Covert suicide and families of adolescents

"Covert suicide" refers to self-destructive behaviors whose suicidal intent is denied by the adolescent and his/her family. Such behaviors are considered to be an outcome of certain family dynamics and processes. Case examples are given, and issues presented to the clinician in assessing and making initial interventions are discussed. Social issues connected with expanding the range of behaviors considered suicidal, and with considering suicide as a family process, are reviewed briefly.     

Lunar association with suicide

Suicides in Cuyahoga County, Ohio, for 1972--1975 are tabulated by year, month of year, day of week, lunar phase, and holiday occurrence. Only lunar phase demonstrates a significant (p less than .01) variation in suicide rate; an increase is observed in this sample with respect to new moon phase but not for full moon phase. Explanations for this finding are considered, but the precise reasons remain unknown.     

Comparing suicide attempters, suicide ideators, and nonsuicidal homeless and runaway adolescents.

This study considers variables that best distinguish among attempters, ideators, and nonsuicidal youth in a sample of 527 homeless and runaway adolescents from four Midwestern states. Univariate results indicate that attempters are significantly more likely than ideators and nonsuicidal youth to have experienced physical or sexual abuse by an adult caretaker, to have experienced sexual victimization while on their own, and to have a friend who attempted suicide. Multivariate analyses reveal five variables that best distinguish among the three groups: self-esteem, depression, physical abuse, sexual abuse, and having a friend who attempted suicide. Further analysis suggests that the accumulation of these risk factors greatly increases the chance that these youth will engage in suicidal behavior.     

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.     

Visual-motor problems of adolescents who attempt suicide.

Using the Canter Background Interference Procedure with the Bender-Gestalt Test, a group of 18 adolescent suicide attempters earned test scores indicating they had significantly more problems with visual-motor coordination than did a control group of 21 adolescents. There were also a greater number of school failures and behavior problems among these suicide attempters. The findings suggest that learning disabilities may be an unrecognized factor which increases the risk of suicide attempts by adolescents.     

Current suicide proneness and past suicidal behavior in adjudicated adolescents

Youth recently assigned to probation (n = 233) were assessed for current suicide proneness, depression, and hopelessness, as well as for recent suicide ideation, previous suicide ideation, or suicide attempt(s). The Life Attitudes Schedule-Short Form (LAS-SF) was used to assess suicide proneness. As per the LAS-SF, suicide proneness was defined broadly to include current engagement in overtly suicidal behavior as well as in risk-taking and potentially injury-producing behaviors, coupled with a lack of engagement in health and safety behaviors, or self-enhancement behaviors. As expected, current suicide proneness was significantly associated with a history of suicide ideation and attempts, recent ideation, and current depression and hopelessness for adjudicated youth. Gender differences were obtained between the strength of the association between suicide proneness and depressive symptoms. A subgroup of adjudicated youth (n = 39) was then interviewed about their suicidal behaviors. Among other things, these youth indicated that the majority of their previous suicide attempts were committed impulsively.     

Positive mental health moderates the association between depression and suicide ideation: A longitudinal study

Background/Objective: Depression and suicide ideation regularly occur together. Yet, little is known about factors that buffer individuals against the development of suicide ideation. The present study investigated, whether positive mental health buffers the association between depression and suicide ideation in a longitudinal study design. Methods: A total of 207 German students (70.3% female; age: M = 26.04, SD = 5.33) were assessed at a baseline evaluation and again twelve months later. Data were collected using self-report questionnaires. Linear hierarchical regression analysis was used to analyze the data. Positive mental health was considered to moderate the impact of depression on suicide ideation – controlling for age and gender. Results: Positive mental health was shown to moderate the impact of depression on suicide ideation: in those students who reported higher levels of positive mental health, depression severity showed no association with suicide ideation over time. Conclusion: Positive mental health seems to confer resilience and should be taken into account, when assessing individuals for suicide risk.     

Adolescent alcohol use and suicide indicators among adolescents in Hawaii

Research on suicide has focused on gender, age, ethnicity, and psychiatric profiles. However, few studies have examined alcohol use and its relationship to suicide among Native Hawaiians and other Asian American/Pacific Islanders. This study analyzes data from the 1997 and 1999 Hawaii Youth Risk Behavior Survey to examine whether alcohol problems increase the risk for suicide indicators (as evidenced by responses to questions asking whether an individual has considered, planned, attempted, or required treatment for a suicide attempt). Drinking pattern was the best predictor for all suicide indicators. School and community-based programs can help to increase an adolescent's knowledge about the consequences of alcohol use and prevention of suicide.     

Utah youth suicide study: barriers to mental health treatment for adolescents

Forty-nine suicide cases were drawn from an original sample of 151 consecutive youth suicide deaths. We used information from 270 interviews with parents and other survivors to evaluate mental health treatment sought for and by the decedent and barriers to mental health treatment. Participants reported the same primary barriers for the decedent: belief that nothing could help, seeking help is a sign of weakness or failure, reluctance to admit to having mental health problems, denial of problems, and too embarrassed to seek help. It is suggested that the stigma of mental illness is a considerable barrier to mental health treatment.     

The association between bankruptcy and hospital-presenting attempted suicide: a record linkage study

The associations between admissions to an emergency department following attempted suicide and personal bankruptcy in the preceding and subsequent 2 years were evaluated. Records from a level 1 trauma center (June 1993-December 2002) in Seattle, WA, were linked with case files from the local U.S. District Bankruptcy Court (June 1991 onward). Univariable and multivariable logistic regression models were used to examine the risk of bankruptcy in (i) the 2 years after and (ii) the 2 years before a suicide attempt using a violent method, compared to patients admitted for any other reason. After adjusting for several confounders, patients who had attempted suicide were more likely than other patients to experience bankruptcy in the following 2 years (OR = 2.10, 95% CIs: 1.29, 3.42). A somewhat weaker association was seen with bankruptcy in the preceding 2 years (OR = 1.68, 95% CIs 1.06; 2.67). Attempted suicide is therefore associated with bankruptcy in the preceding and following 2 years. Changes to legislation, improved mental health counselling for those in financial difficulty, and provision of financial advice to those admitted to hospital following a suicide attempt may reduce future cases of serious self-harm and completed suicide.     

A population-based study of the association between pathological gambling and attempted suicide

The association between pathological gambling and attempted suicide was examined using data from a prevalence study conducted in Edmonton, Alberta, Canada. The sample size was 7,214, the questionnaire was the Diagnostic Interview Schedule, and diagnoses were made on a lifetime basis according to DSM-III criteria. Logistic regression analysis was performed, with attempted suicide as the dependent variable. The odds ratio for pathological gambling was statistically significant (odds ratio = 4.91; 95% confidence interval = [1.41,17.1]) when major depression was the only comorbid mental disorder in the model. As terms for additional mental disorders were included, pathological gambling ceased to be statistically significant. It was concluded that a history of pathological gambling is associated with previous attempted suicide, and that the association may be due to a common factor--"mental illness."     

Gender identity conflicts in adolescents as motivation for suicide

One of the motivational factors for suicide in adolescents is examined in light of gender identity issues and conflicts. It is proposed that difficulties in the formation of a cohesive gender identity are related to the adolescent's motivation to attempt suicide. This paper makes use of Fast's (1984) distinction between "event-centered" and "self-centered" experiences in order to explore problems in the formation of gender identity with reference to regression to earlier stages of psychosexual development. Physiological changes and regressive pull may lead the adolescent to the "event-centered" mode of experience. Thus one minor event may become the focus of the adolescent's gender and self identities. The adolescent may then have regressive omnipotent fantasies of being able to change gender identity through suicidal acts.     

An association account of false belief understanding

The elicited-response false belief task has traditionally been considered as reliably indicating that children acquire an understanding of false belief around 4 years of age. However, recent investigations using spontaneous-response tasks suggest that false belief understanding emerges much earlier. This leads to a developmental paradox: if young infants already understand false belief, then why do they fail the elicited-response false belief task? We postulate two systems to account for the development of false belief understanding: an association module, which provides infants with the capacity to register congruent associations between agents and objects, and an operating system, which allows them to transform these associations into incongruent associations through a process of inhibition, selection and representation. The interaction between the association module and the operating system enables infants to register increasingly complex associations on the basis of another agent’s movements, visual perspective and propositional attitudes. This allows us account for the full range of findings on false belief understanding.     

Gay Identity and the Experience of Gay Social Stress1

The hypothesis that identity commitment affects the experience of identity-related stressors brings identity theory and social stress research together. Research findings are not yet conclusive regarding this hypothesis. Part of the contradictory research findings stem from inadequate knowledge about the causal direction of the relationship between depression and commitment. The authors analyze if identity commitment interacts with social stress in its impact on mental well-being. Only chronic stress has a moderate impact on the experience of depression. Commitment toward the gay identity did not buffer the experience of stress. The authors also use a nonrecursive model to establish the causal relationship between depression and commitment. They show that it is depression that lowers identity commitment. It is concluded that identity commitment cannot act as a buffer against identity-related stress because commitment is affected by the resulting distress.     

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.