Temporal trends of suicidality among adolescents in the last decade in Piedmont, Northwestern Italy

Abstract Background Over the last decade, trends of suicidality among adolescents remain unclear. We conducted a cross-sectional study using surveillance data collected over the past 10 years in the Piedmont region, Italy, to explore temporal trends in suicidality among hospitalized adolescents. Methods This was a retrospective study over an 11-year period of time. The target cohort was adolescents aged 13-19 discharged from inpatient/day-hospital care with at least one suicidality-related ICD9-CM code (i.e., suicidal ideation-SI, suicidal risk-SR and suspected suicide-SS) between 2011 and 2021 in Piedmont (Northwestern Italy). Social-economic related data is available from Census 2011. Yearly incidence rates (IR) were calculated based on the overall hospitals’ catchment population and by sex. Poisson regression model was estimated to evaluate the trend over time and the association with sex, and a potential effect of the COVID-19 pandemic. A non-linear trend was allowed by modelling natural splines. Results We included 490 adolescents (median age: 15 years, IQR: 13-16), 380 girls and 110 boys, with ICD9-CM codes for SI (264; 53.9%), SR (142; 29%), SS (90; 18.4%) at first discharge. Girls showed a higher risk of repeated inpatient care than boys (19.2% vs 7.3%, p < 0.01). Since 2013, yearly suicidality IRs started increasing linearly in boys (+1.7/100,000 per year, 95%CI: 0.7-2.8). Apparently, suicidality IRs increasing in girls were observed since 2011 (+5.8/100,000 per year, 95%CI 2.8-8.9) and were significantly higher than in boys (p < 0.001). Conclusions Suicidality among young inpatients increased in Piedmont during the last decade. Females seemed to be more affected than males. Further research is needed to better understand gender-related risk factors for suicidality. Key messages • There has been an increase in the number of adolescents reporting suicidal ideation in the last decade, especially in girls. • Intervention strategies are urgently needed to reverse a potentially alarming trend in suicidality among young people.


Background:
Nonmedical use of prescription drugs such as sedatives and anxiolytics is a fast growing public health threat in several countries. In Tunisia, although several studies have investigated the prevalence of nonmedical use of anxiolytics among school-age students, there is a gap in knowledge regarding trends in anxiolytics misuse. We aimed to determine the prevalence of nonmedical use of anxiolytics and examine trends between 2013 and 2021. Methods: Pooled data from three Mediterranean school surveys on alcohol and other drugs (MedSPAD I-2013, MedSPAD II-2017, MedSPAD III-2021 were used. Based on three-stage stratification sampling method, teenagers in first and second grades of secondary education, were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Data collection was performed using a self-administered standardized questionnaire. We studied weighted lifetime nonmedical use of prescription anxiolytics and performed global and by gender trend analysis. Epi data software was used for data entry and all statistical analysis, were performed with STATA software.

Results:
A total of 14.723 students were enrolled with sex ratio (Male/ Female) equal to 0.61 and mean age of 16.2AE0.8 years. The prevalence of nonmedical anxiolytics' use increased from 2.1% to 3% then to 8.4% for 2013, 2017 and 2021, respectively. Global and by gender trends analysis concluded to significant increase from 2017 to 2021 (p < 10-3). However, a nonsignificant increase was revealed from 2013 to 2017.

Conclusions:
Our study is the first to confirm a significant increasing trend in non-medical use of anxiolytics among Tunisian adolescents. These findings emphasize the urgent need for early detection of psychological vulnerability among adolescents in order to prevent their engagement in such risky behaviors. Key messages: Decision makers should be sensitized regarding the alarming increasing trend in non-medical use of anxiolytics, among Tunisian adolescents.
The state control of these substances accessibility and early detection of psychological vulnerability, are highly required.

Background:
Mortality data represent a primary source of information for monitoring a population health status over years. In Tunisia, the national Information System on Causes of Death (ISCD) lacks completeness (average coverage rate of 40%); however, in order to examine covid-19's effect on mortality data, the ISCD was reinforced. We aimed to give an overview of leading causes of death in Tunisia for 2020.

Methods:
Data were obtained from Medical Certificates of Cause Of Death (MCCOD) sent by municipalities to the National Institute of Health in accordance with the legislative framework. Causes of Death (CoD) coding process was performed based on the International Classification of Diseases, Tenth Revision (ICD-10). The underlying cause of death was identified based on IRIS software, and mortality statistics were presented based on the world health organization causeof-death lists for tabulating mortality statistics. Data analysis was performed using SPSS software.

Results:
A total of 46.420 MCCOD among 75.365 deaths officially declared by the National Institute of Statistics, were analyzed (coverage rate of 61.2%). The 10 leading causes of death for both sexes, in rank order were: diabetes mellitus, cerebrovascular diseases, covid-19, ischemic heart diseases, external causes of death, digestive and pulmonary malignant neoplasms, conditions of neonatal period, hypertensive diseases, and influenza and pneumonia. Leading causes of infant deaths were: certain conditions originating in perinatal period, congenital malformations, deformations and chromosomal abnormalities, diseases of respiratory system, certain infectious and parasitic diseases, and diseases of nervous system.

Conclusions:
The COVID-19 pandemic was an opportunity to improve the Tunisian ISCD's coverage rate. However, efforts should be maintained to optimize system completeness, and decision makers should be more sensitized regarding the urgent need for system digitalization.

Key messages:
Mortality statistics have shown that covid-19 ranks third among leading causes of death in Tunisia for 2020; and non communicable disease accounted for 6 out of 10 leading causes of deaths. The ISCD coverage rate was improved in 2020 reaching 61.2%; however the system digitalization is an essential and sustainable solution to optimize completeness.
Abstract citation ID: ckac131.219 Temporal trends of suicidality among adolescents in the last decade in Piedmont, Northwestern Italy

Background:
Over the last decade, trends of suicidality among adolescents remain unclear. We conducted a cross-sectional study using surveillance data collected over the past 10 years in the Piedmont region, Italy, to explore temporal trends in suicidality among hospitalized adolescents.

Methods:
This was a retrospective study over an 11-year period of time.
The target cohort was adolescents aged 13-19 discharged from inpatient/day-hospital care with at least one suicidality-related ICD9-CM code (i.e., suicidal ideation-SI, suicidal risk-SR and suspected suicide-SS) between 2011 and 2021 in Piedmont (Northwestern Italy). Social-economic related data is available from Census 2011. Yearly incidence rates (IR) were calculated based on the overall hospitals' catchment population and by sex. Poisson regression model was estimated to evaluate the trend over time and the association with sex, and a potential effect of the COVID-19 pandemic. A non-linear trend was allowed by modelling natural splines.

Background:
Despite a decrease in mortality rates CVD remains the leading cause of morbidity and mortality in Europe. Health behavioural risk factors, low socioeconomic status and cohabitation status are all associated with CVD. However, little is known about social inequality in health behaviour among cohabitating individuals with CVD. Thus, the aim of this study was to examine social inequality in health behaviour among cohabitating individuals with CVD.

Methods:
Register data on CVD were linked with self-reported health behaviour from the Danish 2017 population-based health survey 'How are you?'. In total, 2,443 survey participants aged 45 years and above were registered with CVD. Daily smoking was assessed using a single question about smoking habits.
Physical inactivity was categorised as less than 30 minutes of physical activity at least six days per week. Respondents with a BMI ! 30 were considered obese. Unhealthy diet was assessed using the Diet Quality Score. Moderate risk alcohol consumption was categorised as exceeding the Danish Health Authority's recommendations. Self-reported educational attainment was used as a marker of social position and was categorised as low (0-10 years), medium (11-15 years) or high (! 15 years). Sociodemographic differences in health behaviour were compared using adjusted logistic regression models with health behaviours as dependent variables and adjusted for sex, age, ethnic background, time since initial CVD diagnosis and multimorbidity.

Results:
Cohabitating individuals with CVD and low educational attainment had higher adjusted odds for daily smoking (3.31), physical inactivity (2.10), unhealthy diet (6.37) and obesity (2.55) than cohabitating individuals with CVD and high educational attainment. However, they also had lower adjusted odds for moderate risk alcohol intake (0.35).

Conclusions:
Social inequality in daily smoking, physical inactivity, unhealthy diet and obesity was found among cohabitating individuals with CVD. Key messages: Social inequality in health behaviour was found among cohabitating individuals with CVD. Thus, low educational attainment affects CVD risk profile regardless of cohabitation status. Social inequality in health behaviour among cohabitating individuals with CVD should be addressed in public health strategies, targeted secondary prevention, treatment and rehabilitation.

Background:
Cannabis is the most widely used illicit psychoactive substance worldwide. In Tunisia, the prevalence of cannabis use and its association with other risky behaviours were reported in several publications interesting mainly early adolescence. However, no publications exploring trends based on national epidemiological data are available yet. Our purpose was to determine cannabis prevalence in Tunisian high school adolescents and assess significant trends from 2013 to 2021.

Methods:
Pooled data from Mediterranean school surveys on alcohol and other drugs conducted in 2013, 2017, and 2021, were used. Based on three-stage stratification sampling method, first and second grade secondary education students were enrolled.
Were not included students enrolled in vocational training centers and out-of-school adolescents. Self-administered standardized questionnaire was used in data collection. We studied weighted lifetime prevalence of cannabis use and chi square test for trend was used for global, by gender and by sector (private/public) trends assessement. STATA software was used for statistical analysis.

Results:
A total of 14.723 students were enrolled with sex ratio (M/F) equal to 0.61 and mean age of 16.2AE0.8 years. The prevalence