The Suicidal Adolescent and Special Services Providers

Issues related to adolescents at risk for suicide are discussed. An approach is offered to assist special services providers with early identification of adolescents who might be at risk for suicide. In this article, the approach is reflected as a set of 28 behavioral indicator guidelines. In addition, psychosocial characteristics of adolescents at risk for suicide are considered.     

Prevalence and Correlates of Direct Self-Injurious Behavior among Chinese Adolescents: Findings from a Multicenter and Multistage Survey

Direct self-injurious behavior (DSIB) has become an important focus due to its perniciousness and perplexity. Little is known about its prevalence and correlative factors in Chinese adolescents, including how data may differ according to gender. A multicenter, multistage stratified cluster random sampling was used to examine the previous 12-month prevalence of DSIB, as well as the possible correlates of demographics, risky behaviors, suicidality, and psychosocial factors associated with DSIB in a school-based sample of 11,880 students (49.5 % boys and 50.5 % girls). Approximately 30 % of the adolescents in the sample reported at least one incident of DSIB in the past 12-month period. After controlling for demographic variables, analyses of the independent relationships of DSIB with risky behaviors, suicidality, and psychosocial factors were conducted for each gender. Smoking, binge drinking, running away from home, suicide ideation, suicide plans, positive affect, and physical symptoms were identified as common factors associated with DSIB for both genders in the final model. In addition, truancy, fighting, physical inactivity, motor impulsiveness, and depressed affect were found to be related to DSIB in boys, whereas suicide attempts and somatic complaints were found to be related to DSIB in girls. Separation anxiety and social anxiety associated negatively with DSIB in boys and girls, respectively. DSIB was not found to independently relate to attention impulsiveness, non-planned impulsiveness, self-esteem, or harm avoidance in either genders. DSIB was prevalent in Chinese adolescents. Programs intended to promote physical and mental health in adolescents should take into account gender differences in DSIB-associated factors, including risky behaviors, suicidality, and psychosocial factors.     

Psychosocial treatment of depression and suicidality in adolescents

Depression is a common disorder among adolescents and is associated with a high risk of suicide. Suicide is the third leading cause of death among adolescents in the United States. Currently, there are only two evidence-based psychotherapies for adolescence depression: cognitive-behavioral therapy and interpersonal psychotherapy. Furthermore, psychosocial interventions that specifically target suicidal behavior in adolescents are even fewer in number than treatments for depression. This article will review the psychosocial interventions for depression and suicidality in adolescents and will describe a recently developed treatment that is under study for depressed suicidal adolescents.     

The association between adolescents' attitudes toward suicide and their psychosocial background and suicidal tendencies.

The present study examined the relationship between adolescents' attitudes toward suicide and their psychosocial background. It also evaluated the association between attitudes toward suicide and the subjects' own suicidal tendencies. A questionnaire assessing these issues was administered to 525 Israeli adolescents. Results indicated that significantly more females, nonreligious adolescents, those exposed to suicidal behavior, and those with increased suicidal risk held more accepting attitudes. Ethnic origin, socioeconomic status, and living in intact/nonintact families were not associated with adolescents' attitudes toward suicide.     

Gay adolescents and suicide: understanding the association

Suicide among gay adolescents is a major public health concern, but it is still under-emphasized within mainstream healthcare. This article brings together information garnered from past studies, articles, and experiences to create a more in-depth understanding of why gay adolescents are at a higher risk for suicide. By creating a better understanding, this article attempts to push forward the significance of this issue and encourages physicians to take a more active role in suicide prevention. The article initially explores why issues involving homosexuality are seldom discussed and provides evidence for an increased risk in suicide among gay adolescents. By addressing major psychosocial issues faced by gay adolescents, it spends the majority of time facilitating an understanding of the increased risk. In this article "gay" refers to homosexual males and females, and bisexuals unless otherwise indicated.     

Suicidality,Self‐Harm,and Body Dissatisfaction in Transgender Adolescents and Emerging Adults with Gender Dysphoria

Prevalence of suicide attempts, self‐injurious behaviors, and associated psychosocial factors were examined in a clinical sample of transgender (TG) adolescents and emerging adults (n = 96). Twenty‐seven (30.3%) TG youth reported a history of at least one suicide attempt and 40 (41.8%) reported a history of self‐injurious behaviors. There was a higher frequency of suicide attempts in TG youth with a desire for weight change, and more female‐to‐male youth reported a history of suicide attempts and self‐harm behaviors than male‐to‐female youth. Findings indicate that this population is at a high risk for psychiatric comorbidities and life‐threatening behaviors.     

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.     

Self-injury behavior, economic status and the family anomie syndrome among adolescents.

Only recently has there been a focus upon the psychosocial environment of the family that surrounds the suicide-prone individual. The purpose of this research was to learn more about the association of economic status and family anomie, operationationalized by family normlessness and powerlessness scales, to the differential vulnerability of adolescents to suicide potential. The research design called for a detailed interview with the persons attempting suicide and members of their families. The study samples consisted of 30 low economic and 25 high economic status families. It was predicted that social anomie could be translated into behavioral (attempted suicide) and attitudinal (normlessness and powerlessness) determinants when viewed with regard to its impact upon the family. Significant differences in the degree of normlessness and powerlessness were found for suicidal and nonsuicidal adolescents and their families. These differences appear to be part of a family anomie syndrome.     

Youth suicide risk factors and attitudes in New York and Vienna: a cross-cultural comparison

The prevalence of suicide risk factors and attitudes about suicide and help-seeking among New York and Viennese adolescents were compared in order to explore possible cross-cultural differences. Viennese adolescents exhibited higher rates of depressive symptomatology than their New York counterparts and had more first-hand experience with suicidal peers. More attribution of suicide to mental illness was reported in Vienna; yet Viennese youth were less likely than New York adolescents to recognize the seriousness of suicide threats. Help-seeking patterns of Viennese adolescents were influenced by their setting a high value on confidentiality. These cross-cultural differences may reflect the limited exposure of Austrian youth to school-based suicide prevention programs. The findings highlight the need of taking the sociocultural context into consideration in the planning of youth suicide prevention strategies.     

Nonfatal and fatal self-harm injuries among children aged 10-14 years--United States and Oregon, 2001-2003

Fatal and nonfatal injuries due to suicidal behavior among younger adolescents are of growing concern for many communities. We examined the incidence and patterns of these injuries among persons aged 10-14 years using three databases, two national and a third from Oregon. Suffocation and firearm gunshot were the leading external causes of suicide; poisoning and cutting/piercing were the leading causes of nonfatal self-harm injuries. The most common psychosocial factors associated with those treated in emergency departments for self-harm injuries were psychological conditions; drug/alcohol involvement; and adverse circumstances, including family discord, school problems, and physical/sexual abuse. Analysis of population-based data from these databases are part of the public health approach and can help direct much needed research and prevention efforts that address self-harming behavior in these younger adolescents.     

Adolescents' attitudes toward suicide, and a suicidal peer: A comparison between Swedish and Turkish high school students

The present paper first presents the attitudes toward suicide and a suicidal classmate among 98 female and 69 male (N = 167) Swedish high school students. Secondly, the Swedish sample was compared with 167 (89 female and 78 male) Turkish high school students from a previous study. Among Swedish students, more males than females said that people have the right to commit suicide and suicide can be a solution to some problems. More females than males expressed a belief in life after death. Swedish adolescents were found to be holding more liberal attitudes toward suicide than Turkish adolescents. However, Turkish adolescents showed greater acceptance for a suicidal peer than Swedish adolescents. The results are discussed in terms of socio-cultural factors and related literature. The need for educational programs to provide basic knowledge about suicide and, effective ways of dealing with and helping suicidal peers is implicated.     

Sexual assault history and suicidal behavior in a national sample of women

This study examined demographic and psychosocial correlates of suicidal ideation and suicide attempts in women with histories of sexual assault in childhood and/or adulthood identified from a national sample of women. Multivariate analyses showed that women with histories of sexual assault in both childhood and adulthood reported significantly greater odds of lifetime suicide attempts, controlling for demographic factors and other psychosocial characteristics. As predicted, younger age (marginal), stressful life events (marginal), depression, PTSD, and alcohol dependence symptoms were also significantly associated with suicidal ideation. Furthermore, number of lifetime traumatic events and depression were each associated with lifetime odds of suicide attempts. Implications for studying the role of sexual trauma and other psychosocial factors in relation to women's suicidal behavior are discussed.     

Gender differences in psychosocial risk factors among Slovenian adolescents

This study investigated psychosocial risk factors in adolescents and assessed gender differences in the frequency of their occurrence. A specially designed questionnaire, which included validated scales for the evaluation of depression (Zung Self-rating Depression Scale) and self-esteem (Rosenberg Self-Esteem Scale), was administered to a representative sample of Slovenian adolescents. The final sample consisted of 4,590 high school students of both sexes, aged 14 to 19 years. Data analysis revealed several significant gender differences. Girls more often than boys reported family conflict, personal problems, physical inactivity, attempts to control body weight, use of psychoactive drugs, suicidal ideation, and suicide attempts. Their level of depression was higher and self-esteem lower when compared with their male counterparts. Boys more often than girls indicated that they watched a great deal of television, were the victims of peer violence, and drank alcohol.     

Suicide Ideation in Adolescents Following Inpatient Hospitalization: Examination of Intensity and Lability Over 6 Months

Understanding suicide ideation (SI) in adolescents, especially during the high‐risk time following hospitalization for a suicidal event, is a crucial component of improving risk assessment. Most studies rely on single assessments of SI, despite the potential for SI to vary considerably over time. This study examined how indices of SI intensity (mean values) and lability (mean squared successive difference values) over a 6‐month period predict suicide attempts (SAs) and self‐harm, as well as how they relate to psychosocial risk factors and affective functioning, in a sample of 103 adolescents hospitalized for a SA or significant SI. Across the sample, SI intensity, but not lability, was associated with SAs and nonsuicidal self‐injury at 6‐month follow‐up. SI intensity performed similarly to single time point SI assessments, and its relations were not moderated by SI lability. SI intensity was also associated with borderline personality disorder criteria and a history of sexual abuse. In contrast, SI lability was associated with greater negative affect intensity and lability. These findings suggest that intensity of SI may confer more risk posthospitalization, and provide support for using these statistical methods to capture two distinct parameters of SI.     

Social and individual risk factors for suicide ideation among Chinese children and adolescents: A multilevel analysis

The objective of this study was to investigate the prevalence and predictors of suicide ideation among primary, middle and high school students. We used multilevel modelling to investigate suicide ideation among 12,733 Chinese children and adolescents aged 9–18 years from wide range of areas across China. Approximately, 32.09% of children and adolescents reported suicide ideation, with females were more likely to report suicide ideation than males (38.09% vs. 29.95%). Our results showed that the risk factors in primary school students were different from middle and high school student groups, whereas significant risk factors for middle and high school students were similar. The city's standard of living as indicated by the Engel coefficient and the city's divorce rate were positively associated with the prevalence of suicide ideation; in contrast, the school's pupil‐to‐teacher ratio was negatively correlated with elevated suicide ideation. Significant risk factors for suicide ideation included study anxiety, self‐accusation tendency, impulsive tendency, terror tendency and physical symptoms. These results have important implications for the prevention of suicide, suggesting that both contextual (city‐level) and compositional (individual‐level) factors could be important targets for prevention and intervention for children and adolescents at risk of suicide ideation.     

Assessment of mode of anger expression in adolescent psychiatric inpatients.

Anger can play an important role in depression and suicide risk among adolescents. The present study evaluated internalized and externalized anger in 92 adolescent psychiatric inpatients. Results indicated that adolescents who internalized their anger were more likely to be depressed and to experience feelings of hopelessness. In addition, adolescents who internalized their anger made more serious suicide attempts than did those who externalized their anger. In contrast, adolescents who externalized their anger were more likely to have alcohol-related problems. Thus, different modes of anger expression appear to be related to different manifestations of psychopathology. It was concluded that assessment of mode of anger expression in adolescents may enhance our understanding of suicide and its risk factors.     

Suicidality Among Adolescent Alberta Indians

A high rate of suicide attempts and suicide ideation characterized a sample of 229 grade 7 to 9 adolescents resident on seven reserves in central Alberta. The prevalence of suicidality for these adolescent Indians was very similar to rates reported for Navajo youth and for 8th- and 10th-grade American non-Indian students. Comparison of Indian and non-Indian suicidality risk factors showed somewhat elevated levels of family disruption and psychological problems among Indian adolescents. Compared to Canadian nonadolescents, substance abuse levels were high, and conditions necessary to modeling were virtually omnipresent. Suicide ideation was significantly elevated for Indian adolescents with low psychological well-being, no father in the home, and a prior suicide in the household. Controlling for age, risk factors for suicide attempts were heavy alcohol use, no father in the home, sleeping problems, and low psychological well-being. The high rates of adolescent Native suicide imply that a much higher proportion of their suicide attempts succeed. Targeted, community-based counselling and educational programs are needed to address these problems.     

Reasons for Attempting Suicide among a Community Sample of Adolescents

The motives of suicide attempts among a community sample of 99 U.S. high school students were explored. Participants completed an in‐depth computer‐assisted self interview about their most recent attempts as well as additional psychosocial measures. Results indicated that nearly 75% of the adolescents engaged in suicide attempts for reasons other than killing themselves and that depressive symptoms and premeditation prior to the attempt were significantly associated with increased risk for engaging in the attempts with death as a clear motive. Linking motive for an attempt (death, interpersonal communication, emotion regulation) and treatment approach may improve prevention of subsequent attempts and completed suicides.     

Evidence for an emotion-cognition interaction in the statistical prediction of suicide attempts

Suicidal behavior is a prevalent problem among adolescents and young adults. Although most theoretical models of suicide suggest that this behavior results from the interaction of different risk factors, most prior studies have tested only bivariate associations between individual risk factors and suicidal behaviors. The current study was designed to address this limitation by testing the effect of an emotion–cognition interaction on suicide attempts among youth. Specifically, we hypothesized that the interaction of emotion reactivity and problem-solving skills would statistically predict the probability of a recent suicide attempt among 87 adolescents and young adults. Results revealed a significant interaction, such that emotion reactivity was strongly associated with the probability of a suicide attempt among those with poor problem-solving skills, moderately associated among those with average problem-solving skills, and not significantly associated among those with good problem-solving skills. The next generation of studies on suicidal behavior should continue to examine how risk factors interact to predict this dangerous outcome.