***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This experimental study examined the effect of communication about type of screening follow-up ( in-person follow-up vs. no in-person follow-up ) on adolescents ' responses to a self-report  suicide risk screen  . Participants were 245 adolescents ( 131 girls , 114 boys ; ages 13–17 ; 80 % White , 21.6 % Black , 9.8 % American Indian , 2.9 % Asian ) seeking medical emergency services . They were r and omized to a screening follow-up condition . Screening measures assessed primary risk factors for suicidal behavior , including suicidal thoughts , depressive symptoms , alcohol use , and aggressive/delinquent behavior . There was no main effect of follow-up condition on adolescents ' screening scores ; however , significant interactions between follow-up condition and public assistance status were evident . Adolescents whose families received public assistance were less likely to report aggressive-delinquent behavior if assigned to in-person follow-up . Adolescents whose families did not receive public assistance reported significantly higher levels of suicidal ideation if assigned to in-person follow-up . Findings suggest that response biases impact some adolescents ' responses to suicide risk screenings . Because national policy strongly recommends suicide risk screening in emergency setting s , and because screening scores are used to make critical decisions regarding risk management and treatment recommendations , findings indicate the importance of improving the reliability and validity of suicide risk screening for adolescents Objective To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts , compared with st and ard treatment . Design R and omised , parallel group , superiority trial with blinded outcome assessment . Setting Outpatient intervention at one location at Copenhagen University Hospital , Denmark . Participants Patients older than 12 years admitted to regional hospitals in Copenhagen with a suicide attempt within the past 14 days . We excluded patients diagnosed with schizophrenia spectrum disorders and patients living in institutions . Intervention Case management through assertive outreach that provided crisis intervention and flexible problem solving . This approach incorporated motivational support and actively assisted patients to scheduled appointments to improve adherence with after-treatment as an add on to st and ard treatment . Main outcome Repeated suicide attempt and death by suicide , recorded in medical records and death register at 1-year follow-up . Results 243 patients were included . During 12 months of follow-up , 20/123 ( 16 % ) patients in the intervention group had been registered in hospital records with subsequent suicide attempt , compared with 13/120 ( 11 % ) in the control group ( odds ratio 1.60 , 95 % confidence interval 0.76 to 3.38 ; P=0.22 ) . By contrast , self reported data on new events showed 11/95 ( 12 % ) in the intervention group versus 13/74 ( 18 % ) in the control group ( 0.61 , 0.26 to 1.46 ; P=0.27 ) . By imputing missing data on the selfreported outcomes , we estimated 15/123 ( 12 % ) events in the intervention group and 23/120 ( 19 % ) in the control group ( 0.69 , 0.34 to 1.43 ; P=0.32 ) . Conclusion Assertive outreach showed no significant effect on subsequent suicide attempt . The difference in rates of events between register data and self reported data could indicate detection bias . Trial registration Clinical Trials.gov NCT00700089 A central component of Dialectical Behavior Therapy ( DBT ) is the teaching of specific behavioral skills with the aim of helping individuals with Borderline Personality Disorder ( BPD ) replace maladaptive behaviors with skillful behavior . Although existing evidence indirectly supports this proposed mechanism of action , no study to date has directly tested it . Therefore , we examined the skills use of 108 women with BPD participating in one of three r and omized control trials throughout one year of treatment and four months of follow-up . Using a hierarchical linear modeling approach we found that although all participants reported using some DBT skills before treatment started , participants treated with DBT reported using three times more skills at the end of treatment than participants treated with a control treatment . Significant mediation effects also indicated that  DBT skills use fully mediated the decrease in suicide attempts and depression and the increase in control of anger over time . DBT skills use also partially mediated the decrease of nonsuicidal self-injury over time . Anger suppression and expression were not mediated . This study is the first to clearly support the skills deficit model for BPD by indicating that increasing skills use is a mechanism of change for suicidal behavior , depression , and anger control In a prospect ive-longitudinal study of a representative birth cohort , we tested why stressful experiences lead to  depression  in some people but not in others . A functional polymorphism in the promoter region of the serotonin transporter ( 5-HT T ) gene was found to moderate the influence of stressful life events on depression . Individuals with one or two copies of the short allele of the 5-HT T promoter polymorphism exhibited more depressive symptoms , diagnosable depression , and suicidality in relation to stressful life events than individuals homozygous for the long allele . This epidemiological study thus provides evidence of a gene-by-environment interaction , in which an individual 's response to environmental insults is moderated by his or her genetic makeup Background There have been only a few reports illustrating the moderate effectiveness of suicide-preventive interventions in reducing suicidal behavior , and , in most of those studies , the target population s were primarily adults , whereas few focused on adolescents . Essentially , there have been no r and omized controlled studies comparing the efficacy , cost-effectiveness and cultural adaptability of suicide-prevention strategies in schools . There is also a lack of information on whether suicide-preventive interventions can , in addition to preventing suicide , reduce risk behaviors and promote healthier ones as well as improve  young people 's mental health . The aim of the SEYLE project , which is funded by the European Union under the Seventh Framework Health Program , is to address these issues by collecting baseline and follow-up data on health and well-being among European adolescents and compiling an epidemiological data base ; testing , in a r and omized controlled trial , three different suicide-preventive interventions ; evaluating the outcome of each intervention in comparison with a control group from a multidisciplinary perspective ; as well as recommending culturally adjusted models for promoting mental health and preventing suicidal behaviors . Methods and design The study comprises 11,000 adolescents emitted from r and omized schools in 11 European countries : Austria , Estonia , France , Germany , Hungary , Irel and , Israel , Italy , Romania , Slovenia and Spain , with Sweden serving as the scientific coordinating center . Each country performs three active interventions and one minimal intervention as a control group . The active interventions include gatekeeper training ( QPR ) , awareness training on mental health promotion for adolescents , and screening for at-risk adolescents by health professionals . Structured question naires are utilized at baseline , 3- and 12-month follow-ups in order to assess changes . Discussion Although it has been reported that suicide-preventive interventions can be effective in decreasing suicidal behavior , well-documented and r and omized studies are lacking . The effects of such interventions in terms of combating unhealthy lifestyles in young people , which often characterize suicidal individuals , have never been reported . We know that unhealthy and risk-taking behaviors are detrimental to individuals ' current and future health . It is , therefore , crucial to test well- design ed , longitudinal mental health-promoting and suicide-preventive interventions by evaluating the implication s of such activities for reducing unhealthy and risk behaviors while concurrently promoting healthy ones . Trial registration The German Clinical Trials Register , DRKS00000214 OBJECTIVE To determine whether brief intervention and contact is effective in reducing subsequent suicide mortality among suicide attempters in low and middle-income countries . METHODS Suicide attempters ( n = 1867 ) identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites ( Campinas , Brazil ; Chennai , India ; Colombo , Sri Lanka ; Karaj , Islamic Republic of Iran ; and Yuncheng , China ) participated , from January 2002 to October 2005 , in a r and omized controlled trial to receive either treatment as usual , or treatment as usual plus brief intervention and contact ( BIC ) , which included patient education and follow-up . Overall , 91 % completed the study . The primary study outcome measurement was death from suicide at 18-month follow-up . FINDINGS Significantly fewer deaths from suicide occurred in the BIC than in the treatment-as-usual group ( 0.2 % versus 2.2 % , respectively ; chi2 = 13.83 , P < 0.001 ) . CONCLUSION This low-cost brief intervention may be an important part of suicide prevention programmes for underre source d low- and middle-income countries CONTEXT Universal screening for mental health problems and suicide risk is at the forefront of the national agenda for youth suicide prevention , yet no study has directly addressed the potential harm of suicide screening . OBJECTIVE To examine whether asking about suicidal ideation or behavior during a screening program creates distress or increases suicidal ideation among high school students generally or among high-risk students reporting depressive symptoms , substance use problems , or suicide attempts . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled study conducted within the context of a 2-day screening strategy . Participants were 2342 students in 6 high schools in New York State in 2002 - 2004 . Classes were r and omized to an experimental group ( n = 1172 ) , which received the first survey with suicide questions , or to a control group ( n = 1170 ) , which did not receive suicide questions . MAIN OUTCOME MEASURES Distress measured at the end of the first survey and at the beginning of the second survey 2 days after the first measured on the Profile of Mood States adolescent version ( POMS-A ) instrument . Suicidal ideation assessed in the second survey . RESULTS Experimental and control groups did not differ on distress levels immediately after the first survey ( mean [ SD ] POMS-A score , 5.5 [ 9.7 ] in the experimental group and 5.1 [ 10.0 ] in the control group ; P = .66 ) or 2 days later ( mean [ SD ] POMS-A score , 4.3 [ 9.0 ] in the experimental group and 3.9 [ 9.4 ] in the control group ; P = .41 ) , nor did rates of depressive feelings differ ( 13.3 % and 11.0 % , respectively ; P = .19 ) . Students exposed to suicide questions were no more likely to report suicidal ideation after the survey than unexposed students ( 4.7 % and 3.9 % , respectively ; P = .49 ) . High-risk students ( defined as those with depression symptoms , substance use problems , or any previous suicide attempt ) in the experimental group were neither more suicidal nor distressed than high-risk youth in the control group ; on the contrary , depressed students and previous suicide attempters in the experimental group appeared less distressed ( P = .01 ) and suicidal ( P = .02 ) , respectively , than high-risk control students . CONCLUSIONS No evidence of iatrogenic effects of suicide screening emerged . Screening in high schools is a safe component of youth suicide prevention efforts The purpose of this study was to examine the efficacy of the Youth-Nominated Support Team-Version II ( YST-II ) for suicidal adolescents , an intervention based on social support and health behavior models , which was design ed to supplement st and ard treatments . Psychiatrically hospitalized and suicidal adolescents , 13 - 17 years of age , were r and omly assigned to treatment-as-usual ( TAU ) + YST-II ( n = 223 ) or TAU only ( n = 225 ) . YST-II provided tailored psychoeducation to youth-nominated adults in addition to weekly check-ins for 3 months following hospitalization . In turn , these adults had regular supportive contact with adolescents . Adolescents assigned to TAU + YST-II had an average of 3.43 ( SD = 0.83 ) nominated adults . Measures included the Suicidal Ideation Question naire-Junior ( SIQ-JR ; W. M. Reynolds , 1988 ) , Children 's Depression Rating Scale-Revised ( E. O. Poznanski & H. B. Mokros , 1996 ) , Beck Hopelessness Scale ( A. T. Beck & R. A. Steer , 1993 ) , and Child and Adolescent Functional Assessment Scale ( CAFAS ; K. Hodges , 1996 ) . YST-II had very limited positive effects , which were moderated by history of multiple suicide attempts , and no negative effects . It result ed in more rapid decreases in suicidal ideation ( SIQ-JR ) for multiple suicide attempters during the initial 6 weeks after hospitalization ( small-to-moderate effect size ) . For nonmultiple attempters , it was associated with greater declines in functional impairment ( CAFAS ) at 3 and 12 months ( small effect sizes ) . YST-II had no effects on suicide attempts and no enduring effects on SIQ-JR scores AIM Suicide attempt , ideation and deliberate self-harm are common among adolescents . Limited evidence exists regarding interventions that can reduce risk ; however , research indicates that maintaining contact with at-risk adults following discharge from services via letter or postcard can reduce risk . The aim of the study was to test a postcard intervention among people aged 15 - 24 who presented to mental health services but were not accepted , yet were at risk of suicide . METHODS A r and omized controlled trial 
    Output:
    
The anti-suicidal effects of clozapine and lithium have been substantiated , but might be less specific than previously thought .
Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care , in general public education and media guidelines .