The relationship between posttraumatic stress symptomatology and suicidal behavior in school-based adolescents

This study investigated the relationship between posttraumatic stress disorder (PTSD) symptomatology and suicidal behavior, specifically suicidal ideation and suicide attempt history, while controlling for depression and gender in 106 adolescents in an urban high school. Participants completed self-report measures of the Adolescent Psychopathology Scales-Posttraumatic Stress Disorder Subscale (APS-PTS), the APS-Suicide Attempt History (APS-SAH), the Suicidal Ideation Questionnaire-Junior (SIQ-JR), and the Reynolds Adolescent Depression Scale (RADS). Analyses were conducted using a hierarchical multiple regression design to account for the relationship between PTSD symptomatology and depression. Regression results showed that after controlling for depression and gender, PTSD symptomatology was significantly related to suicidal ideation and showed a trend toward suicide attempt history. In addition, adolescents with high levels of PTSD symptomatology were more likely than peers with "average" levels of PTSD symptomatology to be currently thinking about suicide and to have made a past suicide attempt. These findings show that PTSD symptomatology has a unique relationship to adolescent suicidal behavior that cannot be explained by depression or gender. The importance of these results and their implications for future research are discussed.     

创伤暴露对青少年暴力行为和自杀意念的影响:创伤后应激障碍和抑郁的中介作用

采用创伤暴露问卷、基于DSM-5的创伤后应激障碍症状核查表、流调中心用抑郁量表和青少年行为问题调查表,在雅安地震3.5年后对地震极重灾区的703名中学生进行调查,考察创伤暴露对暴力行为和自杀意念的影响,并检验创伤后应激障碍和抑郁在其中的中介作用。结果发现：创伤暴露可以直接正向预测暴力行为和自杀意念,PTSD在创伤暴露对暴力行为和自杀意念的影响间起中介作用,抑郁仅在创伤暴露对自杀意念的影响间起中介作用,而在创伤暴露对暴力行为影响间的中介效应不显著。     

创伤暴露对青少年暴力行为和自杀意念的影响:创伤后应激障碍和抑郁的中介作用

采用创伤暴露问卷、基于DSM-5的创伤后应激障碍症状核查表、流调中心用抑郁量表和青少年行为问题调查表,在雅安地震3.5年后对地震极重灾区的703名中学生进行调查,考察创伤暴露对暴力行为和自杀意念的影响,并检验创伤后应激障碍和抑郁在其中的中介作用。结果发现：创伤暴露可以直接正向预测暴力行为和自杀意念,PTSD在创伤暴露对暴力行为和自杀意念的影响间起中介作用,抑郁仅在创伤暴露对自杀意念的影响间起中介作用,而在创伤暴露对暴力行为影响间的中介效应不显著。     

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.     

Family support,family stress,and suicidal ideation in a combat-exposed sample of Operation Enduring Freedom/Operation Iraqi Freedom veterans

Background and Objectives: Deployment-related risk factors for suicidal ideation among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans have received a great deal of attention. Studies show that mental health symptoms mediate the association between most deployment stressors and suicidal ideation; however, family-related factors during deployment are largely unexplored. We examined posttraumatic stress disorder (PTSD) and depression symptoms as mediators of the associations between deployment family support and stress and post-deployment suicidal ideation in combat-exposed OEF/OIF veterans. Design: National cross-sectional mail survey. Methods: 1046 veterans responded to the survey. The sample for this study was 978 veterans who experienced combat. Regression-based path analyses were conducted. Results: Family support and stress had direct associations with suicidal ideation. When PTSD and depression symptoms were examined as mediators of these associations, results revealed significant indirect paths through these symptoms. Conclusions: This study contributes to the literature on suicidal ideation risk factors among OEF/OIF veterans. Deployment family support and family stress are associated with suicidal ideation; however these associations occur primarily through mental health symptomatology, consistent with findings observed for other deployment factors. This research supports ongoing efforts to treat mental health symptomatology as a means of suicide prevention.     

Moral transgression during the Vietnam War: a path analysis of the psychological impact of veterans’ involvement in wartime atrocities

Background and Objectives: Involvement in wartime combat often conveys a number of deleterious outcomes, including posttraumatic stress disorder (PTSD), depression, hostility, aggression, and suicidal ideation. Less studied is the effect of engagement in wartime atrocities, including witnessing and perpetrating abusive violence.

Design and Methods: This study employed path analysis to examine the direct effects of involvement in wartime atrocities on hostility, aggression, depression, and suicidal ideation independent of combat exposure, as well as the indirect effects via guilt and PTSD symptom severity among 603 help-seeking male Vietnam War veterans.

Results: Involvement in wartime atrocities was predictive of increased guilt, PTSD severity, hostility, aggression, depressive symptoms, and suicidal ideation after controlling for overall combat exposure. Combat-related guilt played a minor role in mediating the effect of atrocity involvement on depression and suicidal ideation. PTSD severity had a larger mediational effect. However, it still accounted for less than half of the total effect of involvement in wartime atrocities on hostility, aggression, and suicidal ideation.

Conclusions: These findings highlight the heightened risk conveyed by involvement in wartime atrocities and suggest that the psychological sequelae experienced following atrocity involvement may extend well beyond guilt and PTSD.     

Self-Esteem and Social Support as Moderators of Depression,Body Image,and Disordered Eating for Suicidal Ideation in Adolescents

The current study investigated risk factors for suicidal ideation in a community sample of 392 adolescents (males 51.9 %; females 48.1 %), while also evaluating self-esteem, perceived parent support, and perceived peer support as protective factors and potential moderators between suicidal ideation and the 3 risk factors. Disordered eating, depression, parent support, and peer support were found to be significant predictors of current suicidal ideation, but body satisfaction was not. The relationship between depression and suicidal ideation was significantly moderated by both self-esteem and parent support, while the relationship between disordered eating and suicidal ideation was significantly moderated by peer support. Results underscore the importance of examining protective factors for suicide risk, as they have the potential to reduce suicidal ideation in adolescents.     

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.     

Adolescent suicidal ideation

Adolescent suicidal ideation and its relationship to other variables was tapped by a self-report questionnaire administered to 88 high school seniors. Eighteen percent responded positively to the statement "sometimes I feel suicidal." Those who reported suicidal ideation were found to differ from those who did not on a number of variables, including family relationships (quality of relationship with mother, intimacy with parents, and closeness to siblings), family history of depression (maternal depression), peer relations (quality of peer relationships, popularity, and number of friends), emotional well-being (happiness, anger, and depression), drug use (cigarettes, marijuana, and cocaine), and grade point average. Stepwise regression indicated that happiness explained 46% of the variance in suicidal ideation, and number of friends, anger, and marijuana use explained an additional 20%, for a total of 66% of the variance. While 34% of the variance remained unexplained, it is suggested that the questions used to measure these four variables be included in global screenings to identify adolescents at risk for suicidal ideation.     

A Longitudinal Investigation of Depression,Hopelessness, Social Support,and Major and Minor Life Events and Their Relation to Suicidal Ideation in Adolescents

The longitudinal relationship of psychological and social-environmental factors with adolescent suicidal ideation over a 1-year-period was examined in a sample of 374 high school students. Students were assessed twice over a 1-year period with measures of depression, hopelessness, major negative life events, daily hassles, social support, and suicidal ideation. At the initial assessment, daily hassles and negative life events for males and social support and depression for females were significant factors related to suicidal ideation levels 1 year later. Changes in depression and hopelessness were significantly related to changes in suicidal ideation over the 1 year interval for males and females. Differences found between males and females in the relationship of psychological and social-environmental variables with suicidal ideation supports the need to examine gender specific relationships when conducting research on suicidal behavior in adolescents.     

Relations Between Suicidal Ideation,Depression, and Emotional Autonomy from Parents in Adolescence

We examined the relations between depression, emotional autonomy quality-related constructs of separation and detachment, and suicidal ideation, focusing on the unique and common contribution that depression, separation and detachment made to suicidal ideation. We also examined gender differences. 403 adolescents, 196 boys and 207 girls, completed self-report measures of depression, separation and detachment, and suicidal ideation. The data showed a significant relation between depression and suicidal ideation both for boys and girls, and between detachment and suicidal ideation only for boys. Results for boys supported an additive model such that depression and detachment each contributed unique variance to boys’ suicidal ideation, and an interactive model such that detachment contributed to exacerbate the risk of suicidal ideation when boys were already at risk because of depression. The data for girls supported an interactive, but not additive, model such that depression and detachment did not contribute independently to girls’ suicidal ideation but in a joint way.     

Low self‐esteem,entrapment, and reason for living: A moderated mediation model of suicidal ideation

Adolescent suicidal ideation has become a top public health concern. It is thus significant to explore both risk and protective factors of adolescent suicidal ideation. The present study tested a moderated mediation model of suicidal ideation in a sample of Chinese adolescents. Chinese adolescents of 1074 (54.2% females, aged between 11 and 18 years) completed questionnaires assessing self‐esteem, entrapment, reason for living, and suicidal ideation. We found that entrapment mediated the association between low self‐esteem and suicidal ideation. The association between entrapment and suicidal ideation was moderated by reason for living. Findings of this study may expand our understanding of the development of suicidal ideation, and facilitate future research exploring the interplay of risk and protective factors of suicidality. Clinical implications of these findings were also discussed.     

Trust in higher guidance and suicidality in Afghan students under the Taliban regime

Background/ObjectiveAfter years of war, political instability and natural catastrophes high rates of PTSD and depression have been found in the Afghan population. On this background, it was investigated whether religious beliefs (trust in higher guidance; TIHG) moderated the association between PTSD symptoms and/or depression and suicidal ideation.MethodA total of 279 Afghan university students (61.6% women; aged 18 to 30 years) took part in this cross-sectional study between July and November 2022. Self-report measures of PTSD, depression, suicidal ideation, trust in higher guidance were used.ResultsSevere PTSD symptoms were reported by 58.4%, clinically relevant depression symptoms were reported by 55.2% and current suicidal ideation was reported by 44.4% of the sample. TIHG moderated the impact of PTSD symptoms, on suicidal ideation. TIHG and depression were unrelated.ConclusionPTSD symptoms, depression and suicidal ideation show an alarmingly high prevalence in this specific sample of Afghan students. TIHG seems to be a resilience factor of special importance.     

创伤后应激障碍对震后青少年自杀意念的影响：安全感的调节作用

为探讨创伤后应激障碍（PTSD）及其各个症状簇对震后青少年自杀意念的影响,并检验安全感在其中的调节作用,研究采用创伤暴露程度问卷、流调中心抑郁量表儿童版、DSM-5的PTSD症状核查表、安全感量表和儿童行为问题核查表对汶川地震8.5年后的1136名中学生进行调查。结果发现：PTSD、负性认知和情绪改变症状、警觉性增高症状分别正向预测自杀意念,侵入性症状和回避性症状对自杀意念的预测作用不显著;安全感在侵入性症状、负性认知和情绪改变症状、警觉性增高症状、PTSD与自杀意念之间起负向调节作用,在回避性症状与自杀意念之间不起调节作用。这表明PTSD各症状簇对震后青少年自杀意念的预测作用不同,且安全感在其中发挥的调节作用也不同。     

Forgiveness,Depression, and Suicidal Behavior in Adolescents: Gender Differences in this Relationship

With the development of positive psychology, protective factors have received increased attention as buffers against suicidal ideation and attempts and against the risk factors for suicide (e.g., depressive symptoms). Empirical evidence suggests that one of the protective factors associated with depression and suicide is forgiveness. Although previous studies have demonstrated a negative association between forgiveness and risk of suicide, studies on gender differences in adolescents are still scarce. Thus, the authors assessed the moderating role of gender in a sample of adolescents. The participants were 572 adolescents (50.9% boys; M age = 15.49 years, SD = 1.09 years) from secondary school centers. The results revealed that forgiveness moderated the relationship between depression and suicidal ideation for boys but not for girls. Specifically, for boys the relationship between depression and suicidal thoughts and behaviors weakened as levels of forgiveness increased. These findings suggest therapeutic applications to reduce the likelihood of suicide in the group of adolescent boys with higher scores on depression and lower levels of forgiveness. The study results are discussed in terms of the need to use gender perspectives in positive psychology intervention programs.     

Attributional style as a diathesis in predicting depression,hopelessness, and suicide ideation in college students

Attributional style was examined as a diathesis for depression, hopelessness, and suicidal ideation. A naturalistic stressor—obtaining a D or F on an Introductory Psychology exam—was used in a longitudinal design to test for the effects of stress in predicting these criteria. Controlling for preexam levels of depression, hopelessness, and suicide ideation, prestress attributional style was consistently related to poststress levels of each of these criteria. Both positive and negative attributional styles measured at Time 1 were predictive of these criteria at Time 2. Regression analyses revealed that exam grade, attributional style alone, and attributional style in interaction with stress predicted each of the three criteria. The results are seen as supportive of a prestress attributional style diathesis to depression, hopelessness, and suicidal ideation.     

Relationships between stuttering,depression, and suicidal ideation in young adults: Accounting for gender differences

PurposeThe purpose of this study was to investigate the relationship between depressive symptoms and suicidal ideation and living with stuttering while accounting for time, sex, and health-related confounders.MethodThe data for this study come from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative survey study that has followed 13,564 respondents over the course of 14 years. Responses to the question “Do you have a problem with stuttering or stammering?” at two time points were used to establish stuttering and non-stuttering groups. Regression analysis, propensity score matching, and structural equation modeling were used.ResultsCompared to their fluent counterparts, males and females reported significantly elevated symptoms of depression. Although symptoms of depression among males who stutter were stable over time, depressive symptoms among females who stutter increased with age. Compared to males who do not stutter, males who stutter were significantly more likely to report feelings of suicidal ideation. There were no differences in suicidal ideation between females who do and do not stutter.ConclusionsSpeech-language pathologists should be aware of the associations between stuttering and depressive symptoms, as well as the increased risk for suicidal ideation among males who stutter. Clinicians should be knowledgeable about symptoms of depression and suicidal ideation and be familiar with processes to refer as needed.     

Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression,Suicidal Ideation,and Suicidal Behavior in High‐Risk Adolescents

The relationship between hopelessness and depression in predicting suicide‐related outcomes varies based on the anticipation of positive versus negative events. In this prospective study of adolescents at elevated risk for suicide, we used two Beck Hopelessness Scale subscales to assess the impact of positive and negative expectations in predicting depression, suicidal ideation, and suicidal behavior over a 2‐ to 4‐year period. In multivariate regressions controlling for depression, suicidal ideation, and negative‐expectation hopelessness, positive‐expectation hopelessness was the only significant predictor of depressive symptoms and suicidal behavior. Clinical interventions may benefit from bolstering positive expectations and building optimism.     

Suicidal Ideation and Behavior in Adolescents Aged 12–16 Years: A 17‐Year Follow‐Up

The prevalence of suicidal ideation/behavior in 1983 or 1987 and its association with future mental health in 2001 were evaluated in a provincially representative sample of Canadian adolescents (n = 1,248) aged 12 to 16 years. Approximately 13.3% (95% CI = 11.5–15.3) of adolescents self‐reported suicidal ideation/behavior. Adolescent agreement with parent (κ = .07) and teacher (κ = .05) reports at baseline was low because adults identified so few subjects. In adulthood, the associations between adolescent self‐reports of suicidal behavior/ideation and major depression and other mental health indicators were explained by respondent sex and adolescent emotional problems reported in 1983/1987. Adolescents with suicidal behavior/ideation often are not recognized by their parents and teachers and may be at risk for persistent psychiatric problems attributable to coexisting mental health problems early‐on.     

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.