Adolescents' self-reported suicide attempts, self-harm thoughts and their correlates across 17 European countries

Prevalence of Suicidal Ideation, Suicide Plans, and Suicide Attempts Among Children and Adolescents Under 18 years of Age in Mainland China: A Systematic Review and Meta-Analysis

Despite suicide in younger population having become a severe public health issue, information on the prevalence of suicidality among Chinese children and adolescents is still limited. This study aims to estimate the prevalence of suicidal ideation, suicide plans, and suicide attempts in Chinese children and adolescents aged under 18 years. A meta-analysis was conducted based on English and Chinese publications from January 1, 2010 to December 31, 2020 using random-effects models. Based on 132 eligible studies with a combined total of 1,103,309 Chinese children and adolescents below 18 years old, the pooled prevalence of the overall suicidal ideation, suicide plans, and suicide attempts were 15.4% (95% CI [14.3, 16.6]), 6.4% (95% CI [5.5, 7.4]) and 3.5% (95% CI [3.1, 4.1]), respectively. The subgroup analyses showed that there were significant variations of prevalence of suicidal risks across genders, school stages, and geographical areas in mainland China. It was the first systematic review and meta-analysis to show suicidality among younger population aged below 18 years is prevalent in mainland China. This study suggests that gender-age-region-specific prevention and intervention programs should be urgently needed to reduce suicidal risks among Chinese children and adolescents.

Mental health after the COVID-19 pandemic among Finnish youth: a repeated, cross-sectional, population-based study

BACKGROUND

High levels of mental health problems among young people were reported during the COVID-19 pandemic, but studies of the post-pandemic period are scarce. We assessed mental health problems among Finnish youth before, during, and after the COVID-19 pandemic using nationwide population-based samples. Our aim was to examine in which direction the heightened levels of adolescent mental health problems have developed after the pandemic.

METHODS

In this national, repeated cross-sectional, population-based study in Finland, we recruited students at lower and upper secondary level (aged 13-20 years) who were taking part in the Finnish School Health Promotion (SHP) survey in 2015-23 (119 681-158 897 participants per round). The SHP is based on total sampling and conducted biennially between March and May. Self-reports covered the seven-item Generalized Anxiety Disorder Scale; the two-item Patient Health Questionnaire for depression; the Mini Social Phobia Inventory for social anxiety; the Short Warwick-Edinburgh Mental Wellbeing Scale for mental wellbeing; loneliness; the Sick, Control, One Stone, Fat, Food measure for disordered eating; and suicidality (suicidal ideation, deliberate self-harm, and suicide attempts). Scales were dichotomised using validated cutoffs. Presence of any and comorbid mental health problems was assessed. Logistic (for dichotomised outcomes) and linear (for Short Warwick-Edinburgh Mental Wellbeing Scale) mixed effects models were used to analyse the effect of survey year on mental health, controlling for sociodemographic background factors and stratified by gender and school level. Cisgender and transgender youth were compared.

FINDINGS

Between 2015 and 2023, the SHP study recruited 722 488 students (371 634 [51·6%] girls and 348 857 [48·4%] boys) with a mean age of 15·8 years (SD 1·3) who were either in the eighth and ninth grades of comprehensive school or the first and second years of general and vocational upper secondary schools in Finland. The proportion of participants with generalised anxiety, depression, and social anxiety symptoms above the cutoff increased from pre-COVID-19 levels to 2021 and remained at these higher levels in 2023 among all study groups. Among girls in lower secondary education, prevalence of generalised anxiety, depression, and social anxiety symptoms increased from 2021 to 2023, as did social anxiety among girls in upper secondary education. Among boys, the proportion with social anxiety symptoms decreased between 2021 and 2023. Mental wellbeing scores decreased in all groups between 2021 and 2023, and disordered eating increased in girls, and in boys in lower secondary education. Suicidality increased in girls but not in boys. Loneliness was the only measure to show improvement in all groups from 2021 to 2023. In 2023, 55 895 (72·6%) of 76 994 girls and 22 718 (32·8%) of 69 205 boys reported at least one mental health problem, and 37 250 (48·4%) girls and 9442 (13·6%) boys reported comorbid mental health problems. Among both transfeminine and transmasculine youth, the prevalence of generalised anxiety and depression symptoms decreased from 2021 to 2023, but compared with cisgender youth, the proportions were significantly higher throughout.

INTERPRETATION

The effects of the COVID-19 pandemic on youth mental health could be long lasting. In this study, the substantial change for the better among transgender youth was a positive exception. Providing adequate support and treatment for young people with poor mental health is essential, but solutions to the mental health crisis need to address a wider societal perspective and should be developed in partnership with young people.

FUNDING

NordForsk, Research Council of Finland.

TRANSLATIONS

For the Finnish and Swedish translations of the abstract see Supplementary Materials section.

The effect of bullying and cyberbullying on predicting suicide risk in adolescent females: The mediating role of depression

This paper analyzed the role of depression as a mediator in the association between bullying, cyberbullying, and suicide risk in adolescent females. A total of 751 Colombian adolescent females (M= 13.71, SD=1.897), who were administered the Plutchik Suicide Risk Scale, the Beck Depression Inventory, the European Bullying Intervention Project Questionnaire and Cyberbullying. Bullying victimization and aggression and cyberbullying victimization were found to contribute statistically significant effects that explaining 22 % of the variance in depression. The variables of victimization in bullying and cyberbullying and depression explained 64 % of the variance in suicidal risk, and depression mediated the association between victim and aggressor roles in bullying and cyberbullying in predicting suicidal risk, whose total direct and indirect effects are statistically significant. The findings support the role of depression as a mediating variable between bullying and cyberbullying and suicidal risk in female adolescents and highlight the importance of focusing prevention and intervention efforts on risk factors for depression and suicidal behavior in cases of bullying and cyberbullying.

Weekly links among irritability and suicidal thoughts and behaviors in high-risk youth

BACKGROUND

Previous studies demonstrate a link between irritability and suicidal thoughts and behaviors (STBs) in youth samples. However, they have mostly assessed irritability in community samples and as a largely dispositional (i.e. trait-like) construct. Thus, it remains unclear to what extent links between irritability and STBs reflect within-person processes of elevated risk in clinically meaningful time periods.

METHODS

The present study used clinical data from 689 adolescents aged 12-19 years attending a total of 6,128 visits at a specialty Intensive Outpatient Program for depressed and suicidal youth to examine patterns in weekly assessments of irritability and STBs throughout treatment, including associations among trends and fluctuations departing from these trends via multilevel structural equation modeling. Youth completed self-report measures of irritability, depression, and STBs weekly as part of standard IOP clinical care.

RESULTS

Overall, two-thirds of variance in weekly irritable mood was accounted for by between-person differences and the remaining portion by weekly fluctuations. After controlling for depression, during weeks when youth were more irritable they experienced increased STBs. Rates of change in irritability and STBs tended to track together at early stages of treatment, but these effects were generally accounted for by depression severity.

CONCLUSIONS

Our results suggest that although changes in STBs are best accounted for by depression, irritability can be understood as a specific, proximal risk factor for youth STBs that exacerbates youth STBs in clinically informative timeframes above and beyond depression.

Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis

BACKGROUND

Adolescence is characterized by complex and dynamic changes, often involving experimentation, including the use of psychotropic substances. Although it is well-established that recreational psychotropic drugs are associated with suicide ideation in adults, evidence of this association in adolescents remains limited.

OBJECTIVE

To investigate the relationship between suicide ideation and psychotropic recreational drug use among adolescents.

DESIGN AND SETTING

Systematic review with meta-analysis developed at Universidade Federal de Uberlândia (UFU) and Universidade Estadual de Campinas (UNICAMP), Brazil.

METHODS

A search across eight electronic databases for observational studies, without language or publication year restrictions, was conducted. The Joanna Briggs Institute tool was used to assess the risk of bias. Random-effects meta-analyses and odds ratios were used to measure the effects.

RESULTS

The search yielded 19,732 studies, of which 78 were included in the qualitative synthesis and 32 in the meta-analysis. The findings indicated that suicidal ideation was 1.96 times more likely (95% confidence interval, CI = 1.47; 2.61) for adolescents who used some drug recurrently and 3.32 times more likely (95%CI = 1.86; 5.93) among those who abused drugs. Additionally, adolescents who used cannabis were 1.57 times more likely (95%CI = 1.34; 1.84) to experience suicide ideation compared with non-users, while cocaine users had 2.57 times higher odds (95%CI = 1.47; 4.50).

CONCLUSIONS

Psychotropic recreational drug use is associated with suicidal ideation among adolescents regardless of current or previous use, abuse, or type of substance used.

SYSTEMATIC REVIEW REGISTRATION

Registered in the PROSPERO database under the identification number CRD42021232360. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232360.

Suicidality and Self-Harm Behavior of Adolescents During the Early Phase of the War in Ukraine

OBJECTIVE

War profoundly impacts people's lives, causing death, displacement, and psychological trauma, but research investigating suicidality of adolescents in this context has been limited. We compared suicidality or self-harm behavior among adolescents in regions that were, and were not, affected by Russia's initial invasion of Ukraine in 2014.

METHOD

This cross-sectional study comprised 2,752 school students aged 11 to 17 years from the war-affected Donetsk region and non-war Kirovograd region. Data collection occurred in 2016 and 2017 using self-report tools to assess suicidality or self-harm behavior; psychopathology including posttraumatic stress disorder (PTSD), depression, and anxiety; and war trauma exposure.

RESULTS

Adolescent girls in the war-affected region reported more suicide attempts (9.5% vs 5.1%; adjusted odds ratio [aOR] 1.8, 95% CI 1.2-2.8), suicidal ideation (39.3% vs 19.6%; aOR 2.6, 95% CI 2.01-3.3), or self-harm behavior (19.6% vs 13.1%; aOR 1.6, 95% CI 1.2-2.1), and boys reported more suicidal ideation (17.0% vs 9.8%; aOR 1.7, 95% CI 1.2-2.4). Boys and girls with PTSD, depression, or anxiety showed increased risks for any suicidality or self-harm. A dose-effect relation was observed between war trauma exposure and suicidality or self-harm. The association was strongest for adolescents who had experienced 5 or more different war trauma exposures (aOR 3.2, 95% CI 2.2-4.8).

CONCLUSION

War trauma exposure and psychopathology were strongly associated with suicidality or self-harm behavior, with a greater impact in girls than boys. The high prevalence of suicidality found in this study emphasizes the need for intervention on a large scale for adolescents living in war situations.

Risk Factors for Suicide Reattempt among Adolescents and Young Adults: The Role of Psychiatric Disorders

Suicidal behaviour among young people is a serious public health concern. Each suicide attempt is related to further suicide attempts and completed suicide. This study aims to explore risk factors associated with repeated suicide attempt among adolescents and young adults. The cohort included 510 patients aged 12-29 years residing in Piedmont Region in North-Western Italy, who had been admitted to hospital or emergency department with a diagnosis of suicide attempt between 2010 and 2020. Cox regression models were used to evaluate potential risk factors for repeated suicide attempt. During the 11-years follow-up, 20.6% of adolescents and young adults repeated suicide attempt, 24.8% of females and 12.3% of males. Nearly 90% of youth who attempted suicide had a diagnosis of psychiatric disorder. After adjustment, younger age of onset of suicidal behaviour, and diagnosis of schizophrenia, bipolar disorder, depressive disorder, anorexia nervosa and personality disorder were significantly associated with repeated suicide attempt. The early identification of patients at higher risk of repetition of suicidal behaviour is of crucial importance. Better understanding of risk factors and effective treatment of mental disorders could help suicide prevention to reduce the burden of the problem among young people. Special attention should be paid during the initial months following discharge from hospital or emergency department, when suicide reattempt risk is very high.

Spatial, geographic, and demographic factors associated with adolescent and youth suicide: a systematic review study

Background

Suicide is a public health issue and a main cause of mortality among adolescents and the youth worldwide, particularly in developing countries.

Objectives

The present research is a systematic review aiming to investigate the spatial, geographical, and demographic factors related to suicide among adolescents and the youth.

Methods

In this systematic review, two researchers examined PsycINFO, Web of Science, Scopus, and PubMed databases on December 7th, 2022 with no time limits from the beginning of publication until 2022 to identify the primary studies on spatial and geographic analysis on adolescent and youth suicides. Once duplicate studies were identified and removed, the titles and abstracts of studies were examined and irrelevant studies were also removed. Finally, 22 studies were reviewed based on the inclusion criteria.

Results

Our findings show that suicide rates are generally higher among men, residents of rural and less densely populated regions, coastal and mountainous regions, natives, 15-29 age group, less privileged populations with social fragmentation, unemployed, divorced or lonely people, those who live in single parent families, people with mental health issues, and those with low levels of education.

Conclusions

Stronger evidence supports the effects of geographic and demographic variables on youth and adolescent suicide rates as compared with spatial variables. These findings suggest that policy makers take spatial and demographic factors into consideration when health systems allocate resources for suicide prevention, and that national policymakers integrate demographic and geographic variables into health service programs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023430994.

Interpersonal theory of suicide and stressful life events in a clinical sample of adolescents in Spain

AIMS

The interpersonal theory of suicide (ITPS) provides a theoretical model for suicidal behaviour. It includes two interpersonal variables, thwarted belongingness (TB) and perceived burdensomeness (PB). This study tested the relationship between ITPS interpersonal variables and suicide risk (presence/absence of suicidal ideation and suicide attempts throughout life) in a clinical sample of Spanish adolescents. We also assessed the potential mediation effect of these variables in the well-established relationship between stressful life events (SLE) and suicide risk.

METHODS

We recruited 147 adolescents aged 11-17 from the Child and Adolescent Mental Health Outpatient Services of the Jiménez Díaz Foundation (Madrid, Spain). Different questionnaires were administered to assess suicidal behaviour and SLE (SITBI, The Stressful Life Events Scale) and to calculate proxy measures for ITPS interpersonal factors (SDQ, STAXI-NA, CDI).

RESULTS

TB and PB significantly correlated with suicide risk. PB played a mediating role in the relationship between SLE and suicide risk: adolescents reporting SLE were more likely to enact suicide behaviours when they experienced higher PB. Patients scoring higher PB were more likely to receive more intense treatment but tended to abandon intervention promptly.

CONCLUSIONS

ITPS seems useful for predicting suicide risk in an adolescent clinical sample. The results suggest an important role for PB in the SLE-suicide risk relationship and may impact the treatment process. Our exploratory findings should be addressed in future studies.

Suicide attempt management among Turkish and American adolescents: A comparison of two pediatric emergency departments

Background/aim

Suicide is one of the leading causes of death among adolescents. This study aimed to compare the characteristics and short-term outcomes of Turkish and American adolescents with suicide attempts and determine the differences in management and resource utilization between two pediatric emergency departments; one in Türkiye and one in the United States of America.

Materials and methods

Adolescents who presented to the emergency departments with a chief complaint of suicide attempt between October 2017 and September 2018 were eligible for including in the study. Characteristics and other information of 217 (131 American and 86 Turkish) suicide attempter adolescents were retrieved from medical records. Outcome was defined as re-admission to the emergency department for another suicide attempt within 3 months of the index visit.

Results

Overall, 78% of adolescents were female. Abuse history (physical/sexual) was more common among American adolescents (p = 0.005), whereas uncontrolled psychiatric diseases were more evident in Turkish cases (p < 0.001). Social worker assessment and hospitalization rates were significantly lower, with shorter mean duration of follow-up in the emergency department among Turkish compared to American adolescents (respectively, p < 0.001, p < 0.001 and p = 0.002). Repeated suicide attempts within three months were significantly higher in the Turkish group compared to the American one (29% vs. 8%, p < 0.001). Receiving a social worker assessment, hospitalization and longer observation in emergency department reduced the incidence of repeated suicide attempts (respectively, p < 0.001, p = 0.003 and p = 0.012).

Conclusion

Turkish adolescents had shorter observation time in the emergency department, received fewer assessment by social workers and were less likely to be hospitalized. These may have contributed to the higher rate of repeat suicide attempts following discharge from the emergency department. Adequate resources are needed to help decrease the burden of suicide among Turkish adolescents.

A network study to differentiate suicide attempt risk profiles in male and female patients with major depressive disorder

Suicide attempts are a possible consequence of Major Depressive Disorder (MDD), although their prevalence varies across different epidemiological studies. Suicide attempt is a significant predictor of death by suicide, highlighting its importance in understanding and preventing tragic outcomes. Researchers are increasingly recognizing the need to study the differences between males and females, as several distinctions emerge in terms of the characteristics, types and motivations of suicide attempts. These differences emphasize the importance of considering gender-specific factors in the study of suicide attempts and developing tailored prevention strategies. We conducted a network analysis to represent and investigate which among multiple neurocognitive, psychosocial, demographic and affective variables may prove to be a reliable predictor for identifying the 'suicide attempt risk' (SAR) in a sample of 81 adults who met DSM-5 criteria for MDD. Network analysis resulted in differences between males and females regarding the variables that were going to interact and predict the SAR; in particular, for males, there is a stronger link toward psychosocial aspects, while for females, the neurocognitive domain is more relevant in its mnestic subcomponents. Network analysis allowed us to describe otherwise less obvious differences in the risk profiles of males and females that attempted to take their own lives. Different neurocognitive and psychosocial variables and different interactions between them predict the probability of suicide attempt unique to male and female patients.

Suicides among Children and Adolescents in Paraguay: An 18-year National Exploratory Study (2004-2022)

BACKGROUND

Suicide and suicide attempts are impacting events for patients and their relatives, and these behaviors are still taboo among adults and may be even more traumatic when involving children and adolescents.

AIM

In this study we aimed to describe suicide rates among children and adolescents in Paraguay over the last decades as well as associated factors such as sociodemographic characteristics and methods used for suicide.

METHODS

This was an observational and exploratory study describing the frequency and characteristics of suicide among children and adolescents in Paraguay between 2004 and 2022. Official records of all deaths by suicide were reviewed, and statistical analyses were performed. In addition, an attempt was made to predict the number of suicides in the next 5 years using a mathematical model based on simple linear regression.

RESULTS

In the 18-year period observed, 940 suicides among children and adolescents were recorded. The mean age was 15.05 ± 1.8 years old. Of these, 51.17% were male, 74.6% were from urban areas, and 22.2% were from the Greater Asunción and Central Department of Paraguay. The most frequently used method of suicide was intentional self-inflicted injury by hanging, strangulation, or suffocation, which all represented 75.3% of the cases. Our mathematical modeling based on simple linear regression determined that the expected yearly number of national suicides in the pediatric population for the following years, from 2023 to 2027, will range between 72 and 81.

CONCLUSION

This study is the first large national epidemiological report on the emerging issue of suicide among children and adolescents in Paraguay. It may be a relevant source of information for mental health professionals, health authorities, and decision makers to develop national prevention strategies and actions against suicide among youths.

Cannabis use disorder, suicide attempts, and self-harm among adolescents: A national inpatient study across the United States

BACKGROUND

Suicide is among the top three causes of adolescent mortality. There is a scarcity of research examining cannabis use and suicidal behavior in adolescents.

OBJECTIVES

To determine the association between cannabis use disorder (CUD) and suicide attempt/self-harm in a hospitalized sample of adolescents.

METHODS

We conducted a cross-sectional observation study using data from the Nationwide Inpatient Sample collected over four years from January 1, 2016, through December 31, 2019. We included adolescents aged 10-19 hospitalized during the above period (N = 807,105). The primary outcome was suicide attempt/self-harm and the main predictor was CUD. The International Classification of Diseases Tenth Revision (ICD 10) diagnostic codes was used to identify a diagnosis of CUD, suicide attempt/self-harm, and other diagnoses included in the analyses. Adolescents diagnosed with CUD (n = 53,751) were compared to adolescents without CUD (n = 753,354). Univariate and multivariate logistic regressions were conducted to determine the association between CUD and suicide attempts/self-harm.

RESULTS

807,105 adolescent hospitalizations were analyzed, of which 6.9% had CUD. Adolescents with CUD were more likely to be older (17 years vs. 15 years), female (52% vs. 48%), have depression (44% vs. 17%), anxiety (32% vs. 13%), an eating disorder (1.9% vs. 1.2%), ADHD (16.3% vs. 9.1%), Conduct Disorder (4.1% vs. 1.3%), Alcohol Use Disorder (11.9% vs. 0.8%), Nicotine Use Disorder (31.1% vs. 4.1%), Cocaine Use Disorder (5.4% vs. 0.2%), Stimulant Use Disorder (0.8% vs. 0.4%) and report suicide attempts/self-harm (2.8% vs. 0.9%) [all ps<0.001]. After adjusting for potential confounders, CUD was associated with a higher risk of suicide attempts/self-harm (OR = 1.4, 95% CI 1.3-1.6, p <0.001). Post-hoc analyses showed the presence of depression moderated the association between CUD and suicide attempts/self-harm in that adolescents with CUD and depression had 2.4 times the odds of suicide attempt/self-harm compared to those with CUD but no depression after controlling for potential confounders (p<0.001).

CONCLUSIONS

Our study provides evidence for the association between CUD and suicide risk among hospitalized adolescents and underscores the importance of recognizing and addressing co-occurring mental and substance use disorders along with CUD to mitigate suicide risk. Identifying high-risk adolescents in inpatient settings provides an opportunity for intervention.

Practice-based insights from specialized clinicians into youth suicide risk assessment and psychotherapy: A qualitative study

Objective: The experience of frontline clinicians is an underutilized source of knowledge about improving youth suicide intervention. This qualitative study explored the perspectives of highly experienced, specialized mental health clinicians on the practical application of risk assessment, stabilization, and treatment and their experience of working in this practice area.Method: Data were collected from seven focus groups with 28 clinicians and analyzed using consensual qualitative research methods.Results: Four domains emerged, describing 1) youth suicide intervention as relationally focused and attachment-informed, 2) the need for flexible and tailored care balancing individual and family intervention in the context of family complexity and fractured relationships, 3) a nuanced, therapeutic approach to managing the complexity and uncertainty of adolescent suicide risk, and 4) working in youth suicide intervention as emotionally demanding and facilitated or hampered by the organizational and systems context.Conclusion: The importance of harnessing family systems and attachment-informed approaches to alliance, risk assessment, and treatment was emphasized, along with the parallel need for systemic clinician support and consideration of the potential negative consequences of administrative and risk management protocols.

A Three-Way Interaction of Sex, PER2 rs56013859 Polymorphism, and Family Maltreatment in Depressive Symptoms in Adolescents

The prevalence of depressive symptoms in adolescents is 12-18% and is twice as frequent in females. Sleep problems and thoughts of death are depressive symptoms or co-occurrent phenomena. Family maltreatment is a risk factor for later depressive symptoms and the period circadian regulator (PER) has been studied in relation to neurotransmitters, adaptation to stress, and winter depression. The purpose of this work was to study the relation of the three-way interactions of sex, PER2 rs56013859, and family maltreatment in relation to core depressive symptoms, sleep complaints, and thoughts of death and suicide in self-reports from a cohort of Swedish adolescents in 2012, 2015, and 2018. Cross-sectional and longitudinal analyses with linear and logistic regressions were used to study the relationships to the three outcomes. The three-way interaction was related to core depressive symptoms at both baseline and six years later. In contrast, the model did not show any relation to the other dependent variables. At 13-15 years, a sex-related differential expression was observed: females with the minor allele C:C/C:T exposed to family maltreatment showed higher levels of core depressive symptoms. Six years later, the trend was inverted among carriers of minor alleles.

The Association Between Atypical Speech Development and Adolescent Self-Harm

BACKGROUND

Adolescent self-harm is a major public health issue internationally. Various factors associated with adolescent self-harm have been identified, including being bullied and experiencing mental health problems. Stuttering and speech sound disorder are associated with both of these factors. It was hypothesized that both stuttering and speech sound disorder would be associated with self-harm. This is the first study to explore the relationship between communication disorders and adolescent self-harm.

METHOD

Secondary analysis of a large, longitudinal, prospective, community sample, the Avon Longitudinal Study of Parents and Children, was carried out. Clinicians identified children who stuttered or exhibited speech sound disorder at the age of 8 years. When the cohort members were 16 years old, they were asked to complete a questionnaire about self-harm. Multinomial logistic regression was used to examine the associations between stuttering and speech sound disorder and the self-harm outcomes, adjusting for other relevant factors.

RESULTS

Of 3,824 participants with data for both speech status and self-harm, 94 (2.5%; 95% confidence interval [CI; 2.0, 3.0]) stuttered at 8 years of age and 127 (3.3%; 95% CI [2.8, 3.9]) displayed speech sound disorder. Speech sound disorder at the age of 8 years was associated with self-harm with suicidal intent in both unadjusted and adjusted models. Differences between the adjusted and unadjusted models were small, suggesting that speech sound disorder is largely an independent risk factor for self-harm with suicidal intent. Stuttering at the age of 8 years was not associated with adolescent self-harm, and there was no association between speech sound disorder and self-harm without suicidal intent.

CONCLUSION

Compared with individuals without speech sound disorder, adolescents with speech sound disorder at the age of 8 years have twice the risk of reporting self-harm with suicidal intent, even when other important predictors are taken into account.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22573030.

Non-suicidal self-injury and professional psychological help-seeking among Chinese left-behind children: prevalence and influencing factors

BACKGROUND

Non-suicidal self-injury (NSSI) is a risk factor for suicide. This study aimed to investigate the prevalence of NSSI and professional psychological help-seeking status and influencing factors among left-behind children (LBC) in China.

METHODS

We implemented a population-based cross-sectional study in participants aged 10-18 years. Sociodemographic characteristics, NSSI, help-seeking status and coping style were measured by self-reported questionnaires. A total of 16,866 valid questionnaires were collected, including 6096 LBC. Binary logistic regression models were used to analyze the factors influencing NSSI and professional psychological help-seeking.

RESULTS

The incidence of NSSI among LBC was 4.6%, significantly higher than that of non-left-behind children (NLBC). This incidence was higher among girls. Moreover, 53.9% of LBC with NSSI did not receive any treatment and only 22.0% sought professional psychological help. LBC often adopt emotion-oriented coping styles, specifically, those with NSSI. LBC with NSSI who seek professional help tend to adopt problem-oriented coping styles. Logistic regression analysis revealed that girls, learning stage, single-parent, remarried families, patience, and emotional venting were risk factors for NSSI in LBC, while problem-solving and social support seeking were protective factors. Moreover, problem-solving was also a predictor for seeking professional psychological help, patience will prevent it.

LIMITATIONS

This was an online survey.

CONCLUSIONS

The prevalence of NSSI in LBC is high. Gender, grade, family structure, and coping style affect the occurrence of NSSI among LBC. Only a few LBC with NSSI seek professional psychological help, while the coping style will affect the help-seeking behavior.

Problematic internet use and suicidality and self-injurious behaviors in adolescents: Effects of negative affectivity and social support

BACKGROUND

Problematic internet use (PIU) has been shown to be closely associated with suicidality and self-injurious behavior (SSIB), but the mechanism to help explain this association is understudied. The aim of the present study is to test mediating effects of negative affectivity between PIU and SSIB and whether social support moderates this mediating effect.

METHODS

A sample of 2173 middle and high school students (M_age = 14.66, SD_age = 1.87) in central China were recruited. All participants completed a self-report questionnaire assessing PIU, SSIB, negative affectivity, and social support. Simple mediation analysis and moderated mediation analysis were conducted to examine the roles of negative affectivity and social support in the association between PIU and SSIB.

RESULTS

PIU was positively associated with SSIB, and negative affectivity mediated this association (β = 0.255, Boot 95 % CI: 0.219 to 0.296). The indirect effect of negative affectivity was moderated by social support, with a stronger association between PIU and SSIB for adolescents with lower social support (β = 0.228, Boot 95 % CI: 0.178 to 0.282) than their counterparts (β = 0.098, Boot 95 % CI: 0.068 to 0.133).

LIMITATION

Cross-sectional design with self-report measures.

CONCLUSIONS

PIU is a detrimental risk factor for SSIB, as it is associated with high negative affectivity and increased SSIB, which was more robust for adolescents with lower social support. These results highlight the importance of helping adolescents regulate negative affectivity and improving social support-based preventative interventions to reduce SSIB.

Suizide im Kindes- und Jugendalter

Hintergrund

Suizide stellen in Westeuropa nach Verkehrsunfällen den zweit- oder drittgrößten Anteil an Todesfällen von Kindern, Jugendlichen und Heranwachsenden dar und sind eine extreme Belastung für die Hinterbliebenen.

Methodik

In der anonymisierten Datenanalyse wurden nichtnatürliche Todesfälle von Kindern, Jugendlichen und Heranwachsenden im Einzugsgebiet des Instituts für Rechtsmedizin Leipzig, Sachsen, im Zeitraum 1998–2017 analysiert. Suizide wurden auf die Häufigkeit bezüglich des Geschlechts und der Methode hin untersucht und ihr Zusammenhang mit Alkohol- oder Drogenkonsum und psychiatrischen Erkrankungen dargestellt.

Ergebnisse

Es zeigten sich signifikant mehr männliche als weibliche Suizidenten (p < 0,05). Keiner von ihnen war jünger als 12 Jahre. Als häufigste Suizidmethode erwies sich der Bahnsuizid (27 %), gefolgt von Sturz aus großer Höhe (22 %), Intoxikation (21 %) und Erhängen (12 %). Es zeigte sich ein signifikanter Zusammenhang zwischen Suiziden und positiven toxikologischen Befunden (X2 = 27,16; p < 0,001), und es konnten Hinweise auf psychiatrische Erkrankungen bei Suizidenten herausgearbeitet werden.

Schlussfolgerungen

Substanzmissbrauch und psychiatrische Erkrankungen sind mit Suiziden bei Kindern, Jugendlichen und Heranwachsenden assoziiert. Eine besondere Bedeutung wird in diesem Kontext psychiatrischen Erkrankungen beigemessen, da diese das Suizidrisiko stark erhöhen können. Eine große Rolle in der Suizidprävention spielt das soziale Umfeld. Dieses kann durch rechtzeitiges Erkennen möglicher Vorzeichen – beispielsweise Veränderung des Verhaltens, Verletzungen oder Substanzkonsum – entscheidend aktiv werden.

Internet addiction and suicidal behavior among vocational high school students in Hunan Province, China: A moderated mediation model

Background

Vocational education is an important part of high school education in China. However, there is little research on high school students' mental health. This study aimed to investigate the prevalence of suicidal behavior (SB) among this population and the mediating role of insomnia, depression, anxiety, and stress in the relationship between Internet addiction (IA) and SB using a structural equation model.

Methods

A cross-sectional questionnaire survey was conducted among several vocational high school students in Hunan Province, and 7,968 valid questionnaires were obtained. General demographic data and data from the Dual-Mode Self-Control Scale, Athens Insomnia Scale, Depression Anxiety Stress scale-21, and Revised Chen Internet Addiction Scale were collected. A structural equation model was used to explore the different pathways from IA to SB.

Results

Among the participants, 37.7, 15.7, and 21.8% reported suicidal ideation, plans, and attempts, respectively. The structural equation model confirmed that IA was indirectly related to SB and was mediated by insomnia and/or depression, anxiety, and stress.

Limitations

First, we only recruited students from vocational schools in Hunan Province, therefore, the sample may not represent the entire population of vocational students in China. Second, self-report scales were used in this study, and clinical diagnosis required professional interviews. Third, since this study had a cross-sectional design, the causal relationship between the variables could not be determined.

Conclusions

The prevalence of SB among vocational high school students in China was significantly high. The prevention of SB related to IA can be attributed to the improvement of insomnia and emotional problems.

Epidemiology of suicidal behaviors among junior and senior high school adolescents: Exploring the interactions between bullying victimization, substance use, and physical inactivity

Suicide is a pandemic among global youths and adolescents. Still, there is insufficient evidence to show whether the interactions between bullying victimization, physical inactivity, substance use, and mental health illness aggravate suicidal behaviors among high school students. Based on the Global School-Based Student Health Survey, we analyzed the individual and interaction impacts of bullying victimization, physical inactivity, substance use, and suicidal behaviors among 3,632 adolescents. The 12-month prevalence of suicidal thoughts and plans among senior high school students was over fifty percent. Junior high school students had higher rates of suicide attempts and bullying victimization than senior high school students. Multivariate results indicate that bullying victimization, substance use, and physical inactivity were significantly associated with suicidal thoughts, plans, and attempts among high school students. The interaction of physical inactivity and alcohol was significantly associated with suicidal thoughts in junior high school. In contrast, the interaction of bullying and alcohol was associated with suicidal plans among senior high school adolescents. We hope the findings from this study will generate interventions toward reducing the suicide epidemic in Ghana.

The Relationship of Family Functioning and Suicidal Ideation among Adolescents: The Mediating Role of Defeat and the Moderating Role of Meaning in Life

OBJECTIVE

To investigate the relationship between family functioning and suicidal ideation among adolescents.

METHOD

A total of 4515 junior and senior high school students were assessed using the Family APGAR, the Depressive Symptom Index-Suicidality Subscale, the Defeat Scale, and the Chinese Meaning in Life Questionnaire.

RESULTS

This study found pairwise correlations between suicidal ideation, family functioning, defeat, and meaning in life. Specifically, family functioning was an influencing factor of adolescent suicidal ideation, and defeat was a mediator of the relationship between family functioning and adolescent suicidal ideation; meaning in life was found to be a moderator of the first half of the mediation process by defeat, that is, it moderated the influence of family functioning on adolescent defeat.

CONCLUSIONS

This study demonstrated that the relationship between family functioning and adolescent suicidal ideation, as well as the influence of defeat and meaning in life on this relationship, constituted a moderated intermediary model. This finding has both theoretical and practical value for the implementation of a psychosocial model of adolescent suicide prevention and intervention.

Risk and protective factors for self-harm and suicide in children and adolescents: a systematic review and meta-analysis protocol

INTRODUCTION

Self-harm and suicide are major public health concerns among children and adolescents. Many risk and protective factors for suicide and self-harm have been identified and reported in the literature. However, the capacity of these identified risk and protective factors to guide assessment and management is limited due to their great number. This protocol describes an ongoing systematic review and meta-analysis which aims to examine longitudinal studies of risk factors for self-harm and suicide in children and adolescents, to provide a comparison of the strengths of association of the various risk factors for self-harm and suicide and to shed light on those that require further investigation.

METHODS AND ANALYSIS

We perform a systematic search of the literature using the databases EMBASE, PsycINFO, Medline, CINAHL and HMIC from inception up to 28 October 2020, and the search will be updated before the systematic review publication. Additionally, we will contact experts in the field, including principal investigators whose peer-reviewed publications are included in our systematic review as well as investigators from our extensive research network, and we will search the reference lists of relevant reviews to retrieve any articles that were not identified in our search. We will extract relevant data and present a narrative synthesis and combine the results in meta-analyses where there are sufficient data. We will assess the risk of bias for each study using the Newcastle-Ottawa Scale and present a summary of the quantity and the quality of the evidence for each risk or protective factor.

ETHICS AND DISSEMINATION

Ethical approval will not be sought as this is a systematic review of the literature. Results will be published in mental health journals and presented at conferences focused on suicide prevention.

PROSPERO REGISTRATION NUMBER

CRD42021228212.

Temporal trends in suicide attempts among adolescents aged 12-15 years from 12 low- and middle-income countries

PURPOSE

Suicide is a major public health problem, especially in low- and middle-income countries (LMICs). However, current data on temporal trends in suicide attempts are limited. Therefore, we explored the temporal trends in suicide attempts among adolescents aged 12-15 years from 12 LMICs.

METHODS

The data for this study were obtained from the Global School-based Student Health Survey (GSHS) 2009-2017, wherein the interval between two surveys in most of the participating countries was approximately 6 years. The prevalences of suicide attempts were reported as weighted prevalences and 95% confidence intervals (CIs). Pooled overall estimates were calculated using meta-analysis with a random-effects model. Linear regression was used to assess the associations of a country's GNI/capita with the prevalence and temporal variations of suicide attempts.

RESULTS

The pooled prevalence of suicide attempts in the LMICs decreased significantly from 17.56% in the first survey to 13.77% in the second survey (difference = 3.65%, 95% CI = 0.35-6.95%, P = 0.03). However, significant decreasing trends were only observed in two countries (Benin and Samoa), the prevalence in the remaining countries remained relatively stable. The pooled prevalence of suicide attempts decreased significantly in boys and in the 12- to 13 year age group (difference = 3.77% and 4.44%, Both P < 0.05). In addition, the correlations of gross national income per capita with the prevalences of suicide attempts was negative but not significant (P > 0.05).

CONCLUSIONS

Our findings reveal a decreasing trend in the prevalence of suicide attempts among 12-15 year-old adolescents in 12 LMICs. However, the trend varied in each country. This suggests the need for tailored suicide prevention strategies in each country to reduce suicide attempts.

Longitudinal associations of the duration of mobile phone use with suicidal behavior in adolescents: The mediating role of depressive symptoms

BACKGROUND

Prolonged mobile phone use has been demonstrated to be associated with mental health problems and suicidal behavior in adolescents. This study examined the mediating role of depressive symptoms in the association between duration of mobile phone use (DMPU) and suicidal behavior in adolescents.

METHODS

A total of 6,923 participants from the Shandong Adolescent Behavior & Health Cohort (SABHC) were included in the analysis. Participants completed a self-administered questionnaire to assess DMPU on weekdays and weekends, mental disorders, insomnia symptoms, depressive symptoms, suicidal behavior (thought, plan, or attempt), and family demographics in November-December 2015. One year later, a follow-up survey was conducted to ask participants to report their depressive symptoms and suicidal behavior. Path analyses with logistic regressions were performed to examine the mediating role of depressive symptoms in the DMPU-suicidal behavior link.

RESULTS

Of the sample, mean age was 14.58 (SD = 1.45) and 3,455 (49.9 %) were female at baseline. 12.12 % of participants reported having ever suicidal behavior during the past 12 months at baseline, and 10.63 % reported having ever suicidal behavior during 1-year follow-up. Path analyses showed that the depressive symptoms played a partial mediating role in the association of DMPU on weekdays and weekends with subsequent suicidal behavior. After controlling for covariates, depressive symptoms accounted for 33.6 % and 58.6 % of the total effect of DMPU on weekdays and weekends on suicidal behavior, respectively.

LIMITATION

All variables were measured based on self-report.

CONCLUSIONS

The link between DMPU and suicidal behavior was partially mediated by depressive symptoms. Prolonged mobile phone use and depressive symptoms should be assessed and intervened to prevent suicidal behavior in adolescents.

Psychosocial determinants of adolescent suicide: A national survey

BACKGROUND

Suicide is a global health problem with considerable variability across countries in its prevalence and correlates. The aims of this study were to: (a) explore the prevalence and psychosocial determinants of adolescent suicidal ideation, and (b) explore the perceived stigma of suicide among adolescents.

METHOD

A nationally representative electronic survey was utilized to collect data from school adolescents. The Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data was used to design the survey. The study collected data on adolescents' suicidal ideation, depression, self-esteem, stigma of suicide, family functioning, educational stress, and anxiety levels. A representative sample of 647 Jordanian school adolescents was included.

RESULTS

The prevalence of suicidal ideation among school adolescents was 11%. Suicidal ideation was significantly higher among respondents who were boys and enrolled in public schools, had a mental health problem, a family history of suicidal attempt, a lower self-esteem, and higher depressive symptoms. The majority of school adolescents agreed with the descriptions of people who take their own lives as being "lost" (70%), "coward" (53%), "stupid" (51%), and "lonely" (49%).

CONCLUSION

There is no typical suicide victim, and there are no specific characteristics that can point out those who are suicidal. Suicide remains a complex phenomenon that is embedded in its sociocultural context. Collaborative efforts from Jordanian policy makers, healthcare providers, researchers, and educators are needed to develop culturally appropriate screening and prevention approaches to address suicide among adolescents. Nurses have a significant role in helping adolescents experiencing suicidal ideation and their families restore, maintain, and/or promote their mental health and wellbeing.

Exploring the Suicide Mechanism Path of High-Suicide-Risk Adolescents-Based on Weibo Text Analysis

BACKGROUND

Adolescent suicide can have serious consequences for individuals, families and society, so we should pay attention to it. As social media becomes a platform for adolescents to share their daily lives and express their emotions, online identification and intervention of adolescent suicide problems become possible. In order to find the suicide mechanism path of high-suicide-risk adolescents, we explore the factors that influence is, especially the relations between psychological pain, hopelessness and suicide stages.

METHODS

We identified high-suicide-risk adolescents through machine learning model identification and manual identification, and used the Weibo text analysis method to explore the suicide mechanism path of high-suicide-risk adolescents.

RESULTS

Qualitative analysis showed that 36.2% of high-suicide-risk adolescents suffered from mental illness, and depression accounted for 76.3% of all mental illnesses. The mediating effect analysis showed that hopelessness played a complete mediating role between psychological pain and suicide stages. In addition, hopelessness was significantly negatively correlated with suicide stages.

CONCLUSION

mental illness (especially depression) in high-suicide-risk adolescents is closely related to suicide stages, the later the suicide stage, the higher the diagnosis rate of mental illness. The suicide mechanism path in high-suicide-risk adolescents is: psychological pain→ hopelessness → suicide stages, indicating that psychological pain mainly affects suicide risk through hopelessness. Adolescents who are later in the suicide stages have fewer expressions of hopelessness in the traditional sense.

Prevalence and Correlational Factors of Suicidal Ideation and Suicide Attempts Among Chinese Adolescents

This study’s purpose was to (1) determine the prevalence of suicidality (i.e., suicidal ideation or suicide attempts) among adolescents in a city in Northeast China and (2) identify the correlational factors among adolescents with suicidality. A total of 69,519 adolescents from grades 5 to 12 in a city in Northeast China participated in the online investigation. Students completed a structured questionnaire to report their demographic information, psychological characteristics, and suicidality. Univariable and multivariable logistic regressions were applied to determine significant correlational factors associated with suicidal ideation (SI) and suicide attempts (SA). The prevalence of SI and SA among adolescents in the past 12 months was 13 and 4.8%, respectively. Multivariable logistic regression analyses found that the potential risk factors for SI and SA included female, non-nuclear family, higher subjective socioeconomic status, meaningless in life, depression, bullying perpetrator, negative parental rearing styles, lower self-esteem scores, hopelessness, and stressful life events. In order to improve the accuracy of suicide risk identification, a cumulative risk index was used. With the increase in the number of cumulative risks, the risk of SI and SA also increased. So the cumulative risk index was very valuable. The total prevalence of SI and SA among primary and middle school students was high. Preventive measures could be implemented according to the risk factors.

Potential lethality of suicide attempts in youth

Rates of suicide in youth have increased over the last 50 years, yet our ability to predict suicidal behaviours has not significantly improved during this time. Examining predictors of suicide attempt lethality can enhance our understanding of suicidality in youth, yet research has focused on actual medical lethality (the actual danger to life resulting from a suicide attempt) rather than potential lethality (the potential for death that is associated with a suicide attempt). Thus, the aim of the present study was twofold: first, we quantified the percentage of youth for whom the severity of suicide attempt was misclassified by considering only actual lethality; second, we tested whether key variables that predict the actual lethality of suicide attempts also predict the potential lethality of suicide attempts in youth. We examined these questions in a sample of children and adolescents admitted to a psychiatric inpatient unit following a suicide attempt. Over 70% of youth who made serious suicide attempts would have been misclassified by assessments relying on only actual lethality. Although several variables relevant to the construct of actual lethality significantly predicted potential lethality (e.g., male sex, substance use disorder), others did not. In addition, we found that the subset of youth who would have been misclassified as low risk based on actual lethality had a disproportionately high need for healthcare resources due to future hospital admissions. The present study provides evidence to suggest that considering potential lethality may lead to improved detection and prediction of suicide risk in youth, and in doing so supports recent calls to broaden considerations of the lethality associated with suicide attempts.

Independent and Cumulative Effects of Recent Maltreatment on Suicidal Ideation and Thoughts of Self-harm in a National Sample of Youth

PURPOSE

This study examines the impact of several forms of past-year maltreatment on thoughts of self-harm and suicidal ideation and considers how these effects may vary by gender.

METHODS

Analyses are based on telephone interviews with a nationally representative sample of 6,364 youth aged 10-17 years, from three waves (2008, 2011, and 2014) of the National Survey of Children's Exposure to Violence. Suicidal and self-harm ideation were measured with items from the Trauma Symptoms Checklist for Children. Emotional maltreatment, physical maltreatment, neglect, and witnessing family violence were measured using items from the Juvenile Victimization Questionnaire.

RESULTS

Over 8% of the sample reported suicidal and/or self-harm ideation in the past month, with females more likely to report these outcomes than males. Youth who experienced recent emotional maltreatment, neglect, or witnessing family violence were more likely to report suicidal or self-harm ideation, independent of the other maltreatment types, presence of an internalizing disorder, and demographics. A dose-response relationship between the number of types of maltreatments and these outcomes was also evident. Finally, females were more negatively affected by emotional abuse and by experiencing two forms of past-year maltreatment than their male counterparts.

CONCLUSIONS

Emotional abuse was the type of maltreatment most strongly related to thoughts of self-harm and/or suicidal ideation and was particularly detrimental to females in this sample. Given the especially damaging effects of exposure to multiple forms of maltreatment, our research highlights the importance of including comprehensive maltreatment assessment in youth suicide and self-harm prevention efforts.

Suicide Attempts Among Adult Eritrean Refugees in Tigray, Ethiopia: Prevalence and Associated Factors

Purpose

The present study assessed the prevalence of and factors associated with suicide attempts among adult Eritrean refugees in Tigray, Ethiopia.

Methods

A community-based cross-sectional study was carried out among adult refugees from February 2020 to April 2020. The exposure variables included socio-demographic, clinically related, and psychosocial characteristics, and substance use-related factors. We included 400 participants and recruited them via a systematic random sampling technique. The study participants were between 18 and 60 years old. Data were collected using a structured interviewer-administered questionnaire. We applied bivariable and multivariable logistic regression to determine predictors for suicide attempts. Multicollinearity was checked to test correlations among predictor variables, and the Hosmer and Lemeshow test (p>0.2) was conducted to check the fitness of the model. Odds ratios and p-values were determined to check the associations between variables, and a p-value <0.05 was considered as a cut-off for statistical significance.

Results

The prevalence of suicide attempts was 7.3% (95% CI: 4.8%, 9.8%). Having current symptoms of trauma (AOR=5.6, 95% CI: 2.1, 14.9), a family history of mental disorder (AOR=3.02, 95% CI: 1.01, 9.07), a history of post-traumatic stress disorder (PTSD) (AOR=2.7, 95% CI: 1.01, 7.4), and severe hopelessness (AOR=3.9, 95% CI: 1.3, 12.7) were significantly associated with suicide attempts.

Conclusion

This study showed that during the stay in the refugee camp, there was a high prevalence of suicide attempts compared to the prevalence of suicide attempts among the general populations of Ethiopia, Europe, and China, and the lifetime pooled prevalence across 17 countries. Current symptoms of trauma, PTSD, a family history of mental illness, and hopelessness were the factors statistically associated with the suicide attempt. Early screening, detection, and management of suicidal behavior, as well as appropriate mental healthcare, are warranted in refugee camps to reduce the number of suicide attempts.

Amphetamine-type stimulant use and self-harm: protocol for a systematic review of observational studies

INTRODUCTION

Amphetamine type stimulant (ATS) use and self-harm are both major public health concerns globally. Use of ATS is associated with a range of health and social problems, and has been increasing internationally in the last decade. Self-harm and ATS use share a number of underlying risk factors and occur at elevated rates in marginalised groups with high rates of exposure to trauma. The relationship between self-harm and ATS use is likely complex, and the causal pathway may run in either direction. A comprehensive review, synthesis and analysis of the evidence are warranted to investigate this relationship and inform policy and practice.

METHODS AND ANALYSIS

We will search the Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Scopus databases for relevant observational studies published in peer-reviewed journals. The initial search was conducted on 5 February 2021, with a final search expected on 1 February 2022. All studies will be independently screened by two reviewers, first on title and abstract, and then on full-text to determine inclusion in the review. We place no restriction on the population that studies investigate, our exposure of interest is both prescription and illicit ATS use, comparators will be those not currently using ATS, and our primary outcome of interest is the prevalence of self-harm. Data will be extracted using a predesigned template, and pooled prevalence and pooled measures of effect for the association between ATS use and self-harm. If sufficient data are available, we will perform multiple meta-analyses to produce pooled measures of effect for each measure of ATS exposure, as well as different population sub-groups. The Methodological Standard for Epidemiological Research scale will be used to assess study quality, and Egger's test and I² values will be used to assess publication bias and heterogeneity, respectively.

ETHICS AND DISSEMINATION

No ethical approval is required for this review. We will only synthesise information from published studies that were conducted with ethical approval, so no individual participant data will be used. We will disseminate our findings via publication in a peer-reviewed journal, national and international conference presentations, and presentations to stakeholders in the community.

TRIAL REGISTRATION NUMBER

This study has been registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021226562).

The risk and protective factors for suicidal burden among 251 763 school-based adolescents in 77 low- and middle-income to high-income countries: assessing global, regional and national variations

BACKGROUND

Adolescent suicide is a global public health concern and the second leading cause of adolescent death worldwide. This study aimed to estimate the burden of adolescent suicidal behaviours and its association with violence and unintentional injury, psychosocial, protective, lifestyle and food security-related factors amongst school-based adolescents across 77 countries in the six World Health Organization (WHO) regions.

METHODS

This study comprised a sample of 251 763 adolescents drawn from the latest Global School-based Student Health Survey of school-based adolescents, aged 11-17 years, across 77 countries. Logistic regression analyses were employed to estimate the adjusted effect of independent factors on adolescent suicidal behaviours.

RESULTS

The population-weighted 12-month prevalence of suicidal ideation (SI), suicidal planning (SP) and suicidal attempts (SA) amongst school-based adolescents was 18, 18 and 16%, respectively. Adolescent suicidal behaviours (i.e. SI, SP and SA) were respectively associated with being physically attacked, physical fighting, high levels of anxiety, feeling lonely, being bullied, lack of parental support, poor peer support, not having close friends and high levels of sedentary behaviours. Overall, these associations also extended to the context of food insecurity across regions and country income groups, where the magnitude of association slightly varied from odds ratios of 1.25 times to 3.13.

CONCLUSIONS

The burden of school-going adolescent suicidal thoughts, suicide planning and suicide attempts is of particular concern in low-resource countries. Comprehensive suicide prevention programmes for school-going adolescents in LMICs are needed that address socio-cultural inequities related to violence and unintentional injury, social support and psychological factors, protective, and lifestyle-related factors.

Suicidal Ideation Among Children and Young Adults in a 24/7 Messenger-Based Psychological Chat Counseling Service

BACKGROUND

Suicidality in children and young adults is a pervasive problem: approximately 40% of respondents in epidemiological surveys in German schools reported suicidal ideation, while up to 9% reported a suicide attempt in the past. While there is compelling evidence for the effectiveness of telephone-based hotline services, an increasing preference of adolescents for messenger-based counseling services can be observed. Therefore, the present study aims to investigate the utilization behavior and user satisfaction of users contacting a German messenger-based chat counseling service ("krisenchat") regarding suicidal ideation.

METHODS

The present cross-sectional study analyzed retrospective anonymous data on sociodemographic variables, utilization behavior, and user satisfaction of krisenchat users who used the service between May 2020 and July 2021. Chi-square-tests were used to identify associations of sociodemographic characteristics and utilization behavior with suicidal ideation. Mann-Whitney-U-tests were used to compare the user satisfaction and the recommendation-to-others-rate between suicidal and non-suicidal krisenchat-users.

RESULTS

In total, chat data of N = 11,031 users were collected. Of the n = 6,962 users included in the final analysis, n = 1,444 (20.7%) contacted krisenchat because of suicidal ideation. The average user experiencing suicidal ideation was 17 years old, female and currently not receiving other treatment. Further, suicidal ideation was significantly and positively associated with age and non-suicidal self-injury. Regarding utilization patterns, there were significant positive associations between suicidal ideation and counseling session count, mean amount of messages sent, and mean amount of words used per message by the user. User satisfaction was high, with 64.7% (n = 413) of users that answered the feedback survey and experiencing suicidal ideation rating the help they received as at least "good" and a recommendation rate of 89.6% (n = 571). Most importantly, no differences were found between users reporting suicidal ideation and those that do not regarding satisfaction and the probability of recommending the service.

CONCLUSION

Results imply satisfaction with the counseling service among users with suicidal ideation. Nevertheless, there is a need for further research into messenger-based counseling services regarding the prevention of suicidal behavior in children, youths, and young adults. Longitudinal studies are especially needed to assess the effectiveness of messenger-based interventions.

STUDY REGISTRATION

DRKS00026671.

Predictors of deliberate self-harm among adolescents: Answers from a cross-sectional study on India

BACKGROUND

Although existing research supports the correlation of hereditary and psychological factors with an adolescent's deliberate self-harm, there is a dearth of research that focus on their socio-economic characteristics. This paper intends to identity the potential risk factors that influence an adolescent's deliberate self-harm.

METHODS

Data for this study was obtained from Understanding the Lives of Adolescents and Young Adults (UDAYA) study conducted in 2015-16 with sample of 5,969 adolescent boys and 9,419 girls aged 10-19 years. The outcome variable was deliberate self-harm among adolescents. The explanatory variables added in the study were age, current schooling status, working status, media exposure, access to internet, parental abuse, involvement in fights, substance use, depressive symptoms, caste, religion, wealth index, residence and states. Bivariate analysis along with binary logistic regression analysis was done to fulfill the study objectives.

RESULTS

About 4.5% and 3.2% of adolescent boys and girls, respectively had deliberate self-harm. The odds of deliberate self-harm were 50 per cent more likely among adolescent girls who had internet access [OR 1.50; CI 1.05-2.16]. The likelihood of deliberate self-harm was 49 per cent and 61 per cent significantly more likely among adolescent boys [OR 1.49; CI 1.11-2.0] and girls [OR 1.61; CI 1.27-2.04] who experienced parental physical abuse respectively. With reference to minimal/mild depressive symptoms, adolescents who had moderate [boys-OR 2.10; CI 1.29-3.4 and girls-OR 2.50; CI 1.774-3.59] or moderately high/severe [boys-OR 4.58; CI 2.88-7.29 and girls-OR 4.18; CI 3.1-5.63] depressive symptoms had significantly higher odds of deliberate self-harm.

CONCLUSIONS

Internet access, parental abuse, involvement in fights, and depressive symptoms emerged as significant predictors of deliberate self-harm among adolescent boys and girls. Results suggest that an early identification of the predictors and intervention might prevent deliberate self-harm among adolescents. Since parents play a major role in the lives and development of adolescents, it is highly recommended that they initiate open and supportive communication with their children.

A Social-Ecological Approach to Understanding the Relationship between Cyberbullying Victimization and Suicidal Ideation in South Korean Adolescents: The Moderating Effect of School Connectedness

Background: Cyberbullying victimization and suicidal ideation are both ongoing deleterious social problems in South Korea. Using the social-ecological approach, this study examined the association between cyberbullying victimization and suicidal ideation as well as the buffering role of school connectedness in this relationship. Methods: A nationally representative sample of 7333 adolescents from the 2016 Korean Children and Youth Right Study participated in the study. Data were analyzed using descriptive statistics, Wald chi-square test, bivariate correlations, and multivariate logistic regression analyses. Results: Nearly 17.7% of adolescents were cyberbullied, and 28.4% had suicidal ideation in the past 12 months. Cyberbullying victims were at an increased risk of suicidal ideation. The results also found that parental abuse, family dysfunction, and perceived peer relationship stress were positively associated with suicidal ideation, while parental support for autonomy was negatively associated with suicidal ideation. Further, school connectedness moderated on the relationship between cyberbullying victimization and adolescent suicidal ideation. Conclusions: These findings suggest that various stakeholders should consider interventions and preventive programs that address school connectedness when working with adolescents who are victims of cyberbullying and exhibit suicidal behavior.

Prevalence of Suicidality in the European General Population: A Systematic Review and Meta-Analysis

OBJECTIVE

To conduct a systematic review and meta-analysis of the prevalence and variability in suicidality in the general adult population of Europe between 2008 and 2017.

METHODS

Studies containing original data on suicidality were identified in five electronic databases. Point, 12-month and lifetime prevalences were calculated for various types of suicidality. Pooled prevalence rates were calculated using a random effects model. Subgroup analysis and multivariate meta-regression were also performed.

RESULTS

We identified 24 papers containing original data, which provided 97 prevalence rates for suicidality. The pooled point prevalence rate was 3.96% (2.37-5.56), pooled 12-month prevalence 2.9% (1.49-4.32), and pooled lifetime prevalence 5.55% (4.31-6.79). The subgroup analysis showed that lifetime prevalence figures for wishing to be dead and suicidal ideation were higher in areas with a population of less than 3,849 inhabitants and in Eastern Europe. Finally, the multivariate meta-regression showed differences with respect to the period and type of suicidality, lower and upper age thresholds, population size, and study area.

CONCLUSION

Our data showed that approximately 21% of European individuals have wished to be dead at some point during their lifetime. Studies like this are necessary to highlight the need for efforts to prevent and intervene in suicidality.

Suicide prevention in childhood and adolescence: a narrative review of current knowledge on risk and protective factors and effectiveness of interventions

INTRODUCTION

Suicide is a global mental health problem for people of all ages. While rates of suicide in children and adolescents are reported as lower than those in older populations worldwide, they represent the third leading cause of death in 15-19-year-olds. The rates are higher among boys than girls worldwide, though the death rates for girls exceed those for boys in Bangladesh, China, India, and Nepal. There has been a general decrease in adolescent suicide rates over recent decades. However, increases are reported in South East Asia as well as South America over the same time period.

METHODS

A narrative review method has been used to summarize current knowledge about risk and protective factors for suicide among children and adolescents and to discuss evidence-based strategy for suicide prevention in this age group.

RESULTS

Identified suicide risk and protective factors for children and adolescents largely overlap with those for adults. Nevertheless, developmental characteristics may strengthen the impact of some factors, such as decision-making style, coping strategies, family and peer relationships, and victimization. The implementation of evidence-based suicide preventive strategies is needed. Restricting access to lethal means, school-based awareness and skill training programs, and interventions delivered in clinical and community settings have been proven effective. The effectiveness of gatekeeper training and screening programs in reducing suicidal ideation and behavior is unproven but widely examined in selected settings.

DISCUSSION

Since most studies have been conducted in western countries, future research should assess the effectiveness of these promising strategies in different cultural contexts. The use of more rigorous study designs, the use of both short- and long-term follow-up evaluations, the larger inclusion of individuals belonging to vulnerable groups, the evaluation of online intervention, and the analysis of programs' cost-effectiveness are also required.

Neurocognitive Functioning in Adolescents at Risk for Suicidal Behaviors

Today, little is still known about the neurocognitive functioning of the individual at risk for suicide in a relevant developmental stage like adolescence. Thus, the main goal of the present work was to analyze the neurocognitive performance of adolescents at high risk for suicide. A total of 1509 adolescents from a stratified random cluster sampling were selected. Adolescents at risk for suicidal behaviors included 83 participants. A comparison group of 83 participants matched by age and gender was also randomly selected from the sample. The Paykel Suicide Scale (PSS) and the University of Pennsylvania Computerized Neurocognitive Battery for children (included 14 tasks assessing five neurobehavioral domains: executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed) were used. Adolescents at risk for suicide revealed statistically significant impairments across different neurocognitive domains including complex cognition, episodic memory and social cognition. No significant differences were found for Sensorimotor and Executive Function domains. Results found in the present study contribute relevant information about the nature of the neurocognitive impairments associated with suicide and add information in order to deeper comprehend the tentative etiology of suicide thoughts and attempts in adolescents with the aim to establish preventive treatments.

Pediatric Suicide Screening: A Review of the Evidence

BACKGROUND

Suicide rates are increasing for youths and suicide is the second leading cause of death for 10-24 year olds. This evidence-based practice project critically reviews literature regarding the effectiveness of pediatric suicide screening.

METHODS

A literature search was guided by the following question: In pediatric patients, does suicide screening at every health encounter compared to an annual screen increase clinician identification of patients at-risk. Ten articles met inclusion criteria and were critically appraised and synthesized.

FINDINGS

Youths had high rates of suicidal ideation (SI), anxiety, and depression. Pediatric universal suicide screening identified SI in youths with both psychiatric and non-psychiatric medical complaints. Patients with chronic health conditions reported higher rates of mental health symptoms and SI. A specific suicide screening instrument should be used as general mental health screens likely miss youths at-risk for SI. The Ask Suicide-Screening Questions tool is an easy to use and highly sensitive instrument for detecting suicide risk in youths.

DISCUSSION

Many youths that screen positive for SI do not have known mental health concerns and would have been missed if not asked directly. Universal screening for SI identifies at-risk youth and allows nurses and other providers to intervene. The need for universal screening across pediatric health care settings using brief, validated screening tools is paramount.

APPLICATION TO PRACTICE

Nurses working in pediatric settings should champion universal screening for SI. Unit-based quality improvement projects using the Plan-Do-Study-Act change cycle provides a model for instituting universal screening for SI.

Prospective Associations of Frequent Pain Symptoms With Suicidal Behavior in Adolescents

Chronic pain and suicidal behavior are prevalent in adolescents. This longitudinal study examined the associations between pain symptoms and suicidal behavior in adolescents. A total of 7,072 adolescents participated in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other nonspecific pain), insomnia, anxiety/depression, substance use, stressful life events, prior suicidal behavior, and family environment in November-December in 2015. One year later, a follow-up survey was conducted. Mean age of the sample was 14.6 years, and half were female. Of the sample, 44.8% and 8.4% reported having one or more pain symptoms "sometimes" and "often", respectively. A total of 22.4% and 10.6% reported having lifetime suicidal behavior at baseline and subsequent suicidal behavior over the 1-year follow-up, respectively. Frequent pain was significantly associated with increased risk of suicidal behavior at baseline (OR=1.64, 95%CI=1.32-2.03) and during the subsequent year (OR=1.50, 95%CI=1.17-1.93) while adjusting for adolescent individual and family covariates. Among adolescents without a history of prior suicidal behavior, frequent pain was significantly associated with an approximately 70% increased risk of incident suicidal behavior (OR= 1.69, 95%CI=1.14-2.51). In conclusion, frequent pain appears to be predictive of adolescent suicidal behavior one year later. PERSPECTIVE: This article presents the prospective associations of frequent pain symptoms with suicidal behavior in adolescents. Frequent pain was associated with a 50-70% increased risk of suicidal behavior 1 year later. The finding underscores the importance of pain assessment and treatment in comprehensive suicide prevention efforts in adolescents.

Analyses of Child and Youth Self-Poisoning Hospitalizations by Substance and Socioeconomic Status

Child and youth self-poisoning is a growing public health issue in many regions of the world, including British Columbia (BC), Canada, where 15–19-year-olds have the highest rates of self-poisoning hospitalizations compared with those of all other ages. The purpose of this study was to identify what substances children and youth commonly used to poison themselves in BC and how socioeconomic status may impact self-poisoning risk. Self-poisoning hospitalization rates among 10–14 and 15–19-year-olds from 1 April 2012 to 31 March 2020 were calculated by substance using ICD-10-CA codes X60-X69 and T36-T65, as well as by socioeconomic status using the Institut National de Santé Publique du Québec’s Deprivation Index. Nonopioid analgesics, antipyretics, and antirheumatics were the most common substances involved, with rates of 27.6 and 74.3 per 100,000 population among 10–14 and 15–19-year-olds, respectively, followed by antiepileptic, sedative–hypnotic, antiparkinsonism, and psychotropic drugs, with rates of 20.2 and 68.1 per 100,000 population among 10–14 and 15–19-year-olds, respectively. In terms of socioeconomic status, rates were highest among 10–19-year-olds living in neighbourhoods with the fewest social connections (243.7 per 100,000 population). These findings can inform poisoning prevention strategies and relevant policies, thereby reducing the number of self-poisoning events among children and youth.

Innovating Technology-Enhanced Interventions for Youth Suicide: Insights for Measuring Implementation Outcomes

Technology is one medium to increase youth engagement, especially among underserved and minority groups, in suicide preventive interventions. Technology can be used to supplement or adjunct an in-person intervention, guide an in-person intervention, or be the stand-alone (automated) component of the intervention. This range in technological use is now called the continuum of behavioral intervention technologies (BITs). Overall, suicide intervention researchers do not use this terminology to categorize how the role of technology differs across technology-enhanced youth interventions. There is growing recognition that technology-enhanced interventions will not create substantial public health impact without an understanding of the individual (youth, families, and providers), mezzo (clinics and health systems of care), and contextual factors (society, culture, community) that are associated with their implementation. Implementation science is the study of methods to promote uptake of evidence-based practices and policies into the broader health care system. In this review, we incorporate work from implementation science and BIT implementation to illustrate how the study of technology-enhanced interventions for youth suicide can be advanced by specifying the role of technology and measuring implementation outcomes.

Resilience buffers the effects of sleep problems on the trajectory of suicidal ideation from adolescence through young adulthood

OBJECTIVES

To examine both the between-person and within-person effects of sleep problems on the trajectory of suicidal ideation from ages 14 to 22 and investigate whether resilience moderates the effects. Age and sex differences were explored in the main and interaction effects of sleep problems and resilience on suicidal ideation.

METHODS

The study sample included 2491 adolescents (1260 males and 1231 females) who participated in a prospective study spanning 2009 through 2016 in northern Taiwan. Sex-stratified multilevel models were used to examine the between-person and within-person effects of sleep problems and the moderating effects of resilience on the trajectory of suicidal ideation in males and females.

RESULTS

Across adolescents, higher levels of sleep problems contributed to an elevated risk of suicidal ideation for both sexes. Within individuals, a higher risk of suicidal ideation was observed when an adolescent's sleep problems exceeded their typical levels. The within-person effects of sleep problems were further determined to vary by age in males, with the effects gradually decreasing throughout late adolescence but increasing again in young adulthood. The buffering effects of resilience were only observed in females. The relationships between the within-person effects of sleep problems and suicidal ideation were only significant in female adolescents with low levels of resilience.

CONCLUSIONS

Our findings extend the research by demonstrating both the between-person and within-person association between sleep problems and suicidal ideation. We further revealed age and sex differences in the within-person effects of sleep problems and the buffering effects of resilience. Prevention and intervention programs that target sleep problems could be tailored based on individuals' age, sex, and levels of resilience to prevent suicidal ideation.

Social Disconnectedness, Loneliness, and Mental Health Among Adolescents in Danish High Schools: A Nationwide Cross-Sectional Study

Background: Previous research has suggested that social disconnectedness experienced at school is linked to mental health problems, however, more research is needed to investigate (1) whether the accumulation of various types of social disconnectedness is associated with risk for mental health problems, and (2) whether loneliness is a mechanism that explains these associations. Methods: Using data from the Danish National Youth Study 2019 (UNG19), nation-wide cross-sectional data from 29,086 high school students in Denmark were analyzed to assess associations between social disconnectedness experienced at school (lack of classmate support, lack of teacher support, lack of class social cohesion, and not being part of the school community) and various mental health outcomes, as well as the mediating role of loneliness for each type of disconnectedness. Multilevel regression analyses were conducted to assess the associations. Results: Descriptive analyses suggest that 27.5% of Danish high school students experience at least one type of social disconnectedness at school. Each type of social disconnectedness was positively associated with mental health problems (depression symptoms, anxiety symptoms, stress, sleep problems, suicidal ideation, non-suicidal self-injury, eating disorder, body dissatisfaction, and low self-esteem) and negatively associated with mental well-being. In all cases, loneliness significantly mediated the associations. We found a clear dose-response pattern, where each addition in types of social disconnectedness was associated with (1) stronger negative coefficients with mental well-being and (2) stronger positive coefficients with mental health problems. Conclusion: Our results add to a large evidence-base suggesting that mental health problems among adolescents may be prevented by promoting social connectedness at school. More specifically, fostering social connectedness at school may prevent loneliness, which in turn may promote mental well-being and prevent mental health problems during the developmental stages of adolescence. It is important to note that focusing on single indicators of school social connectedness/disconnectedness would appear to be insufficient. Implications for practices within school settings to enhance social connectedness are discussed.

Trajectories of Victimization and Bullying at University: Prevention for a Healthy and Sustainable Educational Environment

The bullying phenomenon is both an uncomfortable reality and a serious social problem for educational community institutions. Its presence is incompatible with a healthy and sustainable education environment. The educational, psychological, and social consequences of bullying transcend the personal sphere and reach the family and work environment in adulthood. Traditionally, bullying has been studied in the compulsory educational stages. However, at present, this problem is also being addressed in higher education. The present research, which is of a transversal nature, aims to explore bullying in the Spanish university setting, along with its typology, scope, and predictive factors, from both socio-demographic and family perspectives. In this sense, we set ourselves the following objectives: (GO1) to see if university students are exposed to bullying, as well as to identify the profiles of the subjects of bullying from three dimensions (physical, relational, and verbal victimization) and (GO2) to determine whether there are trajectories of bullying in university students from the compulsory education stage to the present. Based on a descriptive quantitative methodology, this study was conducted in 10 Spanish universities. The research’s major results show that the persistence of bullying in university classrooms is of a relational and verbal nature, but is not physical. Victimization occurs mainly in women who carry out studies linked to social and legal sciences or art and the humanities. Additionally, it is observed that a spiral of relational violence is produced, perpetuating this type of aggression over time. Among other predictive factors in university students is that they have suffered relational violence during their compulsory education. These data should alert educational and health institutions about the persistence of bullying in university students to prevent it and to facilitate its early detection and treatment to eradicate this problem from higher education classrooms.

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.

Environmental changes to reduce self-harm on an adolescent inpatient psychiatric ward: an interrupted time series analysis

Existing interventions to reduce self-harm in adolescents admitted to psychiatric wards are usually focused on individual psychological treatments. However, the immediate ward environment in which treatment takes place is an important factor in the success of the treatment and can also influence the likelihood of self-harming behaviours. The aim of the current study was to evaluate changes made to a psychiatric ward environment on incidence of self-harm in adolescents. A quasi-experimental interrupted time series study was conducted on one child and adolescent psychiatric ward. An intervention was developed alongside staff and patients to address the high incidence of self-harm on weekday evenings on the ward. The intervention components involved adding a regular twilight shift (3-11 pm) for nursing staff and introducing a structured evening activity programme on the ward. A segmented regression analysis of an interrupted time series found that the rate of self-harm per 100 bed days was already declining at baseline and continued to decline post-intervention, but the rate of decline was not significant (p = 0.415). However, the proportion of patients self-harming was increasing at baseline and significantly reduced post-intervention (p = 0.001), and this reduction was significantly larger in the evenings (p = 0.004) compared to other times of day (p = 0.09). A tailored intervention targeting the psychiatric ward environment helped to reduce the proportion of adolescents self-harming on the ward. An interrupted time series analysis should be considered for future interventions making changes to health systems over time.