Suicide attempts among American Indian and Alaska Native youth: risk and protective factors.

CONTEXT: American Indians and Alaska Natives have the highest suicide rates of all ethnic groups in the United States, and suicide is the second leading cause of death for American Indian and Alaska Native youth. OBJECTIVE: To identify risk and protective factors associated with suicide attempts among native male and female adolescents. DESIGN: The 1990 National American Indian Adolescent Health Survey. SETTING: Schools of reservation communities in 8 Indian Health Service areas. PARTICIPANTS: Eleven thousand six hundred sixty-six 7th- through 12th-grade American Indian and Alaska native youth. MAIN OUTCOME MEASURES: Responses were compared among adolescents with and without a self-reported history of attempted suicide. Independent variables included measures of community, family, and individual characteristics. Separate analyses were conducted for boys and girls. RESULTS: Ever attempting suicide was reported by 21.8% of girls and 11.8% of boys. By logistic regression done on boys and girls separately, suicide attempts were associated with friends or family members attempting or completing suicide; somatic symptoms; physical or sexual abuse; health concerns; using alcohol, marijuana, or other drugs; a history of being in a special education class; treatment for emotional problems; gang involvement; and gun availability. For male and female youth, discussing problems with friends or family, emotional health, and connectedness to family were protective against suicide attempts. The estimated probability of attempting suicide increased dramatically as the number of risk factors to which an adolescent was exposed increased; however, increasing protective factors was more effective at reducing the probability of a suicide attempt than was decreasing risk factors. CONCLUSIONS: A history of attempted suicide was associated with several risk and protective factors. In addition to targeting youth at increased risk, preventive efforts should include promotion of protective factors in the lives of all youth in this population.     

Nondisclosure of sexual orientation to a physician among a sample of gay, lesbian, and bisexual youth

BACKGROUND: The American Medical Association, the American Academy of Pediatrics, and the Society for Adolescent Medicine recommend discussing sexual orientation as part of the health supervision of all adolescents. Little is known about whether lesbian, gay, and bisexual (LGB) youth hide their orientation from health care providers, which can potentially lead to missed opportunities in identifying individual health risks and provide appropriate screening and counseling. OBJECTIVES: To describe the health care experiences of a nonclinical sample of LGB youth and identify factors associated with disclosure and nondisclosure of orientation to physicians. DESIGN: Community-based participatory study using a self-administered questionnaire. SETTING: Los Angeles youth empowerment conference held in October 2003 targeting high school-aged LGB youth. PARTICIPANTS: One hundred thirty-one youth aged 14 to 18 years who identified themselves as LGB. Main Outcome Measure Physician's knowledge of participant's sexual orientation. RESULTS: Thirty-five percent of the sample reported that their physician knew they were LGB. Bisexual youth were less likely than gay and lesbian youth to have disclosed. The strongest predictor of disclosure was having discussed sex or sexual health of any kind with a physician (odds ratio, 15.47; 95% confidence interval, 4.34-55.18). When asked what a physician could do to make talking about being LGB more comfortable, 64% of participants chose the survey response, "Just ask me." CONCLUSIONS: Even among a nonclinical sample of LGB youth who were open enough about their orientation to attend a conference on the subject, only 35% reported that their physician knew their orientation. The results indicate that physicians had not discussed sexuality with most LGB youth in the study and that most youth would welcome such a discussion.     

Adolescent suicide and suicide attempts: a population study

To clarify the epidemiology of adolescent suicide, a retrospective study was undertaken of suicides (1978 to 1982) and hospitalized suicide attempts (1979 to 1983) by adolescents aged 10 to 19 years in an affluent suburban area. Data included date of injury, demography (for both suicides and suicide attempts), and recorded personal and social history (available for attempts only). There were 11 deaths due to suicide (definite or possible) in the five years reviewed: seven male, 10 aged 15 to 19 years. The mean annual rate for suicide deaths (definite and possible, based on ICD codes) was 10.3 per 100,000 15 to 19 year olds, with male rates exceeding female rates. Male rates were lower in the study area than in Chicago, Illinois or the United States, but female rates were higher. Suicides represented an unusually high proportion of all adolescent deaths. Atypically, there were no firearm suicide deaths. Two hundred ten suicide attempts were studied: 77% aged 15 to 19 years, 70% female, and 82% white; 83% involved ingestion of medications or poisons. The mean annual suicide attempt rate was approximately 140 per 100,000 for 15 to 19 year olds, and 45 per 100,000 for 10 to 14 year olds, with female rates exceeding male rates. There was an association between suicide attempt dates and occurrence of holidays, and there was a peak in attempts at the end of the school year. Detailed analysis of personal and social attributes associated with suicide attempts was prevented by poor recording of relevant factors in the medical record.(ABSTRACT TRUNCATED AT 250 WORDS)     

The association between health risk behaviors and sexual orientation among a school-based sample of adolescents

OBJECTIVE: This study is one of the first to examine the association between sexual orientation and health risk behaviors among a representative, school-based sample of adolescents. DESIGN: This study was conducted on an anonymous, representative sample of 4159 9th- to 12th-grade students in public high schools from Massachusetts' expanded Centers for Disease Control and Prevention 1995 Youth Risk Behavior Survey. Sexual orientation was determined by the following question: "Which of the following best describes you?" A total of 104 students self-identified as gay, lesbian, or bisexual (GLB), representing 2.5% of the overall population. Of GLB youth, 66.7% were male and 70% were white (not Hispanic). Health risk and problem behaviors were analyzed comparing GLB youth and their peers. Those variables found to be significantly associated with GLB youth were then analyzed by multiple logistic regression models. RESULTS: GLB youth were more likely than their peers to have been victimized and threatened and to have been engaged in a variety of risk behaviors including suicidal ideation and attempts, multiple substance use, and sexual risk behaviors. Four separate logistic regression models were constructed. Model I, Onset of Behaviors Before Age 13, showed use of cocaine before age 13 years as strongly associated with GLB orientation (odds ratio [OR]: 6.10; 95% confidence interval [CI] = 2.45-15.20). Early initiation of sexual intercourse (2.15; 10.6-4.38), marijuana use (1.98; 1.04-4.09), and alcohol use (1.82; 1.03-3.23) also was associated with GLB orientation. Model II, Lifetime Frequencies of Behaviors, showed that frequency of crack cocaine use (1.38; 1.06-1.79), inhalant use (1.30; 1.05-1.61), and number of sexual partners (1.27; 1.06-1.43) was associated with GLB orientation. Model III, Frequency of Recent Behaviors, showed smokeless tobacco use in the past 30 days (1.38; 1. 20-1.59) and number of sexual partners in the previous 3 months (1. 47; 1.31-1.65) were associated with GLB orientation. Model IV, Frequency of Behaviors at School, showed having one's property stolen or deliberately damaged (1.23; 1.08-1.40) and using marijuana (1.29; 1.05-1.59) and smokeless tobacco (1.53; 1.30-1.81) were associated with GLB orientation. Overall, GLB respondents engaged disproportionately in multiple risk behaviors, reporting an increased mean number of risk behaviors (mean = 6.81 +/- 4.49) compared with the overall student population (mean = 3.45 +/- 3.15). CONCLUSION: GLB youth who self-identify during high school report disproportionate risk for a variety of health risk and problem behaviors, including suicide, victimization, sexual risk behaviors, and multiple substance use. In addition, these youth are more likely to report engaging in multiple risk behaviors and initiating risk behaviors at an earlier age than are their peers. These findings suggest that educational efforts, prevention programs, and health services must be designed to address the unique needs of GLB youth.     

Correlates of body mass index among a nationally representative sample of New Zealand children.

OBJECTIVES: To describe how nutrition behaviours and physical activity are associated with body mass index (BMI) among New Zealand children and to determine if these relationships vary by ethnicity. METHODS: Data were collected during the 2002 National Children's Nutrition Survey. 3250 children provided information about their eating and activity behaviours and anthropometric measurements. RESULTS: Approximately 31% of New Zealand children aged 5 to 14 years were overweight/obese, with the highest prevalences of overweight/obesity among Pacific children (62%) and M?ori children (41%). Higher prevalences of obesity were also observed among females and children experiencing socioeconomic deprivation. Television use, buying school food from the dairy/takeaway shops, skipping breakfast, consumption of fruit drinks/soft drinks, and low physical activity were associated with BMI in analyses controlling for demographic characteristics among the total population. Buying school food from the dairy/takeaway (p=0.04) and skipping breakfast (p=0.007) retained significance when all nutrition behaviours and physical activity were analysed simultaneously. Significant interactions between ethnicity and bringing school food from home and buying school food from school were observed in relation to BMI. In most cases, the relationships were most significant for Pacific children. CONCLUSIONS: Strategies to address childhood obesity among all New Zealand children should primarily include efforts to increase breakfast consumption and decrease food purchases away from home. Given the high rates of obesity between Pacific and M?ori children, targeted interventions are warranted and should include strategies to improve the school food environment.     

Preadolescence and suicide attempts]

The authors refer their experience regarding suicide attempts in preadolescence, an age less discussed than adolescence in the international literature on the subject. A case-study of 27 patients (12 boys and 15 girls), all under 13 years and in-patients in the Child Neuropsychiatry Section of the Department of Pediatric and Adolescence Sciences of the Turin University during ten years (1990-1999), is described. Various criteria are taken into consideration, including incidence peaks, social extraction, birth order, methods used, psychiatric illness in the family, family break-ups, organic illness in the family, experience of loss, previous signs of emotional disturbance, precipitant events, any repeat attempts and the patients' psychopathological profiles, and the most important aspects are illustrated. The data resulting from the case-study show that suicide attempts by pre-teenagers are not as rare as commonly believed, especially at the age just before entering into true adolescence. The authors conclude by emphasising that suicide attempts seem to be a phenomenon involving particularly less well-off classes (a good 87% of the case-study); among the methods used, the ingestion of drugs is the most common, the incidence of psychiatric illness in the family (45%) is certainly relevant and in 70% of cases there were previous and evident signs of emotional disturbance. In consideration of the information already available and the findings reported in this study, attempted suicide attempts appear to be a and not a pathology, at which basis different psychopathological profiles can be found: it is a symptom of a serious emotional and relational problem, which rarely reveals itself suddenly and even more rarely is resolved without help.     

Risk and prevention of youth suicide.

The rate of fatal suicide attempts among males rose dramatically between 1950 and 1980 and has continued to rise significantly during the 1980s among 15- to 19-year-old youth. Nonfatal suicide attempts, although far more frequent among females, appear to share similar risk factors with completed suicide. The most important preconditional risk factors for both fatal and nonfatal suicide attempts are a history of a previous attempt, major affective and conduct disorders, chronic substance abuse, and a history of personal losses, including experience of suicide attempts by peers and family members. Risk factors for the acute precipitation of an attempt include the acute disruption of an interpersonal relationship, alcohol intoxication, and access to firearms. Preventive efforts can be enhanced by pediatricians both in the office and the community. Clinical case finding of individuals thought to be at high risk will continue to identify some potential victims. Families with household firearms should be counseled regarding the risk of firearm injury and death, particularly in a home with an individual with other risk factors. Community campaigns to improve the mental health of youth and to reduce firearm ownership may hold future promise for the reduction of the unacceptable morbidity and mortality associated with adolescent suicide attempts.     

Dating violence, sexual assault, and suicide attempts among urban teenagers

OBJECTIVE: To evaluate the relationship between dating violence, sexual assault, and suicide attempts among urban adolescents. DESIGN: Secondary analysis of the 2005 New York City Youth Risk Behavior Survey. SETTING: Eighty-seven New York City public high schools. PARTICIPANTS: Representative population-based sample of 8080 students, 14 years and older. MAIN EXPOSURES: Dating violence in the past year and lifetime history of sexual assault. OUTCOME MEASURE: One or more suicide attempts in the past year. RESULTS: Respondents were 50.0% female and primarily black (36.0%) or Hispanic (40.1%). In the past year, 11.7% of females and 7.2% of males reported 1 or more suicide attempts. Lifetime history of sexual assault was reported by 9.6% of females and 5.4% of males. Dating violence in the past year was reported by 10.6% of females and 9.5% of males. In multivariate models, controlling for persistent sadness, sexual orientation, and significant risk behaviors, recent dating violence (odds ratio, 1.61; 95% confidence interval, 1.05-2.47) was associated with suicide attempts in adolescent girls, while lifetime history of sexual assault (odds ratio, 3.86; 95% confidence interval, 2.11-7.06) was associated with suicide attempts in adolescent boys. CONCLUSIONS: In this population of urban youth, recent dating violence among females and lifetime history of sexual assault among males were significantly associated with suicide attempts. Clinicians and educators should be trained to routinely screen adolescents for violence victimization and should have a low threshold for referring these at-risk teenagers for mental health services.     

Suicide and suicide attempts in adolescents

Suicide is the third-leading cause of death for adolescents 15 to 19 years old. Pediatricians can take steps to help reduce the incidence of adolescent suicide by screening for depression and suicidal ideation and behavior. This report updates the previous statement of the American Academy of Pediatrics and is intended to assist the pediatrician in the identification and management of the adolescent at risk of suicide. The extent to which pediatricians provide appropriate care for suicidal adolescents depends on their knowledge, skill, comfort with the topic, and ready access to appropriate community resources. All teenagers with suicidal thoughts or behaviors should know that their pleas for assistance are heard and that pediatricians are willing to serve as advocates to help resolve the crisis.     

Risk indicators of suicide ideation among on-reserve First Nations youth

BACKGROUND:

Despite the known disparity in suicide rates in Canada, there is limited information on the independent risk indicators of suicide ideation among First Nations youth living on reserve.

OBJECTIVE:

To determine the prevalence and adjusted risk indicators for suicide ideation among on-reserve First Nations youth.

METHODS:

Saskatoon Tribal Council (Saskatchewan) First Nations students enrolled in grades 5 through 8 who were living on reserve were asked to complete a health survey using validated questionnaires. In total, 75.3% of the students completed the survey. The study was led by the Saskatoon Tribal Council with assistance from three departments at the University of Saskatchewan (Saskatoon, Saskatchewan).

RESULTS:

Among on-reserve First Nations youth, 23% experienced suicide ideation within the past 12 months. In comparison, 8.5% of Saskatoon urban youth and 19% of Saskatoon urban Aboriginal youth within the same grades experienced suicide ideation. Wanting to leave home (OR 13.91 [95% CI 3.05 to 63.42]), having depressed mood (OR 2.98 [95% CI 1.16 to 7.67]) and not feeling loved (OR 3.85 [95% CI 1.49 to 9.93]) were independently associated with suicide ideation among on-reserve youth. None of the children with a father who was professionally employed reported suicide ideation.

CONCLUSIONS:

Understanding the independent risk indicators associated with suicide ideation among First Nations youth living on reserve will hopefully aid in appropriate interventions.     

Associations of body mass index and perceived weight with suicide ideation and suicide attempts among US high school students

BACKGROUND: Previous research with adolescents has shown associations of body weight and perceptions of body size with suicide ideation and suicide attempts, but it is unclear whether these associations are direct or whether a mediating effect exists. OBJECTIVES: To determine if body mass index and perceived weight are associated significantly with suicide ideation and suicide attempts, controlling for weight control practices, and if perceived weight mediates the associations of body mass index with suicide ideation and suicide attempts. DESIGN, SETTING, AND PARTICIPANTS: Data were analyzed from the 2001 Youth Risk Behavior Survey, a school-based survey administered to a nationally representative sample of students in grades 9 through 12 (N = 13 601). MAIN OUTCOME MEASURE: Self-reported past-year suicide ideation and suicide attempts, compared by perceived weight and body mass index category, calculated from self-reported height and weight. RESULTS: Body mass index category was associated significantly with suicide ideation (among all students) and suicide attempts (among white and Hispanic students) without perceived weight in the model but not with perceived weight added to the model. In contrast with those who perceive themselves as about the right weight, students who perceived themselves as very underweight (odds ratio [OR], 2.29 [95% confidence interval (CI), 1.46-3.59]), slightly underweight (OR, 1.36 [95% CI, 1.03-1.79]), slightly overweight (OR, 1.33 [95% CI, 1.12-1.58]), and very overweight (OR, 2.50 [95% CI, 1.73-3.60]) had greater adjusted odds of suicide ideation. Among white students, perceiving oneself as very underweight (OR, 3.04 [95% CI, 1.40-6.58]) or very overweight (OR, 2.74 [95% CI, 1.21-6.23]) was associated with greater odds of suicide attempts. Perceiving oneself as very underweight was associated with greater odds for suicide attempts among black (OR, 2.86 [95% CI, 1.10-7.45]) and Hispanic (OR, 3.40 [95% CI, 1.54-7.51]) students. CONCLUSIONS: How adolescents perceive their body weight may be more important than their actual weight in terms of increased likelihood of suicidal behavior. Regardless of body mass index, extreme perceptions of weight appear to be significant risk factors for suicidal behavior; important racial/ethnic differences exist.     

Young people's risk of suicide attempts in relation to parental death: a population-based register study

Background: The objective of this study was to examine the association between the death of a biological parent and subsequent suicide attempts by young people (aged 10–22 years), and to explore sociodemographic factors as modifying factors in the process. Methods: The study used a nested case–control design. The full study population was obtained from the Danish longitudinal registers and included all individuals born between 1983 and 1989 (n = 403,431 individuals). The 3,465 registered suicide attempters from that group were matched with 75,300 population‐based control subjects. Potentially confounding variables including age and gender were controlled for by conditional logistic regression analyses. Results: The findings indicated that young people who had lost one biological parent showed a significantly increased risk of attempting suicide (relative risk = 1.71, 95% confidence interval = 1.49–1.96). Losing the remaining parent nearly doubled the risk (relative risk = 2.7, 95% confidence interval = 1.48–5.06). Conclusion: Experiencing the death of one or both biological parents increased the risk of suicide attempts in young people. Relative risk was moderated by high income of the father.