Adolescent sexual orientation and suicide risk: evidence from a national study

OBJECTIVES: Sexual orientation has been a debated risk factor for adolescent suicidality over the past 20 years. This study examined the link between sexual orientation and suicidality, using data that are nationally representative and that include other critical youth suicide risk factors. METHODS: Data from the National Longitudinal Study of Adolescent Health were examined. Survey logistic regression was used to control for sample design effects. RESULTS: There is a strong link between adolescent sexual orientation and suicidal thoughts and behaviors. The strong effect of sexual orientation on suicidal thoughts is mediated by critical youth suicide risk factors, including depression, hopelessness, alcohol abuse, recent suicide attempts by a peer or a family member, and experiences of victimization. CONCLUSIONS: The findings provide strong evidence that sexual minority youths are more likely than their peers to think about and attempt suicide.     

Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment

BACKGROUND: Adolescent school victimization due to lesbian, gay, bisexual, or transgender (LGBT) status is commonplace, and is associated with compromised health and adjustment. Few studies have examined the long‐term implications of LGBT school victimization for young adult adjustment. We examine the association between reports of LGBT school victimization and young adult psychosocial health and risk behavior. METHODS: The young adult survey from the Family Acceptance Project included 245 LGBT young adults between the ages of 21 and 25 years, with an equal proportion of Latino and non‐Latino White respondents. A 10‐item retrospective scale assessed school victimization due to actual or perceived LGBT identity between the ages of 13 and 19 years. Multiple regression was used to test the association between LGBT school victimization and young adult depression, suicidal ideation, life satisfaction, self‐esteem, and social integration, while controlling for background characteristics. Logistic regression was used to examine young adult suicide attempts, clinical levels of depression, heavy drinking and substance use problems, sexually transmitted disease (STD) diagnoses, and self‐reported HIV risk. RESULTS: Lesbian, gay, bisexual, and transgender‐related school victimization is strongly linked to young adult mental health and risk for STDs and HIV; there is no strong association with substance use or abuse. Elevated levels of depression and suicidal ideation among males can be explained by their high rates of LGBT school victimization. CONCLUSIONS: Reducing LGBT‐related school victimization will likely result in significant long‐term health gains and will reduce health disparities for LGBT people. Reducing the dramatic disparities for LGBT youth should be educational and public health priorities.     

Impact of victimization on risk of suicide among lesbian, gay, and bisexual high school students in San Francisco

PurposeThis study investigated the association between sexual orientation, victimization, and suicide risk-related outcomes among youth attending public high schools in San Francisco.MethodsData from the 2009 Youth Risk Behavior Survey were analyzed using bivariate and logistic regression methods for complex samples to examine the relationship between sexual orientation, victimization, and three suicide risk-related outcomes (sadness/depression, suicide planning, and attempting suicide) while controlling for demographics and substance use.ResultsLesbian, gay, or bisexual (LGB) youth reported significantly higher rates of substance use, victimization, and suicide risk-related outcomes than heterosexual youth. However, in the controlled regression models, victimization was a significant predictor of sadness/depression and suicide attempts, regardless of sexual orientation. There was a significant interaction effect between sexual orientation and victimization on suicide planning, with heterosexual youth more affected than LGB youth.ConclusionsResults underscore the deleterious effect of victimization on suicide risk-related outcomes, regardless of sexual orientation. As LGB youth continue to report higher rates of victimization, effective violence prevention approaches must focus on reducing violence among youth, specifically LGB youth. Additional research should focus on identification of other factors that may help further explain elevated suicide risk among LGB youth.     

Examining Gender Differences in Risk Factors for Suicide Attempts Made 1 and 7 Years Later in a Nationally Representative Sample

ObjectivesThis study examined the prospective risk factors for making a nonfatal suicide attempt and whether they varied by gender.MethodsWe used data from the National Longitudinal Study of Adolescent Health. A nationally representative sample of 10,828 youth was assessed over three different time points spanning 7 years. We conducted multivariable logistic regression to examine the main and interactive effects on the odds of making a suicide attempt 1 and 7 years later.ResultsRegardless of an individual's gender, multivariable analyses indicated unique risk factors including suicidal ideation, depressive symptoms, a friend's past history of attempted and completed suicide, and a family member's past history of attempted suicide that were significantly associated with increased odds of suicide attempts made 1 and 7 years later. Parental loss predicted likelihood of suicide attempt 1 year later but not 7 years later. Moderational analyses indicated that gender did not interact with most of the risk factors. However, post hoc probing of two significant interaction terms indicated that young age was a risk factor for making a nonfatal suicide attempt 1 year later for females but not for males, and that females with high somatic symptoms had a greater risk for making a nonfatal suicide attempt as compared with those with low somatic symptoms and with males with low or high somatic symptoms.ConclusionThese results indicate similar risk factors for nonfatal suicide attempts among males and females. However, younger age and somatic symptoms were reported to be risk factors for females but not for males, suggesting the need for targeted interventions with young females with somatic complaints.     

School Practices to Foster LGBT-Supportive Climate: Associations with Adolescent Bullying Involvement

Lesbian, gay, bisexual, and transgender (LGBT) youth experience disproportionate rates of bullying compared to their heterosexual peers. Schools are well-positioned to address these disparities by creating supportive school climates for LGBT youth, but more research is needed to examine the variety of practices and professional development opportunities put in place to this end. The current study examines how school practices to create supportive LGBT student climate relate to student reports of bullying. Student-level data come from the 2013 Minnesota Student Survey, a state-wide survey of risk and protective factors. Ninth and eleventh grade students (N = 31,183) reported on frequency of physical and relational bullying victimization and perpetration and sexual orientation-based harassment. School administrators reported on six practices related to creating supportive LGBT school climate (N = 103 schools): having a point person for LGBT student issues, displaying sexual orientation-specific content, having a gay-straight alliance, discussing bullying based on sexual orientation, and providing professional development around LGBT inclusion and LGBT student issues. An index was created to indicate how many practices each school used (M = 2.45; SD = 1.76). Multilevel logistic regressions indicated that students attending schools with more supportive LGBT climates reported lower odds of relational bullying victimization, physical bullying perpetration, and sexual orientation-based harassment compared to students in schools with less supportive LGBT climates. Sexual orientation did not moderate these relations, indicating that LGBT-supportive practices may be protective for all students, regardless of their sexual orientation. Findings support school-wide efforts to create supportive climates for LGBQ youth as part of a larger bullying prevention strategy.     

Adolescent suicide attempters in Hong Kong and the United States

Using a nested case-control design drawing from a larger sample of 2272 adolescents, this study examined the characteristics of adolescents from Hong Kong (n = 99) and the United States (US) (n = 60), who indicated that they had made a suicide attempt at least once in the past, compared to their equally depressed sex- and age-matched counterparts who had not attempted suicide. The cross-cultural literature suggested three hypotheses which were tested: (a) depressive symptoms would differentiate between suicide attempters compared to non-attempters less in Hong Kong and more in the US; (b) discord in interpersonal relationships would be a more important distinguishing factor in suicide attempts in Hong Kong than in the US and (c) cognitive variables such as hopelessness would be less associated with suicide attempts in Hong Kong compared to the US. There were strong similarities in the two cultures with regard to characteristics that distinguished between attempters and matched controls. Hypotheses regarding cultural differences between attempters in Hong Kong and the US were not supported. Depression, current and lifetime suicide ideation, hopelessness, poor interpersonal relationships and exposure to suicide attempters and completers distinguished attempters from controls equally in the two cultures and in both genders. These findings do not support the proposition that depression is a less relevant variable in suicide attempts in Chinese versus western groups.     

Elevated Prevalence of Suicide Attempts among Victims of Police Violence in the USA

Recent evidence suggests that police victimization is widespread in the USA and psychologically impactful. We hypothesized that civilian-reported police victimization, particularly assaultive victimization (i.e., physical/sexual), would be associated with a greater prevalence of suicide attempts and suicidal ideation. Data were drawn from the Survey of Police-Public Encounters, a population-based survey of adults (N = 1615) residing in four US cities. Surveys assessed lifetime exposure to police victimization based on the World Health Organization domains of violence (i.e., physical, sexual, psychological, and neglect), using the Police Practices Inventory. Logistic regression models tested for associations between police victimization and (1) past 12-month suicide attempts and (2) past 12-month suicidal ideation, adjusted for demographic factors (i.e., gender, sexual orientation, race/ethnicity, income), crime involvement, past intimate partner and sexual victimization exposure, and lifetime mental illness. Police victimization was associated with suicide attempts but not suicidal ideation in adjusted analyses. Specifically, odds of attempts were greatly increased for respondents reporting assaultive forms of victimization, including physical victimization (odds ratio = 4.5), physical victimization with a weapon (odds ratio = 10.7), and sexual victimization (odds ratio = 10.2). Assessing for police victimization and other violence exposures may be a useful component of suicide risk screening in urban US settings. Further, community-based efforts should be made to reduce the prevalence of exposure to police victimization.     

Asian/Pacific Islander adolescent sexual orientation and suicide risk in Guam

OBJECTIVES: We examined the effects of same-sex orientation on suicide risks for Guam's Asian/Pacific Islander adolescents. METHODS: We used a probability sample and logistic regression analysis to identify suicide risk factors. RESULTS: Same-sex orientation was associated with a greater risk of suicide attempt, especially for boys. Adolescents who reported suffering physical abuse in the context of a romantic relationship, engaging in binge drinking, and experiencing feelings of hopelessness were at greater risk for suicidal ideation and attempts. Race/ethnicity was associated with suicide risk for both boys and girls, and patterns suggest that membership in the same racial/ethnic group decreased suicide risk for girls and increased risk of suicide for boys. CONCLUSIONS: Gay, lesbian, and bisexual Asian/Pacific Islander adolescents in Guam deserve intervention and counseling programs to reduce suicide risk.     

A Longitudinal Examination of Risk and Protective Factors for Cigarette Smoking Among Lesbian,Gay, Bisexual,and Transgender Youth

PurposeTo investigate change across development in two smoking outcomes (smoking status and rate), describe demographic differences in smoking, and longitudinally examine the effects of psychosocial variables on smoking (psychological distress, victimization, and social support) in lesbian, gay, bisexual, and transgender (LGBT) youth.MethodsParticipants were 248 ethnically diverse LGBT youth (ages 16–20 years at baseline) from a longitudinal cohort study with six waves over 3.5 years. Baseline questionnaires included demographic variables and a measure of impulsivity, and longitudinal questionnaires included measures of cigarette smoking (status and average number of cigarettes smoked daily), LGBT-based victimization, psychological distress, and perceived social support. Analyses were conducted with hierarchical linear modeling.ResultsMales had higher odds of smoking and smoking rate than females, but females' smoking rate increased more rapidly over time. Psychological distress was associated with higher odds of smoking and smoking rate at the same wave, and it predicted smoking rate at the subsequent wave. LGBT victimization was associated with higher odds of smoking at the same wave and predicted smoking rate at the subsequent wave. Finally, significant other support predicted higher odds of smoking and smoking rate at the subsequent wave, but family support was negatively correlated with smoking rate at the same wave.ConclusionsThere are several viable avenues for the development of smoking prevention interventions for LGBT youth. To optimize the efficacy of prevention strategies, we must consider experiences with victimization, the impact of psychological distress, and optimizing support from families and romantic partners.     

Correlates of suicide attempts in an open cohort of young men who have sex with men

OBJECTIVE: To investigate baseline correlates of attempted suicide in a large cohort of young gay and bisexual men. METHODS: Participants completed annual questionnaires asking demographic information, sexual behaviours, history of forced and paid sex, comfort with sexual orientation, use of illicit drugs, and validated measures of depression, social support, alcohol dependency, self-esteem and suicide ideation and attempts. Contingency table analysis and step-wise logistic regression were used to identify potential predictors of self-reported suicide attempts. RESULTS: Of 345 gay and bisexual men eligible for this cross-sectional analysis, 150 (43.5%) reported that they had ever considered suicide and 67 (19.4%) that they had attempted suicide at least once. After adjustment for multiple explanatory variables, the use of nitrite inhalants (poppers) (AOR = 2.37; 95% CI 1.30, 4.33), social support scores below the 75th percentile of all scores (AOR = 2.19; 95% CI 1.18, 4.09) and low or moderate self-esteem (AOR = 3.73; 95% CI 2.03, 6.86) were independently associated with elevated risk of attempted suicide. CONCLUSION: Our data indicate that men in this analysis who ideate or attempt suicide earlier in life are more likely to report lower social support and self-esteem, and high popper use.     

An Examination of the Validity of Retrospective Measures of Suicide Attempts in Youth

Purpose

This study used prospective data to investigate the validity of a retrospective measure of suicide attempts from four different perspectives.

Methods

Data were retrieved from 883 participants in the Raising Healthy Children project, a longitudinal study of youth recruited from a Pacific Northwest school district. The retrospective measure was collected when participants were 18–19 years of age and results were compared with measures of depressive symptoms collected prospectively.

Results

Results showed strong corroboration between retrospective reports of first suicide attempt and prospective measures of depression, with attempters experiencing significantly more depression than their nonattempting peers, t (df = 853) = 10.26, p < .001. In addition, within the attempter group, depression scores during the year of their reported first attempt were significantly higher than the average depression score across previous years, t (df = 67) = 3.01, p < .01.

Conclusions

Results from this study suggest that the reports of older adolescents regarding their suicide attempts are corroborated by their prospective reports of depression in childhood and earlier adolescence. Thus, there is support that retrospective measures of suicidal behavior, namely suicide attempts, may be a valid method of assessment.     

215例抑郁症患者自杀未遂危险因素的配对病例对照研究

目的了解汉族人群抑郁症患者自杀未遂的环境危险因素、色氨酸羟化酶2(TPH2)基因rs7305115单核苷酸多态性与自杀未遂有无关联。方法采用配对病例对照研究,对215例自杀未遂者(男性92例、女性123例)与相应对照(与病例同性别、年龄相差3岁以内、同地区)进行TPH2 rs7305115基因型测定、自杀行为干预研究量表调查环境因素与抑郁症自杀未遂的关系研究。结果研究组与对照组在TPH2 rs7305115基因型、基因频率的差异有统计学意义(P<0.001);多因素条件logistic回归模型分析显示,绝望、负性生活事件、有自杀家族史,均为抑郁症自杀未遂危险因素,OR值分别为7.68(95%CI:5.79-13.74)、6.64(95%CI:2.48-11.04)、2.98(95%CI:1.17-5.04); TPH2 rs7305115 A/A为抑郁症自杀未遂的保护因素0.33(95%CI:0.22-0.99)。结论绝望、负性生活事件、自杀家族史是抑郁症自杀未遂的危险因素,TPH2 rs7305115 A/A可能是抑郁症自杀行为的保护因素。     

北京50家综合医院门诊患者自杀意念及自杀未遂调查

目的 了解北京市综合医院门诊患者的自杀意念和自杀未遂出现率及其危险因素.方法 采用自制量表对随机抽取的北京市50家各级综合医院2877例门诊患者进行调查,通过logistic分析筛选出其危险因素.结果 自杀意念和自杀未遂终生发生率分别为6.08%和1.18%;多因素分析显示两者的共同危险因素为近一年有绝望感、年纪轻、熟人有过自杀行为、女性.结论 北京市综合医院门诊就诊患者经常有自杀危险、抑郁等心理问题;应培养普通门诊医务人员识别、评估和处理这类问题的技能.     

Repeat suicide attempts in Hong Kong community adolescents

It has been well documented that a history of suicide attempts confers risk for subsequent attempts; however, efforts to explain how variables may change after a previous attempt and in turn relate to future suicide attempts are rare in the literature. This study presents longitudinal data on adolescent suicide attempts in Hong Kong, and examines whether the data support the "crescendo" model to explain repeat suicide attempts. One thousand and ninety-nine community adolescents aged 12-18 years were evaluated at two assessment points 12 months apart (T1 and T2). The study assessed (1) risk factors at T1 for a suicide attempt between T1 and T2, (2) whether a suicide attempt during the 12 months prior to T1 predicted an attempt between the two assessment points, and (3) whether the indicators of distress worsened from T1 to T2 if an attempt had taken place in the interim. The results indicated that: (1) depressive symptoms, substance use, and suicidal ideation measured at T1 were independent predictors of a suicide attempt between T1 and T2; (2) suicide attempt in the year prior to T1 predicted suicide attempt between T1 and T2 after controlling for other predictors; and (3) suicide attempt between T1 and T2 was a predictive factor for a negative change from T1 to T2 in substance use, suicidal ideation, family relationships, depression, anxiety, and life stress. These findings are consistent with the "crescendo" model proposing that the risk of repeat attempts is enhanced following a previous suicide attempt.     

Discrimination and Depressive Symptoms Among Sexual Minority Youth: Is Gay-Affirming Religious Affiliation a Protective Factor?

Researchers have examined perceived discrimination as a risk factor for depression among sexual minorities; however, the role of religion as a protective factor is under-investigated, especially among sexual minority youth. Drawing on a cross-sectional study investigating campus climate at a large public university in the U.S. midwest, we examined the role of affiliation with a gay-affirming denomination (i.e., endorsing same-sex marriage) as a moderating factor in the discrimination–depression relationship among self-identified sexual minority (n = 393) and heterosexual youth (n = 1,727). Using multivariate linear regression analysis, religious affiliation was found to moderate the discrimination–depression relationship among sexual minorities. Specifically, the results indicated that the harmful effects of discrimination among sexual minority youth affiliated with denominations that endorsed same-sex marriage were significantly less than those among peers who affiliated with denominations opposing same-sex marriage or who identified as secular. In contrast, religious affiliation with gay-affirming denominations did not moderate the discrimination–depression relationship among heterosexual participants. The findings suggest that, although religion and same-sex sexuality are often seen as incompatible topics, it is important when working with sexual minority clients for clinicians to assess religious affiliation, as it could be either a risk or a protective factor, depending on the religious group’s stance toward same-sex sexuality. To promote the well-being of sexual minority youth affiliated with denominations opposed to same-sex marriage, the results suggest these faith communities may be encouraged to reconsider their position and/or identify ways to foster youth’s resilience to interpersonal discrimination.     

School Environment and the Mental Health of Sexual Minority Youths: A Study Among Dutch Young Adolescents

Objectives. We examined whether structural elements of the school environment, in particular cultural pluralism and consistency and clarity of school rules and expectations of students, could mitigate the risk for mental health problems among young sexual minority adolescents.Methods. Data were collected in 2008 by means of a computer-based questionnaire completed at school by 513 young Dutch adolescents (12–15 years old) during regular class times. Eleven percent of these students, who were enrolled in 8 different schools, reported having at least some feelings of same-sex attraction.Results. Adolescents with same-sex attractions in schools where rules and expectations were experienced as less consistent and clear reported significantly more mental health problems than their peers with no same-sex attractions in the same schools. Such differences were absent in schools where rules and expectations were experienced as more consistent and clear. There were no such effects of cultural pluralism.Conclusions. Our results suggest that schools with consistent and clear rules and expectations mitigate the risk for mental health problems among students with same-sex attractions and underscore the importance of structural measures for the health of sexual minority youth.Shocking reports appear in the press with some regularity about the bullying of adolescents who are gay or lesbian or who are perceived as such, sometimes resulting in suicide attempts and even actual suicides.^1–3 Such reports draw attention to the role of schools: what can schools do to protect sexual minority youths?Studies conducted in various countries have shown that sexual minority youths are at disproportionate risk for several negative health outcomes, including victimization, witnessing and perpetrating violence, substance use, sexual risk behaviors, and suicide ideation and attempts.^4–9 A recent Dutch study of younger adolescents (13- to 15-year-olds) showed that those experiencing same-sex attractions had significantly higher levels of depression and lower self-esteem than did their peers not experiencing same-sex attractions.¹⁰Sexual minority youths come of age in a society that is often hostile to their interests and needs. Increased health problems in these youths are usually understood as a consequence of discrimination by peers and family. Victimization in high school has been shown to be positively associated with mental health and traumatic stress symptoms in sexual minority youths.¹¹ In a survey of Illinois middle school students, being the target of homophobic verbal harassment was associated with higher levels of anxiety and depression, personal distress, and a lower sense of school belonging among boys and higher levels of withdrawal among girls.¹²Homophobic bullying by classmates can start at an early age, as suggested by the April 2009 suicides of 2 boys, both 11 years old, in Massachusetts and Georgia, each bullied at school for being perceived as gay.^1,2 In a study involving a community-based sample of self-identified lesbian, gay, and bisexual youths (aged 15–19 years) who were interviewed about their lifetime experiences of sexual orientation victimization, the mean ages at which verbal victimization began were 11.4 years for male participants and 14.4 years for female participants.¹³ The corresponding mean ages at which physical victimization began were 13.1 years and 14.2 years.¹³ School was reported as the setting for 72% of first experiences with verbal victimization and 56% of first experiences with physical victimization.¹³A few studies suggest that structural factors may affect how young people feel at school. In one investigation, students who reported having a Gay–Straight Alliance (GSA) at school, knowing where to go for information and support related to sexual orientation and gender identity, and having lesbian, gay, bisexual, and transgender (LGBT) issues included in their school curriculum were more likely to report feeling safe at school than were those who did not have these resources.¹⁴Another study showed that sexual minority students in schools that have a comprehensive harassment policy (i.e., specifying sexual orientation or gender identity and expression) are less frequently verbally harassed and hear fewer homophobic remarks than students in schools with no policy or a policy not specifically inclusive of LGBT people; students reported that school personnel were also more likely to intervene upon hearing homophobic remarks in these schools.¹⁵ Feeling safe at school seems to be a protective factor for sexual minority youths. In one study, feeling safe at school attenuated the association between sexual orientation and suicidal ideation and attempts.¹⁶Further support for the importance of structural factors comes from a cross-sectional study that compared rates of victimization and suicidality among sexual minority adolescents in schools with and without GSAs and other school programs.¹⁷ Using data from the Massachusetts Youth Risk Behavior Survey and controlling for student demographic characteristics and school characteristics, Goodenow et al. showed that sexual minority youths in Massachusetts schools with GSAs were less than half as likely as those in other schools to report dating violence, being threatened or injured at school, or skipping school as a result of fear; in addition, they were less than one third as likely to report multiple suicide attempts in the past year.Goodenow et al. also found that peer support groups other than GSAs, nonacademic counseling, school antibullying policies, a student judiciary, staff training on sexual harassment, and peer tutoring systems were associated with lower rates of victimization and suicidality among sexual minority students. Sexual minority youths from schools where there was a perception that school staff could be approached about a problem were less likely to report multiple suicide attempts, and those from schools where antibullying policies were in place were less likely to report single or multiple suicide attempts.Building on existing knowledge, we explored whether a protective school climate offsets negative health outcomes among young adolescents. In particular, we hypothesized that when schools support cultural pluralism and have consistent and clear rules and expectations, the relationship between same-sex attraction and mental health will be attenuated.     

Exposure to suicide and suicidal behaviors among Hong Kong adolescents

Suicidal behaviors (deliberate self-injury with the intent to hurt or kill oneself) have been little examined outside the West. The aims of this study were to (a) determine the correlates of suicidal behaviors, and (b) examine whether depression and suicide ideation moderated the effects of exposure to completed and attempted suicide on suicidal behaviors among a community sample of Hong Kong youth ages 12-17. Adolescents responded to questions regarding self-injurious behaviors, and also indicated presence of intention to hurt or kill themselves in the past 12 months. Based on their responses, two groups of interest were formed: 96 youths reported both self-injurious behaviors and the intent to hurt or kill themselves, and formed the "suicidal behaviors" group; and, 1213 adolescents reported neither self-injurious behaviors nor intent to hurt self or die, and formed the control group. The participants also responded to questions about depressive symptoms, anxiety, suicidal ideation and attempt, alcohol/drug use, stressful life events, and family relationships. They indicated whether anyone they knew had attempted or completed suicide in the previous 12 months. Logistic regression indicated that depressive symptoms, stressful life events, suicidal ideation and exposure to suicide attempt (but not completed suicide) contributed unique variance to the presence of suicidal behaviors, after controlling for demographic variables. Depression (and at trend levels, suicidal ideation) moderated the effect of exposure to suicide attempt by others on suicidal behaviors. Our results indicate that completed suicide in the social network increases risk for suicidal behaviors, but not when other risk factors are controlled. By contrast, a suicide attempt independently increases risk for suicidal behaviors. Furthermore, those youths who experience depressive symptoms or suicidal ideation are at particularly high risk for engaging in suicidal behaviors when an exposure to suicide attempt occurs.     

北京市某社区医院门诊患者及家属自杀意念及自杀未遂的影响因素分析

目的 了解北京市海淀区某社区医院门诊就诊患者及家属的自杀意念和自杀未遂检出率及其危险因素.方法 2008年6月至9月,采用现况研究及偶遇抽样方法,对在北京市海淀区某社区卫生服务站,使用一般情况调查表、Beck抑郁量表、Beck焦虑量表和Beck无望量表,对前来该社区卫生服务站就诊的患者及家属进行问卷调查,在SPSS 13.0软件的支持下对自杀意念和自杀未遂的影响因素进行单因素Х^2检验和多因素Logistic回归分析.结果 发放问卷3100份,收回有效问卷2791份,问卷有效率为90.0％.调查对象的平均年龄（36.8±13.1）岁,其中男性1074例,女性1717例.近1年内自杀意念和自杀未遂的检出率分别为2.8％（77/2791）和1.1％（30/2791）.不同职业、有无负性生活事件、有无自杀家族史、有无精神疾病家族史、无望程度、抑郁程度和焦虑程度的调查对象在1年内自杀意念检出率方面,差异有统计学意义（Х^2=12.512、53.287、103.922、20.640、77.337、135.918、70.303,P＜0.05）.不同职业、有无精神疾病家族史、无望程度、抑郁程度和焦虑程度的调查对象在1年内自杀未遂检出率方面,差异有统计学意义（Х^2=7.954、6.257、29.838、21.352、10.014,P＜0.05）.多因素分析显示：抑郁（轻度、中度和重度抑郁的OR值分别为2.38、5.55和16.21;95％CI分别为1.07～5.31、2.31～13.37和6.93～37.92）、有自杀家族史（OR=11.68,95％CI：5.03～27.10）、无望（轻度、中度和重度无望的OR值分别为3.65、4.25和5.02;95％CI分别为1.55～8.56、1.70～10.65和1.46～17.26）以及近期有负性生活事件（0R=2.25,95％CI为1.35～4.45）是自杀意念的危险因素.无望（轻度、中度和重度无望的OR值分别为1.09、5.58和7.62;95％CI分别为0.36～3.34、2.03～15.30和1.50～38.72）、抑郁（轻度、中度和重度抑郁的OR值分别为1.08、0.27和3.02;95％CI分别为0.43～2.75、0.03～2.29和1.05～8.75）以及有精神病家族史（OR=3.00,95％CI为1.07～8.46）是自杀未遂的危险因素.结论 无望及抑郁情绪增加自杀的危险;应加强社区人群心理健康管理工作,培养社区医生识别、评估和处理心理危机的技能.     

Transitions in Suicide Risk in a Nationally Representative Sample of Adolescents

PurposeSuicide is the third leading cause of death among older adolescents, and represents a significant public health problem. Preventing suicidal behavior depends on an understanding of the developmental transitions in suicide risk and whether the likelihood of a suicide attempt can be predicted prospectively.MethodsData from the National Longitudinal Study of Adolescent Health were used for the study. The sample is nationally representative, and includes 10,424 youth assessed over three time points spanning 7 years. MPLUS was used to analyze the data.ResultsLatent class analysis showed that youth could be classified into three latent classes representing degree of suicide risk. Indicators of risk included depressive symptoms, hopelessness, suicidal ideation, having a family history of suicidal behavior, and having a friend history of suicidal behavior. Latent transition analyses showed that youth in the low-risk group remained at low risk both 1 and 7 years later. Although some youth who were classified as high-risk transitioned to a lower risk group 7 years later, a significant proportion remained at high risk. Analyses also revealed that the probability of making a suicide attempt was higher for youth in the high-risk latent class 1 and 7 years earlier.ConclusionsFindings indicate that suicide prevention efforts should be targeted primarily at youth at high risk for suicide; most youth classified as “low risk” remained at low risk as they transitioned to young adulthood.