Family economic pressure and adolescent suicidal ideation: application of the family stress model

This study used a sample of 501 families from the Mississippi Delta region to examine the feasibility of the Family Stress Model for understanding adolescent suicidal ideation. The results indicated that family economic pressure was related to parental depressive symptoms, which, in turn, was related to parental hostile behavior and physical abuse. These parental behaviors were related to adolescent self-esteem and depressive symptoms, which, in turn, were related to adolescent suicidal ideation. Therefore, family economic pressure and parental depressive symptoms and behaviors were indirectly related to adolescent suicidal ideation. The results indicate the applicability of the Family Stress Model for understanding adolescent suicidal ideation.     

Peer functioning, family dysfunction, and psychological symptoms in a risk factor model for adolescent inpatients' suicidal ideation severity

Examined models of suicidal ideation severity that include two psychosocial risk factors (i.e., peer and family functioning) and four domains of psychological symptoms (i.e., generalized anxiety, depression, conduct problems, and substance abuse/dependence). Participants were 96 psychiatric inpatients (32 boys, 64 girls), ages 12 to 17, who were hospitalized because of concerns of suicidality. Adolescents completed a structured diagnostic interview, measures of suicidal ideation, and several dimensions of family and peer functioning. Results supported a model in which greater levels of perceived peer rejection and lower levels of close friendship support were associated directly with more severe suicidal ideation. In addition, indirect pathways included deviant peer affiliation and global family dysfunction related to suicidal ideation via substance use and depression symptoms. The results are among the first to demonstrate relations between suicidal ideation and several areas of adolescent peer functioning, as well as divergent processes for peer and family predictors of suicidal ideation.     

Suicidal Adolescents' Social Support from Family and Peers: Gender-Specific Associations with Psychopathology

Perceptions of social support from family, non-family adults, and peers were examined in relation to the psychopathology reported by 220 suicidal adolescents (152 females) during a psychiatric hospitalization. Results of regression analyses showed that, among females, family support was negatively related to hopelessness, depressive symptoms, and suicidal ideation. Among males, peer support was positively associated with depressive symptoms and suicidal ideation. Across gender, more peer support was associated with more externalizing behavior problems; whereas, family support was negatively related to these problems and to alcohol/substance abuse. Paralleling normative findings, age was positively associated with peer support, and females perceived more peer support than did males. Findings extend previous research on social support to suicidal adolescents, and broaden the literature by examining extrafamilial support and a broader range of relevant psychopathology. That is, perceived social support relates to psychiatric impairment differentially by gender, and normative, age-related variations in perceptions of social support are detected even among highly impaired adolescents. Clinical implications and directions for future research are discussed.     

Suicidal ideation in Hispanic and mixed-ancestry adolescents.

This survey examined differences in suicidal ideation, depressive symptomatology, acculturation, and coping strategies based on ethnicity. The author gathered data from a self-report questionnaire administered to students in an ethnically diverse middle school (grades 6-8, N= 158). Hispanic (predominantly Mexican American) and mixed-ancestry adolescents displayed significantly higher risk of suicidal ideation compared to Anglo peers, even when socioeconomic status, age, and gender were controlled for. Suicidal ideation was associated with depressive symptoms, family problems, lower levels of acculturation, and various coping strategies. Using multivariate analysis, Hispanic ancestry, depressive symptoms, family problems, and the use of social coping remained in the model.     

Parent and peer attachment in early adolescent depression

Insecure attachment relations have been theorized to play a significant role in the development of depressogenic modes of adaptation and to thus form a vulnerability factor for the emergence of depressive disorder in children. This study examined security of parent and peer attachment among four groups of early adolescents: clinically depressed, nondepressed psychiatric controls, nonpsychiatric controls, and adolescents with resolved depression. Depressed adolescents reported significantly less secure parent attachment than either of the control groups, and less secure peer attachment than the nonpsychiatric control group. Attachment security of adolescents with resolved depression was on a par with the nonpsychiatric control group. Among all psychiatric patients, security of attachment to parents was negatively correlated with severity of depression according to interview and self-report ratings. Less secure attachment to parents, but generally not to peers, was also related to more maladaptive attributional styles, presence of separation anxiety disorder, and history of suicidal ideation.     

The Mediating Role of Rumination in the Relation Between Quality of Attachment Relations and Depressive Symptoms in Non-Clinical Adolescents

This study examined associations between indices of the quality of attachment relationships of adolescents with parents and peers, rumination, and symptoms of depression. More specifically, a mediation model was investigated in which rumination was hypothesized to mediate the relation between quality of attachment relations and symptoms of depression. A total of 455 high school students completed a battery of questionnaires, including quality of attachment relations, rumination, and depression. Results showed that most indices of quality of attachment relations were significantly associated with rumination and symptoms of depression. When examining the relative contribution of these variables in explaining variance in depression symptoms, trust in parents, communication with peers, and alienation from peers accounted for a significant portion of the variance in depression scores. Finally, the relation between communication with peers and depressive symptoms was fully mediated by rumination, whereas partial mediation was found for the relations between parental trust and depressive symptoms, and between alienation from peers and depressive symptoms. Implications of the findings may be that the treatment of depression in adolescence should consist of both cognitive interventions aimed at targeting ruminative thinking as well as a focus on interpersonal relationships of the adolescent with parents and peers.     

Suicide Crisis Syndrome Mediates the Relationship Between Long‐term Risk Factors and Lifetime Suicidal Phenomena

In recent years, there has been growing attention to the distinction between acute and long‐term suicidal risk factors. We have previously characterized an acute, negative affect state, termed the suicide crisis syndrome (SCS ), as a marker of near‐term suicidal risk. Here, we test whether documented long‐term risk factors (i.e., trait vulnerabilities), including perfectionism, impulsivity, chronic substance abuse, insecure attachment, poor social support, and childhood trauma, associate to suicidal phenomena through a pathway of the SCS . A sample of 207 psychiatric inpatients were administered a battery of eight scales, including the Suicide Trigger Scale (STS ‐3) as a measure of the SCS . While both STS ‐3 and all trait vulnerabilities were associated with lifetime suicidal ideation and attempts, only STS ‐3 was related to pre‐admission suicide attempts. The STS ‐3 significantly mediated the effect of each trait vulnerability on lifetime suicidal phenomena (combining ideation and behavior), with the proportion of mediating effect ranging from .29 to .56. Reverse mediation analyses were only significant for insecure attachment, supporting a largely unidirectional mediation effect. The SCS appears to serve as an acute risk factor for suicidal behavior in psychiatric inpatients and may act as a mechanism by which long‐term risk factors increase suicidal risk.     

Pathways to suicidal behaviors in childhood

Path analyses were applied to test a model that includes internalizing and externalizing behavior problems as predictors of suicidal behaviors in children. Parents of an inpatient sample of boys (N=87; M age=9.81 years) rated the frequency of suicidal ideation and completed standardized measures of behavior problems. Blind raters rated the severity of the children's suicidal behaviors. Results revealed a significant direct effect for suicidal ideation on suicide attempt and for depressive symptoms on suicidal ideation. There was also a significant indirect path from impulsivity to suicidal ideation through aggressive and depressive symptoms. Clinical implications are discussed.     

Mediators of the Daily Hassles–Suicidal Ideation Link in African American Women

Depressive symptoms and hopelessness as mediators of the daily hassles–suicidal ideation link in low‐income African American women exposed to intimate partner violence (n = 100) were investigated. As hypothesized, daily hassles, depressive symptoms, and hopelessness were each significantly and positively associated with suicidal ideation. Moreover, the relation between daily hassles and suicidal ideation was, in part, accounted for by depressive symptoms and hopelessness. This study demonstrates the importance of assessing for the presence of these risk factors when determining the likelihood that an abused African American woman will consider suicide. The findings further highlight the value of designing and implementing interventions that target the reduction in depressive symptoms and hopelessness in abused African American women exposed to daily hassles to reduce their suicide risk.     

In Eating‐Disordered Inpatient Adolescents,Self‐Criticism Predicts Nonsuicidal Self‐Injury

We examined the role of depressive traits—self‐criticism and dependency—in nonsuicidal self‐injury (NSSI) and suicidal ideation among inpatient adolescents with eating disorders. In two studies (N = 103 and 55), inpatients were assessed for depressive traits, suicidal ideations, and NSSI. In Study 2, motivation for carrying out NSSI was also assessed. In both studies, depression predicted suicidal ideation and self‐criticism predicted NSSI. In Study 2, depression and suicidal ideation also predicted NSSI. The automatic positive motivation for NSSI was predicted by dependency and depressive symptoms, and by a two‐way interaction between self‐criticism and dependency. Consistent with the “self‐punishment model,” self‐criticism appears to constitute a dimension of vulnerability for NSSI.     

Peer victimization and suicidal ideation: The role of gender and depression in a school-based sample

The current study investigated the relations among traditional and cyber victimization, depressive symptoms, suicidal ideation, and gender in a school-based sample of 403 9th grade (13 to 16-year-old) adolescents. Path analyses indicated that both traditional victimization and cyber victimization were associated with suicidal ideation indirectly through depressive symptoms. Although there was little evidence of gender differences in the associations among peer victimization and depressive symptoms and suicidal ideation, the relation between depressive symptoms and suicidal ideation was found to be significantly stronger for girls than boys. The current investigation confirms the complexity of the association between peer victimization and suicidal ideation and that depressive symptoms, as well as gender, may play a role in this complex relation. Future research should continue to explore the associations among victimization, depressive symptoms, and suicidal ideation within a social ecological framework.     

Social Anxiety Symptoms and Suicidal Ideation in a Clinical Sample of Early Adolescents: Examining Loneliness and Social Support as Longitudinal Mediators

Recent research has shown that social anxiety may be related to increased risk for suicidal ideation in teens, although this research largely has been cross-sectional and has not examined potential mediators of this relationship. A clinical sample of 144 early adolescents (72 % female; 12–15 years old) was assessed during psychiatric inpatient hospitalization and followed up at 9 and 18 months post-baseline. Symptoms of social anxiety, depression, suicidal ideation, loneliness, and perceived social support were assessed via structured interviews and self-report instruments. Structural equation modeling revealed a significant direct relationship between social anxiety symptoms at baseline and suicidal ideation at 18 months post-baseline, even after controlling for baseline depressive symptoms and ideation. A second multiple mediation model revealed that baseline social anxiety had a significant indirect effect on suicidal ideation at 18 months post-baseline through loneliness at 9 months post-baseline. Social anxiety did not have a significant indirect effect on suicidal ideation through perceived social support from either parents or close friends. Findings suggest that loneliness may be particularly implicated in the relationship between social anxiety and suicidality in teens. Clinicians should assess and address feelings of loneliness when treating socially anxious adolescents.     

Assessment of Depression and Suicidal Actions: Agreement between Suicide Attempters and Informant Reports

Knowledgeable informants may be able to provide useful information about depressive symptoms and suicidal actions when a suicidal patient is uncooperative with a clinical interview or not available for a psychiatric evaluation. The present study was designed to examine information gathered from psychiatric inpatients who had attempted suicide as compared to similar information obtained from a close friend or family member. From a larger sample of adult psychiatric inpatients diagnosed with major depression, 25 suicide attempters were assessed and their reports were compared to similar information solicited from a close friend or family member. The assessment focused on depressive symptoms from the SCID and the presence of various suicidal actions. Moderate to high agreement was found on all measures. Psychiatric patients and their informants tended to agree on the presence of depressive symptoms, the presence of recent stressful life events, and specific actions taken during the suicidal crisis, suggesting that informants may be capable of providing useful information about the patient.     

Suicidal ideation in anxiety-disordered youth

Evidence is mixed regarding an independent association between anxiety and suicidality in youth. Study 1 examined suicidal ideation in treatment-referred, anxiety-disordered youth (N = 312, aged 7-17). Forty-one percent of anxiety-disordered youth endorsed suicidal ideation. Anxiety disorder severity, global impairment, and current depressive symptoms predicted suicidal ideation in a multivariate model. Study 2 compared youth (N = 216, aged 7-14) with and without anxiety disorders. Higher rates of suicidal ideation were associated with anxiety diagnosis, and levels of anxiety predicted suicidal ideation after controlling for comorbid depressive disorders, current depressive symptoms, and global impairment. Results support an association between anxiety disorders and suicidal ideation in treatment-referred youth and recommend routine screening for suicidal ideation in this population.     

Hopelessness,Parent‐Adolescent Communication,and Suicidal Ideation among Chinese Adolescents in Hong Kong

Based on the responses of 5,557 Chinese secondary students in Hong Kong, the relationships among perceived hopelessness, family functioning, and suicidal ideation were examined. Results showed that suicidal ideation was positively related to hopelessness, but negatively related to parent‐adolescent communication. Compared with father‐adolescent communication, mother‐adolescent communication generally had a stronger association with adolescent suicidal ideation. It was further found that the linkage between hopelessness and adolescent suicidal ideation was stronger under a low parent‐adolescent communication condition, thus suggesting the moderating effect of parent‐adolescent communication on the effect of hopelessness on suicidal ideation. The theoretical and practical implications of the findings are discussed.     

Suicidal Ideation, Depression, and Conduct Disorder in a Sample of Adolescent and Young Adult Twins

The co-occurrence of suicidal ideation, depression, and conduct disturbance is likely explained in part by correlated genetic and environmental risk factors. Little is known about the specific nature of these associations. Structured interviews on 2,814 twins from the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) and Young Adult Follow-Up (YAFU) yielded data on symptoms of depression, conduct disorder, and adolescent and young adult suicidal ideation. Univariate analyses revealed that the familial aggregation for each trait was explained by a combination of additive genetic and shared environmental effects. Suicidal ideation in adolescence was explained in part by genetic influences, but predominantly accounted for by environmental factors. A mixture of genetic and shared environmental influences explained ideation occurring in young adulthood. Multivariate analyses revealed that there are genetic and shared environmental effects common to suicidal ideation, depression, and conduct disorder. The association between adolescent suicidal ideation and CD was attributable to the same genetic and environmental risk factors for depression. These findings underscore that prevention and intervention strategies should reflect the different underlying mechanisms involving depression and conduct disorder to assist in identifying adolescents at suicidal risk.     

Exposure to violence and suicide risk in adolescents: a community study

The prevalence of violence exposure is relatively unexplored in adolescents in European communities, and reports on the association between exposure to community violence and suicidal behavior are rare. The aim of this study was to investigate (1) the prevalence of community violence in a European urban adolescent sample, (2) the relationship between exposure to community violence and suicidal ideation/deliberate self-harm, and (3) the influence of depressive symptoms and aggressive behavior on this relationship. Self-report surveys were administered to a representative school-based sample of 1509 adolescents in Antwerp (Belgium). The prevalence rate of violence exposure was still high but lower than that reported in U.S. communities. Suicidal ideation and deliberate self-harm were both related to violence exposure. The gender-specific influence of depressive symptomatology and aggressive behavior on the association between exposure to violence and suicidal behavior suggests the need for further research.     

Inpatient suicide in a Chinese psychiatric hospital

Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.     

Loneliness and Suicidal Risk in Young Adults: Does Believing in a Changeable Future Help Minimize Suicidal Risk Among the Lonely?

This study examined loneliness and future orientation as predictors of suicidal risk, namely, depressive symptoms and suicide ideation, in a sample of 228 college students (54 males and 174 females). Results of regression analyses indicated that loneliness was a significant predictor of both indices of suicidal risk. The inclusion of future orientation was found to significantly augment the prediction model of both depressive symptoms and suicide ideation, even after accounting for loneliness. Noteworthy, beyond loneliness and future orientation, the Loneliness × Future Orientation interaction term was found to further augment both prediction models of suicidal risk. Consistent with the notion that future orientation is an important buffer of suicidal risk, among lonely students, those with high future orientation, compared to low future orientation, were found to report significantly lower levels of depressive symptoms and suicide ideation. Some implications of the present findings for studying both risk and protective factors associated with suicidal risk in young adults are discussed.     

Does Reintegration Stress Contribute to Suicidal Ideation Among Returning Veterans Seeking PTSD Treatment?

Although posttraumatic stress disorder (PTSD) and other psychiatric symptoms are well‐established risk factors for suicidal ideation among returning veterans, less attention has been paid to whether the stress of reintegrating into civilian society contributes to suicidal ideation. Utilizing a sample of 232 returning veterans (95% male, mean age = 33.63 years) seeking PTSD treatment, this study tested whether reintegration difficulties contribute to suicidal ideation over and above the influence of PTSD symptoms, depression symptoms, and potential substance misuse. Logistic regressions indicated that reintegration stress had a unique effect on suicidal ideation over and above PTSD and depression symptoms. Reintegration stress interacted with substance misuse to predict suicidal ideation, such that the effect of reintegration stress on suicidal ideation was much larger for those with potential substance misuse. Exploratory analyses also examined which types of reintegration difficulties were associated with suicidal ideation, and found that difficulty maintaining military friendships, difficulty getting along with relatives, difficulty feeling like you belong in civilian society, and difficulty finding meaning/purpose in life were all significantly associated with suicidal ideation, beyond the effects of psychiatric symptoms and potential substance misuse. Findings highlight the importance of addressing reintegration stress for the prevention of suicide among returning veterans. Implications for treatment are discussed.