Factors Associated with Suicidality Among a National Sample of Transgender Veterans

Correlates of past‐year suicidal ideation and lifetime suicide risk among a national sample of transgender veterans were examined. An online, convenience sample of 212 U.S. transgender veterans participated in a cross‐sectional survey in February–May 2014. We evaluated associations between sociodemographic characteristics, stigma, mental health, and psychosocial resources with past‐year suicidal ideation and lifetime suicide plans and attempts. Participants reported high rates of past‐year suicidal ideation (57%) as well as history of suicide plan or attempt (66%). Transgender‐related felt stigma during military service and current posttraumatic stress disorder and depressive symptoms were associated with suicide outcomes as were economic and demographic factors.     

Risk Factors for Suicidality Among a Nationally Representative Sample of High School Students

Using the 2005 Youth Risk Behavior Surveillance data (n = 13,917) of high school students, we examined the association between four domains of risk factors (alcohol/drug use, aggression, HIV risk‐related behaviors, and health problems) and indicators of suicidality (considering a suicide attempt, making a plan to attempt suicide, and actually attempting suicide). Logistic regressions showed that drug use (e.g., recent smoking, drinking before 13), victimization (e.g., threatened at school, hit by girl/boyfriend), risky sexual behavior (e.g., forced to have sex, used a condom) and two health problems (health as fair/poor, has disability/health problem) were associated with all three indicators of suicidality. These findings suggest that programs to prevent alcohol/drug use, address aggression, promote safety, and prevent unsafe sexual practices may also prevent suicidality.     

Suicidality in bipolar I disorder

People with bipolar disorder are at high suicide risk. The literature suggests that suicidality is predicted by higher symptom severity and less use of pharmacological agents, but few studies have examined the joint contributions of these variables. The present study examines the conjoint contribution of symptom severity and pharmacological treatment to suicidal ideation and behavior among participants with bipolar disorder. The model was able to account for 53% of the variance in suicidality scores. Depression, mixed state, and hopelessness were significantly associated with suicidality. All other variables were nonsignificant once symptom severity had been controlled. Implications for future research are described.     

Specificity of Depressive Symptoms and Suicidality in a Juvenile Delinquent Population

Research which has related scores on the Children's Depression Inventory (CDI) to suicidality have generally neglected to examine the possibility that specific depressive factors within the CDI may be more predictive of suicidality than the full scale score. Knowledge of such factors would help to explain the relationship between depression and suicidality and improve the prediction of suicidal behavior. The current study examined the relationship of depressive factors to suicidality in a sample of 200 incarcerated juvenile delinquents. The published factor structure for the CDI and one derived from the delinquent population were compared. Results revealed two factors from the derived solution, hopelessness and low self-esteem, to be more powerful predictors of suicidal ideation than the full-scale CDI score. These results suggest that symptoms such as low self-esteem and hopelessness may be responsible for the well-documented relationship between depression and suicidality. Furthermore, it appears that the prediction of suicidality may be improved by examining specific depressive factors in suicide research as opposed to full-scale scores from depression inventories such as the CDI.     

Impulsivity and Suicidality in Adolescent Inpatients

Suicide is the second leading cause of death among adolescents, and impulsivity has emerged as a promising marker of risk. The present study tested whether distinct domains of impulsivity are differentially associated with suicide ideation, plans, and attempts. Adolescents (n?=?381; boys?=?106, girls?=?275) aged 13–19 years (M?=?15.62, SD?=?1.41) were recruited from an acute, residential treatment program. Within 48 h of admission to the hospital, participants were administered structured clinical interviews assessing mental health disorders and suicidality. Following these interviews, participants completed self-report questionnaires assessing symptom severity and impulsivity. Consistent with past research, an exploratory factor analysis of our 90-item impulsivity instrument resulted in a three-factor solution: Pervasive Influence of Feelings, Feelings Trigger Action, and Lack of Follow-Through. Concurrent analysis of these factors confirmed hypotheses of unique associations with suicide ideation and attempts in the past month. Specifically, whereas Pervasive Influence of Feelings (i.e., tendency for emotions to shape thoughts about the self and the future) is uniquely associated with greater suicidal ideation, Feelings Trigger Action (i.e., impulsive behavioral reactivity to emotions) is uniquely associated with the occurrence of suicide attempts, even after controlling for current psychiatric diagnoses and symptoms. Exploratory gender analyses revealed that these effects were significant in female but not male adolescents. These findings provide new insight about how specific domains of impulsivity differentially increase risk for suicide ideation and attempts. Implications for early identification and prevention of youth suicide are discussed.     

Characteristics of Suicidality Among Adolescents

The identification of high-risk adolescent suicide attempters in a population of depressed and suicidal adolescents is of crucial importance. This retrospective study examined characteristics of suicidality (recent and lifetime, active and passive) and psychopathology (depression, aggression, impulsivity, stressful life events, SCL-90 dimensions) among four groups of depressed adolescent outpatients: (1) suicide attempters who required medical treatment (n = 84), (2) suicide attempters who did not require medical treatment (n = 57), (3) suicidal ideators who had never made a suicide attempt (n = 40), and (4) nonsuicidal patients (n = 44). Results indicate that the nonsuicidal group could be differentiated from the three suicidal groups on the basis of suicidality and psychopathology, and that the three suicidal groups could be differentiated from one another on the basis of suicidality but not psychopathology. These findings are discussed in terms of the usefulness of certain self-report measures of suicidality for identifying suicidal adolescents and for differentiating among them. Furthermore, the findings suggest that psychopathological factors do not determine which suicidal adolescents make a medically dangerous suicide attempt and which do not.     

Risk and Protective Factors Associated with Childhood Obesity in a Sample of Low-Income,Single Female,Parent/Guardian Households: Implications for Family Therapists

The United States is in the midst of a childhood obesity epidemic that disproportionately impacts underserved and diverse populations. In this study, in-depth qualitative interviews were conducted with 16 low-income, single, female, parent/guardians of an overweight or obese 3- to 8-year-old from socioeconomically disadvantaged backgrounds. Following the tenets of the thematic analysis approach, interviews focused on identifying risk and protective factors influencing parental and child health behaviors associated with child weight status. Results from the interviews are organized according to the Socioecological Framework to help identify risk and protective factors at various system levels. Findings from this investigation have relevance for family therapists as they can inform clinical and advocacy-focused interventions with disadvantaged families affected by childhood obesity.     

Asking Adolescents to Explain Discrepancies in Self-Reported Suicidality

We present a typology of adolescents' most common explanations for discrepant reporting of suicidal behavior. Forty-eight adolescents provided attempt histories by completing a self-report measure of suicidality. A select number of items were subsequently readministered (average interval = 5 days) using a semistructured interview format. Discrepancies in reporting were found among 50% of the sample. Adolescents were also asked to clarify, using an open-ended format, what might have accounted for a particular discrepancy. Based on these responses, seven mutually exclusive and exhaustive categories were derived. High rates of interrater agreement indicated that these categories were reliable.     

Adolescent Attitudes About Death in Relation to Suicidality

This study examined psychiatrically disturbed adolescents' history of exposure to suicide attempts, completions, and other deaths in relation to attitudes about life and death. A primary goal of the study was to study the mediating processes involved in the impact of loss on suicidality. Adolescents who experienced the suicide of a friend or immediate family member reported a weaker attraction to life and stronger attraction to death than adolescents lacking this experience. Exposure to attempted suicide resulted in attitudes indicating a stronger attraction to death and repulsion by life. We conclude that a comprehensive history of loss and assessment of current attitudes toward death are important aspects of evaluation and subsequent treatment of at-risk adolescents.     

Predictors of Suicidality Among Patients with Psychotic Disorders in a Partial Hospital Treatment Program

Individuals with psychotic disorders are at increased risk for suicidality. Demographic and clinical characteristics were compared in individuals with psychotic disorders reporting either high or low suicidality. Among this sample of 259 partial hospital patients, 116 (44.8%) were classified as high risk on the suicidality section of the Mini Neuropsychiatric Interview, and 143 (55.2%) were considered low risk. Bivariate analyses revealed that patients classified as high risk demonstrated greater depression severity, more relationship difficulties, greater emotional lability, and more substance use problems. A logistic regression model indicated that substance use was the most powerful predictor of higher levels of suicidality. Monitoring and intervention for substance use should be targeted as a particularly important aspect of treatment for acutely ill patients diagnosed with psychotic disorders.     

Suicidality in adolescence: review and legal considerations

Adolescence is a unique developmental stage in which suicidality first emerges as a public health problem. The increasing trend of teenage suicide since the 1950s has only relented in the past ten years. The risk factors for adolescent suicide, suicidal ideation, and suicide attempts and an approach to assessing the suicidal adolescent for risk of future self-harm are reviewed. Treatment consists of ensuring safety and then treating the underlying psychiatric, psychological, and interpersonal disturbances. Issues of consent, confidentiality, and malpractice actions are addressed.     

Suicidality as a function of impulsivity, callous-unemotional traits, and depressive symptoms in youth

Suicidality represents one of the most important areas of risk for adolescents, with both internalizing (e.g., depression, anxiety) and externalizing-antisocial (e.g., substance use, conduct) disorders conferring risk for suicidal ideation and attempts (e.g., Bridge, Goldstein, & Brent, 2006). However, no study has attended to gender differences in relationships between suicidality and different facets of psychopathic tendencies in youth. Further, very little research has focused on disentangling the multiple manifestations of suicide risk in the same study, including behaviors (suicide attempts with intent to die, self-injurious behavior) and general suicide risk marked by suicidal ideation and plans. To better understand these relationships, we recruited 184 adolescents from the community and in treatment. As predicted, psychopathic traits and depressive symptoms in youth showed differential associations with components of suicidality. Specifically, impulsive traits uniquely contributed to suicide attempts and self-injurious behaviors, above the influence of depression. Indeed, once psychopathic tendencies were entered in the model, depressive symptoms only explained general suicide risk marked by ideation or plans but not behaviors. Further, callous-unemotional traits conferred protection from suicide attempts selectively in girls. These findings have important implications for developing integrative models that incorporate differential relationships between (a) depressed mood and (b) personality risk factors (i.e., impulsivity and callous-unemotional traits) for suicidality in youth.     

Psychological Distress in a Sample of Teachers

This article describes a cross-sectional study of the links between job-related stressors and depressive and psychophysiologic symptoms and morale in 67 New York City teachers. The teachers' mean score on the Center for Epidemiologic Studies Depression Scale (CES-D; M = 13.03) was higher than might be expected from average community residents. The teachers also tended to express dissatisfaction with their jobs. The CES-D and the Psychophysiologic Symptom Scale were correlated as highly as their reliabilities would permit, a finding consistent with the view that the CES-D and the Psycho physiologic Symptom Scale measure the same construct, nonspecific psychological distress. The correlational findings suggest that distress is distinct from job-related morale, which was indexed by measures of motivation to continue teaching and job satisfaction. The results of regression analyses, which controlled for sociodemographic factors, indicated that the level of job strain (frequency of ongoing stressors) is more closely related to psychological distress and low morale than episodic stressors, including crimes in which the teacher was victim. The regression analyses also indicated that colleague support was related to lower symptom levels and higher morale.     

Suicidality in primary health care and national suicide rates

The incidence of suicidal symptoms for primary health care patients did not predict national suicide rates in a sample of 10 nations.     

Duties When an Anonymous Student Health Survey Finds a Hot Spot of Suicidality

Abstract

Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that included school-level analysis discovered a school with alarmingly prevalent student suicidality. Given confidentiality protocols typical of surveillance, the surveyors were uncertain whether and how to intervene. We searched literature for duties to warn at-risk groups discovered during public health surveillance, but we found no directly applicable guidance or cases. Reasoning by analogy, we conclude that surveyors should contact the school’s leaders to call attention to its outlier status, but public warning is unwarranted. However, such an ad hoc decision to issue a warning, even if only to school leaders, raises significant practical, legal and ethical issues. National public health and education associations should produce guidance that clarifies ethical and legal duties owed to schools and students involved in population health-risk surveillance.     

Family Environment as a Moderator of the Association between Conduct Disorder and Suicidality

This study examined whether perceived family support and conflict moderate the relationship between conduct disorder (CD) and suicide attempts (SAs) in a sample of 185 psychiatrically hospitalized adolescents, ages 13 to 18, and their parents. Data were collected using the Schedule for Affective Disorders and Schizophrenia for School Aged Children (K–SADS–PL), the Survey of Children’s Social Support Scale–Short Version, and the Conflict Behavior Questionnaire. Binary logistic regression and simple slope analyses were conducted to test study hypotheses. Results suggest that perceptions of family support, but not conflict, moderate the association between CD and SAs. Specifically, adolescents diagnosed with CD were found to be at heightened risk for an SA if they reported lower family support. These results suggest that clinicians who treat adolescents with CD should assess for perceptions of family support. Incorporating family work into treatment could help to prevent SAs.     

Suicidality in Schizophrenia: Implications for the Counseling Profession

Schizophrenia is a common mental disorder treated by many counseling professionals, and it is associated with a high rate of early mortality. The most common reason for early mortality in schizophrenia is suicide. To date, the most recent comprehensive study on correlates of suicidality among clients with schizophrenia is titled “Suicidal Behavior in Schizophrenia: Characteristics of Individuals Who Had and Had Not Attempted Suicide” (J. M. Harkavy‐Friedman et al., 1999). It is the purpose of this Trends article to review this study and discuss its implications for counselors.