Can adolescent suicide attempters be distinguished from at-risk adolescents?

Psychiatric disorders, psychosocial dysfunction, family pathology, and environmental stressors are thought to be risk factors for adolescent suicide attempts. Variables from each of these categories were examined, by means of a structured interview and questionnaires, to determine whether a group of 21 adolescent suicide attempters could be differentiated from a group of 34 normal control subjects and a group of 15 at-risk adolescents (teenagers with known risk factors but without recent suicide attempt). The attempters differed significantly from control subjects on a large number of variables, particularly in the areas of substance abuse, depression, self-image, interpersonal relationships, communication patterns, family support, and problem behaviors. Only three items--the Beck Hopelessness Scale score, the SCL-90-R Positive Symptom Distress Index, and a history of suicidal ideation--differentiated the attempters from the at-risk adolescents. A discriminant analysis revealed that hopelessness and suicidal ideation were able to identify 93% of the suicide attempters.     

Pathways from adolescent deliberate self-poisoning to early adult outcomes: a six-year follow-up

Background: Prospective studies show that the adult outcomes of adolescents who deliberately harm themselves are marked by high rates of adversity and psychiatric disorders. The goal of this study was to identify pathways linking childhood risk factors to early adult outcomes of suicidal adolescents. Methods: A clinical sample of 158 adolescents who deliberately poisoned themselves was followed up six years later. Eighty per cent of the cohort (n = 126) were interviewed in early adulthood using a battery of standardised measures of psychopathology and social functioning. Results: Multivariate mediation path analysis identified four pathways linking child and adolescent risk factors to adverse outcomes in early adulthood. Family dysfunction, conduct disorder and hopelessness contributed to the risk of high adversity in early adulthood indirectly through its effect on other risk domains, including dropping out of school and adopting adult roles at a younger age. Hopelessness not only predicted dropping out of school but also independently contributed to the risk of chronic major depressive disorder in early adulthood. Child sexual abuse independently predicted high adversity and chronic major depression over and above the influence of hopelessness. Juvenile onset major depression independently predicted chronic major depression in early adulthood. A substantial proportion of the effects of child sexual abuse and hopelessness on the risk of deliberate self‐harm in early adulthood was mediated by high adversity and the duration of major depression. However, chronic major depression was the only risk factor independently associated with deliberate self‐harm in adulthood once correlation with adversity was taken into account. Conclusions: Chronic major depressive disorder is central to deliberate self‐harm repetition. However, adult outcomes of suicidal adolescents are also dominated by the accumulating effects and consequences of other childhood risk factors, including child sexual abuse and adolescent hopelessness.     

Testing Longitudinal Relationships between Internet Addiction and Well-Being in Hong Kong Adolescents: Cross-Lagged Analyses Based on three Waves of Data

Using a panel design, this study examined the prospective relationships between Internet addiction and life satisfaction as well as hopelessness in a representative sample of Hong Kong adolescents. Starting from 2009/10 academic year, 3328 Secondary 1 students in 28 secondary schools in Hong Kong participated in this longitudinal study (Mean age = 12.59 years; SD = 0.74 years). All participants responded to a questionnaire that includes the Internet Addiction Test, Life Satisfaction Scale, and Hopelessness Scale on a yearly basis. Cross-lagged analyses based on three waves of data collected during three junior adolescent years showed that Internet addiction measured at Time 1 predicted poor life satisfaction and hopelessness at Time 2, but not vice versa. Similarly, Internet addiction at Time 2 predicted low life satisfaction at Time 3, and the cross-lagged effects of life satisfaction and hopelessness on Internet addiction from Time 2 to Time 3 remained non-significant. The findings support the thesis that poor personal well-being in adolescents is the consequence rather than the cause of Internet addictive behaviors. To improve quality of life and prevent suicidality in adolescents, strategies that help reduce addictive behaviors related to the Internet should be considered.     

Disordered eating attitudes and behaviours among adolescents in Hong Kong: prevalence and correlates

AIMS: To study the prevalence of disordered eating attitudes and behaviours among adolescents in Hong Kong and to examine the socio-demographic and behavioural correlates. METHODS: Three secondary schools with different academic performance were selected from the Eastern District of Hong Kong. A total of 2382 students enrolled in Forms 1-7 at the three schools completed a specially designed questionnaire. The questionnaire contained questions on socio-demographic information, body weight satisfaction, exposure to mass media, health behaviours as well as the Eating Attitudes Test - 26 (EAT-26). Data were analysed using Student's t-test, chi2 analysis and multivariate logistic regression models. RESULTS: Disordered eating (EAT score > or =20) was present in 52 (3.9%) adolescent boys and 68 (6.5%) adolescent girls. The youngest case was only 11 years old. A high degree of body weight dissatisfaction was shared by our adolescents. Teenage girls, overweight youths and those with poor academic performance were at increased risk of having disordered eating. Strong associations were found between disordered eating and other health-compromising behaviours including smoking, alcohol and soft drug use, delinquent behaviours, suicidal ideation and self-harm behaviours. Exposure to entertainment, beauty and youth magazines was positively related to disordered eating. CONCLUSIONS: Disordered eating is prevalent among adolescents in Hong Kong. It remains a significant public health challenge to our community. Prevention programmes targeting youths at the greatest risk should be considered.     

Factors distinguishing youth who report self-injurious behavior: a population-based sample

ObjectiveTo identify factors distinguishing adolescents across 3 groups: no self-harm, nonsuicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA).MethodsData were from the 2007 Minnesota Student Survey. The sample included 61,330 students in grades 9 and 12. Logistic regression analysis determined factors that best distinguished adolescents who reported NSSI from those who reported no self-harm, and adolescents who reported NSSI + SA. Final models were developed over 3 stages of analysis that tested the importance of variables within risk factor, protective factor, and co-occurring health-risk behavior domains.ResultsFor male and female subjects, factors that consistently distinguished youth who reported NSSI from those who reported no self-harm included depressive symptoms, hopelessness, physical abuse, less parent connectedness, running away from home, and maladaptive dieting behavior. Factors that distinguished the NSSI + SA group from the NSSI only group for both sexes were a mental health problem, depressive symptoms, hopelessness, physical abuse, and running away from home. Other factors, such as sexual abuse, were significant in models for males or females only. Hopelessness constituted the leading factor to increase the likelihood that youth who self-injured also attempted suicide.ConclusionsYouth engaging in NSSI experience diverse psychosocial stressors and significant distress. Clinicians and school personnel are well-positioned to offer support to these youth. Furthermore, they can help address NSSI among youth by identifying those who self-injure early, assessing for hopelessness and suicidality, facilitating connections to prosocial adults, addressing maladaptive dieting behavior, and supporting runaway youth.     

Effects of Objective and Subjective Socioeconomic Status on Self-Rated Health, Depressive Symptoms, and Suicidal Ideation in Adolescents

The purpose of this study was to identify relationships between three indicators of socioeconomic status (SES)—parental education, Family Affluence Scale (FAS), and subjective household economic status—and adolescent health (self-rated health, depressive symptoms, and suicidal ideation). Data from 69,196 students from 800 middle and high schools were analyzed. Relationships between the three SES indicators and adolescent health were examined using the chi-square test, and logistic regression analysis was then performed after adjusting for covariates. Female students whose parents had less education were more likely to report poor health than were those whose parents had a higher education. Low FAS scores were associated with higher odds ratios for poor self-rated health but not for depressive symptoms or suicidal ideation. In the logistic regression analysis, lower subjective household economic status significantly predicted poor self-rated health, higher levels of depressive symptoms, and more suicidal ideation. The findings suggest that subjective household economic status, rather than objective SES measures, is associated with adolescent health. Thus, future research about adolescent health should consider multiple dimensions of subjective social status of adolescents.     

Where do youth learn about suicides on the Internet,and what influence does this have on suicidal ideation?

Background: Young people are susceptible to suicidal behavior as a result of learning about the suicidal behavior of others. This study was designed to determine whether Internet sites, such as online news and social networking websites, expose young people to suicide stories that might increase suicide ideation. Method: We reinterviewed 719 young people ages 14 to 24 who had participated in a prior nationally representative survey. Respondents reported knowledge of persons they knew who had committed or attempted suicide as well as personal experiences of hopelessness and suicidal ideation on both occasions. On the second occasion one year later, they also reported use of various Internet platforms and how often they had been exposed to suicide stories on those sites, as well as from personal sources. Changes in ideation as a function of exposure to different sources of suicide stories were analyzed holding constant prior hopelessness and ideation. Results: While traditional sources of information about suicide were most often cited (79% were from friends and family or newspapers), online sources were also quite common (59%). Social networking sites were frequently cited as sources, but these reports were not linked to increases in ideation. However, online discussion forums were both cited as sources and associated with increases in ideation. Conclusions: The Internet and especially social networking sites are important sources of suicide stories. However, discussion forums appear to be particularly associated with increases in suicidal ideation. Greater efforts should be undertaken to promote Internet sites directed to young people that enhance effective coping with hopelessness and suicidal ideation.     

Associations of weight-based teasing and emotional well-being among adolescents

BACKGROUND: Verbal harassment, such as bullying and hate speech, has received considerable attention recently, but less is known about weight-based teasing and its potential harmful effects on young people's psychosocial well-being. OBJECTIVE: To determine the associations of weight-based teasing and body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts using a large sample of adolescents. DESIGN: Secondary analysis of survey and anthropometric data. SETTING: Ethnically and socioeconomically diverse communities in the urban and suburban school districts of the Minneapolis/St Paul metropolitan area. PARTICIPANTS: A school-based sample of 4746 adolescents in grades 7 to 12 at 31 public middle schools and high schools. MAIN OUTCOME MEASURES: Weight-based teasing from peers or family members, body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts. RESULTS: Of the eligible students, 81.5% participated; 30.0% of adolescent girls and 24.7% of adolescent boys were teased by peers, and 28.7% of adolescent girls and 16.1% of adolescent boys were teased by family members. Approximately 14.6% of adolescent girls and 9.6% of adolescent boys reported teasing from both of these sources. Teasing about body weight was consistently associated with low body satisfaction, low self-esteem, high depressive symptoms, and thinking about and attempting suicide, even after controlling for actual body weight. These associations held for adolescent boys and girls, across racial, ethnic, and weight groups. Furthermore, teasing from 2 sources was associated with a higher prevalence of emotional health problems than either teasing from a single source or no teasing. CONCLUSIONS: Physicians and other health care providers should recognize the importance of weight-based teasing for young patients. Policy, programs, and education should focus on increasing awareness of what constitutes weight-based teasing, its potentially harmful effects on adolescents' emotional well-being, and reduction of this behavior.     

Identifying Suicide Risk in Adolescents With Firearm Access: Screening in the Emergency Department

ObjectiveThis study compares current suicidal ideation, prior suicide attempt and associated self-reported risk factors in adolescents with and without access to firearms.MethodsUsing data from a clinically applied behavioral health assessment completed by adolescents presenting to a tertiary children's hospital emergency department (ED; N = 15,806), we evaluated the association between firearm access (ie, firearm in the home or ability to obtain one within 24 hours), each of the included suicide risk factors (ie, depressive symptoms, trauma victimization, bullying victimization), and our primary outcomes (ie, current suicidal ideation and prior suicide attempt). We performed regression analyses on 3 groups: 1) The overall population; 2) Only the participants with firearm access; and 3) Only the participants without firearm access.ResultsFourteen percent (2179/15,806) of the sample reported a firearm in the home or ability to access one within 24 hours. Overall, 6.8% of participants reported current suicidal ideation and 9.1% reported prior suicide attempt. Youth with firearm access had 1.52 times higher odds of current suicidal ideation and 1.61 times higher odds of prior suicide attempt compared to youth without firearm access. All included suicide risk factors were found to significantly increase the odds of current suicidal ideation and prior suicide attempt in the overall sample; this increase was similar in the groups with and without firearm access.ConclusionsAdolescents with firearm access have higher odds of suicidal ideation and prior attempt compared to those without firearm access, highlighting the need for universal ED-based screening for suicidality and lethal means.     

The Role of Emotional Competence in the Association Between Optimism and Depression Among Chinese Adolescents

Positive psychology is the scientific study of positive emotions, positive thoughts and positive behaviors that serve as protective factors to help people bounce back and recover from stress. Fredrickson’s broaden and build model postulates that positive emotions catalyze upward spirals toward future well-being by broadening people’s positive thoughts and behaviors. This study investigated direct and interactional effects of emotional competence and dispositional optimism on depressive symptoms among a sample of secondary school students in Hong Kong, China. A cross sectional survey design was adopted, and data was collected from 513 adolescents (197 males, 316 females, mean age=13.80) from four secondary schools. Results showed that dispositional optimism and emotional competence were significantly and negatively associated with depressive symptoms. In addition, emotional competence enhanced the protective effects of dispositional optimism on depressive symptoms. Therefore, despite their culture-specific meanings in the Chinese context, dispositional optimism and emotional competence were found to independently and jointly protect Chinese adolescents to offset depression, which lends empirical support to the cross-cultural validity of the two positive psychological constructs and the Broaden and Build model of positive emotions. This study sheds light on promoting a positive psychology model that includes both cognitive and emotional positive psychological factors for depression prevention or early intervention.     

Effectiveness of Cognitive-Behavioral Therapy in Decreasing Suicidal Ideation and Hopelessness of the Adolescents with Previous Suicidal Attempts

Objective

To evaluate the effectiveness of a Cognitive-Behavioral therapy (CBT) for suicide prevention in decreasing suicidal ideation and hopelessness in a sample of depressed 12 to 18 year-old adolescents who had at least one previous suicidal attempt.

Methods

In a clinical trial, 30 depressed adolescents who attempted suicide in the recent 3 months were selected using simple sampling method and divided randomly into intervention and wait-list control groups. Both groups received psychiatric interventions as routine. The intervention group received a 12 session (once a week) of CBT program according to the package developed by Stanley et al, including psychoeducational interventions and individual and family skills training modules. All of the patients were evaluated by Scale for Suicidal Ideation, Beck''s hopelessness Inventory, and Beck''s Depression Inventory before the intervention and after 12 weeks.

Findings

There were significant differences between the two groups regarding the scores of the above mentioned scales after 12 weeks. Fifty-four to 77 percent decreases in the mean scores of the used scales were observed in the invention group. There were no significant changes in the scores of the control wait-list group. The differences between pre- and post-intervention scores in the intervention group were significant.

Conclusion

CBT is an effective method in reducing suicidal ideation and hopelessness in the depressed adolescents with previous suicidal attempts.     

Suicidal behaviors in adolescents

Objective. Suicidal ideation and suicide attempt are generally considered as non-fatal suicidal behaviors (NFSB) by most researchers. Across different cultures, the prevalence of NFSB has been found to be alarmingly high among adolescents. As there is no published study estimating prevalence rates in India, we conducted a study on adolescents in Delhi to find prevalence of NFSB and other related behaviors and to identify risk factors for NFSB.Methods: We collected data from 1205 adolescents in the age group from 12 to 19 years from 2 schools through semi-structured questionnaire on demographic variables, NFSB, death wish, deliberate self harm (DSH), Adjustment Inventory for School Students (AISS) by Sinha et al. & BDI.Results: Prevalence of suicidal ideation (lifetime), suicidal ideation (last year), suicide attempt (lifetime), suicide attempt (last year) were 21.7%, 11.7%, 8% and 3.5%, respectively. All the significant variables were entered into a logistic regression analysis model, and the adjusted odds ratios, with 95% confidence intervals, were obtained for them. Hindu religion, female sex, older adolescent, physical abuse by parents, feeling neglected by parents, history of running away from school, history of suicide by a friend, death wish and DSH were found to be significant risk factors for NFSB.Conclusions: There is high prevalence of suicidal ideation, suicide attempt, death wish and deliberate self-harm in adolescent population of two schools in Delhi. Clinical implications of these findings are discussed.     

Suicidal ideation among urban nine and ten year olds

Little is known about rates and correlates of suicidal ideation among nonclinical samples of preadolescents from low-income urban backgrounds. Using the Children's Depression Inventory, we measured suicidal ideation in 131 preadolescent urban children (49% female, 90% African American/Caribbean) participating in an ongoing prospective longitudinal study of prenatal cocaine exposure and children's outcome. Suicidal ideation was reported by 14.5% of the children in this sample at 9 to 10 years of age. Children's reports of depressive symptoms, exposure to violence, and distress symptoms in response to witnessing violence were associated with suicidal ideation, but prenatal cocaine exposure, parent-rated child behavior, and caregivers' psychological distress symptoms were not. Suicidal ideation may be more prevalent among preadolescents from urban, low-income backgrounds than clinicians suspect, particularly among children exposed to violence.     

Suicidal ideation among 8-year-olds who are maltreated and at risk: findings from the LONGSCAN studies

Suicidal ideation was examined among 1,051 8-year-old children identified as maltreated or at risk for maltreatment. Of these children, 9.9% reported suicidal ideation. Many variables, including maltreatment, had bivariate associations with suicidal ideation. Severity of physical abuse, chronicity of maltreatment, and the presence of multiple types of maltreatment strongly predicted suicidal ideation. In multivariate analyses of the domains of proximity, only ethnic background remained significant among demographic variables, only witnessed violence and maltreatment remained significant among family or contextual variables, and only child psychological distress, substance use, and poor social problem solving remained significant among child variables. The effects of ethnicity, maltreatment, and witnessed violence on suicidal ideation were mediated by child functioning. There were few interactions between maltreatment and other factors to predict suicidal ideation. Children who are maltreated and those exposed to community and domestic violence are at increased risk of suicidal ideation, even by age 8.     

Consequences and correlates of adolescent depression

OBJECTIVE: To examine the correlates and consequences of high levels of depressive symptoms among adolescents. DESIGN: Secondary analysis of the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, a survey of a nationally representative sample of 4648 adolescent boys and girls between the ages of 10 and 18 years, inclusive, conducted in school settings. The self-administered questionnaire contains a screening instrument for depression based on the Children's Depression Inventory. OUTCOME: Days of school missed, performance at grade level, alcohol use, drug use, smoking, and bingeing. RESULTS: After controlling for sociodemographics, life events, sexual abuse, physical abuse, and exposure to violence, relative to other children, children and adolescents with high degrees of depressive symptoms missed about 1 day more of school in the month preceding the survey (P<.05) and had higher odds of smoking (odds ratio, 1.84; P<.001), bingeing (odds ratio, 2.02; P<.001), and suicidal ideation (odds ratio, 16.59; P<.001). CONCLUSION: High levels of depressive symptoms are correlated with serious and significant consequences, even after controlling for life circumstances.     

青少年自杀意念与家庭环境和心理弹性之间的关联研究

目的 探讨青少年自杀意念与家庭环境因素和心理弹性之间的关系。方法 采用整群抽样法,于2014年12月对河南省新乡市3 230名初高中生进行一般社会资料问卷及Kutcher青少年抑郁量表（11项）（KADS-11）、家庭环境量表中文版（FES-CV）、中文版心理弹性量表（CD-RISC）评估测评后,采用多因素logistic回归分析和病例对照研究探讨青少年家庭环境和心理弹性与自杀意念之间的关联。结果 有效问卷为2 960份,有自杀意念者247例（8.50%）,其中男性98例,女性149例。多因素logistic回归分析显示,控制了年龄和性别因素后,单亲/再婚家庭模式与青少年自杀意念风险增加有关（OR=2.655）。男性青少年的自杀意念与家庭亲密度（OR=0.750,P < 0.001）及组织性（OR=0.855,P=0.036）呈明显负关联,与家庭矛盾性呈明显正关联（OR=1.159,P=0.017）。女性青少年的自杀意念与家庭亲密度（OR=0.771,P < 0.001）、情感表达（OR=0.815,P=0.001）及知识性（OR=0.915,P=0.037）存在负性关联。CD-RISC量表评估显示,有自杀意念的青少年心理弹性总得分明显低于无自杀意念的青少年（P < 0.05）,有自杀意念青少年该量表中的能力、忍受消极情感、接受变化和控制4个维度的得分均比无自杀意念青少年低（P < 0.05）。结论 青少年家庭环境亲密度是青少年自杀意念的保护因素;男性青少年的家庭组织性和女性青少年家庭情感表达与降低自杀风险有关;增强心理弹性可能有助于降低青少年的自杀意念。     

The Association Among Negative Life Events, Perceived Problem Solving Alternatives, Depression, and Suicidal Ideation in Adolescent Psychiatric Patients

Previous research demonstrated that the combination of a negative life event (NLE) and less constructive perceived problem solving alternatives (PPSAs) was associated with more depression in unselected adolescents. This study investigated these variables and their association with suicidal ideation in 80 adolescent psychiatric patients. Depressed patients reported more negative effects from NLEs, particularly family conflict and academic failure, and were more likely to consider self-destructive PPSAs than their less depressed counterparts. The impacts of NLEs and negative PPSAs were independently associated with both depression and suicidal ideation for this population, in contrast to non-patients.     

Predictors of suicidal ideation with sub-optimal health status and anxiety symptom among Chinese adolescents

Evidences in respect to the predictors of suicide ideation are uncertain and most associations only have been identified in cross-sectional studies. More information is needed to identify whether these predictors are true risk factors and can predict the development of suicidal ideation independently. Using the data from a prospective, longitudinal study (n?=?2348), we examined the predictors of suicide ideation with demographic variety and psychological well-being of adolescents. Positive items of sub-optimal health status and anxiety symptom at baseline could strongly predict the incidence of self-reported suicidal ideation on a 1-year follow-up study. These results have implications for programs aimed at identifying school students at risk for suicide.     

Traumatic events and suicide-related outcomes among Mexico City adolescents

Background:  We report the prevalence and associations between traumatic events and suicidal ideation, suicide plans and suicide attempts among Mexican adolescents.
Methods:  The data are from a representative multistage probability household survey of 3,005 adolescents aged 12 to 17 years residing in the Mexico City Metropolitan Area that was carried out in 2005. We used discrete time survival analyses to model the net impact of retrospectively reported prior occurrence of traumatic events on ideation, plans and attempts, taking into account the onset of psychiatric disorders.
Results:  Prevalence of suicidality was high among respondents with traumatic events, ranging from a 43% prevalence of suicidal ideation among those with a history of 'Being raped' to a 25% prevalence of suicide attempts among those that reported 'Purposely injured, tortured or killed someone.' In cross-sectional estimates, any traumatic event was associated with an increase of 3.2 times the odds of suicide ideation, 5.1 times the odds of a plan and 6.6 times the odds of an attempt. Number of events was also associated with increasing suicidality such that those with three or more events were 13.7 times more likely to report a suicide attempt than those with none. Multivariate discrete time survival models that took into account a large number of demographic, suicide-related and psychiatric disorder variables reduced in strength but did not alter these basic relationships.
Conclusions:  We conclude that traumatic events such as rape and sexual assault have a profound impact upon suicidality and that this relationship is not entirely explained by the onset of psychiatric disorders. Comprehensive interventions for adolescent victims of traumatic events, especially those with a history of cumulative events, should include, but not be restricted to, treatment of any associated psychiatric disorder.     

Suicide attempts versus suicidal ideation in bulimic female adolescents

BACKGROUND: Suicide attempts by adolescents continue to be a major public health problem. The purpose of this study was to examine the difference in the family functioning and sociopsychopathological risk factor relationship between female bulimic adolescents with suicidal ideation only, and those who attempted suicide. METHODS: A group of 211 patients were observed for 12 months. Data from 63 subjects (SUG [suicide group], age 17.2 +/- 1.3 years) who had attempted suicide were then compared with 148 (control group, age 18.1 +/- 1.5 years) who had expressed suicidal ideation but did not follow through. RESULTS: Those in the suicide attempt group had been exposed more frequently to physical/sexual violence in childhood. As adults they either lived alone or were dissatisfied with their partnership. The frequency of borderline personality disorders and depressive disorders in this group was significant. Psychosomatic symptoms, disturbed coenesthesia, substance abuse, social impairment and interference with their perception of their own life circumstances, as well as their job performance, often preceded the suicide attempt. Nine genuine risk factors that occurred significantly more often in the SUG were calculated out of all the stress factors using stepwise logistic regression: 'as a child I was even hit with a stick or whip', 'I had no set orientation in life', 'I had a feeling of loneliness despite family and friends', 'I could not relax', 'incapable of dealing with the public', 'I do not like to be touched', 'parents have psychiatric disorders', 'misuse of stimulants', and 'as a child I felt lonely' (odds ratio, 10.56-1.90). CONCLUSION: Adverse family experiences and multiple sociopsychopathological factors may increase the risk of suicide in female bulimic adolescents.