Predicting risk of suicidal ideation in youth using a multigene panel for impulsive aggression

Self-injury and suicidal ideation among Chinese adolescents involved in different subtypes of aggression: The role of gender

BACKGROUND

Although aggression associated self-injury and suicidal ideation, but the specific impact of different subtypes of aggression is unclear. Therefore, the current study aims to quantify the associations between five subtypes of aggression, self-injury, and suicidal ideation in Chinese adolescents.

METHOD

A total of 18,532 students were recruited in grades 7 to 12 using a stratified cluster sampling across five representative provinces in China. The Functional Assessment of Self-Mutilation (CH-FASM) and Buss and Warren's Aggression Questionnaire (BWAQ) assess self-injury and aggression, respectively.

RESULTS

During the last year, the proportion of self-injury, suicidal ideation, and self-injury plus suicidal ideation (SSI) were 13.4 %, 10.0 %, 12.4 %, respectively. Multivariate logistic regression indicated that hostility was associated with self-injury-only (OR = 1.033, 95 % CI = 1.021-1.044), suicidal ideation-only (OR = 1.075, 95 % CI = 1.061-1.088), and SSI (OR = 1.100, 95 % CI = 1.087-1.114) (all P < 0.001) across five subtypes of aggression. In gender stratification, physical aggression was risk factor for self-injury-only, suicidal ideation-only, and SSI (OR = 1.028, 95 % CI = 1.018-1.037, P < 0.001) in females. While anger was association with self-injury-only and suicidal ideation-only in males (P < 0.05).

LIMITATIONS

This study was a cross-sectional design and self-reported questionnaire.

CONCLUSION

Hostility is a strong predictor of self-injury and suicidal ideation across five subtypes of aggression. There are gender differences in relationships. Prevention programs for adolescents' self-injury and suicidal ideation should consider different subtypes of aggression and gender differences.

The mediating role of impulsivity between sleep quality and suicidal ideation in adolescent population: a multicenter cross-sectional study in the northeastern Sichuan, China

Introduction

Suicidal ideation is a critical early stage in the progression towards suicidal be havior. Prior research has established links between sleep quality, impulsivity, and suicidal tendencies, yet the interaction among these factors has been less explored. This study aims to explore the mediating role of impulsivity in the relationship between sleep quality and suicidal ideation in adolescents.

Methods

Employing a cross-sectional study design, 6,974 questionnaires were distributed,including the Socio-demographic Characteristics Questionnaire, Barratt Impulsiveness Scale, the Positive and Negative Suicide Ideation Inventory,and the Pittsburgh Sleep Quality Index Scale. The participants were high school and middle school students from 33 schools in northeastern Sichuan, China, selected through random cluster sampling.

Results

Of these 6,786 questionnaires were analyzed. The participant distribution included 47.2% male and 52.8% female students, with 68.3% from junior schools and 31.7% from senior schools. The prevalence of suicidal ideation was found to be 13.6%. The analysis, which involved correlation analysis and the construction of a structural equation model, revealed that sleep quality had a significant positive effect on impulsivity (β:0.289,p < 0.05), and impulsivity, in turn, had a positive impact on suicidal ideation (β:0.355,p < 0.05).Moreover, sleep quality was directly linked to suicidal ideation (β:0.208,p < 0.05). Thus, sleep quality affects suicidal ideation both directly and indirectly through impulsivity.

Discussion

The results of this study suggest that both sleep quality and impulsivity are significant direct influencers of suicidal ideation among adolescents in the region studied, with impulsivity also playing an indirect role in the relationship between sleep quality and suicidal ideation.

COMT Val/Met, stressful life events and externalizing behaviors in youth: A longitudinal study from the ABCD sample

Early adolescence is a crucial time for understanding and detecting the risk factors that may influence youth externalizing/disruptive behaviors and disorders. Previous literature reported evidence that risk factors for disruptive behaviors include catechol-O-methyltransferase (COMT) Val158Met (rs4680) polymorphism and environmental influences. An unanswered question is whether there is a change in these risk factors over stages of youth development. This longitudinal study examines the interaction effect of Val158Met and stressful life events (SLE) on youth externalizing behaviors from ages 9-11. Participants were 2363 children of European ancestry recruited as part of the Adolescent Brain Cognitive Development study. Repeated measures linear mixed models were used to examine the effect of the interaction between Val158Met and SLE (G × E) on disruptive behaviors over development. Externalizing behaviors were analyzed at both baseline and two-year follow-up. Both Val158Met genotype and SLE scores demonstrated significant main effects on disruptive behaviors in youth, and those effects were consistent at both time points. G × E was not associated with externalizing behaviors. Youth who carried the Val allele and/or were exposed to higher SLE consistently had increased externalizing behavior scores. To our knowledge, this is the first study to longitudinally examine the interaction effects of Val158Met and SLE on externalizing behaviors in youth. The results highlight the importance of understanding the genetic and environmental factors underlying externalizing behaviors for better detection of at-risk youth, helping further with early prevention efforts. The findings propose that COMT Val158Met genotype may act as a biomarker for development of novel treatment strategies for disruptive behaviors.

Risks and familial coaggregation of death by suicide, accidental death and major psychiatric disorders in first-degree relatives of individuals who died by suicide

BACKGROUND

Evidence suggests a familial coaggregation of major psychiatric disorders, including schizophrenia, bipolar disorder, major depression (MDD), autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). Those disorders are further related to suicide and accidental death. However, whether death by suicide may coaggregate with accidental death and major psychiatric disorders within families remains unclear.

AIMS

To clarify the familial coaggregation of deaths by suicide with accidental death and five major psychiatric disorders.

METHOD

Using a database linked to the entire Taiwanese population, 68 214 first-degree relatives of individuals who died by suicide between 2003 and 2017 and 272 856 age- and gender-matched controls were assessed for the risks of death by suicide, accidental death and major psychiatric disorders.

RESULTS

A Poisson regression model showed that the first-degree relatives of individuals who died by suicide were more likely to die by suicide (relative risk RR = 4.61, 95% CI 4.02-5.29) or accident (RR = 1.62, 95% CI 1.43-1.84) or to be diagnosed with schizophrenia (RR = 1.53, 95% CI 1.40-1.66), bipolar disorder (RR = 1.99, 95% CI 1.83-2.16), MDD (RR = 1.98, 95% CI 1.89-2.08) or ADHD (RR = 1.34, 95% CI 1.24-1.44).

CONCLUSIONS

Our findings identified a familial coaggregation of death by suicide with accidental death, schizophrenia, major affective disorders and ADHD. Further studies would be required to elucidate the pathological mechanisms underlying this coaggregation.

Association between Suicidal Behaviors in Adolescence and Negative Emotions, the Level of Stress, Stress Coping Strategies and the Quality of Sleep

Suicidal behaviors in adolescents stem from complex processes deeply rooted in various spheres of life and functioning. The study was aimed at assessing the relationship between selected negative emotions, the quality of sleep, the level of perceived stress as well as stress coping strategies and suicidal ideation and attempts among high school students. The examined group consisted of adolescents aged 16-18 recruited by social-media groups in Poland. The study was based on a diagnostic survey with the application of CAWI method. The other research tools applied in the study included: Hospital Anxiety and Depression Scale-Modified, Perceived Stress Scale-10, How do you cope?-Questionnaire, Athens Insomnia Scale as well as the authors' own questionnaire on suicidal ideation and suicide attempts. Anxiety, depression, aggression and insomnia as well as a high level of stress were statistically more common in girls than in boys (p < 0.001). The high level of negative emotions and insomnia, in turn, increased the risk of suicidal ideation (OR = 3.59, 95% CI: 2.13-6.06 and OR = 2.35, 95% CI: 1.60-3.46), as well as suicide attempts (OR = 6.29, 95% CI: 2.93-14.80 and OR = 3.29, 95% CI: 2.07-5.35). Additionally, high level of stress was associated with more than twice larger odds of suicidal ideation (OR = 2.26, 95% CI: 1.13-4.63). Significantly higher prevalence of suicidal ideation (p = 0.017) and suicide attempts (p = 0.016) was observed in girls. A high level of negative emotions and stress accompanied by a low quality of sleep are factors predisposing people to suicidal ideation and attempted suicide.

Association between childhood physical abuse and suicidal behaviors among Chinese adolescents: The mediation of aggression

BACKGROUND

Although previous studies have examined many predictors of suicidal behaviors. However, little is known for childhood physical abuse (CPA) and aggression, which are prevalent among adolescents. This study aimed to explore association between CPA and suicidal behaviors, and the potential mediating role of aggression.

METHOD

A total of 16,111 students graded 7 to 12 were recruited using a stratified cluster sampling across five representative provinces in China. Conflict Tactics Scale-Parents to Child (CTS-PC) and Buss and Warren's Aggression Questionnaire (BWAQ) were used to measure CPA and aggression, respectively.

RESULTS

During the last year, 16.0 % of adolescents reported suicidal behaviors. Specifically, 7.9 % were suicide ideators, 4.6 % were planners, and 3.5 % were attempters. The prevalence of CPA in mild, moderate, and severe was 15.7 %, 26.9 %, and 4.4 %, respectively. Multinomial logistic regression indicated that moderate and severe CPA and overall aggression were associated with suicide ideators, planners, and attempters. In five sub-types of aggression, only hostility was significantly associated with all three suicidal behaviors. Structural equation modelling showed that aggression partially mediate the relationship between CPA and suicidal behaviors. The mediation proportion of overall aggression, physical aggression, verbal aggression, anger, hostility, and indirect aggression were 27.2 %, 22.4 %, 5.2 %, 14.2 %, 23.5 %, and 12.1 %, respectively.

LIMITATIONS

Cross-sectional design, self-reported questionnaire, and no other forms of childhood maltreatment.

CONCLUSIONS

CPA is a critical risk factor of suicidal behaviors among Chinese adolescents and aggression is a mediator between CPA and suicidal behaviors. Targeted suicide prevention should focus on those adolescents who report CPA and aggression, especially for hostility.

Youth suicide and hospital-presenting suicide attempts: Examination of risk factors for multiple suicide attempts in adolescence

BACKGROUND

The suicide rate among adolescents around the world has increased rapidly. There are many risk factors for attempting suicide, but not all have been clarified yet. Therefore, it is very important to identify risk factors. This study evaluated adolescents with a history of suicide attempts and their association with chronic diseases. Besides, to check whether they attempted suicide multiple times. Other clinical features related to multiple suicide attempts were investigated.

METHOD

This study used a multicentre, retrospective cross-sectional design; 253 adolescents admitted to emergency departments in 2019 for suicide attempts were evaluated.

RESULTS

Adolescents with chronic disease were at greater risk for both single and multiple suicide attempts and patients had a 6.14 times higher risk of multiple attempts (p = .013). The likelihood of multiple attempts did not differ according to the presence of somatic or psychiatric disease. Multiple attempters were more likely to poison themselves with their therapeutic drugs (p = .002).

CONCLUSION

When adolescents with a chronic disease present to the emergency services after a single suicide attempt using their therapeutic drugs, families should be informed regarding the potential for further attempts.

Impulsiveness indirectly affects suicidal ideation through depression and simultaneously moderates the indirect effect: A moderated mediation path model

OBJECTIVE

This study aims to investigate the indirect effect of impulsiveness on suicidal ideation through depression and the moderating effect of impulsiveness on the indirect effect in an integrated path model.

METHODS

Self-rating depression scale (SDS), Barratt impulsiveness scale-11th version (BIS-11), and self-rating idea of suicide scale (SIOSS) were applied. A moderated mediation path model was established including impulsiveness, depression, and suicidal ideation as observed variables.

RESULTS

The main results revealed that the moderated mediation path model fit well in describing the relationships among impulsiveness, depression, and suicidal ideation. The indirect effect of impulsiveness mediated by depression and the moderating effect of impulsiveness on suicidal ideation was significant. Multiple comparisons showed that the indirect effects under different conditions of impulsiveness had statistical differences. The higher the impulsiveness was, the stronger the predictive effect of depression on suicidal ideation was.

CONCLUSIONS

The present study confirms that people who have impulsive traits are riskier to generate suicidal thoughts because they are more likely to suffer from depression and that people who are depressive have even higher risk to develop suicidal thoughts when they simultaneously have impulsive traits. In clinical and health care work, when considering depression to prevent suicidal ideation, impulsiveness needs to be monitored throughout the process of premorbid and onset stages of depression.

Parents' right strategy on preventing youngsters' recent suicidal ideation: a 13-year prospective cohort study

BACKGROUND

Suicide remains the second leading cause of death among youths. Family-related factors are considered important determinants of children's suicidal ideation, whereas their short-/long-term influence is seldom quantified.

AIMS

We aim to confirm the simultaneous/lagged effects of family-related factors on the occurrence of recent suicidal ideation from childhood to young adulthood (aged from 10 to 22 years old).

METHOD

Data were derived from a longitudinal prospective cohort study. Participants included 2065 students who were followed up for 13 years. Generalized estimating equations were used to clarify the influential effects of family-related factors on suicidal ideation during the past month.

RESULTS

The peak of the rate of recent suicidal ideation arrived during junior high school years. Family interaction, family support, family involvement, and parental punishment had simultaneous effects on recent suicidal ideation. Family involvement, parental conflict, and psychological control had lagged and lasting effects on suicidal ideation. Notably, the lasting protective effects of family involvement were more obvious than simultaneous effects.

CONCLUSIONS

Providing parents with sustained support and education to improve their "positive parenting literacy" can help with their children's mental health development. This is especially the case during COVID-19 quarantine periods when families spend the most time together at home.

Suicide cases in developed and emerging countries: an analysis using wavelets

ABSTRACT Objective The aim of this study was to use a wavelet technique to determine whether the number of suicides is similar between developed and emerging countries. Methods Annual data were obtained from World Health Organization (WHO) reports from 1986 to 2015. Discrete nondecimated wavelet transform was used for the analysis, and the Daubechies wavelet function was applied with five-level decomposition. Regarding clustering, energy (variance) was used to analyze the clusters and visualize the clustering process. We constructed a dendrogram using the Mahalanobis distance. The number of groups was set using a specific function in the R program. Results The cluster analysis verified the formation of four groups as follows: Japan, the United States and Brazil were distinct and isolated groups, and other countries (Austria, Belgium, Chile, Israel, Mexico, Italy and the Netherlands) constituted a single group. Conclusion The methods utilized in this paper enabled a detailed verification of countries with similar behaviors despite very distinct socioeconomic, geographic and climate characteristics.

[Prognosis of the functional outcome of schizophrenia using a multigene panel]

OBJECTIVE

To compare the groups of schizophrenic patients with different levels of functional outcome and different frequency of risk variants in polymorphic loci of five candidate genes to create a multigene panel and to test its predictive ability for long-term outcome of the disease.

MATERIAL AND METHODS

According to the proposed typology, the patients included in the studies were divided into three groups, which differed in the level of social functioning. Group 1 was characterized by the highest level, in group 2 this indicator was significantly lower, and in group 3 the lowest. The multigenic panel included genes for serotonin receptor type 2a (5-HTR2A T102C), serotonin transporter (5-HTTLPR), C-reactive protein (CRP -717A>G), angiotensin II receptor type 1 (AGTR1 A1166C), and brain neurotrophic factor (BDNF Val66Met). A multi-gene risk score was calculated for each patient by summing the total number all his/her risk alleles. For each polymorphism, a score of 2 was assigned to homozygous high-risk genotypes, a score of 1 to heterozygous genotypes and a score of 0 to homozygous low-risk genotype. Accordingly, the multi-gene risk score for a patient could vary from 0 to 10 risk alleles.

RESULTS

A significant effect of the group on the multi-gene risk score was shown (p<0.0001). Between-group differences were significant as well (p<0.01). In group 1, there were no carriers of ≥6 risk alleles, and the number of carriers of less than 5 alleles exceeded 50%. In group 2, the number of carriers of ≥6 risk alleles was 19.4%, and in group 3 - 31.7%. Moreover, in these groups there were no carriers of 0-2 risk alleles, while in group 1 their number was 20.7%.

CONCLUSION

The multi-gene risk score predicts the level of functional outcome in patients with schizophrenia. In the case of a smaller number of risk alleles (0-4) in an individual, a favorable functional outcome can be predicted with a high probability in the long-term period of the disease.

The Co-occurrence of Self-Harm and Aggression: A Cognitive-Emotional Model of Dual-Harm

There is growing evidence that some individuals engage in both self-harm and aggression during the course of their lifetime. The co-occurrence of self-harm and aggression is termed dual-harm. Individuals who engage in dual-harm may represent a high-risk group with unique characteristics and pattern of harmful behaviours. Nevertheless, there is an absence of clinical guidelines for the treatment and prevention of dual-harm and a lack of agreed theoretical framework that accounts for why people may engage in this behaviour. The present work aimed to address this gap in the literature by providing a narrative review of previous research of self-harm, aggression and dual-harm, and through doing so, presenting an evidence-based theory of dual-harm – the cognitive-emotional model of dual-harm. This model draws from previous studies and theories, including the General Aggression Model, diathesis-stress models and emotional dysregulation theories. The cognitive-emotional model highlights the potential distal, proximal and feedback processes of dual-harm, the role of personality style and the possible emotional regulation and interpersonal functions of this behaviour. In line with our theory, various clinical and research implications for dual-harm are suggested, including hypotheses to be tested by future studies.