A multisystems analysis of adolescent suicide attempters

The present study tested an ecologically based model, which predicted that hopelessness (individual level) mediates the effects of family dysfunction (interpersonal level) and socioeconomic status (sociocultural level) on both suicidal intent and suicidal ideation, within a sample of attempters. Subjects included adolescent males and females presenting at a general hospital emergency room following suicide attempts. Baron and Kenny's (1986) criteria for testing mediation models through multiple-regression analyses were employed. Little evidence of mediation was found. Hopelessness proved to be the best predictor of suicidal intent and ideation within a sample of attempters.     

Treatment adherence among Latina female adolescent suicide attempters

Clinicians must identify factors among suicide-attempting adolescents and their families that increase treatment adherence. Researchers assessed a consecutive series of 140 disenfranchised Latina adolescents (ages 12-18 years) and their mothers presenting at a large urban emergency room after a suicide attempt by the adolescent. Adherence was examined as it related to service delivery, individual background characteristics, and psychosocial factors (current symptomatology, treatment attitudes). Each factor was found to predict adolescent treatment adherence. Adolescents receiving a specialized emergency room program, those with a diagnosis of disruptive behavior disorder, and those from single-parent households attended significantly more therapy sessions compared to their suicide-attempting peers receiving standard emergency room care. Adolescents with a diagnosis of anxiety disorders and those whose mothers reported more psychopathology and perceived more cohesive family relationships tended to attend significantly fewer treatment sessions. The implications for the delivery of emergency room interventions are discussed.     

Impairment in risk-sensitive decision-making in older suicide attempters with depression

Suicidal behavior is a potentially lethal complication of late-life depression. In younger adults, suicide has been linked to abnormal decision-making ability. Given that there are substantial age-related decreases in decision-making ability, and that older adults experience environmental stressors that require effective decision-making, we reasoned that impaired decision-making may be particularly relevant to suicidal behavior in the elderly. We thus compared performance on a probabilistic decision-making task that does not involve working memory ("Cambridge Gamble Task") in four groups of older adults: (1) individuals with major depression and a history of suicide attempt (n = 25), (2) individuals with major depression with active suicidal ideation but no suicide attempt (n = 13), (3) individuals with major depression without suicidality (n = 35), and (4) nondepressed control subjects (n = 22). There was a significant effect of group on quality of decision-making, whereby the suicide attempters exhibited poorer ability to choose the likely outcome, compared with the nonsuicidal depressed and nondepressed comparison subjects. There were no group differences in betting behavior. The suicide attempters differed in several aspects of social problem-solving on a self-report scale. Quality of decision-making was negatively correlated with the score on the impulsive/careless problem-solving subscale. These data suggest that older suicide attempters have a deficit in risk-sensitive decision-making, extending observations in younger adults. More specifically, older suicide attempters seem to neglect outcome probability and make poor choices. These impairments may precipitate and perpetuate suicidal crisis in depressed elders. Identification of decision-making impairment in suicidal elders may help with designing effective interventions.     

Common problems and coping strategies II: Findings with adolescent suicide attempters

This study investigated the most common precipitants of adolescent suicide attempts and the strategies used to cope with such problems. Adolescent suicide attempters were compared with both distressed and nondistressed nonsuicidal adolescents on problems reported and coping strategies utilized. All three groups reported four problems as occurring most frequently: school, parents, friends, or boyfriend/girlfriend. The suicide attempters and distressed controls reported problems with parents more frequently than did nondistressed controls, while this latter group reported problems at school more frequently than did suicide attempters or distressed controls. Suicide attempters used social withdrawal, problem solving, and emotional regulation more than did nondistressed controls, but not more frequently than distressed controls. Distressed controls used wishful thinking and resignation more than did suicide atempters. Results are discussed in terms of the similarities between suicide attempters and nonsuicidal distressed adolescents and the need to more closely investigate specific subgroups of suicide attempters.     

Cognitive rigidity in suicide attempters

A number of investigators have reported evidence of cognitive rigidity in suicide attempters (e.g., Levenson & Neuringer, 1971; Neuringer, 1964; Patsiokas, Clum, & Luscomb, 1979). It is important to note, however, that in all of the studies that found suicide attempters to be rigid, the test batteries had been administered to persons during their period of hospitalization immediately following a suicide attempt-thus, presumably, while they were still in the crisis period. The present study was designed as a step toward determining whether cognitive rigidity is a personality trait of suicide attempters or simply a transient characteristic limited to the crisis period. We administered tests for rigidity to persons who had attempted suicide but were well past the crisis period. These persons were less rigid than attempters from previous studies on the Rokeach Map Test (p less than .05) and the Alternate Uses Test (p less than .001). The implication is that if indeed there is a suicidal personality, rigidity is not a defining trait.     

Self-confrontation interview with suicide attempters

Psychiatric and psychological assessment after parasuicide is characterized by a number of difficulties. The interview is a strategically complex task for the patients trying to accommodate the wishes of the psychiatrist/psychologist and their own goals. The psychiatrist/ psychologist on the other hand needs to gain information about the event and the patient's mental state, has to assess the risk of further suicidal behaviour, and has to motivate the patient for treatment. In our experience a routine video prompted recall or self-confrontation interview, can be a helpful means of talking with the patient about his or her feelings and cognitions during the interview. Furthermore, it allows clarification of the processes leading to parasuicide. The procedure of administering a self confrontation interview is described, the theoretical background for interpreting the results is outlined and some examples of patient interviews are presented. It is demonstrated that this method allows access to additional information on the patients' thinking and emotions during the interview and that it also provides more details of the suicidal process.     

Social neuroscience of child and adolescent depression

The social neuroscience of child and adolescent depression is inherently multidisciplinary. Depressive disorders beginning early in life can have serious developmental and functional consequences. Psychopathology research has described depression's defining clinical and contextual features, and intervention research has characterized its response to treatment and prevention programs. Neuroendocrine, electrophysiological, and neuroimaging studies have identified core neurobiological aspects of early-onset mood disorders. These areas are reviewed using a developmental social neuroscience perspective for integrating disparate observations. The paper introduces a dynamic adaptive systems framework, and it discusses hedonic capacity, stress sensitivity, ruminative self-focus, and attentional impairments as fundamental components of mood disorders.     

Psychopathology of adolescent suicide: hopelessness, coping beliefs, and depression

Two studies of adolescents examined the relation of several cognitive variables and depression to suicide-related behaviors. Study 1 compared hopelessness and depression in 281 high school students. Unlike research with adults, depression was significantly related to suicidal behaviors, even after hopelessness was statistically controlled. When depression was controlled, hopelessness was unrelated to suicidal behaviors for boys and only modestly related for girls. Study 2 examined depression, hopelessness, survival-coping beliefs, fear of social disapproval, and social desirability in relation to suicidal behaviors in 53 male juvenile delinquents. Again, hopelessness did not account for a significant proportion of the variance in suicide. Depression was uniquely related to past suicide attempts. Survival-coping beliefs were associated with self-predicted future suicide and other suicidal behaviors. Survival-coping beliefs are discussed as a cognitive buffer to suicidal ideation in adolescence.     

MMPI inmate profiles: suicide completers, suicide attempters, and non-suicidal controls

Results from the Minnesota Multiphasic Personality Inventory (MMPI) were compared for three groups of male inmates in federal penitentiaries: 47 suicide completers, 43 suicide attempters and, 123 non-suicidal controls. Analyses show that the groups differed on all 10 clinical scales and on at least 8 after Bonferroni correction. Attempters obtained the highest scores on 4 of 8 scales; they also posted the highest scores on 3 others, but differences were significant only against non-suicidal controls. Completers posted the highest score on only one scale (Mf), but the difference was significant only against non-suicidal controls. All told, completers proved more similar to non-suicidal controls than to attempters. Regarding profiles, completers are more strongly correlated with non-suicidal controls (r=0.95) than with attempters (r=0.86); non-suicidal controls are less strongly correlated with attempters (r=0.88). The fact that attempters seem more pathological than the others can mislead clinicians screening for suicide risk.     

Adolescent suicide attempters presenting to a pediatric facility

This study profiles the characteristics of adolescent suicide attempters and the treatment they received in a pediatric emergency room (ER). A retrospective chart review of 4,072 adolescents seen in the ER at a children's hospital (CH) from July 1984 to June 1985 was undertaken. Twenty-seven adolescents who had deliberately injured themselves were identified. The average age was 14 years 7 months (range 11-19 years). Fifty-two percent of the patients were white and 78% were female. Ingestion was the most common method (78%), followed by attempted hanging (11%), and wrist laceration (7%). After evaluation by a pediatrician in the ER, 30% of the patients were treated and released, 11% were transferred directly to a psychiatric hospital, and 59% were admitted to the CH, with an average hospital stay of 1.88 days. Once hospitalized, consultations from psychiatry (81%), social service (50%), psychology (19%), and neurology (6%) were obtained. At the time of discharge from either the ER or CH, the patients had a variety of plans for ongoing care, with 52% being referred to outpatient counseling, 37% being transferred to a psychiatric hospital, and 11% having no documented plan for ongoing care. These results demonstrate that the evaluation of suicidal adolescents cared for in a pediatric facility may be episodic and suggest the need for a comprehensive program to approach the problem.     

Social support and suicide potential: preliminary findings for adolescent populations.

The relationship between both the quantity and perceived quality of social support and suicidal risk was examined in a sample of 50 adolescents whose ages ranged from 16 to 20 years. A multiple regression analysis was performed, using scores from Cull and Gill's 1983 Suicide Probability Scale as the criterion measure along with the predictor variables of quantity and quality of experienced social support as measured by the 1983 Social Support Questionnaire of Sarason, Levine, Basham, and Sarason. Analysis showed the social support variables accounted for over 52% of the variance in suicide potential. The greatest proportion of the variance in suicide risk was attributable to the quality of the perceived social support. Adolescents at greater risk for suicide were significantly less satisfied with the quality of their social support.     

Characteristics of suicide attempters in a Slovenian high school population

The study was carried out on a representative sample of Slovenian high school students (n = 3687) of whom 238 (137 girls and 101 boys) have already attempted suicide. Both suicide attempters and nonattempters were assessed by a questionnaire consisting of Zung's (1965) Depression Scale, Rosenberg's (1965) Self-Esteem Scale, sociodemographic data, information on suicide attempt, suicide ideation, family relations, and substance abuse. Statistical analyses indicated that groups differed in the levels of self-esteem, emotional reaction to family problems, running away from home, and substance abuse. The differences in the level of depression, frequency of suicide ideation, family suicide occurrence, smoking, and alcohol use were significant.     

Personality patterns of suicide attempters: gender differences in Ukraine

In the present study, an attempt has been made to investigate the complete 'pattern' of a suicide attempter (SA) within the set of Big Five traits. Two models were used: M1, which includes the five main dimensions of Big Five in the analysis; and M2, which includes facets of those dimensions which were identified as important in M1. The study consisted of a group of SA (men - 326, women - 299) and a group of healthy volunteers (HV) (men - 143, women - 190) with a similar age range. Discriminant analysis (DA) showed that the factors most significant in discriminating the personality pattern of a male SA are (in decreasing order): (E) Extraversion, (N) Neuroticism, (C) Conscientiousness and (O) Openness; and for a female SA these factors were (E) Extraversion, (C) Conscientiousness and (A) Agreeableness. In M2 for men, the largest contribution to pattern recognition is (N3) Depression. Moreover, in M2 for men significant characteristics were (in descending order): (E6) Positive Emotions, (O1) Fantasy, (E4) Activity, and also (N2) Angry Hostility, (C3) Dutifulness, (C4) Achievement Striving, (C2) Order and (O6) Values; and for women: (E4) Activity, (C6) Deliberation, (C2) Order, (A6) Tender-Mindedness, (E5) Excitement Seeking, (E6) Positive Emotions, (C4) Achievement Striving, (A2) Straightforwardness, (C5) Self-Discipline and (E1) Warmth. Analysis of the obtained data demonstrates that suicide attempts amongst males, can largely be associated with personality variables reflecting negative emotions; while female suicide attempts are primarily associated with variables regarding activity and self-regulation.     

The adolescent suicide problem

ABSTRACT: The suicide rate of young people in the United States rose 237 percent between 1960 and 1980. This paper addresses three related issues. First, is this change an epidemic or an artifact? Second, what is there about adolescence as a life-stage in modern society that makes it stressful, even suicide producing? Finally, what are the distinctive traits of the lifestyles or careers of a random sample of young Chicago suicides?     

Social skills training with adolescent male offenders: I. Short-term effects

The effect of a social skills training programme consisting of instructions, modelling, role playing, videotaped feedback and social reinforcement, was examined in a multiple baseline design with five adolescent male offenders. Training led to specific improvements in certain target behaviours. It was found that, whereas improvements in the performance of certain skills such as appropriate eye contact could be brought about relatively quickly, certain listening skills proved much harder to train. Where training was effective in producing improvements in the performance of a skill, these changes were generally maintained at two weeks follow-up.     

Cheap thrills and humble pie: the adolescence of female suicide attempters

The purpose of this study was to identify and describe characteristic social and psychological patterns of the adolescence of females who become suicide attempters during adulthood. To accomplish this retrospective study, life histories of 50 adult female suicide attempters were obtained; these were supplemented by a content analysis of personal documents written by the subjects during their adolescence. Two disparate social and psychological patterns were identified: "Cheap Thrills" and "Humble Pie." Cheap Thrills was a pattern of defiance, rebelliousness, acting-out behaviors, drug involvement, and indiscriminate sexuality. Humble Pie was in polar contrast and involved overconformity, docility, passivity, and emotional submergence. The significance of these findings lies in the identification of the second pattern, Humble Pie; this pattern is a stark contrast to the prevalent image in the suicide literature. More generally, the present study may contribute to an understanding of the long-term and processual nature of the suicidal careers of females.     

A follow-up program for suicide attempters: evaluation of effectiveness.

Suicide attempters are a high-risk group in relation to ultimately completing suicide and are usually "treated and released" with little or no follow-up care. A 4-month follow-up outreach program for suicide attempters seen in the emergency room was developed with an emphasis on continuity and quantity of "treatment" received. Suicide attempters were randomly assigned to the "follow-up outreach" or "normal" treatment programs. Measures for the evaluation of effectiveness were (a) incidence of suicide reattempts and purposive accidents and (b) prevalence of drug misuse and excessive use of alcohol. The experimental group showed a statistically significant reduction in suicide reattempts and excessive use of alcohol, while the reduction of drug abuse, although not statistically significant, did conform to a trend indicating improvement. Purposive accidents occured at a relatively equal rate among both groups.