Gender influence in suicidal behaviour of Polish adolescents

Objective: The aim of the study was to assess the prevalence and possible suicide attempts and ideation predictors in the school population of girls and boys in the city of ód.Method: A selfadministered anonymous questionnaire was distributed to a representative (random) sample of 1663 students, aged 14–21. Boys and girls reporting no suicidal behaviour (NSB) constitute the control groups; the characteristics of these groups were compared to those of the groups with suicidal behaviour (SB), with focus on the associations between different variables and gender, separately for suicidal ideation (SI) and suicide attempts (SA).Results: About 37% of girls and 25% of boys reported suicidal ideation and about 11% and 5%, respectively, suicide attempts. Boys were more likely to make multiple suicide attempts. The relation between SB and the history of psychiatric treatment was the same for both sexes. Boys with SB were significantly more often fascinated with death, and girls were significantly more often exposed to difficult family situations.Abbreviations SI Suicidal Ideation - SA Suicidal Attempt - SB Suicidal Behaviour - NSB No Suicidal Behaviour - AACAP American Academy of Child and Adolescent Psychiatry - CDC Centres for Disease Control     

Gender role in adolescent suicidal behavior: observations and therapeutic implications

We analyzed the relative seriousness of suicide attempts by boys based on 430 hospitalized suicide attempters ages 13 to 19 years. A comparison by sex of adolescent suicide attempters with a school population of non-suicidal adolescents of the same age group shows greater differences in the areas of school failure, psychosomatic and distress-related symptoms and substance abuse between suicidal and non-suicidal boys than between suicidal and non-suicidal girls. These findings suggest that compared with non-suicidal boys and girls, suicidal boys show more deviant behavior than girls. The question then arises as to whether there are differences in the treatment received by male and female suicide attempters. On hospital admission, more boys than girls are sent to psychiatric wards, and boys are proposed follow-up care more frequently than girls. On the other hand, boys and girls are not treated differently with respect to psychiatric consultations during hospitalization or coordination with outside physicians (family doctor, school doctor, other physicians) and the social services. These findings could serve as the basis for the development of specific treatment plans to meet the needs of suicidal boys.     

A population-based survey of the characteristics of high school students with and without a history of suicidal behavior.

In a sample of 570 15- and 16-year-old normal high school students, the characteristics of those with and without a history of suicidal behavior were compared. In a written inquiry, information was obtained on family background, emotional and behavioral problems, sexual and physical abuse and suicidal thoughts and behavior. Differences between the students with and without a history of suicidal behavior were statistically analyzed for boys and girls separately by a matched control design. The results for both boys and girls indicated that the experience of sexual abuse, feelings of loneliness, depressed mood, low self-esteem and the use of drugs were particularly strongly related to suicidal thoughts and behavior; for girls, physical abuse and for boys, low self-reported academic achievement appeared to be clearly related aspects. Furthermore, the strong interrelations between all of these variables is underlined, suggesting a multi-problem background of youngsters with a history of suicidal behavior.     

Risk factors associated with suicide attempt in young French people

Demographic data, personal and familial characteristics, as well as DSM-III-R-based psychiatric diagnoses were collected in 369 adolescents and young adults aged between 15 and 29 years, referred to an Emergency Department for psychological problems. In total, 60% of them were suicide attempters. Separations before the age of 12 years and depression in the family emerged as the main features distinguishing the suicidal group from the psychiatric control group. Fifty per cent of suicide attempters were repeaters. Fostering during childhood, suicide attempts and depression in the family were found to be risk factors for repeated self-attempts. These results support the view that significant levels of dysfunction, together with increased psychiatric morbidity, especially suicidal behaviour, characterize the families of young self-attempters.     

History of suicidal behaviour in the families of young suicides

The prevalence of attempted or completed suicide was studied in the families of a consecutive sample of young suicide victims aged 15–29 years. In 17 of 42 (40%) of the men and 5 of 16 (31%) of the women suicidal behaviour was found to be present in first-degree relatives. Male suicide victims with a family history of suicidal behaviour had an earlier debut of their own suicidal behaviour, longer suicidal processes, and had made more previous suicide attempts. Families in which suicidal behaviour was displayed by the victim's parents or siblings also had more frequent early separations between parent and victim and more substance abuse. Taking into account suicide by a friend or second-degree family member, it was found that 72% of suicide victims had a history of suicidal behaviour in close relationships.     

Menstrual cycle and profiles of suicidal behaviour

The first (or menstrual) and fourth (or premenstrual) week of the menstrual cycle may be associated with many suicide attempts in women. The study sample included 113 Spanish women who attempted suicide and contacted an emergency service. Inclusion criteria were as follows: fertility; regular menstrual cycles; lack of oral contraceptives; and willingness to see a psychiatrist. The incidence of suicide attempts in the first week (36%) was significantly higher than that in the remaining weeks (second week, 19%; third week 16%; fourth week, 29%). A correspondence analysis suggested that suicide attempts were associated with differences in demographics and clinical profiles. In particular, suicide attempts in the third week were correlated with a severe history of psychiatric problems and a lower level of education. The limitations of this study are its exclusiveness to hospitalized cases and its use of patient reports to date menstruation.     

Gender differences in perceptions of the severity and prevalence of eating disorders

Aim: Gender differences in perceptions of the severity and prevalence of anorexia nervosa (AN) and bulimia nervosa (BN) were examined in young men (n = 113) and women (n = 289) recruited from a regional university campus in north‐east Australia. Methods: Participants viewed vignettes of fictional (female) sufferers of AN and BN and responded to the same series of questions in relation to each vignette. Results: For both vignettes, a substantial minority of male, but not female, participants indicated that they would be a little or not at all sympathetic to someone with the problem described, that the problem described would be a little or not at all difficult to treat, and that having the problem described would be moderately or a little distressing. Men were also more likely than women to consider BN to be primarily a problem of ‘lack of will‐power/self‐control’. Perceptions of the prevalence of AN (modal response = ‘very few women/10% or less’) and BN (‘10% to 30%’) did not differ by gender and both male and female participants considered AN to be more severe and less common than BN. Conclusions: The findings suggest that there may be a need to target the attitudes and beliefs of young men in particular in the prevention and early intervention initiatives for eating disorders.     

Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments

OBJECTIVE: To present prevalence findings of DSM-IV somatoform symptoms, syndromes and disorders in a representative sample of adolescents and young adults. METHOD: Data come from the Early Developmental Stages of Psychopathology (EDSP) study, in which a total of 3021 respondents aged 14-24 years were assessed by the Munich-Composite International Diagnostic Interview. RESULTS: Although specific DSM-IV somatoform disorders were relatively rare with a lifetime rate of 2.7%, a considerably higher proportion of respondents met criteria for clinically significant somatoform syndromes as defined by the Somatic Symptom Index SSI4, 6 (lifetime: 1.7%), as well as the undifferentiated somatoform/dissociative syndrome USDS (lifetime: 9.1%), resulting in an overall prevalence rate of 12.6%. Somatoform conditions are often comorbid with other mental disorders and were found to be associated with remarkable impairments and disabilities. CONCLUSION: Somatoform disorders and syndromes in young adults are frequent, impairing and often associated with the development of other mental disorders.     

Suicidal behaviour of psychiatric in-patients

OBJECTIVE: The study aimed to examine suicidal behaviour before and during in-patient care in a psychiatric state hospital. METHOD: Based upon a psychiatric basic documentation system prevalence and risk factors of in-patient suicides, suicide attempts and suicidal thoughts were investigated over an 11-year period from 1989 until 1999. RESULTS: A total of 30 in-patient suicides were found among 21 062 patients. According to the multivariate logistic regression analysis the risk of hospital suicide increases for patients with schizophrenia, higher cumulative length of stay, previous suicide attempt, part-time employment and training/retraining. Predictors of suicide attempt during hospitalization are suicide attempt on admission, personality disorder, suicidal thoughts on admission, schizophrenia and affective disorder. CONCLUSION: As Schizophrenics represent the high-risk group of in-patient suicide, suicide prevention should be a major goal in their treatment. More frequent suicide risk assessment is recommended particularly before granting a leave or an outing.     

Short-term stability of depressive symptoms and suicide attempts in Swedish adolescents.

The prevalence of depressive symptoms, suicidal ideation and their relationship to perceived health problems and social relations were examined in a sample of 605 Swedish adolescents aged 13-18 years. Short-term stability of depressive symptoms and the turnover rate from a nondepressed to a depressed state were examined for subsamples of 36 depressed and 71 nondepressed subjects, respectively, who were retested after 4 to 6 weeks. Using Beck's criteria for clinical depression, 9% of the adolescents experienced moderate to severe depressive symptom levels. However, a more conservative estimate, 4%, was obtained when DSM-III criteria for major depressive disorder were applied. Approximately 3% of the adolescents had pronounced suicidal ideation and had made at least one previous suicide attempt. There was a tendency for boys to show more stable depressive symptoms and suicidal ideation than girls. Furthermore, a set of 5 psychosocial variables concerning the students' satisfaction with their school and leisure time, conflictual level at home and number of close friends predicted 31% of the variance of the subjects' total depressive symptom scores. Although a 32% decrease of depressive symptoms was noted for the depressed subsample of adolescents, 44% of these subjects continued to experience moderate to severe depression at follow-up.     

Differences between adolescent suicide attempters and depressed adolescents.

Most of the characteristics differentiating between adolescent attempters and nonattempters do not have discriminative power in comparing 48 adolescents who recently attempted suicide with 66 depressed adolescents. These characteristics may probably be attributed to an affective disorder that is present in most of the suicide attempters. However, suicide attempters, compared with the depressed group, live in more problematic circumstances (such as family disruption or sexual abuse) and have a cognitive style that promotes a more negative evaluation of events and situations. Their depressive symptoms are distinguished from the depressed group by withdrawal and isolation, besides maintaining a hopeless and negative expectation of the future. Furthermore, there are reasons to accept the idea that suicidal behavior is a serious alternative within their behavioral repertoire. Based on these findings, a psychological interpretation is given concerning the dynamics leading to a suicide attempt. Also, intervention strategies are discussed.     

Gender differences in first onset Schizophrenia spectrum psychoses

Background: Mental health profiles differ between boys and girls from puberty onwards. It is not known whether differences also extend to symptom presentation in schizophrenia spectrum disorders. It may be that girls and boys are not treated entirely equally by the professionals.

Aims: To study gender differences in symptom profiles, family adversities, pathway to care, and characteristics of inpatient treatment at the first episode of diagnosed schizophrenia spectrum disorder (F20–29) among adolescents aged 13–17.

Methods: A retrospective chart review of all (n?=?106) consecutive adolescents diagnosed for the first time with schizophrenia spectrum disorder (F20–29) in a specified catchment area. Girls and boys were compared with regard to sociodemographics, pathways to care, living arrangements, symptom profiles, and treatment received.

Results: During the study period more adolescent girls (n?=?70, 66%) than boys (n?=?36, 34%) were diagnosed with schizophrenia spectrum (F20–29) psychoses, most commonly F29. Girls were moreover younger (mean age?=?15.46) than boys (mean age?=?16.62) at admission. Girls more often displayed mood symptoms and boys aggressive behaviours, alcohol abuse problems, and isolation. Family adversities recorded as current stressors were more numerous among girls. Girls were more likely to be referred to specialized after-care than boys.

Conclusions: The gender differences observed in symptoms presentation are reminiscent of differences encountered in the general adolescent population. Prior to transition to psychosis, girls and boys are equally in contact with psychiatric services due to other (possibly prodromal) symptoms/disorders. Family adversities may be more stressful for girls vulnerable to psychosis than to boys.     

Familial clustering of suicidal behaviour and psychopathology in young suicide attempters

Introduction Familial clustering of suicidal behaviour and psychopathology has been reported in young suicide attempters. Most of these studies were predominantly carried out in clinical treatment settings and lacked statistical power to assess the independent and modifying influences of own and familial psychopathology and suicidal behaviour. Methods We carried out a population-based record-linkage study with a nested case control design. The 14,440 individuals hospitalised due to suicide attempt (cases) and 144,400 matched controls were born in Sweden between 1968 and 1980 and followed up till December 31, 1999. Results Among the strongest independent familial risk factors for youth suicide attempt were siblings’ (OR 3.4; 2.8–4.1), maternal (OR 2.7; 2.5–3.1) and paternal (OR 1.9; 1.7–2.1) suicide attempt. Other important risk factors were familial personality and substance abuse disorders, maternal schizophrenia, non-affective psychoses and organic disorders and parental neurotic, stress-related and somatoform disorders (1.9–3.2 fold increase), and paternal (OR 1.9; 1.6–2.3) and maternal (OR 1.8; 1.3–2.4) suicide completion. Mental illnesses in index subjects, particularly substance abuse, affective and personality disorders, were the dominant determinants of suicide attempt. Strong interactions were observed between psychopathology in index subjects and familial suicidality. Familial suicide completion had a stronger effect on suicide attempt of earlier onset and on boys. Nearly half (47%) of all suicide attempts could be attributed to familial psychopathology (13%), family suicide attempt (7%) and suicide completion (1%) and own psychopathology (25%). Conclusion Early recognition and adequate treatment of individual mental illness contribute to prevent youth suicide attempts. Children of parents with psychopathology and suicidal behaviour should receive early support and attention. Evaluation of familial suicidal behaviour seems to be vital for suicide risk assessment in young psychiatric inpatients. There appears to be an independent effect of familial suicidal behaviour as well as familial psychopathology on youth suicide attempt beyond the transmission of mental illness.     

Family history of suicidal behaviour: prevalence and significance in deliberate self-harm patients

OBJECTIVE: To investigate whether there are differences between the characteristics of deliberate self-harm (DSH) patients with and without a family history of suicidal behaviour. METHOD: In 146 DSH patients, those with and without a positive family history were compared with regard to the nature and repetition of their DSH episodes, and psychological and psychiatric characteristics. RESULTS: Fifty-two (35.6%) patients had a family history of suicidal behaviour. DSH was more frequent in patients' mothers (17.1%) than fathers (2.7%). Patients with a family history of suicidal behaviour, especially females, had higher state anger scores. CONCLUSION: Family history of suicidal behaviour appears to be associated with greater anger. Absence of other associations suggests that family history probably has less implication for individuals who have already engaged in DSH than in contributing to its initiation. Future studies should include patients with violent or life-threatening DSH acts.     

Locus of control as an indicator of risk for suicidal behaviour among adolescents

Using a sample of high school students, this pilot study investigated the relationship between locus of control and a range of suicidal behaviours, the proportion of high school students in an Australian sample who report having engaged in such behaviours and the proportion of suicide attempters who received medical attention following an attempt. Two hundred male and 205 female students aged between 13 and 19 years (mean = 15, SD = 1), attending one randomly chosen metropolitan state high school, completed a questionnaire that included demographic details, the Nowicki-Strickland Locus of Control Scale for Children and questions concerning suicide. The findings indicated that a substantial proportion of individuals in the sample have suicidal ideation. A smaller proportion have engaged in a range of more serious and overt self-destructive and suicidal behaviours. Further, a majority of attempters in the sample had not received medical attention following their attempt. There was also a clear association between locus of control and suicidal behaviour, with the individuals who had engaged in suicidal behaviours characterized by a more external locus of control orientation. This study adds further weight of evidence to the suggestion that the locus of control construct is useful in identifying adolescents at risk of engaging in suicidal behaviour.     

Beck's Depression Inventory as a screening instrument for adolescent depression in Sweden: gender differences

Beck's Depression Inventory was administered in a study of all students aged 16–17 years in the first year of high school in a Swedish town, and was completed by 93% of them (n=2270). Cronbach's reliability coefficient alpha was 0.89, and there were strong correlations between item scores and total scores. A diagnostic interview focused on depressive diagnosis during the last year was conducted with 88% (n=199) of all students with high scores (≥16), and with the same number of controls with low scores. A depressive diagnosis was confirmed in 73% of high scorers and 13% of low scorers. The questionnaire performed better with girls than with boys. The mean score was significantly higher for girls, and the proposed limit for moderate depression (a score of 16) was reached by 14.2% of girls and 4.8% of boys. All symptoms were significantly more frequent and more severe in girls. It was found that 20% of girls and 6% of boys reported suicidal ideation. In a factor analysis the strongest factor that emerged differed between the sexes. For boys it included sadness, crying and suicidal ideation, and for girls it included failure, guilt, self-dislike and feeling unattractive, combined with suicidal ideation. The gender differences are discussed.