Frequency of Suicidal Thought and Self-Destructive Behavior among Females

ABSTRACT: The focus of the present investigation was to examine the importance of a control group in suicide research and to develop an instrument to disguish between levels of suicidal thought among subjects who had a history of attempted suicide and among a comparison group of nonsuicidal individuals. The sample was comprised of female university students ranging in age from 18 to 25 years. A 31-item questionnaire designed by the investigator was given to 199 students, 20 of whom were found to have histories of one or more previous suicide attempts. The remaining 179 nonsuicidal subjects were divided into two categories based on the frequency of expressed suicidal thought. Fifty individuals were randomly selected from each of these two groups. The three groups (individuals who had attempted suicide, individuals who had not attempted suicide but who thought about suicide on a frequent basis, and individuals who had not attempted suicide and who thought about suicide on an infrequent basis) were compared on the variables of motivation for suicidal thoughts, history of self-destructive behaviors, probability of a future suicide attempt, and age of first suicidal considerations. A chi-square analysis was performed on each of these items in order to assess the extent to which the items discriminated among the three comparison groups. The differences among the three groups on each of the items were found to be statistically significant at less than the .01 level. The results of the study have provided support for the necessity of a distinction between groups within a nonsuicidal comparison population and for the suggestion that there may be a quantitative relationship between the frequency of suicidal thought and the likelihood of attempted suicide.     

Characteristics of Suicidality Among Adolescents

The identification of high-risk adolescent suicide attempters in a population of depressed and suicidal adolescents is of crucial importance. This retrospective study examined characteristics of suicidality (recent and lifetime, active and passive) and psychopathology (depression, aggression, impulsivity, stressful life events, SCL-90 dimensions) among four groups of depressed adolescent outpatients: (1) suicide attempters who required medical treatment (n = 84), (2) suicide attempters who did not require medical treatment (n = 57), (3) suicidal ideators who had never made a suicide attempt (n = 40), and (4) nonsuicidal patients (n = 44). Results indicate that the nonsuicidal group could be differentiated from the three suicidal groups on the basis of suicidality and psychopathology, and that the three suicidal groups could be differentiated from one another on the basis of suicidality but not psychopathology. These findings are discussed in terms of the usefulness of certain self-report measures of suicidality for identifying suicidal adolescents and for differentiating among them. Furthermore, the findings suggest that psychopathological factors do not determine which suicidal adolescents make a medically dangerous suicide attempt and which do not.     

Clinical trials for rapid changes in suicidal ideation: Lessons from ketamine

Rapid‐acting treatments for suicidal thoughts are critically needed. Consequently, there is a burgeoning literature exploring psychotherapeutic, pharmacologic, or device‐based brief interventions for suicidal thoughts characterized by a rapid onset of action. Not only do these innovative treatments have potentially important clinical benefits to patient populations, they also highlight a number of methodological considerations for suicide research. First, while most clinical trials related to suicide risk focus on suicide attempts, new clinical trials that use suicidal thoughts as the primary outcome require a number of slight modifications to their clinical trial design. Second, the rapid onset of these new interventions permits an experimental therapeutics approach to suicide research, in which psychological and neurobiological markers are embedded into clinical trials to better understand the underlying pathophysiology of suicidal thoughts. The following review discusses these methodological innovations in light of recent research using the N‐methyl‐D‐aspartate (NMDA) receptor antagonist ketamine, which has been associated with rapid effects on suicidal thoughts. We hope that “lessons learned” from the ketamine literature will provide a blueprint for all researchers evaluating rapid‐acting treatments for suicidal thoughts, whether pharmacologic or psychotherapeutic.     

Suicide and suicide attempts in the European Economic Community: an analysis of trends, with special emphasis upon trends among the young

An attempt is made to explain the increase in adolescent suicidal behavior reported for most countries in the European Economic Community over the last two decades, within the framework of a social learning theory. A typology of suicidal acts based on an outcome-expectancy model is proposed that would make intelligible the observed positive correlation between the incidence of lethal and nonlethal suicidal acts, the latter having grown to epidemic proportions among the young. This epidemic can be attributed to the interplay of three groups of factors, namely, the socialization of a specific problem-solving behavior repertoire, socioeconomic conditions, and attitudes toward suicide. The implications for suicide prevention are briefly discussed.     

A test of the effectiveness of a list of suicide warning signs for the public

In this study we examined the effect that reading a list of warning signs for suicide has on beliefs about suicide, including the belief that one can recognize a suicidal crisis. All participants read two sets of warning signs (with only the experimental group reading the suicide warning signs) and then answered questions concerning beliefs related to three health problems. Results indicate that participants who read the suicide warning signs reported greater abilities to recognize if someone is suicidal but did not report stronger beliefs that suicidal individuals are partly to blame, nor did they report lower likelihoods of befriending suicidal individuals. Results suggest that reading the list of warning signs may be effective in increasing the public's ability to recognize suicidal crises without creating or magnifying stigmatizing beliefs about suicidal individuals.     

Insights from Cowichan: A Hybrid Approach to Understanding Suicide in One First Nations’ Collective

Explanations for suicide are theorized primarily in terms of the individual, seldom considering the interdependent orientation of Indigenous communities. Drawing on the interpersonal theory of suicide and settler colonial theory, this study addresses Indigenous suicide on two levels: the individual and the collective. Twenty‐one interviews were conducted with members of the Cowichan Tribes to understand reasons for suicide in one community. Qualitative analysis identified explanatory constructs proposed by the interpersonal theory as well as negative conditions stemming from colonialism, as proposed by settler colonial theory. These results argue that Indigenous suicidal behavior is best understood from an interdependent standpoint.     

An investigation of psychopathology in nonreferred suicidal and nonsuicidal adolescents

This investigation examined self-reported psychopathology in a school-based sample of 456 suicidal and nonsuicidal adolescents. The sample consisted of four groups: three at-risk for suicidal behavior based on current suicidal ideation as assessed by the Suicidal Ideation Questionnaire (SIQ; Reynolds, 1988), past suicide attempts, or both; and one nonsuicidal comparison group. Psychopathology was examined using ten scales from the Adolescent Psychopathology Scale (APS; Reynolds, 1998a) including: Major Depression, Conduct Disorder, Substance Abuse, Schizophrenia, Adjustment Disorder, Anorexia Nervosa, Borderline Personality Disorder, Obsessive-Compulsive Personality Disorder, Schizotypal Personality Disorder, and Avoidant Personality Disorder. Analyses were conducted separately for males and females using a MANOVA design that examined psychopathology severity among the four groups. Adolescents who engaged in past or current suicidal behavior had higher psychopathology severity scores compared to their nonsuicidal peers. Males with current suicidal thoughts who had attempted suicide had the highest levels of psychopathology severity compared to males in the other three groups. Females with a past suicide attempt or current suicidal ideation had higher psychopathology severity scores compared to nonsuicidal females. Results show greater psychopathology in school-based adolescents who have engaged in past and/or current suicidal behavior. The need for clinicians and mental health professionals working with at-risk youth to focus on concurrent psychopathology along with suicidal behavior is discussed.     

Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths

Three hundred fifty lesbian, gay, and bisexual youths aged 14 to 21 years were questioned about suicidal thoughts and behaviors, families' reactions to youths' sexual orientation, and suicidality among relatives and friends. Results confirmed an association between sexual orientation and suicidality. Nearly half (42%) had sometimes or often thought of suicide; one third (33%) reported at least one suicide attempt. Many related suicidal ideation and suicide attempts to their sexual orientation. Most attempts followed awareness of same-sex feelings and preceded disclosure of sexual orientation to others. One quarter said a family member had made a suicide attempt, and nearly three quarters said a close friend had attempted suicide.     

Adolescent suicide and defensive style.

This empirical study investigated the relation between ego defense mechanisms, diagnoses, and suicidality among 200 adolescent psychiatric patients ages 12 to 16 years. Based on a structured diagnostic interview, adolescents were divided into three groups: suicide attempters, suicidal ideators, and nonsuicidal patients. Using the Defense Mechanisms Inventory (DMI), suicidal adolescents scored higher on the defense of turning-against-self and lower on reversal, as compared to nonsuicidal adolescents. Although suicide was significantly more common among adolescents with an affective disorder, turning-against-self remained significantly associated with suicide attempt even when diagnosis was controlled for. Results demonstrate the importance of defense mechanisms in understanding adolescent suicidal behavior.     

Some sociopsychological factors in attempted suicide among urban black males.

This study tests three hypotheses relating to suicidal behavior among urban black males: that black consciousness and group cohesiveness will be lower and depression will be higher. Inner-city, young adult black males with a suicide attempt in the last 6 months, and matched controls were examined. Hypothesis was one supported; the other two received partial support. The validity of the theory of black self-hatred as the basic cause of suicidal behavior among blacks is questioned. Atwo-factor theory of suicide, focusing on forces moving the person away from suicide toward positive subgroup ties, is proposed.     

Suicide Crisis Syndrome: A review of supporting evidence for a new suicide‐specific diagnosis

Suicide is a major public health problem, and suicide rates are still on the rise. Current strategies for identifying individuals at risk for suicide, such as the use of a patient's self‐reported suicidal ideation or evidence of past suicide attempts, have not been sufficient in reducing suicide rates. Recently, research groups have been focused on determining the acute mental state preceding a suicide attempt. The development of an acute suicidal diagnosis, the Suicide Crisis Syndrome (SCS), is aimed at capturing this state to better treat individuals. The SCS has five main evidence‐based components—entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The SCS may provide clinicians with the ability to identify individuals who are experiencing an acute pre‐suicidal mental state, regardless of their self‐reported suicidal ideation. Future research leading to the incorporation of this diagnosis into clinical practice could improve the quality of care and reduce the personal, societal, and legal burden of suicide.     

Laboratory measured behavioral impulsivity relates to suicide attempt history

The purpose of this study was to examine the relationship between laboratory behavioral measured impulsivity (using the Immediate and Delayed Memory Tasks) and suicidal attempt histories. Three groups of adults were recruited, those with either: no previous suicide attempts (Control, n = 20), only a single suicide attempt (Single, n = 20), or multiple suicidal attempts (Multiple, n = 10). As hypothesized, impulsive responses increased with the number of suicide attempts (Control < Single < Multiple). This study helps to demonstrate how laboratory behavioral measures of impulsivity can be used to discriminate groups based on suicidal histories among samples not currently exhibiting significant suicidal behaviors.     

Empirically Based Criteria for Rational Suicide: A Survey of Psychotherapists

This qualitative study was designed to develop a set of empirically based criteria for rational suicide by asking psychotherapists to define “rational suicide.” Data analysis revealed three components of a rational suicide: (1) the presence of an unremittingly hopeless condition (eight examples provided), (2) a suicidal decision made as a free choice, and (3) the presence of an informed decision-making process (five elements listed). It is suggested that the criteria may possibly be used in assessing the rationality of suicidal clients.     

Suicide: A Multidimensional Malaise

No one really knows why human beings commit suicide. The goal of this paper is to provide a psychological point of view on the topic, among the many other perspectives that are needed. It addresses the question by providing a theory of suicide, arguing that it is theory that allows us to sort out the booming buzzing mess of experience (Wm. James). Suicide is a multidimensional malaise. Metaphorically speaking, it is an intrapsychic drama on an interpersonal stage. As sound theory must be empirically observable, the theory is next applied to research of suicide notes, studying such factors as age, sex, and method of suicide, cross-culture and cross-time. Next, because all theory must have clinical applicability, a clinical case study of Goethe's Werther is provided. Overall, it is concluded that we need to continue to develop models to understand the suicidal mind.     

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.     

Alcohol use disorders and risk factor interactions for adolescent suicidal ideation and attempts.

Four hundred eighty-two adolescents who were diagnosed with at least one mental disorder were studied to determine the predictors of suicidal ideation and suicide attempts. Major depression was predictive of suicidal ideation and suicide attempts for both genders. Chronic stress was found predictive of male suicidal ideation, while low self-esteem and high family dysfunction were found to be predictive of suicidal ideation in females. Statistical trends suggest that females with comorbid alcohol use/conduct disorder were approximately three times more likely to have attempted suicide than those with only one of these conditions. Clinicians working with adolescents should be aware that, while depression remains the number one clinical risk forsuicidal behavior, risk factors for suicidal ideation may be different than those for attempted suicide and may vary by gender.     

Suicide,Loss, and Mourning

ABSTRACT: The intensive treatment of six suicidal patients has been used to explore the relationships among object loss, the mourning process, and suicide. These relationships may be condensed in two propositions: (a) suicidal behavior stems from an arrested grief reaction in which the subject is unable to complete the process of mourning for a lost object; and (b) the suicide's pathological loss reaction is brought about by developmental defects, primarily deficiencies in self-love and individuation. The suicidal subject's mournïng reaction is arrested in one or more of the first three stages of grief: shock, protest, or detachment from the lost object.     

Relation of Marital Separation and Divorce to Suicide: A Report*

ABSTRACT: This paper examines the relation of marital separation and divorce to suicide. The persons studied are applicants to the Benjamin Rush Center, the crisis clinic division of the Didi Hirsch Community Mental Health Center/Los Angeles Psychiatric Service. The sample consists of 238 subjects, of whom 39, or 16.4% were suicidal, and 23 had made one or more suicide attempts at some prior date. Those seriously discussing separation, but not actually separated, tended to be less frequently suicidal than the long-term separated/divorced (.05 < p >. 10). The study further examined the relationship of important events and interspouse transactions to suicide potential. Significant associations were found in the relationship of suicide potential to verbal attack by spouse (p =. 03), vacillation in the last two weeks (p =. 02), and vacillation since the first serious discussion of divorce (p =. 02). Several other associations approached statistical significance. The authors believe that the findings in regard to vacillation and interspouse aggression are especially interesting and merit further study.     

Physiological Reactions to a Suicide Film: Suicide Attempters,Suicide Ideators,and Nonsuicidal Patients

A film about two teenagers who commit suicide was shown to three groups of psychiatric inpatients: 17 who had attempted suicide, 20 who had expressed suicidal thoughts, and 10 who were not suicidal. Anxiety before and after the film was evaluated with psychometric (anxiety rating scale) and physiological tools (heart and respiration rate, blood pressure, electromyogram). Values noted before and after screening, and the degree of change in these values, were compared. In addition, psychomotor agitation was rated at several points during the film. Most results were negative. The suicide attempters had significantly lower postscreening heart rates and a significantly lesser change in heart and respiration rates than the other two groups. The suicide attempters revealed an increase in psychomotor agitation until the discovery of the suicide and a decrease thereafter, whereas the agitation of the nonsuicidal patients continued to increase from the start to the end of the film. The study suggests that on some parameters, suicide attempters reveal less anxiety than nonsuicidal psychiatric patients following exposure to a simulated suicide. The reaction of suicide ideators falls somewhere between the two groups.