Intervention Research with Youths at Elevated Risk for Suicide: Meeting the Ethical and Regulatory Challenges of Informed Consent and Assent

Intervention research with youths at elevated risk for suicidal behavior and suicide—a vulnerable and high risk population—presents investigators with numerous ethical challenges. This report specifically addresses those challenges involving the informed consent and assent process with parents/guardians and youths. The challenges are delineated in the context of pertinent laws and regulatory requirements, and guidelines are suggested for their practical resolution. These are illustrated with case examples from NIMH‐funded intervention trials. Through the sharing of such methodological information, intervention researchers can support each other in conducting ethical research in a manner that does not unduly compromise scientific rigor.     

Adolescent Suicidal Ideation Subgroups and their Association with Suicidal Plans and Attempts in Young Adulthood

Suicidal ideation during adolescence is quite common. Longitudinal ideation patterns may predict adolescents at greatest risk of progressing to more serious suicidal behaviors. We enumerated suicidal ideation trajectory subgroups and estimated subgroup association with later suicidal plans and attempts using data collected across a 13‐year period from 552 Caucasian adolescents. Three subgroups were found: non‐ideators (no ideation), decreasers (ideation decreased), and increasers (ideation persisted or increased). Probability of planning a suicide was greatest among increasers (females: .54, males: 51, p < .01). Probability of attempting suicide was greatest among male decreasers (.36, p < .01) and female increasers (.25, p < .01).     

Legal Bans on Pro‐Suicide Web Sites: An Early Retrospective from Australia

There are worldwide concerns that pro‐suicide web sites may trigger suicidal behaviors among vulnerable individuals. In 2006, A ustralia became the first country to criminalize such sites, sparking heated debate. Concerns were expressed that the law casts the criminal net too widely; inappropriately interferes with the autonomy of those who wish to die; and has jurisdictional limitations, with off‐shore web sites remaining largely immune. Conversely, proponents point out that the law may limit access to domestic pro‐suicide web sites, raise awareness of Internet‐related suicide, mobilize community efforts to combat it, and serve as a powerful expression of societal norms about the promotion of suicidal behavior.     

A Study of Suicide and Socioeconomic Factors

The topic of suicide has long been an important socioeconomic issue studied in many countries. Suicides inject an atmosphere of unrest into society, and media attention furthers that social uneasiness. From the viewpoint of economics and management, suicide is a waste of human resource: it decreases the labor force in society and deteriorates human capital. This paper provides a series of analyses of suicide rate based on theoretical reasoning and empirical approaches. Aggregate data from G7 countries are obtained and stacked into panel data for analysis. Data are collected for different age groups. Even though suicide issues have been extensively discussed in the past, newly developed econometric tools are applied to her. Beyond previously recognized relationships between economic factors and suicide rates findings include that unemployment strikes men more than women in terms of psychological pressure: for middle age or older women, unemployment may even be positive for the entire family; and female labor force participation exerts pressure on male counterparts and increases its suicide rate. As a result, a low income family with an unemployed man and an employed woman is at high risk for adult male suicide.     

Mental Disorders and Socioeconomic Status: Impact on Population Risk of Attempted Suicide in Australia

The population attributable risk (PAR) of mental disorders compared to indicators of socioeconomic status (SES) for attempted suicide was estimated for Australia. For mental disorders, the highest PAR% for attempted suicide was for anxiety disorders (males 28%; females 36%). For SES, the highest PAR% for attempted suicide in males was for occupation (males 31%; females 16%) and education level (males 19%; females 8%), following adjustment for age and mental disorders. The study results suggest that one third of suicide attempts in both males and females are attributable to anxiety disorders, the same proportion attributable to low educational or occupational status.     

Suicide and Its Association with Individual,Family, Peer,and School Factors in an Adolescent Population in Southern Taiwan

A representative sample of 10,233 adolescent students was recruited to examine the rate of suicidal attempt and its correlates in the adolescents living in southern Taiwan. Five questions from the Kiddie Schedule for Affective Disorders and Schizophrenia (Kiddie‐SADS‐E) were used to inquire about the participants' suicidality. The associations between suicidal attempt and multidimensional factors were examined by using logistic regression analysis: 9.1% of the participants reported a suicidal attempt in the preceding year. Female gender, low self‐esteem, weekly alcohol use, illicit drugs use, depression, high family conflict, low maternal education level, poor family function, low connectedness to school, low rank, poor feeling in peer group, and drop out from school were associated with adolescent suicidal attempt. The rate of suicidal attempt was found to be high in Taiwanese adolescents, and multidimensional factors were correlated to adolescent suicidal attempt.