Differentiating Suicide Attempters from Suicide Ideators: A Critical Frontier for Suicidology Research

Most individuals who consider suicide do not make suicide attempts. It is therefore critical to identify which suicide ideators are at greatest risk of acting on their thoughts. However, few seminal theories of suicide address which ideators go on to make attempts. In addition, perhaps surprisingly, most oft‐cited risk factors for suicide—such as psychiatric disorders, depression, hopelessness, and even impulsivity—distinguish poorly between those who attempt suicide and those who only consider suicide. This special section of Suicide and Life‐Threatening Behavior serves to highlight this knowledge gap and provide new data on differences (and similarities) between suicide attempters and suicide ideators.     

Differentiating Suicide Ideators from Attempters: Violence—A Research Note

Which factors distinguish suicide attempters from suicide ideators is a relatively neglected question in suicidology. Data from the 2001 Youth Risk Behavior Survey, encompassing 1,439 youth suicide ideators and 1,097 attempters, was used to explore which factors best differentiate suicide attempters from ideators, with a focus on violence involvement. Measures of violence include the contexts of fights, dating, and weapons carrying. Controls were incorporated for psychiatric disorders, risky sexual behavior, school integration, and demographics. Controlling for the other variables, violence differentiated attempts from ideation: fighting (OR = 2.18) and weapon carrying (OR = 1.13). Psychiatric factors that predicted attempts over ideation included major depression (OR = 1.86), use of cocaine (OR = 2.34), and having a suicide plan (OR = 2.69), while demographic factors included gender, age, residence in the Midwest, and Hispanic, African American, or Asian ethnicity. A supplementary analysis (N = 11,546) determined that violence also helped to differentiate suicide ideators from nonsuicidal youth. Four factors (including violence involvement, eating disorders, and gender consistently) differentiated both between suicide attempts and ideation, and also between suicide ideators and nonsuicidal youth. The link between violence involvement and suicidality is interpreted in terms of the capability for suicide from the interpersonal theory of suicide.     

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.     

Assessment of Depression and Suicidal Actions: Agreement between Suicide Attempters and Informant Reports

Knowledgeable informants may be able to provide useful information about depressive symptoms and suicidal actions when a suicidal patient is uncooperative with a clinical interview or not available for a psychiatric evaluation. The present study was designed to examine information gathered from psychiatric inpatients who had attempted suicide as compared to similar information obtained from a close friend or family member. From a larger sample of adult psychiatric inpatients diagnosed with major depression, 25 suicide attempters were assessed and their reports were compared to similar information solicited from a close friend or family member. The assessment focused on depressive symptoms from the SCID and the presence of various suicidal actions. Moderate to high agreement was found on all measures. Psychiatric patients and their informants tended to agree on the presence of depressive symptoms, the presence of recent stressful life events, and specific actions taken during the suicidal crisis, suggesting that informants may be capable of providing useful information about the patient.     

Differentiating Adolescent Self-Injury from Adolescent Depression: Possible Implications for Borderline Personality Development

Self-inflicted injury (SII) in adolescence marks heightened risk for suicide attempts, completed suicide, and adult psychopathology. Although several studies have revealed elevated rates of depression among adolescents who self injure, no one has compared adolescent self injury with adolescent depression on biological, self-, and informant-report markers of vulnerability and risk. Such a comparison may have important implications for treatment, prevention, and developmental models of self injury and borderline personality disorder. We used a multi-method, multi-informant approach to examine how adolescent SII differs from adolescent depression. Self-injuring, depressed, and typical adolescent females (n = 25 per group) and their mothers completed measures of psychopathology and emotion regulation, among others. In addition, we assessed electrodermal responding (EDR), a peripheral biomarker of trait impulsivity. Participants in the SII group (a) scored higher than depressed adolescents on measures of both externalizing psychopathology and emotion dysregulation, and (b) exhibited attenuated EDR, similar to patterns observed among impulsive, externalizing males. Self-injuring adolescents also scored higher on measures of borderline pathology. These findings reveal a coherent pattern of differences between self-injuring and depressed adolescent girls, consistent with theories that SII differs from depression in etiology and developmental course.     

Clinical Utility of the MMPI in the Evaluation of Adolescent Suicide Attempters

MMPI profiles of female adolescents hospitalized on a general pediatrics floor following a suicide attempt were compared to a control group of medically hospitalized, female adolescents referred for psychiatric evaluation. The suicide attempters had only a lower score on the K scale when compared to the control group. Results do not suggest that a single MMPI profile differentiates suicide attempters from a comparison group of adolescents with emotional difficulties. Implications of these findings are discussed.     

Sociodemographic and Clinical Differences Between Suicide Ideators and Attempters: A Study of Mood Disordered Patients 50 Years and Older

Our study sought to characterize mood disordered suicide ideators and attempters 50 years and older admitted to a psychiatric ward either for a recent suicide attempt or for ongoing suicidal ideation. We enrolled 50 patients with suicide ideation consecutively admitted to an inpatient department and 50 patients admitted for a suicide attempt made in the last 48 hours. Suicide attempters more frequently had low social support and an age of onset of mood disorder of 46 years and older, and less frequently had a history of suicidal behaviors in the family members and pharmacological treatment, despite the fact that the groups did not differ with regard to antidepressants prescribed. The groups were not distinguishable based on several variables assumed to be risk factors for suicide behavior, such as proximal life events and stressors or alcohol use disorders. In both samples, comorbidity with organic diseases, the presence of stressful life events in the past 12 months, and a diagnosis of major depression were frequently reported. In conclusion, the presence of low social support and the absence of a pharmacotherapy may increase suicidal behaviors in patients at risk.     

The Rate and Characteristics of Suicide Attempters in the Native Hawaiian Adolescent Population

Native Hawaiian high school students, N = 1779, were surveyed for symptoms of psycho-pathology and suicide attempts in the previous 6 months. Seventy-seven (4.3%) of the students reported making a suicide attempt. There were no significant differences in prevalence rates for males and females. Depression, anxiety, aggression, substance abuse symptoms, and low family support, but not peer support, were significantly correlated with suicide attempts. On logistic regression, depression, substance abuse, and family support independently predicted attempts. The lack of gender difference may indicate a cultural characteristic of the Hawaiian population that differentiates it from mainstream American populations but likens it to the Native American population.     

青少年的气质与烟酒使用:交互效应检验

考察气质(意志控制、愤怒挫折、感觉寻求)对青少年烟酒使用的主效应,气质与教养方式(权威、专制、纵容)对烟酒使用的交互效应以及气质间的交互效应.采用随机整群抽样的方法,选取660名青少年为被试,匿名完成气质问卷、教养方式问卷和烟酒使用问卷.结果显示:(1)在控制了性别、年龄、社会经济地位后,气质对青少年烟酒使用具有预测作用,低意志控制、高愤怒挫折、高感觉寻求正向预测烟酒使用;(2)教养方式调节部分气质因素与烟酒使用的关系,具体为:权威和专制教养缓冲感觉寻求的风险作用,符合风险缓冲模型;纵容教养增强感觉寻求的风险作用,符合风险增强模型;(3)气质内部在影响青少年烟酒使用时也存在交互作用,愤怒挫折增强感觉寻求的风险作用,符合风险增强模型.因此,烟酒使用是气质与教养方式及气质间交互作用的产物.     

Comparisons of the Interpersonal–Psychological Theory of Suicide Constructs Among Individuals Without Suicidality,Ideators, Planners,and Attempters

The Interpersonal–Psychological Theory of Suicide (IPTS) proposes that combinations of thwarted belongingness, perceived burdensomeness, and acquired capability lead to suicide ideation, planning, and attempting. We compared individuals with and without suicidality on thwarted belongingness and perceived burdensomeness, and compared a combined group of planners and attempters to ideators on fearlessness about death (one component of acquired capability). Individuals with suicidality had higher thwarted belongingness and perceived burdensomeness than individuals without suicidality. Planners and attempters did not have higher fearlessness about death than ideators. These findings partially support IPTS hypotheses. Assessing thwarted belongingness and perceived burdensomeness may improve suicide risk determination.     

A Multivariate Associative Finite Growth Mixture Modeling Approach Examining Adolescent Alcohol and Marijuana Use

Theoretical and empirical substance use development research suggests that adolescent populations are not homogenous and can often be separated into subpopulations characterized by qualitatively different patterns of substance use development. This paper demonstrates the application of a multivariate associative finite latent growth mixture modelling approach to examine heterogeneity in patterns of adolescent alcohol and marijuana use and the influence of age, gender, parent, and peer substance use. Substance use problem outcomes were also examined. Participants were male and female adolescents (N = 1,044) ranging in age from 11 to 17 years at the first assessment (Mean age = 14.47; SD = 1.95). Individuals were 45% female and 82% Caucasian. Using growth mixture methodology, a 7-class model captured distinct simultaneous alcohol and marijuana use patterns over a 3-year period. Findings highlight the importance of examining subgroups of adolescent substance use, rather than focusing only on single samples.     

Psychiatric and Self‐Injury Profiles of Adolescent Suicide Attempters versus Adolescents Engaged in Nonsuicidal Self‐Injury

To better delineate the unique correlates of self‐injurious behaviors (SIB), psychiatric profiles of mutually exclusive groups of adolescents who made a suicide attempt (SA) versus those engaged in nonsuicidal self‐injury (NSSI) were examined. Contrary to hypotheses, the NSSI group endorsed earlier onsets of SIB and suicidal ideation (SI), as well as higher rates of depression and anxiety compared with their SA counterparts. Future work is warranted to understand the role of SI, including duration of SI and anxiety in the development of NSSI, and to identify risk and resiliency factors useful in predicting an adolescent's SIB status.     

Friendship Context Matters: Examining the Domain Specificity of Alcohol and Depression Socialization Among Adolescents

Driven by existing socialization theories, this study describes specific friendship contexts in which peer influence of alcohol misuse and depressive symptoms occurs. In the fall and spring of the school year, surveys were administered to 704 Italian adolescents (53?% male, M (age)?=?15.53) enrolled in Grades 9, 10 and 11. Different friendship contexts were distinguished based on two dimensions referring to the level (i.e., best friendships and friendship networks) and reciprocity (i.e., unilateral and reciprocal) of the relationships. Social network and dyadic analyses were applied in a complementary manner to estimate peer socialization effects across the different friendship contexts. Results showed that within friendship networks both male and female adolescents' alcohol misuse was affected by friends' alcohol misuse, regardless of whether the relationship was reciprocated or not. Conversely, peer socialization of depressive symptoms only emerged within very best friendship dyads of female adolescents. Findings suggest that the effects of peer socialization depend on the friendship context and specific types of behaviors. The theoretical and methodological implications of the findings are discussed.     

Religiousness and College Student Alcohol Use: Examining the Role of Social Support

The purpose of this study was to examine the mediating role of social support in the relationship between religiousness and alcohol use in a sample of college students. Two dimensions of religiousness: religious commitment and religious coping were examined as predictors of alcohol use. Participants were male and female college students (N = 221); the majority of the sample was Christian (73.8%). Emotional social support was tested as a mediator. Both religiousness dimensions and emotional social support were related to less frequent alcohol use; however, mediation was not supported. These findings indicate that religious commitment and dispositional religious coping are protective against alcohol use, yet social support does not account for this relationship.

Pick Your Poison: Examining Adolescent Substance Use through Opportunity Theory

The present study examines substance use behaviors of middle and high school students, focusing on how varying influences of opportunity measures impact use of specific types of substances. The data used in the present study come from almost 4,000 students within 89 school contexts from students attending public school in a Southern state. Hierarchical logistic modeling is used to explore the influence of various opportunities at both the student and school levels on the use of different types of substances. Results indicate measures of opportunity at both the student and school levels were significant; however, measures at the individual level were consistently more influential.     

Variables Associated With Adolescent Alcohol Use: A Multiethnic Comparison

Abstract

The authors examined the influence of sociodemographic variables on the frequency and intensity of alcohol use among a nationally representative sample of Black, Hispanic, and White adolescents who had participated in the 1991 National Household Survey on Drug Abuse (U.S. Department of Health and Human Services, 1993). The sample consisted of 8,756 U.S. adolescents aged 12 to 18 years. The authors found that (a) approximately 19% of the respondents had used alcohol in the last 30 days; (b) among the respondents who had used alcohol, 21% had consumed 1 or more drinks per drinking episode; and (c) there were important similarities as well as important differences in variables that promoted alcohol use among Black, Hispanic, and White adolescents.     

Examining Adolescent Cocaine Use with Social Learning and Self-Control Theories

An estimated 1.6 million adolescents use cocaine on a regular basis. Social learning theory and self-control theory are regularly used to explain adolescent substance use, but few studies have examined Hirschi’s (2004) revised self-control theory. This study examines the efficacy of these three theories in explaining adolescent cocaine use using data from the 2011 Monitoring the Future survey. The study finds that Hirschi’s (2004) revised theory and peer hard drug use predicted the probability of adolescent cocaine use in the previous 30 days. When examining cocaine use in the prior year, all three theoretical perspectives were significant predictor of cocaine use. The implications of the findings are discussed.     

Use of the Beck Depression Inventory-II with Adolescent Psychiatric Outpatients

To provide information on the use of the Beck Depression Inventory-II (BDI-II) with adolescents, the BDI-II was administered to 105 male and 105 female outpatients between 12 and 18 years old who were seeking psychiatric treatment. The internal consistency of the BDI-II was high (coefficient = .92). The mean BDI-II total score of the girls was approximately 5 points higher than that of the boys (p < .001), and age (years) was positively correlated with the BDI-II total scores (r = .18, p < .01). An iterated principal-factor analysis identified three factors, but only the Cognitive and Somatic-Affective factors were generalizable.     

Adolescent Work and Alcohol Use: Moderation by Neighborhood Context and the Role of Peers

Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study looks at the adolescent work and binge drinking relationship among a sample of 4,826 adolescents. The article assesses variability in the work–binge drinking relationship by social class and neighborhood disadvantage and seeks to explain variability by considering social control and social learning processes. Results reveal that the detrimental relationships between work intensity and binge drinking are stronger for those from more advantaged neighborhoods. Results also show that perceived peer substance use explains neighborhood disadvantage differences in the relationship between intense work and binge drinking.