Facility-level characteristics associated with serious suicide attempts and deaths from suicide in juvenile justice residential facilities

Little is known about how facility-level characteristics affect the risk of suicide and suicide attempts in juvenile justice residential facilities. This leaves facility administrators and mental health providers without evidence-based guidance on how the facility itself affects risks. The current study uses data from two recently developed censuses of juvenile justice facilities in the United States to examine the relationship between facility-level characteristics and the likelihood of a facility reporting serious suicide attempts and deaths from suicide. Results suggest highest risks for facilities housing larger populations of Black young people and for facilities locking sleeping room doors. Lower risks are found for facilities screening all young people within 24 hours of arrival.     

Risk factors for medically serious suicide attempts: evidence for a psychodynamic formulation of suicidal crisis

This study explored a psychodynamic model for suicide risk by examining risk factors for medically serious suicide attempts, including assessments of affect flooding, negative self-schema / fragmentation, and impaired reality testing, closely approximating Maltsberger's psycho-dynamic formulation of suicide crisis. Baseline risk factors including age, gender, psychiatric symptoms, high-risk behaviors, and the Implicit Risk for Suicide Index (IRSI) were used to detect medically serious suicide attempts monitored for up to a year after the assessment. Twenty-five psychiatric inpatients who made life-threatening suicide attempts after assessment were compared to 25 inpatients and 25 psychotherapy outpatients who made no suicide attempts during follow-up. Statistical analysis revealed that a history of at least one suicide attempt and elevated IRSI scores accounted for 60 percent of the variance in detecting medically serious suicide attempts. Elevated IRSI accurately identified suicide attempt status above and beyond past suicide attempts and other empirically validated risk factors. Results are discussed in light of psychodynamic formulations of suicide risk.     

Factors associated with suicide attempts in female inmates: the hegemony of hopelessness

In this study factors associated with past suicide attempts in female inmates were examined. Female inmate participants (N = 105) were given structured diagnostic assessments of antisocial and borderline personality disorders and substance dependence, as well as measures of depression, hopelessness, problem-focused coping styles, and reasons for living. There was a high lifetime prevalence of past suicide attempts (38.1%). Suicide attempts were positively associated with personality disorders, hopelessness, depression, childhood physical/emotional abuse, and family history of suicide and mood disorders, and negatively associated with income, reasons for living, and problem-focused coping. Controlling for hopelessness, borderline personality disorder and family history of suicide attempts were the only variables that remained uniquely associated with suicide attempts.     

Predictors of suicide attempts: state and trait components

The authors examined the state and trait components of 3 predictors of suicide attempts (depression, hopelessness, and anxiety), and their relationship to suicidal behavior. Self-report questionnaire and interview data from 180 adolescents enrolled in a prospective naturalistic study were analyzed. Between 23% and 30% of the variance in the predictors was attributable to subjects' trait levels of these variables; the trait, as well as the state, components of the predictor variables were interrelated; and trait levels of these variables were consistently related to suicide attempts. To reduce long-term risk of suicide attempts, clinicians should focus not only on reducing short-term distress but also on reducing individuals' more enduring patterns (trait levels) of negative affectivity.     

Recent suicidal ideation and suicide attempts in a large-scale survey of the U.S. Air Force: prevalences and demographic risk factors

One-year prevalences of self-reported noteworthy suicidal ideation and nonfatal suicide attempts were assessed in a large sample of U.S. Air Force active duty members (N = 52,780). Participants completed the 2006 Community Assessment, which was conducted online. Over 3% of male and 5.5% of female participants reported having experienced noteworthy suicidal ideation during the previous year, and 8.7% of those with ideation reported a recent suicide attempt. Demographic factors predicting significantly increased risk for suicidal ideation included female gender, low rank, and non-Christian religious affiliation; unmarried men were also at increased risk. Groups that were at increased risk for nonfatal suicide attempts included low-ranking men and Hispanic women. Implications for prevention efforts are discussed.     

Worst-point suicidal plans: a dimension of suicidality predictive of past suicide attempts and eventual death by suicide

Among 440 psychiatric outpatients with current suicidal ideation, we examined the empirical distinction between the “plans” vs. “desire” dimensions of suicidality, focusing for conceptual and empirical reasons on a worst-point assessment strategy. Factor analyses were consistent with the distinction, but more importantly, among the current ideators included in this study, the worst-point “plans” dimension was the only predictor significantly related to both of two important indices, history of past attempt and eventual suicide. These findings bear on the trajectory of suicidal behavior over time, as well as inform the clinical assessment of suicidal patients.     

Dimensions of impulsivity and aggression associated with suicide attempts among bipolar patients: a preliminary study

Impulsivity and hostility are often thought to be interrelated among depressed patients with suicidal behavior, but few studies have examined this relationship empirically. In this study, we assessed trait impulsivity and hostility among 52 DSM-IV bipolar subjects with and without histories of suicide attempts. Impulsivity and hostility were correlated among attempters (r = .41, p = .03) but not non-attempters (r = .22, p = .28). As compared to non-attempters, attempters had significantly higher levels of overall hostility, more extensive subcomponents of hostility, and a trend toward higher overall impulsivity. Associations between lifetime suicide attempts and overall hostility were significant while controlling for current depression severity and lifetime illness duration. Aggression and impulsivity appear linked among bipolar patients with lifetime suicide attempts but may be independent constructs among non-attempters. The presence of both factors may elevate risk for suicidal behavior.     

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.     

Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey

Definitions and classification schemes for suicide attempts vary widely among studies, introducing conceptual, methodological, and clinical problems. We tested the importance of the intent to die criterion by comparing self-injurers with intent to die, suicide attempters, and those who self-injured not to die but to communicate with others, suicide gesturers, using data from the National Comorbidity Survey (n = 5,877). Suicide attempters (prevalence = 2.7%) differed from suicide gesturers (prevalence = 1.9%) and were characterized by male gender, fewer years of education, residence in the southern and western United States; psychiatric diagnoses including depressive, impulsive, and aggressive symptoms; comorbidity; and history of multiple physical and sexual assaults. It is possible and useful to distinguish between self-injurers on the basis of intent to die.     

Prevalence of suicide attempts in a Mexican-American population: prevention implications of immigration and cultural issues

Self-reported suicide ideation and suicide attempts were examined among 2,393 Mexican-Americans (706 born in Mexico, 538 born in the United States) and non-Hispanic whites (1,149 born in the United States). Mexican-Americans born in Mexico reported significantly lower age- and gender-adjusted lifetime rates of suicide thoughts (4.5%, 2.7-6.3%) than Mexican-Americans born in the United States (13.0%, 10.0-15.9%), who reported significantly lower rates than non-Hispanic whites born in the United States (19.2%, 17.4-21.0%). Adjusted rates of suicide attempt were lowest among Mexican-Americans born in Mexico (1.6%, 0.6-2.6%) and higher among both Mexican-Americans (4.8%, 2.4-7.2%) and non-Hispanic whites (4.4%, 3.4-5.4%) born in the United States. Rates were not affected by degree of acculturation when immigration status was controlled. High schools and the Catholic church are suggested as sites for programs designed to prevent suicide and suicide attempts among Mexican-Americans.     

Female self-injury and suicide attempts: Culturally reinforced techniques in human relations

There is a consistent and significant higher ratio of females who engage in self-injury or who attempt suicide as compared to males, or as compared to suicidal commits by both sexes. This paper focuses on the problem of female excess in self-injury and suicide attempts. Biological/psychological variables which have been linked to these female self-destructive behaviors are enumerated and an alternative sociocultural explanation is suggested. Sex-role expectations are shown to be essential in explaining female self-injury and suicide attempts. The notion that these female self-destructive behaviors offer self-preservation is criticized, as is the failure in the literature to investigate what female self-injury and suicidal attempts actually do accomplish. Direction for solutions is mentioned in terms of research findings on self-actualization and on androgynous persons.     

Killing the dead: evolution of melancholic identifications underlying suicide attempts in adolescence

Psychic processes underlying suicidal behaviours during adolescence and their evolution are explored. A longitudinal study was conducted of thirty adolescent patients hospitalised following a suicide attempt. Clinical interviews were used combined with the Rorschach Test and the Thematic Apperception Test (TAT) a few days after the suicide attempt and one year later. Results initially showed common forms of psychic adjustment: melancholic identifications were linked to an excessive dependence on objects. One year later, these forms of psychic adjustment changed: for many adolescents, the melancholic identifications shifted and self-image improved. The emergence of representations of murder fantasies immediately after the suicidal behaviour allowed a possible transformation of violence into symbolisation. A case study illustrates these psychic changes.     

MMPI characteristics of drug abusers with and without histories of suicide attempts

Compared to drug addicts without histories of suicidal attempt (n = 50), drug addicts who have attempted suicide (n = 50) were characterized by higher levels of maladjustment--particularly in the areas of depression, feelings of alienation, and use of projection and externalization--and were more emotionally withdrawn. Certain Minnesota Multiphasic Personality Inventory (MMPI) codetypes appeared in the attempt group that were not present in the no history group. Drug addicts with suicidal ideation but no history of attempt (n = 13) were not significantly different from the other two groups, and their inclusion as a comparison group masked the real differences between the other two groups. The MMPI results suggest it may be possible to identify a suicide attempt group in substance abusers but not when contrasted with a suicidal ideation group. Treatment implications are considered.     

Contributors to suicidal ideation among bipolar patients with and without a history of suicide attempts

This study was designed to develop models for vulnerability to suicidal ideation in bipolar patients. Logistic regression models examined correlates of suicidal ideation in patients who had versus had not attempted suicide previously. Of 477 patients assessed, complete data on demographic, illness history, and personality variables were available on 243. The regression models achieved positive predictive values of 55% and 59% for the attempter (N = 92) and nonattempter groups (N = 151), respectively. Depression was cross-sectionally associated with suicidal ideation in both the attempter and nonattempter groups but made a smaller contribution among attempters. Poor psychosocial adaptation and the personality factor "openness" were stronger contributors to suicidal ideation among prior attempters while anxiety and extraversion appeared protective against ideation. Among nonattempters, depression, anxiety, and neuroticism were the predominant influences on suicidal ideation. Bipolar patients with suicidal ideation may benefit from different treatment strategies depending on their prior attempt status.     

Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder

Self-reported reasons for suicide attempts and nonsuicidal self-injury were examined using the Parasuicide History Interview within a sample of chronically suicidal women meeting criteria for borderline personality disorder (N = 75). Overall, reasons given for suicide attempts differed from reasons for nonsuicidal self-injury. Nonsuicidal acts were more often reported as intended to express anger, punish oneself, generate normal feelings, and distract oneself, whereas suicide attempts were more often reported as intended to make others better off. Almost all participants reported that both types of parasuicide were intended to relieve negative emotions. It is likely that suicidal and nonsuicidal parasuicide have multiple intents and functions.     

Belief in the inevitability of suicide: results from a national survey

To examine public opinion regarding the effectiveness of means restriction as an approach to preventing suicide we asked a national sample of 2,770 respondents a hypothetical question about what effect a suicide barrier might have had on the ultimate fate of the more than 1,000 people who have jumped to their death from the Golden Gate Bridge. Thirty-four percent of respondents believed that every single jumper would have found another way to complete suicide and an additional 40% believed that "most" would have completed suicide using other means. The strongest predictors of belief in complete substitution were firearm ownership and cigarette smoking. Belief in the inevitability of suicide may be a political impediment to adopting potentially effective suicide prevention efforts.     

Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts

The purpose of this study was to examine affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Forty-seven adolescents with a history of multiple suicide attempts (MA) were compared to 74 single suicide attempters (SA) on psychiatric diagnosis, depressive symptoms, affect regulation, self-mutilation, alcohol use, and hopelessness. Results revealed that the MA group was more likely to be diagnosed with a mood disorder, and reported more severe depressive symptoms and anger, in comparison to the SA group. Behaviorally, the MA group had higher rates of disruptive behavior disorders and higher levels of affect dysregulation and serious self-mutilation than the SA group. Further, greater levels of hopelessness were reported by the MA than the SA group. After controlling for a mood disorder diagnosis, only differences in anger, affect dysregulation, and serious self-mutilation remained significant. Overall, results suggest that treatment with adolescent suicide attempters might specifically target anger and affect dysregulation to reduce risk for future suicidal behavior.     

Childhood physical and sexual abuse in depressed patients with single and multiple suicide attempts

Research has shown both childhood physical and sexual abuse to be associated with later suicide attempts, although some studies have not supported these findings. However, few studies have investigated differences in physical and sexual abuse histories among single and multiple suicide attempters. The goals of the current study were two-fold: (a) to replicate previous findings of associations between childhood sexual and physical abuse and suicide attempts, and (b) to explore differences in reports of childhood physical and sexual abuse among single and multiple suicide attempters. While our results supported the findings that individuals with a history of suicide attempts are more likely to report histories of childhood physical and sexual abuse, we did not find a difference in reported abuse between single and multiple suicide attempters. Implications of these findings, as well as implications for future research, are discussed.