School poverty and the risk of attempted suicide among adolescents

Child and Adolescent Suicides in Turkey (2004-2023): A Comprehensive Evaluation

This study analyzes suicide rates, causes, methods, and age- and gender-specific trends among children and adolescents in Turkey (2004-2023) using Turkish Statistical Institute data. Utilizing data from the Turkish Statistical Institute, suicide deaths across two age groups (< 15 years and 15-19 years) were examined. During this period, 8,954 suicides were recorded, with 52.6% involving males. Hanging (41.3%) and firearms (30.2%) were the most frequently used methods, showing significant gender differences (p < 0.01). Family discord emerged as the leading cause of suicide among females, while illness was predominant among males. The findings underscore the urgent need for culturally tailored, evidence-based suicide prevention strategies. Key measures include restricting access to means of suicide, enhancing family-based interventions, and improving mental health services with a focus on early detection. Adoption of the WHO's "LIVE LIFE Initiative for Suicide Prevention" could provide a robust framework to reduce youth suicide rates in Turkey.

Suicidal Thoughts and Behaviors in American Indian and Alaska Native Adolescents

American Indians and Alaska Natives (AI/AN) have consistently exhibited suicide rates that surpass all other racial and ethnic groups in the United States. However, not much has been published regarding the epidemiology of AI/AN youth suicides. The objectives of this study on AI/AN adolescents were to assess the prevalence of suicidal thoughts and behaviors by age and gender, assess the number of years of life lost to suicide before the age of 80, and assess the most common methods used to commit suicide by AI/AN adolescents. Data utilized for this study were from the national Youth Risk Behavior Surveys and the Web-Based Injury Statistics Query and Reporting System. We conducted a cross-sectional descriptive analysis of the suicide-related data from years 2015, 2017, 2019, and 2021. We found AI/AN adolescents averaged one in four contemplated suicides, one in five planned suicides, and one in six attempted suicides. A total of 257 adolescents committed suicide during the study period where the majority (62.5%) were observed in males and suicides were more common in older adolescents. AI/AN adolescents had the highest crude suicide death rate of any racial or ethnic group and the most common methods used to commit suicide were suffocation (57.5%) and firearms (35.5%). AI/ AN adolescents lost almost 16,000 years of potential life during the four years of the study and the majority were lost by males. Professionals and policymakers desiring to reduce suicidal thoughts and behaviors among AI/AN adolescents need to focus more of their efforts on providing youths with resilience factors to establish sufficient ego strength in them to deal with all types of stressors. Concurrently, federal, state, and tribal leaders need to work together to improve the social and economic circumstances faced by many AI/AN families and children.

Pathways of Socioeconomic Disadvantage and Peer Bullying in Children and Youth: A Scoping Review

Growing up in socioeconomic disadvantage increases risk of peer bullying at school. Both socioeconomic status and involvement in bullying are predictive of a range of adverse developmental outcomes. However, neither (a) the mechanisms whereby disadvantage increases bullying risk nor (b) the developmental outcomes for which bullying may mediate disadvantage are clear. This review scoped the literature on the relationships between socioeconomic disadvantage, bullying, and health and developmental outcomes for school-aged children and adolescents. Four databases were searched up to June 3, 2023 with 565 studies retrieved, of which 17 met criteria. Most studies were cross-sectional, and studies varied greatly in their definition and measurement of both bullying involvement and disadvantage. No intervention studies were found. Mediators of the disadvantage-bullying association ranged from individual level (e.g., depression) to the national level (e.g., homicide rate); only two studies examined bully-victim status. Of studies where bullying was a mediator, none examined bullying perpetration; the range of outcomes examined was narrowly focused on mental health, failing to capture the full range of developmental outcomes associated with either socioeconomic disadvantage or bullying involvement. This review highlights that future research is needed on identifying and understanding the mediators of the association between disadvantage and bullying victimization, and on the developmental outcomes mediated by bullying perpetration for disadvantaged children. These insights are critical to increase the effectiveness of community- and school-based bullying prevention, particularly in communities with high proportions of socioeconomically disadvantaged families.

Use of Cigarettes and E-Cigarettes, Impulsivity, and Anxiety: Influences on Suicidal Ideation Among Youth and Young Adults in Texas

INTRODUCTION

Cigarette use and smoking intensity increase risk of suicidal ideation. Less is known about e-cigarette use. Here we examine direct influences of cigarette versus e-cigarette use on suicidal ideation among 16- to 23-year-olds in Texas.

AIMS AND METHODS

Since 2019, the Texas Adolescent Tobacco and Marketing Surveillance Study collected data on suicidal ideation every 6 months covering the previous 2 weeks. Youths answering that they had "thoughts that you would be better off dead, or of hurting yourself" on more than 2 of 14 days were categorized as having suicidal ideation. Generalized linear mixed-effects logistic regressions examined the influence of ever and past 30-day (P30D) use of cigarettes, e-cigarettes, impulsivity, and anxiety on suicidal ideation, controlling for gender, race/ethnicity, socioeconomic status (SES), and grade in school. Interactions between ever and P30D use of both products and (a) impulsivity and (b) gender were examined.

RESULTS

Of the 2329 participants, 29.1% reported ever and 6.5% reported P30D cigarette use, 48.2% reported ever and 11.6% reported P30D e-cigarette use, and 18.5% reported suicidal ideation. Ever cigarette use among females (aOR = 1.83; 95% CI: 1.36 to 2.46), P30D e-cigarette use (aOR = 1.30; 95% CI: 1.00 to 1.68), and P30D cigarette use (aOR = 1.47; 95% CI: 1.06 to 2.05) were independently associated with higher risk for suicidal ideation after adjusting for covariates. Impulsivity and anxiety directly increased risk of suicidal ideation regardless of product type used. Hispanic youth had higher risk of suicidal ideation than White youth, while higher levels of SES were protective.

CONCLUSIONS

Cigarette/e-cigarette use, as well as impulsivity and anxiety, directly increase the risk of suicidal ideation.

IMPLICATIONS

Clinicians should ask young adults with a history of tobacco use, anxiety, or impulsive behavior about suicidal ideation. Nicotine prevention and cessation programs might be more effective if they simultaneously target substance use and mental health. Culturally appropriate support is needed for ethnic and racial minority youth and young adults in school, college, and at work. When evaluating and understanding risk, the role of multiple social identities (such as minority status, gender, and SES) is important.

Suicide Risk Factors in High School Students

In Mexico, suicide has become an important public health problem, representing the third leading cause of death in the adolescent population. Suicidal behavior in adolescents is associated with the interaction of complex relationships between personal, interpersonal, and sociocultural factors. Through a quantitative, descriptive, and correlational cross-sectional study, the present study aimed to analyze the prevalence and risk factors associated with suicidal ideation among adolescents from different high schools of the high school system (SEMS) of the University of Guadalajara, in response to the psychosocial impact of the COVID-19 pandemic. A descriptive statistical analysis was carried out on the data obtained from the 3583 students surveyed, followed by a principal component analysis (PCA) to identify closely related social, emotional, and behavioral variables. The PCA yielded eight principal components, which together represent 75.42% of the variance across psychometric tests. A multiple linear regression analysis was used, with a regression value (R2) of 0.4811, indicating that the explanatory model can predict 48.1% of the variability in suicidal ideation, with a statistical significance level of 0.05. According to the studies conducted, 19% (688 students) showed indicators of high suicide risk and 26.8% (960 students) showed moderate risk. Depression, mental health, health-related quality of life, physical and psychological well-being, and mood and emotions are the most influential factors in suicidal ideation.

Do We Belong? Examining the Associations Between Adolescents' Perceptions of School Belonging, Teacher Discrimination, Peer Prejudice and Suicide

In the USA, suicide is a leading cause of death for adolescents ages 12 to 18 (National Institute of Mental Health (NIMH), 2019). Given the urgency of this public health crisis, this paper aims to explore the impact of a sense of school belonging and teacher-based discrimination and peer-based prejudice on suicidal ideation and attempts among Black youth. This secondary analysis used a sample of Black youth (N = 4229; Mage = 16) from the National Longitudinal Study of Adolescents to Adult Health data. Independent variables included a sense of school belonging, school-based teacher discrimination, and school-based peer prejudice; the dependent variable was suicidal thoughts and behaviors. The results of multinomial regression analyses revealed that as Black adolescents' sense of school belonging decreased, they were 35% more likely to be at risk for suicidal ideation and attempts. Findings from our study support the assertion that the school microsystem plays a substantial role in modifying the risk of suicidal behavior among Black youth.

Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs

Adolescents are considered one of the most vulnerable groups affected by suicide. Rapid changes in adolescents' physical and mental states, as well as in their lives, significantly and undeniably increase the risk of suicide. Psychological, social, family, individual, and environmental factors are important risk factors for suicidal behavior among teenagers and may contribute to suicide risk through various direct, indirect, or combined pathways. Social-emotional learning is considered a powerful intervention measure for addressing the crisis of adolescent suicide. When deliberately cultivated, fostered, and enhanced, self-awareness, self-management, social awareness, interpersonal skills, and responsible decision-making, as the five core competencies of social-emotional learning, can be used to effectively target various risk factors for adolescent suicide and provide necessary mental and interpersonal support. Among numerous suicide intervention methods, school-based interventions based on social-emotional competence have shown great potential in preventing and addressing suicide risk factors in adolescents. The characteristics of school-based interventions based on social-emotional competence, including their appropriateness, necessity, cost-effectiveness, comprehensiveness, and effectiveness, make these interventions an important means of addressing the crisis of adolescent suicide. To further determine the potential of school-based interventions based on social-emotional competence and better address the issue of adolescent suicide, additional financial support should be provided, the combination of social-emotional learning and other suicide prevention programs within schools should be fully leveraged, and cooperation between schools and families, society, and other environments should be maximized. These efforts should be considered future research directions.

Misuse of Prescription Opioids and Suicidal Behaviors Among Black Adolescents: Findings from the 2017 and 2019 Youth Risk Behavior Survey

PURPOSE

Although some studies have examined the association between prescription opioid misuse and mental health outcomes, few have investigated the effects of prescription opioid misuse on suicidal behaviors among Black adolescents. The objective of this study was to investigate the cross-sectional association between prescription opioid misuse and suicidal ideation, suicide plan, and suicide attempt among Black adolescents.

METHODS

Data for this study came from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 4798 Black adolescents aged 14-18 years (51.2% female) was analyzed using binary logistic regression. The outcome variables investigated were suicidal ideation, suicide plan, and suicide attempt, and the main explanatory variable was prescription opioid misuse.

RESULTS

Of the 4798 Black adolescents, 15% reported ever misusing prescription opioids; 16.2% experienced suicidal ideation; 14% made a suicide plan; and 11.3% attempted suicide during the past 12 months. In the multivariate logistic regression models, Black adolescents who misused prescription opioids had 1.39 times higher odds of making a suicide plan and 1.65 times higher odds of making a suicide attempt during the past 12 months when compared to their counterparts who did not misuse prescription opioids. Other significant factors associated with suicidal behaviors include female sex, school bullying, cyberbullying, depressive symptoms, and illicit drug use. In addition, physical activity had a protective effect on suicide attempt.

CONCLUSION

The findings of the present study demonstrate the effects of prescription opioid misuse and its association with suicidal behaviors among Black adolescents.

Suicidality Prevalence in a Pediatric Psychiatric Clinic: Relation to Social and Environmental Risk Factors

Suicidality is a growing public health problem in children and adolescents. The aim of this retrospective data analysis study was to estimate the prevalence of suicidality in pediatric patients admitted to an academic Pediatric Psychiatric Clinic (PPC) and to analyze social and environmental risk factors associated with suicide. Suicidal ideation was assessed by the Self-Injurious Thoughts and Behaviors Interview. Using established psychometric scales, social and stressful events were analyzed. During the four-year study, 249 episodes of care were experienced by 152 individuals (mean age 15.2 ± 2 years, girls/boys 107/45). Twenty-eight patients (11.2%) were admitted from the Pediatric Intensive Care Unit and the Department of Pediatrics, 162 (65.1%) from the Pediatric Emergency Department, and 59 (23.7%) from other Hospitals (p = 0.003). A significant longitudinal increase in admissions to PPC, with increasing trends of suicidal ideation, suicide attempts, and suicidality, was recorded. Suicidal behavior, bullying, internet addiction, friends quarreling, and family problems were risk factors for suicide attempts and suicidality. Our results have implications for prevention programs, highlighting an increasing need for care for suicide attempts and suicidal ideation, related to specific stressful events and contextual socio-environmental status.

Social Determinants on Suicidal Thoughts among Young Adults

OBJECTIVE

The main objective of this study was to investigate the relationship between poverty, religion, and suicidal thoughts among U.S. youth. The disparities regarding gender, race, and ethnicity with regard to suicidal thoughts were also assessed.

METHODS

A cross-sectional correlational research design was used for this study and a national representative sample of 1945 young adults aged 18 to 25 was selected from the 2014 National Survey on Drug Use and Health. Logistic regression analysis with interaction effects was utilized to determine if poverty and religion were associated with suicidal thoughts.

RESULTS

About 43 percent of the sample reported having suicidal thoughts when things got worse and this prevalence rate varied by gender and race/ethnicity with white males self-disclosing the highest rate of suicidal thoughts. After adjusting for demographic and socioeconomic characteristics, black males who lived up to two times the poverty line had a higher likelihood of suicidal thoughts (p = 0.011), and religion protected against suicidal thoughts (p = 0.012). Youth with lower education and poor health were more inclined to have suicidal thoughts than their peers.

CONCLUSIONS

Suicide is the second leading cause of death for American young adults aged 18 to 25. Understanding these differences between social determinants of suicide can help public health researchers strategize how to make evidence-based recommendations for suicide prevention efforts.

Understanding Suicide in Our Community through the Lens of the Pediatric ICU: An Epidemiological Review (2011-2017) of One Midwestern City in the US

Suicide frequency has tripled for some pediatric age groups over the last decade, of which, serious attempts result in pediatric intensive care unit (PICU) admissions. We paired clinical, aggregate geospatial, and temporal demographics to understand local community variables to determine if epidemiological patterns emerge that associate with risk for PICU admission. Data were extracted at an urban, high-volume, quaternary care facility from January 2011 to December 2017 via ICD 10 codes associated with suicide. Clinical, socioeconomic, geographical, and temporal variables were reviewed. In total, 1036 patients over the age of 9 were included, of which n = 161 were PICU admissions. Females represented higher proportions of all suicide-related hospital admissions (67.9%). Looking at race/ethnicity, PICU admissions were largely Caucasian (83.2%); Blacks and Hispanics had lower odds of PICU admissions (OR: 0.49; 0.17, respectively). PICU-admitted patients were older (16.0 vs. 15.5; p = 0.0001), with lower basal metabolic index (23.0 vs. 22.0; p = 0.0013), and presented in summer months (OR: 1.51, p = 0.044). Time-series decomposition showed seasonal peaks in June and August. Local regions outside the city limits identified higher numbers of PICU admissions. PICUs serve discrete geographical regions and are a source of information, when paired with clinical geospatial/seasonal analyses, highlighting clinical and societal risk factors associated with PICU admissions.

Annual Research Review: A meta-analytic review of worldwide suicide rates in adolescents

Suicide is a leading cause of death among youth worldwide. The purpose of the current review was to examine recent cross-national trends in suicide mortality rates among 10- to 19-year-olds. This study extracted suicide mortality data from the World Health Organization's (WHO) Mortality Database for the most recent year (since 2010) from any country with available high-quality data (as defined by the WHO's guidelines). Data on access to lethal means (firearms, railways) and measures of economic quality (World Bank Income Group) and inequality (Gini coefficients) were obtained from publicly available data sources. Cross-national suicide mortality rates in youth were heterogeneous. The pooled estimate across all ages, sexes, and countries was 3.77/100,000 people. The highest suicide rates were found in Estonia, New Zealand, and Uzbekistan. Suicide rates were higher among older compared with younger adolescents and higher among males than females. The most common suicide methods were hanging/suffocation and jumping/lying in front of a moving object or jumping from a height. Firearm and railway access were related to suicide deaths by firearms and jumping/lying, respectively. Economic quality and inequality were not related to overall suicide mortality rates. However, economic inequality was correlated with a higher ratio of male:female suicides. This study provides a recent update of cross-national suicide trends in adolescents. Findings replicate prior patterns related to age, sex, geographic region, and common suicide methods. New to this review are findings relating suicide method accessibility to suicide mortality rates and the significant association between income inequality and the ratio of male:female suicide. Future research directions include expanding the worldwide coverage to more low- and middle-income countries, examining demographic groupings beyond binary sex and to race/ethnicity within countries, and clarifying factors that account for cross-national differences in suicide trends.

Food Insecurity Is Associated With Poorer Mental Health and Sleep Outcomes in Young Adults

PURPOSE

The aim of the study was to determine the association between food insecurity, mental health, and sleep outcomes among young adults. Young adulthood represents an important developmental period when educational and economic transitions may increase the risk for food insecurity; however, little is known about associations between food insecurity and health outcomes in this period.

METHODS

Cross-sectional nationally representative data of U.S. young adults aged 24-32 years from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2018. Multiple logistic regression analysis was conducted with food insecurity as the independent variable and self-reported mental health (depression, anxiety, and suicidality) and sleep (trouble falling and staying asleep) outcomes as the dependent variables.

RESULTS

Of the 14,786 young adults in the sample, 11% were food insecure. Food-insecure young adults had greater odds of mental health problems including a depression diagnosis (1.67, 95% confidence interval [CI] 1.39-2.01), anxiety or panic disorder diagnosis (1.47, 95% CI 1.16-1.87), and suicidal ideation in the past 12 months (2.76, 95% CI 2.14-3.55). Food insecurity was also associated with poorer sleep outcomes including trouble falling (adjusted odds ratio 1.78, 95% CI 1.52-2.08) and staying (adjusted odds ratio 1.67, 95% CI 1.42-1.97) asleep.

CONCLUSIONS

Food insecurity is associated with poorer mental and sleep health in young adulthood. Health care providers should screen for food insecurity in young adults and provide referrals when appropriate. Future research should test interventions to simultaneously combat food insecurity and mental health problems in young adulthood.

The Impact of Suicide Prevention Act (2006) on Suicides in Japan

Background: The Suicide Prevention Act was implemented in 2006 in Japan to promote various suicide prevention strategies. Aims: The present study examined the impact of the Suicide Prevention Act on recent suicide mortality rates in Japan. Method: Using an interrupted time-series design, we analyzed monthly mortality rates between January 1996 and December 2016. Death certificate data from vital statistics were obtained. Results: A total of 597,007 suicides (99.3% of all suicides) were analyzed. At the onset of the economic recession in 1998, a significant increase was observed in overall age-standardized mortality rates and sex-/age-specific populations, except for those aged 60 or older. The difference in trend between before and after implementation of the Suicide Prevention Act was not significant for overall or for any stratified populations. After the onset of the Tōhoku earthquake and tsunami of 2011, mortality rates declined for overall and for sex-/age-specific populations. Limitations: No information was available on what could have led to each suicide. Conclusion: The decline in mortality rates may be due to a significant and recent natural disaster. Further studies are needed to clarify plausible mechanisms for the decline in suicide rates following the Tōhoku disaster.