The suicidal process: age of onset and severity of suicidal behaviour

The role of substance use disorders in the transition from suicide attempt to suicide death: a record linkage study of a Swedish cohort

BACKGROUND

Suicidal behavior and substance use disorders (SUDs) are important public health concerns. Prior suicide attempts and SUDs are two of the most consistent predictors of suicide death, and clarifying the role of SUDs in the transition from suicide attempt to suicide death could inform prevention efforts.

METHODS

We used national Swedish registry data to identify individuals born 1960-1985, with an index suicide attempt in 1997-2017 (N = 74 873; 46.7% female). We assessed risk of suicide death as a function of registration for a range of individual SUDs. We further examined whether the impact of SUDs varied as a function of (i) aggregate genetic liability to suicidal behavior, or (ii) age at index suicide attempt.

RESULTS

In univariate models, risk of suicide death was higher among individuals with any SUD registration [hazard ratios (HRs) = 2.68-3.86]. In multivariate models, effects of specific SUDs were attenuated, but remained elevated for AUD (HR = 1.86 95% confidence intervals 1.68-2.05), opiates [HR = 1.58 (1.37-1.82)], sedatives [HR = 1.93 (1.70-2.18)], and multiple substances [HR = 2.09 (1.86-2.35)]. In secondary analyses, the effects of most, but not all, SUD were exacerbated by higher levels of genetic liability to suicide death, and among individuals who were younger at their index suicide attempt.

CONCLUSIONS

In the presence of a strong predictor of suicide death - a prior attempt - substantial predictive power is still attributable to SUDs. Individuals with SUDs may warrant additional suicide screening and prevention efforts, particularly in the context of a family history of suicidal behavior or early onset of suicide attempt.

Association between unmet healthcare needs and suicidal behaviors among the Korean population

OBJECTIVE

Suicide is an important public health concern. In South Korea, suicide rates have steadily risen over the past two decades. Unfortunately, there is a dearth of literature on the effects of unmet healthcare needs on suicide. Therefore, this study aimed to analyze the relationship between unmet healthcare needs and suicidal behaviors (suicidal ideation, plans, and attempts).

METHOD

This study analyzed data from 27,498 participants assessed by the Korea National Health and Nutrition Examination Survey conducted between 2016 and 2020. Logistic regression was used to evaluate the relationship between unmet healthcare needs and suicidal behaviors, while controlling for age, sex, education, household income, occupation, smoking, obesity, and alcohol consumption.

RESULTS

Adjusted odds ratios (95% confidence interval) were significantly higher in participants who experienced unmet healthcare needs [suicidal ideation: 2.31 (1.84-2.90); suicidal planning: 2.23 (1.75-2.85); and suicidal attempts: 1.92 (1.27-2.87)]. After stratifying for sex and depression, this trend was maintained in male participants and those without a depression diagnosis.

CONCLUSIONS

This study analyzed the relationship between unmet healthcare needs and suicidal behavior. Further studies using data sources that include more detailed information on suicide and somatic symptoms are required.

Maternal incarceration increases the risk of self-harm but not suicide: a matched cohort study

AIMS

Children of incarcerated mothers are at increased risk of experiencing multiple adversity such as poverty, mental illness and contact with child protection services (CPS), including being taken into out of home care (OOHC). However, little is known about whether these children are at increased risk of suicide or self-harm compared to children not exposed to maternal incarceration or about the factors that may contribute to this. We aimed to investigate differences in the risk of suicide and self-harm between children exposed to maternal incarceration and those not exposed and examine how socio-demographic factors, maternal mental illness and CPS contact (with or without OOHC) may affect these outcomes.

METHODS

We used a retrospective matched cohort study design, comparing 7674 children exposed to maternal incarceration with 7674 non-exposed children. We used multivariable Cox proportional hazards regression to compare the risk of suicide and self-harm between exposed and non-exposed groups, controlling for geographical remoteness, CPS contact and maternal mental illness.

RESULTS

There was no significant difference in the rate of suicide (rate ratio [RR] = 1.49; 95% confidence interval [CI]: 0.78, 2.87) or risk of suicide (adjusted hazard ratio [aHR] = 0.92; 95% CI: 0.43, 1.96) between the two groups. However, the exposed group had a significantly higher rate of self-harm (RR = 2.83; 95% CI: 2.50, 3.21) and a significantly higher risk of self-harm (aHR = 1.74; 95% CI: 1.45, 2.09) compared to those non-exposed. CPS contact with or without OOHC was independently associated with an increased risk of self-harm for both groups.

CONCLUSION

Children exposed to maternal incarceration are at an increased risk of self-harm and should be prioritized to receive targeted, multimodal support that continues after the mother's release from prison. The association between CPS contact and self-harm warrants further research.

Depression and suicidality severity among TRD patients after 1-year under standard of care: Findings from the TRAL study, a multicenter, multinational, observational study in Latin America

INTRODUCTION

Treatment resistant depression (TRD) is one of the most pressing issues in mental healthcare in LatAm. However, clinical data and outcomes of standard of care (SOC) are scarce. The present study reported on the Treatment-Resistant Depression in America Latina (TRAL) project 1-year follow-up of patients under SOC assessing clinical presentation and outcomes.

MATERIALS AND METHODS

420 patients with clinical diagnoses of TRD from Argentina, Brazil, Colombia and Mexico were included in a 1-year follow-up to assess clinical outcomes of depression (MADRS) and suicidality (C-SSRS), as well as evolution of clinical symptoms of depression. Patients were assessed every 3 months and longitudinal comparison was performed based on change from baseline to each visit and end of study (12 months). Socio demographic characterization was also performed.

RESULTS

Most patients were female (80.9%), married (42.5%) or single (34.4%), with at least 10 years of formal education (71%). MDD diagnosis was set at 37.29 (SD=14.00) years, and MDD duration was 11.11 years (SD=10.34). After 1-year of SOC, 79.1% of the patients were still symptomatic, and 40% of the patients displayed moderate/severe depression. Only 44.1% of the patients achieved a response (≥50% improvement in MADRS), and 60% of the sample failed to achieve remission. Suicidal ideation was reported by more than half of the patients at the end of study.

CONCLUSIONS

Depression and suicidality symptoms after a 1-year of SOC is of great concern. Better therapeutic options are needed to tackle this debilitating and burdensome disease.

Examining mediators of associations of food insecurity and being bullied with suicide among in-school adolescents in Eswatini: a cross-sectional study

We examined the potential mediating roles of anxiety and loneliness on the association of concurrent food insecurity (FI) and being bullied (BB) with suicidal behavior (SB) in Eswatini, a lower-middle-income country. We used data from the Global School-based Student Health Survey (GSHS; N = 3264), which employed a two-stage cluster sampling: first, 25 schools were selected based on the proportionate probability of enrollment; second, classes were randomly selected. A self-reported 84-item GSHS questionnaire was used to collect data for students aged 13-17 years. FI was measured by requesting students to recall how often they went hungry because of a lack of food at home in the 30 days before the study. Multiple logistic regressions and binary mediation function was applied to examine mediating factors of SB. The prevalence of SB, FI, and BB among adolescents was 27.5%, 7.7%, and 30.2%, respectively. Moreover, the relationship between FI and BB with SB was partly (approximately 24%) mediated by anxiety and loneliness. Our results highlight the mediating roles of anxiety and loneliness in suicidal adolescents who experience FI and BB. In conclusion, interventions for alleviating SB in high-risk adolescents experiencing FI and BB should also be aimed at ameliorating anxiety and loneliness.

Lifelong versus not lifelong death wishes in older adults without severe illness: a cross-sectional survey

BACKGROUND

Some older adults with a persistent death wish without being severely ill report having had a death wish their whole lives (lifelong persistent death wish; L-PDW). Differentiating them from older adults without severe illness who developed a death wish later in life (persistent death wish, not lifelong; NL-PDW) can be relevant for the provision of adequate help and support. This study aims to gain insight into the characteristics, experiences, and needs of older adults with a L-PDW versus older adults with a NL-PDW and into the nature of their death wishes.

METHODS

In the Netherlands, in April 2019, a cross-sectional survey study was conducted among a large representative sample of 32,477 citizens aged 55 years and older. Respondents with a L-PDW (N = 50) were compared with respondents with a NL-PDW (N = 217) using descriptive statistics, Kruskal-Wallis tests, and Fisher's exact tests.

RESULTS

Respondents with a L-PDW were relatively younger and less often had (step)children. They less often looked back on a good and satisfying life with many good memories and more often reported trauma. Older adults with a NL-PDW more often reported loss and bereavement. Overall, the groups showed a lot of similarities. Both groups reported a death wish diverse in nature, numerous health problems, and a variety of needs for help and support.

CONCLUSIONS

Some of the differences we found between the groups might be particularly relevant for the provision of adequate help and support to older adults with a L-PDW (i.e., their past and trauma) and to older adults with a NL-PDW (i.e., their loss and bereavement). The heterogeneity of both groups and the diverse nature of their death wish indicate that careful assessment of the death wish, its background, and underlying needs is required to provide personalized help and support to older adults with a death wish.

Suicidal behavior in new patients presenting to the Telepsychiatry services in a Tertiary Care center: An exploratory study

BACKGROUND

The COVID-19 pandemic has led to expansion of telepsychiatry services and formulation of telemedicine guidelines. However, the telemedicine guidelines are not very clear about psychiatric emergencies, such as suicidal behaviour, resulting in psychiatrists facing dilemma about handling such situations.

AIM

To evaluate the prevalence of suicidal behaviour in new patients presenting to the Telepsychiatry services in a Tertiary Care centre.

METHODS

1065 new adult patients (aged > 18 years) registered with telepsychiatry services were assessed for suicidal behaviour, in the form of death wishes, suicidal ideations, plans, attempts (lifetime/recent) and non-suicidal self-injurious behaviour (NSSI) (lifetime/recent).

RESULTS

In terms of suicidal behaviour, in the last few weeks prior to assessment 14.4% of the patients had death wishes, 2.4% had thoughts of killing themselves, 0.9% had attempted suicide in the lifetime and 0.6% in the last few weeks, 1.1% had active suicidal ideations at the time of assessment, 0.6% had active suicidal plan, 1.3% had history of NSSI in the lifetime and 0.5% had NSSI behaviour in the last few weeks. Based on the current suicidal behaviour, 1.3% of the patients were asked to report to the emergency immediately, 0.5% were given an appointment within 72 h for follow-up, and 14.4% were explained high risk management.

CONCLUSIONS

Overall prevalence of suicidal behavior is relatively low in new patients seeking psychiatric help through telepsychiatry services.

Addressing Adolescent Stress in School: Perceptions of a High School Wellness Center

Adolescents are often burdened with academic, home, and peer stressors. With adolescent mental health issues and suicide on the rise, administrators have worked with nonprofit organizations and the community to address stress and internalized behavior problems. School-based wellness centers are tranquil rooms with various sensory activities, calming nature scenes, and sounds for relaxation purposes. School-based wellness centers may have behavioral effects by reducing exposure to aversive events and increasing access to positive and negative reinforcers. There has not yet been a formal study of school-based wellness centers published in the literature. In the present study, we used questionnaires to examine the perceptions of 752 students, 124 parents, and 69 school staff of their high school wellness center. Results indicated that stakeholders had positive perceptions of the wellness center. In particular, results implied that stakeholders believed the wellness center contributed to students' academic success, elevation of mood, confidence, and coping skills. Results also suggested that attendance at the wellness center was associated with a decrease in student stress and anxiety, though recommendations for improvements were noted. Implications and limitations of this study are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43494-022-00079-1.

An exploration of the genetic epidemiology of non-suicidal self-harm and suicide attempt

BACKGROUND

Empirical evidence supporting the distinction between suicide attempt (SA) and non-suicidal self-harm (NSSH) is lacking. Although NSSH is a risk factor for SA, we do not currently know whether these behaviours lie on a continuum of severity, or whether they are discrete outcomes with different aetiologies. We conducted this exploratory genetic epidemiology study to investigate this issue further.

METHODS

We explored the extent of genetic overlap between NSSH and SA in a large, richly-phenotyped cohort (the Avon Longitudinal Study of Parents and Children; N = 4959), utilising individual-level genetic and phenotypic data to conduct analyses of genome-wide complex traits and polygenic risk scores (PRS).

RESULTS

The single nucleotide polymorphism heritability of NSSH was estimated to be 13% (SE 0.07) and that of SA to be 0% (SE 0.07). Of the traits investigated, NSSH was most strongly correlated with higher IQ (rG = 0.31, SE = 0.22), there was little evidence of high genetic correlation between NSSH and SA (rG = - 0.1, SE = 0.54), likely due to the low heritability estimate for SA. The PRS for depression differentiated between those with NSSH and SA in multinomial regression. The optimal PRS prediction model for SA (Nagelkerke R2 0.022, p < 0.001) included ADHD, depression, income, anorexia and neuroticism and explained more variance than the optimal prediction model for NSSH (Nagelkerke R2 0.010, p < 0.001) which included ADHD, alcohol consumption, autism spectrum conditions, depression, IQ, neuroticism and suicide attempt.

CONCLUSIONS

Our findings suggest that SA does not have a large genetic component, and that although NSSH and SA are not discrete outcomes there appears to be little genetic overlap between the two. The relatively small sample size and resulting low heritability estimate for SA was a limitation of the study. Combined with low heritability estimates, this implies that family or population structures in SA GWASs may contribute to signals detected.

Assessing Suicidal Ideation Using a Brief Self-Report Measure

Accurate assessment of suicidal thoughts is a challenge for researchers and clinicians. There is evidence that self-report and clinical interview assessment methods can result in different endorsement numbers when used to assess suicidal ideation. This study investigates endorsement rates and psychometric properties of a two-item self-report measure of suicidal ideation that distinguishes active from passive suicidal ideation, when compared with a clinical interview. Individuals presenting at an outpatient psychiatry clinic completed a measure of depression severity containing two items assessing passive and active suicidal ideation before undergoing a structured clinical interview. Self-report and clinical interview items demonstrated a low level of agreement. Self-report items were more strongly correlated with same-domain clinical interviewer ratings than different-domain ratings. These items demonstrated high negative predictive value and moderate-to-low positive predictive value for interviewer ratings. A two-item measure of suicidal ideation did not highly align with corresponding interviewer ratings, though such a measure may be useful in determining the absence of suicidal ideation, as well as distinguishing between passive and active suicidal ideation.

No Correlation Between Rates of Suicidal Ideation and Completed Suicides in Europe: Analysis of 49,008 Participants (55+ Years) Based on the Survey of Health, Ageing and Retirement in Europe (SHARE)

Background:

Little is known about country-specific variations in suicidal ideation (SID) by sex and how they correspond with completed suicide rate. Therefore, the aim of the present study was to assess variations in SID prevalence rates by sex and its correlation to completed suicide rates across European countries.

Method:

SHARE is a cross-national European survey of individuals over the age of 50 and their spouse of any age. The present study relied on wave 4 conducted in 2010–2012 including 49,008 participants aged 55 to 104 years from 16 countries. SID was evaluated using a single item from the Euro-D. Data on completed suicide rates were taken from the WHO mortality database.

Results:

Of the study population (n = 49,008, 44.3% men, mean age 68.2 ± 9.1 years), a total of 4139 (8.5%, 95% CI 8.2–8.7) reported suicidal ideation within the last month. The women:men ratio in SID prevalence ranged from 1.30 in Estonia to 2.25 in Spain and Portugal. Regarding country-specific variation, the SID prevalence patterns of both men and women did not correspond to the completed suicide rates for males and females aged 55+ reported by the WHO (2013). Correlations were rather moderate in men (r = 0.45) and especially weak in women (r = 0.16).

Conclusion:

The study showed remarkable differences in SID prevalence by sex. The most exciting finding was that SID rates did not correspond with completed suicide rates in each country under investigation. However, the strength of these patterns substantially differs across countries. This unexpected finding need to be further evaluated.

Age at onset of first suicide attempt: Exploring the utility of a potential candidate variable to subgroup attempters

PURPOSE

Our objective was to explore the utility of age at first suicide attempt in identifying subgroups of suicide attempters.

METHODS

In a retrospective study design, we collected information from the clinical charts of 895 patients assessed over a seven-year period. Admixture analysis was used to determine the best fitting theoretical model for distribution of age at first attempt that divided the sample. Subsequently, multivariate analysis was performed to identify variables that distinguished the subgroups identified.

RESULTS

The theoretical solution that best explained the observed distribution of age at first suicide attempt was a mixture of two Gaussian distributions with a cut-off of 31 years for the two subgroups. In logistic regression analysis, male gender (Odds ratios [OR] 3.047, 95% Confidence Interval (CI) 1.818-5.106), fewer years of formal schooling (OR 3.384, 95% CI 1.701-6.734) and being married (OR 23.36, 95% CI 10.753-50.000), were more commonly associated with the late onset subgroup (age at first attempt >31 years). Further, the late onset subgroup had poorer global functioning (OR 0.980, 95% CI 0.962 to 0.998).

CONCLUSION

Age at onset of first suicide attempt is a useful candidate marker to delineate an early and late onset subgroup among suicide attempters. These results are likely to inform customization of suicide prevention strategies.

Exploring Harms Experienced by Children Aged 7 to 11 Using Ambulance Attendance Data: A 6-Year Comparison with Adolescents Aged 12⁻17

Many population data sources do not routinely collect data of children under 12, despite research showing that mental health, self-injurious behaviour, and substance ingestion can have severe consequences in this age group. We used 6 years (January 2012 to December 2017) of ambulance attendance data from the Australian state of Victoria to characterise mental health, self-injurious behaviour, and substance ingestion in children aged 7–11. We compared this group to older children aged 12–17. We found that in comparison to those aged 12–17 (n = 26,778), a smaller number of children aged 7–11 years (n = 1558) were experiencing serious harms, with mental health symptomology the most common harmful outcome. Self-injurious behaviour significantly increased in both age groups throughout the study period. For mental health, self-injurious behaviour and substance ingestion in the 7–11 age group, males were significantly over-represented. These aged 7–11 were more likely to ingest pharmaceuticals, rather than alcohol or illicit substances, and suicidal ideation was the most common self-injurious behaviour in this age group. Our study suggests that data collection needs to occur specifically in the 7–11 age group, and importantly, services and interventions to improve mental health and wellbeing will need to be specifically designed and targeted at this age group.

The Role of Self-Organization in the Suicidal Process

This article describes the application of a dual-regulation model to a case example of a female suicide attempter. The model complements the traditional goal-and-feedback view with self-organizing processes, which may help to better understand the suicidal process. From this view, impulsive suicidal behavior can be interpreted as a dysfunctional pattern by which high-internal tension is reduced through self-organized processes. High tension might result from intrapersonal factors and adverse life conditions, by which self-regulation is depleted. Also concepts from social psychology (i.e., ego depletion, self-regulation failure) are consistent with this view and are discussed in context of a suicidal crisis. Identifying dysfunctional self-organization processes and acquiring strategies to strengthen self-regulation might, therefore, be important for suicide prevention.

Characteristic Risk Factors Associated with Planned versus Impulsive Suicide Attempters

OBJECTIVE

The present study aimed to investigate predictors for planned suicide attempters.

METHODS

This study included 1,003 patients who attempted suicide and visited emergency department. They were divided into two groups, planned suicide attempters (SAs; n=133 [13.3%]) and impulsive SAs (n=870, [86.7%]), and the demographic variables, clinical characteristics, factors related to suicide, and psychiatric resources of the groups were compared.

RESULTS

Major depressive disorder and substance use disorders were more common among planned SAs than among impulsive SAs. Additionally, the planned SAs were older, more likely to be divorced, separated or widowed, and more likely to have comorbid medical illnesses, severe depression, higher suicidality, and self-blaming tendencies than the impulsive SAs. Financial problems and physical illnesses were more common in planned SAs but interpersonal conflicts were more frequent in impulsive SAs. Planned SAs had fewer previous suicide attempts but these were more serious suicide attempts. The presence of the hope to die, a written will, and suicidal ideation of a repetitive, intense, and continuous nature were predictive of planned SAs.

CONCLUSION

The present findings demonstrated that planned SAs had more severe psychopathology and medical illnesses than impulsive SAs. Therefore, screening for depression, substance use disorders, and suicidal plans among old and medically ill patients may be important for preventing suicide attempts.

Impulsive suicide attempts: a systematic literature review of definitions, characteristics and risk factors

BACKGROUND

Extensive research on impulsive suicide attempts, but lack of agreement on the use of this term indicates the need for a systematic literature review of the area. The aim of this review was to examine definitions and likely correlates of impulsive attempts.

METHODS

A search of Medline, Psychinfo, Scopus, Proquest and Web of Knowledge databases was conducted. Additional articles were identified using the cross-referencing function of Google Scholar.

RESULTS

179 relevant papers were identified. Four different groups of research criteria used to assess suicide attempt impulsivity emerged: (a) time-related criteria, (b) absence of proximal planning/preparations, (c) presence of suicide plan in lifetime/previous year, and (d) other. Subsequent analysis used these criteria to compare results from different studies on 20 most researched hypotheses. Conclusions regarding the characteristics of impulsive attempts are more consistent than those on the risk factors specific to such attempts. No risk factors were identified that uniformly related to suicide attempt impulsivity across all criteria groups, but relationships emerged between separate criteria and specific characteristics of suicide attempters.

LIMITATIONS

Only published articles were included. Large inconsistencies in methods of the studies included in this review prevented comparison of effect sizes.

CONCLUSIONS

The vast disparities in findings on risk factors for impulsive suicide attempts among different criteria groups suggest the need to address the methodological issues in defining suicide attempt impulsivity before further research into correlates of such attempts can effectively progress. Specific recommendations are offered for necessary research.

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.

Gender and Ethnic Differences in Health-Promoting Behaviors of Rural Adolescents

Although much is known about health-risk behaviors of adolescents, less is known about their health-promoting behaviors. The purpose of this analysis was to compare health-promoting behaviors in adolescents in Grades 9–12 by gender and ethnicity and explore how these behaviors changed over time. Data were collected from 878 rural adolescents (47.5% Hispanic; mean age at baseline 14.7 years). Males from all ethnic groups scored significantly higher than all females on physical activity; non-Hispanic Black males and females scored significantly higher than other ethnic groups on safety behaviors. Hispanic and non-Hispanic White females scored higher than males in these ethnic groups on stress management. Nutrition, physical activity, and safety behaviors decreased significantly for most participants from Grade 9 to 12 whereas stress management remained relatively stable. Findings are similar to those from nationally representative samples that analyzed cross-sectional data and have implications for school nursing interventions to improve health-promoting behaviors in rural adolescents.

Validation of the French version of the Suicidal Ideation Questionnaire among adolescents

Teenage suicide is a major public health issue in Western societies, especially in France. An instrument to measure suicidal thoughts in French adolescents and thus identify the teenagers at risk is urgently required. The aim of this study was to validate a French version of the Suicidal Ideation Questionnaire (SIQ) for use with teenagers. Respondents (n=956, age range 14-18.0) completed the SIQ and other convergent measures (self-esteem, psychic morbidity, anxiety, and personality) for three validation steps (general and clinical samples). A confirmatory factor analysis was performed on the SIQ. The study supported a 30-item one-factor model, similar to the original questionnaire, with moderate model fit indices (χ(2)/ddl=3.21; RMSEA=0.05; CFI=0.87; GFI=0.92). Significant correlations (-0.22 to 0.74) were found with convergent measures among general (n=871) and psychiatric samples (n=38). A high internal consistency was found with a reliability coefficient of 0.91. The results confirm the psychometric qualities of the questionnaire for French adolescents.

Rural/urban background, depression and suicidal ideation in Chinese college students: a cross-sectional study

Objectives

The objective of this study was to examine, first, the relationship of having a rural vs. urban background with suicidal ideation in Chinese college students, and second, whether a potential relationship was mediated by depression.

Methods

A survey was conducted among 1,145 undergraduate students at a university in China. Suicidal ideation and depressive symptoms were measured by the revised Hopkins’ Symptom checklist (SCL-90-R). Associations between rural vs. urban background, depression and suicidal ideation were estimated by multivariable linear regression-based β coefficients, logistic regression-based odds ratios (ORs), and corresponding 95% confidence intervals (CIs). The magnitude of indirect effect and bias-corrected 95% CIs were obtained through bootstrap techniques.

Results

Rural background was positively associated with depression, which was in turn associated with suicidal ideation. The OR for rural status and suicidal ideation equaled 2.15 (95% CI = 1.36–3.41). This OR was slightly, though significantly (p<0.05) attenuated by additional adjustment for depressive symptoms (OR = 1.99, 95% CI = 1.15–3.44).

Conclusion

Having a rural background is a determinant of suicidal ideation in Chinese college students. Depression may only marginally mediate this association.

Suicide risk and psychopathology in immigrants: a multi-group confirmatory factor analysis

BACKGROUND

Immigrants may experience several negative consequences as a result of their migration including discrimination, unsatisfactory economic conditions, and rejection from the host countries, which may contribute to psychiatric illness and vulnerability to suicidal behaviors. The purpose of the current study was to determine whether or not the theorized components of measured dimensions of suicide risk and psychopathology vary across samples of Italians and immigrants.

METHODS

We investigated 237 Italians and 234 immigrants, who were administered self-report questionnaires to assess temperament (TEMPS-A), hopelessness (BHS), personality (EPQ-R), and self-other perception (9AP).

RESULTS

Multi-group confirmatory factor analyses were conducted, which yielded a final model with an excellent fit to the data (χ (53) (2)  = 57.56; CFI = 0.994; RMSEA = 0.014). This final model fits significantly better than the previously tested models and indicated that the same pattern of relationships was found between suicide risk and psychopathology across both groups.

CONCLUSIONS

Although immigrants represent a unique population and may experience specific stressors contributing to psychopathology and suicide risk, our findings suggest that the samples of Italians and immigrants may be more similar on the study variables under investigation than previously thought. Implications are offered for the improved identification and treatment of immigrants and resident citizens in Europe in general and in Italy in particular.

Socioeconomic disadvantage, mental disorders and risk of 12-month suicide ideation and attempt in the National Comorbidity Survey Replication (NCS-R) in US

PURPOSE

We aim to explore the distinctive interrelationships between family income and mental disorders on suicidality in recent 12 months.

METHODS

A stratified random subsample of adults in a household survey in US, National Comorbidity Survey Replication, was used for analyses. The ratio of family income to poverty threshold (RoFIPT) per capita was the primary predictor of interest to 12-month occurrence of suicide ideation and attempt. Effect modification by mental disorders was further explored.

RESULTS

A total of 4,724 subjects were analyzed. Inverse associations were found with RoFIPT for both suicidal outcomes after confounding control. Furthermore, effect modification was revealed that RoFIPT was more strongly associated with suicide ideation for those with mental disorders (OR 0.87; 95 % CI 0.79, 0.95).

CONCLUSIONS

An inverse gradient of RoFIPT was shown with suicide ideation and attempt. Moreover, having mental disorders was found to be an effect modifier for the relationships between family income and suicidality.