BackgroundIt is unclear which potentially modifiable risk factors best predict post-trauma psychiatric disorders. We aimed to identify pre-trauma risk factors for post-traumatic stress disorder (PTSD) or major depression (MD) that could be targeted with resilience interventions.MethodNewly recruited paramedics (n = 453) were assessed for history of mental disorders with structured clinical interviews within the first week of their paramedic training and completed self-report measures to assess hypothesized predictors. Participants were assessed every 4 months for 2 years to identify any episodes of PTSD and MD; 386 paramedics (85.2%) participated in the follow-up interviews.ResultsIn all, 32 participants (8.3%) developed an episode of PTSD and 41 (10.6%) an episode of MD during follow-up. In all but nine cases (2.3%), episodes had remitted by the next assessment 4 months later. At 2 years, those with episodes of PTSD or MD during follow-up reported more days off work, poorer sleep, poorer quality of life, greater burn-out; and greater weight-gain for those with PTSD. In line with theories of PTSD and depression, analyses controlling for psychiatric and trauma history identified several pre-trauma predictors (cognitive styles, coping styles and psychological traits). Logistic regressions showed that rumination about memories of stressful events at the start of training uniquely predicted an episode of PTSD. Perceived resilience uniquely predicted an episode of MD.ConclusionsParticipants at risk of developing episodes of PTSD or depression could be identified within the first week of paramedic training. Cognitive predictors of episodes of PTSD and MD are promising targets for resilience interventions.

PurposeThe aim of this paper is to review strategies implemented to improve access to mental health care in Jamaica.Design/methodology/approachThe paper is a review of peer‐reviewed articles, official documents, service data and the WHO AIMS data.FindingsDespite limited resources, Jamaica was able to shift from institutional care to community care by implementing the appropriate policy framework, building on primary care services, providing mental health beds at the community level, the training of specialized community mental health nurses (mental health officers) and improving access to psychotropic drugs. As a result, the country has developed a more accessible mental health service; the number of patients treated in the community has doubled over the past decade and 67 percent of inpatients are now treated outside of the mental hospital and there has been a reduction in the population of the mental hospital.Originality/valueThe paper illustrates the approach that serves as a model for mental health services in resource‐limited countries.

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Objective: Suicide is increasingly recognized as a worldwide problem. There is a paucity of quality data pertaining to suicide in developing countries. Epidemiological analysis of suicide data elucidates prevailing patterns that facilitate risk factor identification and the development of germane programmatic responses. This paper analyses temporal variations in suicide rates for the years 2002-2010 in Jamaica and describes the sociodemographic profile of cases and method of suicide for the latter four years. Method: Data pertaining to suicides were extracted from the police (The Jamaica Constabulary Force) records. These were summarized and analysed with respect to person, place and time. Population statistics for the computation of rates were obtained from publications of the Statistical Institute of Jamaica. Age-standardized rates were generated for comparison of trends over time. Poisson and binomial probabilities were used to determine statistically significant differences in rates. Results: Suicide rates in Jamaica have remained relatively stable for the period reviewed with mean overall annual incidence of 2.1 per 100 000 population. Rates for males were significantly higher than those for females. The majority (90.4%) of suicide cases were males. A trend for higher rates of suicide was generally noted in the 25−34-year and the 75-year and over age groups. Hanging was the main method used to commit suicide (77.5%). Conclusions: Age-adjusted rates of suicide indicate no significant changes in Jamaica over the period 2002 to 2010. Continued surveillance of suicide as well as improved recording of the circumstances surrounding suicides are recommended to promote greater understanding of suicides and this will ultimately inform intervention strategies.

The aim of this study was to determine whether perception of risk and accessibility of cannabis predicted the age of initiation of cannabis use among Jamaican secondary school students. Data from a nationally representative sample were analysed. Descriptive statistical analysis was done while binary logistic regression was used to compute point estimates and confidence intervals (CIs). The median age of initiation was 13 years. Gender was a predictor of age of initiation, with females having 39% less risk of initiating cannabis use at the age of 13 years or younger before adjusting for covariates (crude odds ratio [COR]: 0.61; 95% CI: 0.48, 0.77), which increased to 42% reduced risk of initiating cannabis use at the age of 13 years or younger after adjusting for covariates (adjusted OR [AOR]: 0.58; 95% CI: 0.39, 0.85). There was a significant inverse association between grade level in school and age of initiation of cannabis use, with 11 th grade students having a significantly reduced risk of commencing cannabis use at the age of 13 years or younger (COR: 0.41; 95% CI: 0.23, 0.70; AOR: 0.41; 95% CI: 0.23, 0.72). Participants who perceived cannabis use as moderately harmful were 67% less likely to initiate cannabis use at the age of 13 years or younger compared to participants who thought it was not harmful (AOR: 0.33; 95% CI: 0.12, 0.88). Perceptions of access to cannabis did not predict age of initiation of cannabis use. Being female, being in the 11 th grade and the perception that cannabis use was moderately harmful significantly reduced the risk of initiating cannabis use at the age of 13 years or younger. RESUMENEl objetivo de este estudio fue determinar si la percepción del riesgo y la accesibilidad al cannabis predecían la edad de iniciación del uso de cannabis entre los estudiantes de escuela secundaria en Jamaica. Se analizaron los datos de una muestra nacionalmente representativa. Se realizó un análisis estadístico descriptivo, y se utilizó una regresión logística binaria para computar las estimaciones puntuales y los intervalos de confianza (IC). La edad promedio de iniciación fue de 13 años. El género fue un predictor de la edad de iniciación, presentando las hembras un riesgo 39% menor de iniciar el uso de cannabis a la edad de 13 años o más joven,