centre Psychothérapique de Nancy, Laxou 54520, France. jp.kahn@chu-nancy.fr.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Kahn
authors.affiliation: Centre Psychothérapique de Nancy, Laxou 54520, France. alexandra.tubiana@cpn-laxou.com.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Tubiana
authors.affiliation: Centre Psychothérapique de Nancy, Laxou 54520, France. r.cohen@chu-nancy.fr.
authors.forename: Renaud F
authors.initials: RF
authors.lastname: Cohen
authors.affiliation: National Centre for Suicide Research and Prevention of Mental lll-Health (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm SE-171 77, Sweden. vladimir.carli@ki.se.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Carli
authors.affiliation: Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA. marco.sarchiapone@gmail.com.|Department of Health Sciences, University of Molise, Campobasso 86100, Italy. marco.sarchiapone@gmail.com.
authors.forename: Camilla
authors.initials: C
authors.lastname: Wasserman
authors.affiliation: Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA. HOVEN@nyspi.columbia.edu.
authors.forename: Christina
authors.initials: C
authors.lastname: Hoven
authors.affiliation: Department of Health Sciences, University of Molise, Campobasso 86100, Italy. marco.sarchiapone@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Sarchiapone
authors.affiliation: National Centre for Suicide Research and Prevention of Mental lll-Health (NASP)/WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Karolinska Institute, Stockholm SE-171 77, Sweden. Danuta.Wasserman@ki.se.
authors.forename: Danuta
authors.initials: D
authors.lastname: Wasserman
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D018570:Risk Assessment; D012572:School Health Services / Q000706:statistics & numerical data; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000209:etiology; D013334:Students / Q000706:statistics & numerical data; D059020:Suicidal Ideation; D013405:Suicide / Q000706:statistics & numerical data; D000092864:Suicide Prevention
keywords: French SEYLE cohort; SEYLE; adolescents; prevention; professional screening; psychopathology; suicide; two-stage screening