Psychosocial predictors of persistent suicidal ideation among Chinese adolescents: A longitudinal study

Internet gaming disorder predicts the incidence, persistence, and worsening of suicidal ideation: A population-based cohort study of 96,158 Chinese adolescents

INTRODUCTION

While cross-sectional studies suggest a strong association between internet gaming disorder (IGD) and suicidal ideation, longitudinal evidence is limited. This two-wave longitudinal study investigated whether IGD predicts the one-year incidence, persistence, and worsening of suicidal ideation.

METHODS

A total of 96,158 Chinese adolescents were assessed in November 2022 and one year later. IGD was measured using the 9-item Internet Gaming Disorder Scale-Short Form (IGDS9-SF), categorizing participants as non-gamers, gamers without IGD, and gamers with IGD. Suicidal ideation and their severity were evaluated using the ninth item of the 9-item Patient Health Questionnaire. Baseline demographics, lifestyle factors, and internalizing and externalizing problems were collected and controlled. Multiple logistic regression models examined associations between IGD and incident, persistent, and worsening suicidal ideation, with subgroup and sensitivity analyses performed.

RESULTS

The prevalence of baseline suicidal ideation was 21.4 %, including 17.5 % mild, 2.5 % moderate, and 1.3 % severe. The one-year incidence and persistence rates of suicidal ideation were 13.8 % and 50.1 %, respectively. Among 19,254 adolescents with mild or moderate suicidal ideation, 1656 reported worsening over the year. Compared to non-gamers, gamers with IGD had a higher risk of incident (adjusted odds ratio [AOR], 1.95; 95 % CI, 1.57-2.42), persistent (AOR, 1.56; 95 % CI, 1.34-1.82), and worsening suicidal ideation (AOR, 1.75; 95 % CI, 1.37-2.23) (all p < 0.001).

CONCLUSIONS

IGD contributes to the development, persistence, and worsening of suicidal ideation among Chinese adolescents. Targeted interventions addressing IGD may reduce suicidal ideation in this population.

LIMITATIONS

Self-reported data potentially introduced bias.

Associations between suicidal ideation and childhood maltreatment as well as inflammatory cytokines in adolescents with major depressive disorder

BACKGROUND

Suicidal ideation (SI) is thought to be associated with childhood maltreatment (CM) and inflammatory processes. Yet, these links are not thoroughly studied in adolescents with major depressive disorder (MDD). So, this study focused on investigating the predictive value of CM and inflammatory cytokines for SI in this population.

METHODS

This study included 156 depressed adolescents. The Center for Epidemiological Studies Depression Scale (CES-D), the Childhood Trauma Questionnaire (CTQ) and the Positive and Negative Suicidal Ideation Scale (PANSI) were used to assess depression, CM and SI, respectively. Additionally, plasma inflammatory cytokines levels were measured, including interleukin (IL)-1β, IL-6, IL-10, IL-17A and tumor necrosis factor-α (TNF-α).

RESULTS

Univariate analyses showed that females had higher levels of SI in adolescents with MDD. Moreover, the level of SI was negatively correlated with age and age at onset, and positively correlated with duration of illness, CES-D score, CTQ score, as well as levels of IL-1β, IL-6 and TNF-α (all p < 0.05). Furthermore, regression analyses revealed that SI was independently associated with age at onset, CES-D score, CTQ score, and Log IL-1β (all p < 0.05). Finally, receiver operating characteristic (ROC) curve analyses revealed that the combination of the CES-D score, CTQ score, and IL-1β (AUC = 0.910, 95% CI = 0.864-0.956, p < 0.001) had a better ability to identify SI in adolescents with MDD, exhibiting higher sensitivity and specificity.

CONCLUSION

SI is associated with depressive symptoms, CM and elevated levels of inflammatory cytokines (especially IL-1β) in adolescents with MDD. In the future, interventions such as cognitive behavioural therapy and the administration of anti-inflammatory drugs, targeting the modulation of CM and inflammatory cytokine levels, may play important roles in preventing suicidal behaviors in depressed adolescents.

Longitudinal trajectories of psychotic-like experiences influence adolescent suicidal ideation: The mediating role of depressive symptoms

BACKGROUND

Psychotic-like experiences (PLEs) are strongly associated with poor mental health among adolescents. This study aims to investigate distinct longitudinal trajectories of the PLEs and their relationship to suicidal ideation (SI), as well as to evaluate the mediating effect of depressive symptoms on this link.

METHODS

A total of 7529 Chinese adolescents were surveyed on PLEs online during April 21 to May 12, 2021 (Time 1, T1), December 17 to 26, 2021 (Time 2, T2), and May 17 to June 5, 2022 (Time 3, T3). Depressive symptoms and SI were assessed at T1 and T3.

RESULTS

The prevalence of frequent PLEs across the three surveys was 13.5 %, 13.2 %, and 11.0 %, respectively. Five PLEs trajectories were identified: resistance (74.4 % of the sample), recovery (9.2 %), delayed-dysfunction (6.6 %), relapsing/remitting (7.0 %), and chronic-dysfunction (2.8 %). Adolescents in recovery, delayed-dysfunction, relapsing/remitting, and chronic-dysfunction trajectories compared with those in the resistant group were all more likely to experience SI at T3 after adjusting for a wide range of covariates. Depressive symptoms partially mediated the effects of PLEs trajectories (relative to the resistance trajectory) on SI (95 % CIs: 0.07-0.13, 0.37-0.48, and 0.28-0.41 for relapsing/remitting, delayed-dysfunction, and chronic-dysfunction trajectories, respectively).

CONCLUSIONS

PLEs are common among adolescents and have heterogeneity of change patterns. The association between PLEs trajectories and SI is partially mediated by depressive symptoms. Timely assessment and targeted interventions for specific PLEs are necessary to reduce the incidence of mental disorders.

Associations between internet addiction and suicidal ideation in depressed adolescents: the mediating effect of insomnia as well as sex differences

BACKGROUND

Insomnia may mediate the association between internet addiction (IA) and suicidal ideation (SI). However, such association has not been thoroughly investigated in adolescents with major depressive disorder (MDD). Thus, our study aimed to explore whether insomnia significantly affects the association between IA and SI in adolescents with MDD, as well as any sex differences.

METHODS

From January 2021 to September 2023, this cross-sectional study included 502 adolescents with MDD and 123 healthy controls (HCs). The Clinical Global Impression-Severity (CGI-S), the Internet Addiction Test (IAT), the Insomnia Severity Index Scale (ISI) and the Positive and Negative Suicidal Ideation Scale (PANSI) were used to assess subjects' severity of depression, IA, insomnia and SI. And we employed the PROCESS macro program to examine the mediating role of insomnia between IA and SI.

RESULTS

Compared to HCs, adolescents with MDD had significantly higher levels of SI and their prevalence of IA and insomnia were 50.0% and 35.7%. In patients, PANSI scores correlated negatively with age and age of onset, and positively with disease duration as well as the scores of the CGI-S, IAT, and ISI (all p < 0.01). Moreover, above-mentioned correlations were more significant in girls. Mediation analyses showed that insomnia mediated the effect of IA on SI, and the total, direct, and indirect effects were 0.197 (95% CI: 0.132-0.262), 0.157 (95% CI: 0.096-0.218) and 0.040 (95% CI: 0.014-0.068), respectively. In female patients, the total, direct, and indirect effects were 0.224 (95% CI: 0.151-0.296), 0.191 (95% CI: 0.124-0.257) and 0.033 (95% CI: 0.002-0.068), respectively. In male patients, insomnia acted as a fully mediated effect between IA and SI, with an effect value of 0.045 (95% CI: 0.008-0.093).

CONCLUSION

Depressed adolescents have higher suicide risk, and SI is significantly associated with IA and insomnia, especially in girls. Moreover, insomnia may mediate the association between IA and SI. However, given the small sample size of this study and the limitations of assessment tools used, the results need to be viewed with caution. Regardless, clinical interventions should be strengthened for IA and insomnia in adolescents with MDD to reduce suicide risk.

Association between sleep duration, suicidal ideation, suicidal attempt and suicidal behavior among Chinese adolescents

BACKGROUND

A relatively small number of studies have researched the relationship between sleep duration and suicidal ideation, attempts, and behavior. This research aims to investigate the link between sleep duration and suicide in Chinese adolescents, and to examine the role of depression as a mediating factor.

METHOD

Data were collected from 3315 students using a multi-stage random cluster sampling method and self-administered questionnaires. The study applied logistic regression to investigate the relationship between sleep duration and various forms of suicidal behavior, and mediation analysis to understand how depression might influence this relationship.

RESULTS

The average sleep duration among the adolescents was 7.25 h (±0.20), with 59.67 % reporting insufficient sleep. The logistic regression analysis showed that longer sleep duration is linked with lower risks of suicidal ideation (OR: 0.753, 95%CI: 0.696 to 0.814), suicidal attempts (OR: 0.830, 95%CI: 0.748 to 0.922), and suicidal behavior (OR: 0.841, 95%CI: 0.713 to 0.992). Analysis using restricted cubic spline plots indicated the connection between sleep duration and these suicidal factors was not linear. The study found that depression plays a partial mediating role between sleep duration and suicidal ideation, with an effect of 52.29 %.

LIMITATIONS

The cross-sectional study design could not prove causation.

CONCLUSIONS

There is a clear non-linear association between sleep duration and suicidal tendencies in adolescents, with depression acting as a mediator. This suggests that future research could focus on sleep and mood management as ways to address suicide risk in this age group.

Suicidal ideation in Chinese adolescents: prevalence, risk factors, and partial mediation by family support, a cross-sectional study

BACKGROUND

Suicidal ideation is a pressing public health concern, particularly among adolescents. The objective of this study was to examine the prevalence of and factors associated with suicidal ideation in Chinese adolescents, addressing an important gap in current research.

METHODS

This study employed an online survey of 3443 adolescents in Lianyungang, using a cross-sectional design. The assessment included the use of the Patient Health Questionnaire-9, the seven-item Generalized Anxiety Disorder instrument, and the Perceived Social Support Scale to evaluate suicidal ideation, anxiety symptoms, and social support in adolescents, respectively.

RESULTS

In adolescents, the prevalence of suicidal ideation was 22.1%, with a significantly higher proportion among female adolescents than among males (27.9% vs 16.9%, P < 0.001). Binary regression analysis identified (OR = 1.788, 95% CI: 1.467-2.177, P < 0.001), anxiety symptoms (OR = 10.035, 95% CI: 7.441-13.534, P < 0.001), total PHQ-9 scores of mothers (OR = 1.040, 95%CI: 1.003 - 1.078, P = 0.034), total GAD-7 scores of mothers (OR = 0.958, 95%CI: 0.919 - 0.998, P = 0.039), and moderate parental relationships (OR = 2.042, 95% CI: 1.630-2.557, P < 0.001) to be risk factors for suicidal ideation; family support was a protective factor (OR = 0.888, 95% CI: 0.859-0.918, P < 0.001). Furthermore, family support partially mediates the relationship between anxiety symptoms and suicidal ideation among adolescents (9.28%).

CONCLUSIONS

This study highlights high adolescent suicidal ideation rates and recommends gender-specific interventions, anxiety management, and family support for improvement in mental health status.

Changes in suicidal ideation during treatment among patients with major depressive disorder: A 6-month naturalistic follow-up study

AIM

There is limited evidence regarding predictors of changes in suicidal ideation (SI) in patients with major depressive disorder (MDD). The objective of this study was to describe changes in SI over a 6-month period and identify their predictors from naturalistic observations of MDD patients.

METHODS

In the cross-sectional analysis, we examined 257 patients with MDD at the first-visit assessment. Among the patients, 119 who completed the 6-month assessment (completers) were included in the longitudinal analysis. For the evaluation of depressive symptoms, including SI, the Quick Inventory of Depressive Symptomatology-Japanese version was administered at both the first-visit and follow-up assessments. At baseline, we also administered the Japanese version of the Ten Item Personality Inventory to assess personality traits and the PRIME Screen-Revised to assess psychotic symptoms.

RESULTS

In the cross-sectional analysis of first-visit patients, 36.2% (93/257) exhibited SI. Among completers, 14.3% (17/119) had prolonged SI. Among the completers with SI at the first-visit assessment, 38.6% (17/44) had SI at the follow-up assessment (prolonged SI). In linear regression models including all completers, prolonged SI was positively associated with endorsement of suspiciousness/persecutory ideas and negatively associated with higher age.

CONCLUSION

More than one-third of completers who had SI at the first-visit assessment experienced prolonged SI (SI at follow-up). Our findings can help clinicians predict the course of MDD by identifying associated demographic and clinical characteristics.

Sleep disturbance and suicidal ideation mediated by psychotic-like experiences in adolescents: a two-wave longitudinal study

STUDY OBJECTIVES

Sleep disturbance may cause suicidal ideation (SI). This study aimed to examine their co-occurrence rate among adolescents and investigate whether psychotic-like experiences (PLEs) mediate this association.

METHODS

A total of 17 722 Chinese adolescents were included in this two-wave longitudinal study. The baseline survey (time 1, T1) was conducted between April 21 and May 12, 2021, and the follow-up survey (time 2, T2) was implemented between December 17 and 26, 2021. At T1, participants completed questionnaires to assess their sleep disturbance, sleep duration, PLEs, SI, depressive symptoms, and sociodemographic characteristics. At T2, participants reported their PLEs, SI, and negative life events.

RESULTS

The SI prevalence decreased from 20.2% (T1) to 18.4% (T2). Participants with SI showed significantly higher prevalence of sleep disturbance and short sleep duration compared to those without SI. Baseline sleep disturbance and short sleep duration were both associated with the increased risk of SI 6 months later. These longitudinal links were mediated by PLEs, independent of baseline covariates and negative life events.

CONCLUSIONS

These findings provide a novel insight into the mechanism linking sleep problems and suicidality, and stress the significance of assessing and addressing sleep problems and PLEs for adolescent suicide prevention and intervention.