In the proposed study, three objectives will be pursued:
1. To develop a method to identify more effectively the acute and long-term risk of adolescents with the most threatening self-harm behaviours. 2. To identify the factors that influence the risk of self-harm behaviours and the success of treatment/treatment of these behaviours in the most at-risk adolescents (changes in these factors). 3. Develop guidelines for more effective treatment of the most at-risk adolescents.
For this purpose, a sample of approximately 200 young people who will be hospitalised for suicide risk (the most at risk in Slovenia) and an approximately equal number of healthy adolescents will be included. At inclusion, the presence of several factors will be assessed by reviewing demographic data, clinical diagnosis, self-assessment questionnaires and clinical psychological tests (CSSRS, B-NSSI-AT, ISAS, LPFS-BF2.0, BPFSC-11, TSCC, PAI, ECR-RS, DASA-YV, ASHRS), social assessment, and blood sampling for genetic analyses (DNA isolation, sequencing, nucleotide sequence recognition, quantification and evaluation of short tandem repeats, identification of methylation sites). Longitudinal tracking of autoaggressive events and heteroaggressive events during hospitalisation will be performed and recorded on an ongoing basis. The risk and protective factors of the adolescents most at risk will be compared with a control group of adolescents. The same factors will be reassessed in the most at-risk adolescents after 6 and 18 months of treatment as usual. The data will be collected in a data entry and storage system that will ensure the privacy of the data entered in accordance with the GDPR.
This will allow the investigators to identify young people at particular risk of severe self-harm behaviour more reliably, to target them for more intensive and effective treatment, and thus to improve their safety, quality of life and prognosis in the short and long term.
Suicidality
Self-harming with no intention to die
Confirmed acute psychotic disorder
Intellectual disability
Severe physical illness (e.g. cardiovascular or renal disease)
Disease of the central nervous system (e.g. encephalitis, brain injury or haemorrhage, epilepsy)
CLINICAL GROUP: * patients hospitalized in the Intensive Child and Adolescent Psychiatry Unit or the Unit for Adolescent Psychiatry of the Centre for Mental Health University Psychiatric Clinic Ljubljana * aged between 13 and 19 years. * In the case of consent, parents will also be asked for consent for those under 15 years of age. CONTROL GROUP: * 8th grade students in primary school, * 1st year students in secondary school * 1st year students in college * aged 13-19 years * Attending a regular systematic review. These scheduled regular systematic examinations are accompanied by venous blood sampling.
Other
Other
Enrollment questionnaire, General questionnaire1, General questionnaire2, General questionnaire3
Diagnostic testThe questionnaires will cover general and demographic data, information on previous treatments, medication received, mental disorder at discharge (ICD), psychosocial situations (ICD), physical illnesses (ICD), COVID status (vaccinated, recovered, tested), use of psychoactive substances, history of self-harm, suicide attempts, school performance, experience with peers, sexual orientation and identity, residence, family composition, family history of mental disorders, self-harm and suicide attempts.
Columbia Suicide Severity Rating Scale (CSSRS)
Diagnostic testThe questionnaire is scientifically supported, has the most evidence of utility and efficacy, and is internationally accepted. It has been translated into more than 100 different languages, including Slovene. It is easy to use, suitable for all age groups and adapted for successful use outside the hospital setting, for example in schools, colleges, police, military and elsewhere. It contains 2 screening questions on suicidality and 4 more specific questions, 6 items in total. Posner K, Brown GK, Stanley B, et al. Am J Psychiatry 2011;168:1266-77.
The Brief Non-Suicidal Self-Injury Assessment Tool (B-NSSI-AT)
Diagnostic testused for research purposes to assess the core characteristics of NSSI (form, frequency, function) as well as the secondary characteristics of NSSI (habituation, context of NSSI, perceived impact on life and treatment). Whitlock J, Exner-Cortens D, Purington A. Psychol Assess 2014;26:935-46.
Experiences in Close Relationships-Relationship Structures (ECR-RS)
Diagnostic testAssesses the pattern of attachment to attachment figures (friend, romantic partner, mother, father) in adults and adolescents. The questionnaire has been officially translated into Slovene and used with several samples of Slovene adults and adolescents. Fraley RC, Waller NG, Brennan KA. J Pers Soc Psychol 2000;78:350-65.
Trauma Symptom Checklist for Children (TSCC)
Diagnostic testThe questionnaire helps to assess children's/adolescents' experiences of various traumatic experiences, such as physical or sexual violence, peer violence, loss, witnessing violent acts, natural disasters, etc. The questionnaire consists of 6 clinical scales (Anxiety, Depression, Anger, Post-traumatic Stress Symptom, Dissociativeness (two subscales), Sexual Concerns) and 2 validity scales. 6 clinical scales (Anxiety, Depressiveness, Anger, Post-traumatic Stress Symptom, Dissociativeness (two subscales), and 2 validity scales) are included. https://www.center-pds.si/Katalogtestov/Kliničnitesti/Vprašalnikotravmatiziranostiotrokinmladostnik. aspx
Personality Assessment Inventory-Adolescent (PAI-A)
Diagnostic testAn objective-type self-assessment questionnaire for assessing personality in adolescents. It has 264 items to be answered on a 4-point scale. 22 independent scales are obtained (Inconsistency, Rarity, Negative impression, Positive impression, Physical complaints, Anxiety, Anxiety-related disorders, Depressiveness, Mania, Paranoid, Schizophrenia, Borderline traits, Antisocial traits, Alcohol problems, Drug problems, Aggressiveness, Suicidal ideation, Stress, Lack of support, Refusal to deal, Dominance, Warmth). https://www.center-pds.si/Katalogtestov/Kliničnitesti/Vprašalnikzaocenoosebnosti-oblikazamladostnike-PAI-A.aspx
Inventory Of Statements About Self-Injury; ISAS
Diagnostic testA self-assessment questionnaire used for research purposes to assess the basic characteristics of NSSI (form, frequency, function, time to event). It also assesses the desire to stop. The questionnaire has been previously translated into Slovene and used in a population of adolescents with self-injurious behaviour. Glenn CR, Klonsky ED. One-year test-retest reliability of the Inventory of Statements about Self-Injury (ISAS). Assessment. 2011 Sep;18(3):375-8. doi: 10.1177/1073191111411669.
The Level of Personality Functioning Scale-Brief Form 2.0; LPFSBF 2.0
Diagnostic testA short, user-friendly instrument that gives a quick impression of the expression of personality pathology. It consists of 12 items grouped into two higher-order domains: self-functioning and interpersonal functioning. Participants are asked to rate the 12 items on a four-point Likert scale ranging from 1 (completely false) to 4 (completely true). A total score (sum of all items), a self-functioning score (sum of items 1-6) and an interpersonal functioning score (sum of items 7-12) can be calculated. Satisfactory internal consistency and promising construct validity have been demonstrated. Sensitivity to change after three months of treatment was high. Weekers LC, Hutsebaut J, Kamphuis JH. The Level of Personality Functioning Scale-Brief Form 2.0: Update of a brief instrument for assessing level of personality functioning. Personal Ment Health 2019;13:3-14.
Borderline Personality Features Scale, BPFSC-11
Diagnostic testThe BPFS-C-11 includes BPD indicators such as affective instability, identity problems and negative attitudes. Responses to the items are on a 5-point Likert scale ranging from 'not at all true' to 'always true'. Studies have shown construct validity of interpretations of BPFS-C-11 scores through positive associations with other measures of BPD and positive associations with measures of BPD correlates, including emotional dysregulation. In a recent sample, the Cronbach's α over 4 years of follow-up was 0.86, 0.85, 0.86 and 0.90, respectively. The scale has been officially translated into Slovenian and will be used with the permission of the authors. It is intended for use by children and adolescents aged 9-11 years and consists of 11 items. Sharp, C., Steinberg, L., Temple, J., Newlin, E. An 11-Item Measure to Assess Borderline Traits in Adolescents: Refinement of the BPFSC Using IRT . Personality Disorders: Theory, Research, and Treatment 2014;5(1):70-78.
Dynamic Appraisal of Situational Aggression-Youth Version (DASA-YV)
Other interventionIt's a professional assessment tool which provides a daily assessment of the risk of heteroaggression. The evaluation is efficient and takes less than five minutes. The nurse in charge of each patient completes the DASA-YV once a day. Dutch SG, Patil N. Validating a Measurement Tool to Predict Aggressive Behavior in Hospitalized Youth. J Am Psychiatr Nurses Assoc 2019;25:396-404.
Adolescent Self-Harm Risk Scale; ASHRS
Other interventionIt's a professional assessment tool which provides a daily assessment of the risk of heteroaggression. This is the scale we developed for the present study. It will be used to assess and predict the short-term risk of self-harm behaviour during hospitalisation (assessment at admission) and the long-term risk after discharge (assessment at discharge).
Lifetime Incidence of Traumatic Events questionnaire (LITE)
Diagnostic testIs a short checklist for screening and assessing the exposure to trauma in children and adolescents. It covers a broad range of potentially upsetting situations that can cause trauma to children and adolescents, such as a car accident, fire, death of a family member, exposure to threats, sexual assault, or witnessing violence. The questionnaire had been validated on a Slovene population of children and adolesscents. Greenwald R, Rubin A. Assessment of posttraumatic symptoms in children: development and preliminary validation of parent and child scales. Res Soc Work Pract. (1999) 9:61-75. doi: 10.1177/104973159900900105 Uršicˇ K, Bucik V, Klemencˇ icˇ S, Bratina N, Battelino T, Dovcˇ K and Drobnicˇ Radobuljac M (2021) Validation of the Lifetime Incidence of Traumatic Events (LITE-S/P) Questionnaires in Children and Adolescents in Slovenia. Front. Psychiatry 12:665315. doi: 10.3389/fpsyt.2021.665315
Genetic methods
GeneticDNA isolation, Sequencing, Libraries preparation, Analisys; Bioinformatics (Base Calling, Variant Calling, Quantification and evaluation of short tandem repetitions, Methylation sites detection).
Self-harm incident
Registered incident of self-harm
Prevented self-harm incident
Registration of an intended self-harm prevented by hospital staff (nurses)
Click on the lead sponsor to view all of their trials.
University of Ljubljana, Faculty of Medicine
Lead sponsor
University Medical Centre Ljubljana
Collaborator
University Maribor
Collaborator
University Psychiatric Clinic Ljubljana
Collaborator
