Obstacles to research in residential juvenile justice facilities: recommendations for researchers

Federal, state, and local initiatives to improve the treatment and outcomes for young people in the juvenile justice system prompt the need for additional research. Despite the call for empirical data, researchers encounter numerous obstacles when initiating and conducting studies in detention and post-adjudication facilities. These obstacles are often only briefly mentioned in publications, but they can interfere with researchers' desires and abilities to conduct studies in these settings. This paper reviews legal, ethical, and methodological challenges to successfully conducting research in detention and residential post-adjudication placements, including selecting and accessing appropriate facilities, obtaining institutional review board approval, seeking parental permission and youth assent, reporting child abuse and neglect, responding to participants' threats to harm self or others, working effectively with facilities, juvenile justice system-related attrition, and the dissemination of research findings. Recommendations are presented to help investigators anticipate obstacles when designing and executing research protocols to prevent interference and to encourage ethical responses and successful study completion.     

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.     

Variables associated with repeated suicide attempt in a criminal justice population

The aim of this study was to identify factors associated with repeated suicide attempts among criminal justice clients examined for substance abuse using the Addiction Severity Index. Among suicide attempters (n=1,404), repeaters (two or more attempts, n=770) were compared to nonrepeaters. In logistic regression, repetition was associated with younger age, opioid analgesics, somatic medication, overdose, maternal psychiatric problems, delirium tremens, cognitive problems, and violent behavior. As in other settings, factors associated with repetition differed from those associated with suicide attempts in general. In this setting, substance use complications and cognitive problems were connected to repetition and should be addressed in risk assessments.     

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.     

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.     

Risk factors associated with suicide attempts and other self-injury among Hong Kong adolescents

This study examined 1,361 Chinese adolescents who reported self-injurious behaviors. Groups A and B both acknowledged deliberate self-injury, but only Group A had made a suicide attempt. Group C reported accidental self-injury. Deliberate self-injurers (Groups A and B) were more frequently girls, older, and with more suicidal ideation. Group A had more psychopathology, environmental and suicide-related risk factors than group B and C. Group C had higher depressive symptoms than noninjured controls. The study clarifies differences among self-injurious behavior groups based on expressed deliberate self-injury and self-reported suicide attempt. These three groups appear to present a continuum of 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.     

Socio-cultural features and sex profile of the individuals with serious suicide attempts in southeastern Turkey: a one-year survey

Our objective was to elucidate potential causes of higher rates of suicide attempts in females compared to males in southeastern Turkey through a 1-year survey. Gender-related differences observed in 96 subjects who attempted suicide by poisoning for the first time were as follows: in comparison to male, females were predominantly within the age interval of 15-24 years, experienced more stressful events in the previous week before suicide attempt, had lower education level, and had a lower rate of employment. One year after the suicide attempt, unfavorable attitude of family, lack of support, persisting unfavorable lifestyle comparable with that prior to the first attempt, and higher rates of domestic violence were more pronounced in females compared to males. These findings might be contributing factors to the higher suicide attempt rates observed in females compared to the males.     

Personality traits and cognitive styles as risk factors for serious suicide attempts among young people.

The contribution of a series of measures of personality and/or cognitive style to serious suicide attempt risk in young people was examined in a case-control study. Individuals making suicide attempts had elevated odds of hopelessness, neuroticism, introversion, low self-esteem, impulsiveness, and external locus of control. When allowance was made for intercorrelations between these measures, hopelessness, neuroticism, and external locus of control remained significant risk factors for serious suicide attempt; self-esteem, extraversion, and impulsiveness were not significantly associated with suicide attempt risk. Nonsignificant findings were explained by the presence of substantial correlations between these measures and measures of hopelessness, neuroticism, and external locus of control.     

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.     

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.     

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.     

MMPI-A characteristics of male adolescents in juvenile justice and clinical treatment settings

The current study investigates the extent to which the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) profiles of 196 male adolescents evaluated in a South Carolina detention center could be successfully discriminated from the protocols of 200 male adolescent psychiatric inpatients in three states and 151 dually diagnosed male adolescents. Results showed significant differences in mean T-score values among these three groups of adolescents across a variety of MMPI-A scales and subscales. Results from discriminant function analyses indicate that treatment setting can be predicted effectively from MMPI-A profiles. Beyond the MMPI-A profile differences established for adolescents in these groups, the similarities of adolescents were also noted, particularly in terms of the frequent occurrence of Within-Normal-Limits profiles for adolescents in all groups. Potential directions for future research with the MMPI-A are presented.     

Circadian variation in suicide attempts in Tokyo from 1978 to 1985

Circadian variations in suicide attempts in Tokyo from 1978 to 1985 were analyzed on the basis of records of the Ambulance Service of Tokyo. A significant circadian variation in suicide attempts was demonstrated by the cosinor method, power spectrum analysis (by the maximum-entropy method), and analysis of variance. The peak time for suicide attempts was established by cosinor analysis as about 1800 hours (6:00 P.M.). The circadian variation in suicide attempts seemed to be associated with endogenous rhythms such as mood, as well as with daily variation in social activities.     

Intolerance to delayed reward in girls with multiple suicide attempts

Impulsivity has been conceptualized as influencing the expression of suicidal behavior. Adolescence is a developmental period characterized both by a relatively high rate of suicide attempts and a high level of impulsivity. The current study examined two behavioral measures (delay reward and disinhibition) and one self-report measure of impulsivity among girls with suicide attempt histories. Girls with multiple suicide attempts performed more impulsively on measures of delayed reward, and had higher self-ratings of depression and aggression than girls with either one or no suicide attempts. The multiple attempter girls' preference for immediate gratification may directly increase vulnerability to suicidal acts in the context of distressing states or indirectly increase risk by creating poor life experience over time.     

Interpersonal precipitants and suicide attempts in borderline personality disorder

Borderline personality disorder (BPD) is often characterized by multiple low lethality suicide attempts triggered by seemingly minor incidents, and less commonly by high lethality attempts that are attributed to impulsiveness or comorbid major depression. The relationships among life events, impulsiveness, and type of suicidal behavior has hardly been studied in BPD and mood disorders. This study compared depressed attempters with and without BPD to identify specific suicide precipitants and risk factors in BPD and their relationship to severity of suicidal behavior. Attempters with comorbid BPD and major depressive disorder (MDD) had a higher number of lifetime suicide attempts; made their first attempt at a younger age; reported more interpersonal triggers; and had higher levels of lifetime aggression, hostility, and impulsivity, compared with attempters with major depression only. Environmental triggers of attempts in BPD are more likely to be interpersonal stressors. Lethality of attempts in BPD plus MDD is equal to that in MDD only, indicating that the seriousness of precipitants is unrelated to the lethality of the suicidal behavior. The differences between groups suggest that risk assessment and treatment should target both depression and personality disorder in those with combined illness.     

Reported childhood trauma and suicide attempts in schizophrenic patients

Childhood traumas are associated with suicidal behavior but this aspect has not been examined in relation to schizophrenia. In this study, 50 chronic schizophrenic patients who had attempted suicide were compared with 50 chronic schizophrenic patients who had never attempted suicide for their scores on the 34-item Childhood Trauma Questionnaire (CTQ). It was found that schizophrenics who had attempted suicide reported significantly higher CTQ scores for emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect than schizophrenics who had never attempted suicide. Therefore, childhood trauma may be a risk factor predisposing schizophrenic patients to attempt 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.     

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.