Toward an empirical taxonomy of suicide ideation: a cluster analysis of the youth risk behavior survey

In this study we examined adolescent risk behaviors, giving special attention to suicide ideation. Cluster analysis was used to classify adolescents (N = 2,730) on the Youth Risk Behavior Survey. Six clusters of adolescent risk behavior were identified. Although each risk cluster was distinct, some clusters shared overlapping risk behaviors. Suicide ideation was central to two clusters: the Silent Suicide cluster and the Multiple Risk cluster. The findings demonstrate that suicide ideation is both a unique risk behavior for some adolescents and part of a generalized risk syndrome for other adolescents. A multiple subgroup framework is recommended for understanding adolescent risk behaviors.     

Toward conceptual development and empirical measurement of global risk indicators in the lives of court-involved youth

This paper reports work related to the conceptual development and empirical use of global risk indicators meant to measure rapidly and reliably potential threats to the overall development and well-being of adolescents in the juvenile justice system. The development of these indicators and initial data regarding their use with court involved samples are presented. Analysis of data gathered from a sample containing 248 families of adolescents who participated in a family-based diversion program identified a seven-factor structure that corresponded to theoretically derived dimensions of risk in domains associated with prior offenses, family/parenting, education/work, peers, substance use, personality/behavior problems, and attitudes/orientation. Analysis of data gathered from a second sample containing 373 families of adolescents who came into contact with the intake/diversion department of a county juvenile court confirmed the original seven factors of the battery and generated support for an eighth dimension composed of items that reflected leisure activities. The use of these global risk indicators are discussed as part of a practical and effective assessment battery for professionals working with court-involved youth and their families.     

An empirical taxonomy of visual illusions

A classification system for visual-geometric illusions, based upon the interrelationships between behavioral responses to various distortions was created. Forty-five illusion configurations were presented to 221 observers. Factor analysis revealed that there are five classes of illusions. A secondorder analysis revealed that visual distortions are ultimately reducible to two global types of distortions: illlusions of extent and illusions of shape or direction.     

The relationship between violence and youth suicide indicators among Asian American and Pacific Islander youth

The literature documents a relationship between interpersonal violence and suicide. One tool used to understand interpersonal violence is the Power Wheel, developed from clinical experience and originally used in domestic violence education. We examine the relationship between Teen Power and Control Wheel domains and suicidal indicators (seriously considered suicide, made a suicide plan, and attempted suicide) among Asian American and Pacific Islander high school students, in terms of both victimization and perpetration. Data from a 2007 survey of two multi-ethnic high schools on the island of O'ahu, Hawai'i were used. The survey assessed interpersonal youth violence and a multitude of risk and protective factors. It found that females were significantly more likely to seriously consider suicide and attempt suicide, compared to males. There were no statistically significant differences in seriously considering suicide, making a suicide plan, and attempting suicide by ethnic group, employment status, or hours worked per week. Using the Wheel, we found that all dimensions for victimization and perpetration were associated with the three suicidal indicators. However, the magnitude of this association was dramatically higher for victims than for perpetrators. School- and healthcare-based prevention strategies should ensure that both suicide and violence intervention components are addressed. Professionals who work with youth should be trained to feel comfortable, confident, and competent in discussing suicide and violence, and be willing and capable to assess and intervene.     

An empirical investigation of Shneidman's formulations regarding suicide

This study of suicide notes involved the deduction of 50 protocol sentences that reflected important aspects of Shneidman's formulations regarding suicide. Independent judges noted the incidence of contents corresponding to the protocol sentences in 33 genuine and 33 simulated notes. Statements that were found significantly and more frequently in genuine notes included the following: the experience of adult trauma such as a calamitous relationship; a rejection; the withdrawal of a significant person resulting in despair; perceiving another as dooming one to the suicide; expressions of ambivalence; feelings of love, hate and other emotions; feelings of helplessness, pessimism and emotional confusion; appearing to be intoxicated by one's overpowering emotions and constricted perceptions; and the communications appearing to have unconscious implications. Statements of "egression" and more logical reasoning were more characteristic of the simulated notes. A frequency count in the genuine notes indicated that many protocol sentences were also very predictive of the content. Implications of the results are discussed.     

An assessment of community suicide risk

The contributions of several core variables to the white suicide rates in 24 Florida counties were examined, and a prediction equation, using multiple linear regression, was developed. Age was found to be about 50% more important than divorce. With both age and divorce controlled, loneliness and insanity were found to be significant core variables (p less than .05). A prediction equation including age, crime rate, insanity, and alcoholism was found that accounted for 79% of the variation in the suicide rates across counties. The observed rates were divided by predicted rates to yield standardized mortality ratios. It is proposed that these ratios may serve to assess both the need for and the impact of community suicide prevention services by placing suicide rates in the context of relevant social conditions.     

Out-of school youth in high-unemployment areas: An empirical investigation

A total of 551 interviews were conducted with 16-20 year olds living in high unemployment areas in Liverpool, London, Manchester and Wolverhampton. The diverse ways in which the young unemployed react to their predicaments are described, and explanations are offered for why black youth tend to be less acquiescent than whites. Overall, however, the analysis emphasises the ability of the young people at greatest risk of unemployment to devise their own coping strategies. Counsellors and other careers workers are advised to take these into account: otherwise their efforts are likely to be discounted by their clients.     

An empirical study of occupational families in the youth labour market

This research aims at identifying job families for use in broadly based training for young people. A total of 455 job incumbents in the youth labour market were interviewed using the Job Components Inventory (JCI). The job sample was heterogeneous, reflecting a wide range of industries and job titles; some of these were skilled but mainly they were semi- and unskilled. The JCI covers the use of tools and equipment, physical and perceptual skills, mathematical requirements, communication, decision making and responsibility. Cluster analysis of items identified 36 skill components. These formed the basis for job-holder profiles, which in turn were grouped by hierarchical clustering. The optimal solution resulted in six clusters, the characteristics of which were described in terms of JCI component scores. The six clusters were labelled as clerical, skilled interpersonal, operative, unskilled manual, intermediate skilled technical and skilled technical. The stability of these six clusters was assessed using split-half replications. Results are discussed and evaluated in the context of contemporary youth training needs.     

Assessing the effects of peer suicide on youth suicide

Using data from all waves of the National Longitudinal Survey of Adolescent Health, we investigated the short-term and long-term impact of an adolescent friend's suicide on an adolescent's depression and suicidality. Results suggest that a friend's suicide is associated with heightened suicide thoughts and attempts and greater depression during the first year after loss. Six years later, analyses show concurrent behaviors most relevant to explain suicidality fluctuations. Findings suggest the importance of therapeutic availability, especially during the first year, for those losing a friend to suicide.     

An integrated approach to estimating suicide risk

It is ironic that if we had a perfect predictive instrument we would not be able to recognize it because it could never be validated by its critical outcome criterion. Though some exceptions could occur, we would be obliged to take all available measures to prevent a suicidal outcome in cases where suicide was predicted. After the crisis we could have no way of knowing with certainty whether the person would have suicided or not. Even if we accepted the reality that people are not either 0% or 100% likely to suicide, and developed a perfect scale to estimate degree of risk, we would still be unable to validate it in individual cases. If it indicated "moderate" risk of 2.5-5.0%, for example, and no intervention were offered, we would have to observe one suicide in every 20-40 persons assessed at this level of risk to demonstrate its validity. The key to assessment is obtaining information, primarily regarding present or anticipated pain and the threshold of pain tolerance in the individual involved. Since different persons communicate in a variety of ways--verbal, nonverbal, symbolic, metaphoric, etc., eclecticism in approach is essential. For some clinicians communication will be facilitated most by one style; for others, a different method would be most effective. Thus, the "best" approach is the one that works best given the unique characteristics of the persons involved and under the conditions existing at the time. My own bias is that every assessment, whatever the approach, must include some form of direct inquiry regarding suicidal intent, and that the final decision in this regard must be a subjective and intuitive judgment. Contrary to possible assumptions in the legal world, accurate assessment does not necessarily mean safety. It can serve as a guide to the degree of risk that may be involved in a treatment program, but even low risk management measures may have an adverse outcome without implications of negligence or carelessness. There has been no mention here of biological markers of suicide, which are of much current interest but still in an investigational stage. Similarly, rational suicide has not been mentioned, though our aging population and the status of AIDS are making this issue progressively more important. The principles involved in assessment of risk are the same as with other forms of suicide, however. Finally, we can only presume that more precise assessment will operate to reduce suicidal deaths.(ABSTRACT TRUNCATED AT 400 WORDS)     

An empirical investigation of Shneidman's formulations regarding suicide: age and sex

This study of suicide notes, concerning the demographic variables of age and sex, involved the deduction of 50 classifications (protocol sentences) that reflected important aspects of Shneidman's formulations with regard to suicide. Independent judges noted the incidence of contents corresponding to the protocol sentences in the notes left by 60 suicides-20 notes written by individuals (females and males) in each of the three categories of Young, Middle, and Late Adulthood. Age (notably in regard to Young Adults), but not sex, was found to be a critical discriminating variable on a number of specific classifications and clusters of these classifications (Perturbation, Relations, Cognitions Regarding Self, and Long-Term Instability), although considerable similarities were also noted across the adult life span. Implications of the results are discussed.     

Problem drinking in the family and youth suicide

Drawing from the work of Danigelis (1983), the present research put forth a theory of chronic stress to further our understanding of the processes related to suicide among 10- to 14-year-olds. Specifically, the relationship between problematic drinking in the home and youth suicide rates was examined. The hypothesis that chronic stress, as measured by problem drinking in the home, is related to youth suicide was supported.     

Mediating effects of an indicated prevention program for reducing youth depression and suicide risk behaviors

This study explored the intervention processes of an indicated prevention program for high-risk youth. It was hypothesized that intervention effects would be influenced by the direct and mediating effects of teacher social support on both peer group support and perceived personal control. In turn, personal control was hypothesized to mediate between teacher and peer group support, contributing to reductions in depression and suicide risk behaviors. The hypotheses were tested using a three-wave, longitudinal design incorporating data from preintervention, 5-month follow-up, and 10-month follow-up assessments of 106 high-risk youth divided into three comparison groups: two experimental, one control. For the two intervention groups, there were direct and/or indirect effects of teacher and peer group support on personal control, depression, and suicide risk behaviors. The general hypothesis that personal control mediates between support resources and reductions in depression and suicide risk behaviors received partial support across the study groups.     

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.     

Evaluation of a youth suicide prevention school program

Adolescent suicide is a subject of increasing national concern. In California, this problem was addressed through the implementation of a three-year youth suicide prevention school program established by legislative mandate in 1983. Findings for the first two years of the program indicate significant gains in understanding of youth suicide prevention techniques for those high school students who completed a four-hour training course. School staff and parents completing 90-minute youth suicide awareness seminars indicated that they most appreciated receiving practical advice and resources they could use in responding to a potentially suicidal young person.     

The standard of care in suicide risk assessment: An elusive concept

Suicide risk assessment is now a core competency requirement in the residency training of psychiatrists. The purpose of suicide risk assessment is to identify modifiable or treatable acute, high-risk suicide factors, and available protective factors that inform patient treatment and safety management. The standard of care varies according to state statutory definitions. Heretofore, most states adopted an average physician or "ordinarily employed standard." Currently, more states are adopting a "reasonable, prudent physician" standard. No single source or authority defines the standard of care for suicide risk assessment. Evidence-based psychiatry can inform clinicians' suicide risk assessments. Carefully documented risk assessments will assist the courts in evaluating clinicians' decision-making process.     

Social correlates of youth suicide rates in the United States

The 1980 suicide rate of youths in the United States were found to be associated with three clusters of social variables: social integration, the age structure, and race/region. These associations also were found for older groups, suggesting similarities in the impact of social variables on regional suicide rates.     

Environmental risk factors in hospital suicide

Suicide of hospitalized patients is the most common sentinel event reviewed by The Joint Commission on Accreditation of Healthcare Organizations. Shorter lengths of stay, sicker patients, and higher patient to staff ratios challenge the ability of the hospital to maintain safety. Risk factors associated with the physical environment of the inpatient psychiatric unit, cited as the most common root cause of inpatient suicide, may be neglected because evaluation of these factors is generally not included in medical education and training. Minimization of fixtures that can facilitate strangulation and other high risk aspects within the hospital environment is an important element in the prevention of suicide on psychiatric units.     

Adolescent alcohol use and suicide indicators among adolescents in Hawaii

Research on suicide has focused on gender, age, ethnicity, and psychiatric profiles. However, few studies have examined alcohol use and its relationship to suicide among Native Hawaiians and other Asian American/Pacific Islanders. This study analyzes data from the 1997 and 1999 Hawaii Youth Risk Behavior Survey to examine whether alcohol problems increase the risk for suicide indicators (as evidenced by responses to questions asking whether an individual has considered, planned, attempted, or required treatment for a suicide attempt). Drinking pattern was the best predictor for all suicide indicators. School and community-based programs can help to increase an adolescent's knowledge about the consequences of alcohol use and prevention of suicide.