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Grover C, Huber J, Brewer M, Basu A, Large M. Meta-analysis of clinical risk factors for suicide among people presenting to emergency departments and general hospitals with suicidal thoughts and behaviours. Acta Psychiatr Scand 2023; 148:491-524. [PMID: 37904016 DOI: 10.1111/acps.13620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/27/2023] [Accepted: 09/13/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Suicidal thoughts and behaviours (STB) are a common reason for presentation to emergency departments and general hospitals. A meta-analysis of the strength of clinical risk factors for subsequent suicide might aid understanding of suicidal behaviour and help suicide prevention. METHODS We conducted a meta-analysis of cohort and controlled studies on clinical risk factors and later suicide among people presenting to emergency departments and general hospitals with STB. Data were extracted from papers meeting inclusion criteria, published in Medline, PsycINFO, and Embase between 1 January 1960 and 10 October 2022 using papers located with the search terms ((suicide*).m_titl AND (emergency* OR accident and emergency OR casualty OR general hospital OR toxicology service).mp) or were indexed in PubMed and had titles located with the search terms (suicide* OR self-harm OR self-harm OR self-injury OR self-injury OR self-poisoning OR self-poisoning OR overdose OR para-suicide OR parasuicide [title/abstract]) AND (Emergency department OR emergency room OR Casualty OR general hospital OR toxicology OR accident and emergency [all fields]). Data about the association between clinical risk factors and suicide extracted from three or more studies were included in a random-effects meta-analysis of the odds of later death by suicide. The study was registered in PROSPERO and conducted according to MOOSE and PRISMA guidelines. RESULTS Seventy-five studies reported on 741,624 people, of which 19,649 died by suicide (2.65%). Male sex (odds ratio (OR) = 1.99) and age (OR = 2.01) were the most consistently reported risk factors. The strongest associations with subsequent death by suicide related to violent self-harm methods at the hospital presentation, including: unspecified violent method (OR = 4.97), any violent method (OR = 4.57) and the specific violent methods of drowning (OR = 4.32), hanging (OR = 4.26), and use of firearms (OR = 10.08). Patients categorised as higher risk using suicide prediction scales or any other method that combined risk factors had moderately increased odds of suicide (OR = 2.58). Younger age, Black and Hispanic ethnicity, overdose, a diagnosis of adjustment disorder, and the absence of any psychiatric diagnosis were protective against suicide. CONCLUSIONS Most risk factors for suicide among people who have presented with STB are not strongly associated with later suicide. The strongest risk factors relate to self-harm methods. In the absence of clear indicators of future suicide, all people presenting with suicidality warrant a thorough assessment of their needs, and further research is needed before we can meaningfully categorise people with STB according to suicide risk.
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Affiliation(s)
- Cameron Grover
- St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Jacqueline Huber
- St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, The University of Sydney, Camperdown, New South Wales, Australia
| | - Matthew Brewer
- St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Ashna Basu
- The Prince of Wales Hospital, Randwick, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of NSW, Kensington, New South Wales, Australia
| | - Matthew Large
- The Prince of Wales Hospital, Randwick, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of NSW, Kensington, New South Wales, Australia
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Demesmaeker A, Chazard E, Hoang A, Vaiva G, Amad A. Suicide mortality after a nonfatal suicide attempt: A systematic review and meta-analysis. Aust N Z J Psychiatry 2022; 56:603-616. [PMID: 34465221 DOI: 10.1177/00048674211043455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Deliberate self-harm and suicide attempts share common risk factors but are associated with different epidemiological features. While the rate of suicide after deliberate self-harm has been evaluated in meta-analyses, the specific rate of death by suicide after a previous suicide attempt has never been assessed. The aim of our study was to estimate the incidence of death by suicide after a nonfatal suicide attempt. METHOD We developed and followed a standard meta-analysis protocol (systematic review registration-PROSPERO 2021: CRD42021221111). Randomized controlled trials and cohort studies published between 1970 and 2020 focusing on the rate of suicide after suicide attempt were identified in PubMed, PsycInfo and Scopus and qualitatively described. The rates of deaths by suicide at 1, 5 and 10 years after a nonfatal suicide attempt were pooled in a meta-analysis using a random-effects model. Subgroup analysis and meta-regressions were also performed. RESULTS Our meta-analysis is based on 41 studies. The suicide rate after a nonfatal suicide attempt was 2.8% (2.2-3.5) at 1 year, 5.6% (3.9-7.9) at 5 years and 7.4% (5.2-10.4) at 10 years. Estimates of the suicide rate vary widely depending on the psychiatric diagnosis, the method used for the suicide attempt, the type of study and the age group considered. CONCLUSION The evidence of a high rate of suicide deaths in the year following nonfatal suicide attempts should prompt prevention systems to be particularly vigilant during this period.
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Affiliation(s)
- Alice Demesmaeker
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France.,Hôpital Fontan, CHU de Lille, Lille, France
| | - Emmanuel Chazard
- ULR 2694 Metrics, CERIM, Public Health Department, CHU Lille, Université de Lille, Lille, France
| | - Aline Hoang
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France
| | - Guillaume Vaiva
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France.,Hôpital Fontan, CHU de Lille, Lille, France.,Centre National de Ressources et de Résilience (CN2R), Lille, France
| | - Ali Amad
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France.,Hôpital Fontan, CHU de Lille, Lille, France
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López-Steinmetz LC, Godoy JC, Fong SB, López-Steinmetz RL. Factors Increasing Suicidal Risk in Young Argentinean College Students With and Without Suicide Attempt History. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00517-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Ligier F, Kurzenne M, Kabuth B, Guillemin F. Ten years psychosocial outcomes among adolescents following suicide attempts - early recurrence and psychosocial outcomes. Encephale 2020; 47:299-305. [PMID: 33293033 DOI: 10.1016/j.encep.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/14/2020] [Accepted: 09/08/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES A suicide attempt (SA) is a major risk factor of recurrent SA in adolescence and may be associated with psychological or social problems in the future. REPEATERS is a longitudinal study which examines the long-term psychosocial outcome of adolescents following attempted suicide. It focuses on the impact of early recurrence (i.e., within the first year of the index SA) - data which is, in fact, poorly documented. METHODS Ten years after the index SA, a self-reporting questionnaire was sent to all adolescents who had attempted suicide and were followed up by the CHRU (Regional University Hospital Centre) de Nancy, France, between 1994 and 2003 and their parents. The purpose of this questionnaire was to assess psychosocial outcomes. Data concerning SA were collected retrospectively. RESULTS After ten years, 146 of the 309 adolescents who had attempted suicide and were participating in the study had responded: 90% lived with a partner and 41% had children. The mean (SD) current emotional life of suicide attempt survivors scored 7.3 (2.3) on a scale of 0 to 10. Compared to the general population of the same age, responders felt more depressed than their peers (29% vs. less than 8% of males and 20% of females), had more suicidal thoughts (14% vs. 5%), and had more SAs (27% vs. 0.3%). Moreover, the risk of recurrence over the ten year period was associated with suicide recurrence in the first year after the index SA (odds ratio [OR]=2.3; 95% confidence interval [CI]=1.1-4.9) and with a lower level of education at ten years (OR=0.37; 95% CI=0.19-0.45). CONCLUSIONS Although a favorable outcome was reported ten years after the event for the majority of adolescents who had attempted suicide, some with a lower level of education were nevertheless at increased risk of recurrence and depression. Post-intervention strategies are therefore essential in order to evaluate risk factors which may persist if not taken into consideration.
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Affiliation(s)
- F Ligier
- University department of child and adolescent psychiatry (PUPEA), psychotherapeutic center of Nancy, Laxou, France; EA 4360 APEMAC, university of Lorraine, Nancy, France.
| | - M Kurzenne
- University department of child and adolescent psychiatry (PUPEA), psychotherapeutic center of Nancy, Laxou, France
| | - B Kabuth
- University department of child and adolescent psychiatry (PUPEA), psychotherapeutic center of Nancy, Laxou, France
| | - F Guillemin
- EA 4360 APEMAC, university of Lorraine, Nancy, France
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Abstract
RésuméLes auteurs présentent une revue des tendances actuelles concernant divers aspects du suicide de I’adolescent telles qu’elles apparaissent aujourd’hui dans la littérature. L’accent est mis sur la relation entre psychopathologie et suicide, I’épidémiologie, la prévention et les problèmes thérapeutiques que pose le suicide.
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King CA, Arango A, Kramer A, Busby D, Czyz E, Foster CE, Gillespie BW. Association of the Youth-Nominated Support Team Intervention for Suicidal Adolescents With 11- to 14-Year Mortality Outcomes: Secondary Analysis of a Randomized Clinical Trial. JAMA Psychiatry 2019; 76:492-498. [PMID: 30725077 PMCID: PMC6495350 DOI: 10.1001/jamapsychiatry.2018.4358] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE The prevalence of suicide among adolescents is rising, yet little is known about effective interventions. To date, no intervention for suicidal adolescents has been shown to reduce mortality. OBJECTIVE To determine whether the Youth-Nominated Support Team Intervention for Suicidal Adolescents-Version II (YST) is associated with reduced mortality 11 to 14 years after psychiatric hospitalization for suicide risk. DESIGN, SETTING, AND PARTICIPANTS This post hoc secondary analysis of a randomized clinical trial used National Death Index (NDI) data from adolescent psychiatric inpatients from 2 US psychiatric hospitals enrolled in the clinical trial from November 10, 2002, to October 26, 2005. Eligible participants were aged 13 to 17 years and presented with suicidal ideation (frequent or with suicidal plan), a suicide attempt, or both within the past 4 weeks. Participants were randomized to receive treatment as usual (TAU) or YST plus TAU (YST). Evaluators and staff who matched identifying data to NDI records were masked to group. The length of NDI follow-up ranged from 11.2 to 14.1 years. Analyses were conducted between February 12, 2018, and September 18, 2018. INTERVENTIONS The YST is a psychoeducational, social support intervention. Adolescents nominated "caring adults" (mean, 3.4 per adolescent from family, school, and community) to serve as support persons for them after hospitalization. These adults attended a psychoeducational session to learn about the youth's problem list and treatment plan, suicide warning signs, communicating with adolescents, and how to be helpful in supporting treatment adherence and positive behavioral choices. The adults received weekly supportive telephone calls from YST staff for 3 months. MAIN OUTCOMES AND MEASURES Survival 11 to 14 years after index hospitalization, measured by NDI data for deaths (suicide, drug overdose, and other causes of premature death), from January 1, 2002, through December 31, 2016. RESULTS National Death Index records were reviewed for all 448 YST study participants (319 [71.2%] identified as female; mean [SD] age, 15.6 [1.3] years; 375 [83.7%] of white race/ethnicity). There were 13 deaths in the TAU group and 2 deaths in the YST group (hazard ratio, 6.62; 95% CI, 1.49-29.35; P < .01). No patients were withdrawn from YST owing to adverse effects. CONCLUSIONS AND RELEVANCE The findings suggest that the YST intervention for suicidal adolescents is associated with reduced mortality. Because this was a secondary analysis, results warrant replication with examination of mechanisms. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00071617.
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Affiliation(s)
- Cheryl A. King
- Department of Psychiatry, University of Michigan, Ann Arbor
| | | | - Anne Kramer
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Danielle Busby
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Ewa Czyz
- Department of Psychiatry, University of Michigan, Ann Arbor
| | | | - Brenda W. Gillespie
- Consulting for Statistics, Computing and Analytics Research at the University of Michigan, Ann Arbor
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Wang M, Swaraj S, Chung D, Stanton C, Kapur N, Large M. Meta-analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours. Acta Psychiatr Scand 2019; 139:472-483. [PMID: 30864183 DOI: 10.1111/acps.13023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To quantify the suicide rate among people discharged from non-psychiatric settings after presentations with suicidal thoughts or behaviours. METHOD Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. RESULTS A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). CONCLUSIONS People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades.
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Affiliation(s)
- M Wang
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - S Swaraj
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - D Chung
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - C Stanton
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
| | - N Kapur
- Centre for Suicide Prevention, Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester and Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, UK
| | - M Large
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
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Aiken CS, Wagner BM, Benjamin Hinnant J. Observed Interactions in Families of Adolescent Suicide Attempters. Suicide Life Threat Behav 2019; 49:104-119. [PMID: 29194697 DOI: 10.1111/sltb.12423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 08/15/2017] [Indexed: 11/30/2022]
Abstract
Family interactions of 71 adolescents hospitalized following a suicide attempt were compared with those of 29 psychiatric controls, using observational methods and a 2-year prospective, longitudinal design. Parent-adolescent dyadic interactions were coded for emotional validation and invalidation, and problem-solving constructiveness. There were no between-group differences for parents. However, adolescents who had attempted suicide displayed more emotional invalidation than controls. Within the suicide attempt group, maternal constructive problem solving predicted greater declines in youth suicide ideation, and a similar trend was observed for fathers. Adolescents who displayed more unconstructive problem solving with fathers were more likely to reattempt suicide during the follow up.
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Affiliation(s)
- Christine S Aiken
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Barry M Wagner
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - J Benjamin Hinnant
- Department of Psychology, The Catholic University of America, Washington, DC, USA
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Goldman-Mellor S, Allen K, Kaplan MS. Rural/Urban Disparities in Adolescent Nonfatal Suicidal Ideation and Suicide Attempt: A Population-Based Study. Suicide Life Threat Behav 2018; 48:709-719. [PMID: 28940747 DOI: 10.1111/sltb.12390] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/15/2017] [Indexed: 11/28/2022]
Abstract
Adolescent suicide rates exhibit stark geographic disparities, with rates highest in rural areas. The causes of this disparity remain unclear. We investigated whether adolescent nonfatal suicidal ideation and attempt-leading risk factors for suicide-demonstrate the same rural/urban disparity. Using adolescent data from the 2011-2014 waves of the population-representative California Health Interview Survey (CHIS; N = 4,616), we estimated associations between residence in a rural area and suicidal ideation and suicide attempt, as well as access to psychological care. Survey-weighted logistic regression models controlled for individual- and family-level covariates. Results showed that rural adolescents were, compared to urban adolescents, substantially less likely to report recent suicidal ideation (OR = 0.25, 95% confidence interval [CI] = 0.10, 0.61) and suicide attempt (OR = 0.17, 95% CI = 0.05, 0.66). Suicidal youths in rural and urban areas were equally likely, however, to report receiving psychological care. In this study, rural adolescents in California reported lower rates of nonfatal suicidal behavior compared to urban peers. This pattern contrasts with rates of adolescent suicide fatality, which are higher in rural areas. Results suggest that reducing geographic disparities in youth suicide may require multifaceted public health approaches, in addition to better identification and treatment for high-risk adolescents.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA, USA
| | - Kristina Allen
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA, USA
| | - Mark S Kaplan
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
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Lincoln SH, Norkett E, Graber K, Tembulkar S, Morelli N, Gonzalez-Heydrich J, D'Angelo E. Suicidal behaviors in children and adolescents with psychotic disorders. Schizophr Res 2017; 179:13-16. [PMID: 27707531 DOI: 10.1016/j.schres.2016.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/09/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Abstract
Suicide is the leading cause of premature death in individuals with psychotic disorders. Risk for onset of suicidal behaviors tends to begin in adolescence, remaining high into young adulthood. The present study aims to evaluate the interplay of early onset psychosis and suicide risk by examining suicidal behaviors (ideation, planning, and attempts) in children and adolescents with psychotic disorders (PD) compared to typically developing peers (TD). Twenty five youths were recruited and were diagnostically evaluated for psychosis. We found that the PD children exhibited significantly higher levels of suicidal behaviors than TD children, even when parsed into individual at-risk behaviors.
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Affiliation(s)
- Sarah Hope Lincoln
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Emily Norkett
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Kelsey Graber
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Sahil Tembulkar
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Nicholas Morelli
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Joseph Gonzalez-Heydrich
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Eugene D'Angelo
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
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Ng B. Characteristics of 61 Mexican American Adolescents Who Attempted Suicide. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/07399863960181001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A total of 61 Mexican American adolescents who were consecutively admitted to an inpatient psychiatric unit after a suicide attempt were studied. They were given structured interviews to study their demographic, personal, and family characteristics. The intent of the suicide attempts was measured with the Pierce Suicide Intent Scale. Compared to subjects in the low-intent group, those in the high-intent group showed a history of more frequent previous suicide attempts (p < .03), had lived with both biological parents for a longer time (p < .04), usually had at least one biological parent at home at the time of the suicide attempts (p < .001), and had lived in the United States for a shorter period of time (p < .04). Psychosocialfactors including the phenomenon of acculturation are reviewed in the discussion of these results.
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Ligier F, Guillemin F, Angot C, Bourion S, Kabuth B. Recurrence of suicide attempt in adolescents lost to contact early by clinicians: The 10-year REPEATERS cohort of French adolescents. J Adolesc 2015; 43:111-8. [DOI: 10.1016/j.adolescence.2015.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
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Greene-Palmer FN, Wagner BM, Neely LL, Cox DW, Kochanski KM, Perera KU, Ghahramanlou-Holloway M. How Parental Reactions Change in Response to Adolescent Suicide Attempt. Arch Suicide Res 2015; 19:414-21. [PMID: 26452767 DOI: 10.1080/13811118.2015.1094367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined parental reactions to adolescents' suicide attempts and the association of reactions with future suicidal self-directed violence. Participants were 81 mothers and 49 fathers of 85 psychiatric inpatient adolescents. Maternal hostility and paternal anger and arguing predicted future suicide attempts. From pre- to post-attempt, mothers reported feeling increased sadness, caring, anxiety, guilt, fear, and being overwhelmed; fathers reported increased sadness, anxiety, and fear. Findings have clinical implications; improving parent-child relationships post-suicide attempt may serve as a protective factor for suicide.
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14
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La filière de soin des suicidants aux urgences. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0321-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Joe S, Baser RS, Neighbors HW, Caldwell CH, Jackson JS. 12-month and lifetime prevalence of suicide attempts among black adolescents in the National Survey of American Life. J Am Acad Child Adolesc Psychiatry 2009; 48:271-282. [PMID: 19182692 PMCID: PMC2760075 DOI: 10.1097/chi.0b013e318195bccf] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Provide nationally representative data on the prevalence and psychiatric correlates of suicidal ideation and attempts among African American and Caribbean black adolescents in the United States. METHOD Data on nonfatal suicidal behavior among 1,170 African American and Caribbean black adolescents aged 13 to 17 years are from the National Survey of American Life-Adolescent, a nationally representative household survey of adults with an attached adolescent sample conducted between February 2001 and June 2003. RESULTS Nationwide black adolescents reported having a lifetime prevalence of 7.5% for suicidal ideation and 2.7% for attempts. The 12-month prevalence of suicidal ideation and attempt was 3.2% and 1.4%, respectively. Among all respondents, 4% of black American adolescents and 7% of female subjects were projected to attempt suicide by age 17 years. African American adolescents were approximately five times more likely than Caribbean black adolescents to attempt suicide. Almost half of the National Survey of American Life-Adolescent respondents who reported a suicide attempt had never met criteria for any of the DSM-IV disorders by the time of their attempts. CONCLUSIONS Clinicians should be trained to screen for suicidal behavior, even among those without DSM-IV disorders, when treating black adolescents, particularly female subjects. In addition, preventive efforts should consider ethnic differences in suicide risk and targeting nonclinical settings.
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Affiliation(s)
- Sean Joe
- Dr. Joe is with the School of Social Work, University of Michigan, Dr. Baser is with the Institute for Social Research, and Drs. Neighbors, Caldwell, and Jackson are with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan.
| | - Raymond S Baser
- Dr. Joe is with the School of Social Work, University of Michigan, Dr. Baser is with the Institute for Social Research, and Drs. Neighbors, Caldwell, and Jackson are with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan
| | - Harold W Neighbors
- Dr. Joe is with the School of Social Work, University of Michigan, Dr. Baser is with the Institute for Social Research, and Drs. Neighbors, Caldwell, and Jackson are with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan
| | - Cleopatra H Caldwell
- Dr. Joe is with the School of Social Work, University of Michigan, Dr. Baser is with the Institute for Social Research, and Drs. Neighbors, Caldwell, and Jackson are with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan
| | - James S Jackson
- Dr. Joe is with the School of Social Work, University of Michigan, Dr. Baser is with the Institute for Social Research, and Drs. Neighbors, Caldwell, and Jackson are with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan
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Rueter MA, Holm KE, McGeorge CR, Conger RD. Adolescent suicidal ideation subgroups and their association with suicidal plans and attempts in young adulthood. Suicide Life Threat Behav 2008; 38:564-75. [PMID: 19014308 DOI: 10.1521/suli.2008.38.5.564] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Suicidal ideation during adolescence is quite common. Longitudinal ideation patterns may predict adolescents at greatest risk of progressing to more serious suicidal behaviors. We enumerated suicidal ideation trajectory subgroups and estimated subgroup association with later suicidal plans and attempts using data collected across a 13-year period from 552 Caucasian adolescents. Three subgroups were found: non-ideators (no ideation), decreasers (ideation decreased), and increasers (ideation persisted or increased). Probability of planning a suicide was greatest among increasers (females: .54, males: 51, p < .01). Probability of attempting suicide was greatest among male decreasers (.36, p < .01) and female increasers (.25, p < .01).
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Waldvogel JL, Rueter M, Oberg CN. Adolescent suicide: risk factors and prevention strategies. Curr Probl Pediatr Adolesc Health Care 2008; 38:110-25. [PMID: 18328991 DOI: 10.1016/j.cppeds.2008.01.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jacki L Waldvogel
- College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA
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Brezo J, Paris J, Hébert M, Vitaro F, Tremblay R, Turecki G. Broad and narrow personality traits as markers of one-time and repeated suicide attempts: a population-based study. BMC Psychiatry 2008; 8:15. [PMID: 18325111 PMCID: PMC2294113 DOI: 10.1186/1471-244x-8-15] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 03/06/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Studying personality traits with the potential to differentiate between individuals engaging in suicide attempts of different degrees of severity could help us to understand the processes underlying the link of personality and nonfatal suicidal behaviours and to identify at-risk groups. One approach may be to examine whether narrow, i.e., lower-order personality traits may be more useful than their underlying, broad personality trait dimensions. METHODS We investigated qualitative and quantitative differences in broad and narrow personality traits between one-time and repeated suicide attempters in a longitudinal, population-based sample of young French Canadian adults using two multivariate regression models. RESULTS One broad (Compulsivity: OR = 2.0; 95% CI 1.2-3.5) and one narrow personality trait (anxiousness: OR = 1.1; 95% CI 1.01-1.1) differentiated between individuals with histories of repeated and one-time suicide attempts. Affective instability [(OR = 1.1; 95% CI 1.04-1.1)] and anxiousness [(OR = .92; 95% CI .88-.95)], on the other hand, differentiated between nonattempters and one-time suicide attempters. CONCLUSION Emotional and cognitive dysregulation and associated behavioural manifestations may be associated with suicide attempts of different severity. While findings associated with narrow traits may be easier to interpret and link to existing sociobiological theories, larger effect sizes associated with broad traits such as Compulsivity may be better suited to objectives with a more clinical focus.
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Affiliation(s)
- Jelena Brezo
- McGill Group for Suicide Studies, Douglas Hospital Research Center, Montreal, Canada.
| | - Joel Paris
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Martine Hébert
- Department of Sexology, University of Quebec, Montreal, Canada
| | | | | | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Hospital Research Center, Montreal, Canada,Department of Psychiatry, McGill University, Montreal, Canada
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Abstract
Predictors for repetition of suicide attempts were evaluated among 92 adolescent suicide attempters 9 years after an index suicide attempt (90% females). Five were dead, two by suicide. Thirty-one (42%) of 73 had repeated a suicide attempt. In multiple Cox regression analysis, four factors had an independent predictive effect: comorbid disorders, hopelessness, having ever received treatment for mental or behavior problems, and having a father exerting control without affection. Prediction on an individual level was difficult. Since almost half repeated a suicidal act, the best strategy is to evaluate all adolescent suicide attempters thoroughly and provide treatment as needed.
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Affiliation(s)
- Berit Groholt
- Sogn Centre for Child and Adolescent Psychiatry, Oslo, Norway.
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20
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Abstract
This review examines the descriptive epidemiology, and risk and protective factors for youth suicide and suicidal behavior. A model of youth suicidal behavior is articulated, whereby suicidal behavior ensues as a result of an interaction of socio-cultural, developmental, psychiatric, psychological, and family-environmental factors. On the basis of this review, clinical and public health approaches to the reduction in youth suicide and recommendations for further research will be discussed.
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Affiliation(s)
- Jeffrey A Bridge
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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21
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Haavisto A, Sourander A, Multimäki P, Parkkola K, Santalahti P, Helenius H, Nikolakaros G, Moilanen I, Kumpulainen K, Piha J, Aronen E, Puura K, Linna SL, Almqvist F. Factors associated with ideation and acts of deliberate self-harm among 18-year-old boys. A prospective 10-year follow-up study. Soc Psychiatry Psychiatr Epidemiol 2005; 40:912-21. [PMID: 16245189 DOI: 10.1007/s00127-005-0966-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aims of the study were: (1) to identify the prevalence of ideation and acts of deliberate self-harm in 18-year-old boys; (2) to report the use of mental health services among these boys; (3) to identify risk factors assessed at age 8 and (4) to identify associated cross-sectional factors at age 18 of self-reported ideation and acts of deliberate self-harm. METHODS The participants in this community-based 10-year follow-up study consisted of 2,348 boys born during 1981. At baseline, three informant sources were used: parents, teachers and the children themselves. The questionnaires used were the Rutter Parents Scale, the Rutter Teacher Scale and the Children's Depressive Inventory. At follow-up, boys' psychopathology, adaptive functioning and substance use were studied using the Young Adult Self-Report questionnaire. Further questions about demographic factors and life events were added at both stages. RESULTS The prevalence of ideation of deliberate self-harm was 4.0%, and of acts 2.2%, during the preceding 6 months. Of the subjects who reported ideation, 9.7%, and of those who reported acts, 16.0%, had used mental health services during the previous year. Self-reported depressive symptoms at age 8 predicted ideation and acts of deliberate self-harm 10 years later. Suicidal boys' problems in many life areas were linked with suicidal tendency through psychiatric symptoms, especially anxious/depressed symptoms and aggressive behaviour. CONCLUSIONS The connection between self-reported depressive symptoms at age 8 and ideation and acts of deliberate self-harm at age 18 is a good reason to already pay special attention to children's own intimations of distress in elementary school. It is likely that an effective way to prevent suicidality among adolescents is to search for and treat psychiatric problems among young people. Self-reported screening questionnaires used, e.g. in school healthcare, may provide an opportunity to recognize these problems.
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Affiliation(s)
- Antti Haavisto
- Child Welfare and School Health Care Clinic, Joint Authority of Health Work in Rauma Region, Box 283, 26101, Rauma, Finland
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22
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Verger P, Dany L, Bouhnik AD, Coruble G, Prodhon H, Obadia Y. [Practice of trauma and emergency units in delivering care to youth who attempt suicide--experiences from Provence]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2004; 16:541-50. [PMID: 15625809 DOI: 10.3917/spub.043.0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Suicide attempts (SA) represent a significant public health problem and raise questions wih respect to the best, most appropriate methods for triage and the delivery of care. A prospective investigation to evaluate the quality of SA health care was carried out over a three month period within 18 hospitals having an emergency care unit. A total of 393 youth having attempted suicide were triaged and treated by these establishments during the period of the survey, with a large majority of them being girls (77%). Medicinal intoxication was the most often used method (85.1%). The criteria and regulations relating to the initial health care provided upon the patient's arrival were most followed, contrary to those concerning hospitalisation modalities and preparation for release following treatment. Factors explaining the implementation of these criteria were related to the type of emergency unit, the presence of a mental disorder and the duration of the patient's hospitalisation. These results show that several aspects of health care provided to young suicide attempters should be improved in Provence.
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Affiliation(s)
- P Verger
- Observatoire Regional de la Santé Provence-Alpes-Côte d'Azur, 23, rue Stanislas Torrents, 13006 Marseille, France
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23
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Abstract
Eighty-eight subjects with adolescent-onset psychotic disorders (mean age+/-standard deviation 15.7+/-1.5 years), mainly schizophrenia and affective disorders, were followed up 10.6+/-3.6 years later, rediagnosed (DSM-IV) and assessed with the Positive and Negative Symptom Scale, abuse of drugs including nicotine, the Lancashire Quality of Life Profile and occurrence of suicide or suicide attempts. Four males (4.5% of subjects) had died from suicide while another 25% of the subjects had attempted suicide. Suicide attempts were associated to more depressive symptoms but fewer negative symptoms at first episode, and to number of admissions and to dependence on nicotine at follow-up in a logistic regression. Satisfaction with religion, health, family relations and safety at follow-up were inversely associated to attempting suicide but only satisfaction with religious belief remained after controlling for concurrent symptoms of anxiety and depression.
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Affiliation(s)
- Håkan Jarbin
- Department of Child and Adolescent Psychiatry, County Hospital, Halmstad, Sweden.
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24
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Abstract
Suicide is rare in childhood and early adolescence, and becomes more frequent with increasing age. The latest mean worldwide annual rates of suicide per 100 000 were 0.5 for females and 0.9 for males among 5-14-year-olds, and 12.0 for females and 14.2 for males among 15-24-year-olds, respectively. In most countries, males outnumber females in youth suicide statistics. Although the rates vary between countries, suicide is one of the commonest causes of death among young people. Due to the growing risk for suicide with increasing age, adolescents are the main target of suicide prevention. Reportedly, less than half of young people who have committed suicide had received psychiatric care, and thus broad prevention strategies are needed in healthcare and social services. Primary care clinicians are key professionals in recognizing youth at risk for suicide. This article reviews recent population-based psychological autopsy studies of youth suicides and selected follow-up studies of clinical populations and suicide attempters, analyzing risk factors for youth suicides. As youth suicides are rare, research on risk factors for youth suicidal ideation and attempted suicide is also briefly reviewed. The relationship between psychiatric disorders and adolescent suicide is now well established. Mood disorders, substance abuse and prior suicide attempts are strongly related with youth suicides. Factors related to family adversity, social alienation and precipitating problems also contribute to the risk of suicide. The main target of effective prevention of youth suicide is to reduce suicide risk factors. Recognition and effective treatment of psychiatric disorders, e.g. depression, are essential in preventing child and adolescent suicides. Research on the treatment of diagnosed depressive disorders and of those with suicidal behavior is reviewed. In the treatment of youth depression, psychosocial treatments have proved to be useful and efficacious. Although studies on the effectiveness of selective serotonin reuptake inhibitors are limited in number, evidence supports their use as first-line antidepressant medication in youth depression. Available evidence suggests that various treatment modalities are useful in the treatment of suicidal youths, e.g. cognitive behavioral therapy and specialized emergency room interventions. Much of the decrease in suicide ideation and suicide attempts seems to be attributable to nonspecific elements in treatment. For high-risk youth, providing continuity of care is a challenge, since they are often noncompliant and commonly drop out or terminate their treatment prematurely. Developing efficacious treatments for suicidal children and adolescents would offer better possibilities to prevent suicides.
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Affiliation(s)
- Mirjami Pelkonen
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
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25
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Abstract
The aim of this cross-sectional study is to report the self-destructive and suicidal behavior of 98 children and adolescents in child welfare institutions. The children were evaluated using the Child Behavior Checklist (CBCL), the Children's Global Assessment Scale (CGAS) and questionnaires about suicidal and violent behavior, filled in by the child's key worker. Thirty-two per cent of the sample had presented suicidal thoughts, threats or suicide attempts during the previous 6 months. Suicidality was associated with low general functioning level (CGAS<61), self-mutilating behavior and violence. Furthermore, suicidal children had significantly higher CBCL total, externalizing, internalizing, anxious-depressive and aggressive scores. Children with suicide attempts (8% of the sample) had a significantly higher number of different types of traumatic experiences before the placement and higher somatization syndrome scores compared to children with suicidal ideation or non-suicidal children.
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Affiliation(s)
- R Hukkanen
- Department of Child Psychiatry, Turku University Hospital, Finalnd.
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26
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Farbstein I, Dycian A, Gothelf D, King RA, Cohen DJ, Kron S, Apter A. A follow-up study of adolescent attempted suicide in Israel. J Am Acad Child Adolesc Psychiatry 2002; 41:1342-9. [PMID: 12410077 DOI: 10.1097/00004583-200211000-00016] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES (1) To compare the outcome of adolescent subjects who have made a suicide attempt with the outcome of matched controls, using their psychological and psychometric screening tests for military service at age 16.5 years. Their subsequent performance during military service between ages 18 and 21 was also evaluated. (2) To compare the prognosis of those attempters who received intensive psychiatric inpatient evaluation in a general hospital with the prognosis of those who received emergency room treatment only. METHOD The computerized military records of 216 adolescents, who had been treated between 1987 and 1988 for attempted suicide in a general hospital emergency room, prior to their induction into the army, were evaluated. They were rated on the following tests: cognitive/educational performance and psychosocial adaptation, psychiatric and psychological health diagnoses, and performance during their military service between 1989 and 1992. RESULTS Although the female attempters had slightly more problems in the military than the controls, their overall prognosis was surprisingly good. The male suicide attempters did very poorly in their subsequent military service. There was no long-term advantage in having had a psychiatric evaluation performed in a hospital over a brief emergency room evaluation. Most differences between attempters and controls were in service performance, rather than in cognitive and psychometric tests. CONCLUSIONS There may be marked differences between the sexes in the significance of attempted suicide and in the indications for intervention. The policy of mandatory general hospitalization for suicide attempters may need reevaluation.
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Affiliation(s)
- Ilana Farbstein
- Department of Child and Adolescent Psychiatry, Rivka Ziv Hospital, Safed, Israel
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27
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Granboulan V, Roudot-Thoraval F, Lemerle S, Alvin P. Predictive factors of post-discharge follow-up care among adolescent suicide attempters. Acta Psychiatr Scand 2001; 104:31-6. [PMID: 11437747 DOI: 10.1034/j.1600-0447.2001.00297.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study short-term compliance with follow-up care in a sample of adolescent suicide attempters. METHOD One hundred and sixty-seven adolescents, aged from 13-18 years and hospitalized after a suicide attempt, completed a questionnaire that included the CES-Depression Scale and Zung Anxiety Scale. Physicians assessed the hospital care immediately after the attempt, and post-discharge care plans. Three months later, adolescents were contacted by telephone and asked about follow-up care. RESULTS After 3 months, 91.6% of the adolescents could be contacted: 25.5% never attended any follow-up; 11.1% went only once; 31.4% missed some appointments; and 32.0% went to all their scheduled appointments. Adolescents who complied with follow-up care differed significantly from those who did not: they showed more depression, anxiety and illicit drug use at the time of the attempt; they had more often planned the attempt; they were hospitalized longer; and they met with a psychiatrist more often while hospitalized. Compliance was also better when the follow-up appointment was scheduled before discharge. CONCLUSION Compliance with post-discharge follow-up care depends upon the adolescent's psychopathology but may also be improved by the type of hospital care and post-discharge plans.
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Affiliation(s)
- V Granboulan
- Department of Paedopsychiatry, Hôpital Intercommunal, Créteil, France
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28
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Stein D, Apter A, Ratzoni G, Har-Even D, Avidan G. Association between multiple suicide attempts and negative affects in adolescents. J Am Acad Child Adolesc Psychiatry 1998; 37:488-94. [PMID: 9585650 DOI: 10.1097/00004583-199805000-00011] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the level of negative emotions-anxiety, depression, aggression, and impulsivity-in hospitalized adolescents with a history of either a single or multiple suicide attempts. METHOD Thirty-two adolescents hospitalized for a first suicide attempt, 19 hospitalized for a repeated attempt (fifth or more), 109 nonsuicidal psychiatric inpatients, and 85 community controls were assessed for level of depression, anxiety, aggression, and impulsivity with the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Multidimensional Anger Inventory, and the Suicide Potential Scale. RESULTS Both suicidal groups demonstrated higher levels of most of the negative emotions than both the normal controls and the nonsuicidal inpatients. When the first attempters were compared with the multiple attempters, similarly high levels were noted for most dimensions of anxiety and depression. A trend toward increased aggression was noted among the multiple suicide attempters on all parameters evaluated; some of these differences were significant. CONCLUSION In already highly anxious and depressed suicidal inpatients, a high level of aggression might significantly increase the risk of recidivism.
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Affiliation(s)
- D Stein
- Abarbanel Mental Health Care Center, Bat Yam, Israel
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29
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Abstract
One hundred twenty-nine undergraduate students were assessed for suicidal preoccupation, using the Alabama Adolescent Health Survey (AAHS) and selected cards from the Thematic Apperception Test (TAT). They were also administered the Multidimensional Perfectionism Scale (MPS) to assess perfectionistic tendencies. Objective scoring of the TAT was found to be highly reliable. Canonical correlational analyses were nonsignificant for a relationship between perfectionism and suicidal themes on the TAT. However, the more direct questions of the AAHS relating to suicide were significantly related to perfectionism. Results suggest that passive perfectionists who procrastinate out of fear of making mistakes are more likely to be preoccupied with suicide, unlike perfectionists whose strivings produce achievement. High personal standards and parental expectations do not appear related to suicidal preoccupations.
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30
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Larzelere RE, Smith GL, Batenhorst LM, Kelly DB. Predictive validity of the suicide probability scale among adolescents in group home treatment. J Am Acad Child Adolesc Psychiatry 1996; 35:166-72; discussion 172-4. [PMID: 8720626 DOI: 10.1097/00004583-199602000-00009] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine the predictive validity of the Suicide Probability Scale (SPS). METHOD Prospective design, predicting subsequent suicide attempts, suicide verbalizations, and minor self-destructive behaviors from SPS scores at admission to a group home in a sample of 855 adolescents. RESULTS SPS scores significantly predicted all three suicide-relevant measures. Only 48% of subsequent attempts could have been predicted from SPS criteria that would have put 21% of newly admitted adolescents in the at-risk group. Although the prediction is far from perfect, it can prevent some suicide attempts when combined with effective suicide precautions. CONCLUSIONS This is the first known evidence of predictive validity of any measure of suicide risk in adolescents. Its predictive ability may have been reduced by interventions designed to reduce suicide risk. Despite the large number of false-positives and modest predictive validity, a large body of literature indicates that quantitative predictions perform better than clinical judgments in predicting psychological outcomes. However, the SPS measures only a subset of factors predictive of suicide, including suicidal ideation, hopelessness, and social isolation. Risk factors not assessed by the SPS include previous suicide attempts, conduct disorder, substance abuse, and reasons for living. These additional risk factors may be important to improve upon the predictive validity of the SPS.
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Affiliation(s)
- R E Larzelere
- Father.Flanagan's Boys' Home, Boys Town, NE 68010, USA
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31
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Hjelmeland H. Verbally expressed intentions of parasuicide: II. Prediction of fatal and nonfatal repetition. CRISIS 1996; 17:10-4. [PMID: 8768401 DOI: 10.1027/0227-5910.17.1.10] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The predictive value of verbally expressed intentions of parasuicide was studied in 925 patients admitted after deliberate self-harm to one of the health care facilities in the county of Sør-Trøndelag, Norway. Repetition of the suicidal act was studied prospectively, and the results showed that verbally expressed intention to die at the index parasuicide did predict fatal repetition (suicide) but not nonfatal repetition (parasuicide) of the suicidal act.
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Affiliation(s)
- H Hjelmeland
- Department of Psychology, University of Trondheim, Dragvoll, Norway
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32
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Hjelmeland H. Verbally expressed intentions of parasuicide: I. characteristics of patients with various intentions. CRISIS 1995; 16:176-81. [PMID: 8919979 DOI: 10.1027/0227-5910.16.4.176] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Comparisons of 584 parasuicides with a verbalized intention to die and 341 parasuicides with other intentions were made on a number of sociodemographic and clinical/psychological variables. The results revealed that patients with a verbalized intention to die had different life-problems than those with other intentions. More specifically, after sex and age had been controlled for, patients with an intention to die were more often economically inactive and were more likely to report psychiatric problems as their main concern, while those with other intentions more often abused alcohol and were more likely to report family or economical problems. The identification of discriminating risk factors is important in light of the fact that those with an intention to die made more life-threatening attempts, as reflected by the choice of method and the medical judgment of the attempt's seriousness.
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Affiliation(s)
- H Hjelmeland
- Department of Psychology, University of Trondheim, Dragvoll, Norway
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Abstract
A sample of 265 adolescents hospitalized between 1971 and 1980 in a psychiatric unit following a suicide attempt was studied to evaluate outcome. After an average of 11.5 years, 48% of the original sample, or 127 subjects, could be traced. Thirty-nine per cent of these subjects showed signs of improvement, 22% appeared to be unchanged and 33% were worse. Substantial dropout rates were found in postdischarge care, only 32% of the patients having been followed up for a sufficient amount of time. Fifteen subjects had died, only one of whom from a natural cause. Of the remaining 14, 5 had committed suicide and 9 had died from unnatural or violent causes other than suicide, the cause of death appearing in all cases to be closely linked to the subject's adolescent disorders. The implications of these findings for suicide prevention are discussed.
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Affiliation(s)
- V Granboulan
- Department of Child and Adolescent Psychopathology, Salpêtrière Hospital, Paris, France
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34
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Abstract
The increase in adolescent suicides has prompted the World Health Organization to set targets to reduce the incidence of deaths by the year 2000. In order to achieve this target further investigation into the perceptions of adolescent parasuicidal individuals is required to reduce the number of suicide attempts. Statistical evidence shows that parasuicidal individuals are commonly females who attempt suicide by taking an overdose. In the majority of cases help has been sought within the month prior to the attempt. Following an attempt many individuals feel isolated or ignored by health professionals. It appears that communication difficulties and negative attitudes by health professionals often reinforce the stigma associated with suicide. Nurses can contribute to the prevention of parasuicide/suicide by actively providing therapeutic care and counselling parasuicidal individuals to help them deal with major life events.
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Brent DA, Kolko DJ, Wartella ME, Boylan MB, Moritz G, Baugher M, Zelenak JP. Adolescent psychiatric inpatients' risk of suicide attempt at 6-month follow-up. J Am Acad Child Adolesc Psychiatry 1993; 32:95-105. [PMID: 8428891 DOI: 10.1097/00004583-199301000-00015] [Citation(s) in RCA: 115] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Adolescent inpatients (of whom 48 were admitted for a suicide attempt, 33 were admitted for suicidal ideation, and 53 had no history of clinically significant suicidal ideation or attempt), were interviewed while in the hospital and then followed up 6 months later. Of the 134 patients followed up, 13 (9.7%) had made a suicide attempt. The vast majority of those who attempted suicide had been suicidal while in the hospital (12/13 or 92.3%). Other risk factors for suicidal behavior include major depression at intake, affective disorder with nonaffective comorbidity, a depressive disorder that continued through follow-up, death of a relative, and family financial problems. Suicidal inpatients, particularly those with chronic and recurrent affective illness, are at substantial risk for making a suicide attempt within 6 months of discharge. At follow-up, an even higher proportion showed attempts or suicidal ideation with a plan (N = 36 or 26.8%), with risk factors similar to those noted above. More intense outpatient or partial hospital interventions as a transition from the inpatient environment may be necessary to reduce the rate of recidivism among suicidal adolescents.
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Affiliation(s)
- D A Brent
- Division of Child & Adolescent Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, PA 15213
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36
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Abstract
We analyzed the relative seriousness of suicide attempts by boys based on 430 hospitalized suicide attempters ages 13 to 19 years. A comparison by sex of adolescent suicide attempters with a school population of non-suicidal adolescents of the same age group shows greater differences in the areas of school failure, psychosomatic and distress-related symptoms and substance abuse between suicidal and non-suicidal boys than between suicidal and non-suicidal girls. These findings suggest that compared with non-suicidal boys and girls, suicidal boys show more deviant behavior than girls. The question then arises as to whether there are differences in the treatment received by male and female suicide attempters. On hospital admission, more boys than girls are sent to psychiatric wards, and boys are proposed follow-up care more frequently than girls. On the other hand, boys and girls are not treated differently with respect to psychiatric consultations during hospitalization or coordination with outside physicians (family doctor, school doctor, other physicians) and the social services. These findings could serve as the basis for the development of specific treatment plans to meet the needs of suicidal boys.
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Affiliation(s)
- I Gasquet
- National Institute of Health and Medical Research (INSERM), Villejuif, France
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37
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Affiliation(s)
- F Ladame
- University of Geneva School of Medicine, Switzerland
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38
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Affiliation(s)
- L Kotila
- Department of Psychology, Helsinki University, Finland
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39
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Abstract
Characteristics of adolescent suicide victims (N = 53) were investigated in a nationwide study of suicides in Finland. The data were collected through interviews with the victims' parents and attending health care personnel and from official records. Four victims in 10 had shown antisocial behavior. One-third of the adolescents had previous suicide attempts, and 6 in 10 were known to have verbalized their suicidal thoughts. One-third of the victims had been in contact with a psychiatric care system. The results suggest that most adolescent suicides are an endpoint of long-term difficulties, and all suicidal tendencies among adolescents should be taken seriously.
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Affiliation(s)
- M J Marttunen
- National Public Health Institute, Unit for Mental Health Research, Helsinki, Finland
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40
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A guide to the literature on aggressive behavior. Aggress Behav 1989. [DOI: 10.1002/1098-2337(1989)15:5<403::aid-ab2480150509>3.0.co;2-s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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