Predictors of Suicidal Behaviors in Canadian Adolescents with No Recent History of Depression

We examined risk factors for suicidal behaviors (i.e., suicidal ideation and suicide attempts) in the absence of depression during adolescence. Using 6,788 adolescents from the National Longitudinal Survey of Children and Youth (NLSCY), we identified participants with “no recent history of depression.” We then tested the effects of risk factors at age 14–15 on suicidal behaviors at age 16–17. Absence of recent depression history negatively predicted both suicidal ideation and suicide attempt. However, among those with no history of depression, substance use and the presence of a chronic illness both increased the risk of suicidal behaviors. Suicidal behavior in adolescents in the absence of depression history may be explained by factors such as substance use and chronic illness.     

Primary care patients' personal illness models for depression: relationship to coping behavior and functional disability

OBJECTIVE: The applicability and clinical utility of Leventhal et al.'s model of illness cognition were evaluated in depressed primary care patients. The intercorrelations of illness beliefs and the mediational effects of coping behavior on these beliefs were also evaluated. Moderating effects of coping behaviors were explored. METHODS: Baseline evaluations of demographic information, depression diagnoses, depressive symptom severity, self-reported psychosocial and physical functioning, medical comorbidity, illness beliefs and depression coping strategies were obtained from 191 primary care patients receiving antidepressant medication for the treatment of depression. RESULTS: Patients' beliefs about depressive symptoms, causes, duration as well as controllability and the consequences of these symptoms are described. Leventhal et al.'s mediational model was partially supported for the outcome of psychosocial functioning. Coping behavior did not mediate the relationship between illness beliefs and physical functioning. The relationships between participants' beliefs about the cause, controllability and duration of depressive symptoms were mediated by the use of behavioral disengagement, venting or self-blame as a strategy to cope with depression. In addition, use of acceptance, religious coping or behavioral disengagement moderated the relationship between beliefs about the cause of depression (i.e., environment or chance or medical illness) and psychosocial functioning. CONCLUSIONS: Illness models for depression are important determinants of functioning in depressed primary care patients. These beliefs and coping behaviors are potentially modifiable and could be the target of interventions to decrease functional impairment in depressed patients.     

Psychotic-like experiences and their relationship to suicidal ideation in adolescents

Studies have suggested that psychotic-like experiences (PLEs) are associated with behavioral problems in adolescents. The aim of this study was to investigate relationships between domains of PLEs, suicidal ideation, and depression in a large community sample of adolescents. The sample consisted of 8096 Korean subjects (3184 boys and 4912 girls) aged 14 to 19 years. The level of PLEs, depression, and suicidal ideation were assessed by the Eppendorf schizophrenia inventory (ESI), Beck's depression inventory, and Beck's scale for suicidal ideation, respectively. Both the level of depression and suicidal ideation were significantly associated with PLEs. Among the four domains of the ESI, the deviant perception, ideas of reference, and auditory uncertainty were associated with the suicidal ideation. Additionally, subjects with more PLEs had significantly more suicidal ideation and depressive symptoms. PLEs in adolescents are associated with potential risk of suicide and depressive symptoms significantly mediated the association between suicidal ideation and PLEs. The presence of perceptual disturbances, ideas of reference, and depression may be regarded as warning signs for suicide-related behaviors.     

Personality predictors of outcome for adolescents hospitalized for suicidal ideation

OBJECTIVE: Recent cross-sectional studies of adolescents have noted an association between the personality traits of perfectionism and self-criticism and suicidal ideation. The present study was undertaken to examine the relationship between personality dimensions and the outcome of treatment of adolescents hospitalized for suicidal ideation or behavior. METHOD: The study group was composed of 78 adolescents who were admitted to an adolescent psychiatric inpatient unit for suicidal ideation or attempts. Subjects completed measures of self-criticism, interpersonal dependency, self-oriented perfectionism, and socially prescribed perfectionism as well as the broad, higher-order trait neuroticism. Depression symptoms, hopelessness, and suicidal ideation were assessed at the beginning (time 1) and end (time 2) of their inpatient treatment. Readmissions were identified by review of medical records 1 year after hospital discharge. RESULTS: After controlling for baseline symptoms, neuroticism was associated with posttreatment depression and suicidal ideation. After controlling for time 1 symptoms and neuroticism in multiple regression analyses, self-criticism was associated with post-treatment hopelessness and depression. Logistic regression analysis was used to identify predictors of readmission. Baseline suicidal ideation and neuroticism were predictive of psychiatric readmission within 1 year of discharge. CONCLUSIONS: Neuroticism and self-criticism are potentially useful predictors of outcome in suicidal adolescents and can be assessed quickly and reliably. Therapeutic interventions directed at self-criticism (e.g., cognitive-behavioral therapy) may be useful in the treatment of suicidal adolescents.     

Adolescent suicidal ideation as predictive of psychopathology, suicidal behavior, and compromised functioning at age 30

OBJECTIVE: The purpose of this study was to examine whether suicidal ideation in a community population of adolescents represents normative adolescent angst or is predictive of psychopathology, suicidal and problem behaviors, and compromised functioning 15 years after onset. METHOD: Participants were 346 largely Caucasian individuals who were part of a single-age cohort from a working class community and whose development had been traced prospectively from ages 5 to 30. Those with suicidal ideation at age 15 were compared to those without suicidal ideation at age 15 on measures of psychopathology, suicidal ideation and behavior, problem behaviors, and adult functioning at age 30. Gender differences were assessed across all domains. RESULTS: At age 30, there were marked differences between adolescents with suicidal ideation and adolescents without suicidal ideation of both genders in most domains examined. Subjects with suicidal ideation were twice as likely to have an axis I disorder, nearly 12 times more likely to have attempted suicide by age 30, and 15 times more likely to have expressed suicidal thoughts in the past 4 years. Subjects with suicidal ideation had more problem behaviors and poorer overall functioning as assessed by multiple informants. Their self-perceptions of coping ability, self-esteem, and interpersonal relations were also lower. Although subjects with suicidal ideation among both genders had higher levels of psychopathology, suicidal ideation and behavior, and problem behaviors at age 30, male subjects with suicidal ideation had lower salaries and socioeconomic status and were less likely to have achieved residential independence. CONCLUSIONS: Findings underscore the importance of considering suicidal ideation in adolescence as a marker of severe distress and a predictor of compromised functioning, indicating the need for early identification and continued intervention.     

Cross-situational coping with peer and family stressors in adolescent offspring of depressed parents

Offspring of depressed parents are faced with significant interpersonal stress both within their families and in peer relationships. The present study examined parent and self-reports of adolescents' coping in response to family and peer stressors in 73 adolescent children of parents with a history of depression. Correlational analyses indicated that adolescents were moderately consistent in the coping strategies used with peer stress and family stress. Mean levels of coping were similar across situations, as adolescents reported greater use of secondary control coping (i.e., acceptance, distraction) than primary control coping (i.e., problem solving, emotional expression) or disengagement coping (i.e., avoidance) with both types of stress. Regression analyses indicated that fewer symptoms of self-reported anxiety/depression and aggression were related to using secondary control coping strategies in response to family stress and primary control coping in response to peer stress. Implications for understanding the characteristics of effective coping with stress related to living with a depressed parent are highlighted.     

Spirituality,Religion, and Suicidality Among Veterans: A Qualitative Study

This qualitative study explores the relationship between veterans’ spirituality/religion and suicide ideation and attempts. Qualitative semi-structured interviews were conducted with 30 veterans who either endorsed chronic suicidal ideation or had made suicide attempt(s). Interviews explored the bi-directional relationship between spirituality/religion (e.g., beliefs, practices, and experiences), and suicide ideation and behaviors. Interviews were analyzed using thematic analysis. Veterans’ responses indicate that spirituality/religion can discourage or permit suicidal ideation, help in coping with ideation, and facilitate meaning making and coping in the presence of self-perceived suffering. Veterans who survived a suicide attempt explored the impact of their spirituality/religion on their recovery. Findings highlight a complex and diverse relationship between spirituality/religion and suicidality. These findings may inform further research on treatment strategies that assess the function of spirituality/religion, and incorporate protective aspects of spirituality/religion into mental health treatment.     

Suicidal ideation in treatment-seeking Veterans of Operations Enduring Freedom and Iraqi Freedom: the role of coping strategies, resilience, and social support

Background

Recent epidemiologic studies have found an increased risk of suicide among Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF) with psychiatric disorders. However, little is known about whether variables other than psychiatric conditions, such as coping strategies, resilience, and social support, may be related to suicidality in this population.

Methods

A total of 167 OEF-OIF Veterans seeking behavioral or primary care services completed a survey containing measures of combat exposure, psychopathology, pain, psychological resilience, social support, and cognitive coping strategies.

Results

Thirty-six respondents (21.6%) reported contemplating suicide in the two weeks prior to completing the survey. Compared to suicide non-contemplators, suicide contemplators were older, and more likely to screen positive for depression and posttraumatic stress disorder (PTSD), and to report a deployment-related pain condition or complaint. They also scored higher on measures of worry, self-punishment, and cognitive-behavioral avoidance strategies, and lower on measures of psychological resilience and postdeployment social support. Multivariate analysis revealed that a positive depression screen, and higher scores on measures of self-punishment and cognitive-social avoidance coping were positively associated with suicidal ideation, while higher scores on measures of psychological resilience (i.e., positive acceptance of change) were negatively related to suicidal ideation. Moderator analysis revealed that a positive screen for depression or PTSD significantly diminished the protective effect of postdeployment social support on suicidal ideation.

Conclusions

1 in 5 treatment-seeking OEF-OIF Veterans may contemplate suicide. Interventions to reduce depressive symptoms, and maladaptive cognitive-behavioral coping strategies of self-punishment and cognitive social avoidance, and to bolster psychological resilience may help mitigate suicidality in this population.     

Real-time predictors of suicidal ideation: mobile assessment of hospitalized depressed patients

Suicidal ideation is a risk factor for suicide attempt and completion. Cross-sectional or retrospective studies cannot capture the dynamic course and possible predictors of suicidal ideation as it occurs in daily life. This study utilizes an experience sampling paradigm to identify real-time predictors of suicidal ideation in inpatients with major depressive disorder. Thirty-one depressed patients admitted to a psychiatric unit were signaled by a mobile device to record suicidal ideation, affect, and other symptoms, multiple times a day over 1 week. Participants completed a total of 1350 questionnaires. Seventy-four percent of the sample reported suicidal ideation during the week. Time-lagged analyses revealed that momentary ratings of Sadness, Tension, and Boredom (as well as suicidal ideation itself) predicted subsequent suicidal thoughts in the following hours. Baseline severity of depression and past suicide attempts were both correlated with mean ideation severity during the week. A number of predictors identified in prior research (e.g. hopelessness) were unrelated to subsequent suicidal ideation in the current study. Momentary interventions that guide individuals through activities designed to reduce levels of Sadness, Tension, and Boredom in real-time (e.g., thought challenging, relaxation, behavioral activation) may be especially warranted.     

Coping and depressive symptoms in adolescents with a chronic medical condition: A search for intervention targets

The aim of the present study was to find relevant coping factors for the development of psychological intervention programs for adolescents with a chronic medical condition. A wide range of coping techniques were studied, including cognitive coping, behavioral coping and goal adjustment coping. A total of 176 adolescents participated. They were contacted through social networking websites or Internet forums and through schools for children with a physical disability. Several cognitive and behavioral coping strategies and goal adjustment were found to be related to symptoms of depression. The cognitive coping strategies had the strongest influence on depressive symptoms. Especially self-blame, rumination and catastrophizing seemed to be important factors. If these findings can be confirmed, they could contribute to the focus and content of intervention programs for adolescents with a chronic medical condition.     

Suicidality in Chinese adolescents in Hong Kong: the role of family and cultural influences

BACKGROUND: Adolescent suicidal ideation has found to predict suicidal behaviors and psychopathology in adulthood. Previous studies focused solely on the medical and environmental risk factors, which were insufficient to give a holistic picture of adolescent suicidality. OBJECTIVES: To assess the role of affective and cognitive attributes in the identification and prevention of adolescent suicidal ideation. METHOD: A community sample of 511 participants (age 15-19 years) were asked to indicate their suicidality in the 12 months and in their lifetime. Generalized estimating equation regression models were used to examine the effect of psychosocial and socio-environmental correlates in relation to adolescent suicidal ideation. RESULTS: The data show that perceived responsibilities for family was the only protective factor, while a coping mechanism by behavioral disengagement, severity of depressive symptoms, a history of deliberate self-harm, chronic physical illness or pain, media reporting of suicide news, and low household income were the risk factors for adolescent suicidal ideation. CONCLUSIONS: The results suggest that a multilayer effort for preventing adolescent suicide is needed by providing support for children in deprived families; enhancing life skills in the teens; strengthening family relationship; improving mental and health services; and promoting responsible media reporting on suicide.     

Teenagers' attitudes about coping strategies and help-seeking behavior for suicidality

OBJECTIVE: To identify youths' attitudes about coping and help-seeking strategies for suicidal ideation/behavior and examine their demographic and clinical correlates. METHOD: A self-report survey was completed by high school students (N = 2,419) in six New York State schools from 1998 through 2001. The relationship between suicide attitudes and gender, depression, substance problems, serious suicidal ideation/behavior, and first-hand experience with a suicidal peer was examined. RESULTS: Two factors that approximate avoidance and approach coping responses, maladaptive coping strategies and help-seeking strategies, respectively, were identified. Boys scored higher than girls (t = 7.96, df = 2341, p < .001), and depressed youths (t = 15.56, df = 2323, p < .001), students with substance problems (t = 11.07, df = 2340, p < .001), and suicidal youths (t = 15.14, df = 2341, p < .001) scored significantly higher than their healthy counterparts on the maladaptive coping strategies factor. Students with first-hand experience with a suicidal peer scored significantly higher on the maladaptive coping strategies factor than those without this experience (t = 7.95, df = 2321, p < .001). Lower risk groups scored significantly higher on an adaptive help-seeking strategies factor. CONCLUSIONS: High-risk adolescents' attitudes are characterized by core beliefs that support the use of maladaptive coping strategies in response to depression and suicidal thoughts and behaviors. Targeting such attitudes is a recommended component of youth suicide prevention efforts.     

Developing coping typologies of minority adolescents: a latent profile analysis

Latent profile analysis (LPA) was used to develop a coping typology of minority adolescents (M=15.5 years). A multiethnic sample (n=354) was recruited from a program aimed at serving low-income students. LPA revealed three distinct coping profiles. The first comprised adolescents who used a number of specific coping strategies at a low level (low generic copers). The second comprised adolescents who emphasized active/approach strategies (e.g., planning; active copers). The third comprised adolescents who emphasized avoidant/passive strategies (e.g., substance abuse; avoidant copers). Active copers experienced significantly less depression and more stress-related growth than low generic copers. Low generic copers not only experienced significantly less depression than avoidant copers but also significantly less stress-related growth than active copers. Discussion focuses on integrating the current typology with traditional coping taxonomies.     

Do Addictive Behaviors Matter for College Students’ Depression and Suicidal Ideation?

Previous research has shown that depression is an important predictor for suicidal ideation and that depression, addictive behaviors, and suicidal ideations are highly associated with each other. However, no studies have specifically investigated the role of addictive behaviors (i.e., alcohol use, gambling) as moderators on the association between depression and suicidal ideation among Korean college students. This study examined (1) the association between depression and suicidal ideation using Depression, Anxiety and Stress Scale (DASS-21) and five selected items from the Youth Risk Behavior Surveillance System (YRBSS), and (2) the moderating roles of alcohol use and problem gambling using Alcohol Use Disorder Identification Test (AUDIT) and Problem Gambling Severity Index (PGSI). We collected data from full-time students (n?=?870) enrolled at 14 universities throughout South Korea using a self-reported paper-pencil survey conducted on college campuses. More than half of the total sample (52.3%, n?=?450) reported either alcohol use or gambling, and findings revealed that depression, alcohol use, and gambling are associated with suicidal ideation. We found a significant moderating effect of alcohol use on the relationship between depression and suicidal ideation (ß?=?.151, p?<?.001); whereas, gambling had no significant moderating effect on the relationship (ß?=?.054, p?<?.276). The influence of depression on suicidal ideation was greater for Korean college students who used high levels of alcohol compared to those who used low levels of alcohol. The results suggest that alcohol use is an important modifiable factor for suicidal ideation especially in students with depression, and provide a foundation for future research aimed at understanding complex and nuanced mechanisms linking depression, addictive behaviors, and suicidal ideation.     

The Modified Depression Scale (MDS): A Brief, No-Cost Assessment Tool to Estimate the Level of Depressive Symptoms in Students and Schools

Adolescent health researchers and practitioners are frequently interested in assessing depression as part of student screening and for school-wide prevention and intervention planning. However, this task is challenging given the lack of free, brief assessments of depressive symptoms in youth. This study evaluated the psychometric properties of an adapted version of the Modified Depression Scale (MDS). Data came from a school-based survey of 9th-12th graders in Boston (N = 1,657). We assessed internal consistency reliability and known-group validity, in addition to the feasibility of establishing a dichotomous cut-point to classify adolescents as having high versus low depressive symptoms. We also evaluated the validity of the adapted MDS as a school-wide measure. At the student level, the adapted MDS demonstrated acceptable internal consistency. Students engaging in risk behaviors (e.g., substance use) or who were victimized (e.g., bullied) had significantly higher depressive symptom scores. Students who endorsed four or five MDS symptoms often or always had a heightened risk of suicidal ideation, substance use, and failing grades when compared to students who endorsed three or fewer symptoms often or always. At the school level, higher mean levels of depressive symptoms in a school were associated with higher mean levels of suicidal ideation and failing grades. Results of this study suggest that the adapted MDS is a promising measurement tool that could be useful to school-based professionals and researchers to evaluate depressive symptoms in adolescents and ascertain the prevalence of depressive symptoms in schools.     

Accommodative coping in early adolescence: An investigation of possible developmental components

Despite fruitful research on some aspects of adolescent coping, the development of specific coping mechanisms still remains a neglected topic. The present empirical study with 535 early adolescents (M = 12.60 years) and their parents examines possible developmental components of accommodative coping competences. Using latent path modelling, we investigated how specific components of four sets of variables (cognitive abilities, experiences in life, goal disengagement, and parental influences) contributed to accommodative coping capacities in the adolescents. Direct effects (e.g., specific cognitive abilities, parental influences) and indirect effects (e.g., positive experiences in life) on accommodative coping were identified for the components investigated. Future research should focus on the relevance of these components for the development of accommodative coping capacities.     

Coping and thought suppression as predictors of suicidal ideation in depressed older adults with personality disorders

Suicide rates are higher among older adults than any other age group and suicidal ideation is one of the best predictors of completed suicide in older adults. Despite this, few studies have evaluated predictors of suicidal ideation and other correlates of death by suicide (e.g. hopelessness) among older adults. Even fewer studies on this topic have been conducted among samples characterized as poor responders to treatments (e.g. depressed individuals with co-occurring personality disorder). The purpose of this study was to examine coping styles and thought suppression as predictors of a suicide risk composite score in a sample of depressed older adults with co-occurring personality disorders. Based on the extant literature, it was hypothesized that maladaptive coping (i.e. emotional and avoidance coping) and chronic thought suppression would significantly predict suicide risk. The results of this study indicated that elevated emotional coping and thought suppression were associated with increased suicide risk. Contrary to hypotheses, lower avoidance coping was associated with increased risk, although this finding is moderated by Axis II diagnosis Thus, treatments that focus on decreasing emotional coping and chronic thought suppression may result in decreased suicidal ideation and hopelessness for older adults with depression and Axis II pathology.     

Suicidal ideation in family carers of people with dementia

Objective: Two small studies have suggested that family carers of people with dementia may be a high-risk group for suicide. The objective of this study was to further explore the rate of suicidal ideation in a large sample of carers and identify psychosocial risk and protective factors.

Method: A cross-sectional survey was conducted with 566 family carers. The survey included measures of suicidality, self-efficacy, physical health, depression, anxiety, hopelessness, optimism, burden, coping strategies, and social support.

Results: Sixteen percent of carers had contemplated suicide more than once in the previous year. There were univariate differences between suicidal and non-suicidal carers on self-efficacy, social support, coping, burden, depression, anxiety, hopelessness, optimism, reasons for living, and symptoms of dementia, as well as age and income management. In a multivariate model, age, depression, and reasons for living predicted suicidal ideation. In tests for mediation, satisfaction with social support and dysfunctional coping had indirect effects on suicidal ideation via depression.

Conclusion: Family carers of people with dementia have high rates of suicidal ideation, with depression a risk factor and increasing age and reasons for living as protective factors. Depression and reasons for living should be targeted in interventions to reduce suicide risk in dementia carers.     

Stress and Coping Predicts Adjustment and Glycemic Control in Adolescents with Type 1 Diabetes

Background

Adolescents with type 1 diabetes are at increased risk for deteriorating glycemic control, poor quality of life, and depressive symptoms. Stress and coping are related to these outcomes in adolescents with diabetes, yet few studies have examined these constructs longitudinally.

Purpose

This study aimed to describe stress and coping in adolescents with type 1 diabetes and to examine coping strategies as predictors of adolescent adjustment (i.e., depressive symptoms, quality of life) and glycemic control.

Methods

Adolescents with type 1 diabetes completed measures of diabetes-related stress, coping, symptoms of depression, and quality of life at baseline, 6 months, and 12 months. Data on glycemic control were collected from the adolescents’ medical charts.

Results

The adolescents’ use of primary control coping (e.g., problem solving) and secondary control engagement coping (e.g., positive thinking) strategies predicted significantly fewer problems with quality of life and fewer depressive symptoms over time. In contrast, the use of disengagement coping strategies (e.g., avoidance) predicted more problems with quality of life and depressive symptoms. Coping was not a significant predictor of glycemic control. Coping mediated the effects of diabetes-related stress on depressive symptoms and quality of life.

Conclusions

The ways in which adolescents with type 1 diabetes cope with diabetes-related stress predict quality of life and symptoms of depression but not glycemic control. Through the use of screening to identify adolescent’s diabetes-related stress and targeted interventions to improve coping strategies, there is potential to improve outcomes.

     

Maternal versus adolescent reports of suicidal behaviors: a nationwide survey in Israel

Community and nationwide surveys on adolescent suicidal behaviors using clinical interviews are not abundant. Rates of self-reported suicide attempts in community samples vary greatly between 1 and 20 %. In general, adolescent and parental agreement in child psychiatry practice is low, and their agreement with regard to suicidal behavior is unknown. The current study assesses the rates of suicidal ideation and behaviors as well as the rate of agreement between adolescents and their mothers in a representative nationwide sample. The survey included a representative and randomized community sample of 14- to 17-year-old adolescents (n = 957), and their mothers who were interviewed using the Development and Well-Being Assessment Inventory (DAWBA). The prevalence of suicidal ideation and self-initiated behaviors was 4.9 and 1.9 %, respectively. The concordance between mothers’ and adolescents’ reporting on ideation was low (7.3 %). There was no concordance between mothers’ and adolescents’ reports of suicidal acts. Adolescents reported self-initiated behaviors nearly three times more frequently than their mothers. Paternal unemployment, care by welfare agencies and having a psychiatric disorder, specifically depression or post-traumatic stress disorder, was associated with a higher risk for both suicidal ideation and attempts. In this nationwide community study, by evaluating information gathered by clinical interviews, it was found that the lifetime rates of suicidal ideation were moderate. The rates of suicide attempts were lower than have been previously reported. The concordance between the reports of adolescents and their mothers was low for ideation and nonexistent for attempts. Thus, clinicians should interview adolescents separately from their mothers regarding their suicidality.