Researchers have discovered biological and psychological characteristics that increase the risk of suicidal behavior among teenagers and have developed an application that helps with mental coping
Dr. Amit Shalov, the Voice of the Science website, the National Science Foundation
Suicide is a major cause of death in children and teenagers (from the age of 10). Suicidal behavior - including suicidal thoughts, threats or suicide attempts, and suicide - is caused by a variety of social, mental, personality and biological risk factors that influence each other. It is sometimes accompanied by mental disorders such as eating disorder, post-traumatic stress disorder (PTSD), depression, anxiety and personality disorder. Every year in Israel 20-10 teenagers commit suicide and about 1,000 suicide attempts end with a visit to the emergency room.
"Today, we still don't know how to predict the risk of suicide and how to reduce it, so the phenomenon remains serious and without an adequate solution," says Dr. Amit Shalu, director of the Department of Child and Adolescent Psychiatry at the Hadassah Medical Center. Dr. Shalu and his team treat children and teenagers up to the age of 18 with a mental disorder (such as depression, anxiety or an eating disorder) and suicidal tendencies, who come from different socio-demographic areas. In doing so, they integrate them in their studies.
Their latest research, which is still ongoing, and which won a grant from the National Science Foundation, examines the effect of an innovative therapeutic intervention, supported by technology, on the suicidal behavior of teenagers after psychiatric hospitalization. In addition, they sought to identify biological and psychological characteristics in them that may predict suicidal behavior.
So far, about 90 teenagers (12 years old and older), mainly girls, who are being treated in the full hospitalization department, in the day care unit or in the crisis intervention unit at the Hadassah Medical Center have participated in the study, who tried to commit suicide or expressed such an intention. Half of them were assigned to comprehensive treatment, psychological and medicinal, which includes parental guidance and a support group, and half of them received the same treatment plus four sessions with a psychologist. In these meetings, a security plan was built for them to deal with suicidal impulses and mental help that was embedded in an application on their smartphone (named BRITE). This program includes the option of assessing the distress and tools to deal with it, which help with distraction, emotional regulation and self-soothing. For example, playing sports, taking a cold shower, breathing exercises, holding an ice cube, watching a funny video, calling friends, and contacting helpful contacts (such as psychologists and parents) or an emergency room.
According to Dr. Shalu, "it is an interactive and friendly application that, with the push of a button, helps to deal with suicidal impulses after discharge from hospitalization and reduces distress and suicidal behavior. It was developed by leading researchers from the University of Pittsburgh in collaboration with the American software company NuRelm and we translated it into Hebrew."
The subjects of both groups underwent evaluations from their entry into the study until six months after release based on questionnaires dealing with suicidal behavior, depression, anxiety and childhood trauma such as poverty, neglect, physical and sexual violence (if it occurred and with what intensity).
In addition, the subjects underwent saliva and blood tests (in the laboratory for biological psychiatry in Hadassah) in which biological characteristics were examined. These characteristics included the level of cortisol (a hormone whose level increases in stressful situations) and the expression of genes and receptors related to the HPA axis (the main stress system in the body, which involves the hypothalamus, pituitary gland and adrenal gland and is involved in cortisol production). These characteristics were also tested in a control group - healthy patients of a similar age.
From the analysis of the data so far, it was found that the subjects who used the application went to the emergency room less after being released from hospitalization and were less often re-hospitalized in psychiatric wards. In the blood samples, deciphered through genetic sequencing, a unique expression of three genes was discovered in the suicidal subjects, especially those who experienced childhood trauma, which are related to the activity of the cortisol receptor and the HPA axis. "We found a clear difference between the suicidal and healthy subjects in the level of expression of these genes," explains Dr. Shalu.
The saliva samples were analyzed by ELISA (a biochemical method for detecting proteins or antigens) and it was found that the cortisol level was actually lower in the suicidal subjects compared to the healthy ones. "The explanation for this is the difficult events that happened throughout their lives, which caused the cortisol axis to flatten and its less reactivity to stress," notes Dr. Shalu.
Ultimately, the researchers aim to develop a kind of suicide risk calculator (similar to the one that exists in other diseases). According to Dr. Shalu, "In the current study we built a statistical model that was able to correctly characterize 85% of the suicidal subjects - those with a background of childhood trauma, a lower cortisol level and a specific genetic expression. When these data are weighted, it is possible to assess suicidal risk or strengthen a clinical assessment and then treat accordingly, partly through the application, which, as mentioned, was found to be effective in reducing suicide."
The researchers also examined psychological characteristics such as sleep patterns in the subjects. This is by using a smart watch and filling out the questionnaires for ten days. This is how they discovered that a long duration of falling asleep and a reduced number of hours of sleep at night increase the risk of suicidal thoughts and a wish to die the next day. "This finding contributes to the understanding that sleep is essential for emotional regulation and for reducing mental distress and depression," says Dr. Shalu.
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