Ospina-Pinillos Laura, Skinner Adam, Sánchez-Nítola Mónica Natalí, Shambo-Rodríguez Débora L, Navarro-Mancilla Alvaro A, Camacho Salvador, Hilber Adriane Martin, Uribe-Restrepo Jose Miguel, Gomez-Restrepo Carlos, Hickie Ian B, Occhipinti Jo-An
Department of Psychiatry and Mental Health, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia.
Brain and Mind Centre, The University of Sydney, Camperdown, Australia.
BMC Glob Public Health. 2024 Oct 18;2(1):70. doi: 10.1186/s44263-024-00101-1.
Despite suicide's public health significance and global mental health awareness, current suicide prevention efforts show limited impact, posing a challenge for low- and middle-income countries. This study aimed to develop a dynamic simulation model that could be used to examine the potential effectiveness of alternative interventions for reducing youth mental health problems and suicidal behavior in Bogotá, Colombia.
A system dynamics model was designed using a participatory approach involving three workshops conducted in 2021 and 2022. These workshops engaged 78 stakeholders from various health and social sectors to map key mental health outcomes and influential factors affecting them. A model was subsequently developed, tested, and presented to the participants for interactive feedback, guided by a moderator. Simulation analyses were conducted to compare projected mental health outcomes for a range of intervention scenarios with projections for a reference scenario corresponding to business-as-usual.
A total of 6670 suicide attempts and 347 suicides are projected among 7 - 17-year-olds from January 1, 2023, to early 2031 under the business-as-usual scenario. Mental health issues among 12 - 17-year-olds are projected to increase from 18.9% (2023) to 27.8% (2031), and substance use issues from 2.29 to 2.49% over the same period. School-based suicide prevention and gatekeeper training are the most effective strategies, reducing total numbers of suicide attempts and suicides by more than 20% (i.e., compared to business-as-usual). However, discontinuous funding significantly hinders these effective suicide prevention efforts.
Systems modelling is an important tool for understanding where the best strategic financial and political investments lie for improving youth mental health in resource-constrained settings.
尽管自杀对公共卫生具有重要意义，且全球对心理健康的认识不断提高，但目前的自杀预防措施效果有限，这给低收入和中等收入国家带来了挑战。本研究旨在开发一个动态模拟模型，用于检验在哥伦比亚波哥大减少青少年心理健康问题和自杀行为的替代干预措施的潜在效果。
采用参与式方法设计了一个系统动力学模型，该方法包括在2021年和2022年举办的三次研讨会。这些研讨会让来自不同卫生和社会部门的78名利益相关者参与，以绘制关键的心理健康结果以及影响这些结果的因素。随后开发了一个模型，进行了测试，并在主持人的指导下向参与者展示以获取互动反馈。进行了模拟分析，以比较一系列干预情景下预测的心理健康结果与对应照常营业的参考情景下的预测结果。
在照常营业的情景下，预计从2023年1月1日至2031年初，7至17岁的青少年中共有6670次自杀未遂和347起自杀事件。预计12至17岁青少年的心理健康问题将从2023年的18.9%增至2031年的27.8%，同期物质使用问题将从2.29%增至2.49%。基于学校的自杀预防和守门人培训是最有效的策略，可将自杀未遂和自杀总数减少20%以上（即与照常营业相比）。然而，资金的不连续严重阻碍了这些有效的自杀预防努力。
系统建模是一种重要工具，可用于了解在资源有限的环境中，为改善青少年心理健康，最佳的战略财务和政治投资方向在哪里。
