Risk factors associated with suicide attempts and other self-injury among Hong Kong adolescents

This study examined 1,361 Chinese adolescents who reported self-injurious behaviors. Groups A and B both acknowledged deliberate self-injury, but only Group A had made a suicide attempt. Group C reported accidental self-injury. Deliberate self-injurers (Groups A and B) were more frequently girls, older, and with more suicidal ideation. Group A had more psychopathology, environmental and suicide-related risk factors than group B and C. Group C had higher depressive symptoms than noninjured controls. The study clarifies differences among self-injurious behavior groups based on expressed deliberate self-injury and self-reported suicide attempt. These three groups appear to present a continuum of risk.     

Psychopathology,family functioning,and cognitive style in urban adolescents with suicide attempts

This study examined psychopathology, family functioning, and cognitive style in 121 African-American adolescents who attempted suicide. Group means suggested that these youths, when taken together, were not reporting significant psychological distress. However, after classifying the youths into three groups by level of depressive symptoms interesting findings emerged. Youth self-reports of depressive symptoms on the Children's Depression Inventory were associated with the presence of internalizing and externalizing disorders on the Youth Self-Report and Child Behavior Checklist, and with a maladaptive attributional style. Sixty-seven percent of participants classified their family types as maladaptive in terms of levels of cohesion and/or adaptability. In fact, the majority of adolescents and parents reported their families as disengaged. These findings are discussed from a culturally and developmentally sensitive framework which considers key demographic variables (race, socioeconomic status, age). Clinical implications are offered for individual and family interventions.     

Active school travel is associated with fewer suicide attempts among adolescents from low-and middle-income countries

Background/Objective: This study explored the association between active school travel (AST) and suicide attempts among adolescents in low- and middle-income countries (LMICs). Method: We used the data from the Global School-based Health Survey, including 127,097 adolescents aged 13-17 years from 34 LMICs. A self-reported survey was used to collect data on AST and suicide attempts as well as some variables. Multivariable logistic regression was performed to assess the association between AST and suicide attempts. A meta-analysis with random effects was undertaken to identify the difference in the association between AST and suicide attempts. Results: Across all the adolescents, the prevalence of AST was 37% and the prevalence of suicide attempts was 11.60%. Adolescents who engaged in AST were less likely to have suicide attempts irrespective of gender. The country-wise analysis indicated a large inconsistency in the association between AST and suicide attempt across the countries. Conclusions: AST would appear to be a protective factor for reducing suicide attempts among adolescents. However, the association between AST and suicide attempts varied greatly across the countries. Future studies should confirm the association between AST and suicide attempts.     

Single and multiple suicide attempts and associated health risk factors in New Hampshire adolescents

In this study we examined self-reported suicide attempts and their relationship to other health risk factors in a community sample of 16,644 adolescents. Fifteen percent endorsed suicide attempts (10% single; 5% multiple attempts) We hypothesized that multiple attempters would show higher prevalence of comorbid health risks than single or non-attempters. The three groups showed significant differences in ten health risk domains, on factors such as depressed mood, sexual assault, weight problems, and drug and alcohol use (ORs: 3.26-13.57). Repeated suicide attempts appear to be related to increased vulnerability and likelihood of harm in multiple domains of health risk.     

Dimensions of impulsivity and aggression associated with suicide attempts among bipolar patients: a preliminary study

Impulsivity and hostility are often thought to be interrelated among depressed patients with suicidal behavior, but few studies have examined this relationship empirically. In this study, we assessed trait impulsivity and hostility among 52 DSM-IV bipolar subjects with and without histories of suicide attempts. Impulsivity and hostility were correlated among attempters (r = .41, p = .03) but not non-attempters (r = .22, p = .28). As compared to non-attempters, attempters had significantly higher levels of overall hostility, more extensive subcomponents of hostility, and a trend toward higher overall impulsivity. Associations between lifetime suicide attempts and overall hostility were significant while controlling for current depression severity and lifetime illness duration. Aggression and impulsivity appear linked among bipolar patients with lifetime suicide attempts but may be independent constructs among non-attempters. The presence of both factors may elevate risk for suicidal behavior.     

Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts

The purpose of this study was to examine affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Forty-seven adolescents with a history of multiple suicide attempts (MA) were compared to 74 single suicide attempters (SA) on psychiatric diagnosis, depressive symptoms, affect regulation, self-mutilation, alcohol use, and hopelessness. Results revealed that the MA group was more likely to be diagnosed with a mood disorder, and reported more severe depressive symptoms and anger, in comparison to the SA group. Behaviorally, the MA group had higher rates of disruptive behavior disorders and higher levels of affect dysregulation and serious self-mutilation than the SA group. Further, greater levels of hopelessness were reported by the MA than the SA group. After controlling for a mood disorder diagnosis, only differences in anger, affect dysregulation, and serious self-mutilation remained significant. Overall, results suggest that treatment with adolescent suicide attempters might specifically target anger and affect dysregulation to reduce risk for future suicidal behavior.     

Sex differences in developmental trends of suicide ideation, plans, and attempts among European American adolescents

Although suicide ideation, plans, and attempts increase during adolescence, it remains unclear whether boys' and girls' risk for these outcomes peaks at different ages. We used longitudinal categorical data (never, once, 2+ times) from the Family Transitions Project (N = 1,248 rural European Americans, ages 11-19) to investigate whether yearly prevalence rates of adolescent suicidal episodes follow different patterns by sex. Multiple-group growth models revealed that peak levels of past-year ideation and plans occurred during mid adolescence for girls, but slowly increased through late adolescence for boys. We found that prevalence patterns for attempts were very similar for boys and girls, with both increasing through mid adolescence and then declining, although girls' risk declined slightly more rapidly. This information may help alert gatekeepers to developmental periods during which boys and girls are particularly vulnerable to suicide-related experiences, and also may help inform the timing of preventive efforts.     

Sociological correlates of alienation among adolescent suicide attempts.

The purpose of this research is to assess the relationship between adolescent alienation and a number of sociological factors in a sample adolescent suicide attempts from a northern metropolitan area. First, Dean's alienation scale is employed and the distribution of responses of the adolescent suicide attempts are analyzed. Second a number of sociological variables are examined by means of multiple regression procedures. In the regression analysis, eight variables were found to be statistically significant-in descending order: social contact with peers in the neighborhood, conflict with parents, broken romance, economic status of parents, communication blockage with parents, school performance, stepparents, and broken romance, These variables have been salient in previous research and theorizing about adolescent suicidal behavior. The fact that adolescence, by itself, seems to be a good predictor of whether or not a person will attempt suicide strongly suggests that there is something about the condition of adolescence which underlies this type of behavior. One possibility is that biological maturation is itself the crucial variable. Alternatively, the argument which follows concentrates on a major sociological aspect of adolescence-the adolescent's relative alienation from institutionalized social life. Alienation may be endemic to the period of adolescence.     

Facility-level characteristics associated with serious suicide attempts and deaths from suicide in juvenile justice residential facilities

Little is known about how facility-level characteristics affect the risk of suicide and suicide attempts in juvenile justice residential facilities. This leaves facility administrators and mental health providers without evidence-based guidance on how the facility itself affects risks. The current study uses data from two recently developed censuses of juvenile justice facilities in the United States to examine the relationship between facility-level characteristics and the likelihood of a facility reporting serious suicide attempts and deaths from suicide. Results suggest highest risks for facilities housing larger populations of Black young people and for facilities locking sleeping room doors. Lower risks are found for facilities screening all young people within 24 hours of arrival.     

Factors associated with suicide attempts in female inmates: the hegemony of hopelessness

In this study factors associated with past suicide attempts in female inmates were examined. Female inmate participants (N = 105) were given structured diagnostic assessments of antisocial and borderline personality disorders and substance dependence, as well as measures of depression, hopelessness, problem-focused coping styles, and reasons for living. There was a high lifetime prevalence of past suicide attempts (38.1%). Suicide attempts were positively associated with personality disorders, hopelessness, depression, childhood physical/emotional abuse, and family history of suicide and mood disorders, and negatively associated with income, reasons for living, and problem-focused coping. Controlling for hopelessness, borderline personality disorder and family history of suicide attempts were the only variables that remained uniquely associated with suicide attempts.     

Indicators associated with suicidal ideation and suicide attempts among 16-35-year-old Danes: a national representative population study

In this study indicators associated with suicidal ideation and suicide attempts in a nationwide representative sample (N=3184) of Danes aged 16-35 years were examined. The study was cross-sectional and had three aims: (1) to draw a profile of persons with and without suicidal tendency established on a combined quartered variable on current suicidal thoughts and/or ever attempted suicide; (2) to explore whether the different suicidal tendencies constitute a severity continuum; and (3) to identify factors of significance for suicidal tendency. Factors included were demographic characteristics, living conditions, social network, external health risks, lifestyle, health-related quality of life, symptoms, morbidity, and illness behavior. A continuum hypothesis was not supported, as the multiple logistic regression analysis showed no clear gradient in the different forms of suicidal tendency. Cohabitation status (single, p < 0.0001), exposure to violent threats (p < 0.0001), exposure to sexual abuse (p < 0.0001), being a daily smoker (p < 0.0001), doing nothing to stay healthy (p < 0.0004), poor mental health (p < 0.0001), mental symptoms within the past 2 weeks (p = 0.0003), contact with psychologist (p < 0.0001), and absence from work due to illness (p = 0.005) were indicators significantly related to suicidal tendency.     

Familism, family environment, and suicide attempts among Latina youth

In this study, we examined the relationship between familism and family environment type as well as the relationship between family environment type and suicide attempts among Latina youth. Latina teen attempters (n = 109) and nonattempters (n = 107) were recruited from the New York City area. Latent class analysis revealed three family environment types: tight-knit, intermediate-knit, and loose-knit. Tight-knit families (high cohesion and low conflict) were significantly less likely to have teens who attempted suicide as compared with intermediate-knit families or loose-knit families. Moreover, familism increased the odds of being in a tight-knit family versus a loose-knit family and the odds of being in a tight-knit family versus a intermediate-knit. The results suggest that familism may protect against suicide behavior among Latinas via its influence on family environment.     

Discriminators of suicide thoughts and attempts among homeless veterans who abuse substances

Six hundred homeless military veterans who abused substances were examined to determine what factors discriminate between nonsuicidal veterans, those who had suicidal thoughts, and persons who had attempted suicide. Several factors were considered based on attachment theory, including caregiver attachment, sexual abuse, physical abuse, resilience, self-efficacy, and self-esteem. Suicide attempters were discriminated from others by psychiatric comorbidity, early abuse, severity of substance abuse, and longevity of drug use. In contrast, the discriminators between nonsuicidal homeless substance abusers and others were elements of attachment and commitments such as marriage, employment, and religiosity. Some implications of the findings for intervention are discussed.     

Contributors to suicidal ideation among bipolar patients with and without a history of suicide attempts

This study was designed to develop models for vulnerability to suicidal ideation in bipolar patients. Logistic regression models examined correlates of suicidal ideation in patients who had versus had not attempted suicide previously. Of 477 patients assessed, complete data on demographic, illness history, and personality variables were available on 243. The regression models achieved positive predictive values of 55% and 59% for the attempter (N = 92) and nonattempter groups (N = 151), respectively. Depression was cross-sectionally associated with suicidal ideation in both the attempter and nonattempter groups but made a smaller contribution among attempters. Poor psychosocial adaptation and the personality factor "openness" were stronger contributors to suicidal ideation among prior attempters while anxiety and extraversion appeared protective against ideation. Among nonattempters, depression, anxiety, and neuroticism were the predominant influences on suicidal ideation. Bipolar patients with suicidal ideation may benefit from different treatment strategies depending on their prior attempt status.     

An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents

Data from 390 high school students were collected to examine potential differences between adolescents who had attempted suicide and those who engaged in self-injurious behavior on measures of depression, suicidal ideation, and attitudes toward life and death. Significant differences were found between controls and the self-harm groups on all dependent variables. A significant difference on attitudes toward life was found between the self-injury and suicide attempt groups. Post-hoc regression analyses showed that measures of depression, suicide ideation, and attitudes towards life predicted participants' self-harm categorization. These findings provide preliminary evidence that self-injurious behavior is different from attempted suicide among a community sample of adolescents.     

Correlates of suicidal ideation among rural adolescents

This study examined potential predictors of suicidal ideation among a nonclinical, rural adolescent population. A sample of 76 male and female adolescents enrolled in a rural public high school completed a personal information form, a suicide information questionnaire, short forms of the Beck Depression Inventory and the Family Environment Scale, and the Life Events Checklist. A stepwise multiple regression suggested significant predictive relationships between magnitude of suicidal ideation and measures of family social climate (i.e., Organization, Conflict, Expressiveness, and Independence subscales from the Family Environment Scale--Short Form). Multivariate analyses of variance and a discriminant-function analysis revealed no significant sex differences.     

Explaining the gender difference in self-reported suicide attempts: a nationally representative study of Norwegian adolescents

Predictors of self-reported suicide attempts were studied cross-sectionally and prospectively in order to discern which variables may account for the gender difference in such reports. A representative sample of Norwegian students (N= 9,679) in grades 7-12 were followed from 1992 to 1994. More girls (10.4%) than boys (6.0%) reported a previous attempt and more girls (3.3%) than boys (1.9%) reported an attempt during the study period. The gender difference in previous suicide attempts was significantly reduced when depressed mood was controlled, and was no longer significant when disordered eating was included. There was no gender difference in future attempts when previous attempts, depressed mood, physical appearance, pubertal timing, and romantic involvement were controlled. Girls' higher level of risk factors may account for their higher level of self-reported nonfatal suicidal behavior.