Fatal and non-fatal suicidal behavior in Israeli adolescent males

The objective of this study is examine the similarities and differences between adolescent suicide completers, adolescents with non-fatal suicidal symptoms, and non-suicidal psychiatric controls in an epidemiologic sample. Using the central Israeli military medical registry, 214 18-21 year old males from the same national service cohort were identified, consisting of 43 consecutive completed suicides and 171 consecutive central psychiatric clinic outpatients presenting with near-fatal suicide attempts, serious suicide attempts, para-suicidal gestures, threats, ideation, or other non-suicidal complaints. Systematic pre-induction and service data were available for all subjects, with detailed postmortem inquest data for suicides. Systematic clinical data, including the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS), Hamilton Depression Scale, and Eysenck Personality Inventory were obtained on all clinic subjects. Major depression was present in half of completers, near-lethal attempters, and ideators, but absent in the other clinic groups, whose commonest diagnosis was adjustment disorder. Depression scores increased across groups with increasing intent; ideators also had high scores. Completers and near-lethal attempters had higher I.Q. and medical fitness ratings and were in more demanding assignments than other groups. Prior attempts were commonest in completers, near-lethal attempters, and gesturers. Disciplinary history, ethnicity, family intactness, immigrant status, and Eysenck Personality Inventory scores did not differentiate the groups. The findings may not be generalizable to female adolescents or to other countries or time periods. The findings thus point to contrasts, as well as similarities, between groups of adolescents with different types of suicidal symptoms.     

Adverse childhood experiences and suicidal behavior of adolescent psychiatric inpatients

The present study examines the association of adverse childhood experiences (ACEs) to suicidal behavior and mortality in 508 Finnish adolescents (aged 12–17 years) who required acute psychiatric hospitalization between April 2001 and March 2006. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) and the European Addiction Severity Index (EuropASI) were used to obtain information about ACEs, adolescents’ suicidal behavior and psychiatric diagnoses. The cases of death were obtained from Statistics Finland. The results of our study indicated that, among girls, exposure to sexual abuse statistically significantly increased the risk of non-suicidal self-injury (NSSI) (OR, 1.8; 95 % CI, 1.0–3.2) and suicide attempts (OR, 2.3; 95 % CI, 1.0–4.5). The cumulative number of ACEs was also associated with an increased risk of NSSI (OR, 1.2; 95 % CI, 1.0- 1.4) and suicide attempts (OR, 1.2; 95 % CI, 1.0–1.4) in girls. Among all deceased adolescents, ACEs were most notable among those who had died due to accidents and injuries. Gender differences in the types of ACEs were noted and discussed.     

停止尿床年龄与青少年自杀行为的关系

目的探讨停止尿床年龄与青少年自杀行为的关系。方法对1920名11岁～16岁的青少年进行调查,由父母完成包括青少年生长发育史、自杀行为、抑郁症状、攻击行为及家庭环境等定式问卷。结果在控制一系列儿童及家庭情况变量后,多变量Logistic回归模型显示3岁后停止尿床与青少年自杀行为的危险性增加显著相关,停止尿床年龄与青少年自杀行为之间存在量效关系（3岁～4岁停止尿床OR值为2.1,5岁及以上停止尿床OR值为3.6）。中介变量分析显示,停止尿床时间晚对自杀行为的效应,至少部分通过抑郁及攻击行为中介。结论停止尿床时间晚可能是青少年自杀行为的早期神经发育预测因素,应进一步探讨青少年自杀行为的早期神经发育危险因素及潜在机制。     

An integrative treatment approach to child and adolescent suicidal behavior

The suicide rate for adolescents has tripled during the last 30 years in North America and many Western countries. Although some high risk factors have been defined, the literature is weak on the prevention and treatment issues. This article defines an integrative treatment approach for self-destructive behavior. This model attempts to integrate the well-recognized theoretical and therapeutic approaches such as biologic, psychodynamic, behavioral, cognitive, self-directed, strategic, experiential, and systemic frameworks. In the integrative approach, the therapist integrates the use of drug therapy and child, group, milieu, and family therapy, depending on the needs of each child. After a brief presentation of the author's comprehensive, in-depth study with 139 suicidal children and adolescents, the commonly seen family reactions to suicidal behavior were described. Family stage reactions of shock and fear, panic and action, guilt, resentment, reparation, and partial recovery are defined with case examples. The complementary nature of the supportive and therapeutic work for the families of suicidal children and adolescents with other preventative and therapeutic interventions is highlighted.     

Feasibility of dialectical behavior therapy for suicidal adolescent inpatients

OBJECTIVE: To evaluate the feasibility of dialectical behavior therapy (DBT) implementation in a general child and adolescent psychiatric inpatient unit and to provide preliminary effectiveness data on DBT versus treatment as usual (TAU). METHOD: Sixty-two adolescents with suicide attempts or suicidal ideation were admitted to one of two psychiatric inpatient units. One unit used a DBT protocol and the other unit relied on TAU. Assessments of depressive symptoms, suicidal ideation, hopelessness, parasuicidal behavior, hospitalizations, emergency room visits, and adherence to follow-up recommendations were conducted before and after treatment and at 1-year follow-up for both groups. In addition, behavioral incidents on the units were evaluated. RESULTS: DBT significantly reduced behavioral incidents during admission when compared with TAU. Both groups demonstrated highly significant reductions in parasuicidal behavior, depressive symptoms, and suicidal ideation at 1 year. CONCLUSIONS: DBT can be effectively implemented in acute-care child and adolescent psychiatric inpatient units. The promising results from this pilot study suggest that further evaluation of DBT for adolescent inpatients appears warranted.     

Peer violence,mental health and suicidal ideation in a sample of French adolescent

The aim of this study was to investigate the link between suicidal ideation, psychological morbidity and experiences with peer violence (victim or perpetrator) among adolescents. This study examined direct and indirect violence separately. A sample of 361 high school students from France completed a self-administered survey consisting of the Suicidal Ideation Questionnaire, the Rosenberg Self-Esteem Scale and the General Health Questionnaire. Indirect peer victimization experienced by girls and direct peer victimization experienced by boys were more strongly linked to suicidal thoughts. Indirect aggression was also related to suicidal ideation among boys only. Indirect victimization at school was linked to a drop in self-esteem, a factor strongly related to the level of suicidal ideation, particularly for boys. These findings show that adolescent peer violence must be given particular attention in educational institutions due to its links not only with suicidal ideation, but also more broadly with students’ psychological distress.     

Anxiety measures and their relationship to adolescent suicidal ideation and behavior

This study examines the psychometric properties of three recently published anxiety measures, including their incremental validity in predicting adolescent suicidal ideation and behavior. One hundred and eighteen adolescents aged 12-18 completed measures of anxiety, depression, positive and negative affect, and suicidal ideation and behavior. All of the anxiety scales showed limitations. For example, most of the anxiety scales appeared to lack divergent validity with regard to measures of depression and positive affect. Scales in the panic domain predicted suicidal ideation after controlling for depression. Surprisingly, scales in the social phobia domain were related to lower levels of suicidal behavior after controlling for depression and suicidal ideation. The implications of these results for research on adolescent suicide and the assessment of adolescent anxiety are discussed.     

Community structural instability, anomie, imitation and adolescent suicidal behavior

The current study examines the contextual effects of community structural characteristics, as well as the mediating role of key social mechanisms, on youth suicidal behavior in Iceland. We argue that the contextual influence of community structural instability on youth suicidal behavior should be mediated by weak attachment to social norms and values (anomie), and contact with suicidal others (suggestion-imitation). The data comes from a national survey of 14-16 years old adolescents. Valid questionnaires were obtained from 7018 students (response rate about 87%). The findings show that the community level of residential mobility has a positive, contextual effect on adolescent suicidal behavior. The findings also indicate that the contextual effect of residential mobility is mediated by both anomie and suggestion-imitation. The findings offer the possibility to identify communities that carry a substantial risk for adolescent suicide as well as the mechanisms that mediate the influence of community structural characteristics on adolescent risk behavior.     

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.     

Personal and family risk factors for adolescent suicidal ideation and attempts.

Despite research indicating that suicidal ideation is strongly related to future suicide attempts, there is limited data on variables associated with continued suicidal ideation and behaviors in adolescents. The objective of this study is to investigate whether personal, cognitive and family risk factors can differentiate adolescent suicidal ideation and attempts. Twenty-four attempters, 50 ideators and 50 non-suicidal adolescents (aged 14 to 25 years) were asked during an interview to complete individual and psychosocial measures. Both suicidal groups reported greater personal vulnerability and perceived their family as less functional than did the non-suicidal group. However, no differences were found between both suicidal groups. The results suggest the presence of common factors in both adolescent suicidal ideators and attempters.     

The risk of assaultive behavior in suicidal patients

This study assessed the occurrence of assaultive behavior in a group of suicidal patients who were in psychiatric hospitals, many for long periods of time. Of the 94 suicidal patients, 42 (45%) patients physically assaulted other persons at least once in the 3 months preceding the survey. Although many patients manifested active psychotic psychopathology at the time of the survey, there were no significant differences between assaultive and non-assaultive suicidal patients in terms of the presence of psychosis. The sex, race, primary psychiatric diagnosis, and length of stay of patients also were not related to the occurrence of assaultive behavior in suicidal patients. Only youth and the presence of seizure disorders were related to increased risk of assaultive behavior in hospitalized suicidal patients. The author compares the findings of this study to his previous study of concurrent assault and suicide just before or at the time of admission to psychiatric hospitals.     

Human figure drawings in the evaluation of severe adolescent suicidal behavior

OBJECTIVE: To evaluate the reliability of using certain indicators derived from human figure drawings to distinguish between suicidal and nonsuicidal adolescents. METHOD: Ninety consecutive admissions to an adolescent inpatient unit were assessed. Thirty-nine patients were admitted because of suicidal behavior and 51 for other reasons. All subjects were given the Human Figure Drawing (HFD) test. HFD was evaluated according to the method of Pfeffer and Richman, and the degree of suicidal behavior was rated by the Child Suicide Potential Scale. RESULTS: The internal reliability was satisfactory. HFD indicators correlated significantly with quantitative measures of suicidal behavior; of these indicators specifically, overall impression of the evaluator enabled the prediction of suicidal behavior and the distinction between suicidal and nonsuicidal inpatients (p < .001). A group of graphic indicators derived from a discriminant analysis formed a function, which was able to identify 84.6% of the suicidal and 76.6% of the nonsuicidal adolescents correctly. Many of the items had a regressive quality. CONCLUSIONS: The HFD is an example of a simple projective test that may have empirical reliability. It may be useful for the assessment of severe suicidal behavior in adolescents.     

Autobiographical memory, interpersonal problem solving, and suicidal behavior in adolescent inpatients

OBJECTIVE: The aim of the study was to test Williams' (Williams JMG. Depression and the specificity of autobiographical memory. In: Rubin D, ed. Remembering Our Past: Studies in Autobiographical Memory. London: Cambridge University Press; 1996:244-267.) theory of suicidal behavior in adolescents and young adults by examining the relationship among suicidal behaviors, defective ability to retrieve specific autobiographical memories, impaired interpersonal problem solving, negative life events, repression, and hopelessness. METHODS: Twenty-five suicidal adolescent and young adult inpatients (16.5 y +/- 2.5) were compared with 25 nonsuicidal adolescent and young adult inpatients (16.5 y +/- 2.5) and 25 healthy controls. Autobiographical memory was tested by a word association test; problem solving by the means-ends problem solving technique; negative life events by the Coddington scale; repression by the Life Style Index; hopelessness by the Beck scale; suicidal risk by the Plutchik scale, and suicide attempt by clinical history. RESULTS: Impairment in the ability to produce specific autobiographical memories, difficulties with interpersonal problem solving, negative life events, and repression were all associated with hopelessness and suicidal behavior. There were significant correlations among all the variables except for repression and negative life events. CONCLUSIONS: These findings support Williams' notion that generalized autobiographical memory is associated with deficits in interpersonal problem solving, negative life events, hopelessness, and suicidal behavior. The finding that defects in autobiographical memory are associated with suicidal behavior in adolescents and young adults may lead to improvements in the techniques of cognitive behavioral therapy in this age group.     

青少年抑郁发作患者自杀行为态度及其相关因素

背景 青少年人群对自杀的态度与其自杀行为高度相关,既往关于自杀态度及其相关因素的研究多聚焦于学校样本,对青少年抑郁发作患者相关临床样本的研究不足。目的 分析青少年抑郁发作患者对自杀行为的态度及相关因素,为这一群体的自杀干预提供参考。方法 连续选取2021年5月-2022年7月芜湖市第四人民医院门诊及住院部符合《国际疾病分类（第10版）》（ICD-10）抑郁发作诊断标准的青少年患者共100例。采用自编一般情况调查问卷收集患者人口学资料,采用汉密尔顿抑郁量表17项版（HAMD-17）、自杀态度问卷（QSA）、父母教养方式评价量表（EMBU）以及网络成瘾量表（IAT）分别评定患者的抑郁症状、自杀态度、父母教养方式和网络成瘾情况。采用Spearman和Pearson相关分析探讨患者QSA中对自杀行为的态度因子评分与一般情况和HAMD-17评分、EMBU评分及IAT评分的相关性。采用多元线性回归分析考查自杀行为的态度的危险因素,绘制ROC曲线评估各因素预测对自杀行为的态度的有效性。结果 青少年抑郁发作患者QSA对自杀行为的态度因子评分与对自杀者的态度因子、对安乐死的态度因子、母亲情感温暖与理解因子评分均呈正相关（r=0.210~0.485,P<0.05或0.01）,与父亲受教育程度、近6个月自杀行为、HAMD-17评分、IAT评分、父亲惩罚与严厉、父亲过分干涉、父亲拒绝与否认、父亲过度保护、母亲过分干涉与保护、母亲拒绝与否认、母亲惩罚与严厉因子评分均呈负相关（r=-0.571~-0.290,P<0.05或0.01）。多元线性回归分析显示,QSA对自杀者的态度因子（β=0.198,P<0.01）和对安乐死的态度因子（β=0.302,P<0.01）可正向预测对自杀行为的态度,父亲受教育程度（β=-0.180,P=0.043）、HAMD-17评分（β=-0.366,P<0.01）以及IAT评分（β=-0.191,P=0.030）可负向预测对自杀行为的态度。各因素之间预测效能比较差异均无统计学意义（Z=-1.289~0.092,P均>0.05）。结论 网络成瘾、抑郁严重程度、对自杀者的态度、对安乐死的态度和父亲受教育程度可能影响青少年抑郁发作患者对自杀行为的态度。     

The relationship between adolescent suicidal behavior and life events in childhood and adolescence.

OBJECTIVE: Although the relationship between experience of problematic life events and adolescent suicidal behavior has frequently been recognized during the past decade, few studies of life events have been initiated that discriminated between adolescent suicide attempters and depressed adolescents. Therefore, the authors compared adolescent suicide attempters with both depressed and nondepressed adolescents who never attempted suicide with respect to life events that happened in two periods: childhood (defined as the period up to age 12 years) and adolescence (age 12 and older). METHOD: Using a semistructured interview, the authors gathered life event data about childhood and adolescence from three groups of adolescents: 48 suicide attempters, 66 depressed adolescents who had never made a suicide attempt, and 43 nondepressed adolescents who had never made a suicide attempt. RESULTS: The group of adolescents who attempted suicide differed from both of the other groups in that they had experienced more turmoil in their families, starting in childhood and not stabilizing during adolescence. During adolescence, they were more often sexually abused. During the last year before the attempt, further social instability, such as changes in residence and having to repeat a class, occurred. CONCLUSIONS: For suicidal adolescents, the suicide attempt seems embedded not just in the problems every adolescent has to deal with but in greater turmoil in their families, rooted in childhood and not stabilizing during adolescence, in combination with traumatic events during adolescence and social instability in the year preceding the attempt.     

An exploration of the role of defensive psychopathology in adolescent suicidal ideation and behavior

The aim of the authors' study was to explore a model of suicidal ideation among adolescents in which environmental risk factors were mediated by both depression and defensive psychopathology. Suicidal ideation, depression, defensive psychopathology (substance use, borderline traits or symptoms, dissociative symptoms), parental attachment, and stressful life events were assessed among 615 adolescents (62% male). Despite gender differences, the proposed model received support. Findings suggest a psychodynamic relationship linking suicidal ideation to defensive mechanisms, aiming to alleviate depressive affects.     

Family history of suicidal behavior and earlier onset of suicidal behavior

The study examined whether having a family history of suicidal behavior is associated with an earlier age of first attempting suicide. Interviews were conducted with 545 patients who had attempted suicide about their family history of suicidal behavior and about their age of first suicide attempt. The results showed that attempters with a family history of suicidal behavior, particularly attempters with two or more such family members, had first attempted suicide at an earlier age than attempters who did not have a family history of suicidal behavior. These results suggest that a family history of suicide, which is known to increase the risk of suicidal behavior, may also be associated with an earlier age of first attempting suicide.