2005 Shneidman Award Address. Integratively assessing risk and protective factors for adolescent suicide

This article briefly reviews key issues in adolescent suicide risk assessment and proposes that assessing risk and protective factors in combination has the best probability of informing the field's understanding of this complex problem. Several newer measures are described along with summaries of their psychometric properties. A recommended protocol utilizing 4 developmentally appropriate, valid, and reliable self-report measures is suggested as a parsimonious way of gathering information on the range of risk and protective factors. Finally, a novel approach of employing short-term longitudinal studies to test models of adolescent suicide attempts is described along with a rationale for not focusing research efforts on completed suicide. Implications of this approach for prevention efforts conclude the article.     

Suicide and the suicidal body. 2002 Dublin Award Address

This paper focuses on the bodily experiences and attitudes toward the body in suicidal individuals. It is argued that bodily experiences and attitudes toward the body, such as rejection of the body, detachment, numbness, physical anhedonia, and lack of protection can facilitate acts of self-destruction. This argument is supported by theories of developmental psychology, theories on suicide, and empirical data. It is demonstrated that suicidal individuals experience their body differently from other populations and that these are related to suicidal behavior.     

The anatomy of suicidology: a psychological science perspective on the status of suicide research. 2002 Shneidman Award Address

Suicidologists have made tremendous strides in advancing the knowledge of correlates of completed suicide and nonfatal suicidal behavior since the early 1960s. In order to move beyond the simple identification of risk factors, however, scientific suicidology needs to give greater attention to the critical role of theory in guiding inquiry and advancing the understanding of suicidal behaviors. In this article I argue the importance of theoretical grounding from the perspective of psychological science, provide examples of this perspective from my work, and discuss their implications for future research in the field.     

Selected risk factors in adolescent suicide attempts.

This study examined stress, depression, attempted suicide, and knowledge of common signs of potential suicide in Alabama adolescents. A modified version of the National Adolescent Student Health Survey (NASHS) was administered to 3,803 eighth- and tenth-grade public school students during the fall of 1988. The incidence of stress, depression, and attempted suicide was analyzed by gender, ethnicity, locale (urban vs. rural), and participation in sexual intercourse and use of alcohol. Chi-square tests were used to determine if there were significant differences between groups. Findings indicated that females were at greater risk than were males. Both males and females who engaged in sexual intercourse and alcohol consumption were at greater risk than were abstainers. When analyzed by ethnicity, white adolescents who engaged in these behaviors were at significantly greater risk than were those who abstained; differences were not as pronounced for black youth. Comparisons on the knowledge scale indicated that females scored better than males, whites scored better than blacks, and urban students scored better than rural students. The data suggest that many adolescents are having difficulty coping with stress and depression, and that those who are engaging in various types of risk-taking behavior are at greater risk for depression and suicide.     

Introduction to Stephen G. West's Murray Award Address

I am honored to introduce Stephen G. West, the winner of the Henry A. Murray Award for Outstanding Contributions to Personology and the Study of Human Lives. Steve's contributions as a methodologist and statistician are appreciated by anyone who has struggled with complex interactions and unusual research designs. These empirical innovations have contributed enormously to broadening and deepening the kinds of data that can be used to study personality. Perhaps less apparent, but crucial in his selection for this award, is Steve's leadership in diversifying the field of personality psychology. In his capacity as editor of the Journal of Personality in the 1980s and early 1990s, Steve effectively shepherded personology into the mainstream of personality research. Also important was Steve's willingness not only to mentor his own graduate students, but to rescue a considerable number of strays. In his generativity and inclusiveness, Steve has effectively elevated the field of personality and the persons within it.     

The relationship between forgiveness and history of suicide attempt

The sentiment of forgiveness in relationship to suicide attempts/completions has been mostly examined through studies of suicide notes and the experiences of survivors and therapists – not attempters. In a cross-sectional sample of 304 consecutive primary care patients, we examined sentiments about forgiveness using the Forgiveness Scale, comparing those individuals with versus without past suicide attempts. According to findings, individuals with past suicide attempts (N?=?55; 19.1%) evidenced significantly lower composite scores on the Forgiveness Scale. As for individual items, compared to participants without past suicide attempts, those with past suicide attempts were significantly less believing of forgiveness by others, were less likely to forgive themselves, and to a lesser degree, were less forgiving of others. There were no between-group differences with regard to confession of wrongdoing or existential forgiveness by God. Findings may offer some salient avenues of therapeutic inquiry and endeavour in the psychological healing of individuals with past suicide attempts.     

Prospective risk factors for subsequent exposure to potentially traumatic events

Abstract

In a sample of 1528 college students, we examined (1) whether several risk factors prospectively predicted exposure to potentially traumatic events (PTEs) over a 2-month period and (2) whether dependent events (i.e., those more likely to depend upon one's behavior or characteristics) and independent events were predicted by different risk factors. Logistic regression analyses indicated that overall subsequent PTE exposure was higher for women, those with more previous PTEs, and those who engaged in more binge drinking. Female gender and previous PTE exposure also predicted exposure to independent events. Subsequent dependent PTE exposure was predicted by more previous PTEs and binge drinking, and was somewhat higher in ethnic minority students. Implications for prevention efforts are discussed.     

The relationship between defenses and symptoms in adolescent psychopathology

The relationship between defense mechanisms and symptoms was assessed in a group of 196 psychiatrically hospitalized adolescents. Defense mechanisms were measured through the use of the Defense Mechanisms Inventory (DMI); symptoms and problem behaviors were measured with the Youth Self-Report. Univariate and multivariate analyses indicated that externalizing symptoms are associated with defenses that locate the conflict outside of the self, whereas internalizing symptoms are associated with defenses that locate the conflict within the self. In contrast to previous reports, no gender differences were found in defense preference, though gender differences were found in the relation of defenses to symptoms. The findings are consistent with clinical theory of defense processes and support the distinction between internalizing/externalizing behaviors and personality dimensions for both symptoms and defenses. The study supports the validity of the adolescent form of the DMI.     

The relationship between seriously considering, planning, and attempting suicide in the youth risk behavior survey

The assumed ordinal relationship between seriously considering, planning, and attempting suicide in the 1999 Youth Risk Behavior Survey was examined by constructing a trajectory that identified all possible response patterns among the four questions measuring suicidal activity. Statistical analysis tested for differences in frequency of risk behaviors across levels of the trajectory. Overall, the trajectory provided insight to the progression of adolescent suicidal activity and demonstrated usefulness as a measure of suicidal intent. Significant differences between means of dependent variables at each level of the normative trajectory supported the hypothesis that frequency of risk behaviors increases monotonically with successive suicidal thought and behavior.     

The relationship between initial errorless learning conditions and subsequent performance

This experiment explores a suggestion by [Maxwell, J.P., Masters, R.S.W., Kerr, E., Weedon, E. (2001). The implicit benefit of learning without errors. Quarterly Journal of Experimental Psychology A 54, 1049-1068] that an initial bout of implicit motor learning confers beneficial performance characteristics, such as robustness under secondary task loading, despite subsequent explicit learning. Participants acquired a complex motor skill (golf putting) over 400 trials. The environment was constrained early in learning to minimize performance error. It was predicted that in the absence of explicit instruction, reducing error would prevent hypothesis testing strategies and the concomitant accrual of declarative (explicit) knowledge, thereby reducing dependence on working memory resources. The effect of an additional cognitive task on putting performance was used to assess reliance on working memory. Putting performance of participants in the Implicit-Explicit condition was unaffected by the additional cognitive load, whereas the performance of Explicit participants deteriorated. The relationship between error correction and episodic verbal reports suggested that the explicit group were involved in more hypothesis testing behaviours than the Implicit-Explicit group early in learning. It was concluded that a constrained, uninstructed, environment early in learning, results in procedurally based motor output unencumbered by disadvantages associated with working memory control.     

The relationship between attitudes toward suicide and willingness to pay for suicide prevention: a cross-sectional study in Japan

There are gaps in our knowledge of the role attitudes toward suicide play in determining people’s willingness to participate (WTP) for suicide prevention. We conducted a large nationwide cross-sectional study with the aim of clarifying the relationship between WTP for reducing suicide risk and attitudes toward suicide. Ordinal logistic regression analyses (n = 1771) showed that there were significant associations of WTP for suicide prevention with ‘Suicide as a right’ (β = ?.15, 95% CI: ?.25 to ?.04, p = .006), ‘Preventability/readiness to help’ (β = .81, 95% CI: .69–.94, p < .001) and ‘Common occurrence’ (β = .32, 95% CI: .19–.46, p < .001). ‘Incomprehensibility/unpredictability’ did not show an association with WTP. Taxpayer acceptance for suicide prevention is more likely to be achieved through provision of information that increases endorsement of ‘preventability/readiness to help’ and ‘common occurrence’ factors, and decreases ‘suicide as a right’ scores.     

The relationship between firearms and suicide: A review of the literature

Suicide rates are affected by many factors—psychiatric, biological, familial and situational. This paper focuses on one potential risk factor for completed suicide in the United States—the availability of firearms. Whether the availability of firearms might increase the rate of attempted suicide is not examined. This article is not an exhaustive review of every existing firearm-related suicide study. Rather, it provides a detailed review of the most commonly cited, representative, and thorough empirical studies in the published peer-reviewed literature relating firearms and suicide, focusing largely on the United States. The empirical studies reviewed are grouped according to whether the unit of analysis is the individual (e.g., case-control studies) or a population (e.g., ecological studies) and further divided depending on whether the analysis uses cross-sectional or time-series (longitudinal) data. We begin with a very brief overview of the suicide problem in the United States.     

The relationship between adolescent depression and a history of sexual abuse

The purpose of this study was to examine the occurrence of depression among adolescents attending family planning clinics, and to determine the relationship among depression, a history of sexual abuse, and other risk behaviors. The sample consisted of 279 minority females. Results of the study indicated that 40 adolescents (14.3%) scored at or above a raw score of 77 for depression based on the Reynolds Adolescent Depression Scale (RADS). This suggests that these adolescents should be identified for further evaluation. Results of the Stepwise Linear Regression indicated that a history of sexual abuse was the most potent factor in predicting depression. These findings highlight the importance of screening concurrently for depression and a history of sexual abuse in family planning and other healthcare settings.     

The relationship between early development and psychosexual behaviors in adolescent females

The relationship between early sexual maturation and the psychosexual behaviors of dating and sexual intercourse was investigated using a national sample of adolescent females aged 15 to 19. Among both black and nonblack subjects, early-maturing girls were more likely to have experienced earlier dating and coital onset than were their later-maturing peers. Blacks experienced menarche and first intercourse at earlier ages, yet dating onset at later ages. Early menarche was also associated with marriage at an early age for nonblacks, but not for blacks. These racial differences were explained in terms of diverse socialization patterns or cultural expectations. For both blacks and nonblacks, those with earlier coital experience were found to have had menarche and dating onset at earlier ages.     

The Rorschach test for predicting suicide among depressed adolescent inpatients.

With the decreasing length of psychiatric hospitalizations, identification of test indicators of suicide risk becomes critically important. This Rorschach study was designed to model a clinical decision-making scenario concerning adolescent suicide risk. Using Psychiatric Evaluation Form (PEF) scores, we selected a sample of 25 severely depressed and suicidal adolescents; 26 severely depressed, not suicidal adolescents; and 28 not suicidal, not depressed adolescent inpatients at The Sheppard and Enoch Pratt Hospital. A Rorschach Index using the Exner (1986) Comprehensive System for scoring was developed to predict group membership. Four of six of the features on this index selected 64% of suicidal subjects. This constellation included traditional affective variables (vista responses, color-shading blends, color dominated responses, and morbid content) as well as measures of cognitive distortion (inaccurately perceived human movement responses [M-] and special scores). We discuss the implications of these findings for the diagnosis and treatment of the suicidal adolescent.     

The relationship of offending style to psychological and social risk factors in a sample of adolescent males

Research has indicated that life‐course persistent offenders typically vary their offending style, following a criminal career progression from co‐ to solo‐offending. Few studies have investigated the offenders who contemporaneously mix their style of offending. A sample of 1,047 male adolescent offenders from the Pathways to Desistance study was investigated over a 7‐year period. Participants were identified as solo, co or contemporaneous mixed style (CMS) offenders for each wave of data and one‐way between groups analysis of variance was conducted to examine variations between the different offending styles in terms of offending frequencies, exposure to violence, peer antisocial behaviour and influence, resistance to peer influence, impulse control and psychopathy. CMS offenders were found to consistently report significantly higher rates of offending and present significantly higher negative risk factors and lower protective risk factors than solo‐ and co‐offenders for the duration of the study. A multinomial logistic regression was used to investigate predictors of offending style with CMS as the reference category. Higher levels of exposure to violence and peer antisocial behaviour and lower levels of impulse control predicted membership of the CMS group for the first part of the study when compared with co‐offenders; and higher levels of exposure to violence and peer antisocial behaviour continued to predict CMS offending when compared to solo‐offenders until the end of the study.     

The relationship between body dysmorphic disorder behaviors and the acquired capability for suicide

In a sample of 200 individuals diagnosed with body dysmorphic disorder (BDD), we utilized the interpersonal-psychological theory for suicide as a framework to examine BDD behaviors that might be associated with suicide risk, insofar as they might increase the acquired capability for suicide. We predicted that physically painful BDD behaviors (e.g., cosmetic surgery, restrictive eating) would be associated with suicide attempts but not suicide-related ideation because these behaviors increase capability for, but not thoughts about, suicide. Our hypothesis was partially confirmed, as BDD-related restrictive food intake was associated with suicide attempts (but not suicide-related ideation) even after controlling for numerous covariates.     

The relationship between adolescent attitudes towards authority, self-concept, and delinquency

Attitudes towards authority of youth and adults have been investigated in recent years in a number of Western countries. The present research focused on attitudes towards institutional authority among three groups of adolescents: nondelinquents, noninstitutionalized delinquents, and institutionalized delinquents. Relationships with self-concept were also investigated. It was found that attitudes towards parents, teachers, police, and the law were, in general, positive. Nondelinquents' attitudes were more positive than those of delinquents.