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.     

Improving the validity and reliability of medical-legal certifications of suicide

On a very basic level, those who study suicide are either explicitly or implicitly concerned with the certification of suicide deaths by coroners and medical examiners. Although many authors have questioned the reliability and validity of officially reported rates, these statistics continue to be quoted as fact--a potentially problematic practice for researchers who seek accurate and true causative factors for suicidal behavior. In relation to this topic, this article provides an overview of the existing vital statistics registry system and describes and proposes innovations that could ultimately improve the quality of officially reported suicide statistics.     

Suicide Among Minority Elderly: A Preliminary Investigation

ABSTRACT: In the United States, suicide has traditionally been considered a White elderly phenomenon. Suicide rates have been increasing for Nonwhites in recent years, but it is not clear how this may have affected the age distribution, particularly for specific Nonwhite groups. An investigation of official 1976 suicide statistics among minority elderly revealed that suicide rates are also highest among the old for Chinese-, Japanese- and Filipino-Americans. Among Blacks and Native Americans, however, suicide rates are extremely low for the aged. Explanations for these findings are suggested and the need for a long-term study is indicated.     

Detecting Suicide Risk Among College Students: A Test of the Predictive Validity of the Modified Emotional Stroop Task

Detecting suicide risk among nonclinical populations is challenging due to low base rates and the help‐negation tendency of at‐risk individuals. The current longitudinal study investigated the predictive validity of the modified emotional Stroop task (EST) by conducting a follow‐up study of 197 students who participated in a study by Chung and Jeglic (2016). The EST latencies for suicide‐related cues and past suicidal behaviors were the only significant predictors of suicide risk. The findings of this study provide preliminary support for the use of the EST as part of a suicide risk screening battery that could add to the detection of suicide risk.     

A consideration of the validity and reliability of suicide mortality data

The question of the validity and reliability of suicide statistics may be considered at three levels: (1) Are suicide deaths misidentified or differentially identified across jurisdictions or over time? (2) To what degree are suicide deaths misidentified? and (3) Is the degree to which suicides are misidentified sufficient to threaten the validity of research based on suicide statistics? There is general agreement that suicides are likely to be undercounted, both for structural reasons (the burden-of-proof issue, the requirement that the coroner or medical examiner suspect the possibility of suicide) and for sociocultural reasons. There is also substantial anecdotal and empirical evidence suggesting that the mode of death for some true suicides is in fact certified as other than suicide. Overall, it does not seem that very many true nonsuicides are incorrectly certified as suicides. There is not, however, much agreement as to the degree to which true suicides are undercounted. At least some of the inconsistencies in the findings of different investigators arise because the validity of suicide certification seems to vary from place to place. But the source of apparent conflicts in many of the findings is undoubtedly the lack of a "gold standard" against which the verdicts of any given death certification process can be measured. At best, we can estimate that the sensitivity with which coroners and medical examiners certify true suicides varies from approximately 55% to 99%. A central question in estimating the sensitivity of suicide certification is this: What proportion of true suicides are either equivocal or likely to go unsuspected by the coroner or medical examiner? Very little has been done to investigate this issue. Yet the sensitivity of suicide certification clearly varies for equivocal versus unequivocal suicides. As shown in Table 1.2, specificity is also at issue when it comes to certifying equivocal cases. The final question--whether the degree of undercounting of suicide deaths is so great that it threatens the validity of research based on official statistics--is at the crux of the general concern about suicide certification. There are examples of studies in which conclusions based on crude comparisons of reported suicide statistics appear to be invalid. For the most part, these are comparisons among nations with substantially differing death certification procedures. When official statistics are interpreted with a degree of caution and an understanding of the source and direction of biases likely to affect the published rates, however, it seems unlikely that major conclusions based on these statistics will be in error.(ABSTRACT TRUNCATED AT 400 WORDS)     

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.     

Temperament,Hopelessness, and Attempted Suicide: Direct and Indirect Effects

This study evaluated whether hopelessness mediated the relations between temperament and recent suicide attempter status in a psychiatric sample. Negative temperament and positive temperament (particularly the positive emotionality subscale) uniquely predicted levels of hopelessness. Although these temperament constructs also demonstrated significant indirect effects on recent suicide attempter status, the effects were partially (for the broad temperament scales) or fully (for the positive emotionality subscale) mediated by the levels of hopelessness. These findings indicate that a tendency to experience excessive negative emotions as well as a paucity of positive emotions may lead individuals to experience hopelessness. Although temperament may also indirectly influence suicide attempter status, hopelessness mediates these relations.     

The Association Between Anhedonia,Suicide Ideation,and Suicide Attempts: A Replication in a Persian Student Sample

Research suggests that anhedonia, a common symptom of depression, may be uniquely associated with suicidal behavior. However, little research has examined this association across cultures. To address this limitation, this study attempted to replicate a recent anhedonia and suicide study (conducted in a western culture) in a Persian sample using the Specific Loss of Interest and Pleasure Scale, Persian version. Participants consisted of 404 students who were recruited from a Persian university. Surprisingly, our results indicated that anhedonia levels were more than double those found in similar American student sample. Despite this marked difference in anhedonia symptoms, we found that anhedonia was associated with suicide risk, even when it was statistically accounting for other depressive symptoms. These findings suggest that anhedonia is a robust predictor of suicide risk across these two cultures. Further, anhedonia may be a particularly important treatment target among Persian students.     

Rational suicide and the crisis of terminal illness

Abstract

One of the controversial issues facing counselors in the 1990s is whether or not suicide may be considered a rational choice for clients with terminal illness. This article begins by reviewing the definition of rational suicide and the literature and statistics pertaining to suicide and terminal illness. Then various issues related to rational suicide as a treatment option are addressed, including moral and ethical issues.     

Suicide among police in a federal force

Suicide among police has gained the attention of numerous police forces over the past two decades. The great variation in reported police suicide rates and caveats concerning such statistics are addressed. The paper reports the results of a study of suicide among members (n = 35) of the Royal Canadian Mounted Police (RMCP) between 1960 and 1983. The average annual rate (14.1 per 100,000) of suicide in this force was approximately half that of the comparable general population, and the most common means of suicide was by service revolver (77% of cases). Recommendations are made for suicide prevention and postvention actions in police forces. Finally, the need for reliable, long-term police suicide data bases is stressed.     

Dependent children and suicide of married parents.

In an attempt to analyze the relatively neglected relationship between the presence of dependent children and suicide of married parents, the suicides of both married and single persons in the Chicago-Cook County region for 1970 and 1974 were examined. Single suicides and married suicides with dependent children were compared to similar groups in the general population. It was found that while marrieds with dependent children experienced the lowest average suicide rate, they also had a larger mean number of children than the population as a whole and exhibited a tendency for having children at a very young age or children at an older age in life. These findings contradict contemporary notions that an increasing number of children in a marriage tend to inhibit suicide potential. It appears that the relationship between marital suicide and dependent children is far more complex than previously indicated and requires further research for elaboration.     

Perceived Discrimination and Suicide Ideation: Moderating Roles of Anxiety Symptoms and Ethnic Identity among Asian American,African American,and Hispanic Emerging Adults

Suicide is a leading cause of death for vulnerable ethnic minority emerging adults in the United States (Web‐based injury statistics query and reporting system [WISQARS], 2015). Perceived discrimination (Journal of Youth and Adolescence, 40, 2011, 1465) and anxiety symptoms (Asian American Journal of Psychology, 1, 2010, 18) are two predictors that are theoretically and conceptually related, but have yet to be examined in a simultaneous model for suicide ideation. Existing theory and research suggest that these variables activate similar pathways (American Behavioral Scientist, 51, 2007, 551). This study sought to address this gap in the literature by examining the simultaneous relationship between perceived discrimination and anxiety symptoms as predictors of suicide ideation. The moderating effect of anxiety symptoms on the relationship between perceived discrimination and suicide ideation was examined in a multiethnic sample of emerging adults. Results indicated that anxiety symptoms moderated the perceived discrimination–suicide ideation relationship for Hispanic emerging adults, but not for their Asian American and African American counterparts. Furthermore, ethnic identity has been shown to mitigate suicide risk in the face of other stressors (Cultural Diversity and Ethnic Minority Psychology, 14, 2008, 75). Ethnic identity emerged as a protective factor for Hispanic emerging adults by further interacting with perceived discrimination and anxiety symptoms to negatively predict suicide ideation. The implications of these findings are discussed.     

Interoception,Pain Tolerance,and Self-Injurious Behaviors: A Multidimensional Assessment

Impairments in interoception have been linked to self-injurious behaviors, and capability for suicide may account for this relationship. However, past studies have relied primarily on self-report and unidimensional measures. The present study aimed to replicate and extend previous findings by examining the relationship between interoceptive dysfunction, pain tolerance, and self-injurious behaviors using a multidimensional and multi-method approach. A sample of 245 undergraduate students (M_age = 19.27 years, SD = 2.81; 73.7% female, 72.% White/European American), who reported lifetime suicidal ideation on a screening survey completed a battery of self-report measures, four counterbalanced pain tolerance tasks, and a clinical interview assessing their self-injurious behaviors. A tendency to stay attuned to bodily sensations was significantly related to decreased pain tolerance. Only trust in one’s body was significantly related to decreased presence of lifetime suicide attempts. No other facets of interoception or pain tolerance were significantly associated with self-injurious behaviors. Overall, these findings contrast with previous findings that capability for suicide may account for relations between interoceptive dysfunction and self-injurious behaviors. Nonetheless, the results of this study provide important information on the factor structure of interoceptive dysfunction and pain tolerance, and highlight the importance of careful selection of measures and operationalization of key constructs, particularly interoceptive dysfunction and pain tolerance.     

A thematic comparison of suicide notes drawn from Northern Ireland and the United States

Suicide is a global concern hence cross-cultural research ought to be central to national suicide prevention strategies. This study sought to investigate suicide notes drawn from Northern Ireland and the United States as these countries have broadly similar suicide rates but markedly different cultures. A theoretical-conceptual analysis of sixty suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars (1996) across countries. The results suggested that there were more psychological commonalities than differences. Two differences emerged which suggested that aspects of the interpersonal components may be more salient in Northern Irish rather than American suicides. It is argued that more wide-ranging cross-cultural studies are required to enhance our ability to identify and predict those most at risk from suicide.     

A thematic comparison of suicide notes drawn from Northern Ireland and the United States

Suicide is a global concern hence cross-cultural research ought to be central to national suicide prevention strategies. This study sought to investigate suicide notes drawn from Northern Ireland and the United States as these countries have broadly similar suicide rates but markedly different cultures. A theoretical-conceptual analysis of sixty suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars (1996) across countries. The results suggested that there were more psychological commonalities than differences. Two differences emerged which suggested that aspects of the interpersonal components may be more salient in Northern Irish rather than American suicides. It is argued that more wide-ranging cross-cultural studies are required to enhance our ability to identify and predict those most at risk from suicide.     

Reactions to the family of the suicide

The present study investigated reactions to the survivors of a family member's suicide. One hundred and twenty seven adults, members of a large urban Protestant church, responded to a newspaper account of a suicide in which the following factors were systematically varied: sex of the suicide, causal locus of the suicide, and whether the cause was prior or immediate to the suicide. The design was a 2 (sex of respondent) x 2 (sex of suicide) x 2 (locus of cause internal or external to the individual) x 2 (temporally remote cause or immediate cause). Results indicated a slight tendency for males to be somewhat more socially accepting of the surviving spouse of a suicide. There was also a significant interaction between sex of respondent x sex of the suicide, such that respondents indicated they would feel less tension in talking with the surviving family of a suicide of the same sex.     

Assisted Suicide,Euthanasia, and Suicide Prevention: The Implications of the Dutch Experience

What impact would legalization of assisted suicide and euthanasia have on our ability to treat suicidal patients and to prevent suicide? Information from a study of the Dutch experience illustrates how legal sanction promotes a culture that transforms suicide into assisted suicide and euthanasia and encourages patients and doctors to see choosing death as a preferred way of dealing with serious or terminal illness. The extension of the right to euthanasia to those who are not physically ill further complicates the problem. So too does the tendency of doctors in such a culture to begin to feel that they can make decisions about ending the life of competent terminally ill patients without consulting the patient. “Normalizing” suicide as a medical option lays the groundwork for a society that turns euthanasia into a “cure” for suicidal depression.     

Are Written Reports of Suicide and Seeking Help Contagious? High Schoolers' Perceptions1

To assess contagion for suicide and seeking mental health help, 128 high school students read a short vignette about a teen under stress. Half of them were told that this teen knew someone in the community who had similar problems and had committed suicide, and half were told that the teen knew someone in the community who had similar problems and had sought help from a mental health professional. A 2 (Gender of Respondent) × 2 (Gender of Victim) × 2 (Vignette: Response to Stress) analysis of variance indicated a significant main effect for response, and a significant two-way interaction for gender of respondent and response to stress. These high school students thought contagion occurred for suicide as well as seeking mental health help. Girls tended to be more responsive to seeking help, whereas boys were slightly more responsive to suicide. An implication is that publicity about seeking help may ameliorate suicidal contagion.     

Factors Associated with Suicide Ideation in Severely Obese Bariatric Surgery‐Seeking Individuals

There are high rates of suicide ideation and/or behavior in severely obese individuals. The potential contributors to suicide ideation in a sample of 334 severely obese bariatric surgery candidates was explored. Lack of college education, a history of suicide ideation and/or behavior, psychological distress, hopelessness, loneliness, history of physical and/or sexual abuse, and lifetime major depression were associated with current suicide ideation. Some of the correlates of suicide ideation in severely obese bariatric surgery‐seeking samples are similar to those found in the general community and this knowledge may serve to improve the psychological assessment and care for this group.