Pre- and postloss features of adolescent suicide bereavement: A systematic review

Probably not a substantial claim: may not pass S3 (load-bearing).

The study was conducted following the PRISMA guidelines for systematic reviews.

“The study was conducted following the PRISMA guidelines (http://www.prisma-statement.org/) for systematic reviews (Liberati et al., 2009).”

• cites Liberati et al., 2009 sourceSupported

May combine two claims.

Levels of corumination predict the onset of depression, as well as its severity and duration.

“Levels of corumination are found to predict the onset of depression, as well as its severity and duration (Stone, Hankin, Gibb, & Abela, 2011).”

• cites Stone, Hankin, Gibb, & Abela, 2011 sourceSupported

May combine two claims.

Preloss features include family and personal history of psychiatric problems, closeness of relationship, and having known about the suicide plan.

“Preloss features include family and personal history of psychiatric problems, closeness of relationship, and having known about the suicide plan”

• cites Brent et al., 1992 sourceNot checked — no full text of the source
• cites Cerel et al., 2000 sourceNot checked — no full text of the source
• cites Melhem et al., 2008 sourcePartly supported

  The Results (page unavailable) describe psychiatric histories before the death in parents, caregivers, and offspring, and discuss relationship closeness in connection with depression after bereavement. The paper does not address whether survivors knew of a suicide plan before the death (searched: suicide plan, prior knowledge of suicide intention). (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Studies did not find increased risks of attempted suicide or suicide among friends versus acquaintances exposed to a suicide, despite increased onset of psychopathology shortly after bereavement.

“studies did not find increased risks of attempted suicide or suicide among friends versus acquaintances exposed to a suicide (Brent et al., 1992(Brent et al., , 1996b(Brent et al., , 1994,;,;Feigelman & Gorman, 2008;Swanson & Colman, 2013;Watkins & Gutierrez, 2003), despite increased onset of psychopathology shortly after bereavement (Brent et al., 1993a(Brent et al., , 1993b(Brent et al., , 1994”

• cites Brent et al., 1992 sourceNot checked — no full text of the source
• cites Feigelman & Gorman, 2008 sourceNot checked — no full text of the source
• cites Swanson & Colman, 2013 sourcePartly supported

  The Results and Interpretation report that, among youth exposed to a schoolmate’s suicide, personally knowing the decedent did not increase suicidality risk relative to knowing the person less closely; the measured outcomes included suicide attempts. The paper does not report a comparison for deaths by suicide. The psychopathology clause is attached to different citations, so it is not assessed here. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

A higher level of functioning of the remaining parent after the death, and self-esteem of the surviving adolescent were protective factors for bereaved adolescents.

“a higher level of functioning of the remaining parent after the death, and self-esteem of the surviving adolescent were protective factors for bereaved adolescents (Melhem et al., 2008)”

• cites Melhem et al., 2008 sourceSupported

May combine two claims.

Personal history of depression and family history of psychopathology are related to new onset psychiatric problems after the loss.

“personal history of depression and family history of psychopathology are related to new onset psychiatric problems after the loss”

• cites Brent et al., 1992 sourceNot checked — no full text of the source
• cites Cerel et al., 2000 sourceNot checked — no full text of the source
• cites Melhem et al., 2008 sourceSupported

May combine two claims.

Neither age at time of the death, gender of deceased parent, nor cause of death affected the developmental outcomes.

“Strikingly, neither age at time of the death, gender of deceased parent, nor cause of death affected the developmental outcomes (Brent et al., 2012).”

• cites Brent et al., 2012 sourceSupported

May combine two claims.

Parentally bereaved youth compared with nonbereaved controls had lower competence regarding work performance, career planning, peer attachment, and future educational aspirations.

“Parentally bereaved youth compared with nonbereaved controls had lower competence regarding work performance, career planning, peer attachment, and future educational aspirations”

• cites Hamdan et al., 2013 sourcePartly supported

  The Discussion (page unavailable) says parental bereavement was associated with less optimal attainment of developmental competence. It does not specify lower competence in work performance, career planning, peer attachment, or future educational aspirations compared with nonbereaved controls. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

Parentally bereaved youth compared with nonbereaved controls had higher levels of new onset alcohol and substance abuse and dependence, especially in adolescent boys.

“higher levels of new onset of alcohol and substance abuse and dependence, the latter especially in adolescent boys (Hamdan et al., 2013)”

• cites Hamdan et al., 2013 sourcePartly supported

  The Results report more new-onset alcohol or substance abuse or dependence (ASAD) among bereaved youth than controls (13.6% vs 5.6%). The Abstract Conclusions and Discussion qualify the heightened risk for adolescent boys as applying especially to those with disruptive behavior disorders, which the claim omits. The Results also say the dependence subgroup’s increase was not statistically significant when examined separately. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Preloss features such as history of psychiatric problems, feelings that others are accountable for the death, and postloss features such as quality of remaining parental relationship, and life events, affected the long-term mental health and developmental outcome.

“preloss features such as history of psychiatric problems, feelings that others are accountable for the death, and postloss features such as quality of remaining parental relationship, and life events, affected the long-term mental health and developmental outcome”

• cites Brent et al., 2009 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites Melhem et al., 2007 sourceNot checked — no full text of the source
• cites Melhem et al., 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

From a developmental perspective, increasing age in childhood and adolescence is associated with increasing cognitive capacities, and increasing separation and independence from parents, which may explain an increased vulnerability in younger children, in addition to biochemical and hormonal vulnerabilities in young children.

“from a developmental perspective it is known that increasing age in childhood and adolescence is associated with increasing cognitive capacities, and increasing separation and independence from parents, which may explain an increased vulnerability in younger children, in addition to biochemical and hormonal vulnerabilities in young children (Dietz et al., 2013;Luecken, 2008;Oltjenbruns, 2001).”

• cites Dietz et al., 2013 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites Luecken, 2008 sourceNot checked — no full text of the source
• cites Oltjenbruns, 2001 sourceNot checked — no full text of the source

May combine two claims.

Grief was expressed in thoughts and feelings and affected behavior and relationships.

“Grief was expressed in thoughts and feelings and affected behavior and relationships”

• cites Abbott & Zakriski, 2014 sourceNot checked — no full text of the source
• cites Bartik, Maple, Edwards, & Kiernan, 2013aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Cerel, Fristad, Weller, & Weller, 1999 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S4 (based).

No comprehensive systematic review has been published of the peer-reviewed literature concerning adolescents bereaved by suicide (including all decedent-survivor relationships).

“To the best of our knowledge, no comprehensive systematic review has been published of the peer-reviewed literature concerning adolescents bereaved by suicide (including all decedent-survivor relationships).”

May combine two claims.

Studies on suicidal behavior in peer suicide-exposed adolescents have presented mixed findings, with some mostly cross-sectional studies reporting increased risks, but other mostly controlled and longitudinal studies not.

“Studies that have reported on suicidal behavior in peer suicide-exposed adolescents have presented mixed findings, with some mostly cross-sectional studies (Bjarnason & Thorlindsson, 1994;Blum, Harmon, Harris, Bergeisen, & Resnick, 1992;Ho et al., 2000;Pirelli & Jeglic, 2009;Smith & Crawford, 1986) reporting increased risks, but other mostly controlled and longitudinal studies not (Brent et al., 1”

• cites Bjarnason & Thorlindsson, 1994 sourceNot checked — no full text of the source
• cites Brent et al., 1992 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

More than half of the studies (n = 33, 57%) were U.S.-based, with 21 studies from the same research group.

“More than half of the studies (n ¼ 33, 57%) were U.S.-based, with 21 studies (marked with ° in Tables 1 and 2 and relevant links between studies were included in the tables) from the same research group.”

May combine two claims.

The experience of a suicide changed adolescents' perspective on relationships, life, and their level of maturity.

“The experience of a suicide changed their perspective on relationships, life (Bartik et al., 2013a;Ratnarajah & Schofield, 2008;Silvén Hagström, 2013), and their level of maturity (Dyregrov & Dyregrov, 2005).”

• cites Bartik et al., 2013aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Ratnarajah & Schofield, 2008 sourceNot checked — no full text of the source
• cites Silvén Hagström, 2013 sourceNot checked — no full text of the source

May combine two claims.

Young survivors expressed a need to make meaning of the suicide and to be able to talk about their experience.

“The young survivors expressed a need to make meaning of the suicide, and to be able to talk about their experience”

• cites Bartik et al., 2013aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Dyregrov & Dyregrov, 2005 sourceNot checked — no full text of the source

May combine two claims.

Their positioning in their social circle oscillated between active and passive, between help-seeking and isolation.

“Their positioning in their social circle oscillated between active and passive, between help-seeking and isolation”

• cites Silvén Hagström, 2013 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The search strategy identified 58 studies, published between 1976 and 2014.

“The search strategy identified 58 studies, published between 1976 and 2014.”

May combine two claims.

Several studies have found an age effect with impact of suicide being stronger when experienced at younger age (e.g., before ages 10 or 12), with regard to offspring suicide and attempted suicide, and early onset as well as long-term risk of attempted suicide hospitalization.

“Several studies have found an age effect with impact of suicide being stronger when experienced at younger age (e.g., before ages 10 or 12), with regard to offspring suicide (Agerbo et al., 2002;Niederkrotenthaler et al., 2012;Wilcox et al., 2010) and attempted suicide, and early onset as well as long-term risk of attempted suicide hospitalization (Kuramoto, Runeson, Stuart, Lichtenstein, & Wilcox”

• cites Agerbo et al., 2002 sourceNot checked — no full text of the source
• cites Niederkrotenthaler et al., 2012Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Wilcox et al., 2010 sourceNot checked — no full text of the source

May combine two claims.

Increased social adjustment problems (e.g., difficulties with school, spare time, peers, and siblings) and more internalizing behavior have been found in suicide-bereaved children and adolescents.

“Increased social adjustment problems (e.g., difficulties with school, spare time, peers, and siblings; Sethi & Bhargava, 2003) and more internalizing behavior (Cerel et al., 1999) have been found in suicidebereaved children and adolescents”

• cites Sethi & Bhargava, 2003 sourceNot checked — no full text of the source
• cites Cerel et al., 1999 sourceNot checked — no full text of the source

May combine two claims.

Parental death during childhood (0-12 years old) or adolescence (12-17 yrs old) increased suicide risk (IRR 3.0, p < .05), contrary to young adulthood (18-25 yrs).

“Parental death during childhood (0-12 years old) or adolescence (12-17 yrs old) increased suicide risk (IRR 3.0, p < .05),contrary to young adulthood (18-25 yrs)”

Probably not a substantial claim: may not pass S3 (load-bearing).

Regarding suicide exposure, 22 studies focused on suicide in the peer environment.

“Regarding suicide exposure, 22 studies focused on suicide in the peer environment (e.g., suicide of friends, acquaintances, and school mates (Table 1).”

May combine two claims.

Prior personal history of depression and functional impairment were related to prolonged grief.

“Prior personal history of depression and functional impairment were related to prolonged grief (Melhem et al., 2011).”

• cites Melhem et al., 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

This review of the research literature on the impact of suicide loss on adolescents revealed that neither type of death per se nor mental health or risk behavior determines the level of grief.

“This review of the research literature on the impact of suicide loss on adolescents revealed that neither type of death per se nor mental health or risk behavior determines the level of grief.”

May combine two claims.

Predeath parental and child psychiatric disorder had a negative impact on parent and child functioning and was related to the developmental outcomes mentioned.

“Predeath parental and child psychiatric disorder had a negative impact on parent and child functioning and was related to the developmental outcomes mentioned.”

May combine two claims.

Social support among peers seems to have beneficial effects on more helpful attitudes towards suicide (e.g., belief that suicide is preventable), but it is also related to more negative or stigmatizing attitudes (e.g., belief that suicide is normal or selfish).

“social support among peers seems to have beneficial effects on more helpful attitudes towards suicide (e.g., the belief that suicide is preventable), but it is also related to more negative or stigmatizing attitudes (e.g., the belief that suicide is normal or selfish; Abbot & Zakriski, 2014).”

• cites Abbot & Zakriski, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Abbott and Zakriski (2014) found that the level of grief was highest in peers closest to suicides, and that closeness of relationship and level of grief were linked to a weaker belief in the preventability of the suicide.

“Abbott and Zakriski (2014) found that the level of grief was highest in peers closest to suicides, and that closeness of relationship and level of grief were linked to a weaker belief in the preventability of the suicide.”

• cites Abbott and Zakriski (2014) sourceNot checked — no full text of the source

May combine two claims.

Similar findings were reported by Christiansen, Goldney, Beautrais, and Agerbo (2011); however, high paternal but not maternal income appeared to mitigate risk of attempted suicide after maternal death.

“Similar findings were reported by Christiansen, Goldney, Beautrais, and Agerbo (2011); however, high paternal but not maternal income appeared to mitigate risk of attempted suicide after maternal death (Jakobsen & Christiansen, 2011).”

• cites Christiansen, Goldney, Beautrais, and Agerbo (2011) sourceNot checked — no full text of the source
• cites Jakobsen & Christiansen, 2011 sourceNot checked — no full text of the source

May combine two claims.

The level of grief appears to be related to the emotional closeness of the relationship with the deceased person, and attitudes such as a belief in the preventability of suicide.

“The level of grief appears to be related to the emotional closeness of the relationship with the deceased person, and attitudes such as a belief in the preventability of suicide (Abbott & Zakriski, 2014).”

• cites Abbott & Zakriski, 2014 sourceNot checked — no full text of the source

May combine two claims.

At 3-year follow-up, three grief trajectories emerged irrespective of cause of death: a low grief group (58.8%), an initial high-grief group steadily declining over time (30.8%), and a high grief group that continued over time (10.4%).

“At 3-year follow-up, Melhem et al. (2011) distinguished three grief trajectories, which emerged irrespective of cause of death: (a) a low grief group (58.8% of the total sample), (b) an initial high-grief group steadily declining over time (30.8% of sample), and (c) a high grief group that continued over time (10.4%).”

• cites Melhem et al. (2011)Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

At 3-year follow-up, complicated grief in the remaining parent, feeling that others were accountable for the death, and life events subsequent to the death were related to new onset depression.

“at 3-year follow-up, complicated grief in the remaining parent, feeling that others were accountable for the death, and life events subsequent to the death were related to new onset depression.”

• cites Melhem et al., 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

There was no increased risk over time of depression, PTSD, or anxiety disorders between the two groups.

“No increased risk over time of depression, PTSD, or | anxiety disorders between the two groups”

Probably not a substantial claim: may not pass S3 (load-bearing).

The death of a grandparent is often the first death experience of an adolescent, reported by half (49%) of adolescents.

“the death of a grandparent is often the first death experience of an adolescent, e.g., reported by half (49%) of adolescents (Glass, 1990).”

• cites Glass, 1990Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Own psychiatric illness and poor schooling were linked to death by suicide in young people.

“Also own psychiatric illness and poor schooling | was linked to death by suicide”

• cites Agerbo et al. (2002) sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The majority of adolescents have experienced the death of a first- or second-degree relative or a close friend.

“The majority of adolescents have experienced the death of a first-or second-degree relative or a close friend (Ringler & Hayden, 2000)”

• cites Ringler & Hayden, 2000 sourceNot checked — no full text of the source

May combine two claims.

The majority of studies were undertaken in the United States, and only few studies have been done in non-Western countries.

“The majority of studies were undertaken in the United States, and only few studies have been done in non-Western countries.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

There are robust findings of increased risk of suicide and suicidal behavior among adolescents after a suicide in the family, independent of the familial transmission of psychiatric problems.

“contrary to robust findings of increased risk of suicide and suicidal behavior among adolescents after a suicide in the family, independent of the familial transmission of psychiatric problems.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

77.6% of adolescents in the study by Harrison and Harrington (2001) had experienced a loss through death, with 66% having lost a grandparent.

“77.6% of adolescents in the study by Harrison and Harrington (2001) had experienced a loss through death, with 66% having lost a grandparent.”

• cites Harrison and Harrington (2001) sourceNot checked — no full text of the source

May combine two claims.

There were no differences in symptoms of PTSD, suicidality, and depression (the latter in one third of children), apart from short-lived (6 months postloss) higher symptoms among suicide bereaved children.

“No differences in symptoms of PTSD, suicidality, | and depression (the latter in 1/3rd of children), | apart from short-lived (6 months postloss) higher | symptoms among suicide bereaved children”

May combine two claims.

There was no difference between the two groups regarding postloss parental psychopathology, quality of relationship between surviving parents and children, and experience of social support.

“No difference between the two groups regarding | postloss parental psychopathology, quality of | relationship between surviving parents and | children, and experience of social support”

• cites Cerel et al. (2000) sourceNot checked — no full text of the source

May combine two claims.

Suicide bereaved children felt more anxiety, anger and shame during the first year (p < .05).

“Suicide bereaved children felt more anxiety, anger | and shame”

• cites Cerel et al. (1999) sourceNot checked — no full text of the source

May combine two claims.

Age at time of the death, and gender and cause of death of the deceased parent did not affect the outcomes.

“Age at time of the death, and gender and cause of | death of the deceased parent did not affect the | outcomes”

May combine two claims.

A recent analysis of the postvention articles published in the four core suicidology journals over the last 40 years found only five articles on characteristics of suicide bereavement, and seven articles on support programs that specifically focused on adolescents or students.

“A recent analysis of the postvention articles published in the four core suicidology journals over the last 40 years found only five articles on characteristics of suicide bereavement, and seven articles on support programs that specifically focused on adolescents or students (Andriessen, 2014).”

• cites Andriessen, 2014 sourceNot checked — no full text of the source

May combine two claims.

Children mostly impacted by the loss might have experienced the most preloss problems, and children who have been separated from the suicidal parent might cope well with the loss without serious effects.

“children mostly impacted by the loss might have experienced the most preloss problems, children who have been separated from the suicidal parent might cope well with the loss (Cerel et al., 2000) without serious effects”

• cites Cerel et al., 2000 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Social support in families following a suicide would mitigate impact of suicide, whereas social support among friends could be a risk factor for increased corumination.

“This indicates that social support in families following a suicide would mitigate impact of suicide, whereas social support among friends could be a risk factor for increased corumination.”

May combine two claims.

Income of father is an indicator of socioeconomic status, which correlates with levels of social support.

“Income of father is an indicator of socioeconomic status, which correlates with levels of social support (Gecková, Van Dijk, Stewart, Groothoff, & Post, 2003;Mickelson & Kubzansky, 2003).”

• cites Gecková, Van Dijk, Stewart, Groothoff, & Post, 2003Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Mickelson & Kubzansky, 2003 sourceNot checked — no full text of the source

May combine two claims.

The impact of suicide and the bereavement outcome among adolescents might be affected by preloss features related to personal and family history of mental health, family life and stressors, suicidal behavior, type of kinship relationship and especially emotional closeness of relationship; and postloss issues such as quality of remaining relationships.

“The review revealed that the impact of suicide and the bereavement outcome among adolescents might be affected by (a) preloss features related to personal and family history of mental health, family life and stressors, suicidal behavior, type of kinship relationship and especially emotional closeness of relationship; and (b) postloss issues such as quality of remaining relationships.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Varying gender distributions and research methods might hinder comparison of results of different studies.

“varying gender distributions and research methods might hinder comparison of results of different studies.”

Probably not a substantial claim: may not pass S3 (load-bearing).

It is not possible to exclude the possibility that the search overlooked some studies germane to the review.

“it is not possible to exclude the possibility that the search overlooked some studies germane to the review.”

May combine two claims.

Adolescents in suicidal families might have had less contact with the suicidal family member (usually a parent), which might serve as a protective factor after the loss.

“adolescents in these families might have had less contact with the suicidal family member (usually a parent), which might serve as a protective factor after the loss (Cerel et al., 2000;Shepherd & Barraclough, 1976).”

• cites Cerel et al., 2000 sourceNot checked — no full text of the source
• cites Shepherd & Barraclough, 1976 sourceNot checked — no full text of the source

May combine two claims.

Closeness and quality of remaining relationships (after the loss) buffer the impact of the loss, whereas social support among friends might have negative effects as well.

“Closeness and quality of remaining relationships (after the loss) buffer the impact of the loss, whereas social support among friends might have negative effects as well.”

Classified as probably not a substantial claim. May combine two claims.

Suicide bereavement does not have to be more severe than other bereavement, and adolescents bereaved through suicide are not predisposed to pathological outcomes.

“The point of view that suicide bereavement does not have to be more severe than other bereavement, and that adolescents bereaved through suicide are not predisposed to pathological outcomes, might help to destigmatize suicide bereavement.”

May combine two claims.

Suicide should not be considered as an isolated event, and its impact should be placed within a broader context.

“This review has demonstrated that suicide should not be considered as an isolated event, and that its impact should be placed within a broader context.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Given the high suicide rates among the elderly, especially elderly males in Western countries, the lack of studies on bereavement after grandparent suicide is surprising.

“Given the high suicide rates among the elderly, especially elderly males in Western countries, the lack of studies on bereavement after grandparent suicide is surprising.”

May combine two claims.

The experience of suicide bereavement in adolescents might feature certain reactions/components (e.g., feelings of rejection, shame, stigma, blaming, guilt, suicidal ideation, anger, and search for explanation) more prominently than in other bereavement; it is, however, not clear how unique these reactions are.

“The experience of suicide bereavement in adolescents might feature certain reactions/components (e.g., feelings of rejection, shame, stigma, blaming, guilt, suicidal ideation, anger, and search for explanation) more prominently than in other bereavement; it is, however, not clear how unique these reactions are.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review was limited to peer-reviewed studies, identified through a systematic search of the literature.

“The review was limited to peer-reviewed studies, identified through a systematic search of the literature.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review did not consider studies regarding exposure to suicide via the media, as this would not entail a personal relationship between the suicidal person and the bereaved adolescent.

“The review did not consider studies regarding exposure to suicide via the media, as this would not entail a personal relationship between the suicidal person and the bereaved adolescent.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Death is a common experience in the lives of young people.

“Death is a common experience in the lives of young people.”