Child and adolescent suicide: epidemiology, risk factors, and approaches to prevention

Characteristics and predictors of suicidality in young people with clinical depression: a systematic review protocol

OBJECTIVE

The objective of this review is to examine clinical, psychosocial, and biological factors associated with suicidality in young people diagnosed with depression. This review will describe risk and protective factors, focusing on modifiable attributes, in order to inform suicide prevention and early intervention strategies.

INTRODUCTION

Suicide is the world's second-leading cause of death among young people. Depression is closely associated with suicide; however, it lacks specificity as a predictor of suicidal behavior. There is a clear need to improve our understanding of both risk and protective factors associated with the full spectrum of suicidality in young people, across a range of depressive disorders.

INCLUSION CRITERIA

Studies that include young people 15 to 25 years of age with a diagnosis of depression made in accordance with a diagnostic classification standard will be considered. Diagnosis must be made using a structured clinical interview or be received through standard clinical practice. Analytical cross-sectional studies, prospective and retrospective cohort studies, and case-control studies will be included. Studies must include an assessment of suicidality made using standardized or non-standardized tools. A broad range of inpatient and outpatient settings will be considered.

METHODS

MEDLINE, Embase, and PsycINFO will be searched for studies published in English, with no date limitation. Two independent reviewers will conduct study screening, assess methodological quality, and extract data using standardized tools. If there is sufficient homogeneity across studies, meta-analyses using a random-effects model will be conducted. If quantitative meta-analysis is not possible, a narrative synthesis will be undertaken.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020151612.

Investigating Bullying as a Predictor of Suicidality in a Clinical Sample of Adolescents with Autism Spectrum Disorder

For typically developing adolescents, being bullied is associated with increased risk of suicidality. Although adolescents with autism spectrum disorder (ASD) are at increased risk of both bullying and suicidality, there is very little research that examines the extent to which an experience of being bullied may increase suicidality within this specific population. To address this, we conducted a retrospective cohort study to investigate the longitudinal association between experiencing bullying and suicidality in a clinical population of 680 adolescents with ASD. Electronic health records of adolescents (13–17 years), using mental health services in South London, with a diagnosis of ASD were analyzed. Natural language processing was employed to identify mentions of bullying and suicidality in the free text fields of adolescents' clinical records. Cox regression analysis was employed to investigate the longitudinal relationship between bullying and suicidality outcomes. Reported experience of bullying in the first month of clinical contact was associated with an increased risk suicidality over the follow‐up period (hazard ratio = 1.82; 95% confidence interval = 1.28–2.59). In addition, female gender, psychosis, affective disorder diagnoses, and higher intellectual ability were all associated with suicidality at follow‐up. This study is the first to demonstrate the strength of longitudinal associations between bullying and suicidality in a clinical population of adolescents with ASD, using automated approaches to detect key life events within clinical records. Our findings provide support for identifying and dealing with bullying in schools, and for antibullying strategy's incorporation into wider suicide prevention programs for young people with ASD. Autism Res 2020, 13: 988‐997. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc.

Association between suicidal ideation and acoustic parameters of university students' voice and speech: a pilot study

PURPOSE

At a worldwide level, suicide is a public health problem that, despite displaying downward trends in several areas of the world, in many countries these rates have increased. One of the elements that contributes to its prevention is an early and dynamic evaluation. Due to this, the objective is to determine the association between acoustic parameters of voice and speech (F0, F1, F2, F3, dB, and Jitter) and suicidal ideation arousal amongst some university students from the city of Temuco, Chile.

METHODS

Attending to this issue, a cross-sectional design study was conducted through a non-probabilistic sampling of sixty 18- and 19-year-old adolescents from the city of Temuco, that went through an acoustic evaluation of their voice and speech after taking a test to determine suicidal ideation. Afterwards, data were analyzed through IBM SPSS version 23.0 software (IBM SPSS Statistics, Armonk, NY), by means of exploratory, descriptive, and inferential statistics taking the variable's levels of measurements and the types of distributions into account.

RESULTS

The results point out that 30% of the adolescents, from both genders, displayed suicidal ideation. Taking into account the acoustic results of their voice, it is possible to recognize that the fundamental frequency (F0), the formants (F1, F2), and Jitter, are the ones that majorly link to the presence of suicidal ideation, both in women and men (p < .05). The characteristics that describe F3 were only linked to the presence of suicidal ideation in men (p < .05).

CONCLUSIONS

It is concluded that the acoustic parameters of voice and speech differ in adolescents with suicidal behavior, opening the possibility of representing a useful tool in the diagnosis of suicide.

[Suicidal tendencies in adolescence : Dysfunctional familiar communication as risk factor]

BACKGROUND

Suicide is one of the four most common causes of death in adolescence worldwide. Although it is well known that suicidal people often have insufficient communication strategies, the importance of family communication for adolescent suicidality has not yet been sufficiently explored.

OBJECTIVE

The aim of this study was to provide a systematic review of family communication as a risk factor for adolescent suicidal tendencies and to develop treatment recommendations.

METHODS

In this study a systematic literature search was conducted in PubMed, Embase, CENTRAL and PsychINFO. The methodological quality of the studies was evaluated and a summary prepared.

RESULT

A total of 195 studies were extracted and screened for their suitability. Of these studies, 7 which examined a total of 13,107 adolescents aged 11-22 years were included in this review and critically evaluated. Of the studies evaluated six found a correlative relationship between dysfunctional parent-child communication and adolescent suicidality. Communication with the mother appears to be more essential.

CONCLUSION

The results of this literature search indicate that functional communication with parents seems to be protective for suicidal adolescents. From this, recommendations can be derived for preventive measures in families with adolescents who are otherwise at increased risk of suicide. Longitudinal study designs are needed to conclusively answer the research question.

Association of defecation disorders with suicidal ideation in young adult with chronic abdominal discomfort

BACKGROUND

The role of physical symptoms on suicidal ideation in adolescents is incompletely understood. The purpose of this study was to discover the potential physical symptoms predictors for suicidal ideation in college freshmen.

METHODS

This cross-sectional survey was conducted in a randomly selected freshmen population in Wuhan China (N = 2449). Questionnaire evaluated suicidal ideation as well as related psychosocial risks and gastrointestinal (GI) physical symptoms. The association between the suicidal ideation and potential predictors was analyzed by Mann-Whitney test and multiple logistic regression analysis.

RESULTS

A total of 2053 (83.8%) completed this survey and 64 (3.1%) was reported to have suicidal ideation. Anxiety (OR 5.44(2.40-12.35)), depression (OR 8.36(3.90-17.94)) and chronic abdominal discomfort (OR 2.06(1.07-3.94)) were independent predictors for suicidal ideation. In freshmen with chronic abdominal discomfort, interestingly, defecation disorder(P = 0.01) and low satisfaction of defecation (P = 0.04) was associated with high risk for suicidal ideation.

CONCLUSION

Defecation disorders were associated with high risk of suicidal intention in young adult with chronic abdominal discomfort. Our result implied that clinicians should be vigilant for suicidal ideation in chronic abdominal discomfort patients, especially those with defecation disorders.

Differences by age and sex in adolescent suicide

OBJECTIVES

To compare demographic and psychosocial characteristics of completed suicide between younger and older adolescents, and by sex.

METHODS

Data was collected from the Victorian Suicide Register, which contains information on suicides reported to the Coroners Court of Victoria.

RESULTS

Between 2006 and 2015, there were 273 completed suicides aged 10-19 years, with none aged 10-12 years. There were 171 (63%) suicides in the older adolescent group (17-19 years), and 102 (37%) in the younger group (13-16 years). Males comprised 184 cases (67%) and females 89 (33%). A higher proportion of both younger and female adolescents had experienced abuse, peer conflict and bullying. There was also a higher incidence of previous self-harm in younger and female adolescents. Older adolescents were more likely to not be in formal education, employment or training.

CONCLUSION

Suicide in younger adolescents and females appear to share characteristics, and differ from older and male adolescents. Negative interpersonal relationships and previous self-harm with possible co-existenting mental illness appear to be key differentiating features. Implications for public health: Understanding completed suicide is an important step towards prevention, and our results suggest a need for developmentally and sex-specific suicide prevention strategies.

Clinical spectrum of acute poisoning in children admitted to the pediatric emergency department

BACKGROUND

Pediatric poisoning is a common emergency worldwide. Routine surveillance is required for public health authorities and physicians to update strategies for prevention and management of pediatric poisoning. This study investigated the epidemiology of poisoning among children admitted to an emergency department (ED).

METHODS

This was a retrospective descriptive study. Data were collected from patients under 18 years old (y/o) presenting with poisoning at the largest ED in North Taiwan from 2011 to 2015.

RESULTS

Five-year records of 590 patients-309 (52.3%) boys and 281 (47.7%) girls-were analyzed. The mean age was 5.07 y/o (Standard Deviation [SD] = 5.02 years), and 94.7% of events occurred at home. Incidence was highest from 6 p.m. to 12 a.m. (42.2%, n = 249). Most patients younger than 11 y/o were male, but this gender distribution was reversed in adolescents (11-17 y/o). Pharmaceutical ingestion (41.4%, n = 244) was the leading cause of poisoning; pesticide was the most common non-pharmaceutical poison ingested (9.5%, n = 55). Carbon monoxide (CO) intoxication (87.6%, n = 99) and snakebite (75%, n = 9) were the common causes of inhalation (n = 113) and venom (n = 12) poisoning, respectively. The mean duration of the ED stay was 5.45 h (SD = 7.39 h), and 101 cases (17.2%), including 21 cases (3.6%) requiring intensive care, were admitted to the hospital. All patients survived.

CONCLUSION

Most poisonings occurred in young children, at home, by unintentional ingestion of a single substance, from 6 p.m. to 12 a.m. Female adolescents were the common intentional poisoning patients and pharmaceutical ingestion was the leading cause of poisoning. This kind of information enables ED physicians to improve preparations for pediatric poisoning cases and allows public health authorities to sharpen the focus of poisoning prevention efforts.

Adult Mental Health Outcomes of Preterm Survivors Experiencing Suicidal Ideation in Adolescence

The aim of this study was to examine the link between suicidal ideation in adolescence (age 12-16) and symptoms of psychopathology in adulthood (age 22-26) in a birth cohort of extremely low birth weight (ELBW; <1000g) survivors and matched normal birth weight (NBW; >2500 g) control participants. This study utilized data from a longitudinally followed cohort of 129 ELBW survivors and 116 NBW individuals born in Ontario, Canada between the years 1977 and 1982. Participants self-reported suicidal ideation via questionnaire during adolescence (age 12-16). The depression, anxiety, inattention, and antisocial behavior subscales of the Young Adult Self Report (YASR) were used to assess symptoms of psychopathology during adulthood (age 22-26). Associations were examined in each birth weight group separately prior to and after adjustment for covariates. Before and after adjustment for covariates, suicidal ideation in NBW adolescents predicted symptoms of depression, anxiety, inattention, and antisociality in adulthood. Suicidal ideation among ELBW adolescents predicted inattentive and depressive symptoms, and antisocial behavior only before adjustment. Adolescents born at NBW who endorse suicidal ideation are at elevated risk for developing symptoms of anxiety, depression, inattention, and antisocial problems in adulthood even after adjustment. Among ELBW survivors, the risks were lower and appear to be due to confounding factors.

Suicide Attempt Resiliency in American Indian, Hispanic, and Anglo Youth in New Mexico: The Influence of Positive Adult Relationships

The purpose of this study was to identify whether positive relationships with adults at home, school, and in the community are protective for suicide among American Indian/Alaska Native, Hispanic, and Anglo adolescents. Using data from the New Mexico version of the 2015 Centers for Disease Control and Prevention Youth Risk Behavior Survey, we found that positive relationships with adults affected past-year suicide attempts differently in youth from the 3 groups. The final multivariable model for American Indian/Alaska Native youth included only positive relationships with adults in the home. Among Hispanic and Anglo youth, adults in the home and also in the community were protective.

Clinical and Psychosocial Characteristics of Young Children With Suicidal Ideation, Behaviors, and Nonsuicidal Self-Injurious Behaviors

OBJECTIVE

Based on previous findings that suicidal ideation (SI) and behavior (SB) arose in depressed preschoolers and showed stability into school age, we sought to investigate whether unique clinical and psychosocial correlates of SI/SB and nonsuicidal self-injurious behaviors (NSSI) could be identified in young children recuited into a depression treatment study and healthy controls.

METHOD

Data from 288 children 3.0 to 6.11 years of age who were recruited for participation in a psychotherapy treatment study of depression and 26 healthy control subjects (total N = 314) were used. At baseline, subjects received a comprehensive assessment of psychopathology and suicidal ideation/suicidal behavior. Multinominal logistic regressions were conducted comparing those with no SI/SB/NSSI to those with SI/SB or NSSI. Those with SI/SB who also had NSSI were placed in the SI/SB group.

RESULTS

In this sample of young children, the rates of NSSI, SI, and SB were 21.3%, 19.1%, and 3.5% respectively. Children with SI/SB or NSSI experienced a greater frequency of violent life events than children with no SI/SB/NSSI. Children with SI/SB had significantly more preoccupation with death compared to subjects with NSSI and subjects with no SI/SB/NSSI. Children with SI/SB had more vegetative signs of depression and greater depression severity, and those with NSSI were more irritable with higher depression severity than those with no SI/SB/NSSI.

CONCLUSION

Distinct characteristics of SI/SB and NSSI in early childhood were identified, informing high risk subgroups. Findings suggest that clinicians should be aware of the potential for SI/SB and/or NSSI in young children and should directly address these symptoms in clinical interviews.

CLINICAL TRIAL REGISTRATION INFORMATION

A Randomized Controlled Trial of PCIT-ED for Preschool Depression. https://clinicaltrials.gov/; NCT02076425.

Association between sexual behavior and suicidal ideation among South Korean middle school students

AIM

To identify the association between sexual behavior and suicidal ideation among South Korean middle school students.

METHODS

This study used raw data from the 2013 Korean Youth Risk Behavior Web-Based Survey. Among the data from 72,435 students, the data from 36,530 individuals in middle school were analyzed. The prevalence of sexual behavior and suicidal ideation, according to the participants' general characteristics, and suicidal ideation, according to sexual behaviors, were assessed by using a complex sample Chi-squared test. A complex sample logistic regression was used to examine the association between sexual behavior and suicidal ideation.

RESULTS

Overall, 3.8% of the students reported having had sexual intercourse and 17.6% of the students reported suicidal ideation during the past 12 months. Having had sexual intercourse was statistically significantly associated with suicidal ideation. The students who had had sexual intercourse usually used contraception and those who had contracted sexually transmitted diseases were more likely to report suicidal ideation in both the unadjusted and adjusted models.

CONCLUSION

This study illustrates the need to develop a prevention program that addresses the common factors between sexual behavior and suicidal ideation in order to effectively reduce both sexual behavior and suicidal ideation in middle school students.

Client feedback in psychological therapy for children and adolescents with mental health problems

BACKGROUND

Childhood and adolescent mental health problems are a serious and growing concern worldwide. Research suggests that psychotherapy can have a significant and positive impact on children and adolescents with mental health problems, such as anxiety disorders, depression and conduct disorders. Client feedback tools serve as a method of monitoring clients' progress and providing feedback from clients to therapists during the therapeutic process. These tools may help to enhance clinicians' decision-making by allowing them to adapt their treatment plans as the therapy progresses, resulting in a reduction of treatment failures. Research has shown that client feedback tools have a positive effect on adults' psychotherapy. This review addresses whether feedback tools in child and adolescent therapy could help therapists to better treat their young clients.

OBJECTIVES

To assess the effects of client feedback in psychological therapy on child and adolescent mental health outcomes.

SEARCH METHODS

We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR, Studies and References), the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (1946-), Embase (1974-) and PsycINFO (1967-) to 3 April 2018. We did not apply any restriction on date, language or publication status to the search.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that compared client feedback to no client feedback in psychological therapies for children and adolescents.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed references for inclusion eligibility and extracted outcome, risk of bias and study characteristics data into customised forms. We contacted study authors to obtain missing data. We analysed dichotomous data using risk ratios (RRs) and calculated their 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MDs), or standardised mean differences (SMDs) if different scales were used to measure the same outcome. We used a random-effects model for all analyses.

MAIN RESULTS

We included six published RCTs, conducted in the USA (5 RCTs) and Israel (1 RCT), with 1097 children and adolescents (11 to 18 years old), in the review.We are very uncertain about the effect of client feedback on improvement of symptoms, as reported by youth in the short term because we considered evidence to be of very low-certainty due to high risk of bias and very serious inconsistency in the effect estimates from the different studies. Similarly, we are very uncertain about the effect of client feedback on treatment acceptability, due to high risk of bias, imprecision in the results, and indirectness of measuring the outcome (RR 1.08, 95% CI 0.73 to 1.61; 2 studies, 237 participants; very low-certainty).Overall, most studies reported and carried out randomisation and allocation concealment adequately. None of the studies were blinded or attempted to blind participants and personnel and were at high risk of performance bias, and only one study had blind outcome assessors. All of the studies were at high or unclear risk of attrition bias mainly due to poor, non-transparent reporting of participants' flow through the studies.

AUTHORS' CONCLUSIONS

Due to the paucity of high-quality data and considerable inconsistency in results from different studies, there is currently insufficient evidence to reach any firm conclusions regarding the role of client feedback in psychological therapies for children and adolescents with mental health problems, and further research on this important topic is needed.Future studies should avoid risks of performance, detection and attrition biases, as seen in the studies included in this review. Studies from countries other than the USA are needed, as well as studies including children younger than 10 years.

Suicide in adolescents: findings from the Swiss National cohort

Suicide in adolescents is the second most common cause of death in this age group and an important public health problem. We examined sociodemographic factors associated with suicide in Swiss adolescents and analysed time trends in youth suicide in the Swiss National Cohort (SNC). The SNC is a longitudinal study of the whole Swiss resident population, based on linkage of census and mortality records. We identified suicides in adolescents aged 10-18 years from 1991 to 2013. A total of 2.396 million adolescents were included and 592 suicides were recorded, corresponding to a rate of 3.7 per 100,000 [95% confidence interval (CI) 3.4-4.0]. Rates increased with age from 0.0 per 100,000 at age 10 years to 14.8 per 100,000 (95% CI 12.6-17.5) at 18 years in boys, and from 0.0 to 5.4 per 100,000 (4.1-7.2) in girls. Being a boy, living in a single parent household, being an only or middle-born child, and living in rural regions were factors associated with a higher rate of suicide. Hanging was the most common method in boys, and railway suicides were most frequent in girls. There was no clear evidence for an increase or decrease over calendar time. We conclude that familial and socioeconomic factors including type of household, birth order and urbanity are associated with youth suicide in Switzerland. These factors should be considered when designing prevention programmes for youth suicide.

Suicide and Youth: Risk Factors

Suicide occurs more often in older than in younger people, but is still one of the leading causes of death in late childhood and adolescence worldwide. This not only results in a direct loss of many young lives, but also has disruptive psychosocial and adverse socio-economic effects. From the perspective of public mental health, suicide among young people is a main issue to address. Therefore we need good insight in the risk factors contributing to suicidal behavior in youth. This mini review gives a short overview of the most important risk factors for late school-age children and adolescents, as established by scientific research in this domain. Key risk factors found were: mental disorders, previous suicide attempts, specific personality characteristics, genetic loading and family processes in combination with triggering psychosocial stressors, exposure to inspiring models and availability of means of committing suicide. Further unraveling and knowledge of the complex interplay of these factors is highly relevant with regard to the development of effective prevention strategy plans for youth suicide.

Gender differences of suicides in children and adolescents: Analysis of 167 suicides in a Mexican population from 2003 to 2013

Suicide is the second cause of death in youth population. The aim of the present study was to analyze demographic characteristics and suicide methods used, as well as to identify gender differences among Mexican children and adolescents (aged 10-17 years) that committed suicide. Between January 2003 and December 2013, 167 suicides of children and adolescents between 10 and 17 years of age were documented by the Secretary of Health of the state of Tabasco, Mexico. All sociodemographic characteristics were compared according to gender. Our sample included 67.7% males and 32.3% females (male to female 2.1:1). The predominant marital status was single (89.6%) and hanging (93.7%) was the principal method of suicide used. Both female and male adolescents were predominantly students (50%); however, female adolescents were more frequently married (17%) and were housewives (26.4%). Our results identified that hanging is the principal suicide method used by children and adolescents in Mexican population; we also detected main gender differences in terms of poisoning/drug toxicity as the method used, occupation and marital status. These results should be taken into consideration when designing suicide prevention programs due to the differences found by gender.

High stress, lack of sleep, low school performance, and suicide attempts are associated with high energy drink intake in adolescents

Objective

Although an association between energy drinks and suicide has been suggested, few prior studies have considered the role of emotional factors including stress, sleep, and school performance in adolescents. This study aimed to evaluate the association of energy drinks with suicide, independent of possible confounders including stress, sleep, and school performance.

Methods

In total, 121,106 adolescents with 13–18 years olds from the 2014 and 2015 Korea Youth Risk Behavior Web-based Survey were surveyed for age, sex, region of residence, economic level, paternal and maternal education level, sleep time, stress level, school performance, frequency of energy drink intake, and suicide attempts. Subjective stress levels were classified into severe, moderate, mild, a little, and no stress. Sleep time was divided into 6 groups: < 6 h; 6 ≤ h < 7; 7 ≤ h < 8; 8 ≤ h < 9; and ≥ 9 h. School performance was classified into 5 levels: A (highest), B (middle, high), C (middle), D (middle, low), and E (lowest). Frequency of energy drink consumption was divided into 3 groups: ≥ 3, 1–2, and 0 times a week. The associations of sleep time, stress level, and school performance with suicide attempts and the frequency of energy drink intake were analyzed using multiple and ordinal logistic regression analysis, respectively, with complex sampling. The relationship between frequency of energy drink intake and suicide attempts was analyzed using multiple logistic regression analysis with complex sampling.

Results

Higher stress levels, lack of sleep, and low school performance were significantly associated with suicide attempts (each P < 0.001). These variables of high stress level, abnormal sleep time, and low school performance were also proportionally related with higher energy drink intake (P < 0.001). Frequent energy drink intake was significantly associated with suicide attempts in multiple logistic regression analyses (AOR for frequency of energy intake ≥ 3 times a week = 3.03, 95% CI = 2.64–3.49, P < 0.001).

Conclusion

Severe stress, inadequate sleep, and low school performance were related with more energy drink intake and suicide attempts in Korean adolescents. Frequent energy drink intake was positively related with suicide attempts, even after adjusting for stress, sleep time, and school performance.

Extracurricular Activities are Associated with Lower Suicidality through Decreased Thwarted Belongingness in Young Adults

Research has shown a negative association between extracurricular activities (ECAs) and suicidality. This study builds upon past research by using the interpersonal psychological theory of suicide to better understand the mechanisms involved in the relationship between ECAs and suicide risk. A total of 121 community and online-recruited adults ages 18 to 24-years-old participated. Self-report measures of suicidality, thwarted belongingness, and perceived burdensomeness were collected. Duration and breadth of participation in ECAs were assessed. ECA involvement was negatively associated with thwarted belongingness and perceived burdensomeness. An indirect effect of ECAs on suicidality through thwarted belongingness was statistically significant, but not for perceived burdensomeness. ECA involvement was associated with decreased suicidality through lower levels of thwarted belongingness. Interventions utilizing ECAs may be a low-cost, high-access option for decreasing suicide risk.

Risk-taking behaviors and subgrouping of suicide in Iran: A latent class analysis of national registries data

Suicide is one the most important public health problem which is rapidly growing concerns. The aim of this study was to subgroup suicide using LCA method. This cross-sectional study was conducted in Iran based on 66990 records registered in Ministry of Health in 2014. A case report questionnaire in the form of software was used for case registries. Latent class analysis was used to achieve the research objectives. Four latent classes were identified; (a) Non-lethal attempters without a history of psychiatric disorders, (b) Non-lethal attempters with a history of psychiatric disorders, (c) Lethal attempters without a history of psychiatric disorders, (d) Lethal attempters with a history of psychiatric disorders. The probability of completed/an achieved suicide is high in lethal attempter classes. Being male increases the risk of inclusion in lethal attempters' classes (OR = 4.93). Also, being single (OR = 1.16), having an age lower than 25 years (OR = 1.14) and being a rural citizen (OR = 2.36) associate with lethal attempters classes. The males tend to use more violent methods and have more completed suicide. Majority of the individuals are non-lethal attempters who need to be addressed by implementing preventive interventions and mental support provision.

Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis

BACKGROUND

Adolescents with previous self-injurious thoughts and behaviors (SITB) have over 2-fold risk of dying by suicide, higher than older ages. This meta-analysis aims to disentangle the association of each SITB with subsequent suicidal behavior in adolescence/young adulthood, the contribution of each SITB, and the proportion of suicide deaths with no previous suicide attempt.

METHODS

We searched 6 databases until June 2015.

INCLUSION CRITERIA

1. Assessment of any previous SITB [a) suicidal thoughts and behaviors (ideation; threat/gesture; plan; attempt); b) non-suicidal thoughts and behaviors (thoughts; threat/gesture; self-injury); c) self-harm] as a risk factor of suicide attempt or suicide death; 2. Case-control or cohort studies; 3. Subjects aged 12-26y. Random effect models, metaregression analyses including mental health and environmental variables, and population attributable risks (PAR)s were estimated.

RESULTS

From 23,682 potentially eligible articles, 29 were included in the meta-analysis (1,122,054 individuals). While 68% of all youth suicide deaths had no previous suicide attempt, suicide death was very strongly associated with any previous SITB (OR=22.53, 95%CI: 18.40-27.58). Suicide attempts were also associated with a history of previous SITB (OR=3.48, 95%CI: 2.71-4.43). There were no moderating effects for mental health and environmental features. The PAR of previous SITB to suicide attempts is 26%.

LIMITATIONS

There is considerable heterogeneity between the available studies. Due to limitations in the original studies, an over-estimation of the proportion dying at their first attempt cannot be ruled out, since they might have missed unrecognized previous suicide attempts.

CONCLUSIONS

Although more than two thirds of suicide deaths in adolescence/young adulthood have occurred with no previous suicidal behavior, previous SITBs have a much higher risk of dying by suicide than previously reported in this age group.

Association between adolescent suicide and sociodemographic factors in Chile: cross-sectional ecological study

BACKGROUND

Adolescent suicide rates (ASR) are a matter of concern worldwide. Causes of this trend are not understood and could correspond to socioeconomic factors such as inequality.

AIM

To investigate sociodemographic variables related to ASR, particularly the potential association with indicators of socioeconomic inequality.

METHOD

Cross-sectional ecological study analyzing data from 29 health districts with univariate and multivariable multilevel Poisson models.

RESULTS

ASR were higher in male adolescents and at increasing age. No association was found between ASR and inequality (Gini coefficient and 20/20 ratio). Analysis revealed that living in a single-parent family is associated with ASR.

CONCLUSIONS

The usual demographic patterns of adolescent suicide apply in Chile. An emerging variable of interest is single-parent family. No cross-sectional association between social inequality and ASR was found based on conflicting evidence. These results should be explored in future prospective population studies to further understand associated social factors.

Parent-Child Connectedness and Long-Term Risk for Suicidal Ideation in a Nationally Representative Sample of US Adolescents

BACKGROUND

Few studies have addressed on the role of parent-child connectedness (PCC) on adolescents' risk for suicidal ideation from a longitudinal, developmental perspective.

AIM

This study examined PCC during adolescence and risk of suicidal ideation into adulthood among a nationally representative sample of American adolescents.

METHOD

The study includes 13,234 adolescents aged 11-18 from the National Longitudinal Study of Adolescent to Adult Health (Add Health) who were surveyed during adolescence (1994-1995) and then again in early adulthood (2008-2009). Multinomial logistic regression estimated the association between PCC during adolescence and having ideation during the adolescence period only, in adulthood only, and in both adolescence and adulthood as compared with those without suicidal ideation.

RESULTS

After adjusting for depressive symptoms and other parent and adolescent characteristics, adolescents in two-parent households who reported higher PCC during adolescence had lower relative risk of having ideation during adolescence alone and in both adolescence and adulthood. In mother-only households, higher mother connectedness was also associated with decreased risk of having adolescent ideation.

CONCLUSION

PCC is an important modifiable target for the prevention of suicidal ideation from adolescence into adulthood.

Risk factors and characteristics of suicide attempts among 381 suicidal adolescents

AIM

This study explored the relationships between suicidal adolescents and their parents, siblings and friends. It examined how much adolescents talked to their parents before suicide attempts, the frequency of self-mutilation, the extent of suicidal ideation, previous suicide attempts and suicide attempts in the adolescent's surroundings.

METHODS

We performed a cross-sectional case-control study that focused on 381 adolescents aged 10-17 years who were admitted to hospitals across Denmark after suicide attempts with acetaminophen and 296 age- and gender-matched controls recruited from schools. The study used questionnaires and medical and child psychiatric records.

RESULTS

The study group were ten times more likely to report dissociated parental relationships than the control group (41.5% versus 4%), and there were significant relationships between these reports and feelings of not being heard (p < 0.0001), dissociated relationships with friends (p < 0.0001) and siblings (p < 0.0001) and self-mutilation (p = 0.009). Almost two-thirds (62.5%) of the suicidal adolescents who tried to talk to their parents about their problems felt unheard, and there was a significant relationship between this feeling and the duration of suicidal ideation (p = 0.01) and self-mutilation (p = 0.003).

CONCLUSION

Early risk factors for suicide were dissociated relationships with parents, siblings and friends, feeling unheard, self-mutilation and extended suicidal ideation.

Effects of a Comprehensive, Multiple Risky Behavior Prevention Program on High School Students

The purpose of this research study was to examine the effect of a multiple risky behaviors prevention program applied comprehensively throughout an entire school system involving universal, selective, and indicated levels of students at a local private high school during a 4-year period. The noncurriculum prevention program was created based upon the key elements of effective prevention programming and the need to address the growing variety of risky behaviors that the youth face today. Results (n = 469 to 614) indicated that 7 out of 15 risky behaviors statistically significantly decreased throughout the 4-year study, with 6 behaviors involving alcohol and drugs. However, many of the targeted non-substance-use risky behaviors displayed inconsistent prevalence rate patterns without statistically significant changes. These findings indicate that the frequency and intensity of programming for non-substance-use behaviors should be increased to a value at least equal to that of the substance-use behaviors. Implications for schools, prevention specialists, and future program development and research are discussed.

Factors related to childhood suicides: analysis of the Queensland Child Death Register

BACKGROUND

Suicide among children under the age of 15 years is a leading cause of death.

AIMS

The aim of the current study is to identify demographic, psychosocial, and psychiatric factors associated with child suicides.

METHOD

Using external causes of deaths recorded in the Queensland Child Death Register, a case-control study design was applied. Cases were suicides of children (10-14 years) and adolescents (15-17 years); controls were other external causes of death in the same age band.

RESULTS

Between 2004 and 2012, 149 suicides were recorded: 34 of children aged 10-14 years and 115 of adolescents aged 15-17 years. The gender asymmetry was less evident in child suicides and suicides were significantly more prevalent in indigenous children. Children residing in remote areas were significantly more likely to die by suicide than other external causes compared with children in metropolitan areas. Types of precipitating events differed between children and adolescents, with children more likely to experience family problems. Disorders usually diagnosed during infancy, childhood, and adolescence (e.g., ADHD) were significantly more common among children compared with adolescents who died by suicide.

CONCLUSION

Psychosocial and environmental aspects of children, in addition to mental health and behavioral difficulties, are important in the understanding of suicide in this age group and in the development of targeted suicide prevention.

Being in the Safety Zone

This study examined how previously suicidal adolescents and emerging adults perceived their emotional experiences while being suicidal. Forty-one females and 9 males previously suicidal between the ages of 15 and 24 were interviewed. Qualitative data were analyzed using a grounded theory approach. Three major themes were identified in participants’ perceptions of their emotional experiences: (a) overwhelming despair, (b) shame and self-loathing, and (c) alienation and personal isolation. These emotional states were viewed within the multidimensional process of responding to emotions. Participants’ inability to deal with intense negative emotions appeared to be related to their suicidal state.

Suicidal ideation in adolescents and their caregivers: a cross sectional survey in Japan

BACKGROUNDS

Suicide is a leading cause of death in adolescence. Effective strategies are required to prevent suicide. We aimed to assess the prevalence of suicidal ideation in early teens and the relationship between family mental health and suicidal ideation of their child.

METHODS

A population-based survey in a rural town included 185 junior high school students and their caregivers. Suicidal ideation and mental states were assessed with General Health Questionnaire (GHQ) and Profile of Mood States (POMS) form.

RESULTS

Nineteen (10.3 %) students experienced suicidal ideation in the preceding weeks and had more mental health problems than students without suicidal ideation. Caregivers of students with suicidal ideation demonstrated significantly higher suicidal depression scores in GHQ. Multivariate logistic regression analysis revealed that suicidal depression of caregivers was the most important factor for suicidal ideation of students.

CONCLUSIONS

Suicidal ideation of children is associated with suicidal depression of their caregivers. For the prevention of suicide in adolescents, not only their own mental status but also that of caregivers should be taken into consideration.

Incidence Rates of Deliberate Self-Harm in Denmark 1994-2011

BACKGROUND

The validity and reliability of suicide statistics have been questioned and few nationwide studies of deliberate self-harm have been presented.

AIM

To calculate rates of deliberate self-harm in Denmark in order to investigate trends and assess the reliability of hospital records.

METHOD

A register study based on all individuals recorded with an episode of deliberate self-harm or probable deliberate self-harm in nationwide registers during 1994-2011.

RESULTS

A substantial difference in the rates of deliberate self-harm and probable deliberate self-harm was noted for both genders. The average incidence rate of deliberate self-harm for women and men was 130.7 (95% CI = 129.6-131.8) per 100,000 and 86.9 (95% CI = 86.0-87.8) per 100,000, respectively. The rates of deliberate self-harm for women increased from 137.6 (95% CI = 132.9-142.3) per 100,000 in 1994 to 152.7 (95% CI = 147.8-157.5) in 2011. For a subgroup of younger women aged 15-24 years, an almost threefold increase was observed, IRR = 2.5 (95% CI = 2.4-2.7). The most frequently used method was self-poisoning.

CONCLUSION

The rates of deliberate self-harm and probable deliberate self-harm differed significantly. An increased incidence of deliberate self-harm among young Danish women was observed, despite detection bias. An improved registration procedure of suicidal behavior is needed.

Gender Differences in Youth Suicide and Healthcare Service Use

BACKGROUND

Healthcare service use among suicide decedents must be well characterized and understood since a key strategy for preventing suicide is to improve healthcare providers' ability to effectively detect and treat those in need.

AIMS

To determine gender differences in healthcare service use 12 months prior to suicide.

METHOD

Data for 1,231 young Quebec residents (≤ 25 years) who died by suicide between 2000 and 2007 were collected from public health insurance agency databases and coroner registers. Healthcare visits were categorized according to the setting (emergency department [ED], outpatient, and hospital) and their nature (mental health vs. non-mental health).

RESULTS

Girls were more likely than boys (82.5% vs. 74.9%, p = .011) to have used healthcare services in the year prior to death. A higher proportion of girls had used outpatient services (79.0% vs. 69.5%, p = .003), had been hospitalized (25.7% vs. 15.6%, p < .001) and had received a mental health-related diagnosis (46.7% vs. 33.1%, p < .001). However, no gender differences were observed in ED visits (59.5% vs. 54.5%, p = .150).

CONCLUSION

There is an important proportion of suicide decedents who did not receive a mental health diagnosis and healthcare services in the year prior to death. Future studies should focus on examining gender-specific individual and health system barriers among suicide decedents as well as the quality of care offered regarding detection and treatment.

Suicide Attempt by Swallowing Sponge or Pica Disorder: A Case Report

Introduction: There are many ways how children with mental illness have actually tried to hurt themselves. Suicidal thinking or attempts always indicate that professional help is needed (2). Every object which can be potential dangerous should be removed but this is very difficult to do. Some of children with these symptoms had Pica diseases. Pica is a medical disorder characterized by an appetite for substances largely non-nutritive (e.g. metal, coal, soil, feces, paper, soap, gum, etc.) or an abnormal appetite for some things that may be considered foods. Material and Methods: The patient swallow sponge from a pillow over a long period of time and she came into our hospital with abdominal pain. She was 16 years old and had abdominal distension, vomiting, abdominal cramping and failure to pass gas or stool. Immediately we suspected mechanical blockade of the intestine. Diagnosis was clinically confirmed by X-rays of the abdomen and with ultrasound. Results: The operative treatment was indicated and we found the proximal bowel distended and the distal segment collapsed. The part of bowel necrosis was removed and anastomosis was done. Conclusion: When patients are determined to attempt suicide or have Pica disorder it is very difficult to prevent.

A descriptive study of female suicide deaths from 2005 to 2011 in Van city, Turkey

BACKGROUND

Female suicide is an important problem not only for women but for public health in general.

METHODS

Autopsy reports from the Van Chief Public Prosecutor's Office from 2005 to 2011 were reviewed retrospectively in order to analyse female deaths from suicide.

RESULTS

Sixty-six female suicide cases were recorded during 2005-2011. The mean age of the cases was 22.64 (sd = 10.09) years, and nine were below the age of 15. The most common method of suicide was hanging (44 cases, 66.7 %). Five (7.6 %) of the cases were under treatment for depression, and 12 (18.2 %) cases had a previous suicide attempt.

CONCLUSIONS

Cultural suppression of females and prevention of their socialization in enclave societies are risk factors for female suicides. The number of female suicide attempts, especially recurring attempts, should be reduced via psychiatric scanning, follow-up sessions and therapy for high-risk individuals.

Child abuse and the prevalence of suicide attempts among those reporting suicide ideation

OBJECTIVE

Victims of child abuse may be at increased risk of acting on suicide ideation, although this has not been empirically tested. We estimated the risk of suicide attempts associated with child abuse among individuals who reported suicide ideation.

METHODS

Secondary analysis of data from the population-based Canadian Community Health Survey Mental Health (n = 828). This population-based survey included various structured questionnaires, including the Composite International Diagnostic Interview to assess mental illness and suicidal thoughts and behaviours.

RESULTS

Approximately 80 % of those who attempted suicide had a history of child abuse. Poor mental health, financial difficulties, poor coping skills, and reporting a suicide plan were also associated with an increased prevalence of attempting suicide; adjusted for these factors, child abuse was associated with a 1.77-fold increased prevalence (95 % CI 0.93, 3.36) of suicide attempts.

CONCLUSIONS

Most individuals who attempt suicide experience child abuse, and worse health and social functioning. Adopting a life-course perspective to understand trajectories of suicide risk factors may inform prevention and treatment.

Prescription drug misuse and suicidal ideation: Findings from the National Survey on Drug Use and Health

OBJECTIVE

Suicide is one of the leading causes of injury-related mortality in the United States and prior research has identified alcohol and other drug use as a major risk factor. In recent years, prescription drug misuse has become a serious public health issue; however, very little research examines the relationship between prescription drug misuse and suicide or suicidal ideation.

METHODS

Using data from the National Survey on Drug Use and Health, the current research examines the relationship between prescription drug misuse and suicidal ideation among adults. Suicidal ideation was measured by asking respondents if they seriously thought about killing themselves in the past 12 months. Prescription drug misuse was defined as use without a prescription or solely for the feeling or experience caused by the drug in the past 12 months. Several multivariable logistic regression models were estimated.

RESULTS

Findings show that respondents who report prescription drug misuse in the past year, specifically pain relievers, are more likely to report that they had seriously though about killing themselves.

CONCLUSIONS

The current research fills an important gap in the literature by examining the relationship between prescription drug misuse and suicidal ideation. Consistent with the extant literature, prescription drug misuse is significantly associated with suicidal ideation among adults.

Suicidal behaviors among Moroccan school students: prevalence and association with socio-demographic characteristics and psychoactive substances use: a cross-sectional study

BACKGROUND

Suicidal behavior is a major cause of injury and death worldwide, especially among adolescents and young adults. Few studies have tackled this issue in the Arab world. The present study investigated the prevalence and the risk factors of suicidal behaviors among Moroccan school students.

METHODS

From April 2012 to November 2013, a cross-sectional study was conducted in the North-Centre region of Morocco among students in public secondary schools selected using stratified cluster random sampling. The data were collected via anonymous self-administered questionnaires. The Mini International Neuropsychiatric Interview was used in its Moroccan Colloquial Arabic version to assess suicidality according to the DSM-IV criteria.

RESULTS

A total of 3020 students (53 % boys) aged 11-23 years (average age = 16 ± 2.1 years) were included in the study. The prevalence of suicide ideation, suicide planning and suicide attempts during the last month were 15.7, 6.3, and 6.5 % respectively. Univariate analyses demonstrated that suicidal behaviors followed different epidemiological patterns. According to the multivariate analyses, the risk factors for all suicidal behaviors among Moroccan school students were the female gender, middle school level, urban locations, low family income, parents' divorce, tobacco consumption and psychoactive substances (alcohol and cannabis) use.

CONCLUSIONS

The intervention of preventive programs has become an emergency to overcome the issue of suicidality in Morocco. Further researches on adolescents' suicidal behaviors are suggested to update temporal data and assess the effectiveness of potential interventions.

Two decades of adolescent suicides assessed at Milan University's medicolegal unit: Epidemiology, forensic pathology and psychopathology

AIM

to analyze the cases of suicide committed by adolescents in and around the city of Milan over a 20-year period (1993-2012).

MATERIALS AND METHODS

cases of suicide involving individuals between 10 and 19 years of age were drawn from 20,757 autopsies performed by the Medico-legal Unit at Milan University. Seventy-eight cases were considered (20 females and 58 males, with the ratio of 1:2.9), and their clinical and circumstantial histories, epidemiology, forensic pathology and psychopathological issues were analyzed.

RESULT

Adolescents were involved in 2.23% of all suicides committed in Milan during the period examined. The "mean" victim is a male without psychiatric disease, aged between 16 and 19, that commits suicide outdoors.

CONCLUSIONS

In the majority of cases, there were no premonitory signs, nor any particular contingent or remote reason that might explain these violent deaths, which therefore remain "impulsive".

Global trends in teenage suicide: 2003-2014

The object of this article is to review the past decade of research on teenage suicide, with a particular emphasis on epidemiologic trends by age, gender and indigenous ethnicity. As such, a review of research literature from 2003 to 2014 was conducted via a comprehensive search of relevant psychological and medical databases. Wide gaps in our knowledge base exist concerning the true extent of teenage suicide due to lack of data, particularly in developing countries, resulting in a Western bias. The gender paradox of elevated suicidality in females with higher completed suicide rates in males is observed in teenage populations worldwide, with the notable exceptions of China and India. Native and indigenous ethnic minority teens are at significantly increased risk of suicide in comparison to general population peers. Often those with the highest need for mental health care (such as the suicidal adolescent) have least access to therapeutic support.Globally, suicide in teenagers remains a major public health concern. Further focused research concerning completed suicides of youth below the age of 18 is required across countries and cultures to understand more about risk as children progress through adolescence. Gender and ethnic variations in suicidality are embedded within cultural, historical, psychological, relational and socio-economic domains. Worldwide, the absence of child/adolescent-specific mental health policies may delay the development of care and suicide prevention. Overall, it is vital that clinicians adopt a holistic approach that incorporates an awareness of age and gender influences, and that cultural competency informs tailored and evaluated intervention programmes.

Allergic diseases, excessive Internet use and suicidal ideation in Korean adolescents

OBJECTIVE

The aim of this study is to evaluate the relation between suicidal ideation, allergic diseases, and excessive Internet use in Korean youth using a national representative dataset.

METHODS

Data from the Korean Youth Risk Behavior Web-Based Survey (KYRBWS), conducted by the Korean Centers for Disease Control and Prevention, were used in this study. Complex sample logistic regression and structural equation modeling were performed to define the relation between suicidal ideation, allergic disease and excessive Internet use.

RESULTS

A total of 73,238 students participated in this survey. In Korea, 19.3% of adolescents had suicidal ideation in the previous year. Asthma (OR=1.23, 95% CI=1.15-1.32, p<0.01) and allergic rhinitis (OR=1.17, 95% CI=1.11-1.22, p<0.01) were identified as risk factors for suicidal ideation after adjusting for school and family factors. Structural equation modeling showed that excessive Internet use interacted with the association between allergic diseases and suicidal ideation.

CONCLUSION

Allergy problems could positively affect suicidal ideation in Korean adolescents. Excessive Internet use could be a mediating factor between allergic disease and suicidal ideation.

Subtypes of psychotic-like experiences are differentially associated with suicidal ideation, plans and attempts in young adults

Psychotic-like experiences (PLEs) have been associated with increased risk of suicidality, but it is unclear whether the level of risk varies with different types of PLE. A cross-sectional online survey was completed by 1610 university students. Respondents completed the Community Assessment of Psychic Experiences-15 (CAPE-P15) assessing PLEs on three subscales: Perceptual Abnormalities (PA), Persecutory Ideation (PI) and Bizarre Experiences (BE). Lifetime suicidal ideation, plans and attempts, cannabis, ecstasy and methamphetamine use and family history of mental disorder were also assessed. Multinomal logistic regression was used to examine unique determinants of lifetime suicidality, defined as any history of (i) suicidal ideation or plans and (ii) any attempt, relative to no lifetime history of suicidality. A lifetime history of PA and PI provided significant unique contributions to the prediction of suicide risk, after control for other significant predictors. BE were not associated with any suicide variable demonstrating the variation in risk of suicidality with different types of PLEs. Perceptual abnormalities and persecutory ideation as measured by the CAPE-P15 are the PLEs associated with a higher risk of lifetime suicidality.

Suicide in pediatrics: epidemiology, risk factors, warning signs and the role of the pediatrician in detecting them

Epidemiological data suggests suicide is uncommon in childhood but becomes an extremely serious issue among adolescents.

Several risk factors have been identified and include the presence of psychiatric illness, a previous suicide attempt, family factors, substance abuse, sexual and physical abuse, disorders in gender identity or bullying. Pediatricians have a primary role in searching for these risk factors, recognizing them and acting synergistically with other specialists to prevent and treat suicidal behavior.

Pediatricians should also be able to identify the “warning signs” for suicide since their presence implies a need for immediate action, as attempted suicide may occur in a few hours or days.

The use of antidepressant drugs and its association with suicidal risk in pediatric age is another topic of ongoing debate. Food and Drug Administration has recently introduced the so-called “black box” on antidepressants’ packages with the aim of gaining attention to the possible risk of suicide among adolescents who are treated with antidepressants, with a warning that the risk of suicide is higher when starting a therapy or while adjusting its dosage.

Suicidal ideation and mental health disorders in young school children across Europe

INTRODUCTION

The aim of this study is to measure the prevalence of suicidal ideation and thoughts of death in elementary school children in a European survey and to determine the associated socio-demographic and clinical factors.

METHODS

Data refer to children aged 6-12 (N=7062) from Italy, Turkey, Romania, Bulgaria, Lithuania, Germany, and the Netherlands randomly selected in primary schools. Suicidal thoughts and death ideation were measured using a computerized pictorial diagnostic tool from the Dominic Interactive (DI) completed by the children. The Strengths and Difficulties Questionnaire (SDQ) was administrated to teachers and parents along with a socio-demographic questionnaire.

RESULTS

Suicidal ideation was present in 16.96% of the sample (from 9.9 in Italy to 26.84 in Germany), death thoughts by 21.93% (from 7.71% in Italy to 32.78 in Germany). SI and DT were more frequent in single-parent families and large families. Externalizing disorders were strongly correlated with SI and DT after controlling for other factors and this was true for internalizing disorders only when reported by the children.

CONCLUSION

Recognizing suicidal ideation in young children may be recommended as part of preventive strategies such as screening in the context of the presence of any mental health problems whether externalizing or internalizing.

Frequency and correlates of suicidal ideation in pediatric obsessive-compulsive disorder

This study examined the frequency and sociodemographic and clinical correlates of suicidal ideation in a sample of children and adolescents with obsessive-compulsive disorder (OCD). Fifty-four youth with OCD and their parent(s) were administered the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime, Children's Yale-Brown Obsessive Compulsive Scale, and Children's Depression Rating Scale-Revised. Children completed the Suicidal Ideation Questionnaire-Junior (SIQ-JR), Child Obsessive Compulsive Impact Scale-Child, and Multidimensional Anxiety Scale for Children; parents completed the Child Obsessive Compulsive Impact Scale-Parent, Swanson, Nolan, and Pelham-IV Parent Scale, and Young Mania Rating Scale-Parent Version. Seven youth endorsed clinically significant levels of suicidal ideation on the SIQ-JR. Suicidal ideation was significantly related to clinician-rated depressive symptoms, age, child-rated impairment and anxiety symptoms, and symmetry, sexuality/religiosity and miscellaneous symptom dimensions. There was no significant association between suicidal ideation and obsessive-compulsive symptom severity, comorbidity patterns, or several parent-rated indices (e.g., impairment, impulsivity). These results provide initial information regarding the frequency and correlates of suicidal ideation in treatment-seeking youth with OCD. Clinical implications are discussed, as well as directions for future research.

Exploring Helpful Nursing Care in Pediatric Mental Health Settings: The Perceptions of Children with Suicide Risk Factors and Their Parents

This qualitative descriptive study explored helpful nursing care from the perspective of children with suicide-associated risk factors, and their parents. Data were collected through participant observation followed by a debriefing session with children, and semi-structured interviews with parents. The inductive analysis revealed four themes of helpful interventions: (1) caring for the child as a special person; (2) caring for the parents; (3) managing the child's illness; and (4) creating a therapeutic environment. The study findings highlight the importance of the relational aspect of nursing care and provide important insights related to family-centered and strengths-based practice with children at increased risk for suicide later in life.