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.     

Active school travel is associated with fewer suicide attempts among adolescents from low-and middle-income countries

Background/Objective: This study explored the association between active school travel (AST) and suicide attempts among adolescents in low- and middle-income countries (LMICs). Method: We used the data from the Global School-based Health Survey, including 127,097 adolescents aged 13-17 years from 34 LMICs. A self-reported survey was used to collect data on AST and suicide attempts as well as some variables. Multivariable logistic regression was performed to assess the association between AST and suicide attempts. A meta-analysis with random effects was undertaken to identify the difference in the association between AST and suicide attempts. Results: Across all the adolescents, the prevalence of AST was 37% and the prevalence of suicide attempts was 11.60%. Adolescents who engaged in AST were less likely to have suicide attempts irrespective of gender. The country-wise analysis indicated a large inconsistency in the association between AST and suicide attempt across the countries. Conclusions: AST would appear to be a protective factor for reducing suicide attempts among adolescents. However, the association between AST and suicide attempts varied greatly across the countries. Future studies should confirm the association between AST and suicide attempts.     

Single and multiple suicide attempts and associated health risk factors in New Hampshire adolescents

In this study we examined self-reported suicide attempts and their relationship to other health risk factors in a community sample of 16,644 adolescents. Fifteen percent endorsed suicide attempts (10% single; 5% multiple attempts) We hypothesized that multiple attempters would show higher prevalence of comorbid health risks than single or non-attempters. The three groups showed significant differences in ten health risk domains, on factors such as depressed mood, sexual assault, weight problems, and drug and alcohol use (ORs: 3.26-13.57). Repeated suicide attempts appear to be related to increased vulnerability and likelihood of harm in multiple domains of health risk.     

Attitudes toward suicide among Chinese people in Hong Kong

Since suicide in Chinese people exhibits certain distinctive characteristics, it is important to develop indigenous measures to assess Chinese attitudes toward suicide that may be used to inform suicide reduction programs. Combining qualitative and quantitative methods, we developed a Hong Kong version of the Chinese Attitude toward Suicide Questionnaire (CASQ-HK) which assesses attitudes toward suicide, suicidal inclination under 12 hypothetical scenarios, and prior suicidal experience. A convenience sample of 1,226 people completed the self-report questionnaire. In keeping with Chinese tradition, respondents revealed both tolerant and condemning attitudes that varied with their sociodemographic characteristics. Generally, they were not strongly inclined to consider suicide in the presence of difficult scenarios. Female gender, older age, and the presence of suicidal ideation were associated with more contemplation of suicide.     

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.     

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.     

Risk and protective factors associated with patterns of antisocial behavior among nonmetropolitan adolescents

This study used latent class analysis (LCA) to identify patterns of antisocial behavior (ASB) in a sample of 1,820 adolescents in a nonmetropolitan region of the Northeast. Self-reported ASBs including stealing, fighting, damaging property, and police contact were assessed. LCA identified four classes of ASB including a non-ASB class, a mild, a moderate, and a serious ASB class. Multinomial logistic regression indicated that parent-child relationships served as a protective factor against engaging in ASB and peer, school, and community risk and protective factors differentiated mild patterns of ASB from more intense patterns of involvment. These findings suggest utility in using the LCA to better understand predictors of adolescent ASB to inform more effective prevention and intervention efforts targeting youth who exhibit different patterns of behavior.     

Personal versus interpersonal contributions to depressive symptoms among Hong Kong adolescents

Cross‐cultural theory proposes that an essential distinction between cultures lies in the extent to which individual members see themselves as either independent agents preferentially valuing agency and efficacy, or as embedded within a social context preferentially valuing interpersonal relationships. A nonreferred sample of 605 boys and 503 girls from Hong Kong provided information regarding: (1) perceptions of their personal self‐efficacy or beliefs regarding their own ability to master challenges they face; (2) the degree of harmony in their interpersonal (peer and family) relationships; and (3) depressive symptoms as an assessment of their mood. Cognitive theories of emotions propose that both the individual's assessment of his/her self‐efficacy and of his/her relationships influence mood. Hypotheses, based on cross‐cultural theory, were that in this collective culture, interpersonal evaluations would predict more of the variance in mood than would personal self‐efficacy. Contrary to Western sex‐differences literature, it was predicted that the effect of interpersonal harmony on mood would be equally pronounced for girls and for boys. Structural equation modelling was used to test causal models. Consistent with findings from the West, evaluations of personal self‐efficacy as well as interpersonal relationship harmony were significantly associated with depressed mood. Consistent with cultural theory, interpersonal relationship harmony was more strongly associated with mood than was personal self‐efficacy for the entire sample of adolescents. In contrast to findings of sex differences in the salience of relationships in the West, the prediction of interpersonal relationships to mood was equal for boys and girls in Hong Kong. This preliminary study extends models of cognitive concomitants of mood disruption to a non‐Western culture, and provides a framework to understand relative contnbutors to mood in adolescence. The findings tentatively suggest that treatment for depressive mood in Chinese populations should prioritize enhancement of the perceived quality of interpersonal relationships over increasing a sense of mastery.     

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.     

Risk for suicidal ideation and suicide attempts associated with co-occurring depression and conduct problems in early adolescence

This study investigates the early manifestation of co-occurring depression and conduct problems as a predictor of heightened risk for later suicidal ideation and behavior in a community sample of 521 adolescents. Self-reported symptoms of depression and conduct problems were evaluated in early 6th grade. Suicidal thoughts and behaviors were tracked through multiple assessments carried out over the middle school years. Compared to adolescents with depression symptoms only, conduct problem symptoms only, or low psychopathology, those with co-occurring depression and conduct problem symptoms had the highest risk for subsequent suicidal ideation, recurrent suicidal behaviors, and suicide attempts.     

Suicidal ideation,parenting style,and family climate among Hong Kong adolescents

The prevalence of suicidal ideation and its relations with perceived parenting treatment and family climate was examined in 120 Hong Kong students aged 15–19 years. Fifty‐two per cent of the participants reported suicide ideation. Suicide ideation was found to be significantly associated with perceived authoritarian parenting, low parental warmth, high maternal over‐control, negative child‐rearing practices, and a negative family climate. A positive family climate may act as a buffer against developing suicide ideation in adolescents.     

Predictors of suicide ideation and depression in Hong Kong adolescents: perceptions of academic and family climates

The unique dimensions of perceptions of school and family contributing to depression and suicide ideation in Hong Kong adolescents were examined in two studies. In Study 1, among 327 Hong Kong Chinese female students ages 13-18, 47% reported some suicide ideation. Suicide ideation was significantly associated with depression, test anxiety, academic self-concept, and adolescents' perceived parental dissatisfaction with academic performance. The correlation between test anxiety and depression was especially high (r = .51). Study 2 examined how three different aspects of perceived family relationship were associated with depression and suicide ideation. Among 371 Hong Kong Chinese adolescents ages 14-20, 52.6% reported suicide ideation. Low levels of family cohesion and support and high levels of parent-adolescent conflict were positively related to depression and suicide ideation in both genders. Across both studies, depression mediated associations between academic- and family-related variables and suicide ideation. Findings underscore the importance of both academic and family climate in understanding depression and suicide ideation among Chinese adolescents.     

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.     

Sex differences in developmental trends of suicide ideation, plans, and attempts among European American adolescents

Although suicide ideation, plans, and attempts increase during adolescence, it remains unclear whether boys' and girls' risk for these outcomes peaks at different ages. We used longitudinal categorical data (never, once, 2+ times) from the Family Transitions Project (N = 1,248 rural European Americans, ages 11-19) to investigate whether yearly prevalence rates of adolescent suicidal episodes follow different patterns by sex. Multiple-group growth models revealed that peak levels of past-year ideation and plans occurred during mid adolescence for girls, but slowly increased through late adolescence for boys. We found that prevalence patterns for attempts were very similar for boys and girls, with both increasing through mid adolescence and then declining, although girls' risk declined slightly more rapidly. This information may help alert gatekeepers to developmental periods during which boys and girls are particularly vulnerable to suicide-related experiences, and also may help inform the timing of preventive efforts.     

Selected risk factors in adolescent suicide attempts.

This study examined stress, depression, attempted suicide, and knowledge of common signs of potential suicide in Alabama adolescents. A modified version of the National Adolescent Student Health Survey (NASHS) was administered to 3,803 eighth- and tenth-grade public school students during the fall of 1988. The incidence of stress, depression, and attempted suicide was analyzed by gender, ethnicity, locale (urban vs. rural), and participation in sexual intercourse and use of alcohol. Chi-square tests were used to determine if there were significant differences between groups. Findings indicated that females were at greater risk than were males. Both males and females who engaged in sexual intercourse and alcohol consumption were at greater risk than were abstainers. When analyzed by ethnicity, white adolescents who engaged in these behaviors were at significantly greater risk than were those who abstained; differences were not as pronounced for black youth. Comparisons on the knowledge scale indicated that females scored better than males, whites scored better than blacks, and urban students scored better than rural students. The data suggest that many adolescents are having difficulty coping with stress and depression, and that those who are engaging in various types of risk-taking behavior are at greater risk for depression and suicide.     

Psychopathology,family functioning,and cognitive style in urban adolescents with suicide attempts

This study examined psychopathology, family functioning, and cognitive style in 121 African-American adolescents who attempted suicide. Group means suggested that these youths, when taken together, were not reporting significant psychological distress. However, after classifying the youths into three groups by level of depressive symptoms interesting findings emerged. Youth self-reports of depressive symptoms on the Children's Depression Inventory were associated with the presence of internalizing and externalizing disorders on the Youth Self-Report and Child Behavior Checklist, and with a maladaptive attributional style. Sixty-seven percent of participants classified their family types as maladaptive in terms of levels of cohesion and/or adaptability. In fact, the majority of adolescents and parents reported their families as disengaged. These findings are discussed from a culturally and developmentally sensitive framework which considers key demographic variables (race, socioeconomic status, age). Clinical implications are offered for individual and family interventions.     

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.     

Intimacy and psychosocial adjustment in Hong Kong Chinese adolescents

This study examined the association between 8 aspects of friend intimacy and 3 measures of psychosocial adjustment (self-esteem, deviant behavior, and purpose in life) among Hong Kong Chinese adolescents. The respondents were 289 students between 16 and 19 years of age from a cross-sectional study in Hong Kong. Bivariate correlation and multiple regression analyses revealed (a) friend intimacy was positively associated with self-esteem and purpose in life, and (b) friend intimacy was negatively correlated with deviant behavior. Results indicated that friend intimacy is an important variable that affects some aspects of psychosocial adjustment. Moreover, results of multiple regression analyses indicated that different measures of friend intimacy are related to deviant behavior and purpose in life. Therefore, it is crucial to study the relationship between different aspects of friend intimacy and different aspects of psychosocial adjustment among adolescents.     

Relation of career adaptability to meaning in life and connectedness among adolescents in Hong Kong

This study examined relationships among career adaptability, meaning in life, and connectedness in Hong Kong with Chinese male and female Grade 9 students (n = 543). The results indicated that presence of meaning in life positively predicted connectedness; and in the males career concern was predicted by presence of meaning in life. Also in males, career control was predicted both by presence and search for meaning in life, while career curiosity was predicted by connectedness to school, and by presence and search for meaning in life. Career confidence was predicted by connectedness to school, and presence and search of meaning in life. In the females, career concern was predicted by presence of meaning in life and connectedness to school, but negatively by connectedness to peers. Career control and career curiosity were predicted by presence and search for meaning in life. Career confidence was predicted by presence of meaning in life. Limitations of the study are identified; and implications for future research and guidance with Chinese adolescents in schools are discussed.