Specific coping behaviors in relation to adolescent depression and suicidal ideation

The coping strategies used by adolescents to deal with stress may have implications for the development of depression and suicidal ideation. This study examined coping categories and specific coping behaviors used by adolescents to assess the relation of coping to depression and suicidal ideation. In hierarchical regression models, the specific coping behaviors of behavioral disengagement and self-blame were predictive of higher levels of depression; depression and using emotional support were predictive of suicidal ideation. Results suggest that specific behaviors within the broad coping categories of emotion-focused coping (e.g., self-blame) and avoidant coping (e.g., behavioral disengagement) account for these categories’ associations with depression and suicidal ideation. Specific problem-focused coping strategies did not independently predict lower levels of depression or suicidal ideation. It may be beneficial for interventions to focus on eliminating maladaptive coping behaviors in addition to introducing or enhancing positive coping behaviors.     

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.     

Gratitude and suicidal ideation and suicide attempts among Chinese adolescents: direct, mediated, and moderated effects

In a sample of 1252 Chinese adolescents (mean age = 15.00 years), this study examined the direct relations between gratitude and adolescents' suicidal ideation and suicide attempts. This study also examined indirect relations between gratitude and suicidal ideation and suicide attempts via two self-system beliefs--coping efficacy and self-esteem. Finally, this study examined the extent to which stressful life events moderated the direct and indirect relations between gratitude and suicidal ideation and suicide attempts. The odds of suicidal ideation and suicide attempts were lower among adolescents who scored higher on gratitude, after controlling for demographic variables. Self-esteem mediated the relations between gratitude and suicidal ideation and suicide attempts, while the mediating role of coping efficacy was not significant. Moreover, stressful life events moderated the mediated path through self-esteem. This indirect effect was stronger for adolescents low on stressful life events than that for those high on stressful life events. This study discusses the theoretical and practical implications of these findings.     

Protective factors against suicidal behavior in depressed adults reporting childhood abuse

Most previous studies compared suicidal behavior in subjects with and without a history of childhood abuse, whereas less attention was paid to the comparison of suicide attempters and nonattempters among subjects reporting childhood abuse. To identify risk and protective factors against suicidal behavior, we compared suicide attempters with nonattempters among the sample of 119 depressed inpatients who reported childhood abuse. Compared with nonattempters, suicide attempters were younger, had more self-rated depression severity and suicidal ideation, higher trait aggression and more cluster B personality disorder comorbidity, less coping potential, and fewer moral objections to suicide (MOS)/religious beliefs. Logistic regression showed that more severe suicidal ideation and fewer MOS/religious beliefs were associated with suicidal acts in subjects with reported childhood abuse. Furthermore, suicidal ideation and MOS/religious beliefs were significantly inversely correlated. The results of this clinical study add support to previous reports that religious/spiritual coping could serve as an additional resource in prevention of suicidal behavior for subjects with reported childhood abuse.     

Suicidal ideation and aggressiveness in school-aged youths

This study set out to explore the frequency and correlates of suicidal ideation in a community sample of school-aged adolescents living in a northeastern area of Italy. The study involved a mixed male–female sample of 1000 adolescents, corresponding to 10% of the young population aged 15–19 in the district. We investigated psychological distress through the revised Symptom Checklist (SCL-90-R), from which we also derived our indicators on suicidality (items concerning hopelessness and suicidal ideation). Propensity to aggression was measured with an Italian version of the Aggression Questionnaire. Females scored significantly higher than males on all SCL-90-R subscales, with the exception of the hostility subscale. In our sample, 30.8% of females and 25.3% of males reported having thought about suicide; one adolescent out of 20 reported suicidal ideation of high intensity (5% out of the total sample in both genders). Males scored significantly higher than females on the Aggression Questionnaire. Both males and females who reported suicidal feelings had significantly higher scores on the Aggression Questionnaire than did those who denied suicidal ideation. Suicidal ideation is a rather widespread occurrence among adolescents and correlates with other indicators of psychological distress. Psychological distress in adolescence might also be expressed through turbulent behaviors and conduct disorders. Identification of the mental disorders underlying a higher propensity to aggression might help to prevent other negative outcomes such as suicide.     

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.     

Specificity and sensitivity of the Beck Hopelessness Scale for suicidal ideation among adolescents entering early intervention service

Previous studies have shown an association between hopelessness and suicidal behaviour in clinical populations. The aim of the study was to investigate sensitivity, specificity, and predictive validity of the Beck Hopelessness Scale (BHS) for suicidal ideation in adolescents who show early risk signs on the psychiatric disorder continuum. Three-hundred and two help-seeking adolescents (mean age?=?15.5 years) who were entering an early intervention team at Helsinki University Central Hospital, Finland, completed questionnaires of BHS and suicidal ideation, derived from Beck Depression Inventory (BDI-II). Results suggest that a BHS cut-off score ≥8 (sensitivity?=?0.70, specificity?=?0.76) or cut-off score ≥9 (sensitivity?=?0.63, specificity?=?0.80) may be useful to detect suicidal ideation with BHS in help-seeking adolescents population. Results remain mainly the same in a separate analysis with adolescents at risk for psychosis. The results support previous cut-off points for BHS in identification of suicidal ideation. The results suggest also that lower cut-off scores may be useful in sense of sensitivity, especially in clinical settings.     

Validity and utility of the Japanese version of the WHO-Five Well-Being Index in the context of detecting suicidal ideation in elderly community residents

OBJECTIVE: The aim of this study is to evaluate the validity and the utility of the Japanese version of the WHO-Five Well-Being Index (WHO-5-J) in the context of detecting suicidal ideation in elderly community residents. METHODS: A sample of 696 subjects aged 70 years or over who completed a set of questionnaires was examined. RESULTS: Cronbach's alpha was 0.87 and Loevinger's coefficient was 0.64. The total score was significantly correlated with the number of cohabitants, the number of physical illnesses, physical functioning, instrumental activities of daily living, and depressive symptoms. Subjects with suicidal ideation had significantly lower scores on the WHO-5-J. The receiver-operating characteristic curve analysis indicated that the scale significantly discriminated the subjects with suicidal ideation. When combined with the assessment of a lack of perceived social support (PSS), a standard cut-off criterion of "a total score < or = 12 or answering 0 or 1 to any of the five items" more appropriately identified elderly subjects with suicidal ideation: sensitivity = 87%, specificity = 75%, negative predictive value = 99%, and positive predictive value = 10%. CONCLUSIONS: In combination with PSS, the scale has predictive utility to detect suicidal ideation in elderly community residents.     

Involvement in bullying as predictor of suicidal ideation among 12- to 15-year-old Norwegian adolescents

The aim of this study was to examine relationships between bullying and suicidal ideation. A total of 2,464 adolescents in Norway were assessed at two time points, 1 year apart [i.e., at ages 14 (T1) and 15 (T2)], with identical questionnaires. Suicidal ideation was measured by four items including both active and passive suicidal thoughts. ANOVA and standard linear regression methods were applied. Both bullied adolescents and adolescents who were aggressive toward others had significantly higher levels of suicidal ideation (p < 0.001) at age 14 (T1) than noninvolved adolescents. In the group being bullied, girls had higher levels of suicidal ideation than boys did. This was not the case for the group of adolescents who were the aggressors. In cross-sectional multivariate analyses, both being bullied and being aggressive toward others were significant (p < 0.001) predictors of suicidal ideation at age 14 (T1), when gender, age and socioeconomic status, and depressing symptom levels were controlled for. In the controlled longitudinal multivariate analyses, being bullied (p < 0.001) at age 14 (T1) predicted suicidal ideation at age 15 (T2), while aggressiveness toward others did not. Bullied adolescents (both genders) were at risk for suicidal ideation, and having an additional risk if they were depressed.     

The Mediating Role of Coping Self-Efficacy in Hope Box Use and Suicidal Ideation Severity

In this study, we examined the indirect effect of the Virtual Hope Box (VHB) smartphone application on suicidal ideation, mediated through coping self-efficacy. A total of 117 veterans with suicidal ideation completed measures on coping self-efficacy and suicidal ideation at baseline and weeks 3, 6, and 12. Participants were randomly assigned to either the VHB or enhanced treatment as usual (eTAU) condition. Parallel process growth curve modeling (?0.20 [95% CI?=??0.44, 0.00]) and auto-regressive modeling (?0.12 [95% CI?=??0.35, ?0.01]) revealed that a higher rate of change in coping self-efficacy in the VHB group was associated with a decrease in suicidal ideation severity, as compared to the eTAU group. Findings suggest that coping self-efficacy may be one mechanism by which the VHB operates to help reduce suicidal ideation. More broadly, the role of coping self-efficacy in reducing suicidal ideation is worthy of future study.     

Suicidal ideation and suicide attempts among immigrant adolescents from the former Soviet Union to Israel

OBJECTIVE: A community survey was conducted to examine suicidal ideation and suicide attempts, behavior problems, psychological distress, social support, and adjustment difficulties in a sample of adolescents. METHOD: Four hundred six Russian-born Jewish immigrants to Israel, aged 11 to 18 years, were selected to match the age and sex distribution of the total immigrant adolescent population. Two indigenous samples of Jewish adolescents in Russia (n = 203) and in Israel (n = 104) were matched with immigrants for comparison. Parameters of interest were measured with self-administered questionnaires. RESULTS: The 6-month prevalence rate of suicidal ideation in the immigrant sample (10.9%) was significantly higher than that for Russian controls (3.5%) but not for Israeli natives (8.7%). There were few gender differences in suicidal ideation and suicide attempts. Older adolescents reported suicidal ideation 2 times more frequently than their younger counterparts. Suicide ideators scored significantly higher than nonideators on all scales of psychological distress and behavior problems. They rated higher sources of immigration difficulties concerning language, physical health, personality characteristics, and family problems but had less socioeconomic and intercultural problems of migration and lower social support from the family but not from other sources. CONCLUSIONS: Results clearly support the migration-convergence hypothesis of suicide risk among adolescents.     

Influence of cannabis use on suicidal ideations among 491 high-school students

OBJECTIVE: The aim of the study was to evaluate the relative contributions of cannabis use and depressive symptoms in the prediction of suicidal ideation. METHOD: A random sample of 491 high-school students from the department of Haute-Garonne, France (290 girls, mean age=16.6+/-1.4; 201 boys, mean age=17.3 years+/-1.6) completed a questionnaire assessing cannabis use, the CES-D (center for epidemiological studies-depression scale) completed by the three-item sub-scale measuring suicidal ideation proposed by Garrison et al. (J Am Acad Child Adolesc Psychiatry 30 (1991) 636-641). RESULTS: In the total sample, 15% of girls (n=44) and 23% of boys (n=46) reported having used cannabis at least once a month during the last three months. The mean CES-D score for girls was significantly higher than for boys (20.6+/-11 versus 18.4+/-10.9, t=2.4, p=0.01). According to the cut-off score of 24, 22% of boys and 36% of girls exhibited a moderate to severe depressive symptomatology (p=0.02). The mean suicidal ideation score was not significantly higher in girls than in boys (1.3+/-2 versus 0.95+/-1.9, t=1.7, p=0.10). At least, the occasional wish to kill oneself was reported by 17% of boys and 20% of girls (p=0.40). The contribution of cannabis use and depressive symptomatology in the prediction of suicidal ideation were tested with a hierarchical multiple regression analysis, to determine whether cannabis use improved prediction of suicidal ideation beyond that afforded by CES-D scores. In the first step, including age and sex as covariates, the model accounted for a significant and important part of the variance of suicidal ideation (41%). Age and sex were not significant predictors. The second step, with cannabis use added to the prediction of suicidal ideation, afforded an increase of 1% in predictable variance. Cannabis use (beta=0.08, t=2.2, p=0.03) was significantly but weakly related to suicidal ideation, while depressive symptoms (beta=0.63, t=17.8, p<0.001) remained the main predictor. In a second regression analysis conducted among cannabis users, frequency of use was almost a significant predictor (beta=0.11, t=1.84, p=0.07). DISCUSSION: This result suggests an association between suicidal ideation, depressive symptoms and cannabis use in adolescents. Cannabis use appeared to be an independent predictor of suicidal ideation after controlling for depressive symptoms. However, the increment of variance accounted for by cannabis use was small. This suggests that cannabis use contributes to suicidal ideation independently from depressive symptoms, but weakly. A limitation to the study was the absence of control for other potential confounding variables. The association between cannabis use and suicidal ideation may be linked to common risk factors such as borderline personality disorder traits, sociodemographic and family factors. In this study, cannabis use does not appear as an important risk factor for suicidal ideation in adolescents.     

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.     

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.     

Suicidality and its relationships with individual,family, peer,and psychopathology factors among adolescents with attention-deficit/hyperactivity disorder

The aim of this study was to examine the prevalence rates of suicidal intent and its correlates among adolescents diagnosed with ADHD in Taiwan. A total of 287 adolescents aged 11–18 years and diagnosed with ADHD participated in this study. Their suicidal ideation and suicide attempts were assessed. Logistic regression analysis was used to examine the associations of suicide with individual, family, peer, ADHD, and psychopathology factors. A total of 12.2% of the participants reported suicidal ideation or a suicide attempt. A logistic regression analysis model showed that adolescents who were older, were bullying perpetrators, and reported high depression level were more likely to have suicidal intent. These three factors were also significantly correlated with suicidal ideation; however, only having high depression level was significantly correlated with suicidal attempts. The results of this study showed that a high proportion of adolescents with ADHD reported suicidal ideation or a suicide attempt. Multiple factors were significantly associated with suicidal intent among adolescents with ADHD. Clinicians, educational professionals, and parents of adolescents with ADHD should monitor the possibility of suicide in adolescents with ADHD who exhibit the correlates of suicidal intent identified in this study.     

大中学生自杀意念及相关心理变量研究

目的:探讨大中学生自杀意念与相关心理变量的关系。方法:采用分层取样法,对某市初二到硕士研究生一年级828名被试进行自杀意念量表(SSI)等量表测试。结果:①随年龄增长,大中学生自杀意念、企图呈下降趋势。女生自杀意念比男生多,而男生自杀行为能力比女生强;②有无自杀意念者在临床症状、人格因素、应对风格及生活满意度上差异均有统计学意义;③自杀意念与症状自评量表(SCL-90)各分量表、艾森克个性问卷(EPQ)神经质、精神质、应对检查表(COPE)诸多应对风格显著相关。结论:大中学生自杀意念与临床症状、应对方式、人格和生活满意度存在相关。     

Thought suppression and suicidal ideation: preliminary evidence in support of a robust association

Background: The suppression of unwanted thoughts appears to contribute to the development and maintenance of emotional disorders. This report tested the thought suppression paradigm in relation to suicidal ideation. Based on the ironic process theory, we hypothesized that the suppression of unwanted thoughts, especially suicidal thoughts, would associate with a higher frequency and a greater intensity of suicidal ideation. Methods: Study 1 examined cross‐sectional associations between self‐reported thought suppression and the frequency of suicidal ideation in a nonclinical sample of 166 undergraduate students. Study 2 extended cross‐sectional findings in an inpatient sample of 71 suicidal adolescents. Study 3 examined prospective associations between suicidal thought suppression and increases in self‐reported suicidal ideation over a 4‐week period in a separate nonclinical sample of 118 undergraduate students. Results: Findings across studies support a robust association between thought suppression and suicidal ideation, even controlling for general depressive symptoms. Participants in Studies 1 and 2 who endorsed greater tendencies toward suppression of thoughts, especially suicidal thoughts (Study 2), displayed higher concurrent levels of suicidal ideation. Participants in Study 3 who endorsed greater baseline tendencies toward suppression of suicidal thoughts displayed an increase in the severity of suicidal ideation over time. Conclusions: Suppression of suicidal thoughts may represent 1 mechanism contributing to the persistence of suicidal ideation. Clinicians may wish to explore patients' reactions to suicidal ideation and consider acceptance‐oriented strategies among patients who attempt to control unwanted suicidal thoughts. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

Parental expressed emotion and suicidal ideation in adolescents with bipolar disorder

Family environmental variables are risk factors for recurrent courses of mood disorder in adolescents. The present study examined the association between parental expressed emotion (EE)—critical, hostile and/or emotionally overinvolved attitudes toward a concurrently ill offspring—and suicidal ideation in adolescents with bipolar disorder. The sample consisted of 95 adolescents with a bipolar I or II diagnosis who had experienced a mood episode in the prior 3 months. Participants (mean age=15.54 years, S.D.=1.4) were interviewed and completed questionnaires regarding current and past suicidal ideation prior to their participation in a treatment trial. Parents completed five-minute speech samples from which levels of EE were assessed. High EE attitudes in parents were associated with current suicidal ideation in adolescents. This relationship was independent of the effects of age, gender, current depressive or manic symptoms, comorbid diagnoses, bipolar I/II subtypes, family adaptability, and family cohesion. These results underscore the importance of addressing the emotional reactivity of caregivers in treating adolescents with bipolar disorder who have suicidal ideation.     

Coping and suicidality among homeless youth

This study examined the impact of coping strategies employed by homeless youth upon suicidal ideation, suicide attempts on the streets, and feeling trapped/helpless. Coping strategies examined in the analysis included problem-focused and avoidant coping, along with several coping strategies identified in previous exploratory qualitative studies. Greater risk was associated with avoidant coping, social withdrawal, use of drugs and alcohol as coping, with "belief in a better future" linked to lowered risk levels. Gender interactions emerged with respect to avoidant coping and social withdrawal, both of which served as greater contributors to risk levels among females. Several approaches to coping including problem-focused strategies and strategies identified by youths in previous qualitative works emerged as not serving to ameliorate suicidality.     

Cognitive factors related to suicidal ideation and resolution in psychiatrically hospitalized children and adolescents

OBJECTIVE: This study was conducted to determine whether there are changes in the cognitive factors of attributional style, hopelessness, and self-esteem when suicidal ideation fades in psychiatrically hospitalized children and adolescents. METHOD: The cognitive factors of attributional style, hopelessness, and self-esteem were assessed in subjects aged 7-17 years (50 with and 50 without suicidal ideation) at admission and discharge from a psychiatric hospital. RESULTS: For subjects with suicidal ideation, attributional style became significantly more positive and hopelessness was decreased from admission to discharge, by which time suicidal ideation had faded. There was no association between self-esteem and suicidal ideation after control for depression. These changes in cognitive factors were not seen in the group without suicidal ideation. There were no significant differences between children and adolescents in the pattern of results. CONCLUSIONS: Change in attributional style was shown to be a factor significantly related to the resolution of suicidal ideation in children and adolescents. This cognitive style could be specifically addressed in psychotherapy with depressed children and adolescents as a means of reducing suicidal ideation. These results may have an implication for reducing the length of psychiatric inpatient stays.