Suicide method runs in families: a birth certificate cohort study of adolescent suicide in Taiwan

Suicide method used by adolescents was examined to determine if it was the same as that employed by their suicidal parents. Six hundred eighty adolescents completed suicide between 1997 and 2007, of whom 12 had parents who had previously died by suicide. The suicide method used by these adolescents was compared with that employed by their suicidal parent and that of a matched peer control adolescent with no exposure to parental suicide and living in the same area. In 10 of the 12 suicidal parent-adolescent dyads, the same suicide method was employed by parent and adolescent. Of seven adolescents whose age at parental suicide was 15 years or above, six used the same suicide method as their suicidal parent had. On the contrary, of 12 exposure-nonexposure suicidal adolescent dyads, the same method was used in only four. Adolescents exposed to parental suicide are more likely to use the suicide method employed by their suicidal parents than the method used by adolescent peers with no exposure to parental suicide.     

Child-Adolescent Suicidal Potential Index (CASPI): a screen for risk for early onset suicidal behavior

This study's purpose was to develop a reliable and valid self-report questionnaire, the Child-Adolescent Suicidal Potential Index (CASPI), to screen for risk for suicidal behavior in children and adolescents. Four hundred twenty-five child and adolescent psychiatric patients and nonpatients completed the CASPI and other research instruments to rate suicidal and assaultive behavior and symptoms of depression, anxiety, and hopelessness. The 30-item CASPI involves 3 factors (anxious-impulsive depression, suicidal ideation or acts, family distress) that contributed to a unidimensional 2nd-order factor accounting for 59% of the total variance. Internal consistency (alpha) for the total score was .90, and test-retest reliability (ICC) for the total score was .76. Total score distinguished between children and adolescents with different severity of psychopathology and different levels of suicidal and assaultive behavior. Each of the 3 factors had different contributions to discriminating between levels of suicidal status. CASPI total score of 11 distinguished suicidal ideation or acts from nonsuicidal behavior, with sensitivity 70% and specificity 65%. CASPI total score positively correlated with symptom severity of depression, anxiety, and hopelessness.     

A Prospective Study of Adolescent Suicidal Behavior Following Hospitalization

Identification of factors associated with adolescent suicidal behavior following psychiatric hospitalization would facilitate development of effective aftercare interventions. This prospective study identified specific predictors of suicidal behavior in 100 adolescents during a 6-month follow-up period. Standardized baseline assessments and structured follow-up telephone interviews were conducted with adolescents and their guardians. Eighteen percent of adolescents reported suicidal behavior during the follow-up period, primarily of low medical lethality and minimal or ambivalent suicidal intent. This behavior was associated with suicidal thoughts, family dysfunction, and dysthymia. It was not associated with initial posthospitalization treatment compliance. Implications of these findings are discussed.     

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.     

Suicidal Ideation of Psychiatrically Hospitalized Adolescents has One-Year Predictive Validity for Suicide Attempts in Girls Only

Clinicians commonly incorporate adolescents’ self-reported suicidal ideation into formulations regarding adolescents’ risk for suicide. Data are limited, however, regarding the extent to which adolescent boys’ and girls’ reports of suicidal ideation have clinically significant predictive validity in terms of subsequent suicidal behavior. This study examined psychiatrically hospitalized adolescent boys’ and girls’ self-reported suicidal ideation as a predictor of suicide attempts during the first year following hospitalization. A total of 354 adolescents (97 boys; 257 girls; ages 13–17 years) hospitalized for acute suicide risk were evaluated at the time of hospitalization as well as 3, 6, and 12 months later. Study measures included the Suicidal Ideation Questionnaire-Junior, Multidimensional Anxiety Scale for Children, Children’s Depression Rating Scale-Revised, Beck Hopelessness Scale, Youth Self-Report, and Personal Experiences Screen Questionnaire. The main study outcome was presence and number of suicide attempt(s) in the year after hospitalization, measured by the Diagnostic Interview Schedule for Children. Results indicated a significant interaction between suicidal ideation, assessed during first week of hospitalization, and gender for the prediction of subsequent suicide attempts. Suicidal ideation was a significant predictor of subsequent suicide attempts for girls, but not boys. Baseline history of multiple suicide attempts was a significant predictor of subsequent suicide attempts across genders. Results support the importance of empirically validating suicide risk assessment strategies separately for adolescent boys and girls. Among adolescent boys who have been hospitalized due to acute suicide risk, low levels of self-reported suicidal ideation may not be indicative of low risk for suicidal behavior following hospitalization.     

The subjective experience of problem irresolvability and suicidal behavior: dynamics and measurement.

This article presents the dynamics and measurement of a relatively unstudied concept in children's and adolescents' suicidal behavior: the subjective experience of problem irresolvability (SEPI). This concept relates to the youngsters' sense of lack of control due to being pressured to resolve irresolvable problems within the family circle. The first study describes the construction and factor analysis of the SEPI scale as well as its relationship to suicidal tendencies, perceived parental care, and self-esteem. The second study presents a repeated factor analysis and the association between the SEPI scale and suicidal tendencies, hopelessness, depression, anxiety, and commitment to parents. The results suggest that the scale has a 4-factor structure with sound psychometric properties that distinguish successfully between suicidal adolescents on the one hand, and psychiatric and normal adolescents on the other. The SEPI was also found to be associated with the various studied variables.     

Depression, hopelessness, and self-esteem: accounting for suicidality in adolescent psychiatric inpatients

The present study was designed to examine depression, hopelessness, and self-esteem as related to suicidal behavior in three groups of depressed adolescent psychiatric inpatients. Depressed adolescents who had never attempted suicide were compared to depressed adolescents who had attempted suicide once and to depressed adolescents who had attempted suicide on several different occasions. Results showed that suicidal adolescents experienced significantly greater depression and hopelessness than did the nonsuicidal adolescents. However, all three groups of depressed adolescents reported similar low levels of self-esteem. Measures of depression and hopelessness were useful in classifying the adolescents based on their suicidal behavior. Results suggest that the treatment of suicidal adolescents could benefit from strategies that focus on reducing feelings of depression and hopelessness.     

Interventions for Suicidal Youth: A Review of the Literature and Developmental Considerations

Suicidal behavior is developmentally mediated, but the degree to which interventions for suicidal behaviors have been developmentally tailored has varied widely. Published controlled studies of psychosocial treatment interventions for reducing adolescent suicidal behavior are reviewed, with a particular emphasis on the developmental nuances of these interventions. In addition, developmental considerations important in the treatment of suicidal adolescents are discussed. There are insufficient data available from controlled trials to recommend one intervention over another for the treatment of suicidal youth, but interventions that are sensitive to the multiple developmental contexts have potential for greater effectiveness in reducing adolescent suicidal behavior.     

Risk of future suicide attempts in adolescent psychiatric inpatients at 18-month follow-up

This study investigated potential predictors of suicidal behavior in adolescents during an 18-month follow-up period. Subjects included 60 adolescent psychiatric inpatients initially assessed in a private psychiatric hospital. Follow-up suicidality was most strongly predicted by high intake levels of hopelessness, and an increase in or persistent problems with depression during follow-up. Some family functioning variables measured at intake were predictive of suicidal behavior at the univariate level but did not add to the predictive ability of individual functioning variables. A mediational model was proposed in which the impact of family functioning on adolescent suicidality is mediated by its impact on individual functioning.     

童年期心理虐待与忽视对高中生自杀意念的影响：述情障碍的中介作用和寻求意义感的调节作用

为了探讨童年期心理虐待与忽视与自杀意念之间的关系及其作用机制,本研究采用心理虐待与忽视量表、多伦多述情障碍量表、青少年自杀意念量表及生命意义感量表中的寻求意义感分量表对1074名高中生进行调查。结果表明：（1）童年期心理虐待与忽视对自杀意念有正向预测作用,并且能够通过述情障碍的中介作用影响高中生自杀意念;（2）寻求意义感调节了这一中介过程的直接路径和后半段路径,对后半段路径的调节作用存在性别差异。     

Adolescent Adjustment to Parental Divorce: An Investigation from the Perspective of Basic Dimensions of Structural Family Therapy Theory

This study, conducted within the framework of concepts of structural family therapy, examined the relationship of four family-based, clinical dimensions to the adjustment of 45 adolescents during the first 18 months of parental separation. There were two samples of mother-custody families: an Aided group that applied for treatment, and an Unaided group of paid volunteers. The inclusion of this variable addressed a major methodological deficit of previous studies. There was a significant association between perceived postseparation family structure and adolescent adjustment, demonstrating that individual adolescent adjustment is contingent on structural features of the contemporary postseparation family. Further, Aided families were perceived as more chaotic, disengaged, and enmeshed than Unaided families, while Aided adolescents were characterized by more behavior problems than Unaided adolescents. This suggests that divorce, as an unscheduled transition, might be within the realm of adaptation for many families and adolescents and is not necessarily "disastrous."     

Social problem solving in adolescents with suicidal behavior: a systematic review

There is an increasing focus on deficiencies in problem solving as a vulnerability factor for suicidal behavior in general and hence a target for treatment in suicide attempters. In view of the uncertainty of evidence for this in adolescents we conducted a systematic review of the international research literature examining the possible relationship between deficiencies in social problem-solving skills and suicidal behavior in this population. This was based on searching two electronic databases: Medline 1966 to September 2003 and PsychInfo 1887 to September 2003. Twenty-two studies of social problem-solving skills in adolescents with suicidal behavior were found. Most of these studies, which compared adolescent patients with suicide attempts versus either nonsuicidal psychiatric or normal controls, found evidence for problem-solving deficits in the attempters; however, few of the differences remain after controlling for depression and/or hopelessness. Because most of the studies are cross-sectional, it is difficult to differentiate between the possibilities that deficiencies in problem-solving skills lead to depression when adolescents are faced by adversity and hence to suicidal behavior, or whether depression is the main factor which undermines problem-solving skills. Future research, preferably with longitudinal research designs, is required to determine the nature of the association between problem-solving skills and suicidal behavior in adolescents. This has important implications for therapeutic interventions.     

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.     

The Contributions of Child Behavioral Functioning and Parent Distress to Family Functioning in Pediatric Inflammatory Bowel Disease

The objective of this study was to examine the relative contributions of both parental and adolescent functioning to family functioning in adolescent patients with inflammatory bowel disease (IBD) and their families. Participants were 45 adolescents (27 male, 18 female) 13-17?years old (M?=?15.41?years, SD?=?1.32) with IBD and their parents. Families completed measures of patient behavioral functioning and depression, parent distress and family functioning. Disease severity assessments were completed via data provided by patients' gastroenterologists. Results indicated that parent-reported patient behavioral problems accounted for a significant 26% of variance in family functioning. Post-hoc analysis revealed that externalizing behavior problems accounted for the majority of this variance compared to internalizing behavior problems. These results suggest that externalizing problems may have a more significant impact on these families than previous research indicates. Moreover, externalizing behaviors may significantly impact family adaptation and should be taken into consideration during routine clinical care. Further research is needed to replicate and expand upon these findings.     

Family transitions during the adolescent transition: implications for parenting

This study explored how family transitions affect parenting practices in a sample of 7,000 ethnically diverse students in 9th, 10th, or 11th grade over a period of 2 years. Adolescent perceptions of parental control and parental responsiveness were assessed in three groups: (1) adolescents moving into mother-custody households following a marital separation or divorce, (2) adolescents from stable never-divorced households, and (3) adolescents from stable mother-custody households. The study examined pre- and posttransition data to determine whether adolescents in newly formed single-parent families experienced a larger drop in parental control and responsiveness than did adolescents in stable nondivorced and stable mother-custody households. Adolescents from all family types reported significant declines in behavioral control, but not parental responsiveness. However, the lack of family-type differences contrasts sharply with findings from the childhood-divorce literature. Findings suggest that adolescent individuation may overshadow family-type differences during middle adolescence. As expected, boys reported lower parental control than did girls. Ethnic differences revealed that European American adolescents reported the highest levels of parental responsiveness, and African American adolescents reported the highest levels of parental control. Contextual and individual pathways in adolescence are discussed.     

Parent–Adolescent Discrepancies in Perceived Parenting Characteristics and Adolescent Developmental Outcomes in Poor Chinese Families

We examined the relationships between parent–adolescent discrepancies in perceived parenting characteristics (indexed by parental responsiveness, parental demandingness, and parental control) and adolescent developmental outcomes (indexed by achievement motivation and psychological competence) in poor families in Hong Kong. A sample of 275 intact families having at least one child aged 11–16 experiencing economic disadvantage were invited to participate in the study. Fathers and mothers completed the Parenting Style Scale and Chinese Parental Control Scale, and adolescents completed the Social-Oriented Achievement Motivation Scale and Chinese Positive Youth Development Scale in addition to paternal and maternal Parenting Style Scale and Chinese Parental Control Scale. Results indicated that parents and adolescents had different perceptions of parental responsiveness, parental demandingness, and paternal control, with adolescents generally perceived lower levels of parenting behaviors than did their parents. While father–adolescent discrepancy in perceived paternal responsiveness and mother–adolescent discrepancy in perceived maternal control negatively predicted adolescent achievement motivation, mother–adolescent discrepancy in perceptions of maternal responsiveness negatively predicted psychological competence in adolescents experiencing economic disadvantage. The present findings provided support that parent–child discrepancies in perceived parenting characteristics have negative impacts on the developmental outcomes of adolescents experiencing economic disadvantage. The present study addresses parent–child discrepancies in perceived parental behaviors as “legitimate” constructs, and explores their links with adolescent psychosocial development, which sheds light for researchers and clinical practitioners in helping the Chinese families experiencing economic disadvantage.     

Autonomy and Relatedness in Family Interactions with Depressed Adolescents

This study investigated family interaction patterns associated with adolescent depression. Twenty adolescent–mother dyads with clinically depressed adolescents participated in the study. Twenty dyads with externalizing youths and 20 nonclinic dyads were included as controls. Dimensions of autonomy and relatedness were rated during a videotaped mother–adolescent problem-solving task. Adolescent perceptions of parent attachment were also evaluated. Results indicated that depressed adolescents and their mothers did not differ in their behavior compared with nonclinic adolescents. Dyads with externalizing adolescents showed the highest impairment in autonomy and relatedness. Depressed adolescents perceived the quality of their relationships with their parents to be impaired relative to nonclinic dyads, as did externalizing adolescents.     

A Safety and Coping Planning Intervention for Suicidal Adolescents in Acute Psychiatric Care

Transitioning from an acute psychiatric care setting to a less restrictive environment after a suicidal event is arguably the most critical period of suicide risk for adolescents, making comprehensive safety and coping plans for this population ever more critical. In this paper we provide theoretical and empirical rationale for the need for developmental adaptations to current safety planning procedures for suicidal adolescents, as well as the standardization of pediatric safety plans for broader use across settings that provide acute psychiatric care to adolescents. We describe how we developed the Adolescent Safety and Coping Plan (ASCP) using qualitative in-depth interviews with 20 adolescents and their parents, explain the specific components of the ASCP, and give a case example of the ASCP being used with a young adolescent and her parents. Finally, we conclude with a discussion of the barriers and facilitators of the use of the ASCP in settings that provide acute psychiatric care, as well as the need for future research to test the ASCP with diverse adolescent and family populations and settings.     

Occupational Therapist,Biomedical Science Corps Officer and Former Firefighter

Abstract

What the literature reports that adolescents need within their parent-adolescent relationships, as well as what adolescents with serious emotional disturbances may experience within their parent-adolescent relationships are discussed. A framework for providing parent-adolescent group intervention for psychiatrically hospitalized adolescents and their parents to promote positive interaction and co-occupation are provided. Summaries of the parent-adolescent activity group experiences of three families are provided to illustrate how different adolescent psychiatric issues and family dynamics might be addressed in a parent adolescent activity group.