Suicidal Ideation of Psychiatrically Hospitalized Adolescents has One-Year Predictive Validity for Suicide Attempts in Girls Only

Clinicians commonly incorporate adolescents’ self-reported suicidal ideation into formulations regarding adolescents’ risk for suicide. Data are limited, however, regarding the extent to which adolescent boys’ and girls’ reports of suicidal ideation have clinically significant predictive validity in terms of subsequent suicidal behavior. This study examined psychiatrically hospitalized adolescent boys’ and girls’ self-reported suicidal ideation as a predictor of suicide attempts during the first year following hospitalization. A total of 354 adolescents (97 boys; 257 girls; ages 13–17 years) hospitalized for acute suicide risk were evaluated at the time of hospitalization as well as 3, 6, and 12 months later. Study measures included the Suicidal Ideation Questionnaire-Junior, Multidimensional Anxiety Scale for Children, Children’s Depression Rating Scale-Revised, Beck Hopelessness Scale, Youth Self-Report, and Personal Experiences Screen Questionnaire. The main study outcome was presence and number of suicide attempt(s) in the year after hospitalization, measured by the Diagnostic Interview Schedule for Children. Results indicated a significant interaction between suicidal ideation, assessed during first week of hospitalization, and gender for the prediction of subsequent suicide attempts. Suicidal ideation was a significant predictor of subsequent suicide attempts for girls, but not boys. Baseline history of multiple suicide attempts was a significant predictor of subsequent suicide attempts across genders. Results support the importance of empirically validating suicide risk assessment strategies separately for adolescent boys and girls. Among adolescent boys who have been hospitalized due to acute suicide risk, low levels of self-reported suicidal ideation may not be indicative of low risk for suicidal behavior following hospitalization.     

Future Well-Being Among U.S. Youth Who Attempted Suicide and Survived

To what extent does a suicide attempt impair a person’s future well-being? We estimated the prevalence of future well-being (FWB) among suicide attempt survivors using a nationally representative sample of 15,170 youths. Suicide attempt survivors were classified as having high FWB if they reported (a) a suicide attempt at Wave I, (b) no suicidal ideation or attempts over the past year at Wave III (7 years after), and (c) a well-being profile at or above the top quartile of nonsuicidal peers. Seventy-five of 574 suicide attempt survivors (∼13%) met criteria for FWB at Wave III, compared to 26% of nonsuicidal peers. Wave I well-being levels, not depressive symptoms, predicted the likelihood of FWB at Wave III (OR = 1.23, 95% CI [1.05, 1.44], p < .05). In conclusion, a nonfatal suicide attempt reduced but did not preclude FWB in a large national sample. The observation that a segment of the population of suicide attempt survivors achieves FWB carries implications for the prognosis of suicidal behavior and the value of incorporating well-being into investigations of suicide-related phenomena.     

Mortality and Causes of Death in a 10-Year Follow-Up of Patients Treated for Self-Poisonings in Oslo

The present 10-year follow-up study includes all patients (N = 926; 50% females) treated in the medical departments in Oslo for self-poisonings during one year (1980). Seventeen percent were considered suicidal attempts upon admission, 25% among the non-substance abusers and 8% among the abusers. At follow-up, 207 patients (22%) were dead (62% males). The mortality rate was highest among the abusers. The most common causes of death were suicide (21%), heart disease (17%), opiate abuse (15%), and accidents/wounds (13%). Forty-one percent of the suicides occurred during the first two years of the follow-up period. The suicides were by poisoning (57%), hanging (20%), and other methods (23%). The female mortality rate decreased in the second half of the follow-up period whereas the male rate did not change. The risk of death within 10 years after discharge increased with age and was higher in men and in abusers, whereas social group and motive for suicide were not predictive factors. The females had an excess suicide rate of 182 (36–327, 95% CI) in the first year after the self-poisoning and 61 (36–87, 95% CI) in the total period. The corresponding figures for males were 70 (19–122) and 21 (12–30). The only factor associated with an increased suicide rate was a suicidal motive upon the admission for self-poisoning with a 3.1 (1.7–5.8, 95% CI) times increased risk of suicide in the 10-year follow-up period.     

Treatment‐Resistant Depression and Risk of Suicide

We evaluated whether treatment‐resistant depression (TRD) as measured by the Massachusetts General Hospital (MGH) staging method was associated with suicide in a large U.S. health system. Data from the Veterans Health Administration and the National Death Index were used to conduct a case–control study of patients newly diagnosed with depression who received antidepressant treatment between 2003 and 2006. Suicide cases (N = 499) were matched with nonsuicide controls (N = 1994). Conditional logistic regression was used to assess whether MGH stage at time of suicide (or matched date) was associated with case status, adjusting for patient demographic characteristics, comorbidity, and service use. Results indicated 11.6% of suicide cases had MGH stage 3 or greater (indicating at least two antidepressant trials) compared to 6.4% of controls (p < .001). In adjusted analyses, suicide was not significantly more likely among patients with stage 3 or greater (OR 1.52; 95% CI: 0.98, 2.37) or stages 1.5–2.5 (OR 1.19; 95% CI: 0.91, 1.55) compared to patients with stage 1 or less (<10 weeks of antidepressant medication). Staging TRD using MGH criteria is unlikely to substantially improve suicide risk assessment of depressed patients beyond existing measures contained in health system records.     

Forgiveness,Depression, and Suicidal Behavior in Adolescents: Gender Differences in this Relationship

With the development of positive psychology, protective factors have received increased attention as buffers against suicidal ideation and attempts and against the risk factors for suicide (e.g., depressive symptoms). Empirical evidence suggests that one of the protective factors associated with depression and suicide is forgiveness. Although previous studies have demonstrated a negative association between forgiveness and risk of suicide, studies on gender differences in adolescents are still scarce. Thus, the authors assessed the moderating role of gender in a sample of adolescents. The participants were 572 adolescents (50.9% boys; M age = 15.49 years, SD = 1.09 years) from secondary school centers. The results revealed that forgiveness moderated the relationship between depression and suicidal ideation for boys but not for girls. Specifically, for boys the relationship between depression and suicidal thoughts and behaviors weakened as levels of forgiveness increased. These findings suggest therapeutic applications to reduce the likelihood of suicide in the group of adolescent boys with higher scores on depression and lower levels of forgiveness. The study results are discussed in terms of the need to use gender perspectives in positive psychology intervention programs.     

Encountering the Body at the Site of the Suicide: A Population‐Based Survey in Sweden

Encountering the body of a child who died by suicide at the site of death is believed to be especially harmful for bereaved parents. We investigated the association between encountering the body at the site of the suicide and psychological distress in 666 suicide‐bereaved parents. Parents who had encountered their child's body at the site of the suicide (n = 147) did not have a higher risk of nightmares (relative risk [RR] 0.95, 95% confidence interval [CI] 0.67–1.35), intrusive memories (RR 0.97, 95% CI 0.84–1.13), avoidance of thoughts (RR 0.97, 95% CI 0.74–1.27), avoidance of places or things (RR 0.91, 95% CI 0.66–1.25), anxiety (RR 0.93, 95% CI 0.64–1.33), or depression (RR 0.94, 95% CI 0.63–1.42) compared with parents who had not encountered the body (n = 512). Our results suggest that losing a child by suicide is sufficiently disastrous by itself to elicit posttraumatic responses or psychiatric morbidity whether or not the parent has encountered the deceased child at the site of death.     

Childhood Parental Death and Lifetime Suicide Attempt of the Opposite‐Gender Offspring in a Nationwide Community Sample of Korea

Although previous studies have shown that childhood parental death influences suicide attempts of their offspring, few studies have examined influence of gender and age at exposure. Koreans show the third highest suicide rate in the world, and many children and adolescents lost their parents during and after the Korean War. A total of 12,532 adults, randomly selected through a one‐person‐per‐household method, completed the Korean version of the Composite International Diagnostic Interview and questionnaire for suicidal ideation, plan, and attempt (response rate 80.2%). A total of 2,332 subjects experienced biological parental death in childhood (18.6%). Male suicide attempts were associated with age of exposure to maternal death from 0 to 4 years (adjusted OR = 4.48, 95% CI 1.32–15.18) and from 5 to 9 years (adjusted OR = 5.52, 95% CI 1.97–16.46), but not with paternal death, after adjusting for age, education years, marital status, monthly income, and psychiatric comorbidities. Female suicide attempts were associated with paternal death from 5 to 9 years (adjusted OR = 2.20, 95% CI 1.13–4.27), but not with maternal death. Childhood parental death is significantly associated with lifetime suicide attempt in the opposite‐gender offspring, especially when exposure occurs before age 10.     

How Often Does Deliberate Self‐Harm Occur Relative to Each Suicide? A Study of Variations by Gender and Age

Deliberate self‐harm (DSH; i.e., nonfatal self‐poisoning or self‐injury) occurs much more frequently than suicide, yet there has been little detailed investigation of the comparative rates of DSH and suicide. We conducted a study of how rates of DSH relate to suicide rates across the life cycle by gender and by method of estimation of DSH rates, using 10 years of data from a local system for monitoring DSH presentations to a general hospital and national and local suicide statistics. The rate‐ratio of DSH to suicide was 36 (95% CI 34.9–37.1) based on annual person‐based rates of DSH episodes and was nearly five times higher in females (87.9; 95% CI 84.4–91.6) than in males (18.7; 95% CI 17.9–19.6). The ratio varied markedly across the life cycle, decreasing from more than 200 in teenagers to less than 10 in persons aged 60 years and over. The difference in the ratio between females and males also decreased over the life cycle. There were very similar findings when local suicide rates were used. These patterns were replicated when the data were analyzed, first, on the basis of all episodes of DSH during the study period, but with expectedly larger DSH:suicide ratios (e.g., overall 52.7; 95% CI 51.4–54.1), and second, on the basis of individual persons only engaging in DSH during the study period, but with smaller ratios (e.g., overall 26.2; 95% CI 25.4–27.2). The DSH:suicide rate ratios for those with high and low suicidal intent were similar within age groups except for those aged 60 years and over, in whom there was a greater proportion of high intent acts. These findings illustrate how the nature of self‐harming behavior may vary in intention across the life cycle and between the genders, and provide a basis for further comparative work of this kind.     

Temperamental Vulnerability and Suicide Risk After Attempted Suicide

The aim was to extend recent findings of suggested temperamental features in attempted suicide and to explore possible domains of vulnerability to suicide risk after attempted suicide. Fifty-four psychiatric inpatients hospitalized after a suicide attempt underwent lumbar puncture for analysis of CSF 5-HIAA concentration and also completed the Karolinska Scales of Personality (KSP) before discharge from the hospital. Suicide attempters scored high on Somatic Anxiety, Psychic Anxiety, and Muscular Tension, and low on Socialization, findings that support recent findings in suicide attempters followed up after an emergency room visit. Five patients committed early suicide, i.e., within 3 years, and the overall long-term suicide mortality after attempted suicide was 13%. There were significant correlations between survival time among early suicides and CSF 5-HIAA (r = .87;p = .054), and the following KSP scale t scores: Somatic Anxiety (r = ?.96;p < .05), Impulsivity (r = ?.88; p < .05), and Socialization (r = .90; p < .05). KSP Socialization showed correlations with CSF 5-HIAA (r = .89; p = .046) among the early suicides. Features of temperamental vulnerability to suicide risk after attempted suicide might involve anxiety proneness, impulsivity, low socialization, and low CSF 5-HIAA.     

Help‐Seeking Behavior Prior to Nearly Lethal Suicide Attempts

T he association between help‐seeking and nearly lethal suicide attempts was evaluated using data from a population‐based, case‐control study of 153 13‐ to 34‐year‐old suicide attempt case‐patients treated at emergency departments in Houston, Texas, and a random sample of 513 control‐subjects. Measures of help‐seeking included whether the participant sought help for health/emotional problems in the past month, type of consultant contacted, and whether suicide was discussed during the interaction. Overall, friends/family were consulted most frequently (48%). After controlling for potential confounders, case‐patients were less likely than control‐subjects to seek help from any consultant (OR = 0.5, 95% CI = 0.3–0.8) or a professional (e.g., physician, counselor) consultant (OR = 0.5, 95% CI = 0.29–0.8). Among those who sought help, case‐patients were more likely than to discuss suicide (OR = 2.6, 95% CI = 1.2–5.4), particularly with professionals (OR = 11.8, 95% CI = 3.2–43.2). Our findings suggest that efforts to better understand the role of help‐seeking in suicide prevention, including help sought from family and friends, deserves further attention.     

Patterns of Adolescent Aggression and Victimization: Sex Differences and Correlates

This study identified heterogeneous patterns of peer and dating aggression and victimization among boys and girls and examined their relation to risk and protective correlates. Girls (n = 1648) and boys (n = 1420) in grades 8–10 completed surveys assessing 14 indicators of violence involvement. Latent class analyses indicated a four-class solution, though a test of measurement invariance indicated the nature of the classes differed by sex. Among boys and girls, three classes emerged: Uninvolved (45% of girls, 61% of boys), Peer Aggressor-Victims (23% of girls, 21% of boys), and Cross-Context Aggressor-Victims (CCAV) (12% of girls, 5% of boys). Those in the Peer Aggressor-Victims class were likely to report involvement in peer aggression only; however, girls in this class were likely to be involved only in moderate violence, whereas boys were likely to be involved in moderate and severe violence. Those in the CCAV class were likely to report involvement in all forms of violence except sexual and controlling aggression, which was likely only among boys. Among girls, but not boys, a Verbal Dating Aggressor-Victims class (21% of girls) emerged that was characterized by involvement in occasional verbal dating aggression only. Among boys, but not girls, a Cross-Context Physical Victims class (13% of boys) emerged that was characterized by being only a victim of moderate physical peer and dating violence. Unique and shared risk and protective factors distinguished class membership for girls and boys. Findings suggest the pathways leading to violence may differ by sex and result in different patterns of violence involvement.     

Suicide Among Health Care Practitioners and Technicians in Colorado: An Epidemiological Study

Suicide is a public health concern with risks that vary between occupation groups. Many suicide victims with a health care occupation die by poisoning, but few studies have epidemiologically studied this association. The objective of this study was to quantify the increased risk of suicide death by poisoning among health care professionals in Colorado. Eleven years (2004–2014, N = 8,753) of suicide deaths in Colorado were compiled from the Colorado Violent Death Reporting System. A retrospective cohort study using multivariate logistic regression was conducted to examine the risk associated with having a health care occupation and eventual suicide death by poisoning, compared independently to firearm and hanging methods. Suicide victims with a health care occupation were more likely to die by poisoning rather than by hanging (RR 1.54, 95% CI: 1.41–1.68) or firearm (RR 1.79, 95% CI: 1.60–2.01), when compared to suicide victims without a health care occupation. The association between health care occupation and suicide method was significantly (p = .032) modified by gender. The results show that health care workers who die by suicide have an increased risk of eventual suicide death by poisoning rather than by firearm or hanging. These results can be used to inform tailored suicide prevention efforts in health care professionals.     

Young Adult Follow‐up of Adolescent Girls in Juvenile Justice Using the Columbia Suicide Severity Rating Scale

This study focused on the reliability and validity of the Columbia Suicide Severity Scale (C‐SSRS). Severely delinquent adolescent girls (n = 166) participated in a treatment trial and repeated assessments over time. Lifetime suicide attempt history was measured using the C‐SSRS in early adulthood (n = 144; 7–12 years postbaseline). Nonclinician raters showed strong interrater reliability using the C‐SSRS. Self‐reports, caseworker reports, and caregiver reports of girls' suicide attempt histories collected at baseline correlated with adult participants' recollections of their baseline attempt histories. Suicidal ideation measured prospectively across a 7‐ to –12‐year period was associated with retrospectively reported suicide attempt across the same period.     

Adopted children's language difficulties and their relation to symptoms of reactive attachment disorder: FinAdo study

This study investigated the potential association between symptoms of reactive attachment disorder and language difficulties among internationally adopted children in Finland (the FinAdo study). The language difficulties were assessed using a standardised Five to Fifteen (FTF) parental questionnaire and the symptoms of reactive attachment disorder using a FinAdo questionnaire. The study sample consisted of 689 6–15 year old children (49.2% boys, response rate 48%). Twenty-nine percent of the children were reported to have language difficulties and 8% severe language difficulties (10% and 2%, respectively, in the general population). A child's symptoms of reactive attachment disorder were associated with language difficulties and severe language difficulties, OR 2.15, 95% CI [1.39, 3.31] and OR 4.33, 95% CI [1.57, 11.98], respectively, the associations being robust to adjustments for background factors.     

Ethnocultural Differences in Prevalence of Adolescent Suicidal Behaviors

Data from an ethnically diverse sample of middle school students (grades 6–8; n = 5,423) are analyzed for ethnic differences in suicidal ideation, thoughts about suicide in the past 2 weeks, suicide plans, and suicide attempts. Ideation was examined using a four-item scale and a single item on suicidal thoughts. Ideation was higher among females, older youths, and lower status youths. The same general pattern held for recent suicidal plans and attempts, with the exception of gender, where the trend was for males to report more attempts. Lifetime plans and attempts were higher for females, older youths, and lower status youths. Data were sufficient to compare nine ethnic groups. Multivariate logistic regression analyses, adjusting for the effects of age, gender, and socioeconomic status, yielded significant odds ratios using the Anglo group as the reference, for suicidal ideation for the Mexican (OR = 1.76, p < .001), Pakistani (OR = 2.0, p < .01), and Vietnamese (OR = 1.48, p < .05) American groups. For thoughts about suicide in the past 2 weeks, only Pakistani and Mixed Ancestry youths had elevated risk. For suicidal plans in the past 2 weeks, Mixed Ancestry youths (OR = 2.02, p < .05) and Pakistani youths (OR = 3.20, p < .01) had elevated risk. For recent attempts, only the Pakistani American youths had elevated risk (OR = 3.19, p < .01). Future research needs to address whether these results hold in other ethnically diverse communities and, if so, what factors contribute to increased risk among some minority youth and not others.     

Predicting Suicide Attempts for Racial and Ethnic Groups of Patients During Routine Clinical Care

The aim of this study was to examine variation in suicide ideation and its relationship to risk of suicide attempt in the subsequent 90 days by race and ethnicity. Participants were adults who completed the Patient Health Questionnaire depression module (PHQ9) during an outpatient encounter between January 10, 2010, and December 12, 2012 (N = 509,945 patients; N = 1,228,308 completed PHQ9). Data came from the Virtual Data Warehouse from four health care systems in the Mental Health Research Network. The sample was majority female (73.7%), primarily 30–64 years old (60.1%), healthy (64.5% comorbidity index = 0), and over half were non‐Hispanic White (52.9%). Only Asian patients (OR: 1.31; 95% CI: 1.24, 1.39) had higher odds of reporting suicide ideation when compared to non‐Hispanic White people. All racial and ethnic groups had increased risk for suicide attempt with increased frequency of suicide ideation. The PHQ9 item 9 can be used as an indicator of suicide ideation and risk for suicide attempt up to 90 days after the reported ideation in racial and ethnic minority patients during routine clinical care.     

Assessing Legal Strains and Risk of Suicide Using Archived Court Data

Relatively little is known about legal entanglements and suicide risk. This matched case–control study estimated the risk of suicide associated with legal strains using online court archives, a novel source of exposure data. Court records linked to suicide deaths (N = 315), controls (N = 630), and unintentional injury and poisoning deaths (N = 630) for an urban county from 2000 to 2005 revealed that nearly a third of suicide victims had recent court involvement, twice the proportion among controls. Misdemeanors, car accidents, and foreclosures were each associated with a threefold risk of suicide. Implications for suicide prevention and research are discussed.     

Knowledge and Concern about STIs/HIV and Sociodemographic Variables Associated with Getting Tested for HIV Among the General Population in Spain

HIV testing is important in terms of prevention and treatment. However, HIV testing rates in the Spanish general population remains low. Therefore, HIV testing promotion constitutes a key issue. A high level of knowledge about HIV/AIDS is associated with having been tested for HIV. The general aim of this study was to determine the prevalence of people who had ever been tested for HIV in Spain. The sample consisted of 1,106 participants from the general population — 60.0% females and 40.0% males — aged between 17 and 55 years old. The assessment instruments were a questionnaire on sociodemographic data and HIV testing, a scale of knowledge about STIs and HIV/AIDS, and a scale of concern about STIs/HIV. Results showed that greater knowledge about STIs and HIV was associated with a greater likelihood of being tested for HIV (OR = .77; 95.0% CI = .73–.82; p < .05). In addition, higher concern about HIV/AIDS decreased the likelihood of not having been tested for HIV (OR = .87; 95.0% CI = .83–.92; p < .05). In fact, the higher participants concern about STIs was, the lower their likelihood of not having been tested for HIV was (OR = .87; 95.0% CI = .83–.91; p < .05). It is necessary to promote HIV testing in the general population as well as to consider their socio-demographic and psychological characteristics.