Psychiatric diagnosis in child and adolescent suicide

The association between depressive symptoms and physical status including physical activity, aerobic and muscular fitness tests in children

OBJECTIVES

The aims of the study were to explore the association between depressive symptoms (DS), physical activity (PA), aerobic and muscular fitness in a sample of children.

METHODS

Four hundred and fifty-six schoolboys aged 7-11-year-old underwent standard anthropometry and various physical fitness tests (e.g., aerobic fitness, strength, speed, power, agility and flexibility). DS and PA were obtained by questionnaires.

RESULTS

After adjustment for potential confounders (e.g., age, socioeconomic status and adiposity), PA was significantly and negatively related to DS (P < 0.05). Among the physical fitness tests, just time in one-mile run/walk was significantly related to DS (P < 0.05).

CONCLUSION

Physical activity and aerobic fitness were significantly correlated with DS; however, no significant relationship was observed between DS and the muscular fitness tests in the children.

Demographic and clinical correlates of suicidality in adolescents attending a specialist community mental health service: a naturalistic study

BACKGROUND

Adolescents comprise a unique and often challenging group of patients with diverse presentations to the Mental Health Services; suicidal behavior being one of them.

AIMS

The main aim of this naturalistic project was to investigate demographic and clinical correlates of adolescent suicidal and self-harm events, which may be of value to decision-making in clinical practice.

METHOD

All adolescents (n = 149) registered and actively managed by a specialist community mental health service in South London were included in the study. Clinical information from their files was used to determine suicidality/self-harm events. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) was utilised for classification purposes. Logistic regression was used to explore the effects of age, sex, diagnosis, medication, substance use (alcohol and/or cannabis) and ethnicity on suicidality/self-harming behaviors.

RESULTS

Age, sex and use of psychotropic medication were identified to play a significant role in determining the risk of engaging in self-harming behavior. The risk was higher with increasing age and female sex. Medication seemed to have a protective effect. Reporting a 20% prevalence of non-suicidal self-injury (NSSI) in our population, we highlight the importance of NSSI as a distinct diagnostic category.

CONCLUSIONS

Our findings have implications for risk assessment and appropriate decision-making in clinical settings. Results are translatable and relevant to other metropolitan areas.

Intra-personal and extra-personal predictors of suicide attempts of South Korean adolescents

The purpose of this study was to explore significant variables predicting adolescent suicidal attempts. Socio-environmental variables such as gender, school record, school grade, school adaptation, and family intimacy together with intra-individual variables including depression, anxiety, delinquency, stress, and self-esteem were considered as candidates. Data from 1481 adolescents were collected from Korea National Youth Policy Institute. For statistical analyses, hierarchical logistic regression analysis was performed. Results of hierarchical logistic regression analysis showed that gender, school grade, depression, delinquent, stress, and family intimacy were significant predictors of suicidal attempts of adolescents. Among those, the most powerful predictor was depression, and the second was delinquency. Classification accuracy by the model of our study was 87.6%. Implications and limitations of present study and suggestions for future study were discussed.

Sleep problems and suicide attempts among adolescents: a case-control study

This study used a case-control design to compare sleep disturbances in 40 adolescents who attempted suicide with 40 never-suicidal adolescents. Using hierarchical logistic regression analyses, we found that self-reported nighttime awakenings were significantly associated with attempted suicide, after controlling for antidepressant use, antipsychotic use, affective problems, and being bullied. In a separate regression analysis, the parent-reported total sleep problems score also predicted suicide attempt status, controlling for key covariates. No associations were found between suicide attempts and other distinct sleep problems, including falling asleep at bedtime, sleeping a lot during the day, trouble waking up in the morning, sleep duration, and parent-reported nightmares. Clinicians should be aware of sleep problems as potential risk factors for suicide attempts for adolescents.

Ethnic Differences in Correlates of Suicidal Behavior Among Women Seeking Help for Intimate Partner Violence

Abstract. Background: Women abused by an intimate partner are at risk of engaging in nonfatal suicidal behavior and suicidal communication (NSBSC). No studies have examined ethnic differences in correlates of NSBSC among abused women. Aims: This secondary data analytic study examined whether correlates of NSBSC previously reported among a mixed ethnic sample of women seeking help for abuse by a male intimate partner differed for those who self-identified as Latina (N = 340), African American (N = 184), or European American (N = 67). Method: Logistic regression was used to examine correlates of NSBSC separately among Latina, African American, and European American women. Results: More severe violence by a male intimate partner, having a chronic or disabling illness, being younger, and being unemployed were positively associated with NSBSC in bivariate analyses among Latina women, but unemployment did not remain significantly associated with NSBSC in the multiple logistic regression. There were no significant correlates of NSBSC for African American women. Having a chronic illness was significantly associated with NSBSC among European American women. Conclusion: Findings suggest the need for culturally tailored suicide prevention interventions and studies that examine risk and protective factors for NSBSC among a diversity of women abused by male intimate partners

The role of the kynurenine pathway in suicidality in adolescent major depressive disorder

The neuroimmunological kynurenine pathway (KP) has been implicated in major depressive disorder (MDD) in adults and adolescents, most recently in suicidality in adults. The KP is initiated by the enzyme indoleamine 2,3-dioxygenase (IDO), which degrades tryptophan (TRP) into kynurenine (KYN) en route to neurotoxins. Here, we examined the KP in 20 suicidal depressed adolescents-composed of past attempters and those who expressed active suicidal intent-30 non-suicidal depressed youth, and 22 healthy controls (HC). Plasma levels of TRP, KYN, 3-hydroxyanthranilic acid (3-HAA), and KYN/TRP (index of IDO) were assessed. Suicidal adolescents showed decreased TRP and elevated KYN/TRP compared to both non-suicidal depressed adolescents and HC. Findings became more significantly pronounced when excluding medicated participants, wherein there was also a significant positive correlation between KYN/TRP and suicidality. Finally, although depressed adolescents with a history of suicide attempt differed from acutely suicidal adolescents with respect to disease severity, anhedonia, and suicidality, the groups did not differ in KP measures. Our findings suggest a possible specific role of the KP in suicidality in depressed adolescents, while illustrating the clinical phenomenon that depressed adolescents with a history of suicide attempt are similar to acutely suicidal youth and are at increased risk for completion of suicide.

Genetic sensitivity to emotional cues, racial discrimination and depressive symptoms among African-American adolescent females

Psychosocial stress, including stress resulting from racial discrimination (RD), has been associated with elevated depressive symptoms. However, individuals vary in their reactivity to stress, with some variability resulting from genetic differences. Specifically, genetic variation within the linked promoter region of the serotonin transporter gene (5-HTTLPR) is related to heightened reactivity to emotional environmental cues. Likewise, variations within this region may interact with stressful life events (e.g., discrimination) to influence depressive symptoms, but this has not been empirically examined in prior studies. The objective of this study was to examine whether variation in the 5-HTTLPR gene interacts with RD to predict depressive symptoms among a sample of African-American adolescent females. Participants were 304 African-American adolescent females enrolled in a sexually transmitted disease prevention trial. Participants completed a baseline survey assessing psychosocial factors including RD (low vs. high) and depressive symptomatology (low vs. high) and provided a saliva sample for genotyping the risk polymorphism 5-HTTLPR (s allele present vs. not present). In a logistic regression model adjusting for psychosocial correlates of depressive symptoms, an interaction between RD and 5-HTTLPR group was significantly associated with depressive symptomatology (AOR = 3.79, 95% CI: 1.20-11.98, p = 0.02). Follow-up tests found that high RD was significantly associated with greater odds of high depressive symptoms only for participants with the s allele. RD and 5-HTTLPR status interact to differentially impact depressive symptoms among African-American adolescent females. Efforts to decrease depression among minority youth should include interventions which address RD and strengthen factors (e.g., coping, emotion regulation, building support systems) which protect youth from the psychological costs of discrimination.

Assessment of suicidal youth in the emergency department

Accurate evaluation of suicidal adolescents in the emergency department (ED) is critical for safety and linkage to follow-up care. We examined self-reports of 181 adolescents who presented to an ED with suicidal ideation (SI) or a suicide attempt (SA). Parents also completed self-reports. Results showed fair agreement between parents and youth on the reason for the ED visit (e.g., SI vs. SA) and greater agreement between independent judges and youths than between judges and parents. In accordance with accepted definitions of suicide attempts (e.g., Crosby, Ortega, & Melanson, 2011; O'Carroll, Berman, Maris, Moscicki, Tanney, & Silverman, 1996, p. 237; Posner, Oquendo, Gould, Stanley, & Davies, 2007, p. 1035; Silverman, Berman, Sanddal, O'Carroll, & Joiner, 2007, p. 248), most youth with SA as the reason for the ED visit reported some intent to die associated with the attempt. Finally, youth presenting to the ED with SA did not differ clinically from youth presenting with SI, and almost half of youths with SI reported past suicide attempts. These results highlight the need to emphasize adolescents' reports in clinical decision making, suggest adolescents' defined suicide attempts similarly to published definitions, and show that assessment of past SAs, as well as present suicidal thoughts and behaviors, is critical in determining future risk.

Suicidal risk and sexual orientation in adolescence: a population-based study in Iceland

AIM

Suicidality is an important public health problem, particularly among lesbian, gay, and bisexual (LGB) adolescents and young adults. The purpose of the present study is to compare the rate of suicide ideations and attempts among LGB adolescent to that of non-LGB adolescents in a population-based sample, and to identify important protective factors as well as risk factors Method: We used the Icelandic data set from the 2009/2010 Health Behaviour in School-aged Children (HBSC) study. The sample consisted of 3813 grade 10 Icelandic adolescents; 1876 girls and 1937 boys. The participants were asked about attraction and/or activity, as well as about suicidal ideation and/or attempts. The questionnaire also included various other items regarding health and lifestyle.

RESULTS

LGB adolescents were five to six times more likely to have had frequent suicidal ideations. Factors that were associated with less suicide ideations and fewer attempts were easy communication and liking school. The LGB girls were six times more likely to have had frequent suicide attempts, whilst the LGB boys were 17 times more likely to have attempted suicide that often. No specific protective or risk factors were identified for suicidality in LGB adolescents other than bullying.

CONCLUSIONS

Adolescents that had engaged in heterosexual activity and those that had LGB attraction had similarly heightened risk for suicidality, but sexually active LGB adolescents were far more likely to have suicidal ideations or to have attempted suicide.

Primary care provider training in screening, assessment, and treatment of adolescent depression

OBJECTIVE

Adolescent depression is underrecognized and undertreated. Primary care providers (PCP) require training to successfully identify adolescents with depression. We examined the effects of a PCP training program in the screening, assessment, and treatment of adolescent depression (SAT-D) on adolescents' reports of PCP screening for adolescent depression at annual well visits and PCP SAT-D confidence and knowledge.

METHODS

PCP (n = 31) attended one SAT-D training program consisting of a 60-minute SAT-D seminar and a 60-minute standardized patient session where PCP practiced SAT-D skills. A pre-post design evaluated effects of training on PCP depression screening practices as reported by 3 groups of adolescent patients at well visits (n = 582 before, n = 525 at 2 to 8 months after training, n = 208 at 18 to 24 months after training). A generalized linear mixed effects logistic regression controlled for provider and patient demographics that may have influenced depression screening. PCP SAT-D self-reported confidence and objectively tested knowledge were assessed at baseline, immediately after training, and at 4 to 6 months after training.

RESULTS

On the basis of the regression analysis, PCP screening for adolescent depression increased significantly from pretraining (49%) to 2 to 8 months after training (68%, odds ratio 2.78, 95% confidence interval 2.10-3.68) and 18 to 24 months after training (74%, odds ratio 3.17, 95% confidence interval 2.16-4.67; both P < .0001). PCP SAT-D confidence and knowledge also significantly improved.

CONCLUSIONS

PCP SAT-D training resulted in significant increases in primary care screening for adolescent depression that were maintained up to 24 months after training. Future studies should determine if changes in PCP screening improve identification of adolescent depression and patient outcomes for adolescents with depression.

Comorbid Adolescent Difficulties: Social Work Prevention of Delinquency and Serious Youthful Offending

A majority of adolescents who are formally involved with the juvenile courts and detained or incarcerated are dealing with past or present maltreatment victimization, learning disabilities, and/or mental health/substance abuse difficulties. Addressing these problems and traumas is an integral part of preventing delinquency and breaking a youthful offender's recidivist cycle, a pattern that often predicts adult offending and incarceration. Fortunately, there are effective programs across the social work profession that decrease or may even eliminate delinquent behaviors, both for low-level and more serious youthful offenders. Unfortunately, the use of these social work preventative programs is not consistent or extensive within the juvenile justice system.

A prospective examination of the interpersonal-psychological theory of suicidal behavior among psychiatric adolescent inpatients

The challenge of identifying suicide risk in adolescents, and particularly among high-risk subgroups such as adolescent inpatients, calls for further study of models of suicidal behavior that could meaningfully aid in the prediction of risk. This study examined how well the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS)--with its constructs of thwarted belongingness (TB), perceived burdensomeness (PB), and an acquired capability (AC) for lethal self-injury--predicts suicide attempts among adolescents (N = 376) 3 and 12 months after hospitalization. The three-way interaction between PB, TB, and AC, defined as a history of multiple suicide attempts, was not significant. However, there were significant 2-way interaction effects, which varied by sex: girls with low AC and increasing TB, and boys with high AC and increasing PB, were more likely to attempt suicide at 3 months. Only high AC predicted 12-month attempts. Results suggest gender-specific associations between theory components and attempts. The time-limited effects of these associations point to TB and PB being dynamic and modifiable in high-risk populations, whereas the effects of AC are more lasting. The study also fills an important gap in existing research by examining IPTS prospectively.

Detection and treatment of mental health issues by pediatric PCPs in New York State: an evaluation of Project TEACH

OBJECTIVE

The authors evaluated Project TEACH (PT), a statewide training and consultation program for pediatric primary care providers (PCPs) on identification and treatment of mental health conditions.

METHODS

An intervention group of 176 PCPs who volunteered for PT training was compared with a stratified random sample of 200 PCPs who did not receive PT training. Data on prescription practices, diagnoses, and follow-up care were from New York State Medicaid files (2009-2013) for youths seen by the trained (N=21,784) and untrained (N=46,607) PCPs.

RESULTS

The percentage of children prescribed psychotropic medication increased after PT training (9% to 12%, p<.001), a larger increase than in the untrained group (4% to 5%, p<.001) (comparison, p<.001). Fewer differences were noted in diagnoses and in medication use and follow-up care among children with depression.

CONCLUSIONS

This intervention may have an impact on providers' behaviors, but further research is needed to clarify its effectiveness.

Impulsive aggression, delay discounting, and adolescent suicide attempts: effects of current psychotropic medication use and family history of suicidal behavior

OBJECTIVE

Impulsive-aggressive behaviors have been consistently implicated in the phenomenology, neurobiology, and familial aggregation of suicidal behavior. The purpose of this study was to extend previous work by examining laboratory behavioral measures of delayed reward impulsivity and impulsive aggression in adolescent suicide attempters and never-suicidal comparison subjects.

METHODS

Using the Point Subtraction Aggression Paradigm (PSAP) and the Delay Discounting Task (DDQ), the authors examined delay discounting and impulsive aggression in 40 adolescent suicide attempters, ages 13-18, and 40 never-suicidal, demographically matched psychiatric comparison subjects.

RESULTS

Overall, suicide attempters and comparison subjects performed similarly on the PSAP and DDQ. There was a significant group by current psychotropic medication use interaction (p=0.013) for mean aggressive responses on the PSAP. Group comparisons revealed that attempters emitted more aggressive responses per provocation than comparison subjects, only in those not on psychotropic medication (p=0.049), whereas for those currently treated with psychotropic medication, there were no group differences (p>0.05). This interaction effect was specific to current antidepressant use. Among all subjects, family history of suicidal behavior (suicide or suicide attempt) in first degree relatives was significantly correlated with both delay discounting (r=-0.22, p=0.049), and aggressive responding (r=0.27, p=0.015). Family history of suicidal behavior was associated with delay discounting, but not with aggressive responding on the PSAP, after controlling for relevant covariates.

CONCLUSIONS

In this study, impulsive-aggressive responding was associated with suicide attempt only in those not being treated with antidepressants. Future work to replicate and extend these findings could have important therapeutic implications for the treatment of depressed suicide attempters, many of whom are affected by impulsive aggression.

Identifying adolescents at highly elevated risk for suicidal behavior in the emergency department

OBJECTIVE

The feasibility and concurrent validity of adolescent suicide risk screening in medical emergency departments (EDs) has been documented. The objectives of this short-term prospective study of adolescents who screened positive for suicide risk in the ED were: 1) to examine adolescents' rate of suicidal behavior during the 2 months following their ED visits and compare it with reported rates for psychiatric samples; and 2) to identify possible predictors of acute risk for suicidal behavior in this at-risk sample.

METHOD

Participants were 81 adolescents, ages 14-19 years, seeking services for psychiatric and nonpsychiatric chief complaints, who screened positive for suicide risk because of recent suicidal ideation, a suicide attempt, and/or depression plus alcohol or substance misuse. A comprehensive assessment of suicidal behavior, using the Columbia-Suicide Severity Rating Scale, was conducted at baseline and 2 month follow-up.

RESULTS

Six adolescents (7.4%) reported a suicide attempt and 15 (18.5%) engaged in some type of suicidal behavior (actual, aborted, or interrupted suicide attempt; preparatory behavior) during the 2 months following their ED visit. These rates suggest that this screen identified a high-risk sample. Furthermore, adolescents who screened positive for suicidal ideation and/or attempt plus depression and alcohol/substance misuse were most likely to engage in future suicidal behavior (38.9%).

CONCLUSIONS

In this study, use of a higher screen threshold (multiple suicide risk factors) showed promise for identifying highly elevated acute risk for suicidal behavior.

Prevalence and correlates of depression, posttraumatic stress disorder, and suicidality in Jordanian youth in institutional care

Youth in institutional care centers have higher mental illness rates compared with community populations. Research examining mental illness among youth in institutional care in the Middle East is lacking. This study examines the prevalence and correlates of depression, posttraumatic stress disorder (PTSD), and suicidality of youth in institutional care in Jordan. Data were collected through youth interviews, staff-caregiver surveys, and administrative files. Prevalence rates and logistic regressions were used to model suicidality across depression, PTSD, and comorbid depression/PTSD, controlling for youth characteristics, case history, and social support factors. Institutionalized youth endorsed high rates of mental illness (45% depression, 24% PTSD, 17% depression/PTSD, 27% suicidality). The odds of suicidality for depressed youth were 3.6 times higher. Abuse was significant, with the odds of suicidality for abused youth 4 times higher. Elevated rates of mental illness and suicidality indicate the importance of addressing these needs within institutions. Developing institutional programs that foster peer relationships is recommended.

Duration of U.S. residence and suicidality among racial/ethnic minority immigrants

PURPOSE

The immigration experience embodies a range of factors including different cultural norms and expectations, which may be particularly important for groups who become racial/ethnic minorities when they migrate to the U.S. However, little is known about the correlates of mental health indicators among these groups. The primary and secondary aims were to determine the association between duration of U.S. residence and suicidality, and 12-month mood, anxiety, and substance use disorders, respectively, among racial/ethnic minority immigrants.

METHODS

Data were obtained from the National Survey of American Life and the National Latino and Asian American Survey. Multivariable logistic regression was used to determine the association between duration of US residence, and suicidality and 12-month psychopathology.

RESULTS

Among Afro-Caribbeans, there was a modest positive association between duration of U.S. residence and 12-month psychopathology (P linear trend = 0.016). Among Asians there was a modest positive association between duration of US residence and suicidal ideation and attempts (P linear trend = 0.018, 0.063, respectively). Among Latinos, there was a positive association between duration of US residence, and suicidal ideation, attempts and 12-month psychopathology (P linear trend = 0.001, 0.012, 0.002, respectively). Latinos who had been in the U.S. for >20 years had 2.6 times greater likelihood of suicidal ideation relative to those who had been in the U.S. for <5 years (95% CI 1.01-6.78).

CONCLUSIONS

The association between duration of US residence and suicidality and psychopathology varies across racial/ethnic minority groups. The results for Latino immigrants are broadly consistent with the goal-striving or acculturation stress hypothesis.

Familial pathways to early-onset suicide attempt: a 5.6-year prospective study

IMPORTANCE

Suicide attempts are strong predictors of suicide, a leading cause of adolescent mortality. Suicide attempts are highly familial, although the mechanisms of familial transmission are not understood. Better delineation of these mechanisms could help frame potential targets for prevention.

OBJECTIVE

To examine the mechanisms and pathways by which suicidal behavior is transmitted from parent to child.

DESIGN, SETTING, AND PARTICIPANTS

In this prospective study conducted from July 15, 1997, through June 21, 2012, a total of 701 offspring aged 10 to 50 years (mean age, 17.7 years) of 334 clinically referred probands with mood disorders, 191 (57.2%) of whom had also made a suicide attempt, were followed up for a mean of 5.6 years.

MAIN OUTCOMES AND MEASURES

The primary outcome was a suicide attempt. Variables were examined at baseline, intermediate time points, and the time point proximal to the attempt. Participants were assessed by structured psychiatric assessments and self-report and by interview measures of domains hypothesized to be related to familial transmission (eg, mood disorder and impulsive aggression).

RESULTS

Among the 701 offspring, 44 (6.3%) had made a suicide attempt before participating in the study, and 29 (4.1%) made an attempt during study follow-up. Multivariate logistic regression revealed that proband suicide attempt was a predictor of offspring suicide attempt (odds ratio [OR], 4.79; 95% CI, 1.75-13.07), even controlling for other salient offspring variables: baseline history of mood disorder (OR, 4.20; 95% CI, 1.37-12.86), baseline history of suicide attempt (OR, 5.69; 95% CI, 1.94-16.74), and mood disorder at the time point before the attempt (OR, 11.32; 95% CI, 2.29-56.00). Path analyses were consistent with these findings, revealing a direct effect of proband attempt on offspring suicide attempt, a strong effect of offspring mood disorder at each time point, and impulsive aggression as a precursor of mood disorder.

CONCLUSIONS AND RELEVANCE

Parental history of a suicide attempt conveys a nearly 5-fold increased odds of suicide attempt in offspring at risk for mood disorder, even after adjusting for the familial transmission of mood disorder. Interventions that target mood disorder and impulsive aggression in high-risk offspring may attenuate the familial transmission of suicidal behavior.

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.

Annual report on health care for children and youth in the United States: national estimates of cost, utilization and expenditures for children with mental health conditions

OBJECTIVE

To examine national trends in hospital utilization, costs, and expenditures for children with mental health conditions.

METHODS

The analyses of children aged 1 to 17 are based on AHRQ's 2006 and 2011 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) databases, and on AHRQ's pooled 2006 to 2011 Medical Expenditure Panel Survey (MEPS). All estimates are nationally representative, and standard errors account for the complex survey designs.

RESULTS

Although overall all-cause children's hospitalizations did not increase between 2006 and 2011, hospitalizations for all listed mental health conditions increased by nearly 50% among children aged 10 to 14 years, and by 21% for emergency department (ED) visits. Behavioral disorders experienced a shift in underlying patterns between 2006 and 2011: inpatient stays for alcohol-related disorders declined by 44%, but ED visits increased by 34% for substance-related disorders and by 71% for impulse control disorders. Inpatient visits for suicide, suicidal ideation, and self-injury increased by 104% for children ages 1 to 17 years, and by 151% for children ages 10 to 14 years during this period. A total of $11.6 billion was spent on hospital visits for mental health during this period. Medicaid covered half of the inpatient visits, but with 50% to 30% longer length of stays in 2006 and 2011, respectively, than private payers. Medicaid's overall share of the ED visits increased from 45% in 2006 to 53% in 2011.

CONCLUSIONS

These alarming trends highlight the renewed need for research on mental health care for children. This study also provides a baseline for evaluating the impact of the Affordable Care Act and the mental health parity legislation on mental health utilization and expenditures for children.

Prevalence and correlates of attention-deficit hyperactivity disorder symptoms in Korean college students

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) persists into adulthood in a high proportion of cases, causing social difficulties and affective problems. We evaluated the prevalence of symptoms of ADHD and the correlates thereof in Korean college students.

METHODS

A total of 2,172 college students, stratified to reflect geographical differences, were asked to complete self-report questionnaires on ADHD symptoms, depression, and related factors.

RESULTS

ADHD symptoms were found in 7.6% of college students. Univariate analysis revealed that younger students had higher rates of ADHD symptoms than did older students. We found significant associations between ADHD symptoms and problematic alcohol use, depression, and lifetime suicidal behavior. Multivariate analysis revealed that ADHD symptoms in adults were significantly associated with depression (odds ratio [OR] =4.69; 95% confidence interval [CI] 3.23-6.80; P<0.001) and overweight or obesity (OR =1.50; 95% CI 1.02-2.22; P=0.040), after controlling for sex and age.

CONCLUSION

These results have implications in terms of the mental health interventions required to assess problems such as depression, alcohol use, obesity, and suicidality in young adults with ADHD symptoms.

Age-related differences in suicidality between young people and older adults with depression: data from a nationwide depression cohort study in Korea (the CRESCEND study)

This study compared young people and older adults with depression to identify differences in suicidality between these groups. A total of 1003 patients with moderate to severe depression (Hamilton Depression Rating Scale [HDRS] score ≥14) were recruited from a national sample of 18 hospitals. Of the patients included in this study, 103 (10.3%) were placed in the younger group (age <25years) and 900 (89.7%) were placed in the older group (age ≥25years). Suicide-related variables and predictive factors associated with significant suicidal ideation were compared between the two groups. Regardless of the severity of depression, subjects in the younger group were more likely than were those in the older group to report significant suicidal ideation (scores ≥6 on the Beck Scale for Suicide Ideation [SSI-B], 79.6 vs. 53.7%, respectively; p<0.001), have had a suicide attempt at the current episode (4.9 vs. 1.6%, respectively; p=0.037), and have a history of suicide attempts (43.7 vs. 19.4%, respectively; p<0.001). Logistic regression models revealed that, in contrast to the predictive factors in the older group, subjects in the younger group were more affected by their history of suicide attempts (OR [95% CI]: 12.4, [1.5-99.1]; p=0.018) and depressive episodes (OR [95% CI]: 13.0, [1.6-104.0]; p=0.016). Also in contrast to the older group, an increase in HDRS score was not identified as a possible precipitating factor of significant suicidal ideation in younger subjects. The present findings demonstrate that suicidality in depressed young people was more severe than in older adults, but that suicidality was not correlated with the severity of depression. These data suggest that close attention should be paid to young people even in mild or moderate depression.

Challenges of managing pediatric mental health crises in the emergency department

Children with mental health problems are increasingly being evaluated and treated in pediatric clinical settings. This article focuses on the epidemiology, evaluation, and management of the 2 most common pediatric mental health emergencies, suicidal and homicidal/aggressive patients, as well as the equally challenging population of children with autism or other developmental disabilities.

Suicide in Children: A Systematic Review

The objective of this study was to provide a review of studies on suicide in children aged 14 years and younger. Articles were identified through a systematic search of Scopus, MEDLINE, and PsychINFO. Key words were "children, suicide, psychological autopsy, and case-study." Additional articles were identified through manual search of reference lists and discussion with colleagues. Fifteen published articles were identified, 8 psychological autopsy studies (PA), and 7 retrospective case-study series. Suicide incidence and gender asymmetry increases with age. Hanging is the most frequent method. Lower rates of psychopathology are evident among child suicides compared to adolescents. Previous suicide attempts were an important risk factor. Children were less likely to consume alcohol prior to suicide. Parent-child conflicts were the most common precipitant.

Rethinking Adolescent Inpatient Psychiatric Care: The Importance of Integrated Interventions for Suicidal Youth With Substance Use Problems

Adolescents psychiatrically hospitalized following a suicide attempt are at high risk for a repeat attempt or suicide completion, and substance use is consistently implicated as a risk factor for continued suicidal behavior in adolescents. Despite this knowledge, there have been few studies that have investigated the effectiveness of combined suicidality and substance use interventions within acute psychiatric care settings for suicidal youth with substance use problems. While social workers are well-positioned to deliver such interventions, greater emphasis on teaching integrated therapeutic techniques in social work curriculum and professional training is needed to ensure their implementation.

Suicide risks among adolescents and young adults in rural China

Background: In China, suicide is one of the major causes of death among adolescents and young adults aged 15 to 34 years. Aim: The current study examines how risk factors vary by age groups in rural China, referring to those aged 15 to 24 years and those aged 25 to 34 years. Method: A case-control psychological autopsy (PA) study is conducted in sixteen counties from three Chinese provinces, including 392 suicide cases and 416 community living controls in the sample. Results: In China, young adults aged 25 to 34 years have a higher risk for suicide than adolescents aged 15 to 24 years, and it holds true even controlling for relevant social factors. In addition, age-related factors such as education, marital status, whether having children, status in the family, physical health, and personal income all have varying degrees of impact on suicide risks for rural youth. Conclusions: This study shows that there are some age-related risk factors for suicide at certain life stages and emphasizes that young adults in rural China aged 25 to 34 years have an increased risk of suicide as a result of experiencing more psychological strains with age.

Antecedents and sex/gender differences in youth suicidal behavior

Suicide is the second leading cause of death in youth globally; however, there is uncertainty about how best to intervene. Suicide rates are typically higher in males than females, while the converse is true for suicide attempts. We review this "gender paradox" in youth, and in particular, the age-dependency of these sex/gender differences and the developmental mechanisms that may explain them. Epidemiologic, genetic, neurodevelopmental and psychopathological research have identified suicidal behaviour risks arising from genetic vulnerabilities and sex/gender differences in early adverse environments, neurodevelopment, mental disorder and their complex interconnections. Further, evolving sex-/gender-defined social expectations and norms have been thought to influence suicide risk. In particular, how youth perceive and cope with threats and losses (including conforming to others' or one's own expectations of sex/gender identity) and adapt to pain (through substance use and help-seeking behaviours). Taken together, considering brain plasticity over the lifespan, these proposed antecedents to youth suicide highlight the importance of interventions that alter early environment(s) (e.g., childhood maltreatment) and/or one's ability to adapt to them. Further, such interventions may have more enduring protective effects, for the individual and for future generations, if implemented in youth.

Educational interventions for general practitioners to identify and manage depression as a suicide risk factor in young people: a systematic review and meta-analysis protocol

BACKGROUND

Suicide is a major public health problem and globally is the second leading cause of death in young adults. Globally, there are 164,000 suicides per year in young people under 25 years. Depression is a strong risk factor for suicide. Evidence shows that 45% of those completing suicide, including young adults, contact their general practitioner rather than a mental health professional in the month before their death. Further evidence indicates that risk factors or early warning signs of suicide in young people go undetected and untreated by general practitioners. Healthcare-based suicide prevention interventions targeted at general practitioners are designed to increase identification of at-risk young people. The rationale of this type of intervention is that early identification and improved clinical management of at-risk individuals will reduce morbidity and mortality. This systematic review will synthesise evidence on the effectiveness of education interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people.

METHODS/DESIGN

We shall conduct a systematic review and meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions guidelines and conform to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases will be systematically searched for randomised controlled trials and quasi-experimental studies investigating the effectiveness of interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people in comparison to any other intervention, no intervention, usual care or waiting list. Grey literature will be searched by screening trial registers. Only studies published in English will be included. No date restrictions will be applied. Two authors will independently screen titles and abstracts of potential studies. The primary outcome is identification and management of depression. Secondary outcomes are suicidal ideation, suicide attempts, deliberate self-harm, knowledge of suicide risk factors and suicide-related behaviours, attitudes towards suicide risk and suicide-related behaviours, confidence in dealing with suicide risk factors and suicide-related behaviour.

DISCUSSION

Our study will inform the development of future education interventions and provide feasibility and acceptability evidence, to help general practitioners identify and manage suicidal behaviour in young people.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42014009110.

Understanding the role of adjunctive nonpharmacological therapies in management of the multiple pathways to depression

Major depressive disorder (MDD) is a common disorder with a lifetime prevalence of 16.2% and the fourth highest cause of disability globally. It is hypothesized to be a syndromatic manifestation of multiple pathological processes leading to similar clinical manifestation. MDD is associated with at least three categories of peripheral hormone-type factors including neurotrophic factors, proinflammatory cytokines, and processes that impair regulation of the hypothalamic-pituitary-adrenocortical axis. Neuroimaging studies have identified functional abnormalities including subcortical systems associated with reward and emotion processing, medial prefrontal and anterior cingulate cortical regions and the lateral prefrontal cortical systems involved in cognitive control and voluntary emotion regulation. Studies investigating the effects of psychotherapy and pharmacotherapy on functional brain measures show normalization of brain function with return to euthymia. Nevertheless, approximately 50% of patients with MDD will not respond sufficiently and 60 to 70% will not achieve full remission with first-line pharmacotherapy, therefore clinicians strive to improve patient responses through the use of adjunct therapies. This review discusses recent research in the various biological processes associated with MDD as well as recent data in support of the use of adjunctive non-pharmacological therapies including psychotherapy, bibliotherapy, Internet therapy, "natural" or herbal approaches, exercise therapy, and somatic therapies.

Mediating effects of stress, weight-related issues, and depression on suicidality in college students

OBJECTIVE

Through a holistic health lens, the current study examines the effects of weight-related issues and stress on suicidality while controlling for depressive symptoms in college students.

PARTICIPANTS

In total, 872 undergraduate and graduate students at DePaul University completed the American College Health Association-National College Health Assessment II Web-based survey in Spring 2010.

METHODS

Measures of suicidality, depression, weight-related issues, and life stressors were assessed, along with gender differences.

RESULTS

Females reported experiencing more weight loss attempts and total stressors than males. Weight-related issues and stress both significantly predicted depressive symptoms in a path analysis; depressive symptoms, in turn, significantly predicted suicidality. Gender differences were found; depressive symptoms mediate the relation between stress and suicidal behavior for females but not for males.

IMPLICATIONS

This investigation furthers previous research on suicidality in college students and suggests that all-inclusive interventions that address weight-related issues and stress may help reduce depressive symptoms, which then may reduce suicidal behavior.

Development of practice principles for the management of ongoing suicidal ideation in young people diagnosed with major depressive disorder

OBJECTIVES

There is a lack of clear guidance regarding the management of ongoing suicidality in young people experiencing major depressive disorder. This study utilised an expert consensus approach in identifying practice principles to complement relevant clinical guidelines for the treatment of major depressive disorder in young people. The study also sought to outline a broad treatment framework for clinical intervention with young people experiencing ongoing suicidal ideation.

METHODS

In-depth focus groups were undertaken with a specialist multidisciplinary clinical team (the Youth Mood Clinic at Orygen Youth Health Clinical Program, Melbourne) working with young people aged 15-25 years experiencing ongoing suicidal ideation. Each focus group was audio recorded and transcribed verbatim using orthographic conventions. Principles of grounded theory and thematic analysis were used to analyse and code the resultant data.

RESULTS

The identified codes were subsequently synthesised into eight practice principles reflecting engagement and consistency of care, ongoing risk assessment and documentation, individualised crisis planning, engaging systems of support, engendering hopefulness, development of adaptive coping, management of acute risk, and consultation and supervision.

CONCLUSIONS

The identified practice principles provide a broad management framework, and may assist to improve treatment consistency and clinical management of young people experiencing ongoing suicidal ideation. The practice principles may be of use to health professionals working within a team-based setting involved in the provision of care, even if peripherally, to young people with ongoing suicidal ideation. Findings address the lack of treatment consistency and shared terminology and may provide containment and guidance to multidisciplinary clinicians working with this at-risk group.

Suicidal behaviors in adolescents with ADHD: associations with depressive and other comorbidity, parent-child conflict, trauma exposure, and impairment

OBJECTIVE

To examine potential predictors of lifetime suicidal behaviors (SBs) in adolescents with ADHD.

METHOD

Participants were 101 adolescents with ADHD aged 11 to 18 years, evaluated for lifetime SB and psychopathology with semistructured interviews, and for lifetime trauma exposure, parent-child conflict, ADHD symptoms, and functional impairment with child, parent, and teacher ratings.

RESULTS

Controlling for the effects of age, female sex, and comorbid depressive and other disorders, lifetime SB (n = 28) remained significantly associated (p = .001) with parent-child conflict, and to a lesser extent (p < .05) with impairment in nonacademic domains of function and breadth of exposure to victimization events. Measures related to past and current ADHD symptoms and signs were not associated with lifetime SB.

CONCLUSION

Apart from depression, clinicians should pay particular attention to parent-child conflict, victimization trauma, and social impairment rather than levels of ADHD symptoms when weighing the likelihood of SB in youth with ADHD.

Characteristics of suicidal ideation that predict the transition to future suicide attempts in adolescents

BACKGROUND

The present study sought to examine characteristics of suicidal ideation (SI) that predict a future suicide attempt (SA), beyond psychiatric diagnosis and previous SA history.

METHODS

Participants were 506 adolescents (307 female) who completed the Columbia Suicide Screen (CSS) and selected modules from the Diagnostic Interview Schedule for Children (C-DISC 2.3) as part of a two-stage high school screening and who were followed up 4-6 years later to assess for a SA since baseline. At baseline, participants who endorsed SI on the CSS responded to four questions regarding currency, frequency, seriousness, and duration of their SI. A subsample of 122 adolescents who endorsed SI at baseline also completed a detailed interview about their most recent SI.

RESULTS

Thinking about suicide often (OR = 3.5, 95% CI = 1.7-7.2), seriously (OR = 3.1, 95% CI = 1.4-6.7), and for a long time (OR = 2.3, 95% CI = 1.1-5.2) were associated with a future SA, adjusting for sex, the presence of a mood, anxiety, and substance use diagnosis, and baseline SA history. However, only SI frequency was significantly associated with higher odds of a future SA (OR = 3.6, 95% CI = 1.4-9.1) when also adjusting for currency, seriousness, and duration. Among ideators interviewed further about their most recent SI, ideating 1 hr or more (vs. less than 1 hr) was associated with a future SA (OR = 3.6, 95% CI = 1.0-12.7), adjusting for sex, depressive symptoms, previous SA history, and other baseline SI characteristics, and it was also associated with making a future SA earlier.

CONCLUSIONS

Assessments of SI in adolescents should take special care to inquire about frequency of their SI, along with length of their most recent SI.

Suicide in children and young adolescents: a 25-year database on suicides from Northern Finland

Despite the large amount of research on adolescent suicidality, there are few detailed studies illustrating the characteristics of child and adolescent completed suicide. Our study presents the characteristics of child and adolescent suicides occurring over a period of 25 years within a large geographical area in Northern Finland, with a special focus on gender differences. The study sample included all 58 suicides among children and adolescents (<18 years) occurring in the province of Oulu in Finland between 1988 and 2012. The data is based on documents pertaining to establish the cause of death from forensic autopsy investigations. A register linkage to the data from the Finnish Hospital Discharge Register (FHDR) was also made. 79% of the suicide victims were male. Violent suicide methods predominated in both genders (males 98%, females 83%). While symptoms of mental illness were common, only a minority (15% of males and 17% of females) had a previous history of psychiatric hospitalization. 17% of females but none of the males had been hospitalized previously due to self-poisoning. A greater proportion of females than males had a history of self-cutting (33% vs. 7%) and previous suicide attempts (25% vs. 4%). 48% of males and 58% of females were under the influence of alcohol at the time of their suicide, and alcohol intoxication was related to suicides during the night. One fifth of the adolescents screened positive for substances other than alcohol. The results of this study indicate that there are similarities but also some differences in the characteristics of male and female suicides in adolescents.

Attempted suicide of an adolescent with autism spectrum disorder

Although the suicide risk of autism spectrum disorder (ASD) has been suggested to be higher than previously recognized, there are few case reports focusing on the process for preventing suicide reattempts. We reported that a 17-year-old male who had attempted suicide by jumping was admitted to our emergency department and hospitalized for lumbar spine fracture. In addition to the diagnosis of adjustment disorder, he was diagnosed as ASD according to his life history. This article presents the characteristics of the suicidal behaviors and the process for preventing a suicide reattempt associated with an adolescent with ASD who attempted suicide.

Association among depressive disorder, adjustment disorder, sleep disturbance, and suicidal ideation in Taiwanese adolescent

INTRODUCTION

The aim of this study is to investigate the association among depressive disorder, adjustment disorder, sleep disturbance, and suicidal ideation in Taiwanese adolescent.

METHODS

We recruited 607 students (grades 5-9) to fill out the investigation of basic data and sleep disturbance. Psychiatrists then used the Mini International Neuropsychiatric Interview-Kid to interview these students to assess their suicidal ideation and psychiatric diagnosis. Multiple logistic regression with forward conditionals was used to find the risk factors for multivariate analysis.

RESULTS

Female, age, depressive disorder, adjustment disorder, and poor sleep all contributed to adolescent suicidal ideation in univariate analysis. However, poor sleep became non-significant under the control of depressive disorder and adjustment disorder.

DISCUSSION

We found that both depressive disorder and adjustment disorder play important roles in sleep and adolescent suicidal ideation. After controlling both depressive disorder and adjustment disorder, sleep disturbance was no longer a risk of adolescent suicidal ideation. We also confirm the indirect influence of sleep on suicidal ideation in adolescent.

Follow-up treatment utilization by hospitalized suicidal adolescents

This study examines treatment utilization in a sample of 99 adolescents who were psychiatrically hospitalized due to a risk of suicide and followed for 6 months. Descriptive information regarding participants' use of various forms of outpatient and intensive treatment, including emergency, inpatient, and residential care is presented. In addition, the relationships between utilization of mental health services and various characteristics of the adolescents and their families were assessed. Overall treatment engagement was high, with 78 participants (79%) receiving some care for the duration of the follow-up period and 91 (92%) participating in at least one session of outpatient treatment, although the extent of utilization was highly variable. In addition, 28 participants (28%) were rehospitalized during follow-up. Both family and individual characteristics were associated with differences in adolescents' participation in follow-up treatment. Specifically, adolescents with a family history of mood disorders were more likely to participate in outpatient treatment and less likely to require intensive treatments. Conversely, more impaired baseline functioning and suicide attempts during the follow-up period were associated with greater utilization of intensive treatments and less utilization of outpatient therapy. Given that 19 participants (19%) in our sample attempted suicide during the follow-up interval, the findings of this study suggest that, in spite of high rates of outpatient treatment engagement, rates of suicide attempts and use of intensive treatment services remain high. These results suggest the need for improved outpatient care, as well as possibly longer inpatient stays and more elaborate discharge and transition planning.

Exploring Prospective Predictors of Completed Suicides

Background: This study was based on over 30,000 respondents who completed General Social Surveys between 1978 and 2002. Aims: We approached these respondents prospectively, comparing and contrasting the responses of those who subsequently died by suicide (N = 141) with those who died from all other causes (N = 9,115). Method: We employed chi-square and logistic regression analyses of important demographic confounders to test for statistically significant differences between suicide decedents and all other decedents. Results: Suicide decedents died on average 2 years sooner than all other decedents. When covariates of age and gender were applied, suicide decedents exhibited greater acceptance of suicide for dealing with various adverse life circumstances, were more likely to have been the gun owners in their households, lived in regions where gun ownership was more commonplace, and held less strong religious beliefs and less of a belief of an afterlife. Conclusion: The observed affinity between attitudes of suicide acceptability and completed suicide suggests a potential for creating a meaningful assessment tool to identify those positioned at the extreme end of the suicide risk continuum.

Differences in the quality of life of two groups of drug users

Objectives: The aim of this study was to compare aspects of the quality of life of drug users on a methadone maintenance programme to drug users on a harm minimisation programme.

Method: Thirty-six clients attending the harm minimisation programme in the National Drug Treatment Centre, Dublin, were matched for age and sex to 36 clients on the methadone maintenance programme. All were interviewed with the SF-36 Health Survey Questionnaire to measure health related quality of life and with the Hospital Anxiety and Depression Scale (HADs) to measure psychological morbidity.

Results: More clients from the harm minimisation programme had previous psychiatric problems than clients on the methadone maintenance programme, with an odds ratio of 4.3 CI(1.2,15.2). On the HADs, clients on the methadone maintenance programme had significantly lower depression scores than clients on the harm minimisation programme. In addition more clients on the harm minimisation programme were severely depressed than clients on the methadone maintenance programme. On the UK SF-36 Scale, clients on the harm minimisation programme perceived a significantly greater deterioration in ‘change in health’ over the previous year than clients on the methadone maintenance programme.

Conclusions: Although clients on a methadone maintenance programme had an improved perception of their quality of life in relation to psychological and overall health function from the previous year, compared to clients on a harm minimisation programme, there still existed varying degrees of psychopathology in both groups which need to be considered when providing future services for drug users.

Prevalence of suicide ideation and attempts among Black Americans in later life

This article provides the first national estimates of the prevalence and correlates of nonfatal suicidal behavior among older Black Americans. There is a lack of national data on suicide ideation and attempts across ethnic classifications of Blacks in a nationally representative sample. Data are a subsample from the National Survey of American Life (NSAL), a national U.S. adult household probability sample of 5,191 Black Americans. The WHO Composite International Diagnostic Interview (CIDI) was used to assess older Blacks for nonfatal suicidal behavior and 14 DSM-IV disorders. Bivariate and multivariate logistic regression analyses were employed to delineate patterns and correlates of nonfatal suicidal behavior. The estimated lifetime prevalence of suicidal ideation and attempts among older Blacks in the United States was 6.1% and 2.1%, respectively. On an average it took 2.5 and 5.7 years respectively to go from ideation to attempts or from planning to attempts. Surprisingly, among older Black adults, men reported attempting suicide and seriously consider taking their own lives more than women. Older Blacks at higher risk for suicide attempts were middle aged, had poorer health, were anxious, and had multiple DSM-IV disorders. The results also show that approximately 1 in 4 attempters and 2 in 5 ideators have never sought treatment for their emotional or psychological problems. Preventative care, particularly screening in primary care settings, should consider these findings when treating older Black Americans for psychiatric-related risk.

Prenatal and childhood antecedents of suicide: 50-year follow-up of the 1958 British Birth Cohort study

BACKGROUND

We aimed to elucidate early antecedents of suicide including possible mediation by early child development.

METHOD

Using the 1958 birth cohort, based on British births in March 1958, individuals were followed up to adulthood. We used data collected at birth and at age 7 years from various informants. Suicides occurring up to 31 May 2009 were identified from linked national death certificates. Multivariable Cox proportional hazard models were used to investigate risk factors.

RESULTS

Altogether 12399 participants (n = 44 suicides) had complete data. The strongest prenatal risk factors for suicide were: birth order, with risk increasing in later-born children [p trend = 0.063, adjusted hazard ratio (HR)], e.g. for fourth- or later-born children [HR = 2.27, 95% confidence interval (CI) 0.90-5.75]; young maternal age (HR = 1.18, 95% CI 0.34-4.13 for ⩽19 years and HR = 0.41, 95% CI 0.19-0.91 for >29 years, p trend = 0.034); and low (<2.5 kg) birth weight (HR = 2.48, 95% CI 1.03-5.95). The strongest risk factors at 7 years were externalizing problems in males (HR = 2.96, 95% CI 1.03-8.47, p trend = 0.050) and number of emotional adversities (i.e. parental death, neglected appearance, domestic tension, institutional care, contact with social services, parental divorce/separation and bullying) for which there was a graded association with risk of suicide (p trend = 0.033); the highest (HR = 3.12, 95% CI 1.01-9.62) was for persons with three or more adversities.

CONCLUSIONS

Risk factors recorded at birth and at 7 years may influence an individual's long-term risk of suicide, suggesting that trajectories leading to suicide have roots in early life. Some factors are amenable to intervention, but for others a better understanding of causal mechanisms may provide new insights for intervention to reduce suicide risk.

Suicide in young adults: psychiatric and socio-economic factors from a case-control study

BACKGROUND

Suicide in young adults remains an important public health issue in Australia. The attributable risks associated with broader socioeconomic factors, compared to more proximal psychiatric disorders, have not been considered previously in individual-level studies of young adults. This study compared the relative contributions of psychiatric disorder and socio-economic disadvantage associated with suicide in terms of relative and attributable risk in young adults.

METHOD

A population-based case-control study of young adults (18-34 years) compared cases of suicide (n = 84) with randomly selected controls (n = 250) from population catchments in New South Wales (Australia), with exposure information collected from key informant interviews (for both cases and controls). The relative and attributable risk of suicide associated with ICD-10 defined substance use, affective, and anxiety disorder was compared with educational achievement and household income, adjusting for key confounders. Prevalence of exposures from the control group was used to estimate population attributable fractions (PAF).

RESULTS

Strong associations were evident between mental disorders and suicide for both males and females (ORs 3.1 to 18.7). The strongest association was for anxiety disorders (both males and females), followed by affective disorders and substance use disorders. Associations for socio-economic status were smaller in magnitude than for mental disorders for both males and females (ORs 1.1 to 4.8 for lower compared to high SES groups). The combined PAF% for all mental disorders (48% for males and 52% for females) was similar in magnitude to socio-economic status (46% for males and 58% for females).

CONCLUSION

Socio-economic status had a similar magnitude of population attributable risk for suicide as mental disorders. Public health interventions to reduce suicide should incorporate socio-economic disadvantage in addition to mental illness as a potential target for intervention.

An examination of the relationship between anger and suicide risk through the lens of the interpersonal theory of suicide

Research has implicated a relationship between anger and suicidality, though underlying mechanisms remain unclear. The current study examined this relationship through the lens of the interpersonal theory of suicide (ITS). According to the ITS, individuals who experience thwarted belongingness, perceived burdensomeness, and elevated acquired capability for suicide are at increased risk for death by suicide. The relationships between anger and these variables were examined and these variables were examined as potential mediators between anger and suicidal ideation and behavior. Additionally, exposure to painful and provocative events was examined as a potential mediator between anger and acquired capability. As part of intake at a community mental health clinic, 215 outpatients completed questionnaires assessing depression, suicidal ideation, anger, perceived burdensomeness, thwarted belongingness, and acquired capability. Regression analyses revealed unique relationships between anger and both thwarted belongingness and perceived burdensomeness, covarying for depression. The association between anger and acquired capability trended toward significance. The links between anger and suicidal ideation and behavior were fully mediated by thwarted belongingness and perceived burdensomeness, but this effect was driven by perceived burdensomeness. Additionally, the link between anger and acquired capability was fully mediated by experience with painful and provocative events. In conclusion, results suggest that anger is uniquely associated with perceived burdensomeness and thwarted belongingness. Anger is associated with suicidal ideation and behavior via perceived burdensomeness and with greater acquired capability for suicide via experiences with painful and provocative events. Treatment for problematic anger may be beneficial to decrease risk for suicide.

Gender differences in methods of suicide attempts and prevalence of previous suicide attempts

OBJECTIVE

Suicide attempts are important predictors of completed suicide. Adolescents admitted to the emergency room of a large university hospital in Bern after a suicide attempt during the years 2004-2010 were prospectively assessed for methods of suicide attempt.

METHOD

Adolescents (N = 257; 66.5% female; age 14-21 years), presenting after a suicide attempt, were assessed with the WHO/EURO Multicentre Study on Parasuicide assessment tool.

RESULTS

Males more often used jumping from a high place (14% vs. 4.6% in females, p < .05) and less often intoxication (36% vs. 71.3%, p < .01). At least one previous suicide attempt was reported in 100 patients (44.4%; more females than males: Cramer-V = 0.21; p = .002). Of these, 35 adolescents did not present to this hospital or not at all for a previous suicide attempt.

CONCLUSIONS

The present study is the first to examine methods of suicide attempts according to the ICD-10 X codes in this age group. Gender differences were observed. Because a relevant number of patients did not present to the same hospital or not at all for a previous suicide attempt, studies on pathways to care of adolescents after their first suicide attempt are important for early detection and intervention strategies.