Suicidal ideation among Viennese high school students

OBJECTIVE: Suicidality spans a spectrum ranging from suicidal thoughts to suicidal acts, and suicidal ideation is more prevalent in youth populations, suggesting important developmental issues. We assessed the prevalence of lifetime suicidal ideation and associated psychosocial factors among Viennese high school students. METHOD: An anonymous self-report survey assessing demographic characteristics and the major psychiatric risk factors of teenage suicide was completed by students at three Viennese high schools (n = 214; mean age 15.4 years). RESULTS: Eighty-one (37.9%) high school students reported having had suicidal thoughts at some point in their lives, girls significantly more often than boys (48.5% vs. 29.1%, P = 0.004). Furthermore, lifetime suicidal ideation in Viennese high school students was associated with living in broken-home families, cigarette smoking, substance problems (alcohol/drugs), self-reported depression, and high school type (the highest prevalence was in grammar school). After adjusting for confounders, we found that female gender, substance problems, school type and cigarette smoking were significantly associated with lifetime suicidal ideation in Viennese high school students. CONCLUSIONS: The psychosocial factors associated with adolescent suicidal ideation require attention in the contexts of suicide prevention and mental health promotion.     

Depressive symptoms and age of alcohol use onset interact to predict suicidal ideation

Abstract

Distal risk factors of alcohol use may increase suicidal ideation in the presence of proximal risk factors, such as depressive symptoms. We tested whether depressive symptoms and age at onset of alcohol use interact to predict suicidal ideation in 500 individuals (67% men; 68% Black/African American) under criminal justice supervision. Regression analysis revealed that age of onset negatively associated with suicidal ideation only at average and high levels of depressive symptoms while controlling for suicide attempt history. Clinicians may consider individuals with an early age of onset of alcohol use and current depressive symptoms at risk for suicidal ideation.     

Associations between overuse of the internet and mental health in adolescents

This study examined the factors influencing internet addiction levels and mental health in a nationally‐representative sample of 74,980 Korean middle‐ and high‐school students who completed the 2010 Korea Youth Risk Behavior Web‐Based Survey. The prevalence rates of potential internet addiction and internet addiction were 14.8% and 3%, respectively. The odds ratios for potential internet addiction were higher in both boys and girls who reported suicidal ideation, depressive mood, moderate or higher subjective stress, moderate or more happiness, or ever having engaged in problematic substance use. Adolescents at high risk for internet addiction had poor mental health outcomes. The findings indicate the need for measures to prevent and manage internet addiction in adolescents that consider the severity of factors related to internet addiction.     

Prevalence and risk factors of the development of irritable bowel syndrome in adolescents: a population study

AIM: To determine prevalence of irritable bowel syndrome (IBS) and associated factors in a community-based population of adolescents. MATERIAL AND METHODS: 189 schoolboys and 250 schoolgirls aged 14-17 years from four randomly chosen schools of Novosibirsk participated in the study. RESULTS: The prevalence of IBS defined according to Rome criteria was higher in girls (24 vs 14% in boys, p = 0.01). Colonic pain frequency was similar in both genders (11% in girls vs 9% in boys, p = 0.46), however disturbed defecation occurred significantly more often in girls than in boys (16 vs 7%, p = 0.003). Half of the subjects who reported IBS had also dyspeptic symptoms. Fiber-rich diet and/or laxatives to prevent constipation were used by 2% of boys and 7% of girls (p = 0.012). However, only one third of those having less than 3 stools a week thought it abnormal. IBS is associated with the age over 15-16 years, female gender, abdominal pain in childhood, appendectomy, irregular meals and smoking (in girls). No association was found with other socio-demographic factors and serological markers of some infections and invasions (H. pylori, G. lamblia, O. felineus, hepatitis viruses B and C). Of the persons with diagnosable IBS, 49% have consulted a physician about it, 21% have undergone upper endoscopy. School absenteeism was reported by 62% of the IBS sufferers. CONCLUSION: IBS is common among adolescents (especially girls) with the prevalence rates similar to those described in adults from West Europe and USA. These disorders are associated with significant disability and health care costs.     

Reasons for Living and Their Moderating Effects on Korean Adolescents' Suicidal Ideation

The present study validated the use of the Korean version of the Reasons for Living Inventory for Adolescents (KRFL-A) in a group of 406 South Korean high school students. Confirmatory factor analysis confirmed the original 5-factor structure, and other psychometric properties demonstrated the usefulness of the KRFL-A as a measure of cognitive protective factors. Hierarchical regression analyses revealed that the KRFL-A total significantly moderated the impact of depressive symptoms on suicidal ideation. More specifically, the Family Alliance subscale among boys and the Peer Acceptance and Support subscale among girls moderated the relationships between depressive symptoms and suicidal ideation. This suggests that for Korean adolescents, gender-specific strategies are needed for more effective suicide interventions.     

Prevalence of health-risk behavior among seventh grade students in North Carolina

Data from 386 seventh grade students, 48% male and 65% white, were collected at two sites in North Carolina. The purpose of the study was to estimate the prevalence of alcohol and drug use among adolescents as part of a continuing study of preventive health behaviors. The data were collected anonymously from self-completed questionnaires and were analyzed by race and sex to determine knowledge of and attitudes toward alcohol and smoking, self-concept, and locus of control. Black boys had the highest prevalence of alcohol (16%) and tobacco (20%) use and at the same time had the lowest amount of knowledge about the dangers of the substances. White boys, while knowing more about the potential dangers, reported similar patterns of use. In general, girls used much less alcohol and tobacco and had higher levels of knowledge and more prudent attitudes. Boys, particularly blacks, were found to be at greater risk than girls of developing patterns of behavior that are associated with abuse of alcohol and heavy smoking. The findings suggest that health education to inform adolescents of the dangers of alcohol and smoking needs to be specific to cultural and sex groups.     

Adolescent Suicide Risk Screening in the Emergency Department

Objectives: Many adolescents who die by suicide have never obtained mental health services. In response to this, the National Strategy for Suicide Prevention recommends screening for elevated suicide risk in emergency departments (EDs). This cross‐sectional study was designed to examine 1) the concurrent validity and utility of an adolescent suicide risk screen for use in general medical EDs and 2) the prevalence of positive screens for adolescent males and females using two different sets of screening criteria. Methods: Participants were 298 adolescents seeking pediatric or psychiatric emergency services (50% male; 83% white, 16% black or African American, 5.4% Hispanic). The inclusion criterion was age 13 to 17 years. Exclusion criteria were severe cognitive impairment, no parent or legal guardian present to provide consent, or abnormal vital signs. Parent or guardian consent and adolescent assent were obtained for 61% of consecutively eligible adolescents. Elevated risk was defined as 1) Suicidal Ideation Questionnaire‐Junior [SIQ‐JR] score of ≥31 or suicide attempt in the past 3 months or 2) alcohol abuse plus depression (Alcohol Use Disorders Identification Test‐3 [AUDIT‐3] score of ≥3, Reynolds Adolescent Depression Scale‐2 [RADS‐2] score of ≥76). The Beck Hopelessness Scale (BHS) and Problem Oriented Screening Instrument for Teenagers (POSIT) were used to ascertain concurrent validity. Results: Sixteen percent (n = 48) of adolescents screened positive for elevated suicide risk. Within this group, 98% reported severe suicide ideation or a recent suicide attempt (46% attempt and ideation, 10% attempt only, 42% ideation only) and 27% reported alcohol abuse and depression. Nineteen percent of adolescents who screened positive presented for nonpsychiatric reasons. One‐third of adolescents with positive screens were not receiving any mental health or substance use treatment. Demonstrating concurrent validity, the BHS scores of adolescents with positive screens and the POSIT scores of those with positive screens due to alcohol abuse and depression indicated substantial impairment. The addition of alcohol abuse with co‐occurring depression as a positive screen criterion did not result in improved case identification. Among the subgroup screening positive due to depression plus alcohol abuse, all but one (>90%) also reported severe suicide ideation and/or a recent suicide attempt. This subgroup (approximately 17% of adolescents who screened positive) also reported significantly more impulsivity than other adolescents who screened positive. Conclusions: The suicide risk screen showed evidence of concurrent validity. It also demonstrated utility in identifying 1) adolescents at elevated risk for suicide who presented to the ED with unrelated medical concerns and 2) a subgroup of adolescents who may be at highly elevated risk for suicide due to the combination of depression, alcohol abuse, suicidality, and impulsivity.     

Childhood abuse, adult alcohol use disorders and suicidal behaviour

Childhood abuse is linked to a variety of maladaptive outcomes that can extend far into adulthood. Two of the most significant are alcohol use disorders and suicidal ideation/behaviour. This article explores the pathway from childhood abuse to suicidal behaviour through the development of alcohol use disorders, and examines the significance of a familial history of alcohol misuse in exacerbating suicidal behaviour in adults who were abused as children. It discusses the implications of this pathway, and describes areas of focus for those who work with child abuse victims and/or patients experiencing alcohol use disorders. Practitioners working with children or adolescents who have experienced or are experiencing abuse should take a preventative approach, identifying and treating those at risk for alcohol misuse and/or suicide. Practitioners working with adults who are already abusing alcohol and/or are suicidal should work with the adult to identify and examine life events such as abuse that may be responsible. By identifying factors that have led to the misuse of alcohol and/or suicidal ideation, adults can obtain appropriate psychotherapy and deal in a more productive and beneficial manner with the pain that underlies their self-destructive impulses.     

Drug use and reported suicide ideation and attempt among Kosovar adolescents

Abstract

Suicide among adolescents continues to be a serious problem. Studies have found that substance use of tobacco, alcohol and illicit drugs is associated with suicide ideation and attempts. An article also analyzed gender differences in terms of suicide ideation and suicide attempts by considering substance use factors separately for males and females. The article is based on the data collected for the 2011 European School Survey Project on Alcohol and other Drugs (ESPAD), which was carried out in 42 secondary schools in Kosovo. A total of 4709 students born in 1995 and 1996 were surveyed according to ESPAD methodology. Logistic regression results indicate that cannabis use during the last 30 days was strongly associated with suicide attempts for both males and females. Frequency of alcohol consumption over the last 30 days was also associated with suicide ideation and attempts. The lifetime use of illegal drugs (amphetamines, ecstasy or hallucinogenic) was highly associated with suicide ideation for males but not for females. Findings show gender differences in suicide ideation; females reported higher rates of suicidal thoughts (9%) than males (6.3%). On the other hand, there were no gender differences for lifetime self-reported suicide attempt rates (3.4%). Findings from this article have a major relevance for youth suicide prevention strategies and action plans, emphasizing that not only the illegal drugs but also legal drugs such as, tranquilizers and alcohol are strongly associated with suicide ideation and attempts.     

Friendship and Suicidality among Mexican-American Adolescent Girls and Boys

Friendship factors have been implicated in adolescent suicidality, but this relationship has not been verified across ethnicities. This study examined suicidality and friendship problems (i.e., social isolation, poor friendship quality, friends' school disconnection, and friends' delinquency) among Mexican-American adolescents, an understudied, vulnerable group in terms of suicidality. Three hundred thirty-eight community adolescents, two thirds of whom were educationally-at-risk, participated in the study. Suicidal ideation and behavior rates were high, particularly among girls. Friends' school disconnectedness increased girls' odds for suicidal ideation by 13%. This association was even greater for girls in good academic standing. Friendship problems were not associated with suicidality in boys. Ethnic identity was a minor factor in suicidal ideation, and only for girls. These findings confirm, among Mexican American adolescents, the role of gender in the relationship between friendship and suicidality.     

Ethnic,Gender, and Age Differences in Adolescent Nonfatal Suicidal Behaviors

This study examined ethnic differences in adolescent nonfatal suicidal behaviors as well as age and gender variation both across and within ethnic groups. Using a large (n = 14, 346) sample of adolescents in Grades 7 through 12, African Americans reported relatively high rates of suicidal thoughts and attempts and Southeast Asians reported high rates of suicidal thoughts. Hispanic Americans, European Americans, and Asian Americans were similar in their reports of nonfatal suicidal behaviors. Gender differences also varied across ethnicity as Southeast Asian boys (particularly older boys) reported more suicidal thoughts and attempts than Southeast Asian girls.     

Differences between early and late onset of substance abuse: an inpatient experience

Of 100 consecutive patients admitted to an inpatient alcohol and drug abuse ward, approximately four fifths reported the onset of substance use before 18 years of age. The majority used both alcohol and drugs, and had a history of problems with school authorities and suicidal ideation. We found general and sex-specific patterns of substance use among both depressed and nondepressed substance users and abusers.     

Sexual abuse, alcohol and other drug use, and suicidal behaviors in homeless adolescents.

Previous research has shown that homeless youth have high rates of suicidal ideation, sexual abuse, and abuse of alcohol and other drugs. However, little is known about how these rates differ by gender and ethnicity. Our objective was to describe patterns of sexual abuse, alcohol and other drug use, and indicators of suicidal behaviors in homeless adolescents and to determine gender and ethnic differences in these factors. We used secondary data analysis of data from surveys completed by 96 homeless youth whose average age was 17.9 years. Over 60% of the sample reported a history of sexual abuse; the majority were under the age of 12 years when they first tried alcohol, marijuana, and cocaine; 56.3% had injected drugs, and 46.9% had tried inhalants. During the past 12 months, 35.1% had seriously considered suicide and 12.3% had actually attempted suicide at least once. Significantly more Hispanics than Whites had considered suicide (chi 2 = 4.31, p = .038). A disproportionate number of Hispanics (95% of the sample) reported a history of sexual abuse. Participants with a history of sexual abuse were significantly more likely than those who did not have a history of sexual abuse to have used alcohol and/or marijuana (chi 2 = 9.93, p < .01) and to have considered suicide in the past 12 months (F = 14.93, p < .001). We found that sexual abuse history is greater in this sample than in the general population and is particularly prevalent among Hispanic/Latino subjects. As in other studies, sexual abuse was more common among females than among males. High prevalence of sexual abuse, alcohol and other drug use, and suicidal behaviors in this sample of homeless youth underscores the need to develop and test community-based interventions to improve their health status.     

Unrecognized suicidal ideation in ED patients: are we missing an opportunity?

Objective

To determine whether patients who disclosed suicidal ideation during a health-risk survey had their mental health symptoms documented by physicians and were given mental health referrals and to evaluate how many of these patients subsequently attempted suicide.

Methods

As part of a larger survey, patients responded to questions on a computer kiosk about general health risk behaviors and mental health symptoms. Fifteen months after initiating the survey, we reviewed medical records on those patients who had disclosed suicidal ideation. A standardized abstraction sheet was used to collect data regarding the ED diagnosis at the time of enrollment, physician documentation of suicidal ideation, and referral to psychiatric services, as well as subsequent ED and clinic visits and suicide attempts.

Results

Of the 165 patients who disclosed suicidal ideation on the computer survey, 118 charts (72%) were available. During the index ED visit, only 25% of patients had suicidal ideation or other mental health issues noted on the chart. The majority (76%) of patients were discharged home, 10% were transferred to psychiatric services, and 3% were admitted for medical reasons. Although 72 patients had no future visits to the ED or other hospital-affiliated clinics, 39% of patients had at least one subsequent visit to the ED, and 17% had at least one visit to the psychiatric services. Four patients attempted suicide after their initial index visit to the ED.

Conclusion

Suicidal ideation was self-disclosed frequently by waiting room patients in our urban ED, and patients who disclosed suicidal ideation did not always receive referrals for mental health services.     

Tracking of avoidance of alcohol use and smoking behavior in a fifth grade cohort over three years

This study examined the maintenance of positive health behavior (avoidance of alcohol use and cigarette smoking) and factors associated with the maintenance of these behaviors from fifth through seventh grade by a cohort of rural students (N = 232). African American and White students showed similar patterns of high avoidance of alcohol until seventh grade. Although more girls avoided use than boys, avoidance decreased in both groups with progression in grade. Mothers', fathers', and best friends' drinking behaviors influenced avoidance behavior; drinking was less likely to occur among those whose parents and friends did not drink. Friends' drinking behavior influenced alcohol use as early as fifth grade. Smoking avoidance was maintained by 74% of the students over the 3 years. Although there were no racial differences in smoking, African Americans started smoking about 1 year earlier than Whites. During seventh grade, an increase in smoking occurred among boys and girls, but was particularly striking among girls. Avoidance of smoking was influenced by mothers' behavior but not fathers'. Best friends' smoking behavior exerted a major influence on avoidance between grades 6 and 7. In grades 5 and 6, those who avoided smoking were more physically active than smokers, but by seventh grade their physical activity declined to a similar level as smokers. Rural adolescent boys seemed to be at early risk for alcohol use and smoking, while rural girls delayed involvement by 1 to 2 years. Communities, schools, and families can help adolescents avoid alcohol use and smoking through early prevention efforts.     

Outcomes following suicidal crisis among hazardous and harmful alcohol users in the Crisis Resolution Team

Despite associations between alcohol use and suicidal acts, little research measures prognoses of alcohol-using patients treated by Crisis Resolution Teams (CRTs), an intensive community-based intervention. We estimated the association of alcohol use amongst patients accepted following suicidal acts or ideation in four London-based Crisis Resolution Teams, with death-by-any-cause or recontact with crisis care. We analysed the electronic health records of 1615 CRT patients accepted following suicidal acts or ideation over 38 months, following STROBE guidelines. Using logistic regression we estimated the association of alcohol use (indicated by risk-assessment, AUDIT, or ICD-10 diagnosis) with death-or-recontact at (i) 30-days and (ii) 1-year after treatment start, adjusted for age, sex, ethnicity, psychiatric diagnosis, and severity of need. Hazardous, harmful, or dependent drinking was identified in 270 cases at baseline (16.7%); 73 (4.5%) were alcohol dependent. By 1-year, 622 patients (38.5%) had recontacted crisis care or died. After adjustment, alcohol use at a hazardous, harmful, or dependent level was not associated with increased odds of death-or-recontact at 30-days (AOR 1.17, 95%CI 0.73, 1.88) or 1-year (AOR 1.17, 95%CI 0.85, 1.60). Patients with hazardous, harmful, and dependent alcohol use are a small proportion of CRT patients, despite being more commonly encountered in emergency settings from which patients may be referred to CRTs, indicating a potential gap in provision. Those who are included in CRTs are not at increased risk of death-or-recontact within 1 year of treatment, suggesting that their inclusion can work, at least in a sample with predominantly hazardous or harmful alcohol use.     

Drunkenness-related alcoholic beverage choices among adolescents

The aim was to find out the preferred alcoholic beverages of 12 to 18 year-olds and to explore the relationships between beverage preferences and heavy drinking. The data for the Adolescent Health and Lifestyle Survey ( n = 8219) was collected among Finns aged 12, 14, 16 and 18 years by mail in 1999. The instrument included a four-item scale on subjective perceptions of drunkenness on the latest drinking occasion, and on the qualities and quantities of alcohol consumed. Alcohol use among the 12 year-olds was rare; they preferred wine. The favourites among 14 to 18 year-olds, who reported having been sober or only slightly drunk, were beer and cider. Adolescents who reported having been 'really drunk' often combined these low-alcohol beverages with spirits. However, even in this group the three low-alcohol beverages (beer, cider, long drinks) together accounted for 60% of total ethanol consumption, most of which the boys drank in beer and girls in cider or beer. While spirits were associated with drunkenness among adolescents, low-alcohol beverages, beer in particular, also appeared to show a significant association with heavy drinking. The alcohol policy assumption that low-alcohol beverages are less harmful than spirits should be abandoned and health promotion efforts adjusted accordingly.     

Chronic Pain,TBI, and PTSD in Military Veterans: A Link to Suicidal Ideation and Violent Impulses?

The polytrauma clinical triad refers to the co-occurrence of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Despite research implicating dyadic relationships between these conditions and adverse outcomes, scant research has examined the polytrauma clinical triad's relation to suicide or violence. The present cross-sectional study was designed to examine whether this complex clinical presentation increases risk of suicidal ideation and violent impulses after accounting for other established risk factors. Veterans who served in the military since September 11, 2001 (N?=?667) who reported chronic pain completed an interview and self-report battery. Bivariate analyses showed that suicidal ideation and violent impulses both correlated with PTSD, TBI+PTSD, pain intensity and interference, drug abuse, and major depressive disorder (MDD). Multiple regression analyses showed that: 1) race, chronic pain with PTSD, alcohol abuse, and MDD significantly predicted suicidal ideation, 2) pain interference, chronic pain with TBI, chronic pain with PTSD, chronic pain with TBI+PTSD, drug abuse, and MDD significantly predicted violent impulses, and 3) pain interference was a more critical predictor of suicidal and violent ideation than pain intensity. Implications for risk assessment and treatment are discussed.

No-suicide contracts among college students

This study evaluates the use of 3 no-suicide contracts that differed in length from 1 to 9 sentences, and in specificity from indicating that clients will talk to a friend or therapist to a clear outline of persons and interventions to be used if they feel suicidal. Of the sample of 112 college students, 40% admitted to suicidal ideation and 54% reported some form of previous counseling. Students read all 3 contracts and rated them on how well they helped stop suicidal thoughts, communicated that the therapist cared, strengthened resistance to suicide, lessened depression, gave hope, encouraged cooperation with therapy and empowered, and how much they were complicated, short, or unrealistic. Regardless of gender, ethnicity, history of counseling, or prior suicidal ideation, students rated the more detailed contract best overall. Although other groups may respond differently, for college students, a specific, detailed no-suicide contract is best.     

NO-SUICIDE CONTRACTS AMONG COLLEGE STUDENTS

This study evaluates the use of 3 no-suicide contracts that differed in length from 1 to 9 sentences, and in specificity from indicating that clients will talk to a friend or therapist to a clear outline of persons and interventions to be used if they feel suicidal. Of the sample of 112 college students, 40% admitted to suicidal ideation and 54% reported some form of previous counseling. Students read all 3 contracts and rated them on how well they helped stop suicidal thoughts, communicated that the therapist cared, strengthened resistance to suicide, lessened depression, gave hope, encouraged cooperation with therapy and empowered, and how much they were complicated, short, or unrealistic. Regardless of gender, ethnicity, history of counseling, or prior suicidal ideation, students rated the more detailed contract best overall. Although other groups may respond differently, for college students, a specific, detailed no-suicide contract is best.