Clinical Utility of the MMPI in the Evaluation of Adolescent Suicide Attempters

MMPI profiles of female adolescents hospitalized on a general pediatrics floor following a suicide attempt were compared to a control group of medically hospitalized, female adolescents referred for psychiatric evaluation. The suicide attempters had only a lower score on the K scale when compared to the control group. Results do not suggest that a single MMPI profile differentiates suicide attempters from a comparison group of adolescents with emotional difficulties. Implications of these findings are discussed.     

Suicide Attempters in Norway

ABSTRACT: A personal follow-up study is presented of 74 patients consecutively admitted to a Norwegian psychiatric hospital who had attempted suicide during the six months prior to admission. The mean observation time subsequent to discharge was eight years. Of these 74 patients, 5 later committed suicide (6.8 percent) and 16 (26 percent of the living) repeated the suicide attempt. The clinical and social course for the living patients is described. A previous report of a similar follow-up study on patients in a psychiatric department had demonstrated a much lower frequency of subsequent suicide and suicide attempts and a higher percentage of clinical cure and social rehabilitation. These differences are discussed and ascribed mainly to the greater proportion of psychotic patients in the hospital sample (82 percent versus 34 percent).     

The Future Fate of Suicide Attempters

A review is made of studies of suicide attempters in which there was a personal follow-up examination. Two studies by the author are presented: suicide attempters admitted to a psychiatric clinic and suicide attempters admitted to a traditional psychiatric hospital. The committed suicide rate among the hospital cases was three to six times higher than in the clinic cases (6.8 percent versus 1.4 to 2.8 percent). In the hospital material, 28 percent of the subjects had repeated the attempt without lethal outcome compared to 14 percent of the clinic cases. A correlation with the higher incidence of psychosis in the mental hospital cases is suggested.     

Serum Lipids in Suicide Attempters

As other studies have shown possible associations of low serum cholesterol concentrations as well as serotonin and corticosteroid deviances with suicide or depression, the present study was undertaken to investigate the serum lipid levels in subgroups of suicide attempters. Serum lipids were determined in 72 suicide attempters. Cerebrospinal fluid monoamine metabolites and plasma cortisol levels were measured, and dexamethasone suppression tests were performed. Hopelessness and suicidality were rated by the Hopelessness Scale (HS) and the Suicidal Intent Scales (SIS). The mean total serum cholesterol (TSC) level was 5.0 ± 1.2 mmol/L. We found no significant correlations between TSC and the monoamine metabolites. High-density lipoprotein cholesterol showed positive correlations with the dopamine metabolite homovanillic acid (r = 0.39, p = 0.04) and the serotonin metabolite 5-hydroxyindoleacetic acid (r = 0.34, p = 0.07). The SIS and HS scales did not correlate significantly with serum lipids. “Violent” attempters showed somewhat higher serum lipid levels than “nonviolent” attempters. We found no significant differences in serum lipid levels between the diagnostic subgroups. Hence, we could not find much support for the hypothesis of associations between low cholesterol levels and decreased serotonin activity in the brain. However, this field merits further investigation.     

Physiological Reactions to a Suicide Film: Suicide Attempters,Suicide Ideators,and Nonsuicidal Patients

A film about two teenagers who commit suicide was shown to three groups of psychiatric inpatients: 17 who had attempted suicide, 20 who had expressed suicidal thoughts, and 10 who were not suicidal. Anxiety before and after the film was evaluated with psychometric (anxiety rating scale) and physiological tools (heart and respiration rate, blood pressure, electromyogram). Values noted before and after screening, and the degree of change in these values, were compared. In addition, psychomotor agitation was rated at several points during the film. Most results were negative. The suicide attempters had significantly lower postscreening heart rates and a significantly lesser change in heart and respiration rates than the other two groups. The suicide attempters revealed an increase in psychomotor agitation until the discovery of the suicide and a decrease thereafter, whereas the agitation of the nonsuicidal patients continued to increase from the start to the end of the film. The study suggests that on some parameters, suicide attempters reveal less anxiety than nonsuicidal psychiatric patients following exposure to a simulated suicide. The reaction of suicide ideators falls somewhere between the two groups.     

Factor Structure of the Reasons for Attempting Suicide Questionnaire (RASQ) with Suicide Attempters

A sample of 134 suicide attempters completed the Reasons for Attempting Suicide Questionnaire (RASQ). Maximum likelihood factor and principal components analyses confirmed the multidimensionality of the RASQ, with two-component and three-factor models each receiving support. Scales from these competing multidimensional RASQ models demonstrated adequate internal consistency reliability. For the two-component model, two previously developed scales demonstrated differential validity with suicide indices. It is concluded that the RASQ has at least two dimensions, and it is recommended that the RASQ be scored for two scales: Internal Perturbation-Based Reasons and Extrapunitive/Manipulative Motivations.     

Comorbidity of Symptoms Among Junior and Senior High School Suicide Attempters

This paper examines comorbidity among depressive symptoms, conduct problems, and alcohol and drug abuse, in a sample of 1050 junior and senior high school students. Adolescents reporting high levels of depression along with either alcohol abuse or conduct problems were more likely to have made a suicide attempt than were adolescents reporting only one of these disorders. Adolescents reporting comorbid drug abuse plus either depression or conduct problems were more likely to have made a prior suicide attempt than those reporting only depression or conduct problems without drug abuse. The findings are discussed in the context of the literature on comorbidity and suicide attempts in community and clinical samples.     

Risks of Mortality of Suicide Attempters Compared with Psychiatric and General Populations

ABSTRACT: This study compares mortality risk among suicide attempters, psychiatric patients, and members of the general population using demographic data from the Monroe County (New York) Psychiatric Case Register for 1960 to 1970. During this 11-year period there were 172 deaths reported for the suicide attempt group, 6,108 for the Psychiatric Register population, and 58,542 for the general population. The relative risk of death from all causes of the suicide attempt group was nearly twice that of the general population and slightly higher than that of the psychiatric group. High risks of mortality were differentially associated with several demographic and treatment variables. Implications for predictive criteria and interventive strategies are discussed.     

Adolescent Development and Youth Suicide

The adolescent years, being a period of unique developmental changes, are of great interest in understanding suicidal behavior. The occurrence of completed suicide by age in 1-year age groups in adolescence and young adulthood was studied via official Finnish mortality statistics and the population statistics. Suicide rates increased sharply by age during adolescence, starting somewhat earlier among boys than among girls. During the periods of rapidly rising and high suicide rates in the 1970s and 1980s among boys, the increase in suicide rates started at a younger age than during a spell of lower rates in the 1960s.     

7 Suicide: The Scourge of Native American People

Reportedly, Native Americans have a rate of suicide that is greater than any other ethnic group in the United States, especially in the age range of 15–24. Many who are concerned as to why this is the case offer a variety of theories. Most of the theories have yet to be tested. This particular presentation focuses on the traditional tribal structure of most Native Americans and events of history that have impacted the cultures of Native American Tribes. The particular events covered refer to Western education, various religions, and legislation as playing a most significant role in impacting the cultures of Native Americans. With the hope that we can all work together to diminish the scourge of Native American people, I repeat the words of Chief Seattle, “… be just and deal kindly with my people.”     

Temporal Variation in Adolescent Suicide Attempts

The purpose of this study was to examine the association between adolescent suicide attempts and temporal cycles in a multiethnic population. Medical records at two hospitals in the state of Hawaii were reviewed for all adolescents (ages 12–18) admitted for suicide attempts during the years 1987–1991. Results showed 296 adolescents attempted suicide, and as hypothesized, temporal factors were associated with the attempts. A significant increase in attempts was found during the afternoon/evening and on Mondays and Tuesdays, transition points between home and school. The results are discussed and implications for delivery and temporal theory development considered.     

Perfectionism and Suicide Ideation in Adolescent Psychiatric Patients

This study was conducted to examine the relations between dimensions of perfectionism and suicide ideation in an adolescent psychiatric sample. A sample of 66 adolescents from an inpatient psychiatric facility completed the Child and Adolescent Perfectionism Scale, the Child's Hopelessness Scale, and the Suicide Ideation Questionnaire. Overall, the results indicated that socially prescribed perfectionism was associated with greater suicide ideation and that it, along with hopelessness, accounted for unique variance in suicide ideation scores. The findings are discussed in terms of their practical and theoretical significance as well as their consistency with similar research with adults.     

美国人口自杀状况分析

自杀不仅是个人和家庭的灾难,而且成为重要的社会问题,也是目前发达国家造成死亡的主要因素之一.尽管美国的自杀率在世界各国中不是最高的,但同其他发达国家一样所造成的社会问题最为突出.通过美国不同性别、年龄、种族、区域等自杀人群的分析,了解美国自杀人群的特点,以期采取相应的措施.     

Resistances Encountered in Starting a Group Therapy Program for Suicide Attempters in Varied Administrative Settings

ABSTRACT: This paper reports the predictable areas of difficulty—funding issues, management and personal bias issues, theoretical issues—which emerged in the development of five treatment groups composed entirely of depressed and suicidal patients. These groups represent a coordinated effort between the city/county mental health system and the authors' funding agencies. Effective strategies for overcoming these difficulties are discussed.     

Resistances Encountered in Starting a Group Therapy Program for Suicide Attempters in Varied Administrative Settings

ABSTRACT: This paper reports a number of areas of difficulty—funding issues, managment and personal bias issues, theoretical issues—which emerged in the development of five treatment groups comprised entirely of depressed and suicidal patients. These groups reflected a coordinated effort between the city-county mental health system and the specific funding agencies. Strategies for overcoming these difficulties are discussed.     

An Overview of the School-Based Prevention of Adolescent Suicide

This article provides an overview of the options available to school special services personnel in preventing suicide in the secondary schools. A model curriculum based primary prevention program is described, after a discussion of barriers to prevention activities. Secondary prevention activities outlined include direct counseling approaches and peer counseling activities. Counseling strategies include identifying children at risk, and evaluating the suicidal individual. There is little in the literature on the school prevention of suicide but directions for future research are offered.     

An Evaluation of Postvention Following Adolescent Suicide

This study sought to evaluate postvention provided to two schools following student suicides. A risk index for suicidal behavior among exposed adolescents was devised. The index clearly differentiated high (n = 272) and low (n = 534) scorers on a range of outcome variables. While two-thirds of students attending postvention counselling had two or more putative risk factors for suicidal behavior, a further 231 uncounselled students had similar risk scores. Counselled students (n = 63) did not differ from matched controls (n = 63) at 8-month follow-up on a range of outcome variables. Measures to improve future postvention are discussed.