Correlates of suicidal ideation in a community sample of children and adolescents

The correlates of suicidal ideation were studied in a community sample of 210 children and adolescents. Psychopathology of the child by the child's report and by the parent's report was analyzed, as well as analysis of the psychopathology of the parent. Fourteen children [corrected] in this sample reported suicidal ideation. Parents were generally not aware of their children's suicidal ideations. Children who reported suicidal ideation showed significantly more psychopathology than children who did not. The parents of children with suicidal ideation reported that their children had more externalizing but fewer internalizing symptoms than reported by their children. Parents of children who reported suicidal ideations were themselves experiencing a greater intensity of psychological distress. The implications of these results are discussed.     

Smoking and the risk of suicidal behavior: a prospective study of a community sample

BACKGROUND: A link between cigarette smoking and suicidal behavior has been reported in clinical and epidemiological studies. OBJECTIVE: To examine the association between smoking and suicidal thoughts or attempt in a longitudinal study, in which proximate status of smoking and psychiatric disorders in relation to timing of suicidal behaviors is taken into account. DESIGN: A longitudinal study of young adults interviewed initially in 1989, with repeated assessments over a 10-year follow-up. SETTING AND PARTICIPANTS: The sample was selected from a large health maintenance organization representing the geographic area, except for the extremes of the socioeconomic range. The response rate at each follow-up (3, 5, and 10 years after baseline) exceeded 91%. MAIN OUTCOME MEASURES: Relative risk of occurrence of suicidal behaviors during follow-up intervals by status of smoking and psychiatric disorders at the start of the interval, estimated by generalized estimating equations with repeated measures. The National Institute of Mental Health Diagnostic Interview Schedule was used at baseline and at each reassessment. RESULTS: Current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt, independent of prior depression and substance use disorders (adjusted odds ratio, 1.82; 95% confidence interval, 1.22-2.69). Additionally, current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt, adjusting for suicidal predisposition, indicated by prior suicidality, and controlling for prior psychiatric disorders (adjusted odds ratio, 1.74; 95% confidence interval, 1.17-2.54). CONCLUSIONS: The biological explanation of the finding that current smoking is associated with subsequent suicidal behavior is unclear. Recent observations of lower monoamine oxidase activity (which may play a role in central nervous system serotonin metabolism) in current smokers but not ex-smokers might provide clues, but interpretations should proceed cautiously.     

Risk behavior in a community sample of children and adolescents

OBJECTIVES: First, to investigate whether there is covariation between risk behaviors, including suicidality, in a community probability sample of children and adolescents; and second, to investigate whether risk behavior is associated with selected potential correlates. METHOD: A sample of 9- to 17-year-old youths (N = 1,285) and their caretakers were interviewed in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. The risk behaviors were marijuana smoking, alcohol use, intercourse, fighting, cigarette smoking, and suicidal ideation/attempts. Relationships between the risk behaviors were described using odds ratios. Linear regression analyses of an index of risk behavior on the selected potential correlates of risk behavior were conducted. RESULTS: There were significant relationships between all pairs of risk behaviors. The score on the index of risk behavior was associated with stressors, lack of resources, family psychiatric disorder, psychopathology, and functional impairment. CONCLUSIONS: Clinicians should be alerted to the possibility of risk behaviors, especially in children and adolescents engaging in other risk behaviors and those with inadequate resources, stressors, functional impairment, or psychopathology.     

Conduct disordered adolescents from a community sample

This study reports on a group of adolescents with conduct disorder in a community sample. Utilizing structured interviews for the adolescents and their parents, and strict requirements for caseness, conduct disorder was found to be the most common psychiatric problem (along with anxiety disorders). Various instruments were used. The findings, including approaches to conflict resolution in adolescents and their parents, are discussed.     

Sexual abuse, antisocial behaviour and substance use: gender differences in young community adolescents

OBJECTIVE: To investigate gender-specific relationships between self-reported sexual abuse, antisocial behaviour and substance use in a large community sample of adolescents. METHOD: A cross-sectional study of students aged, on average, 13 (n = 2596), 14 (n = 2475) and 15 years (n = 2290), from 27 schools in South Australia with a questionnaire including sexual abuse, frequency and severity of substance use, depressive symptomatology (CES-D), family functioning (McMaster Family Assessment Device), and antisocial behaviour (an adapted 22-item Self-Report Delinquency Scale). Logistic regression analyses using HLM V5.05 with a population-average model were conducted. RESULTS: In the model considered, reported sexual abuse is significantly independently associated with antisocial behaviour, controlling for confounding factors of depressive symptomatology and family dysfunction, with increased risks of three- to eightfold for sexually abused boys, and two- to threefold for sexually abused girls, compared to nonabused. Increased risks of extreme substance use in sexually abused girls (age 13) and boys (ages 13-15) are more than fourfold, compared to nonabused. Age differences were not statistically significant. CONCLUSION: Childhood sexual abuse is a risk factor for the development of antisocial behaviour and substance use in young adolescents. Clinicians should be aware of gender differences.     

Financial loss and suicidal ideation in a rural community sample

OBJECTIVE: To examine the prevalence and correlates of suicidal ideation in a community-based rural sample. METHOD: The sample was a random sample of people living in a single county in Iowa. Participants aged 18 or older (n=1617) were asked about suicidal ideation in the past year as well as mood, alcohol use, social support, and stressful life events. RESULTS: About 8.2% of the sample reported suicidal ideation. Depressive symptoms, problems resulting from alcohol use, infrequent social contact and financial loss characterized the suicidal group. CONCLUSION: Depressive symptoms were the strongest correlate of suicidal ideation in this rural sample. In the multivariate analysis, financial loss rather than low income remained a significant correlate of suicidal ideation after controlling for depression. This suggests that change in financial status rather than chronic poverty poses a risk for suicidal ideation.     

Depressive symptoms and suicidal behavior in adolescents

Depressive symptoms and suicidal behavior in 64 adolescent psychiatric patients were assessed by a structured interview and the Schedule for Affective Disorders and Schizophrenia. The medical seriousness of suicidal behavior was associated with conscious intent to die and with the number of previous nonlethal suicide attempts. Suicidal behavior was associated with depressed mood, negative self-evaluation, anhedonia, insomnia, poor concentration, indecisiveness, lack of reactivity of mood, psychomotor disturbance, and alcohol and drug abuse. The results suggest that adolescents can be reliable reporters of their suicide potential and that clinicians need to be sensitive to symptoms of major depressive disorder in assessing potentially suicidal adolescents.     

Serum tryptophan ratio and suicidal behavior in adolescents: a prospective study

A lower ratio of tryptophan to other amino acids in serum (tryptophan ratio), established as an index of serotonin precursor available to the brain, has been shown to be associated with increased suicidal behavior in cross-sectional studies. The purpose of this study was to conduct the first prospective examination of the utility of the tryptophan ratio along with clinical variables in predicting suicidal behavior in high-risk and reference adolescents. Adolescents with alcohol use disorders (AUDs) and prior suicidal attempts (n=20), adolescents with AUDs without suicide attempts (n=20), and community controls with neither of these characteristics (n=20) were matched on demographic variables. These groups were not significantly different on the tryptophan ratio at baseline. Of 56 subjects who completed follow-up assessments, six had suicidal behavior in the follow-up period. The tryptophan ratio, along with demographic and clinical variables, was examined using Cox regression with a backward stepwise variable elimination procedure. In the final model, the tryptophan ratio and major depressive disorder both significantly contributed to the prediction of suicidal behavior. This finding suggests that the tryptophan ratio may improve the identification of adolescents at high risk for suicidal behavior.     

Comparative study of the prevalence of suicidal behavior and sexual abuse history in delinquent and non-delinquent adolescents

The present study examined the prevalence of suicidal behavior and sexual abuse history in delinquent and non-delinquent adolescents aged 15–17 years. Results showed that delinquent adolescents, particularly girls, more frequently reported histories of suicidal behavior and sexual abuse than non-delinquent adolescents.     

Psychiatric disorders in a community sample of adolescents

The prevalence of psychiatric disorders diagnosed according to DSM-III in adolescents in the general population is not known. The authors address this issue in a community sample of 150 adolescents 14-16 years of age. Structured interviews as well as other instruments were used to collect data. Twenty-eight (18.7%) of the 150 adolescents were identified as having a psychiatric disorder. These 28 adolescents viewed their parents as less caring, had lower self-esteem, and resolved their conflicts through verbal aggression and physical violence more often than did the adolescents who did not have a psychiatric disorder. The authors make recommendations regarding the use of structured interviews in future research.     

DSM-III disorders in a large sample of adolescents

The prevalence of DSM-III disorders was studied in 943 adolescents aged 15 years from a general population. Prevalence rates of disorder of 25.9% for girls and 18.2% for boys were found. The most prevalent disorders were overanxious disorder, nonaggressive conduct disorder, and simple phobia. Marked differences were noted among the disorders in terms of associated social competence, with multiple disorders and primarily "externalizing" disorders being related to poorer competence. A model of parental confirmation of disorder was developed suggesting that confirmation was more likely where the mother was depressed, the family low in social support, and the adolescent less socially competent.     

Psychopathology in a community sample of children and adolescents: a developmental perspective

Psychiatric disorders, symptom clusters and adjustment problems in a community based sample comprised three age cohorts: 8, 12, and 17 years. The data indicated that anxiety symptoms decreased with age. Conduct problems increased with age for males, affective problems increased with age for females, and substance use and social anxiety increased with age for both sexes. Concerns about inadequacy also increases with age, but only for females. These gender-based developmental differences in psychopathology and other findings are discussed.     

Childhood abuse and lifetime psychopathology in a community sample.

OBJECTIVE: The authors assessed lifetime psychopathology in a general population sample and compared the rates of five psychiatric disorder categories between those who reported a childhood history of either physical or sexual abuse and those who did not. METHOD: A modified version of the Composite International Diagnostic Interview and a self-completed questionnaire on child abuse were administered to a probability sample (N=7,016) of Ontario residents 15 to 64 years of age. RESULTS: Those reporting a history of childhood physical abuse had significantly higher lifetime rates of anxiety disorders, alcohol abuse/dependence, and antisocial behavior and were more likely to have one or more disorders than were those without such a history. Women, but not men, with a history of physical abuse had significantly higher lifetime rates of major depression and illicit drug abuse/dependence than did women with no such history. A history of childhood sexual abuse was also associated with higher rates of all disorders considered in women. In men, the prevalence of disorders tended to be higher among those who reported exposure to sexual abuse, but only the associations with alcohol abuse/dependence and the category of one or more disorders reached statistical significance. The relationship between a childhood history of physical abuse and lifetime psychopathology varied significantly by gender for all categories except for anxiety disorders. Although not statistically significant, a similar relationship was seen between childhood history of sexual abuse and lifetime psychopathology. CONCLUSIONS: A history of abuse in childhood increases the likelihood of lifetime psychopathology; this association appears stronger for women than men.     

Assessment of psychiatrically hospitalized suicidal adolescents: self-report instruments as predictors of suicidal thoughts and behavior

OBJECTIVE: The validity and clinical utility of the Reynolds Adolescent Depression Scale, Beck Hopelessness Scale, Suicidal Ideation Questionnaire-Junior, and Suicide Probability Scale (SPS) were examined longitudinally among suicidal adolescents. METHOD: Between 1998 and 2000, 289 psychiatrically hospitalized, suicidal youth, ages 12 to 17 years, participated in this study. Self-report measures were completed at baseline. Clinician-rated suicidality and suicide attempt were collected at baseline and 6-month follow-up. RESULTS: Baseline self-reports were internally consistent and strongly intercorrelated within male, female, white, and black subsamples. All of the measures predicted follow-up suicidality and suicide attempts. Using published cutoff scores, the Beck Hopelessness Scale and SPS were moderately to highly sensitive predictors of subsequent suicide attempts, as was the Suicidal Ideation Questionnaire-Junior for predicting suicide attempts and broad suicidality. Alternative cutoff scores that predicted outcomes with moderate and high sensitivity also were examined, with attention to resultant sacrifices in specificity. CONCLUSIONS: Baseline self-report scores predicted follow-up suicidality. SPS contributed uniquely to prediction of future suicidality and suicide attempt. SPS may supplement other sources of information when assessing suicide risk with this population.     

Sexual assault and psychiatric disorders among a community sample of women

The authors examined the relationships between sexual assault and psychiatric disorders in a sample of 1,157 women 18-64 years old in the North Carolina site of the NIMH Epidemiologic Catchment Area Program. The results suggest that sexual assault is a risk factor for a number of psychiatric disorders. In addition, several characteristics of the assault among sexual assault victims were significantly related to one or more psychiatric disorders. However, there was no clear pattern relating characteristics of the assault to the risk of specific psychiatric disorders.