The psychosocial climate of families with suicidal pre-adolescent children

Race, Family Conflict and Suicidal Thoughts and Behaviors among 9-10-Year-Old American Children

Family conflict is known to operate as a major risk factor for children’s suicidal thoughts and behaviors (STBs). However, it is unknown whether this effect is similar or different in Black and White children. Objectives: We compared Black and White children for the association between family conflict and STBs in a national sample of 9–10-year-old American children. Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study. This study included 9918 White or Black children between the ages of 9 and 10 living in married households. The predictor variable was family conflict. Race was the moderator. The outcome variable was STBs, treated as a count variable, reflecting positive STB items that were endorsed. Covariates included ethnicity, sex, age, immigration status, family structure, parental education, and parental employment, and household income. Poisson regression was used for data analysis. Results: Of all participants, 7751 were Whites, and 2167 were Blacks. In the pooled sample and in the absence of interaction terms, high family conflict was associated with higher STBs. A statistically significant association was found between Black race and family conflict, suggesting that the association between family conflict and STBs is stronger in Black than White children. Conclusion: The association between family conflict and STBs is stronger in Black than White children. Black children with family conflict may be at a higher risk of STBs than White children with the same family conflict level. These findings align with the literature on the more significant salience of social relations as determinants of mental health of Black than White people. Reducing family conflict should be regarded a significant element of suicide prevention for Black children in the US.

Maternal and paternal personality profiles of adolescent suicide attempters

Personality features have been correlated with suicidal behaviors in recent decades. Given its neurobiological background, Cloninger's model of personality, the Temperament and Character Inventory (TCI), may help to identify the maternal and paternal personality dimensions associated with adolescent suicide attempts. The present study is the first that specifically compares the temperament and character profiles of both mothers and fathers of the adolescent suicide attempters with a control group, by considering the influence of demographic and clinical factors. The study group comprised 117 parents of 71 adolescent suicide attempters and 119 parents of 71 age- and gender-matched adolescents without a suicide attempt included as a control group. The TCI and Brief Symptom Inventory (BSI) were applied to the parents in both groups. Logistic regression analysis, which was performed to adjust confounding factors, demonstrated significantly higher scores for harm avoidance among the mothers and lower scores of self-directedness among the fathers of the adolescent suicide attempters. New psychotherapeutic modalities considering the high-risk parental personality traits would be beneficial to support parent-adolescent relationships and may have a preventative effect on adolescent suicide.

Stress And Coping in Adolescents: The Effects of Family Configuration and Environment on Suicidality

Research examining the relationship between family disruption and suicidal behavior is integrated into a stress and coping conceptual framework. The number of suicides, unsuccessful attempts, and suicidal ideation is apparently on the rise and represents a major concern. In the last decade, the adolescent suicide rate in Quebec has doubled, and continues to be well above the national average. Parental conflict and divorce are acknowledged as important factors that may increase psychological vulnerability during the developmental phase of adolescence, consequently augmenting the risk of suicidality. Suicidal behavior during adolescence is a concomitant of prolonged and progressive family disruption, inadequate family relationships, and ineffective parent-child interactions. As such, it is not uncommon that the adolescent's psychological and social coping resotcrces are diminished, and feelings of isolation, loss, and hostility toward family members are reported. With respect to coping behaviors, it has been suggested that the adolescent from a dysfunctional home may resort to suicide as a communication system, as other efforts to communicate with family members have been perceived by the youth as ineffective. This article explores the effects of family disruption on suicidality in adolescents and provides recommendations for research and practice in school psychology.

Are suicide attempts by young Latinas a cultural idiom of distress?

The high rates of suicide attempts among adolescent Hispanic females in the United States have been well established by epidemiological and clinical studies. In this paper, we review the research history of Latina suicide attempts and their characteristics. Then we apply multi-faceted conceptual and empirical criteria found in the anthropological and psychiatric literature about cultural idioms of distress to the suicide attempts of young Latinas. We contrast the suicide-attempt phenomenon to the well-known ataque de nervios and propose that the phenomenon may reflect a developmental or cultural variant of the ataque. The attempt-as-idiom proposition is intended to invite discussion that can deepen our understanding of the cultural roots of the suicide attempts and their possible designation as cultural idiom. Establishing the meaning of suicide attempts within a cultural perspective can assist psychological and psychiatric research and clinical interventions.

Risk for suicidal ideation among the offspring of bipolar parents: results from the Bipolar Offspring Study (BIOS)

The objective of the study was to examine rates and identify risk factors for suicidal ideation among offspring of parents with bipolar disorder. Subjects included 388 offspring of parents with bipolar disorder and 250 offspring of matched community controls enrolled in the Pittsburgh Bipolar Offspring Study (BIOS). Offspring of bipolar probands displayed greater rates of lifetime suicidal ideation than offspring of controls (33% versus 20%). Factors most strongly associated with lifetime suicidal ideation in offspring of bipolar parents included offspring mood disorder, hostility, recent sexual abuse, and family conflict. Offspring of parents with bipolar disorder are at elevated risk for suicidal ideation as compared with offspring of controls. Suicide risk assessment in this population should attend to specific risk factors identified.

Familism, parent-adolescent conflict, self-esteem, internalizing behaviors and suicide attempts among adolescent Latinas

Adolescent Latinas continue to report higher levels of suicide attempts than their African-American and White peers. The phenomenon is still not understood and is theorized to be the result of the confluence of many cultural, familial, and individual level factors. In Latino cultures, belief in the importance of the family, the value known as familism, appears to protect youth's emotional and behavioral health, but parent-adolescent conflict has been found to be a risk factor for suicide attempts. The role of familism in relation to parent-adolescent conflict, self-esteem, internalizing behaviors, and suicide attempts has not been studied extensively. To address this question, we interviewed 226 adolescent Latinas, 50% of whom had histories of suicide attempts. Using path analysis, familism as a cultural asset was associated with lower levels of parent-adolescent conflict, but higher levels of internalizing behaviors, while self-esteem and internalizing behaviors mediated the relationship between parent-adolescent conflict and suicide attempts. Our findings point to the importance of family involvement in culturally competent suicide prevention and intervention programs. Reducing parent-daughter conflict and fostering closer family ties has the added effect of improving self-esteem and shrinking the likelihood of suicide attempts.

Family environment and suicidal ideation among bipolar youth

The objective of this study was to examine the association between family environment and suicidal ideation among youth with bipolar disorder. Subjects included 446 bipolar (BP) youth (age 7-17) enrolled in the Course and Outcome of Bipolar Youth study. Current suicidal ideation, family functioning and family stress were assessed at intake. BP youth with current suicidal ideation reported more conflict with their mother and less family adaptability. Ideators endorsed more stressful family events over the prior year and higher rates of specific familial stressors. Clinicians treating bipolar youth should consider family stress when conducting suicide risk assessment. Treatment goals may include enhancing family communication and addressing issues of loss.

Suicidal ideation among urban nine and ten year olds

Little is known about rates and correlates of suicidal ideation among nonclinical samples of preadolescents from low-income urban backgrounds. Using the Children's Depression Inventory, we measured suicidal ideation in 131 preadolescent urban children (49% female, 90% African American/Caribbean) participating in an ongoing prospective longitudinal study of prenatal cocaine exposure and children's outcome. Suicidal ideation was reported by 14.5% of the children in this sample at 9 to 10 years of age. Children's reports of depressive symptoms, exposure to violence, and distress symptoms in response to witnessing violence were associated with suicidal ideation, but prenatal cocaine exposure, parent-rated child behavior, and caregivers' psychological distress symptoms were not. Suicidal ideation may be more prevalent among preadolescents from urban, low-income backgrounds than clinicians suspect, particularly among children exposed to violence.

Why do so many latina teens attempt suicide? A conceptual model for research

Rates of suicide attempts among adolescent Latinas have been reported to be higher than for their non-Hispanic counterparts. Yet researchers know very little about the attempts, their antecedents, and why the girls attempt suicide. Latina girls have been included in research on suicidal adolescents and typically show higher rates of attempts relative to similar psychopathology when compared with other young women. A few small studies have focused on Latinas, but none have explored why suicide attempt rates are higher. The authors constructed a conceptual model to provide a formulation of this phenomenon on the basis of a review of the literature on suicide attempts among Latinas and their clinical experience. This model can serve as a framework to guide research on the unique sociocultural processes present in Latina adolescent suicide attempts and may also benefit the work of clinicians.

The relative contribution of diagnostic and psychosocial factors in the prediction of adolescent suicidal ideation

Examined the relative importance of diagnostic and psychosocial factors in the prediction of adolescent suicidal ideation. Seventy-three high school students exhibiting emotional disturbance in the school setting completed a diagnostic interview and self-report measures assessing social support, family environment, negative life events, and problem solving. Using hierarchical regression analyses, only the presence of a pure internalizing disorder predicted suicidal ideation in addition to psychosocial variables. Interactions were found between psychiatric disorders and psychosocial variables. These results underscore the importance of including both diagnostic and psychosocial variables in research examining risk factors for adolescent suicidal behavior. Further, they suggest that adolescents presenting with psychiatric disorders, high levels of stress, and poor social support networks should be monitored for suicidality.

The relationship of adolescent personality and family environment to psychiatric diagnosis

This study examines the relationship of adolescent personality and family environment to psychiatric diagnosis in 170 adolescents admitted to a psychiatric inpatient unit. Patients were administered the Child Assessment Schedule (CAS), the family Environment Scale (FES), and the Millon Adolescent Personality Inventory (MAPI). Adolescent personality and/or family environment were related to 1) major depression, conduct disorder, and attention deficit/hyperactivity disorder in both boys and girls, 2) oppositional defiant disorder, post traumatic stress disorder and overanxious disorder in girls, and 3) dysthymic disorder and alcohol use in boys. The study empirically shows the relationship of both personality and family environment in psychiatric diagnoses.

Psychological and family factors associated with suicidal ideation in pre-adolescents

To assess the psychological and family factors associated with suicidal ideation in pre-adolescent children, we studied a sample of 361 students, average age 9 years old. Two groups were formed, on the basis of the presence (n = 34) or absence (n = 44) of suicidal ideation. Suicidal ideation was assessed with the Children's Depression Inventory and the Children's Depression Rating Scale-Revised. Depression, hopelessness, self-esteem, and perceived family environment were compared in both the suicidal ideation and the control groups. Students with suicidal ideation generally presented greater depressive symptoms and hopelessness, and lower self-esteem and family expressiveness, although there were differences both between sexes, and when the variable depression was controlled. Identifying these risk factors in pre-adolescents may have an impact on prevention of suicidal behavior at higher risk ages.

Youth suicidal behavior: assessment and intervention

In this article, the authors review the research on risk assessment of suicidal adolescents and describe the small body of randomized-clinical-treatment trials for this population. Research has yielded a fairly consistent set of direct and indirect risk factors for suicidal behavior in adolescents. The authors describe a variety of measures commonly used to assess these risk factors. Treatment studies targeting suicide are sparse for all ages. In the adult literature, evidence suggests clozapine, depot flupenthixol, lithium, and dialectical behavior therapy (DBT) are significantly more effective in decreasing suicidal behavior than placebo or Treatment as Usual. For adolescents, it is difficult to draw conclusions about treatment efficacy. In general, control conditions are just as effective at reducing suicidal behavior as experimental conditions. While some novel interventions for suicidal adolescents are described, there is a desperate need for more research to be conducted in order to advance this burgeoning field.

Family characteristics and behavior problems of suicidal and non-suicidal children and adolescents

The present study examined familial and individual variables in youngsters at high risk for suicide and non-suicidal youngsters. One hundred inpatient children and adolescents completed a battery of questionnaires including, FACES II, Family Strengths, and Problem Behavior Scales, to assess family dysfunction and individual behavior problems. The results indicated that suicidal youngsters have lower pride in their families and perceived them as less adaptable than non-suicidal youngsters as indicated by scores on the Family Strengths and FACES II, respectively. Scores on the Problem Behavior Scales indicated that suicidal youngsters also exhibited self-inflicted behaviors, withdrawal from others, little interest in activities, poor concentration, and difficulties with sleeping. In addition, youths at risk for suicide were more likely to be diagnosed with a mood disorder, including major depressive disorder and dysthymia, as well as substance abuse and phobias. These findings suggest that suicidal youngsters' negative perceptions of their families and their maladaptive behaviors should be given special attention in designing appropriate interventions. In this way, treatment would likely be effective by providing appropriate coping skills and preventing future suicidal attempts in high risk youngsters.

Childhood suicidal behavior. A developmental perspective

This article provides an overview of the sociocultural and psychosocial features and implications for treatment of prepubertal suicidal children. It provides cross-sectional and longitudinal information about specific risk factors of prepubertal suicidal behavior with a focus on how these factors also predict future suicidal behavior. A developmental focus addresses issues of cognitive and emotional immaturity as related to early onset suicidal behavior.

Family environment, attitudes toward life and death, depression, and suicidality in elementary-school children

This study examines whether perception of family environment, attitudes toward life and death, and depression predict suicidality in elementary-school children. Seventy-eight participants ages 8 to 13 recruited through an elementary school and a university were assessed for attitudes toward life and death, depression, suicidality, and family environment. A regression equation indicated that depression and attraction to life were the only variables accounting for variance in suicidality (49%). Family environment variables were moderately correlated with depression, indicating that family environment may play a role in the development and maintenance of depression, of which suicidality is a symptom. Concurrent treatment of family issues may not only ameliorate children's symptoms, but also provide a critical sense of support that may decrease the likelihood that these children will become suicidal in the future.

Adolescent suicide, depression and family dysfunction

This study investigated associations between adolescents' perceptions of their family dynamics (McMaster Family Assessment Device, FAD) and depression, suicide thoughts and attempts. High school students (mean age 15.2 years) completed self-report questionnaires including the Beck Depression Inventory (BDI), the FAD, questions about suicidal thoughts, plans and attempts, deliberate self harm, and selected life experiences. Univariate analysis showed that family dysfunction measured on the FAD is associated with thinking and planning suicide, deliberate self harm, suicide attempts, as well as severe depression (BDI > or = 22). Despite this, stepwise regression indicated that family dysfunction influences suicide behaviors indirectly through other variables such as depression. The FAD is recommended as a useful addition to questionnaires seeking to identify vulnerability to both depression and adolescent attempted suicide in early detection studies.

A quantitative and qualitative analysis of suicidal preadolescent children and their families

This study identified a sample of suicidal preadolescent children who also were depressed, aggressive, and socially isolated. The study explored the dimensions of cohesion and control associated with the families of these children. Two hypotheses were suggested: 1) the families have a deficit in emotional bonding and 2) the families have a chaotic disciplinary style. It also seems likely that children learn suicidal behavior through observation of others in their family and social contexts.