A close eye on suicidality in the young
Are there medicines that could destroy a young person's will to live? An EU-funded project has developed a suite of web-based tools to shed new light on suicidality in children and teenagers, with an emphasis on any risks arising from medication. It has also produced a predictive system to identify persons in particular danger.
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The STOP project focused on suicidality in youth aged 8 to 18. We developed a web-based mechanism to collect information from children, adolescents, parents and clinicians, says project coordinator Paramala Santosh of the Department of Child and Adolescent Psychiatry at Kings College London.
This suite of questionnaires was designed as a new module on the health-monitoring platform HealthTracker. Respondents submit information online, replying to questionnaires that are available in several languages.
The module the STOP Suite of Suicidality Measures combines five components also developed by the project. Respectively, these components were built to measure suicidality, take stock of risk factors, note protective aspects, record side effects of any medication young participants may be taking, and monitor whether users were coming off these drugs.
STOP ended in April 2015. Building on work initiated in the project, the researchers involved have since improved an additional risk stratification tool. This is a system specifically designed to identify persons at higher risk of attempting suicide, Santosh explains. While it still requires testing, he notes, this predictive system could eventually help doctors to provide timely, effective treatment.
Do medicines play a role?
The STOP suite enables clinicians to monitor young users state of mind, both as part of the treatment of respondents found to be at risk and in support of research into the emergence of suicidal ideas and their potential progression. It is optimised for use in clinical trials.
STOP had a very specific focus on trying to understand whether suicidality might start or get worse when particular medications are initiated, Santosh observes. A number of drugs carry warnings about potential risks, he explains, adding that the links and the actual processes at play are still being explored.
The instrument we have developed is the first to measure side effects that are specifically related to increasing suicidality, he notes.
This emphasis on the medication-related aspects is unique to the STOP suite, as is the combination of components, he says. There is no other system where you have everything in one module, Santosh adds.
Eliciting real answers
The STOP suite was tested in three trials involving a total of about 1 000 boys and girls, along with their parents and doctors. While these trials were too limited to produce conclusive results on the effects of the drugs on which they focused, they did enable the researchers to validate the module and the approach, Santosh reports.
In particular, he highlights the success achieved in getting the surveyed children and adolescents to open up about this difficult, painful issue. Great care was taken to design interfaces that would encourage them to share their thoughts, as part of a wider commitment to user-friendliness that was rewarded by very positive comments from the various groups of respondents, Santosh notes.
As a result, the majority stated that they would be willing to participate in further studies based on this approach, Santosh observes. He attributes this encouraging outcome partly to the fact that the participating children and adolescents had helped to design the interfaces intended for them.
The medium itself also appears to appeal. Many of the young participants said that they were able to tell us things online that they might not have managed to tell us face to face, says Santosh. And many parents said that they had learned a lot by answering our questions. Otherwise, these are things people hardly ever talk about.
And yet, suicide is largely preventable, according to the World Health Organization. Many tragedies could be avoided if persons at risk were identified early and given effective support. The module developed by STOP could make a contribution in this respect, and Santosh and his colleagues are keen to raise awareness of its potential.