National differences in intelligence and population rates of suicidal ideation, suicide plans, and attempted suicide

Population rates of suicidal ideation, suicide plans or attempted suicide from three independent multinational epidemiological surveys (the WHO/EURO and WHO SUPRE-MISS studies and a third one) were not significantly associated with national IQ figures. This result conflicts with previous evidence from cross-national studies (by Lester and by Voracek) of a positive ecological correlation between level of national intelligence and rates of completed suicide. Across nations, the indicators for the prevalence of suicidal behavior also lacked close correspondence with suicide rates, which may be due to the higher unreliability of assessing covert suicidal behavior (suicide ideas, thoughts, plans, and, to a lesser extent, also suicide attempts) as compared to suicidal behavior that is indisputably overt (completed suicide). Several alternative explanations for the current nil findings are also discussed.     

Habitual starvation and provocative behaviors: Two potential routes to extreme suicidal behavior in anorexia nervosa

Anorexia nervosa (AN) is perhaps the most lethal mental disorder, in part due to starvation-related health problems, but especially because of high suicide rates. One potential reason for high suicide rates in AN may be that those affected face pain and provocation on many fronts, which may in turn reduce their fear of pain and thereby increase risk for death by suicide. The purpose of the following studies was to explore whether repetitive exposure to painful and destructive behaviors such as vomiting, laxative use, and non-suicidal self-injury (NSSI) was a mechanism that linked AN-binge-purging (ANBP) subtype, as opposed to AN-restricting subtype (ANR), to extreme suicidal behavior. Study 1 utilized a sample of 787 individuals diagnosed with one or the other subtype of AN, and structural equation modeling results supported provocative behaviors as a mechanism linking ANBP to suicidal behavior. A second, unexpected mechanism emerged linking ANR to suicidal behavior via restricting. Study 2, which used a sample of 249 AN patients, replicated these findings, including the second mechanism linking ANR to suicide attempts. Two potential routes to suicidal behavior in AN appear to have been identified: one route through repetitive experience with provocative behaviors for ANBP, and a second for exposure to pain through the starvation of restricting in ANR.     

Adolescent suicide, gender, and culture: A rate and risk factor analysis

The current paper provides a comprehensive research review of gender differences in rates of and risk factors for adolescent suicidal behavior in four main U.S cultural subgroups: African Americans, Native Americans, Asian Americans, and Latino Americans. The paper highlights substantial findings from the most recent literature and provides direction for future research and clinical work. The data presented suggest that clinicians and interventionists relying on nonfatal expressions of suicide will continue to fail to identify adolescent males at risk for suicide, as females are more likely to report suicide ideation and attempts across all cultural groups reviewed. We conclude that researchers and clinicians should utilize indirect, broad measures of suicide proneness, as opposed to the traditional direct self-report tools. Although past research has examined cultural and gender differences in risk factors for suicidal behavior, these investigations have been primarily isolated from each other. Therefore, we sought to examine adolescent suicidal behavior and how it operates as a function of both gender and culture.     

Adolescents' Attitudes About the Role of Mental Illness in Suicide,and Their Association with Suicide Risk

We examined teenagers' attitudes about the role of mental illness in suicidal behavior and the relationship between these attitudes and suicide risk. Serious suicidal ideation or behavior and associated risk factors (gender, depression, substance problems, and first‐hand experience with a suicidal peer) were assessed in 2,419 students at six New York high schools. Less than one fifth of students thought that mental illness was a major contributor to suicide. Suicidal adolescents and those at risk were less likely than their nonsuicidal and low‐risk counterparts to associate suicide with mental illness. Our findings contribute to the debate over whether accepting attitudes toward suicide increase suicide risk.     

The cycle of schizoaffective disorder, cognitive ability, alcoholism, and suicidality

In this study we investigated the putative role of cognitive dysfunction, diagnosis (schizoaffective versus schizophrenia disorder), and alcoholism as risk factors for suicidal behavior among individuals with DSM-TV schizophrenia or schizoaffective disorders. Subjects received cognitive tests and medical records were reviewed for evidence of a history of suicide attempts or suicidal ideation. Discriminant analysis was used to identify cognitive test performance measures that distinguished those with versus those without suicidal behavior. None of the cognitive measures discriminated between the two groups. The rates of suicidal behavior (suicidal ideation and suicide attempts) did not differ between participants with versus those without comorbid alcohol use. An association was found between suicidal behavior and the diagnosis of schizoaffective disorder. It was concluded that the history of prominent mood syndromes characteristic of schizoaffective disorder contributes to increased risk of suicidal behaviors. Cognitive dysfunction and/or alcoholism did not contribute additionally to risk in this study.     

Suicidal behavior, negative affect, gender, and self-reported delinquency in college students

The associations among suicidal behavior, negative affect, and delinquency were assessed via an anonymous self-report survey administered to male and female college students ( N = 383). Contrary to our hypothesized results, there were no gender differences in rates of suicidal ideation and attempts. Confirming our hypotheses about gender differences, college men did report significantly more delinquent behavior than college women. College men also scored higher on the suicide-proneness scale, which contained a mixture of death-related, risk-related, and negative self- and health-related items. Furthermore, as predicted, college students with a history of depression, suicide ideation, and/or suicide attempts all reported significantly more delinquent behavior. Self-reported delinquency and current levels of depressive symptomology emerged as significant predictors of suicide-prone behavior for both college men and women, explaining 34% of the variance for women and 17% for men. Levels of engagement in suicide-prone behavior and feelings of depression were elevated in college students with any type of juvenile arrest history. Students with an arrest history were also more likely to have had a diagnosis of depression and to have engaged in suicide ideation in their past. These findings suggest there are complex links between depression, delinquency, and suicidal behavior in college men and women.     

Development of a questionnaire on attitudes towards suicide (ATTS) and its application in a Swedish population

An instrument measuring attitudes toward suicide was developed through two postal questionnaire surveys, 1986 and 1996, approaching general population samples of 700 and 1,000 persons, respectively, and with response rates of 75% and 64%. A 10-factor model was obtained and comparisons between waves revealed an overall more permissive and pro-preventional attitude in 1996. The results implied complex relationships at the aggregated level between attitudes and suicidal behavior, depending on type of suicidal behavior, attitude factor, and subgroup. At the individual level, persons answering affirmative on own suicidal behavior, as compared to the nonsuicidal group, held a more permissive and understanding attitude toward suicide.     

Suicide and attempted suicide: their relation to subjective social stress indicators

We investigated the relationship between the subjective perception of external stress and suicidal behavior, using a stress model which indicated that the probability of suicide and attempted suicide, as a reaction to stress, increases when social support systems fail or malfunction. We conceived the subjective perception of social stress as expressions of worry or dissatisfaction regarding cardinal life domains such as economic, security, or political situations. We defined support systems in terms of national solidarity expressed as positive (or improved) attitudes regarding the relations between various segments of the population, and we derived the data regarding the subjective indicators from continuing surveys of representative samples of urban Israeli population during the years 1967 through 1979. Eight stress indicators and three solidarity indicators were included, and our findings generally supported the theoretical model. However, the findings regarding men conformed best in relation to suicide, whereas those regarding women confirmed the theoretical model mainly in relation to attempted suicide. Contrary to the model, female suicide rates decreased in times of stress. Feelings of social solidarity in the population were found to reduce suicidal behavior of both men and women.     

The Gender Paradox in Suicide

In most Western countries females have higher rates of suicidal ideation and behavior than males, yet mortality from suicide is typically lower for females than for males. This article explores the gender paradox of suicidal behavior, examines its validity, and critically examines some of the explanations, concluding that the gender paradox of suicidal behavior is a real phenomenon and not a mere artifact of data collection. At the same time, the gender paradox in suicide is a more culture-bound phenomenon than has been traditionally assumed; cultural expectations about gender and suicidal behavior strongly determine its existence. Evidence from the United States and Canada suggests that the gender gap may be more prominent in communities where different suicidal behaviors are expected of females and males. These divergent expectations may affect the scenarios chosen by females and males, once suicide becomes a possibility, as well as the interpretations of those who are charged with determining whether a particular behavior is suicidal (e.g., coroners). The realization that cultural influences play an important role in the gender paradox of suicidal behaviors holds important implications for research and for public policy.     

Dementia and suicidal behavior

Behavioral and psychological symptoms of dementia, including depression, might complicate the course of the disorder additionally. Dementia is more frequent in older people and suicide rates are higher in later life than in any other age group. To explore the phenomenology of suicidal behavior in patients with dementia, we searched electronic databases and key journals for original research and review articles on suicide in demented patients using the search terms “suicide, suicidal behavior, dementia, Alzheimer disease, and old age”. Although cognitive impairment could result in a diminishing ability to think flexibly and to solve problems or to cope with conflict, in the early stage of dementia such impairments are absent or mild, and suicidal behavior might be expected, especially following diagnosis. In addition, personality changes based on declining cognitive capacity and the neurochemical imbalances described in late-life depression and in dementia may predispose patients to aggressive or impulsive acts, such as suicide attempt. The literature on suicidal behavior and dementia highlights the need for further research in this area.     

Observations on Long-Term Group Therapy with Suicidal and Depressed Persons

ABSTRACT: A long-term, open-ended group for depressed and suicidal individuals who had made suicide attempts is described. Two hundred persons participated in the sample groups over a 46-month period, with only 10 suicide attempts and 1 suicide occurring in this high risk group during the period of the study. Our observations corroborated some findings and differed with others reported of experiences with groups of individuals who have manifested suicidal behavior. The paper includes recommendations for starting groups of suicidal persons and emphasizes that this method of therapy appears to be an effective mode of suicide prevention.     

Temporal variation in Irish suicide rates

Using Irish suicide data for the period 1990-1998, the independent effects of month and day adjusting for age, gender, and calendar year effects and distinguishing between holiday and working Mondays were assessed. The male suicide rate was significantly higher on working Mondays (+31%) and Saturdays (+14%), and during April, June, and August (+17%), after adjustment for the other variables. In contrast, female suicide rates were higher only in August (+35%) and exhibited no day effect. Teenage men had a greater elevation of risk on Saturdays, Sundays, and both working and holiday Mondays than any other group. The study findings should be taken into account in the planning of specialized health care services and helplines for suicidal people. Furthermore, the findings provide support for Gabennesch's (1988) broken promise theory and the relationship between dysfunctions of the serotonergic system and suicidal behavior.     

Miseries Suffered,Unvoiced, Unknown? Communication of Suicidal Intent by Men in “Rural” Queensland,Australia

It has long been argued that suicide prevention efforts in rural locations face not only structural barriers, such as a lack of accessible health care and specialized mental health services, but also a range of cultural barriers. A commonly discussed cultural factor that may contribute to higher rural suicide rates is low levels of help‐seeking behavior, which in turn act as a barrier to accessing and receiving care. However, the assumption that suicide by rural men is more likely to be accompanied by low help‐seeking behavior, relative to urban men, has not been well tested. Using data from the Queensland Suicide Register, this study evaluates one form of help‐seeking behavior—communication of suicidal intent—among men who died by suicide. Contrary to the expectation that suicide in rural areas would be associated with lower levels of help‐seeking behavior than suicide in urban areas, it was found that communication of suicidal intent was broadly comparable across rural and urban settings. The implications for suicide prevention policies and service delivery strategies are discussed.     

The Impact of Exposure to Peer Suicidal Self‐Directed Violence on Youth Suicidal Behavior: A Critical Review of the Literature

There is considerable evidence that being exposed to the suicide or suicidal behavior of another can increase the risk for suicide. Significant relationships between media coverage and youth suicide have been documented in the professional literature. Exposure to familial suicidal behavior has also been established as a risk factor for youth suicidal behavior; However, peer suicide exposure is not as clear cut as research results in this area have been mixed. In the current paper the empirical literature focused on the associations between exposure to peer suicides and suicide attempts and youth suicidal behavior is critically reviewed. Effect sizes were computed for each of the 23 studies included in the review to allow for cross‐study comparisons. The results demonstrate that having a friend or acquaintance attempt suicide is significantly related to risk for suicidal thoughts and behavior. However, the support for the relationship between the suicide of a peer and youth suicidal behavior was less consistent. Implications for clinical practice and suicide postvention as well as areas of future research are discussed.     

Sequelae of Aggression in Acutely Suicidal Adolescents

The consequences of aggression on problem course and suicide risk were examined in 270 acutely suicidal adolescents (ages 12-17 years; 184 girls). Participants were assessed during psychiatric hospitalization (T1), 6-months post-hospitalization (T2), and 15 or more months post-hospitalization (T3). Study variables included self- and parent-reported aggression; self-reported internalizing symptoms, suicidal ideation, suicide attempt, and adverse events; and clinician-rated suicidal behavior. Aggression was not directly related to suicide attempt concurrently or prospectively. However, among more aggressive youth, internalizing symptoms were more predictive of T3 suicide attempt than among less aggressive youth. T1 aggression predicted aggressive incidents and the likelihood of incarceration prior to T3. Two-level hierarchical linear modeling indicated that self-reported aggression and internalizing problems were linked in terms of severity and rates of decline over time. Overall, parent-reported aggression was negatively associated with suicidal ideation. Findings highlight (a) the continuity and consequences of aggression, (b) a possible role of aggression in worsening suicide risk factors and potentiating suicide attempt, and (c) the importance of ongoing research on subtypes of suicidal adolescents.     

Further suicidal behavior among medically serious suicide attempters

Analysis of rates of further suicidal behavior among individuals making medically serious suicide attempts may help to predict suicide and suicide attempt from baseline characteristics of the individual and the index suicide attempt. Data are drawn from a 5-year study of 302 individuals making medically serious suicide attempts with information collected by personal interview at baseline, 6, 18, 30, and 60 months after the index attempt. Within 5 years, 6.7% died by suicide; 37% made at least one nonfatal suicide attempt. Although baseline characteristics permitted a modest prediction of suicide attempt, only a very limited prediction of suicide was possible. Almost half of those who made serious suicide attempts made a further fatal or nonfatal attempt within 5 years. These findings imply the need for enhanced follow-up, treatment, and surveillance of all patients making serious suicide attempts.     

The utility of MMPI-2 suicide items for assessing suicidal potential: development of a Suicidal Potential Scale

The assessment of suicidal potential is one of the most challenging and stress-inducing tasks facing clinicians. Studies that have attempted to identify specific MMPI codetypes, scales, or individual items predictive of completed suicide have produced inconsistent findings. This study focused on the relationship between the six most direct MMPI-2 suicide items (Items 150, 303, 506, 520, 524, and 530) and verbally reported history of suicidal ideation and behavior among a sample of psychotherapy outpatients (n =116). These six MMPI-2 suicide items provided valuable information regarding suicidal ideation and behavior above and beyond that of verbal self-report. These items were grouped together to create a single scale, the Suicidal Potential Scale (SPS) that manifested strong internal consistency. The SPS provides the clinician with a reliable method of assessing for self-reported suicidal ideation and behavior.     

Gender and suicide in the elderly.

Gender is one of the most important predictors of suicide in the elderly. In North America, older women are less likely to be suicidal than older men. So far, suicidologists have either ignored gender differences or have focused on the presumed causes of older men's suicidal behavior. In this paper, the focus is on older women's low rates of suicidal mortality. On the basis of a review of the literature, several hypotheses are suggested. One is that gender differences in suicide mortality reflect differences in coping. Another hypothesis is that gender differences are influenced by gender norms of suicidal behavior. Directions for prevention are proposed.     

Aspects of suicidal behavior, depression, and treatment in college students: results from the spring 2000 national college health assessment survey

The National College Health Assessment Survey (NCHA), sponsored by the American College Health Association, measured depression, suicidal ideation, and suicide attempts among 15,977 college students in the academic year 1999-2000. Similar to the National College Health Risk Behavior Survey, conducted by the Centers for Disease Control and Prevention in 1995, 9.5% of students reported that they had seriously considered attempting suicide and 1.5% of students reported that they had attempted suicide within the last school year. The NCHA findings show a relationship between suicidal behavior and depressed mood. Depressed mood, difficulties of sexual identity, and problematic relationships all increase the likelihood of vulnerability to suicidal behavior. Less than 20% of students reporting suicidal ideation or attempts were receiving treatment.