Common problems and coping strategies II: Findings with adolescent suicide attempters

This study investigated the most common precipitants of adolescent suicide attempts and the strategies used to cope with such problems. Adolescent suicide attempters were compared with both distressed and nondistressed nonsuicidal adolescents on problems reported and coping strategies utilized. All three groups reported four problems as occurring most frequently: school, parents, friends, or boyfriend/girlfriend. The suicide attempters and distressed controls reported problems with parents more frequently than did nondistressed controls, while this latter group reported problems at school more frequently than did suicide attempters or distressed controls. Suicide attempters used social withdrawal, problem solving, and emotional regulation more than did nondistressed controls, but not more frequently than distressed controls. Distressed controls used wishful thinking and resignation more than did suicide atempters. Results are discussed in terms of the similarities between suicide attempters and nonsuicidal distressed adolescents and the need to more closely investigate specific subgroups of suicide attempters.     

The Hopelessness Scale for Children: Psychometric properties with normal and emotionally disturbed adolescents

The psychometric properties of the Hopelessness Scale for Children (HSC) were evaluated with a sample of 834 normal adolescents and 93 adolescent suicide attempters. Factor analyses studies revealed two factors with both groups. Internal consistency with item-total score correlations were acceptable, while moderate test-retest reliability was found over a 10-week period with the normal sample. Support for the validity of the HSC was provided via studies with the suicide attempter group in which positive correlations with depression and depressive attributional style were found. Predicted differences between the suicide attempters, an outpatient psychiatric sample, and normal controls were also found. However, some items did not appear to discriminate suicide attempters from controls. Results are discussed in terms of the utility of the HSC with adolescents and adolescent suicide attempters and with regard to differences between child and adult samples in hopelessness.     

Social skills and depression in adolescent suicide attempters

The relationship among depression, social skills, and suicidal behavior was examined in a sample of 41 adolescents hospitalized in a general medical setting following a suicide attempt. These subjects were compared to 40 nonsuicidal psychiatrically hospitalized adolescents. Level of depression, assessed using the Children's Depression Inventory (CDI), and social skills, assessed via the Matson Evaluation of Social Skills with Youngsters (MESSY), were evaluated for all subjects. The suicide attempters and psychiatrically hospitalized patients were not found to differ on either the CDI or MESSY. However, multiple regression analyses revealed the factor scores of the MESSY to be related to depression in both patient groups. The data provide support for the relationship between social skills and depression. Results are also discussed in terms of the similarities between adolescent suicide attempters and nonsuicidal psychiatrically disturbed adolescents.     

Predictors of Multiple Suicide Attempts among Suicidal Black Adolescents

Psychopathology, social support, and interpersonal orientation were studied in relation to suicide attempt status in acutely suicidal, psychiatrically hospitalized Black adolescents and a matched sample of White adolescents. In the total sample, multiple attempters were differentiated by lower perceived support. Within the Black youth subsample, social comparison and positive stimulation from others differentiated multiple attempters from single attempters/ideators. Only suicidal ideation predicted multiple attempts among White youth and only higher interpersonal orientation predicted multiple suicide attempts within Black adolescents.     

Protective Factors Against Suicide Attempt Risk Among African American Women Experiencing Intimate Partner Violence

Protective factors (hope, spirituality, self-efficacy, coping, social support–family, social support–friends, and effectiveness of obtaining resources) against suicide attempts were examined in economically, educationally, and socially disadvantaged African American women (100 suicide attempters, 100 nonattempters) who had experienced recent intimate partner violence. Significant positive associations were found between all possible pairs of protective factors. Bivariate logistic regressions revealed that higher scores on each of the seven protective factors predicted nonattempter status; multivariate logistic regressions indicated that higher scores on measures of hope or social support–family showed unique predictive value for nonattempter status. Further, the multivariate model accurately predicted suicide attempt status 69.5% of the time. Partial support was found for a cumulative protective model hypothesizing a linear relationship between the number of protective factors endorsed and decreased risk for suicide attempts. Implications of these findings for community-based preventive intervention efforts and future research are discussed.     

Psychopathology associated with suicide attempts among rural adolescents of China

This case control study examined the relationship between psychopathological profiles and self-reported suicide attempts among rural adolescents of China. Cases consisted of 142 adolescents who reported a suicide attempt in the past 6 months in a questionnaire survey (n=1365). An equal number of adolescents without reporting a suicide attempt, matched on age, gender, and school class, were selected from the same survey sample as controls. The Youth Self Report (YSR) was used to assess psychopathological profiles for suicide attempters and matched controls. Results indicated that 73% of suicide attempters had at least one behavioral/emotional syndrome, significantly higher than in controls (30%). Logistic regression analyses showed that anxiety/depression (OR = 3.68) and aggression (OR = 5.02) were each significantly associated with increased risk of suicide attempts after controlling for other behavioral problems. These findings demonstrated the independent contribution of anxiety/depression and aggression to suicide attempts in Chinese adolescents.     

MMPI inmate profiles: suicide completers, suicide attempters, and non-suicidal controls

Results from the Minnesota Multiphasic Personality Inventory (MMPI) were compared for three groups of male inmates in federal penitentiaries: 47 suicide completers, 43 suicide attempters and, 123 non-suicidal controls. Analyses show that the groups differed on all 10 clinical scales and on at least 8 after Bonferroni correction. Attempters obtained the highest scores on 4 of 8 scales; they also posted the highest scores on 3 others, but differences were significant only against non-suicidal controls. Completers posted the highest score on only one scale (Mf), but the difference was significant only against non-suicidal controls. All told, completers proved more similar to non-suicidal controls than to attempters. Regarding profiles, completers are more strongly correlated with non-suicidal controls (r=0.95) than with attempters (r=0.86); non-suicidal controls are less strongly correlated with attempters (r=0.88). The fact that attempters seem more pathological than the others can mislead clinicians screening for suicide risk.     

Suicide attempts and stressful life events among female victims of intimate partner violence living in poverty in Nicaragua

This article describes a study of 136 female intimate partner violence victims living in poverty in Nicaragua. The paper aimed to analyze the relationship between experiencing stressful life events (SLE) and perceived social support with suicide attempts, and to evaluate the differences in the SLE experienced by female suicide attempters versus non‐attempters. The results showed the existence of a high level of SLE among the interviewees, and that women who have attempted suicide have experienced substantially more of these events. Experiences of violence and less social support were especially related to suicide attempts among the interviewees.     

Evaluation of an evolutionary model of self-preservation and self-destruction.

According to deCatanzaro's mathematical model of self-preservation and self-destruction, staying alive actually may reduce inclusive fitness for an individual who is low in reproductive potential and, at the same time, poses such a burden to close kin that it costs them opportunities for reproduction. Predictions generated from this model were tested using 175 university students as subjects and variables constructed from a 164-item questionnaire. The criterion variables were separate measures of depression, hopelessness, and suicide ideation and behavior. The predictor variables derived from the model were separate measures of reproductive potential of the individual, the individual's perceived benefit or cost to kin, and reproductive potential of the individual's kin. As predicted, there were negative and significant bivariate correlations between each of the model-generated predictor variables and one or more of the criterion variables. Multiple regression analyses showed that benefit to kin was the best predictor of both depression and hopelessness. Discriminant analysis showed that reproductive potential of kin significantly differentiated suicide attempters from nonattempters. Overall, our results support and extend deCatanzaro's model and empirical findings.     

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.     

Factor analysis of the Beck Scale for Suicide Ideation with female suicide attempters

A sample of 119 female suicide attempters completed the Beck Scale for Suicide Ideation (BSS). Although confirmatory common factor analyses of BSS items failed to support previously hypothesized one-, two-, or three-factor models, confirmatory principal components analyses substantiated hypothesized one- and two-dimensional models. Heuristics for the number of factors converged on two latent dimensions and exploratory principal components analyses verified the presence of two previously hypothesized suicide ideation factors: motivation and preparation. Scales based on this two-dimensional model demonstrated convergent validity with other suicide indices.     

Social-psychological correlates of adolescent and youthful suicide

Recently it has been suggested that social-psychological profiles of suicide attempters are useful to identify high-risk persons. There also is evidence that the complexity of interpersonal and intrapersonal factors constrict the extent to which such identification can be made. Using data from a nonprobability sample of 455 adolescent and youthful committers to test the hypothesis that attempters and committers do not differ with respect to environmental and stress-producing factors, the results reveal some differences between committers and attempters. Social-psychological characteristics of committers and factors relating to their social support systems are also discussed in the context of these differences.     

Effective problem solving in suicide attempters depends on specific autobiographical recall.

The relationship between over-general autobiographical memory and interpersonal problem solving was investigated by comparing a group of suicide attempters with a nonsuicidal psychiatric control group and a normal control group. Results showed that suicide attempters were more over-general in memory and displayed significantly poorer problem solving than the other two groups. Furthermore, suicide attempters who were more over-general displayed greater deficits in problem solving. It was concluded that effective problem solving in suicide attempters depends on specific autobiographical recall.     

Suicide attempts and stressful life events among homeless people in Madrid (Spain)

The article describes a study carried out with a representative sample of homeless people in Madrid (Spain; N = 188). This study aims to corroborate the relationship identified in the literature between stressful life events and suicidal behaviour in a group in a situation of social exclusion, to assess the differences in the number and characteristics of stressful life events experienced by homeless people who are attempters and non‐attempters, and to identify which combination of stressful life events enables discrimination for suicide attempts among homeless people. The results show that 30% of homeless people in Madrid had attempted suicide, and 57.9% of them had done so for the first time when they were homeless. The interviewees are shown to have experienced a large amount of stressful life events, with substantially more stressors experienced by the homeless people who tried to commit suicide, during both their childhood and adolescence and throughout their life. Finally, we found that the combination of 7 stressful life events provided the best possible discrimination between homeless attempters and non‐attempters.     

The transition from middle childhood to early adolescence: Sex differences in the social network and perceived self-competence

This study concerns the development of social networks from middle childhood to early adolescence. On a longitudinal sample of 100 children seen at 9 and 13 years of age, three basic questions were addressed: 1) age changes, 2) sex differences, and 3) the relation between network characteristics and self-perceived competence in early adolescence. The number of and frequency of contact with kin, adults and friends for each subject were assessed at 9 and 13 years using maternal report. Teenager report of academic, social, athletic and behavioral conduct was also collected. The transition to early adolescence was marked by several changes in the social network. At 13 years networks become more age segregated. Both opposite and same sex friends show an increase. Sex differences were also evident. For example, adolescent girls had a larger network of friends than boys. Adolescent boys had less segregated adult networks. For adolescent girls but not boys, the friendship network was related to specific types of competence.The preparation of this paper was made possible by the support of the William T. Grant Foundation.     

Grief and Attitudes Toward Suicide in Peers Affected by a Cluster of Suicides as Adolescents

Eighty‐five young adults exposed to a cluster of peer suicides as adolescents completed measures of attitudes toward suicide, grief, and social support. Closeness to the peers lost to suicide was positively correlated with grief and the belief that suicide is not preventable, with grief further elevated in close individuals with high social support from friends. Overall, social support was related to healthy attitudes about suicide including preventability, yet it was also related to some stigmatizing beliefs. Compared with 67 young adults who had not been exposed to a suicide cluster, the exposed sample was more likely to think that suicide is normal but more likely to think of it as incomprehensible.     

Comparative Psychopathology of Suicide Attempts and Assaults

ABSTRACT: Using the Katz Adjustment Scales to measure psycho-pathology, systematic samples of 108 suicide attempters and 42 persons arrested for assault were tested in Baltimore, Maryland. The subjects' scores were compared with ratings by third-party respondents, who knew the subjects well, and with scores of 450 controls. Both suicide attempters and assaulters displayed significantly more psychopathology than the controls. The suicide attempters were differentiated from the assaulters on six Katz items: Helplessness, Anxiety, Nervousness, Depression, Stability, and General Psychopathology. An attempt was made to refine prediction and control of these two different life-threatening behaviors by interpreting the data in terms of Henry and Short's concept of “internal restraint.”     

Predictors and correlates of bereavement in suicide support group participants

A sample of 210 survivors of suicide, all participants in suicide support groups, was studied. Associations between demographic factors, circumstances surrounding the suicide, and overall levels of grief (using the Grief Experience Questionnaire) were calculated. Results showed that seeing the body at the scene of the death was the most significant predictor of high levels of distress, and support from family and friends was the strongest protective factor. Time since the death (for women) and attendance at Alcoholics Anonymous meetings (for those participating in nonsuicide support groups) were also significantly related to level of grief. For men, a moderate level of participation in other support groups, as compared with none, was associated with higher levels of grief. All other variables were not significant. Results suggest that a model that combines posttraumatic reactions and grief is most appropriate for the aftermath of suicide.     

Nonlinear Change Processes During Psychotherapy Characterize Patients Who Have Made Multiple Suicide Attempts

Research suggests that multiple suicide attempters experience considerable variability in suicide ideation and longer‐duration suicidal crises, which suggests the possibility of two states of stability (one low risk and one high risk). To date, however, few studies have examined nonlinear change processes in suicide ideation among patients. In a sample of 76 active duty U.S. Army soldiers receiving brief cognitive behavioral therapy for acute suicide risk, we examined differences in the ebb and flow of suicide ideation among multiple attempters, first‐time attempters, and ideators. Results indicated that multiple attempters were characterized by two states of stability corresponding to low and high intensity suicide ideation; these states were separated by a region of instability corresponding to moderate intensity suicide ideation. In contrast, ideators and first‐time attempters were characterized by only a single state of stability corresponding to low intensity suicide ideation. Among patients who have made multiple suicide attempts, suicide ideation may function as a bimodal rather than a continuous construct.     

Role of serotonin in human aggressive behaviour

This study aimed to evaluate a peripheral serotonergic marker, ³H-imipramine (³H-IMI) binding to platelet membranes, in a group of severely aggressive subjects (A), institutionalized since childhood for mental retardation, as compared with suicide attempters (S) and healthy controls (H). The maximum binding capacity of ³H-IMI to platelet membranes was statistically lower in (A) and (S) than in (H). In addition, a statistically significant difference was observed between the Bmax values of aggressive subjects and those of suicide attempters. No changes in the dissociation constant (Kd) of IMI binding were observed. These data provide further supporting evidence for the hypothesis of an abnormality of the 5HT system in aggressive behaviour and suggest that such an abnormality, as reflected by platelet markers, is more severe in suicide attempters. © 1993 Wiley-Liss, Inc.