A cross-cultural investigation of the communication of suicidal intent in Swedish and Turkish adolescents

A recent study found that Swedish adolescents were more disapproving of a suicidal disclosure by a fictional friend than their Turkish counterparts. Given this finding, the present study investigated whether or not more adolescents in Turkey than in Sweden disclose their own suicidal thoughts to someone, to whom adolescents disclose their suicidal thoughts, what reactions such disclosures produce, and reasons for not disclosing suicidal feelings among 966 Swedish and 956 Turkish high school students. A questionnaire was used to collect information about different aspects of suicidal disclosures. More Turkish than Swedish adolescent suicide ideators disclosed their thoughts. More Turkish than Swedish students believed also that young people thinking about and planning suicide tell others of their plans and thereby ask for help. An overwhelming majority of adolescents in both groups revealed their thoughts to peers. The social reactions to suicidal disclosures in both samples were mainly positive. The two most common reasons for not disclosing in both groups involved interpersonal hopelessness. Adolescents who disclosed their past suicidal thoughts to someone reported having lower current suicidal ideation than those who had not. In line with favorable social attitudes towards suicidal disclosures and lower suicidal mortality rates in Turkey compared with Sweden, more Turkish than Swedish adolescents reported having disclosed their own suicidal thoughts to someone in their social milieu.     

Coping,Reasons for Living,and Suicide in Black College Students

The authors examined the roles of reasons for living and coping in protecting against suicidal behaviors among 361 Black college students. Results of a path analysis revealed that reasons for living mediated against suicidal ideation through an inverse effect on depression. Results also indicated that greater use of emotion‐oriented coping may lead to suicidal ideation through increased depression and decreased reasons for living, whereas avoidance‐oriented coping protected against suicide. Implications for these results are further discussed.     

Purpose in life and reasons for living as mediators of the relationship between stress,coping, and suicidal behavior

Positive psychological factors that help protect vulnerable persons from suicidal behavior are vital in understanding resiliency and suicide prevention. The purpose of the current study was to examine whether positive factors (including purpose in life, reasons for living, and coping styles) mediate the relationship between stressful life events and suicidal behaviors among 416 college student volunteers. Reasons for living inversely predicted suicidal behavior and thoughts directly as well as indirectly via an inverse relationship with depression. Purpose in life indirectly predicted suicidal behavior and thoughts via an inverse effect on depression, whereas emotion-focused coping indirectly predicted suicidal behavior and thoughts both through an effect on depression and an inverse effect on reasons for living. In addition, avoidant coping indirectly predicted suicidal behavior via a direct, positive effect on reasons for living. Reasons for living and emotion-oriented coping had the largest effects in the model. Results of this study underscore the importance of augmenting reasons for living and purpose in life among suicidal or potentially suicidal persons.     

Factors in the assessment of suicidality in youth

Suicide remains a leading cause of death among youth, and suicide ideation and behavior are relatively common in both normal and clinical populations. Clinicians working with young people must assess for the presence of suicidal ideation, suicidal behavior, and other risk factors, in order to determine the level of risk. This paper provides the clinician with a summary of risk factors for youth suicide, as well as providing standardized terminology to enhance assessment of suicidal ideation and behavior.     

The Internal Suicide Debate Hypothesis: Exploring the Life versus Death Struggle

Researchers and theorists (e.g., Shneidman, Stengel, Kovacs, and Beck) hyothesized that suicidal people engage in an internal debate, or struggle, over whether to live or die, but few studies have tested its tenability. This study introduces direct assessment of a suicidal debate, revealing new aspects of suicidal ideation. Results, from an online survey (N = 1,016), showed nearly all suicide‐risk respondents engaged in the debate. In addition, debate frequency accounted for 54% of the variance in suicidality scores, and showed significant associations with other indicators of suicide risk. Likely factors of the debate, reasons for living and dying, showed significant differences by suicidality, and most suicide‐risk participants reported going online for such purposes, demonstrating a behavioral component of the debate.     

Suicidal behavior in schizophrenia and schizoaffective disorder: examining the role of depression

Understanding the relationship between depression and suicidal behavior among individuals with schizophrenia and schizoaffective disorder can aid assessment and treatment. In this study, 86 individuals with schizophrenia and schizoaffective disorder were assessed for past and current suicidal behavior, depression, hopelessness, and reasons for living. Thirty-four percent reported a history of suicide attempts. Suicidal behavior typically occurred 4.5 years after the onset of psychosis and 7.5 years after the onset of the first major depressive episode for those who had a history of major depression. Depression was frequent among both attempters and non-attempters, but only half of the attempters reported a suicide attempt during an episode of major depression. And almost half of those with depression never made a suicide attempt despite a long history of illness. Although depression is a potential stressor for triggering suicidal behavior in a vulnerable subset of individuals with schizophrenia, schizophrenia research must identify other risk factors for suicidal behavior. Clinicians should remember that even without a depressive episode there is still a significant risk for suicidal behavior in schizophrenia.     

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.     

Racial differences in self-disclosure of suicidal ideation and reasons for living: implications for training

Racial differences in suicidal self-disclosure and reasons for living were investigated in 2 separate studies. In Study 1, a random sample of archival client and therapist intake data from a university counseling center for 1 year was examined, and results indicate that ethnic minority clients do not self-disclose suicidal ideation as readily as their nonethnic minority peers. In addition, a significantly higher number of ethnic minority clients were deemed "hidden ideators" because their suicidal ideation only became evident when a counselor performed a suicide risk assessment. Only 1 of the 36 ethnic minority clients with suicidal ideation in the sample voluntarily self-disclosed this ideation at intake without an assessment by the therapist. Study 2 used the Reasons for Living Inventory (RFL) and compared African American and European American college students from an introductory psychology course. The RFL is a useful instrument to compare potential race differences in reasons people report for choosing not to kill themselves, because it does not require respondents to self-disclose (or to have) current suicidal ideation. The results from Study 2 indicate European Americans report fewer reasons for choosing not to kill themselves than their African American peers and that African Americans scored significantly higher than European Americans on the moral objections and survival and coping beliefs subscales of the RFL. Implications for training counselors in suicide risk assessment, prevention, and treatment with ethnic minorities are discussed.     

Suicide Intervention Skills and Related Factors in Community and Health Professionals

Health and community professionals have considerable exposure to suicidal people and need to be well skilled to deal with them. We assessed suicide intervention skills with a Dutch version of the SIRI in 980 health and community professionals and psychology students. Suicide intervention skills clearly differed among professional groups and were strongly related to experience, especially suicide‐specific experience. Some community professionals scored below acceptable levels on their ability to respond appropriately to suicidal people they encounter, and tended to overestimate their skills level. Training is therefore indicated for these groups, and may be useful to more highly experienced groups too.     

The suicide of Ṣàngó through the prism of Integrated Motivational–Volitional model of suicide: implications for culturally sensitive public education among the Yorùbá

Recent studies have continued to recommend community-based public enlightenment and education as a key suicide-prevention strategy in sub-Saharan Africa. The role of socio-cultural factors in suicidal behaviours and the relevance of cultural factors in better understanding of and formulating more effective prevention strategies for suicidal behaviours are gaining wider acceptance. Therefore, in a multi-ethnic and multicultural region like sub-Saharan Africa, successful public enlightenment campaign has to be cognisant of specific cultural and historical nuances of suicidal behaviours in different ethnic groups. Understanding cultural contexts requires a foray into the history, cultural beliefs and the worldview of a people. We present a brief narrative of the cultural and historical perspectives of the Yorùbá people of sub-Saharan Africa about suicide. We then further situate the suicide of ?àngó – a well-known historical icon among the Yorùbá – within the framework of the Integrated Motivational–Volitional model of suicide. The outcome is a culturally and historically nuanced and a theoretically sound public enlightenment tool that can be used among the Yorùbá. Broader lessons for successful public enlightenment about suicide in Yorùbá communities – and indeed the sub-Saharan Africa region – were also drawn.     

Characteristics of Telephone Crisis Hotline Callers with Suicidal Ideation in Japan

Hotline callers do not always have suicidal ideation and previous studies have noted that the rate of such callers is limited. Crisis hotline counselors must be able to identify high‐risk callers in order to provide appropriate support. This study investigated the characteristics of Japanese crisis hotline callers in 2012 (N = 541,694) and is the first to analyze crisis hotline data for all parts of Japan over 1 year. About 14% of the callers had suicidal ideation and 6% had a history of attempted suicide. The odds ratio for suicidal ideation among those with a history of attempted suicide was 15.5. The suicidal ideation rate was much smaller compared to previous studies in other countries. There is a psychological barrier that must be broken for high‐risk people to use support hotlines. In addition, attempted suicide is a strong exclusive predisposing factor for death due to suicide; therefore, counselors should pay careful attention to callers with a history of attempted suicide. The characteristics of Japanese crisis hotline callers and the features of suicidal ideation revealed in the present study are expected to be useful in developing telephone crisis hotline strategies.     

Educating parents about youth suicide: knowledge, response to suicidal statements, attitudes, and intention to help

This study evaluated the video Youth Suicide: Recognising the Signs as a parent educational medium. Before and after viewing the video, parents (N = 112) of young people answered questionnaires measuring their (1) knowledge of suicidal signs, (2) responses to a young person showing suicidal signs, (3) attitude to suicide, and (4) intentionalitv toward suicidal people. After the video, parents' knowledge of suicidal signs, responses toward a suicidal person, and intention to help improved. Their attitude was more rejecting of suicide. Knowledge and intentionality predicted response to suicidal statements, but no relationships existed between attitude and the other variables. Implications for youth suicide education programs are discussed.     

Gender differences in the psychosocial correlates of suicidal ideation among adolescents.

Gender differences in the psychosocial correlates of suicidal ideation were studied. A sample of 613 high school students (ages 14-19) completed measures of suicidal ideation, depression, hopelessness, life stress, loneliness, alcohol and drug use, and reasons for living. The results of a discriminant function analysis indicated that males reported higher loneliness and substance abuse scores than females whereas females reported greater suicidal ideation, depression, and reasons for living. The results of multiple regression analyses found that, although the same four variables, depression, hopelessness, substance abuse, and few reasons for living emerged as significant predictors of suicidal ideation in both samples, the predictive equation accounted for more of the variance in ideation scores in females (57%) than in males (46%). In a final analysis a discriminant function analysis of the subscales of the reasons for living inventory revealed that females have a greater fear of death and injury whereas males have a greater fear of social disapproval over having suicidal thoughts. This may account for the greater rate of suicide completing among males. Fear of social disapproval, more anger and impulsivity, and less help-seeking behavior among males are offered as potential variables to explain the observed gender differences.     

Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder

Self-reported reasons for suicide attempts and nonsuicidal self-injury were examined using the Parasuicide History Interview within a sample of chronically suicidal women meeting criteria for borderline personality disorder (N = 75). Overall, reasons given for suicide attempts differed from reasons for nonsuicidal self-injury. Nonsuicidal acts were more often reported as intended to express anger, punish oneself, generate normal feelings, and distract oneself, whereas suicide attempts were more often reported as intended to make others better off. Almost all participants reported that both types of parasuicide were intended to relieve negative emotions. It is likely that suicidal and nonsuicidal parasuicide have multiple intents and functions.     

Lesbian,gay, and bisexual suicidal behavior: testing a constructivist model

The present investigation surveyed 162 self-identified lesbian, gay, and bisexual individuals recruited from LGB-related social organizations or contacted through networking procedures with regard to suicidal behaviors, suicide risk factors, and reasons for living. Approximately 41% of the respondents indicated a serious consideration of suicide including the identification of a specific suicide plan (23%) or a past suicide attempt (36%) with significant intent to die (13%). Forty-six percent of the sample indicated at least some degree of chance of attempting suicide in the future. Grounded in the existential-constructivist theory of suicide (Rogers, 2001), empirically and theoretically identified suicide risk factors were found as a group to predict suicidal ideation (R2 = .16) and attempts (R2 = .17), with abuse-related items independently predicting both suicidal ideation (R2 = .03) and attempts (R2 = .08). Items related to self-identity issues and social acceptance were predictive of suicidal ideation (R2 = .04), while substance abuse was predictive of suicidal ideation (R2 = .05) and attempts (R2 = .13) for males only. The established factor structure of the Reasons for Living Inventory (Linehan et al., 1983) was not supported in the current data, suggesting that it may not be an appropriate measure of reasons for living with LGB individuals.     

Attitudes toward suicide among Chinese people in Hong Kong

Since suicide in Chinese people exhibits certain distinctive characteristics, it is important to develop indigenous measures to assess Chinese attitudes toward suicide that may be used to inform suicide reduction programs. Combining qualitative and quantitative methods, we developed a Hong Kong version of the Chinese Attitude toward Suicide Questionnaire (CASQ-HK) which assesses attitudes toward suicide, suicidal inclination under 12 hypothetical scenarios, and prior suicidal experience. A convenience sample of 1,226 people completed the self-report questionnaire. In keeping with Chinese tradition, respondents revealed both tolerant and condemning attitudes that varied with their sociodemographic characteristics. Generally, they were not strongly inclined to consider suicide in the presence of difficult scenarios. Female gender, older age, and the presence of suicidal ideation were associated with more contemplation of suicide.     

Six year follow-up of health status changes in Danish adults with suicide tendency in 1994

The purpose of this study was to determine whether suicidal ideation and/ or suicide attempts have any long-term health effects. The relationship between suicidal thoughts and/or a previous suicide attempt in 1994 and the presence of suicidal ideation in 2000 was analyzed. We found that health status in 1994 differed significantly between the groups with and without suicidal ideation or a previous suicide attempt and that the differences persisted or even deepened (not significant) after 6 years. Further, people who had suicidal ideation or a suicide attempt in 1994 had a significantly greater risk (OR = 7.4) of having suicidal ideation in 2000 than people who had not.     

HIV infection and mental health: suicidal behaviour--systematic review

Suicide has long been associated with serious illness generally and HIV specifically. New treatments have affected prognosis in HIV positively, but it is unclear how they impact on suicidal burden (thoughts, self-harm and completions). This review examines all published suicide and HIV data for a definitive account of (1) prevalence of HIV-related suicidality, (2) measurement within studies and (3) effectiveness of interventions. Standard systematic research methods were used to gather quality published papers on HIV and suicide, searching published databases according to quality inclusion criteria. From the search, 332 papers were generated and hand searched resulting in 66 studies for analysis. Of these, 75% were American/European, but there was representation from developing countries. The breakdown of papers provided 12, which measured completed suicides (death records), five reporting suicide as a cause of attrition. Deliberate self-harm was measured in 21, using 22 instruments; 16 studies measured suicidal ideation using 14 instruments, suicidal thoughts were measured in 17, using 15 instruments. Navigating the diverse range of studies clearly points to a high-suicidal burden among people with HIV. The overview shows that autopsy studies reveal 9.4% of deceased HIV+?individuals had committed suicide; 2.4% HIV+?study participants commit suicide; approximately 20% of HIV+?people studied had deliberately harmed themselves; 26.9% reported suicidal ideation, 28.5% during the past week and 6.5% reported ideation as a side effect to medication; 22.2% had a suicide plan; 19.7% were generally "suicidal" (11.7% of people with AIDS, 15.3% at other stages of HIV); 23.1% reported thoughts of ending their own life; and 14.4% expressed a desire for death. Only three studies recruited over 70% female participants (39 studies recruited over 70% men), and six focussed on injecting drug users. Only three studies looked at interventions - predominantly indirect. Our detailed data suggest that all aspects of suicide are elevated and urgently require routine monitoring and tracking as a standard component of clinical care. There is scant evidence of direct interventions to reduce any aspect of suicidality, which needs urgent redress.     

Undergraduate education majors' knowledge about suicide

Undergraduate education majors' knowledge about suicide was evaluated to identify what training they may need about suicide prevention and to explore the hypothesis that individuals previously exposed to suicide in their social context may hold higher suicide-related knowledge than those without. 71 college students completed the 50-item Expanded Revised Facts on Suicide Quiz to examine their knowledge about suicide. While overall knowledge was low for general information and for specific items concerning suicide among youth and elderly persons, knowledge was high on several items important for suicide prevention work. Higher suicide-related knowledge was found for knowing a suicide attempter, providing partial support for the hypothesis that personal experience with suicidal people may correspond with greater knowledge about suicide.     

Youth Suicide: The Knowledge and Attitudes of Australian Teachers and Clergy

This is the first study of the suicide-related knowledge and attitudes of teachers and clergy in Australia. These professional groups have been identified as “gatekeepers” who might serve as a first line of assistance for distressed young people. Such gatekeepers, along with medical and mental health professionals, have a vital role to play in the prevention of youth suicide, of which Australia has the highest rates in the world. This research confirmed that high numbers of teachers and clergy have been approached by suicidal young persons. However, their gatekeeping role may be compromised by a low level of knowledge about signs of suicide risk, which was found even among those who had taken courses in suicide or death and dying or who had personally known someone who suicided. Suicidal behavior was found to be generally regarded as unacceptable, especially by those with a high religious commitment. Further educational efforts about suicide risk identification and prevention seem to be needed for both teachers and clergy; it will be important for such education to take into account attitudinal issues and how these might affect communication with young suicidal people.