Suicidal Thoughts and Attempts Among U.S. High School Students: Trends and Associated Health-Risk Behaviors, 1991–2011

PurposeTo describe secular trends in suicidal thoughts and attempts and the types of health-risk behaviors associated with suicidal thoughts and attempts among U.S. high school students.MethodsData were analyzed from 11 national Youth Risk Behavior Surveys conducted biennially during 1991–2011. Each survey employed a nationally representative sample of students in grades 9–12 and provided data from approximately 14,000 students. Using sex-stratified logistic regression models that controlled for race/ethnicity and grade, we analyzed secular trends in the prevalence of suicidal thoughts and attempts. Adjusted prevalence ratios (APR) were calculated to measure associations between suicide risk and a broad range of health-risk behaviors.ResultsDuring 1991–2011, among female students, both suicidal thoughts (seriously considered suicide; made a plan to attempt suicide) and attempts (any attempt; attempt with injury requiring medical treatment) decreased significantly; among male students, only suicidal thoughts decreased significantly. During 2011, compared with students with no suicidal thoughts or attempts, the health-risk behaviors most strongly associated with suicide attempts among female students were injection drug use (APR = 12.8), carrying a weapon on school property (APR = 9.7), and methamphetamine use (APR = 8.7); among male students, the strongest associations were for IDU (APR = 22.4), using vomiting/laxatives for weight control (APR = 17.1), and having been forced to have sex (APR = 14.8).ConclusionsSchool-based suicide prevention programs should consider confidential screening for health-risk behaviors that are strongly associated with suicide attempts to help identify students at increased risk for suicide and provide referrals to suicide and other prevention services (e.g., substance abuse and violence prevention) as appropriate.     

Adolescent Alcohol Use,Suicidal Ideation,and Suicide Attempts

PurposeTo examine the association between self-reported alcohol use and suicide attempts among adolescents who did and did not report suicidal ideation during the past year.MethodsScreening data from 31,953 students attending schools in the United States that implemented the Signs of Suicide (SOS) program in 2001–2002 were used in this analysis. Two types of alcohol use were investigated: heavy episodic drinking, and drinking while down. Self-reported suicide attempts were regressed on suicidal ideation and both measures of alcohol use, controlling for participants’ levels of depressive symptoms, and demographic characteristics.ResultsLogistic regression analyses indicated that both drinking while down and heavy episodic drinking were significantly associated with self-reported suicide attempts. Analyses examining the conditional association of alcohol use and suicidal ideation with self-reported suicide attempts revealed that drinking while down was associated with significantly greater risk of suicide attempt among those not reporting suicidal ideation in the past year. Heavy episodic drinking was associated with increased risk of suicide attempt equally among those who did and did not report suicidal ideation.ConclusionsThis study identified the use of alcohol while sad or depressed as a marker for suicidal behavior in adolescents who did not report ideating prior to an attempt, and hence, may not be detected by current strategies for assessing suicide risk. Findings from this study should provide further impetus for alcohol screening among clinicians beyond that motivated by concerns about alcohol and substance use.     

Psychotherapy in the treatment of alcohol and substance abusing adolescents with suicidal behavior

Adolescence is a unique time period in an individual's life, one in which suicide and substance abuse become substantial health risks. Currently, suicide accounts for approximately 14% of all deaths among 15-24 year olds in the U.S.A. Drug, alcohol abuse and dependence are the most prevalent causes of adolescent morbidity and mortality in the USA. Numerous studies have demonstrated the link between adolescent alcohol, substance abuse and suicide. When compared to community controls, the rate of a substance abuse disorder was 8.5 times higher in a sample of adolescent suicide completers and the rate of alcohol abuse was 7.5 times higher. Genetic and biological variables may also be responsible for either alcohol and substance abuse or suicide or both alcohol and substance abuse and suicide. There is little empirical research evaluating the effectiveness of alcohol and substance abuse treatments for adolescents. Therapies such as multisystemic therapy, functional family therapy, motivational interviewing, community reinforcement, the 12-step approach and contingency management reinforcement seem to be effective treatments. Despite the strong association between adolescent alcohol and substance use and suicidal behaviors, few studies have investigated the combined treatment of these two issues. Cognitive behavioral therapy, particularly dialectical behavior therapy, seems to be a promising psychotherapy treatment for suicidality in alcohol and substance abusing adolescents. Further research is needed to determine the efficacy of various treatments of alcohol and substance abusing adolescents with suicidal behavior.     

Childhood abuse and adolescent suicidality: a direct link and an indirect link through alcohol and substance misuse

Childhood abuse is responsible for a variety of outcomes that are characterized by maladjustment and maladaption. Two of the most significant results are suicide and alcohol and substance misuse. This paper explores the direct link between childhood abuse and adolescent suicide, the direct link between childhood abuse and adolescent alcohol and substance misuse, the indirect link between childhood abuse and adolescent suicide through alcohol and substance misuse, and finally implications of these links for practitioners working with adolescents who are experiencing or who have experienced childhood abuse. Both suicide and alcohol and substance misuse are prevalent in the adolescent population; however those adolescents who were victims of childhood abuse show an even greater prevalence of both suicidality and substance and alcohol misuse. Additionally adolescents who exhibit alcohol or substance misuse show greater rater of suicidality than those without alcohol and substance misuse. It appears that abuse is a risk factor for eventual suicidality. Practitioners working with children or adolescents who have experienced abuse need to work towards secondary prevention by identifying, predicting and treating those at risk for substance abuse and/or suicide; and those working with adolescents who are already abusing substances and/or are suicidal should work with the adolescent to identify and examine life events such as abuse that may have triggered the chain towards substance misuse and/or suicidal ideation.     

Suicidality in DSM IV cluster B personality disorders. An overview

Personality disorders are a considerable risk factor for suicidal behavior. In psychological autopsy studies, individuals with personality disorders are frequently found among suicide victims. Suicidal attempts (which are a major risk factor for completed suicide) are also an important issue among affected patients. We performed careful MedLine, Excerpta Medica, PsycLit and PsycINFO searches from 1980 to 2004. Search terms were "suicide", "personality disorders", "mortality", "follow-up". We identified studies dealing with suicide and the following areas of interest: borderline personality disorder, narcissistic personality disorder, antisocial personality disorder, comorbidity (especially with affective disorder and substance abuse disorder) and risk factors for suicide in personality disorders. Despite the fact that comorbidity with DSM-IV Axis I disorders often impairs a correct judgment of suicidality in personality disorders, this overview showed that some personality disorders have a stronger link to suicide and that identifiable risk factors may be used for the development of preventive measures. Given the fact that personality disorders have high prevalence in the general population, prediction and prevention of suicide among these individuals is a problem of public health.     

重庆市初中生受虐待经历与自杀意念和行为的关联

  目的  探究受虐待经历对初中生自杀意念和自杀未遂的影响, 为初中生的自杀预防提供依据。  方法  采用随机整群抽样方式, 从2020年6—9月对重庆市的调研数据中抽取25个区、县的初中生数据, 纳入分析10 289人。使用儿童期虐待问卷、中学生心理健康量表等进行调查, 并收集人口学信息、自杀意念和自杀行为。  结果  初中生自杀意念的报告率为20.93%, 自杀未遂的报告率为10.83%。多因素Logistic回归分析显示, 控制人口学变量及心理健康水平后, 情感虐待(OR=2.07)和情感忽视(OR=2.03)的发生与自杀意念的相关高于其他3种类型的儿童期虐待(OR_躯体忽视=1.19, OR_躯体虐待=1.60, OR_性虐待=1.37, P值均 < 0.05);性虐待(OR=2.29)和躯体忽视(OR=1.87)的发生与初中生自杀未遂的相关高于其他3种类型的虐待(OR_情感虐待=1.63, OR_情感忽视=1.59, OR_躯体虐待=1.50, P值均 < 0.01)。  结论  5种类型的虐待对初中生的自杀意念和自杀未遂均有重要影响, 且情感忽视和情感虐待对自杀意念的影响更大, 性虐待和躯体忽视对自杀未遂的影响更大。     

Longitudinal Associations Between Types of Childhood Trauma and Suicidal Behavior Among Substance Users: A Cohort Study

Objectives. We examined the longitudinal associations between different types and severities of childhood trauma and suicide attempts among illicit drug users.Methods. Data came from 2 prospective cohort studies of illicit drug users in Vancouver, Canada, in 2005 to 2010. We used recurrent event proportional means models to estimate adjusted and weighted associations between types and severities of childhood maltreatment and suicide attempts.Results. Of 1634 participants, 411 (25.2%) reported a history of suicidal behavior at baseline. Over 5 years, 80 (4.9%) participants reported 97 suicide attempts, a rate of 2.6 per 100 person-years. Severe to extreme levels of sexual abuse (adjusted hazard ratio [AHR] = 2.5; 95% confidence interval [CI] = 1.4, 4.4), physical abuse (AHR = 2.0; 95% CI = 1.1, 3.8), and emotional abuse (AHR = 3.5; 95% CI = 1.4, 8.7) predicted suicide attempts. Severe forms of physical and emotional neglect were not significantly associated with an increased risk of suicidal behavior.Conclusions. Severe sexual, physical, and emotional childhood abuse confer substantial risk of repeated suicidal behavior in adulthood. Illicit drug users require intensive secondary suicide prevention efforts, particularly among those with a history of childhood trauma.The global burden of suicide is considerable and is the tenth leading cause of death worldwide, with annual mortality estimated at 14.5 deaths per 100 000.1 Suicide is a major and preventable public health problem among young people aged 15 to 24 years in Canada (second leading cause of death2) and the United States (third leading cause of death3). Each year, approximately 1 million adults in the United States attempt suicide, resulting in 35 000 deaths and more than 320 000 emergency department visits.4 The societal, financial, and public health burdens associated with suicide are therefore substantial.The epidemiology of suicide is multifactorial and complex.1 The 2012 National Strategy for Suicide Prevention identifies several groups at particularly high risk of suicide in the United States, including individuals with a past history of suicidal behavior, members of the armed forces and veterans, American Indians/Alaska Natives, men in midlife, and individuals in justice and child welfare settings.5 Of public health concern in Canada, suicide rates among Aboriginal Peoples are 2 to 3 times that observed in the nonaboriginal population.6,7 A large body of literature has also demonstrated high rates of suicidal behavior among lesbian, gay, bisexual, and transgender populations.8–10People who use illicit drugs are particularly vulnerable to suicidal ideation and behavior, and suicide is a leading cause of death in drug-using populations.11,12 Furthermore, the relationship between substance abuse and increased suicide risk has been well established.13,14 A growing body of research has examined various correlates of suicide attempts among drug users. In treatment-seeking samples of drug and alcohol abusers, major depressive disorder and other psychiatric conditions (e.g., borderline personality disorder, anxiety, agoraphobia) have been associated with a history of suicide attempts.15–20 Furthermore, markers of social disadvantage and marginalization, such as unemployment and homelessness, are associated with a heightened risk of suicide and are common among drug users.11 Specific typologies of drug use have also been linked to a greater likelihood of attempting suicide, including longer durations of substance use,18,21 polysubstance use,20,22 and injection methamphetamine use.23In recent years, childhood maltreatment has emerged as a consistent correlate of suicidal ideation and behavior among drug users.19,24,25 These studies provide preliminary evidence that childhood abuse and neglect are important determinants of suicide in drug-using populations. However, it is unclear whether certain types of childhood maltreatment are more strongly associated with suicidal behavior than others. The majority of studies to date have examined suicide and early traumatic experiences among clinical samples, which may be subject to selection bias if being in treatment is a common effect of both exposure (i.e., childhood maltreatment) and other, unmeasured factors that may cause suicidal behavior (e.g., genetic or familial susceptibility to psychiatric disorders such as depression). To our knowledge no studies have prospectively examined suicidal behavior in a community-recruited cohort of drug users. Drug-using cohorts are particularly well suited to examining the relationship between childhood maltreatment and recurrent suicidal behavior because of their high rates of suicide. We used recurrent event survival models to determine the longitudinal associations between exposure to different types and severities of childhood trauma and suicide attempts, measured prospectively in a cohort of drug users in Vancouver, British Columbia.     

Alcohol and adolescent suicide

Adolescent suicide is a major public health problem. In this review, the authors discuss different aspects of the relation between alcohol abuse and suicidal behavior in adolescents, including epidemiology, role of family history, comorbidity, gender differences, neurobiology, treatment, and prevention. In the general population, about 2,000 adolescents in the United States die by suicide each year. Suicide continually ranks as the second or third leading cause of death of persons between the ages of 15 and 34 years old. The suicide rate in young people has more than doubled during the period from 1956 to 1993. This increasing suicide rate has been blamed on the increase of adolescent alcohol abuse. Availability of alcohol and guns at home may contribute to suicide risk in adolescents. Comorbid psychopathology, which is common among adolescent alcohol abusers, substantially increases risk for suicide completions and attempts. Depressed adolescents may use alcohol to self-medicate depressive symptoms. Alcohol abuse and suicidal behavior in adolescents and in adults has been found to have biochemical, genetic, and psychological correlates. Ideally, treatment of adolescents who receive a diagnosis of an alcohol use disorder and co-occurring suicidality should follow an integrated protocol that addresses both conditions. Future studies of psychological and neurobiological mechanisms of suicidality in adolescents with alcohol and/or substance abuse are merited.     

Assessment of suicidal behaviour in general practice

AIM: To assess the prevalence of suicidal behavior (wish to die, suicidal thoughts, suicide attempts) and to determine the characteristics of suicide attempters in primary care, including screening for major mental disorders. METHOD: A Hungarian urban general practitioner's district with 1248 inhabitants was screened for suicidal behavior as well as for major mental disorders. All the patients (n=382) who visited their general practitioner within a two-week period were asked to participate. 277 patients completed the Prime-MD questionnaire, an easy-to-use diagnostic instrument developed for general practitioners to recognize the most common psychiatric disorders, like depressive (major depressive disorder, minor depressive disorder), anxiety (panic disorder, generalized anxiety disorder), somatoform, eating and alcohol related disorders. Detailed data about suicidal thoughts and attempts were also collected by the structured questions of MINI-Plus diagnostic interview. RESULTS: Prevalence of suicide attempts in primary care was 2.9%. 9% of the patients had either suicidal thoughts or suicide attempts in the previous month. Suicidal patients were more ready to use psychotropic drugs, they assessed their health status more poorly, and had more mental symptoms than the control group (non-suicidal patients). 60% of suicidal patients and 11.5% of the investigated population had a current depressive episode. Beside depressive symptoms, anxiety disorders and alcohol problems were also more common among suicidal patients. The rate of previous psychiatric treatments was also higher in suicidal patients, who generally visited their general practitioners less frequently than non-suicidal patients. According to multivariate logistic regression, suicidal patients are more ready to take antidepressants, they tend to have more previous psychiatric treatments and suicidal attempts, and they visit their general practitioners less frequently and have a current depressive episode. CONCLUSION: Suicidal behavior and mental disorders are frequent in primary care. Since almost every tenth patient visiting their general practitioner has suicidal thoughts or depressive or anxiety disorder, the recognition of suicide risk and mental disorders is very important in primary care. As for preventing suicides, the diagnosing and treating of mental disorders -especially affective disorders- are very important for general practitioners. In addition to pharmacotherapy, psychotherapies are also important in treating patients in crisis situations, or with suicidal thoughts or depressive disorder. The modified Prime-MD questionnaire can be an effective, easy-to-use method in the hand of the general practitioners to identify suicidal risk and to recognize the most common mental disorders in the average population.     

Impulsivity, suicidality and alcohol use disorders in adolescents and young adults with borderline personality disorder

Borderline Personality Disorder (BPD) is a severe and disabling psychiatric condition that typically emerges in late adolescence or early adulthood. Nearly 50% of individuals with BPD have a co-occurring Alcohol Use Disorder (AUD) at some point in the course of their illness. This study explores clinical characteristics of adolescents and young adults (age 30 years and younger) with BPD and AUD (N=21) compared to BPD without any history of substance use disorders (N=17). Based on theoretical considerations and previous findings, we hypothesized that adolescents and young adults with BPD and AUDs would be more impulsive and exhibit higher rates of suicidal behavior than individuals with BPD and no substance use disorders. Consistent with our first hypothesis, the BPD/AUD group was more impulsive than the BPD only group. However, the two groups did not differ on measures of suicidal behavior. Overall, impulsivity was correlated with total number of suicide attempts in the adolescent/young adult group. When older BPD participants were included in the comparison (up to age 55), the BPD/AUD group exhibited more lifetime suicide attempts that were higher in medical lethality than the BPD only group, suggesting an overall increased lifetime suicide risk in the BPD/AUD group. The relationship between impulsivity, AUD, and suicidal behavior and lifetime suicide risk in adolescent and young adults with BPD is discussed.     

The role of the hypothalamic-pituitary-adrenal axis dysfunction in the pathophysiology of alcohol misuse and suicidal behavior in adolescents

Alterations in the mechanisms that regulate hypothalamic-pituitary-adrenal (HPA) axis activity predate the development of alcohol use disorders. Human and animal studies indicate that chronic alcohol consumption induces a persistent impairment in the ability of the HPA axis to respond to stress. Therefore, HPA axis abnormalities may contribute to the development of alcohol use disorders and may be a result of alcohol misuse. HPA axis interacts with serotonergic mechanisms. Hippocampal function is modulated by serotonergic projections mostly from dorsal raphe nucleus in the midbrain. Glucocorticoids modulate the activity of this raphe-hippocampal system in various ways. These effects are mediated via central corticosteroid receptors, which include glucocorticoid and mineralocorticoid receptors located in the hippocampus and in other cortical structures. An association between suicidal behavior and hyperactivity of the HPA axis has been suggested. An abnormal interaction between the HPA mechanisms and serotonergic systems may substantially contribute to suicidal behavior in adolescents, because abnormalities in HPA and serotonin functions may be inherited and may manifest at young age. Vulnerability to alcohol use disorders and suicide is likely to be due to multiple interacting genetic loci of small to modest effects. The identification and treatment of adolescents at risk for suicide is one of the most critical issues in adolescent psychiatry. The identification of alcohol and drug misuse is critical to the proper assessment of suicide risk in adolescents. HPA dysregulation may contribute to both alcohol abuse and suicidal behavior in adolescents. Studies of HPA function in alcohol abusing adolescents may lead to the development of new diagnostic tests for predisposition to suicidal behavior. Furthermore, study of biological markers may help us towards an understanding of the neurophysiological substrates of severe dysphoric mood states, alcohol and substance abuse, and suicidal behavior in adolescents.     

Health risk behaviors and associated risk and protective factors among Brazilian adolescents in Santos, Brazil.

OBJECTIVE: To describe the prevalence of health risk behaviors and identify risk and protective factors that are associated with several health risk behaviors (cigarette smoking, drug use, onset of sexual intercourse before age 15, pregnancy, gun-carrying, suicidal ideation, and suicide attempts) among adolescents in Brazil, as well as to explore gender differences. METHODS: We estimated prevalence rates, evaluated bivariate associations, and explored multivariate analyses using logistic regression on data from a 1997 survey of adolescent health among 2059 eighth- and 10(th)-grade students in Santos, Brazil. RESULTS: Youth in Santos, Brazil report high rates of gun-carrying, suicidal thoughts and attempts, sexual intercourse, and pregnancy. Factors associated with diminished involvement for nearly all health risk behaviors, for both boys and girls, included having good family relationships, and feeling liked by friends and teachers. Factors associated with increases in nearly all health risk behaviors were: gun-carrying and gun availability in the home, drug use, and sexual abuse. CONCLUSIONS: Factors that are associated with a wide range of health risk behaviors among adolescents in Brazil appear to parallel those found in industrialized countries: access to guns, substance use, and sexual abuse. Likewise, connectedness to family, school, and peers is consistently the protective factor associated with diminished risky behaviors.     

Self-reported abuse history and adolescent problem behaviors. I. Antisocial and suicidal behaviors.

PURPOSE: To examine the associations of self-reported abuse and sexual molestation with self-reported antisocial behavior and suicidal ideation/behavior in a general population of adolescents. METHODS: We used a stratified cluster sampling procedure with replacement to sample 4790 students in Washington State public schools in Grades 8, 10, and 12. Students were asked in a self-administered questionnaire whether they had ever been abused by an adult and whether they had ever been sexually molested. They were also asked about antisocial behavior and suicidal ideation and behavior in the past year. We conducted polytomous logistic regressions, controlling for gender and grade, using Software for the Statistical Analysis of Correlated Data (SUDAAN). RESULTS: Reported abuse history was associated with antisocial behavior and with suicidal ideation and behavior. The associations were stronger for abuse and molestation than for nonsexual abuse or molestation alone, and stronger at higher levels of severity (e.g., suicide attempts vs. suicidal thoughts). For example, adjusted odds ratios and 95% confidence intervals (in parentheses) for abuse and molestation were 4.4 (3.1-6.2) for suicidal thoughts, 6.8 (4.4-10.4) for suicide plan, 12.0 (7.9-18.4) for noninjurious suicide attempt, and 47.1 (23.3-95.3) for injurious suicide attempt. For abuse alone, these figures were 2.3 (1.7-3.2), 3.1 (2.1-4.6), 5.1 (3.3-7.8), and 11.8 (4.4-31.9), respectively. CONCLUSIONS: Efforts to reduce antisocial behavior and suicidal ideation/behavior in adolescence, particularly early or severe manifestations of the behaviors, should consider the possible role of a history of maltreatment, especially the possibility of sexual abuse.     

Suicidality, depression, and alcohol use among adolescents: a review of empirical findings

Suicide is a serious health problem as it is currently the third leading cause of death for teenagers between the ages of 15 and 24 years. Depression, which is also a serious problem for adolescents, is the most significant biological and psychological risk factor for teen suicide. Alcohol use remains extremely widespread among today's teenagers and is related to both suicidality and depression. Suicidality refers to the occurrence of suicidal thoughts or suicidal behavior. The consensus in empirical research is that mental disorders and substance abuse are the most important risk factors in both attempted and completed adolescent suicide. Therefore, it is incumbent upon researchers to identify the factors that can lead to their prevention among today's youth. This review compiles the existing literature on suicidality, depression, and alcohol use among adolescents spanning over the past 15 years. Both Problem Behavior Theory and Stress-coping Theory can explain the relationships among suicidality, depression and alcohol use. The prevention of suicidality is critical, especially during the early school years, when it is associated with depression and alcohol use. Suicidality, depression and alcohol use are three phenomenon that noticeably increase in adolescence marking this time period as an ideal opportunity for prevention efforts to commence. Future empirical work is needed that will further assess the impact of adolescent depression and alcohol use on suicidality. In sum, this review of empirical research highlights critical results and limitations, as well as indicates a need for continued efforts in preventing suicidality, depression, and alcohol use among adolescents.     

Drug Use, Sexual Activity, and Suicidal Behavior in U.S. High School Students

ABSTRACT: Data from the 1990 Youth Risk Behavior Survey were used to examine the interrelationship of drug use, sexual activity, and suicidal behavior in U.S. high school students. Findings indicated adolescents who engaged in substance use and/or sexual activity were more likely to experience suicide ideation and behavior than those who abstained from such activities. Data analysis revealed a significant and positive relationship between cocaine use and severity of outcomes of suicide attempts. Marijuana use and alcohol use were related to suicide behavior, but these relationships were not as strong as those noted for cocaine use. The study also revealed a positive relationship between frequency of sexual activity and attempted suicide, but could not determine whether such sexual activity was coerced, forced, or voluntary in nature.     

Impulsive-aggressive traits and suicidal adolescents and young adults with alcoholism

Suicidal behavior and alcohol use disorders among adolescents and young adults are serious public health problems. In the study of suicidal behavior among young people with alcoholism, it has been shown that aggression and impulsivity are higher among those who attempted suicide. Impulsivity has been related to suicidal and self-destructive behaviors within different psychiatric conditions, i.e. alcohol and substance use disorders, mood disorders, conduct disorder, impulse control disorders, antisocial personality disorder, and borderline personality disorder. The term impulsivity has been used to define different constructs such as (1) personality trait or cognitive style in which disinhibition is the core characteristic, (2) a tendency to act immediately in response to external or internal stimuli, and (3) a group of psychiatric disorders with behavioral dyscontrol. Among adolescents suicidal behavior is transmitted in families independently of psychiatric conditions, but not independently of impulsivity/aggression. Two causal links between impulsiveness and alcoholism have been proposed: (1) adolescents who develop alcoholism possess higher premorbid levels of impulsiveness than those who do not develop alcoholism, and (2) levels of impulsiveness differentiate both populations only after the development of alcoholism, with higher levels of impulsiveness among those adolescents who developed alcoholism. Cognitive behavioral techniques have shown promising results in the treatment of adolescents with alcohol and substance use disorder and suicidality. The relative frequency of suicidal behavior among adolescents and young adults suffering from alcoholism and its subsequent devastating effects on individuals, families and society merits further research and development of prevention strategies.     

Ethnicity and the relationship between adolescent alcohol use and suicidal behavior

Adolescent suicide is the 3rd leading cause of death in the United States and alcohol consumption is estimated to cause adolescent males to be up to 17 times more likely to attempt suicide, and females three times more likely to attempt suicide. Suicide and suicide attempt rates vary across different ethnicities. Also, associated psychopathology, stressors and substance use differ across ethnic groups in adolescents. In an exhaustive review of the literature, we found that depressed Asian-American youth were four times more likely to display suicidal behavior when compared to other Asian youths with other diagnoses; and depressed African-American females were more likely to report suicidal ideation than male adolescents. We also found that Asian-Americans who experience high parental conflict are 30 times more likely to engage in suicidal behavior when compared to Asian-American youths with low parental conflict. African-American adolescents are 6.4 times more likely to attempt suicide as a result of parental conflict. With respect to alcohol use and dependence, Caucasian adolescents were twice as likely as the African American victims to have used alcohol before committing suicide. Alcohol use among adolescents was associated with increased suicidal behavior. Cultural differences in alcohol consumption may account for disparities, however future research is needed to further examine cultural trends in suicidal behavior and alcoholism.     

Emergency medical system responses to suicide-related calls--Maine, November 1999-October 2000

Suicidal acts are morbid and potentially lethal events that are risks for subsequent completed suicide and possibly other health problems (e.g., substance abuse and depression). Suicidal behavior also can have negative consequences on family members, friends, and caregivers. In 1996, the cost of health care and lost wages for suicide attempts in Maine was approximately $115 million. In 1999, a total of 1,079 persons were hospitalized in Maine for self-injurious behavior. Although Maine has no injury-related surveillance systems, the Maine Bureau of Health (MBOH) assessed the use of Emergency Medical Service (EMS) response data to estimate incidence of EMS responses to suicide-related calls in Maine and to summarize the distribution of these responses by patient and event characteristics. This report describes EMS suicide-related responses during November 1999-October 2000 and indicates that EMS data would be a useful component of an integrated statewide suicidal behavior surveillance system.