Suicidality and migration among adolescents in Hong Kong

Suicide as a cause of death among adolescents and migration as a component of population have been growing in importance. Very little research has been conducted on the connections between migration and suicidality among adolescents in Hong Kong, and so is the aim of this article. It uses census and registration data to study suicide mortality, and sample survey data collected for this purpose to investigate suicide attempt, suicide ideation, and self-injurious behavior. Relations between suicidality and socio-demographic/psychological factors replicated those found in the literature. Duration of residence was found important for the study of suicide among migrants. In both the bivariate and multivariate analyses, although the suicidality levels for short-duration (less than 10 years) adolescent migrants were very much lower than the local-born counterparts, those for the long-duration (10 years or more) migrants were very much higher. The findings support the Healthy Migrant Hypothesis and other related hypotheses in migrant mortality studies. They also reveal, in the light of the Integration Theory of Suicide, the problem of migrant integration into the host culture and society, an important social problem for the government to solve.     

2019年湖北省10～24岁青少年自杀死亡特征分析

  目的   分析、评估湖北省青少年自杀死亡水平,以便有针对性地制订防控措施。  方法   2019年湖北省死因监测数据,经过整理、查重、剔除后,采用SAS 9.4软件分析,分析比较不同性别、地区之间的自杀死亡年龄、自杀死亡率等;以2010年全国普查人口以及世界卫生组织更新后的世界标准人口为标准人口,分别计算中国标化死亡率、世界标化死亡率;利用ArcGis 10.6软件开展空间自相关分析、绘制空间分布地图。  结果   2019年湖北省伤害位居青少年死因顺位首位,在全死因构成比中超过52%,其中,自杀死亡位居10～14、15～19岁青少年伤害死因顺位第2位、20～24岁青少年伤害死因顺位首位,在全死因的构成比中均超过10%。 10～24岁青少年自杀死亡率、中国标化死亡率、世界标化死亡率分别为3.33/10万、3.40/10万、3.26/10万;城市地区分别为3.38/10万、3.40/10万、3.31/10万;农村地区分别为3.28/10万、3.38/10万、3.21/10万。 除了20～24岁年龄组男性自杀死亡率高于女性（χ2=16.190,P<0.001）,其他年龄组不同性别的自杀死亡率比较,差异无统计学意义（P>0.05）;各年龄组城乡之间青少年自杀死亡率比较,差异无统计学意义（P>0.05）。 青少年自杀死亡方式主要为从高处跳下,其他依次为其他物质中毒、溺水、悬吊、杀虫剂中毒。不同年龄组（10～14、15～19、20～24岁）青少年自杀死亡的全局空间自相关分析显示不存在空间自相关关系（P>0.05）,青少年自杀死亡随机、离散地分布在湖北省各个县（市、区）中。  结论   2019年湖北省青少年自杀死亡不存在明显的性别、城乡差异,不存在空间自相关关系,应在全省范围内广泛采取防控措施,以降低自杀死亡负担。     

Stigma and suicidality among suicide attempt survivors: A qualitative study

Among people with mental illness, stigma experiences can increase suicidality, and suicidality itself is associated with negative stereotypes. Suicide attempt survivors experience both mental illness stigma and suicide stigma, which could contribute to their increased risk for completed suicide. We interviewed 13 suicide attempt survivors regarding experiences and consequences of stigma and identified five stigma-related themes. Stigma led to substantial emotional strain, including loneliness and hopelessness, which are important precursors of suicidality. Our findings suggest that both mental illness stigma and suicide stigma can contribute to suicidality among people with mental illness in general, and in suicide attempt survivors specifically.     

Suicidality, hopelessness, and attitudes toward life and death in clinical and nonclinical adolescents

To see if hopelessness and four attitudes (attraction to life and death and repulsion by life and death) account for the development of suicidality in children, 15 adolescent psychiatric inpatients and 84 middle and high school students, average age. 15.2 years, took a four-item version of the Suicidal Behaviors Questionnaire, the Hopelessness Scale for Children (HSC), and the Multi-Attitude Suicide Tendency Scale for Adolescents (MAST-A). Profiles on the four attitudes differentiated adolescents at risk for suicide from those not at risk. Suicidality was negatively related to Attraction to Death and positively related to Repulsion by Life, Attraction to Death, Repulsion by Death, and hopelessness. Hopelessness was negatively related to Attraction to Life, and positively related to Repulsion by Life and Repulsion by Death. The best predictors of suicidality were hopelessness and Repulsion by Life. Results imply that reducing feelings of rejection by their families might lessen suicidality in adolescents.     

Examining childhood bullying and adolescent suicide: implications for school nurses

Adolescent suicide is a preventable tragedy yet is still the third leading cause of death in young people of age 10-24. Contrary to the idea that childhood bullying is a normal part of growing up or a rite of passage, it is now correlated with adolescent suicidality. An integrative review of the contemporary, extant literature was conducted to examine the following question: Are adolescents who have been involved in childhood bullying or cyberbullying as victim, offender, or victim/offender at greater risk for suicidality than those who have not. It is important to empower school nurses with current and evidence-based information regarding childhood bullying and examine empirical science and tools to effectively address the current serious problem of adolescent suicide risk assessment and intervention.     

Coming out to talk about suicide: Gay men and suicidality

International studies report increased rates of mental health problems and subsequent suicidality among homosexual populations. While international health‐care policy is concerned with reducing suicide among young people, important research findings relating to gay people and suicidality remain unacknowledged in the Suicide Prevention Strategy for England. This qualitative study, utilizing single case studies, was used to gain an in‐depth understanding of the life experiences contributing to the suicidality of four gay men. The methodology was psychoanalytically informed, using free association narrative interviewing. The initial data analysis involved interpretation of each of the case studies and a subsequent analysis exploring the shared experiences found in each of the individual narratives. Thematically, these are described as ‘knowing and not knowing’, ‘the centrality of the father–son relationship’, ‘the loneliness of outsiderness’, ‘leading a double life’, and ‘crime and punishment’. The significance of the life experiences these themes illustrate reveal why some gay men might not only experience long‐term mental health problems, but also engage in suicidality. Individually and collectively, the analyses provide important insights for mental health nurses becoming more attuned to provide sensitive mental health care to those who have a gay sexual orientation.     

Suicide behavior among Latino and Latina adolescents: conceptual and methodological issues

Suicide is the cause of 11.7 % of all deaths among youth and young adults aged 10 to 24 years in the United States (J. A. Grunbaum et al., 2004). Suicide is third leading cause of death for young Latinos/as aged 10 to 24 years (National Institute of Mental Health, 2001). Latino/a youth are at a greater risk of suicide behavior than other ethnic groups (G. Canino & R. E. Roberts, 2001). Latinos/as have less access to mental health services than do Whites and are less likely to receive needed care (U.S. Department of Health and Human Services, 2001). This article reviews the scientific literature related to suicide behavior among Latino/a adolescent since 1990. Conceptual and methodological issues in research are examined and the role of contextual and developmental factors on suicide behavior is discussed. The empirical findings of comparative ethnic minority studies, studies focused on Latino/a youth, and within-group studies are reviewed. Research on Latino/a adolescent suicide behavior is limited, few studies focus on any Latino subgroup and it is rare to find comparative studies focus on within-group diversity among Latinos. For the most part, no explanatory variables that may account for the differences among groups or that help explain the meaning of the suicide behavior were found. Research efforts should move away from using generic labels (e.g., Hispanics, Latinos, etc.) and shift toward addressing group-specific (e.g., Mexican Americans, Puerto Ricans, etc.) findings that have implications for prevention and treatment of target populations (G. Canino & R. E. Roberts, 2001; J. D. Hovey & C. A. King, 1997). Suicide behavior studies among specific Latino/a adolescents that are based on theory and informed by ecodevelopmental, gender-specific perspectives should advance the field.     

Suicide Mortality After Spinal Cord Injury in the United States: Injury Cohorts Analysis

Objectives

To compare 12-year suicide-specific mortalities of 3 different injury cohorts, identify the risk factors for suicide mortality after spinal cord injury (SCI), and investigate whether suicide mortality is higher among those with SCI than in the general population.

Design

Retrospective cohort study.

Setting

United States hospitals (n=28) designated as SCI Model Systems.

Participants

Participants (N=31,339) injured between January 1, 1973, and December 31, 1999.

Interventions

Not applicable.

Main Outcome Measure

Suicide death after SCI.

Results

The crude annual suicide mortality rate during the first 12 years after SCI was 91 per 100,000 person-years for 1973 to 1979 injury cohort, 69 per 100,000 person-years for 1980 to 1989 injury cohort, and 46 per 100,000 person-years for 1990 to 1999 injury cohort. Suicide mortality was associated with race, injury severity, and years since injury. The standardized mortality ratios for the 3 cohorts were 5.2, 3.7, and 3.0, respectively.

Conclusions

Suicide mortality among those with SCI decreased over 3 injury cohorts, but it still remained 3 times higher than that of the general population.     

Additive interactions between sex and forced sexual intercourse victimization on depressive symptoms and suicidality: Youth risk behavior survey 2001–2017

BackgroundAdolescents who have been forced to have sexual intercourse have higher rates of depressive symptoms and suicidality.PurposeThis research investigated whether the association between adolescent forced sexual intercourse victimization and depressive symptoms or suicidality varies significantly by sex.MethodThis secondary analysis pooled cross-sectional data from the Youth Risk Behavior Survey 2001 through 2017 (N = 132,580) using R to estimate adjusted risk differences and additive interactions.FindingsResults show an extremely high prevalence of depressive symptoms and suicidality among adolescents who experience forced sexual victimization. This association is significantly higher among females for depressive symptoms, but significantly higher among males for suicide attempt or suicide attempt requiring treatment.Resultsalso showed that approximately 40% of both males and females who attempted suicide requiring treatment also had a history of forced sexual intercourse victimization.DiscussionThese findings highlight the importance of screening for sexual victimization, depression and suicidality among adolescents.     

Adolescent suicide

Suicide is a major public health problem among adolescents. Although the event is rare, and rates have stabilized and even shown slight reduction in recent years, suicide has nevertheless become the second leading cause of morbidity among youths aged 15 to 24, which is otherwise a robust and relatively disease-free population. Although research on predictive factors has yielded increasingly sensitive indices of who the high-risk adolescent might be, the inherent difficulty of predicting rare events from common ones has made sensitive and specific prediction most elusive. Current neurobiologic research holds promise for the use of biologic markers in the identification of high-risk adolescents, and pharmacologic research may yield further advances in the treatment of affectively disordered youths. At this point, the most promising approaches to treating adolescent suicide appear to be (1) treatment of disorders antecedent to suicide crises, such as depression, substance abuse, family conflict, and conduct disturbance, and (2) prevention efforts targeting known high-risk groups, such as affectively disordered young men with accompanying alcohol and drug involvement and other antisocial behavior.     

Crisis centers and their role in treatment: suicide prevention versus health promotion

Suicide is a major health problem. In the industrialized nations, it remains among the 10 leading causes of death. There has been a massive effort to reduce suicide mortality through establishment of pevention centers. These centers have proliferated despite a lack of evidence concerning their efficacy The development and evaluation of suicide prevention centers, primarily community-based, telephone interventions are discussed. The evidence regarding the effectiveness of suicide prevention centers and the presence of a causal relationship between exposure to crisis counseling and a reduction in suicide rates is reviewed. Some cautions and recommendations are made. Finally, a model of health promotion program planning and evaluation is examined in the context of suicide prevention.     

Adolescent Suicide Risk Screening in the Emergency Department

Objectives: Many adolescents who die by suicide have never obtained mental health services. In response to this, the National Strategy for Suicide Prevention recommends screening for elevated suicide risk in emergency departments (EDs). This cross‐sectional study was designed to examine 1) the concurrent validity and utility of an adolescent suicide risk screen for use in general medical EDs and 2) the prevalence of positive screens for adolescent males and females using two different sets of screening criteria. Methods: Participants were 298 adolescents seeking pediatric or psychiatric emergency services (50% male; 83% white, 16% black or African American, 5.4% Hispanic). The inclusion criterion was age 13 to 17 years. Exclusion criteria were severe cognitive impairment, no parent or legal guardian present to provide consent, or abnormal vital signs. Parent or guardian consent and adolescent assent were obtained for 61% of consecutively eligible adolescents. Elevated risk was defined as 1) Suicidal Ideation Questionnaire‐Junior [SIQ‐JR] score of ≥31 or suicide attempt in the past 3 months or 2) alcohol abuse plus depression (Alcohol Use Disorders Identification Test‐3 [AUDIT‐3] score of ≥3, Reynolds Adolescent Depression Scale‐2 [RADS‐2] score of ≥76). The Beck Hopelessness Scale (BHS) and Problem Oriented Screening Instrument for Teenagers (POSIT) were used to ascertain concurrent validity. Results: Sixteen percent (n = 48) of adolescents screened positive for elevated suicide risk. Within this group, 98% reported severe suicide ideation or a recent suicide attempt (46% attempt and ideation, 10% attempt only, 42% ideation only) and 27% reported alcohol abuse and depression. Nineteen percent of adolescents who screened positive presented for nonpsychiatric reasons. One‐third of adolescents with positive screens were not receiving any mental health or substance use treatment. Demonstrating concurrent validity, the BHS scores of adolescents with positive screens and the POSIT scores of those with positive screens due to alcohol abuse and depression indicated substantial impairment. The addition of alcohol abuse with co‐occurring depression as a positive screen criterion did not result in improved case identification. Among the subgroup screening positive due to depression plus alcohol abuse, all but one (>90%) also reported severe suicide ideation and/or a recent suicide attempt. This subgroup (approximately 17% of adolescents who screened positive) also reported significantly more impulsivity than other adolescents who screened positive. Conclusions: The suicide risk screen showed evidence of concurrent validity. It also demonstrated utility in identifying 1) adolescents at elevated risk for suicide who presented to the ED with unrelated medical concerns and 2) a subgroup of adolescents who may be at highly elevated risk for suicide due to the combination of depression, alcohol abuse, suicidality, and impulsivity.     

Sense of coherence and suicidality in suicide attempters: a prospective study

The usefulness of the Sense of Coherence (SOC) scale in the nursing setting is well-established, and an association between SOC and suicidality has been suggested. The aim was to test whether low SOC at index attempt is an independent predictor of suicidality at 2-month follow-up and of risk for repeat attempt. The study, which had a prospective cross-sectional design, included patients admitted to hospital after a suicide attempt. They were interviewed by means of Structured Clinical Interview for DSM-IV. Participants (n=155) completed the SOC scale and the Comprehensive Psychopathological Self-rating Scale for Affective Syndromes. Suicidality was rated with the Suicide Assessment Scale. Instruments were employed again at follow-up. Non-fatal/fatal repetition within 3 years was determined by review of hospital records. Low SOC at baseline predicted high suicidality at follow-up. The association remained after adjustment for major depression and affective symptom burden. Repeat attempts were made by 54 persons. Low baseline SOC was associated with repeat attempt, but the association did not remain after adjustment for major depression and symptom burden. Low SOC ratings could be a marker of risk for high suicidality in the aftermath of a suicide attempt. The SOC scale could be incorporated in nursing assessments of suicide attempters.     

Depression and suicide prevention

Suicide is a major public health problem and the number of suicide victims has exceeded 30,000 a year since 1998 in Japan. The rates of depression are extremely high in suicide victims. Social and environmental factors, such as the slow recovery of Japanese economy, could have a strong effect on depression and suicide, especially in middle-aged men. To reduce the number of suicide victims, we need to use both population-based and high-risk approaches, targeting individuals with high psychological and socioeconomic risks of suicide, especially depressed patients. On the other hand, the role of antidepressants in suicide prevention is a major question given the high prevalence of both depression and depression-related suicidality. Because treatment and prevention of suicide are complex and encompass many factors, success will need multi-sector collaboration.     

The strategy and prospects of suicide prevention in Taiwan

Suicide mortality rates have been steadily rising in Taiwan, and suicide has been among the top ten causes of death for the last consecutive eight years. In response to this situation, the Taiwan Department of Health assigned the Taiwan Association Against Depression the task of setting up the Taiwan Suicide Prevention Center. The mission of the Center, suicide prevention, is advanced by its establishment of efficient networks nationwide capable of delivering related care services. Suicide prevention strategies can be categorized, based on coverage, as universal, selective or indicated interventions. The Center also plans to standardize the national suicide report format and care delivery system, improve mental health service quality, and organize community support networks. It pursues an encompassing health care mechanism model, where clients are considered the first priority, the family a fundamental supporting unit, and the community a solid foundation. The Center will offer a helping hand for individuals who have attempted suicide by maintaining a spirit of positive values and achieving mutual benefits.     

Suicidality in parentally bereaved adolescents

The purpose of the study was to examine the effects on suicidality of exposure to suicidal behavior in other people, depression, parent perceptions, and attitudes about life and death in a sample of 25 parentally bereaved teens. Participants participated in face-to-face interviews and completed the Reynolds Adolescent Depression Scale, Suicidal Ideation Questionnaire, Multi-Attitude Suicide Tendency Scale, and the Parent Perception Inventory. These adolescents were not clinically depressed, did not express serious levels of suicidal ideation, and had relatively minor histories of suicidality. However, significant relationships were found between attitudes, exposure, depression, and suicidality in partial support of previous research. Ways in which this study extend our knowledge of bereaved teens and recommendations for future research are discussed.     

宣武区1990-2000年居民伤害死亡原因及趋势分析

通过对北京市宣武区居民伤害死亡状况及变化趋势研究 ,旨在为伤害的预防提供科学依据。对宣武区1990 -2 0 0 0年居民死亡报告系统中的有关数据进行不同性别、年龄伤害死亡率和潜在寿命损失年的统计。结果显示 ,11年间 ,居民伤害年平均死亡率为 2 4 31/10万 ;男性较女性死亡率高 ,性比为 1 5 4,伤害的前四位死因顺位依次为意外跌落、机动车辆交通事故、自杀和意外中毒 ;6 0岁以上的老年人是意外跌落死亡的高发年龄 ;机动车辆交通事故是男性的第一位死因 ,在 15 -5 9岁组更为突出 ;99.83%的自杀死亡者是在 15岁以上人群 ,其中 35 -59岁是自杀的高发年龄段。伤害死亡居疾病死因顺位的第六位 ,但人均寿命损失量却居第一位。结果表明 ,伤害已成为严重的社会问题 ,应引起高度重视。     

How people live with or get over being suicidal: a review of qualitative studies

Title. How people live with or get over being suicidal: a review of qualitative studies Aim. To systematically review qualitative research which addresses how people live with suicidality or recover a desire to live. Background. Suicide is a pressing social and public health problem. Much emphasis in suicide research has been on the epidemiology of suicide and the identification of risk and protective factors. Relatively little emphasis has been given to the subjective experiences of suicidal people, but this is necessary to inform the care and help provided to individuals. Data sources. Electronic searches of CINAHL Plus with full text, Medline and PsychArticles (included PsycINFO, Social Services Abstracts and Sociological abstracts) were undertaken for the period from 1997 to April 2007. In addition, the following journals were hand searched (1997–2007): ‘Mortality’, ‘Death Studies’, ‘Archives of Suicide Research’ and ‘Crisis: The Journal of Crisis Intervention and Suicide Prevention’. Method. A systematic review of the literature and thematic content analysis of findings. The findings were extracted from selected papers and synthesized by way of content analysis in narrative and tabular form. Findings. Twelve studies were identified. Analysis revealed a number of interconnected themes: the experience of suffering, struggle, connection, turning points and coping. Conclusions. Living with or overcoming suicidality involves various struggles, often existential in nature. Suicide may be seen as both a failure and a means of coping. People may turn away from suicide quite abruptly through experiencing, gaining or regaining the right kind of connection with others. Nurses working with suicidal individuals should aspire to be identified as people who can turn people’s lives around.     

不同年代住院精神病患者自杀的相关因素及护理策略

目的 了解不同年代住院精神病患者自杀的相关因素,探索预防精神病患者自杀的护理策略.方法 回顾性调查1961～2000年住院精神病患者的自杀原因,并采用Logistic回归分析患者自杀的危险因素.结果 各种精神疾病患者自杀率差异无显著性(P>0.05);自杀与精神病理症状有关;既往有自杀史、负性生活事件、家庭成员有自杀史、病情严重、负性生活事件和社会支持不足,是住院精神病患者发生自杀的危险因素;治疗依从性好是患者自杀的保护因素;各年代自杀率呈下降的趋势(P<0.01).结论 做好风险评估和实施预见性护理,在控制病情的基础上加强监管等综合护理措施,有利于预防住院精神病患者自杀.