Ca Final Direct Tax Book For Self Study

[Ara Kistner]

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Purpose: Self-injurious behavior is a frequent phenomenon in adolescence. The present study prospectively examined life events as risk factors for the first onset of direct self-injurious behavior (D-SIB) in the Saving and Empowering Young Lives in Europe school-based multicenter sample.

Results: The number of life events during the past 6 months predicted the first onset of D-SIB in the following year. Gender neither predicted the onset of D-SIB nor moderated the association with life events. Moreover, analyses of individual events identified a range of mainly interpersonal events within both family and peer group as proximal risk factors for first episode D-SIB.

Conclusions: The results support the critical role of interpersonal life events in the development of D-SIB for both genders and refine the conceptualization of proximal risk factors in terms of accumulated stressors and interpersonal events.

Objectives: To investigate the prevalence and associated psychosocial factors of occasional and repetitive direct self-injurious behavior (D-SIB), such as self-cutting, -burning, -biting, -hitting, and skin damage by other methods, in representative adolescent samples from 11 European countries.

Methods: Cross-sectional assessment of adolescents was performed within the European Union funded project, Saving and Empowering Young Lives in Europe (SEYLE), which was conducted in 11 European countries. The representative sample comprised 12,068 adolescents (F/M: 6,717/5,351; mean age: 14.9 0.89) recruited from randomly selected schools. Frequency of D-SIB was assessed by a modified 6-item questionnaire based on previously used versions of the Deliberate Self-Harm Inventory (DSHI). In addition, a broad range of demographic, social, and psychological factors was assessed.

Results: Overall lifetime prevalence of D-SIB was 27.6%; 19.7% reported occasional D-SIB and 7.8% repetitive D-SIB. Lifetime prevalence ranged from 17.1% to 38.6% across countries. Estonia, France, Germany, and Israel had the highest lifetime rates of D-SIB, while students from Hungary, Ireland, and Italy reported low rates. Suicidality as well as anxiety and depressive symptoms had the highest odds ratios for both occasional and repetitive D-SIB. There was a strong association of D-SIB with both psychopathology and risk-behaviors, including family related neglect and peer-related rejection/victimization. Associations between psychosocial variables and D-SIB were strongly influenced by both gender and country. Only a minor proportion of the adolescents who reported D-SIB ever received medical treatment.

Conclusion: These results suggest high lifetime prevalence of D-SIB in European adolescents. Prevalence as well as psychosocial correlates seems to be significantly influenced by both gender and country. These results support the need for a multidimensional approach to better understand the development of SIB and facilitate culturally adapted prevention/intervention.

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Data on the prevalence of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background are scarce. There are hints that this population is at risk. The aim of the study is to investigate the epidemiology of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background in Germany while taking gender-specific differences into consideration.

Suicidal ideation and non-suicidal self-injury are relatively frequent conditions in adolescents [2,3,4]. For a certain percentage of these adolescents, these suicidal ideations cross the intention-behavior gap [5, 6] into suicide attempts.

According to the World Health Organization, one of the most important risk factors for suicide is a previous suicide attempt [7]. It is known that some vulnerable groups such as people with a migration background who might experience discrimination have a higher risk for suicide [7], and this is reflected in the rate of suicide attempts. Therefore, research on the epidemiology of suicidal ideation and suicide attempts in vulnerable groups such as migrants is important and necessary for coming up with preventive measures. Furthermore, there are data that show the association of non-suicidal self-injury and suicide attempts [8]. Prior or current non-suicidal self-injury counts as a risk factor for suicide [1]. Thus, knowledge about non-suicidal self-injurious behavior in vulnerable groups is also required. To date, no representative data for adolescents with a migration background are available for Germany concerning suicidal ideation, suicide attempts, and direct self-injurious behavior.

Merbach, Wittig and Brhler found not only a higher symptom load for anxiety and depression in migrants but also showed an association of the symptoms with the extent of assimilation and sensed discrimination [24].

A pooled analysis of European data stemming from the WHO/EURO study showed that the pattern of an increase in the lifetime prevalence of suicide attempts existed in adults with a migration background (15+ years) in comparison with the native population in 27 of the 56 immigrant groups that were analyzed. Only in a minority of the groups that were analyzed did the persons with a migration background have a lower prevalence of suicidal behavior [27]. However, whether the findings from these data can be transferred to adolescents is questionable.

In this study, we aimed to investigate the epidemiology of direct self-injurious behavior, suicidal ideation, and suicide attempts in a representative sample of German adolescents, focusing on the specifics of adolescents with a migration background.

What are the frequencies of direct self-injurious behavior, suicidal ideation, and suicide attempts in adolescents with a migration background in comparison with adolescents without a migration background?

The following analyses were based on a representative cross-sectional survey of ninth graders in the German state of Lower Saxony conducted in the spring of 2015 [28]. Every tenth German citizen lives in Lower Saxony, a German federal state (about eight million inhabitants). It represents the German average, e.g., regarding the economic situation (unemployment rate or the number of migrants).

The sample included students with a migration background from different countries or regions of origin. The ethno-specific proportion of the total sample was: 6.4% Former Soviet Union, 4.2% Turkey, 2.7% Poland, 1.7% Former Yugoslavia, 1.6% Southern Europe, 2.0% Northern/Western Europe, 1.9% predominantly Islamic countries, 1.0% Asia, and 1.8% other countries. The migration-specific breakdown of the sample description is depicted in Table 1. The matter concerned in the majority adolescents with migration background of at least the second generation (96% of the adolescents with migration background).

The results of Research Question 1 can be replicated when analyzing second generation immigrants only in comparison to adolescents without migration background. A significant higher rate of suicidal ideation and attempts are evident also in this subsample. The results are depicted in Additional file 1.

Female adolescents reported a higher prevalence of suicidal ideation, suicide attempts, and direct self-injurious behavior. This finding applies equally to adolescents with and without a migration background.

When interpreting these results, it has to be taken into account that rates of suicide attempts and suicidal ideation vary over time. This point also applies to the prevalence of these constructs in adolescents with a migration background as shown, for example, by Price & Khubchandani [48]. Furthermore it has to be taken into account that suicide rates differ between cultures and religious background which was also reflected in our results depicting suicidal attempts and ideations.

Looking at the specifics of the groups with different migration backgrounds, our study revealed the following: Two groups of adolescents with a migration background (i.e., students with roots from Poland and from Southern Europe) showed the highest prevalence rates of deliberate self-harm and suicide attempts. The third highest frequency of suicide attempts was reported by adolescents stemming from predominantly Islamic countries (e.g., Lebanon, Iraq, Iran, Morocco, etc.). It is interesting that this finding is in line with results from Lipsicas et al. [49], who reported that migrant adults from Islamic countries displayed high suicide attempt rates despite low rates in their home countries. As mentioned above, rates vary between countries and one would expect that those variations stay constant during the migration process.

When interpreting the results for each of the specific migration groups, it is important to consider that the distribution of gender was not exactly the same in every group. A factor that might partially account for the result for Poland, for example, could be that the number of female adolescents in the sample with a Polish background was 55.9% and thus higher than the average for the total migration sample (49.3%). Since it is known and was also shown in our study that female adolescents showed a higher prevalence of self-harm, suicidal ideation, and suicide attempts, it makes sense for the rates in the Polish-background group to be somewhat higher.

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