Subtypes of suicide attempters based on longitudinal childhood profiles of co-occurring depressive, anxious and aggressive behavior symptoms

Identifying Subgroups of Youth Suicide Decedents Based on Clinical Profiles of Psychiatric and Medical Diagnoses: A Latent Class Analysis

PURPOSE

To identify risk subgroups of youth suicide decedents using demographic and clinical psychiatric and medical diagnostic profiles to inform tailored youth suicide prevention efforts.

METHODS

This study linked Ohio Medicaid and death certificate data for Medicaid enrolled youth aged 8-25 years who died by suicide between January 1, 2010, and December 31, 2020 (N = 511). Latent class analysis was used to identify distinct clinical risk subgroups.

RESULTS

Three latent classes were identified. Internalizing problems were common across all classes, but especially prevalent in class 1, the High Internalizing + Multiple Comorbidities group (n = 152, 30%). A prior history of suicidal behavior was confined to class 1 decedents, who were otherwise characterized by substance misuse, and multiple psychiatric and medical comorbidities. Class 2 decedents, the Internalizing + Externalizing group (n = 176, 34%), were more often younger, male, Black, and unlikely to have a history of substance misuse. Decedents in class 3, the Internalizing + Substance Misuse group (n = 183, 36%), were more often older and likely to have a history of substance misuse, but unlikely to exhibit other externalizing problems.

DISCUSSION

Internalizing psychopathology is particularly common among youth who die by suicide, with comorbid externalizing psychopathology, substance misuse, and medical problems contributing to youth suicide risk. Because less than a third of youth who die by suicide have a prior history of recognized suicidal thinking or behavior, universal screening for youth suicide risk should be considered, particularly in younger children, and efforts to integrate suicide prevention in traditional health care settings should be prioritized.

Identifying unique subgroups in suicide risks among psychiatric outpatients

BACKGROUND

The presence of psychiatric disorders is widely recognized as one of the primary risk factors for suicide. A significant proportion of individuals receiving outpatient psychiatric treatment exhibit varying degrees of suicidal behaviors, which may range from mild suicidal ideations to overt suicide attempts. This study aims to elucidate the transdiagnostic symptom dimensions and associated suicidal features among psychiatric outpatients.

METHODS

The study enrolled patients who attended the psychiatry outpatient clinic at a tertiary hospital in South Korea (n = 1, 849, age range = 18-81; 61% women). A data-driven classification methodology was employed, incorporating a broad spectrum of clinical symptoms, to delineate distinctive subgroups among psychiatric outpatients exhibiting suicidality (n = 1189). A reference group of patients without suicidality (n = 660) was included for comparative purposes to ascertain cluster-specific sociodemographic, suicide-related, and psychiatric characteristics.

RESULTS

Psychiatric outpatients with suicidality (n = 1189) were subdivided into three distinctive clusters: the low-suicide risk cluster (Cluster 1), the high-suicide risk externalizing cluster (Cluster 2), and the high-suicide risk internalizing cluster (Cluster 3). Relative to the reference group (n = 660), each cluster exhibited distinct attributes pertaining to suicide-related characteristics and clinical symptoms, covering domains such as anxiety, externalizing and internalizing behaviors, and feelings of hopelessness. Cluster 1, identified as the low-suicide risk group, exhibited less frequent suicidal ideation, planning, and multiple attempts. In the high-suicide risk groups, Cluster 2 displayed pronounced externalizing symptoms, whereas Cluster 3 was primarily defined by internalizing and hopelessness symptoms. Bipolar disorders were most common in Cluster 2, while depressive disorders were predominant in Cluster 3.

DISCUSSION

Our findings suggest the possibility of differentiating psychiatric outpatients into distinct, clinically relevant subgroups predicated on their suicide risk. This research potentially paves the way for personalizing interventions and preventive strategies that address cluster-specific characteristics, thereby mitigating suicide-related mortality among psychiatric outpatients.

Uncovering the symptom relationship between anxiety, depression, and internet addiction among left-behind children: A large-scale purposive sampling network analysis

Facing long-term separation from their parents, left-behind children are at risk of the co-occurrence of internalizing and externalizing problems. Although previous research has gained substantial information examining the relationship between anxiety, depression, and internet addiction at the aggregate level of variables, little is known about the heterogeneity and interactions between these components at the symptom level with a large-scale purposive sample. Adopting the network approach, two network pathways, depression and anxiety, and associations between these variables and internet addiction were constructed. Our sample included 5367 left-behind children (Mage = 13.57; SDage = 1.37; 50.07% females). Relevant bridging, central symptoms, and network stability were identified. Two relatively stable networks were obtained. For the network of anxiety and depression, sleep problems and tachycardia were vital bridging symptoms. Central symptoms, including tachycardia, restlessness, fatigue, and emptiness, were symptoms of depression. For the network of symptoms of anxiety, depression, and internet addiction, the bridging symptoms remained the same, and the central symptoms included tachycardia, restlessness, loss of control, and emptiness. By identifying relevant bridging and central symptoms, those with higher levels of these symptoms could be regarded as intervention targets, providing a reference for the current issue of valuing diagnosis over prevention in left-behind children.

The use of advanced technology and statistical methods to predict and prevent suicide

In the past decade, two themes have emerged across suicide research. First, according to meta-analyses, the ability to predict and prevent suicidal thoughts and behaviours is weaker than would be expected for the size of the field. Second, review and commentary papers propose that technological and statistical methods (such as smartphones, wearables, digital phenotyping and machine learning) might become solutions to this problem. In this Review, we aim to strike a balance between the pessimistic picture presented by these meta-analyses and the optimistic picture presented by review and commentary papers about the promise of advanced technological and statistical methods to improve the ability to understand, predict and prevent suicide. We divide our discussion into two broad categories. First, we discuss the research aimed at assessment, with the goal of better understanding or more accurately predicting suicidal thoughts and behaviours. Second, we discuss the literature that focuses on prevention of suicidal thoughts and behaviours. Ecological momentary assessment, wearables and other technological and statistical advances hold great promise for predicting and preventing suicide, but there is much yet to do.

Associations of Non-suicidal Self-Injury and Psychological Symptoms With Suicide Attempt in Adolescents: Are There Any Gender Differences?

BACKGROUND

Psychological symptoms and non-suicidal self-injury (NSSI) are independently associated with suicide attempts (SA). Yet, no study has tested the interaction effects between NSSI and psychological symptoms on SA in community adolescent populations, or examined whether the interaction varies by gender. We sought to examine the interaction effects of NSSI and psychological symptoms on SA in adolescents and explore gender differences.

METHODS

A school-based health survey in 3 provinces in China was conducted between 2013-2014. 14,820 students aged 10-20 years completed standard questionnaires, to record the details of various psychological symptoms, SA and NSSI.

RESULTS

Psychological symptoms and NSSI were independently associated with a higher likelihood of SA in both boys and girls (p < 0.001). Adolescents with psychological, conduct or social adaptation symptoms without concurrent NSSI, were twice as likely to report SA (corresponding RORs were 1.80, 1.80 and 2.16, respectively; p < 0.01) than those who reported NSSI. Male adolescents with psychological, emotional, conduct or social adaptation symptoms had a higher risk of SA in the non-NSSI group than the NSSI group (corresponding RORs were 2.85, 2.26, 2.30 and 3.01 respectively; p < 0.01). While in girls, only adolescents with social adaptation symptoms had a higher risk of SA in the non-NSSI group than NSSI group (corresponding RORs was 1.71, p < 0.05). In the non-NSSI group, boys reporting psychological symptoms exhibited a higher likelihood of a SA than their female counterparts.

CONCLUSION

Psychological symptoms and NSSI are independently associated with an increased risk of SA in adolescents. However, to some extent, NSSI may reduce the risk of SA among individuals with psychological symptoms, especially in boys.

Genetic propensity for risky behavior and depression and risk of lifetime suicide attempt among urban African Americans in adolescence and young adulthood

Suicide attempts (SA) among African Americans have increased at a greater rate than any other racial/ethnic group. Research in European ancestry populations has indicated that SA are genetically influenced; however, less is known about the genetic contributors that underpin SA among African Americans. We examined whether genetic propensity for depression and risky behaviors (assessed via polygenic risk scores; PRS) independently and jointly are associated with SA among urban, African Americans and whether sex differences exist in these relations. Participants (N = 1,157, 45.0% male) were originally recruited as part of two first grade universal school-based prevention trials. Participants reported in adolescence and young adulthood on whether they ever attempted suicide in their life. Depression and risky behaviors PRS were created based on large-scale genome-wide association studies conducted by Howard et al. (2019) and Karlson Línner et al. (2019), respectively. There was a significant interaction between the risky behavior PRS and depression PRS such that the combination of high risky behavior polygenic risk and low/moderate polygenic risk for depression was associated with greater risk for lifetime SA among the whole sample and African American males specifically. In addition, the risky behavior PRS was significantly positively associated with lifetime SA among African American males. These findings provide preliminary evidence regarding the importance of examining risky behavior and depression polygenic risk in relation to SA among African Americans, though replication of our findings in other African American samples is needed.

Resilience Factors in the Association Between Depressive Symptoms and Suicidality

PURPOSE

To investigate whether life satisfaction and optimism might reduce the risk of suicidal thoughts and behaviors among adolescents with depressive symptoms.

METHODS

Participants were 1,904 youth from the NEXT Generation Health Study, a national sample of U.S. adolescents, followed over 7 years from 2009/2010 to 2015/2016. Longitudinal latent profile analysis and logistic regressions were conducted.

RESULTS

We identified three subgroups of adolescents with different patterns of depressive symptoms across the first six waves: "Low" (40%), "Mild" (42%), and "Moderate to Severe" (18%). The Moderate to Severe (OR = 14.47, 95% CI [6.61, 31.66]) and Mild (OR = 3.90, 95% CI [2.22, 6.86]) depression profiles had significantly higher odds of developing suicidality than the Low depression profile. Both life satisfaction and optimism moderated the association between depressive symptom profile and suicidality. The difference in suicidality risk between the Mild and Low depression profiles was significantly attenuated at high versus low levels of life satisfaction, with a difference of -.08, 95% CI [-.14, -.03]. In addition, the difference in suicidality risk between the Moderate to Severe and Low depression profiles was attenuated at high versus low levels of optimism, with a difference of -.11, 95% CI [-.21, -.01].

CONCLUSIONS

For adolescents transitioning to young adulthood, resilience factors such as life satisfaction and optimism may buffer against suicidality risk in the face of mild or moderate to severe depressive symptoms.

Voicing Jordanian Adolescents' Suicide

BACKGROUND

Studies focusing on adolescent suicide in Arab countries are particularly scarce, with the few available undertaken from within an epidemiological paradigm.

OBJECTIVE

This study aimed to understand Jordanian adolescents' perceptions, beliefs, and attitudes toward suicide.

METHODS

A qualitative design using 12 dual-moderator focus group discussions was conducted in public schools. Participants were selected from the three main regions of the country (rural southern, urban central, and suburban northern). Participants included Jordanian adolescent boys and girls, aged 14-17 years, who reported experiencing mild to moderate depressive symptoms. A relational content analysis approach was used for coding data, and a content analysis was used to identify salient thematic categories. Data were analyzed using NVivo software.

RESULTS

Four themes emerged, including perceived risk factors, perceived protective factors, active and passive suicidal ideations, and e-games and Internet influences. Main risk factors were depression; anxiety; stigma, shame, and isolation; family issues; life pressures; and guilt. Conversely, religiosity, perceived positive family functioning, and availability of long-term goals seemed to confer resilience to adolescents' suicidal ideation and behavior. Passive suicidality (having death wishes without any plans to complete suicide) was noticed most among participants who feared jeopardizing the family's reputation if they committed suicide. Several boys with active suicidal ideations used the Blue Whale Challenge e-game to learn how to complete suicide and relinquish their problems.

DISCUSSION

Suicide is a multifactorial problem requiring multimodal strategies. Evidence from this research suggests that those most passionate about the outcome of interest are encouraged to redouble efforts to reduce modifiable risk factors, enrich protective factors, target the underlying psychiatric illness that informs suicidal ideations and behavior, and research the effect of social media and Internet activity more deeply. Parents are advised to monitor the online activities of their children and familiarize themselves with the digital applications they use.

Trends in the utilization of a peer-supported youth hotline

BACKGROUND

Peer-supported youth hotlines have been in operation for many years but studies on the acceptance of this hotline model or on the demographics of the callers are lacking. This study was performed to examine the utilization of a metropolitan peer-supported youth hotline between 2010 and 2016.

METHOD

The change in demographics, contact channels, and the reasons for contact were analyzed with standard linear regression analysis in 67,478 contacts over 7 years.

RESULTS

The data revealed a significant increase in hotline utilization from 8008 annual contacts in 2010 to 12,409 contacts in 2016 (p = .03). The majority of contacts were made by 15-year-old and 16-year-old girls, but contacts by children aged 13 years old and younger have also increased significantly over the years (p = .003). In 2016, anxiety and stress were among the leading reasons for contact (20.14%), followed by sadness and depression (17.21%), suicidal ideation (14.18%), and self-harm (8.15%). Recommendations for follow-up with outside mental health resources were made in 56.22% of contacts. More than 60% of contacts had found information about the hotline on the Internet. More than 30% used text messaging to reach out to the hotline.

CONCLUSIONS

Our data indicate that adolescents increasingly utilize a peer-supported youth hotline to get help for mental health concerns. Therefore, it should be explored whether this hotline model could also be used for prevention and early intervention.

KEY PRACTITIONER MESSAGE

Peer-supported youth hotlines are well accepted and frequently utilized by adolescents to get help for mental health issues. Our data indicate that peer-supported youth hotlines could be utilized to identify youth at risk for depression and suicide. Further research should evaluate whether peer-supported youth hotlines could serve in the prevention and in early mental health intervention, and how they could be effectively linked to other mental health resources in the community.

Deliberate self-harm and associated risk factors in young adults: the importance of education attainment and sick leave

PURPOSE

The prevalence of deliberate self-harm (DSH) is high in young adults. However, few studies have examined risk in this specific age group. We, therefore, examined the relative influence and interactive nature of a wide range of potential sociodemographic and sick leave related risk factors in young adults, aged 18-35 years, using Norwegian register data.

METHODS

All subjects with at least one episode of hospital presentation for DSH registered in the Norwegian Patient Register during the period 2008-2013 were compared with age, gender and date matched population controls using a nested case-control design. The relative influence of factors and their interactions were assessed using conditional logistic regression and recursive partitioning models.

RESULTS

9 873 study cases were compared to 186 092 controls. Socioeconomic status, marital status, sick leave and several demographic factors influenced risk for DSH. Specifically, low education (OR 7.44, 95% CI 6.82-8.12), current sick leave due to psychiatric disorders (OR 18.25, 95% CI 14.97-22.25) and being previously married (OR 3.83, 95% CI 3.37-4.36) showed the highest effect sizes. Importantly, there was an interaction between education and sick leave, where those with either low education and no sick leave (OR 13.33, 95% CI 11.66-15.23) or high education and sick leave (OR 18. 87, 95% CI 17.41-24.21) were the subgroups at highest risk.

CONCLUSION

DSH in young adults is associated with multiple sociodemographic and health disadvantages. Importantly, the two high-risk subgroups imply different pathways of risk and a need for differentiated preventative efforts.

Identifying subgroups within a sample of adults with a suicide attempt history using the Interpersonal Psychological Theory of Suicide

This study used a novel theory-informed latent class approach, based on the Interpersonal Psychological Theory of Suicide (IPTS), to identify subgroups of individuals with a suicide attempt history. The identification of subgroups can inform treatments that target these specific subgroups. Using data from a randomised controlled trial, latent class analysis was conducted on 227 adults with a suicide attempt history. Latent classes were identified based on suicide attempt history, perceived burdensomeness, thwarted belongingness, and capability for suicide at the trial baseline. Three classes were found. Classes 1 and 2 (80% of participants) at baseline had higher interpersonal risks and clinical symptoms, and lower protective psychological factors (e.g., positive reframing), compared to Class 3 (20% of participants). Class 1 had elevated suicidal ideation for the duration of the trial. Classes 1 and 2 also had elevated interpersonal risks relative to a population-based sample. These results suggest that some individuals with a suicide attempt history exhibit relatively low interpersonal risks, and given concurrent protective psychological factors, may be suited to low-intensity interventions. At the other extreme, some individuals with a suicide attempt history require high-intensity interventions addressing interpersonal risks, clinical symptoms, and protective psychological factors.

A conceptual model of risk and protective factors associated with internalizing symptoms in autism spectrum disorder: A scoping review, synthesis, and call for more research

This paper reviews and synthesizes key areas of research related to the etiology, development, and maintenance of internalizing symptoms in children, adolescents, and adults with autism spectrum disorder (ASD). In developing an integrated conceptual model, we draw from current conceptual models of internalizing symptoms in ASD and extend the model to include factors related to internalizing within other populations (e.g., children that have experienced early life stress, children with other neurodevelopmental conditions, typically developing children) that have not been systematically examined in ASD. Our review highlights the need for more research to understand the developmental course of internalizing symptoms, potential moderators, and the interplay between early risk and protective factors. Longitudinal studies incorporating multiple methods and both environmental and biological factors will be important in order to elucidate these mechanisms.

Understanding Chronic Aggression and Its Treatment in Children and Adolescents

PURPOSE OF REVIEW

Youth aggression is common and has a significant burden on individuals, families, and society. However, its treatment is often a challenge for clinicians. Thus, this review will examine the current understanding of youth aggression, conceptualize aggression as a symptom rather than its own disorder, and provide an overview of treatment strategies.

RECENT FINDINGS

Youth aggression is associated with complex genetic, neurobiological, and environmental risks. Prevention strategies are of the utmost importance for at-risk families and youth. Psychosocial interventions are the first line treatment. But if not fully effective, then pharmacologic interventions-including psychostimulants, alpha-2 agonists, atomoxetine, and risperidone-have shown benefits. Other medications, such as SSRIs, can be useful in certain scenarios. It is important to conceptualize youth aggression as being a trans-diagnostic symptom in psychopathology. Determining the underlying cause of aggression will help to guide treatment.

Does CBT for anxiety-related disorders alter suicidal ideation? Findings from a naturalistic sample

BACKGROUND

Anxiety disorders commonly co-occur with suicidal ideation (SI). To our knowledge, no studies have reported on the baseline prevalence of SI and the reduction in SI in a naturalistic sample receiving cognitive behavior therapy (CBT) for anxiety-related disorders.

METHODS

Participants (n = 355) recruited from an anxiety specialty clinic reported SI at pre-, mid-, and post-CBT. Multilevel mixed effects logistic regression models compared differences in SI endorsement over Time.

RESULTS

Posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) were associated with significantly elevated baseline SI relative to specific phobia. PTSD and unspecified anxiety-related disorders were associated with significant reductions in SI, whereas reductions in SAD, GAD, OCD, and panic disorder did not reach significance. Rates of new onset and exacerbation of SI were low.

DISCUSSION

CBT for anxiety disorders was associated with significant reductions in SI over time, with no evidence for exacerbation of suicide risk. Clinical implications are discussed, as well as future research directions to further understand the effect of anxiety disorder treatments on SI.

Evaluation of Risk Factors Affecting Substance Use among Tenth-Grade Students

Aim

The aim of this study is to detect the prevalence of substance use among tenth-grade students; their thoughts, attitudes, behaviors, and tendencies towards substance use; and risk factors of substance use in tenth-grade students in general.

Methods

This study is descriptive and cross-sectional conducted between April and May 2016. Research population consists of tenth-grade students in 2015-2016 school year in the city of Ordu. Since the study involved all tenth-grade students, no sampling was done. Questions on substance use were prepared by Ordu Public Health Directorate and the authors by making use of European School Survey Project on Alcohol and Other Drugs (ESPAD) study questions, AMATEM's “Drugs and Addiction Youth Survey” study conducted on May 1996, and scientific studies conducted previously on similar subjects.

Results

9825 tenth-grade students in 88 schools from 19 counties in the city of Ordu were included in the study. 8714 of the students participated in the survey. Being male, being over the age of 15, mother and father being separated, living with relatives, being in low income, negative feelings about school, perception of being unsuccessful in school, failing a year, absenteeism, and not being content with life are the risk factors for substance use.

Conclusions

The tendency of illegal substance use becoming more and more prevalent especially among youth requires the development of new treatment strategies.