Predictors of Suicidal Thoughts in Children with Autism Spectrum Disorder and Anxiety or Obsessive-Compulsive Disorder: The Unique Contribution of Externalizing Behaviors

Children with autism spectrum disorder (ASD) are at elevated risk of suicidal ideation, particularly those with comorbid anxiety disorders and/or obsessive-compulsive disorder (OCD). We investigated the risk factors associated with suicidal ideation in 166 children with ASD and comorbid anxiety disorders/OCD, and the unique contribution of externalizing behaviors. Suicidal ideation was reported in the child sample by 13% of parents. Controlling for child age, sex, and IQ, perceived loneliness positively predicted the likelihood of suicidal ideation. In addition, externalizing behaviors positively predicted suicidal ideation, controlling for all other factors. Reliance on parental report to detect suicidal ideation in youth with ASD is a limitation of this study. Nonetheless, these findings highlight the importance of assessing and addressing suicidal ideation in children with ASD and comorbid anxiety disorders/OCD, and more importantly in those with elevated externalizing behaviors and perceptions of loneliness.

     

Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University

The objective of this investigation was to examine suicidal ideation and depression in undergraduate college students who participated in the American Foundation for Suicide Prevention-sponsored College Screening Project at Emory University. The principal measure of depressive symptoms was the nine-item depression module from the Patient Health Questionnaire (PHQ-9). Additional questions were focused on current suicidal ideation, past suicide attempts, and episodes of deliberate self-harm and on symptoms of anxiety and distress. Seven hundred and twenty-nine students participated over a 3-school-year interval (2002-2005). Most notably, 11.1% of the students endorsed current (past 4 weeks) suicidal ideation and 16.5% had a lifetime suicide attempt or self-injurious episode. Students with current suicidal ideation had significantly higher depression symptom severity than those without suicidal ideation (t = -9.34, df = 706, P<.0001, d = 1.9), and 28.5% of the students with PHQ-9 scores of 15 or higher reported suicidal ideation compared to 5.7% of those with lower scores (chi(2) = 56.29, df = 1, P<.0001, two-tailed). Suicidal ideation was prominently associated with symptoms of desperation (odds ratio 2.6, 95% CI 1.5-4.6, P<.001). The vast majority of students with moderately severe to severe depression (85%) or current suicidal ideation (84%) were not receiving any psychiatric treatment at the time of assessment. These results suggest that there is a strong relationship between severity of depressive symptoms and suicidal ideation in college students, and that suicidal feelings and actions are relatively common in this group. This underscores the need to provide effective mental health outreach and treatment services to this vulnerable population. As this analysis was based on data collected at a single institution, the results may not be representative of all college students or young adults.     

A Study on Correlation between Anxiety Symptoms and Suicidal Ideation

Objective

In South Korea, the number of deaths from suicide has increased in the last two decades, and suicide has become both a social and political problem. In this study, after controlling the variables influencing suicidal ideation, it was expected that it would be determined if anxiety symptoms are independently related to suicidal ideation.

Methods

Data were obtained from 327 psychiatric outpatients accomplished a self-reported questionnaire that included sociodemographic characteristics and clinical variables as well as self-rating scales for measuring the severity of one''s anxiety, depression, and suicidal ideation. Logistic-regression analyses were used to determine the correlation between anxiety symptoms and significant suicidal ideation, adjusting for covariates.

Results

The patients with significant suicidal ideation were shown to be less educated, unemployed, never married, divorced, or separated by death, or living alone, and were shown to have a lower income, a drinking habit, a higher number of past suicide attempts, and more family members who committed suicide, than the patients without significant suicidal ideation. After adjusting the covariates influencing significant suicidal ideation, anxiety symptoms were associated with significant suicidal ideation. However, after adjusting for depressive symptoms, only the trait anxiety was associated with significant suicidal ideation.

Conclusion

These findings suggest that anxiety symptoms are an independent risk factor for suicidal ideation. Clinicians may thus use anxiety symptoms for the screening examination when evaluating suicidal ideation and risk, and will have to actively evaluate and treat the anxiety symptoms of patients with suicidal tendencies.     

Test of the depression distress amplification model in young adults with elevated risk of current suicidality

Suicide is a leading cause of death among young adults and the rate of suicide has been increasing for decades. A depression distress amplification model posits that young adults with comorbid depression and anxiety have elevated suicide rates due to the intensification of their depressive symptoms by anxiety sensitivity cognitive concerns. The current study tested the effects of anxiety sensitivity subfactors as well as the depression distress amplification model in a very large sample of college students with elevated suicide risk. Participants were 721 college students who were at elevated risk of suicidality (scored>0 on the Beck Scale for Suicide Ideation). Consistent with prior work, anxiety sensitivity cognitive concerns, but not physical or social concerns, were associated with suicidal ideation. Consistent with the depression distress amplification model, in individuals high in depression, anxiety sensitivity cognitive concerns predicted elevated suicidal ideation but not among those with low depression. The results of this study corroborate the role of anxiety sensitivity cognitive concerns and the depression distress amplification model in suicidal ideation among a large potentially high-risk group of college students. The depression distress amplification model suggests a specific mechanism, anxiety sensitivity cognitive concerns, that may be responsible for increased suicide rates among those with comorbid anxiety and depression.     

Panic symptoms and elevated suicidal ideation and behaviors among trauma exposed individuals: Moderating effects of post-traumatic stress disorder

Panic attacks (PAs) are highly prevalent among trauma exposed individuals and have been associated with a number of adverse outcomes. Despite high suicide rates among trauma exposed individuals, research to date has not examined the potential relation between panic symptoms and suicidal ideation and behaviors among this high risk population. The current study tested the association of panic with suicidal ideation and behaviors among a large sample of trauma exposed smokers. Community participants (N = 421) who reported a lifetime history of trauma exposure were assessed concurrently for current panic, suicidal ideation and behaviors, and psychiatric diagnoses. Those who met criteria for a current panic disorder diagnosis were removed from analyses to allow for the assessment of non-PD related panic in line with the recent addition of the PA specifier applicable to all DSM-5 disorders. Findings indicated that panic symptoms were significantly associated with suicidal ideation and behaviors beyond the effects of depression and number of trauma types experienced. Further, post-traumatic stress disorder (PTSD) diagnostic status significantly moderated this relationship, indicating that the relationship between panic and suicidal ideation and behaviors is potentiated among individuals with a current PTSD diagnosis. This investigation suggests that panic symptoms may be a valuable clinical target for the assessment and treatment of suicidal ideation and behaviors among trauma exposed individuals.     

Subthreshold depression in adolescence and mental health outcomes in adulthood

BACKGROUND: There is increasing interest in the extent to which individuals with subthreshold depression face increased risks of subsequent major depression and other disorders. OBJECTIVE: To examine linkages between the extent of depressive symptoms (asymptomatic, subthreshold, major depression) at ages 17 to 18 years and mental health outcomes up to age 25 years in a New Zealand birth cohort. DESIGN: Data were gathered during the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of 1265 New Zealand children (635 males, 630 females). SETTING: General community sample. PARTICIPANTS: The analysis was based on 1006 participants who represented 80% of the original cohort. MAIN OUTCOME MEASURES: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptom criteria for major depression and anxiety disorder, treatment-seeking, suicidal ideation, and suicide attempt. RESULTS: There were significant associations (P<.01) between the extent of depression at ages 17 to 18 years and rates of subsequent depressive symptoms, major depression, treatment for depression, anxiety disorder, treatment for anxiety disorder, suicidal ideation, and suicide attempts. After adjustment for covariate factors, the extent of depression at ages 17 to 18 years remained associated with later depression and suicidal tendencies. Planned comparisons showed that sample members with subthreshold depression had a similar prognosis to those meeting criteria for major depression. CONCLUSIONS: Findings suggest that sample members with subthreshold depression are a group with elevated risks of later depression and suicidal behaviors. Current diagnostic procedures, which classify people with subthreshold depression into complex discrete groups, might obscure the fact that depressive symptoms are dimensional and range from none to severe.     

Time to emergence of severe suicidal ideation among psychiatric patients as a function of suicide attempt history

BACKGROUND: Little is known about the emergence of suicidal ideation among psychiatric inpatients with histories of no, single, or multiple suicide attempts. We investigated differences in time to reemergence of severe suicidal ideation among psychiatric patients as a function of their suicide attempt histories. METHOD: One hundred seventeen individuals meeting criteria for a major depressive disorder who were recently discharged from a psychiatric hospital and participating in a larger study of treatments for depression were included in the current study. Suicidal ideation, depressive symptoms, hopelessness, and depressogenic cognitions were assessed at baseline, and suicidal ideation was assessed at 3-, 6-, 12-, and 18-month follow-up, as well as inpatient readmission if applicable. Time to the reemergence of severe suicidal ideation was analyzed using survival analysis. RESULTS: Twenty-two percent of our sample reported the occurrence of severe suicidal ideation over an 18-month period. Severe suicidal ideation emerged earlier among patients who had a history of prior suicide attempts than those who did not, but single and multiple suicide attempters did not differ significantly in time to severe suicidal ideation. Suicide attempt history remained a significant predictor of time to severe suicidal ideation when statistically controlling for hopelessness, depressive symptoms, depressogenic cognitions, and suicidal ideation at admission and initial treatment group assignment, especially between single attempters and nonattempters. CONCLUSIONS: Although nearly a quarter of participants endorsed severe, clinically significant suicidal ideation within 18 months of discharge, those with suicide attempt histories reported the occurrence of severe suicidal ideation significantly earlier than those without suicide attempt histories.     

Prevalence and Correlates of Suicidal Behaviors among College Students in Northeastern China: a Cross-Sectional Study

The present study aimed to investigate the prevalence and correlates of suicidal behaviors among college students in Jilin Province, China. A cross-sectional survey was conducted in 2016, using a self-reported questionnaire. Convenience sampling method was used to select college students as participants. The analysis was based on a sample of 730 college students. We use multivariate logistic model to determine the risk factors of suicidal behaviors.The prevalence of suicidal ideation, suicidal plan, suicidal attempts were respectively 13.2%, 3.3% and 3.4%. After controlling for the potential confounding factors, history of family psychiatric illness, depression and quality of life were significantly associated with suicidal ideation. Besides, suicidal plan was predicted significantly by not living together with university roommates and depression. In terms of suicidal attempts, not living together with university roommates and history of family psychiatric illness were its risk factors. Comprehensive interventions regarding aims at risk factors may be critical as effective strategies to protect college students from suicide.     

Contributors to suicidality in rural communities: beyond the effects of depression

ABSTRACT: BACKGROUND: Rural populations experience a higher suicide rate than urban areas despite their comparable prevalence of depression. This suggests the identification of additional contributors is necessary to improve our understanding of suicide risk in rural regions. Investigating the independent contribution of depression, and the impact of co-existing psychiatric disorders, to suicidal ideation and suicide attempts in a rural community sample may provide clarification of the role of depression in rural suicidality. METHODS: 618 participants in the Australian Rural Mental Health Study completed the Composite International Diagnostic Interview, providing assessment of lifetime suicidal ideation and attempts, affective disorders, anxiety disorders and substance-use disorders. Logistic regression analyses explored the independent contribution of depression and additional diagnoses to suicidality. A receiver operating characteristic (ROC) analysis was performed to illustrate the benefit of assessing secondary psychiatric diagnoses when determining suicide risk. RESULTS: Diagnostic criteria for lifetime depressive disorder were met by 28% (174) of the sample; 25% (154) had a history of suicidal ideation. Overall, 41% (63) of participants with lifetime suicidal ideation and 34% (16) of participants with a lifetime suicide attempt had no history of depression. When lifetime depression was controlled for, suicidal ideation was predicted by younger age, being currently unmarried, and lifetime anxiety or post-traumatic stress disorder. In addition to depression, suicide attempts were predicted by lifetime anxiety and drug use disorders, as well as younger age; being currently married and employed were significant protective factors. The presence of comorbid depression and PTSD significantly increased the odds of reporting a suicide attempt above either of these conditions independently. CONCLUSIONS: While depression contributes significantly to suicidal ideation, and is a key risk factor for suicide attempts, other clinical and demographic factors played an important role in this rural sample. Consideration of the contribution of factors such as substance use and anxiety disorders to suicidal ideation and behaviours may improve our ability to identify individuals at risk of suicide. Acknowledging the contribution of these factors to rural suicide may also result in more effective approaches for the identification and treatment of at-risk individuals.     

Psychiatric symptoms and their relationship to suicidal ideation in a high-risk adolescent community sample.

OBJECTIVE: The purpose of the current study was to investigate the importance of diagnostic factors in the prediction of adolescent suicidal ideation in a high-risk community sample. METHOD: Seventy-three high school students, aged 14 to 18 years, identified by school personnel as exhibiting emotional disturbance participated in the study. Psychiatric disorders were assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version 5, and suicidal ideation with the Modified Scale for Suicidal Ideation. RESULTS: Seventy-four percent of the sample met criteria for a psychiatric disorder. Continuous measures of psychiatric symptoms provided stronger prediction of suicidal ideation than dichotomous measures. In particular, severity of symptoms associated with mood disorders afforded the strongest prediction of suicidal ideation. Moreover, although significantly related to suicidal ideation at the bivariate level, symptoms associated with disruptive behavior, anxiety, and substance use disorders did not predict suicidal ideation over and above mood disorder symptoms. CONCLUSIONS: Adolescents presenting with emotional disturbance should be carefully screened for depression given the strong relationship between depressive symptoms and suicidal ideation. Furthermore, improved prediction of suicidal ideation may be obtained through the utilization of continuous measures of psychiatric symptoms in suicide research.     

大中学生自杀意念及相关心理变量研究

目的:探讨大中学生自杀意念与相关心理变量的关系。方法:采用分层取样法,对某市初二到硕士研究生一年级828名被试进行自杀意念量表(SSI)等量表测试。结果:①随年龄增长,大中学生自杀意念、企图呈下降趋势。女生自杀意念比男生多,而男生自杀行为能力比女生强;②有无自杀意念者在临床症状、人格因素、应对风格及生活满意度上差异均有统计学意义;③自杀意念与症状自评量表(SCL-90)各分量表、艾森克个性问卷(EPQ)神经质、精神质、应对检查表(COPE)诸多应对风格显著相关。结论:大中学生自杀意念与临床症状、应对方式、人格和生活满意度存在相关。     

Thought and Speech†

Objective: Sense of belonging has demonstrated significant relationships with depression and suicidal thoughts, highlighting its potential utility in refining assessment of suicide risk. Method: Structured clinical interviews and self-report measures were used to assess depression, suicidal behaviors, hopelessness, life stress, social support, and sense of belonging in a sample of 116 depressed psychiatric patients. Results: Lower sense of belonging was significantly associated with greater severity of depression, hopelessness, suicidal ideation, and history of prior suicide attempt(s). However, sense of belonging did not predict suicidal ideation and history of prior suicide attempt(s) beyond the association between suicidal behaviors and established risk factors. Sense of belonging displayed a significant relationship with depression and hopelessness and is likely to play a critical role in both the development of and recovery from depression. Conclusions: Sense of belonging is directly related to depression and hopelessness, while indirectly related to suicidal ideation. Low sense of belonging provides an important target for assessment and intervention in the treatment of depression. Cognitive, behavioral, and interpersonal interventions may help improve an individual’s sense of belonging and decrease symptoms of depression and hopelessness.     

Delusions and suicidality

OBJECTIVE: Delusions have been considered a risk factor for suicidal behavior. To determine whether specific delusion types are related to suicidal behaviors, the authors compared the clinical characteristics of patients with mood disorders and schizophrenia who did and did not have a history of suicide attempts. METHOD: After admission for inpatient or outpatient psychiatric treatment, 429 patients (ages 14-72 years; 47.1% male; and 73.0% Caucasian) were assessed with a structured clinical interview that generated axis I and II diagnoses. In addition, their psychiatric symptoms, history of suicide attempts, and overall functioning were rated. RESULTS: Data for three diagnostic subgroups (223 patients with major depression, 150 with schizophrenia, and 56 with bipolar disorder) were analyzed separately. Multivariate analyses did not find evidence of a relationship between delusions and history of suicidal ideation or suicide attempts in any of the diagnostic groups. CONCLUSIONS: This study did not find evidence that the presence of delusions distinguished persons with or without a history of suicide attempt.     

Suicide ideation and social desirability among school-aged young people

A mixed male-female sample of 950 school-aged adolescents, corresponding to 10% of the young population aged 15-19 living in a rural district of Northeast Italy, was investigated with self-reported questionnaires about the links between social desirability and suicide ideation. On the whole 30.6% of females and 23.9% of males reported suicidal ideation of some degree, with 5% in both genders reporting suicide ideation of a high degree (i.e. quite a lot/extremely often). Those who scored higher at the Marlowe-Crowne Social Desirability Scale (SDS) reported lower levels of psychiatric symptoms on the Symptom checklist 90R (SCL-90R), with the "denial" subscale of the SDS resulting specifically associated to lower scores on SCL-90R items measuring hopelessness, thoughts about death and suicide ideation. The personality traits measured by the Marlowe-Crowne SDS, such as defensiveness, denial and self-deception, might be conceived as a protection against psychiatric disorders and suicide ideation.     

Are children and adolescents who have suicidal thoughts different from those who attempt suicide?

In this study we inquire whether children and adolescents with suicidal ideation can be differentiated from children who attempt suicide on the basis of clinical symptoms or social grounds. From a total of 2181 consecutive outpatient referrals to a child and adolescent psychiatry service, 258 young persons who exhibited suicidal ideation are compared with 82 who had actually attempted suicide. We were unable to differentiate children with suicidal thoughts from those who attempted suicide on the basis of clinical symptoms alone. Both groups had similar high levels of symptoms of depression, anxiety, sleep disorder, and irritability. Conduct disorders were less common in both groups but 22% of the attempters abused illicit drugs or alcohol. Suicide attempts were more likely to be associated with chronic family discord and substance abuse. For boys, the odds of suicidal attempts were substantially increased if the subject had experienced loss. Results are discussed with reference to antecedents that may increase the odds of suicidal attempt and suggestions for future research are outlined.     

Anxiety,Depression and Suicidal Ideation in Lebanese Patients Undergoing Hemodialysis

Anxiety, depression and suicidal thoughts are highly prevalent comorbidities of end-stage-renal-disease (ESRD). There are no studies in Lebanon on the prevalence of these symptoms in Lebanese end-stage-renal-disease patients. Moreover, the association between ESRD on one hand, and anxiety, depression and suicidal ideation on the other has never been established in Lebanon. Groups of patients at a high-risk of development of these symptoms are not determined. The Hospital Anxiety and Depression Score and M.I.N.I (module C) were used to measure the prevalence of anxiety, depression and suicidal ideation in 51 patients from the dialysis center of Hotel-Dieu de France Hospital in Lebanon. In our sample, 45 % of included patients suffered from symptoms of anxiety and 50 % presented symptoms of depression.The prevalence of suicidal ideation as detected by the M.I.N.I. is at 37 %. No patients presented with a high risk of suicide. There was a statistically significant correlation between the existence of organic comorbidities and the presence of symptoms of depression and suicidal ideation. As for anxiety, the association was marginally significant. The results obtained by our study are consistent with those found in studies performed in other societies. The profile of depression- and suicidal ideation-prone patients has been determined. It consists of patients with at least one medical comorbidity to the ESRD. This, in turn, should lead to increased awareness and better treatment of these psychiatric ailments, considering their impact on morbidity and mortality in ESRD.     

A proposed model of the development of suicidal ideations

BackgroundSuicidal ideations may precede suicide attempts. They are of particular concern in psychiatric populations because psychopathology is a major risk factor for suicide. The factors affecting the development of suicide ideations may differ among psychiatric patients with and without a previous suicide attempt and individuals without a psychiatric diagnosis.ObjectivesThe aim of this study is to develop a model of suicide ideation in psychiatric patients and the general population.MethodThe study included 196 participants: 92 psychiatric patients with a previous suicide attempt (“attempters”); 47 psychiatric patients who had never attempted suicide (“non-attempters”); and 57 healthy control subjects. Data were collected on socio-demographic parameters, clinical history, and details of the suicide attempts. Participants completed a battery of psychological instruments assessing aggression–impulsivity, mental pain (including depression and hopelessness) and communication difficulties, in addition to negative life events. Findings were correlated with suicidal ideation by group.ResultsThe correlations of the different variables with suicidal ideation differed between suicide attempters and non-attempters; therefore, the model was analyzed separately for each group. The study yielded three major findings: negative life events had a significant effect on both anger-in and impulsivity in non-attempters but not in attempters; hopelessness moderately contributed to suicidal ideations in attempters but not in non-attempters; loneliness contributed significantly to depression in non-attempters but was less distressing in attempters.ConclusionThe mechanism underlying suicidal ideation appears to differ between psychiatric patients who have previously attempted suicide and those who have not, supporting a dual model of suicidal ideation. Although this is only a preliminary study, these findings are important for furthering our understanding of the process of transition of suicidal thoughts to completion of suicide. These results need further replication with a larger cohort of subjects.     

Suicidal ideation and behaviors among youths in juvenile detention

OBJECTIVE: To examine suicidal ideation, suicide attempts, lethality of suicide attempts, and the relationship between psychiatric disorder and recent attempts in newly detained juveniles. METHOD: The sample included 1,829 juveniles, ages 10 to 18 years, sampled after intake to a detention center in Chicago. Interviewers administered the Diagnostic Interview Schedule for Children to assess for thoughts of death, suicidal ideation, suicide plans, lifetime suicide attempts, number of attempts, age at first attempt, attempts within the past 6 months, method of suicide attempts, and psychiatric disorder. RESULTS: More than one third of juvenile detainees and nearly half of females had felt hopeless or thought about death in the 6 months before detention. Approximately 1 in 10 (10.3%, 95% confidence interval: 7.7%-12.8%) juvenile detainees had thought about committing suicide in the past 6 months, and 1 in 10 (11.0%, 95% confidence interval: 8.3%-13.7%) had ever attempted suicide. Recent suicide attempts were most prevalent in females and youths with major depression and generalized anxiety disorder. CONCLUSIONS: Fewer than half of detainees with recent thoughts of suicide had told anyone about their ideation. Identifying youths at risk for suicide, especially those suffering from depressive and anxiety disorders, is a crucial step in preventing suicide.     

Personality and attempted suicide in depressed adults 50 years of age and older: a facet level analysis

We examined the contribution of personality traits to attempted suicide, the number of suicidal attempts, and suicidal ideation in a sample of depressed inpatients. Personality was assessed via the Revised NEO Personality Inventory (NEO-PI-R). Bivariate analyses showed that suicide attempters were more self-conscious, self-effacing, impulsive, and vulnerable to stress, and less warm, gregarious, and inclined to experience positive emotions. Multivariate regression analyses controlling for age, gender, severity of depression, and psychiatric comorbidity showed that patients with a lifetime history of attempted suicide were less inclined to experience positive emotions and be more self-effacing. Patients with more severe suicidal ideation were less warm and more self-effacing. Results indicated that specific personality traits confer risk for suicidal behaviors in middle age and older adults. Interventions tailored to specific personality profiles in this high-risk group should be developed, and their efficacy examined.