Trajectories of Suicidal Ideation from Sixth through Tenth Grades in Predicting Suicide Attempts in Young Adulthood in an Urban African American Cohort

Longitudinal trajectories of suicidal ideation among child welfare-involved 7- to 12-year-old children

BACKGROUND

Young children involved in the child welfare system (CWS) are at high risk for suicidal ideation (SI) at a time when overall rates of suicide death in this age group are rising. Yet risk factors for and changes in SI over time are poorly understood in this population.

METHOD

We combined data from two large representative longitudinal studies of children involved in the United States CWS. We examined patterns of SI among children who were between ages 7 and 12 years at the initial survey wave (N = 2,186), assessed at three waves using a measure of SI in the past 2 weeks. We conducted a multinomial regression to understand the baseline demographic, child maltreatment, and mental health characteristics that distinguish the trajectories.

RESULTS

There were eight different subgroups (Non-Ideators, Late Ideators, Boomerang Ideators, Delayed Ideators, Desisters, Boomerang Non-Ideators, Late Desisters, and Persisters). Differences in race, type of maltreatment, sex, and mental health symptoms were identified when comparing Persisters (SI at all three waves) to other groups.

CONCLUSIONS

These findings can help researchers and practitioners to develop strategies for better identifying CWS-involved children who are in greatest need of suicide risk monitoring and intervention.

Co-developmental trajectories of suicidal ideation and non-suicidal self-injury among Chinese adolescents: Transdiagnostic predictors and association with suicide attempts

INTRODUCTION

Adolescent suicidal ideation (SI) and non-suicidal self-injury (NSSI) are crucial public health issues, yet their co-developmental trajectories during early adolescence and their associations with predictors and outcomes are unclear. This study aimed to (a) identify heterogeneous co-developmental trajectories of SI and NSSI, (b) explore associations between transdiagnostic predictors and trajectories, and (c) assess suicide attempt risk across trajectories.

METHODS

Four hundred fifty-three adolescents (Mage = 12.35 years, 48.3% boys) completed surveys at 6-month intervals across 2 years. At Time 1 (Nov 2020), participants completed surveys encompassing SI, and NSSI, along with family, peer, and individual predictors. Subsequent surveys (Times 2-4) measured SI and NSSI, with suicide attempts queried at Time 4.

RESULTS

Parallel process latent class growth models revealed three co-developmental groups (i.e., Stable low NSSI and SI; Moderate-NSSI and high-SI, parallel decreasing; High-NSSI and moderate-SI, parallel increasing). Multivariate logistic regression indicated that group membership was predicted by parental rejection, parental warmth, bullying victimization, depressive and anxiety symptoms, thwarted belongingness, and perceived burdensomeness. Adolescents in the "High-NSSI and moderate-SI, parallel increasing" group reported the highest suicide attempt frequency.

CONCLUSION

These findings underscore subgroup distinctions and transdiagnostic predictors in comprehending SI and NSSI progression, emphasizing the necessity of dynamic monitoring and tailored interventions for distinct subgroup characteristics.

Examining the integrated model of the interpersonal-psychological theory of suicide and intersectionality theory among Black male adolescents

INTRODUCTION

Guided by Opara et al.'s (2022), Integrated Model of the Interpersonal Psychological Theory of Suicide and Intersectionality Theory, the current study examined contextual stressors experienced disparately by Black youth (racial discrimination, poverty, and community violence) as moderators of the association between individual motivating factors for suicidal thoughts and behaviors (perceived burdensomeness, thwarted belongingness, and hopelessness) and active suicidal ideation.

METHOD

Participants were 457 Black adolescent boys (mean age = 15.31, SD = 1.26) who completed self-report surveys.

RESULTS

As predicted, the association between perceived burdensomeness and active suicidal ideation was significantly moderated by economic stress. In addition, the association between peer belongingness and suicidal ideation was significantly moderated by racial discrimination, but there were no moderating effects for school belongingness. Finally, the association between hopelessness and suicidal ideation was significantly moderated by both racial discrimination and witnessing community violence.

CONCLUSION

These findings highlight the need for research, interventions, and policy work devoted to using integrated approaches of individual and socioeconomically relevant patterns of suicidal thoughts and behaviors to support Black youth exposed to various forms of structural oppression.

Reasons for Suicide in Black Young Adults: A Latent Class Analysis

BACKGROUND

Suicides have increased among Black youth in the US, though it remains unclear if these trends persist into young adulthood. Further, even less is known about the reasons why individuals begin to consider suicide as a viable option. The current study aims to redress these gaps by identifying specific reasons for suicide among a sample of 264 Black young adults who reported experiencing suicidal thoughts within the past 2 weeks.

METHODS

Participants were recruited from an online panel. Reasons for suicide were measured using eight individual items/indicators. Latent class analysis was used to detect underlying patterns in Black young adults' reasons for considering suicide.

RESULTS

The most commonly reported reason for considering suicide among the entire sample was feeling hopeless about the future. Black women were more likely to report considering suicide because they could not live up to other's expectations and because they felt lonely and sad. Findings for the 3-class model were retained. The first class is described as the "Somewhat hopeless and other reasons" class (n = 85; 32%). The second class is "Accomplished but extremely lonely and sad" (n = 24; 9%). The third class is described as "Pronounced feelings of failure, hopelessness, being overwhelmed, and lack of accomplishment" and includes 59% of the sample (n = 155).

CONCLUSIONS

Culturally grounded clinical treatments and interventions are needed to meet the specific mental health needs of Black young adults. A particular focus on identifying factors that drive feelings of hopelessness and failure is warranted.

Black adolescents' racial discrimination and suicide behaviors: Testing perceived school safety as a protective moderator

The current study examined associations between Black adolescents' (Mage  = 15.55, SD = 1.23) racial discrimination and suicide behaviors (i.e., suicide ideation, suicide plan, and suicide attempts), and whether perceived school safety was a protective moderator. Furthermore, we tested gender differences in relations, which were not significant. Racial discrimination predicted greater suicide behaviors, and school safety informed less suicide behaviors. School safety moderated the relation between discrimination and suicide plan, such that at low school safety, discrimination predicted having a suicide plan but was not significant at high school safety. Furthermore, school safety moderated the relation between discrimination and suicide attempts. At low school safety, discrimination predicted more suicide attempts, but was not significant at high school safety.

Profiles of Suicidal Ideation Among Black Male Adolescents: Examination of Individual and Socioecological Predictors

OBJECTIVE

The current study utilized latent profile analysis to identify distinct profiles of suicidal ideation among Black male adolescents and compared profiles on socioecological determinants of suicide and psychological symptoms.

METHOD

A sample of 457 Black male adolescents (mean age = 15.31, SD = 1.26) completed self-report measures of suicidal ideation, racial discrimination, community violence exposure, anxiety symptoms, depressive symptoms, and posttraumatic stress symptoms.

RESULTS

Results of the latent profile analysis revealed a three-profile model: a low ideation profile, with low levels of all forms of suicidal ideation; a general death ideation profile with elevated general thoughts of death and dying; and a high, concealed ideation profile with high levels on all suicidal ideation items, except communicating the ideation to others. ANOVAs revealed that levels of psychological symptoms were significantly different for each profile, with the high, concealed ideation profile showing the highest levels. The low ideation profile had significantly lower scores than the two other profiles on community violence exposure, but the other two profiles did not differ significantly from one another. Further, the general death ideation profile had significantly higher scores on racial discrimination than the other two profiles, but the other two profiles did not differ significantly from one another.

CONCLUSIONS

The current study supports recent socio-cultural theories of suicidal ideation and behavior in Black youth and highlights the need for increased access to care and services for Black boys who are exposed to socioecological factors that heighten suicidal ideation.

Longitudinal patterns and predictors of suicidal ideation in African American adolescents

Suicide rates among African American adolescents have increased dramatically. Suicidal ideation is associated with both suicide attempts and completions, thus understanding ideation patterns and predictors in African American adolescents is critical to informing prevention efforts. This study recruited 160 African American ninth grade students. Participants were those students randomized to the control condition of a randomized controlled preventive intervention. Of the 160 participants, 99 completed all assessment points and were included in latent transition analyses. We assessed participants four times: baseline then again at 6-, 12-, and 18-month postbaseline. Constructs of interest for this study included suicidal ideation, depression, hopelessness, and community violence exposure. A 2-class model (i.e., low ideation [LI] and high ideation [HI]) characterized ideation at each time point. A total of 86%-90% of participants were in the LI class in any given time point and 27.3% of participants were in the HI class at least once. Participants in the LI class tended to stay in that class, whereas those in the HI class often transitioned to the LI group. Depression and hopelessness, but not exposure to community violence, predicted HI class membership. Findings suggest that (a) most African American adolescents may experience suicide ideation at some point in time, (b) a concerning proportion of African American adolescents may experience high ideation, (c) high ideation is often time-limited, and (d) depression and hopelessness predict high ideation.

Psychosocial predictors of persistent suicidal ideation among Chinese adolescents: A longitudinal study

BACKGROUND

Suicide is the fourth leading cause of death among adolescents. Studies have shown that persistent suicidal ideation has a more important effect on suicidal behavior. The objective of this study was to identify predictors of persistent suicidal ideation.

METHODS

Data were collected from 4225 Chinese middle and high school students. These adolescents were assessed for suicidal ideation at baseline and the second year. We used multinomial logistic regression (n = 4171) for the predictive effect of these factors on persistent suicidal ideation. We controlled for gender, residence, clinical diagnosis, clinical diagnosis family, suicide planning, and suicide attempts.

RESULTS

Depressive symptoms are essential in predicting persistent suicidal ideation (OR = 14.0; p < 0.001). Persistent suicidal ideation was predicted by sleep disorders, such as poor sleep quality (OR = 2.3; p = 0.008), difficulty falling asleep (OR = 2.4; p = 0.005), frequently midnight awakening (OR = 1.9; p = 0.044), and frequent nightmares (OR = 2.1; p = 0.040). There was a significant association between concern with persistent ideation and parental-peer alienation (OR for father, 1.9[p = 0.024]; OR for mother, 3.1[p < 0.001]; OR for peer, 2.3[p = 0.003]).

LIMITATIONS

All measures are based on self-report rather than objective assessment or clinical diagnostic assessment.

CONCLUSIONS

Persistent suicidal ideation had a more important role in influencing suicide planning and attempt. Interventions targeting sleep disorders and attention to attachments in the home and school are particularly important in preventing persistent suicidal ideation in adolescents.

Long-term trajectories of suicide ideation and its socioeconomic predictors: A longitudinal 8-year follow-up study

OBJECTIVE

Suicide ideation is the first stage of suicide behavior, and the long-term course of suicide ideation is highly variable. The aim of this study is to identify trajectories of suicide ideation over an 8-year period and explore the association of socioeconomic status (SES) with suicide ideation trajectories.

METHODS

We included 10,017 participants from Waves 7-15 of the Korea Welfare Panel Study; these have data on suicidal ideation (2012-2020). Trajectories analysis was conducted to identify distinct trajectories of suicidal ideation. Multinomial logistic regression was used to examine associations of SES with suicidal ideation trajectories. The interaction effects between current SES and prospective economic condition on trajectories were examined using a synergy index (SI).

RESULTS

We identified three suicide ideation trajectory groups: low-stable, moderate-decreasing, and high-persistent. Individuals in both moderate-decreasing and high-persistent trajectories had poorer current SES and prospective economic conditions than low-stable trajectories. Interestingly, those reporting poorer prospective economic conditions had a greater risk of being in a high-persistent trajectory than being in a moderate-decreasing trajectory. Further, individuals with poorer current SES and prospective economic conditions were more likely to be in the high-persistent trajectory.

CONCLUSIONS

Our findings demonstrated three distinct trajectories of suicide ideation which provide useful information for specific preventive interventions that could be developed. Moreover, poor prospective economic condition is a significant predictor of the high-persistent suicide ideation trajectory. Supporting economic difficulties and helping make goals and plans to strengthen positive thinking would help attenuate suicidal ideation and prevent suicidal behavior.

The rate of transition to a suicide attempt among people with suicidal thoughts in the general population: A systematic review

INTRODUCTION

While suicidal thoughts are relatively common in the general population, roughly affecting one in ten people during their lifetime, the transition from suicidal thoughts to a suicide attempt is rarer. There is limited consensus on the transition rate from suicidal ideation to suicide attempts.

OBJECTIVE

To review and summarize evidence on the rate of transition from suicidal ideation to a suicide attempt, and the factors associated with this transition, in the general population.

METHODS

A comprehensive search was conducted using MEDLINE, PsycINFO, and Embase for relevant articles published between January 1, 2000, and March 3, 2021. We identified 18 eligible studies that examined the transition from suicidal ideation to a suicide attempt in non-clinical populations. We assessed the quality of the included studies using the MASTER scale. The review has been registered with PROSPERO (CRD42021248325).

RESULTS

Rates of transitioning to a suicide attempt among people with suicidal ideation varied substantially across studies, from 2.6 % to 37 %. Follow-up periods also varied substantially, from 12 to 300 months, impeding reliable comparisons across studies or pooling data for further analyses. The most examined risk factors were mental health disorders such as major depressive and anxiety disorders, which were typically associated with higher odds of transition to a suicide attempt.

LIMITATIONS

High level of heterogeneity and limited quality of the studies.

CONCLUSION

The risk of transition from suicidal thoughts to a suicide attempt is moderate to high. Further longitudinal research is required to refine the rate and explore social determinants of transition from suicidal ideation to suicide attempts.

Examining mediators of associations of food insecurity and being bullied with suicide among in-school adolescents in Eswatini: a cross-sectional study

We examined the potential mediating roles of anxiety and loneliness on the association of concurrent food insecurity (FI) and being bullied (BB) with suicidal behavior (SB) in Eswatini, a lower-middle-income country. We used data from the Global School-based Student Health Survey (GSHS; N = 3264), which employed a two-stage cluster sampling: first, 25 schools were selected based on the proportionate probability of enrollment; second, classes were randomly selected. A self-reported 84-item GSHS questionnaire was used to collect data for students aged 13-17 years. FI was measured by requesting students to recall how often they went hungry because of a lack of food at home in the 30 days before the study. Multiple logistic regressions and binary mediation function was applied to examine mediating factors of SB. The prevalence of SB, FI, and BB among adolescents was 27.5%, 7.7%, and 30.2%, respectively. Moreover, the relationship between FI and BB with SB was partly (approximately 24%) mediated by anxiety and loneliness. Our results highlight the mediating roles of anxiety and loneliness in suicidal adolescents who experience FI and BB. In conclusion, interventions for alleviating SB in high-risk adolescents experiencing FI and BB should also be aimed at ameliorating anxiety and loneliness.

Cyber-victimization and Suicidal Ideation in Adolescents: A Longitudinal Moderated Mediation Model

Cyber-victimization is a significant risk factor for suicidal ideation among adolescents. However, little research has studied how cyber-victimization may impact suicidal ideation over time, and little is known about what protective factors can buffer against these associations. Guided by the integrated motivational-volitional model of suicidal behavior, this longitudinal study inspected the mediating role of hopelessness in the relation between cyber-victimization and suicidal ideation and the moderating roles of mindfulness and perceived social support in those mediating associations. A total of 1110 Chinese early adolescents (46.1% female; M_age at Wave 1 = 12.90 years) participated in a three-wave longitudinal study with 6-month intervals. The results showed that cyber-victimization positively predicted adolescents' suicidal ideation 1 year later, and this effect was fully mediated by hopelessness. Mindfulness buffered against the predictive effect of cyber-victimization on hopelessness, and perceived social support buffered against the predictive effect of hopelessness on suicidal ideation. The results further showed that the indirect effect of hopelessness was more salient when there were lower levels of mindfulness and perceived social support. This study reveals the moderated mediation processes explaining the impact of cyber-victimization on adolescents' suicidal ideation. Fostering youth's mindfulness and providing social support may attenuate the effects by which cyber-victimization causes suicidal ideation via hopelessness.

Distinct trajectories of suicidal behaviors throughout the university stage and associated risk and protective factors: A large-scale prospective study

BACKGROUND

Suicide is a major public health concern, especially among adolescents and young adults. Although research has begun to explore the developmental trajectories of suicide-related outcomes, most have thus far focused on children and adolescents. The current study extends existing literature by identifying subgroup trajectories and related factors of college students over a two-year period.

METHODS

The data used in this study was obtained from an ongoing longitudinal study in Guangdong, China. A total of 3871 students participated in assessments performed at three time points at one-year assessment intervals. Growth mixture modeling (GMM) was used to estimate trajectory classes for suicidal behaviors, followed by multivariable logistic regression to explore the association between predictive factors and classes.

RESULTS

GMM analyses extracted two distinct trajectories of suicidal behaviors: a low-decreasing group (n = 3669, 94.8 %) and a high-increasing group (n = 202, 5.2 %). Multivariate logistic regression analyses revealed that depressive symptoms, non-suicidal self-injury, hopelessness, and childhood emotional abuse served as risk factors for the high-increasing group, while reasons for living served as protective factors.

CONCLUSIONS

Psychological interventions aimed at reducing the influence of risk factors and bolstering reasons to live may help to decrease the risk of suicide behaviors in college students.

Pathways to Suicidal Behavior in Children and Adolescents: Examination of Child Maltreatment and Post-Traumatic Symptoms

Suicide in youth exacts significant personal and community costs. Thus, it is important to understand predisposing risk factors. Experiencing adverse childhood experiences (ACEs), such as child maltreatment (CM-ACE), and the presence of post-traumatic stress disorder has been identified as a risk factor of suicidal behaviors among adults. Theoretical models of suicide suggest that the presence of painful experiences such as CM-ACEs increase the risk of suicidal behaviors. The relation between child maltreatment, post-traumatic stress symptom clusters (PTSS) and suicidal behaviors has not been explicitly examined among youth. The present study examined the relations between CM-ACEs, PTSS clusters, and suicidal behaviors in a clinical population of children. Children, male, ages 6 to 14, enrolled in a residential treatment program completed self-report measures to evaluate variables of interest. Path analyses revealed statistically significant direct effects of CM-ACEs and PTSS clusters on suicidal behaviors. Significant total indirect effects and marginally significant individual indirect effects of intrusion and avoidance symptoms were observed for the relation between CM-ACEs and suicidal behavior. Findings suggest that symptoms associated with specific PTSS clusters might help explain the relation between CM-ACEs and suicidal behavior, and therefore, present important implications for clinical practice and future research.

Resilience and Depressive Symptoms Mediated Pathways from Social Support to Suicidal Ideation Among Undergraduates During the COVID-19 Campus Lockdown in China

Purpose

The COVID-19 pandemic has greatly affected people's mental health. The direct and indirect pathways between social support and suicidal ideation in the period are still unclear. This study explores the pathways from social support to suicidal ideation through resilience and depressive symptoms among undergraduates during the COVID-19 campus lockdown.

Methods

During two weeks of the COVID-19 campus lockdown, a total of 12,945 undergraduates at a university in eastern China completed the questionnaire including sociodemographic characteristics, suicidal ideation, social support, resilience, and depressive symptoms. A structural equation modeling (SEM) approach was used to analyze the direct and indirect pathways from social support to suicidal ideation via the mediators of resilience and depressive symptoms.

Results

Of the 12,917 undergraduates included in this study, 7.4% (n = 955) reported they sometimes had suicidal ideation, 0.8% (n = 109) reported they often had suicidal ideation, 0.9% (n = 122) reported they always had suicidal ideation, and 13.2% (n = 1704) reported they had depressive symptoms. Social support exerted significant direct (β = -0.058), indirect (β = -0.225), and total (β = -0.283) effects on suicidal ideation; 20.5% of the total effect was direct, and 79.5% was indirect. Social support predicted suicidal ideation through resilience (β = -0.038), and depressive symptoms (β = -0.087), explaining 13.4%, and 30.7% of the total effect, respectively. Social support predicted suicidal ideation through the sequential mediation of resilience and depressive symptoms (β = -0.099), explaining 35.0% of the total effect.

Conclusion

This is the first study to provide the evidence of pathways from social support to suicidal ideation through resilience and depressive symptoms during the COVID-19 campus lockdown among undergraduates in China. Both direct and indirect pathways from social support to suicidal ideation were identified as intervention targets to reduce suicidal ideation.

Suicide attempt endophenotypes: Latent profiles of child and adolescent aggression and impulsivity differentially predict suicide attempt in females

Suicide is a leading cause of death in young adulthood. Identifying early prevention targets to reduce later suicide is a public health priority. Impulsivity and aggression in early childhood may represent actionable early prevention candidate endophenotypes for later suicidal behavior. Our objective is to to understand the association of aggression and impulsivity trajectories with mental health outcomes to inform future prevention efforts. Participants were part of a longitudinal cohort of a preventative intervention trial (n = 597) and predominantly Black. They were assessed for aggressive and impulsive behaviors yearly in 1st-3rd and 6th-12th grades, and provided mental health data via self-report beginning in 6th grade. Longitudinal latent profiles of aggressive and impulsive behaviors were derived for males and females and used to determine whether profiles was associated with lifetime suicide attempt and meeting diagnostic criteria for major depressive disorder. Two impulsivity and aggression classes were found for males, characterized by low behaviors or moderate to high behaviors across development. Three classes were found for females, one of which was characterized by an undulating pattern of behaviors. For females, the class of severe behaviors was associated with significant risk of suicide attempt (Wald = 6.01, p = 0.05). No relationship was found for males or for MDD diagnosis. An endophenotype model of impulsivity and aggression in predicting later suicide attempt was supported in females, but not males. Results underscore the importance of evaluating sex differences in suicide research and the potential identification of females at risk for later suicidal behavior in school settings.

Trajectories of Suicidal Thoughts and Behaviors From Preschool Through Late Adolescence

OBJECTIVE

Suicidal thoughts and behaviors (STBs) represent a significant and escalating public health concern in youth. Evidence that STBs can emerge in the preschool years suggests that some pathways leading to clinically significant STBs begin early in life.

METHOD

This prospective longitudinal study examined the developmental trajectories of STBs in children from ages 3 to 17, oversampled for preschool-onset depression.

RESULTS

Three unique trajectories of STBs across childhood and adolescence were identified: low class (n = 273) characterized by low rates of STBs, early-persistent class (n = 21) characterized by steadily increasing STBs, and late-onset class (n = 21) characterized by low rates of STBs through age 10 followed by a dramatic increase from ages 11 to 14 years. Preschool measures of depression symptoms, externalizing symptoms, impulsivity, and lower income relative to needs were associated with both high-risk STB classes. Both high-risk STB classes reported greater functional impairment, more externalizing symptoms, and more cumulative stressful life events in adolescence relative to the low class; the late-onset class also reported poorer academic functioning relative to both the early-persistent and low classes.

CONCLUSION

A significant minority of this prospectively followed group of preschool children evidenced STBs by and/or after age 10. Although relatively rare before age 10, approximately half of the children who experienced STBs in adolescence first exhibited STBs in early childhood and comprised a trajectory suggesting increasing STBs. In contrast, approximately half of children first exhibited STBs in early adolescence. Early screening and identification of at-risk youth during both preschool and late childhood is important for early intervention regarding STBs.

The Narrative-Crisis Model of suicide and its prediction of near-term suicide risk

Despite decades of research, much remains unknown about the transition from chronic to imminent suicidal risk. In the context of COVID-19, this question is even more urgent. The present study tests a novel, stepwise model of this transition, termed the Narrative-Crisis Model. This model proposes that, in people with chronic risk factors, stressful life events can trigger a specific progression of cognitive-affective responses (the suicidal narrative and the suicide crisis syndrome), resulting in increased near-term risk of suicidal thoughts and behavior (STB). Identification of each step in this progression provides opportunities for more precise interventions. Concurrent validity was tested with 732 psychiatric patients and predictive validity with 524 participants, assessed one to two months later. Chronic risk factors were measured with the Childhood Trauma Questionnaire, Relationship Styles Questionnaire, and UPPS-P Impulsive Behavior Scale; acute risk factors with the Stressful Life Events Questionnaire, Suicide Narrative Inventory, and Suicide Crisis Inventory. The Columbia Suicide Severity Rating Scale was administered at the initial research assessment and follow-up. Indirect effects were significant for the full model and most pathways, in both concurrent and prospective analyses. In sum, this study provides empirical support for a novel, stepwise model of the progression from chronic to near-term suicidal risk.

Suicide in African American Adolescents: Understanding Risk by Studying Resilience

Historically, suicide rates for African American adolescents have been low,relative to rates for youth of other racial-ethnic backgrounds. Since 2001, however, suicide rates among African American adolescents have escalated: Suicide is now the third leading cause of death for African American adolescents. This disturbing trend warrants focused research on suicide etiology and manifestation in African American adolescents, along with culturally sensitive and effective prevention efforts. First, we revisit leading suicide theories and their relevance for African American adolescents. Next, we discuss health promotive and protective factors within the context of African American youth development. We also critique the current status of suicide risk assessment and prevention for African American adolescents. Then, we present a heuristic model of suicide risk and resilience for African American adolescents that considers their development within a hegemonic society. Finally, we recommend future directions for African American adolescent suicidology. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Incidence of suicide mortality among childhood cancer survivors: A population-based retrospective study

The aim of our study was to investigate the suicide rates among childhood cancer survivors and assess factors associated with higher suicide risk. A review of data from Surveillance, Epidemiology, and End Results (SEER) program from 1975 to 2016 was performed for this study. This program is based on the US population and is supported by the US National Cancer Institute (NCI). Survivors diagnosed with childhood cancer were recorded. There were 40 suicides among 567,233 person-years, giving a suicide rate of 7.1 per 100,000 person-years. Compared with cancer diagnosed between 10 and 14 years old, survivors with cancer diagnosed between 0 and 4 years old had lower suicide risk. Females had a lower risk of suicide than males. Compared with survivors of thyroid cancer, the aHRs were 0.16 for acute lymphocytic leukemia, 0.15 for nodal Hodgkin's lymphoma, 0.14 for brain cancers and 0.09 for kidney cancers. Most suicides occurred after 15 years old. Suicide was a problem for survivors, especially those with thyroid cancer. Beside treating patients holistically, early psychological interventions such as communicating effectively, providing social support and follow-up care related to psychological health are needed.

Electronic cigarette use and suicidal behaviors among adolescents

BACKGROUND

The aim of this study was to investigate the association of the use of e-cigarettes, which are regarded as alternatives to traditional cigarettes and are easy to purchase, with suicidal behaviors in adolescents.

METHODS

Data for 5405 middle and high school students aged 13-18 years who had used e-cigarettes were extracted from the 2016 Korean Youth Risk Behavior Web-Based Survey and analyzed using multiple logistic regression.

RESULTS

Among those who used e-cigarettes for 1-30 days in the past 30 days, suicidal ideation (odds ratio [OR] = 1.58, 95% CI, 1.31-1.89), suicidal plans (OR = 2.44, 95% CI, 1.94-3.08), suicidal attempts (OR = 2.44, 95% CI, 1.85-3.22) and serious attempts (OR = 3.09, 95% CI, 1.51-6.32) were higher compared to those who did not use an e-cigarette in the past 30 days.

CONCLUSIONS

Suicidal behaviors are significantly higher among current adolescent e-cigarette smokers than adolescents who have not used an e-cigarette in the past 30 days. Therefore, comprehensive intervention is needed to protect adolescents' mental health.

Bibliometric Analysis of Suicide Research Among Black Youth

Historically, Black youth have had lower rates of suicide attempts in comparison to their peers; however, in recent years this rate has changed, with self-reported suicide attempts for Black adolescents rising by 73%. The purpose of this study was to analyze the characteristics of research on Black youth and suicide using bibliometric techniques. To conduct our analysis, we developed a search strategy utilizing the Scopus database for the time period from 1980 to 2020. Results indicated an increasing trend in the number of articles published each year related to Black youth and suicide. The most highly productive journals were the Suicide and Life Threatening Behavior, Pediatrics, and Journal of Youth and Adolescence. Authors who frequently published in this area include Nadine Kaslow, Rheeda Walker, and Sean Joe. While this research area is growing, there is a lack of published articles focused on interventions for suicide prevention and non-comparative race specific research focused on Black youth.

Prevalence, risk factors and clinical correlates of suicidal ideation in adolescent patients with depression in a large sample of Chinese

BACKGROUND

Suicidal ideation (SI) has a high risk in adolescents and is now a significant concern due to its problematic outcome. However, few systemic studies of suicidal ideation have been conducted in adolescent patients. Therefore, the current study was aimed to assess the prevalence and its clinical correlate of suicidal ideation among adolescent patients with depression.

METHODS

A total of 1635 adolescent patients (748 males/ 887 females) with depression were recruited in this study. The clinical and demographic data were collected by a self-administered questionnaire. Suicidal ideation was assessed by interview. Children's Depression Inventory (CDI) was used to evaluate depressive symptoms, Adolescent Self-Rating Life Events Check List (ASLEC) was used to assess the stressful life events.

RESULTS

The study showed that the prevalence of suicidal ideation in adolescent depression patients was 38.2% (625/1635). Compared to the non-SI patients, SI patients had greater scores on CDI and ASLEC, had inadequate sleeping time, and were more likely to be females. Further logistic regression analysis indicated that suicidal ideation in adolescent patients with depression was significantly associated with females, inadequate sleeping time, the severity of depression, and higher learning pressure.

LIMITATIONS

No causal relationship could be drawn due to the cross-sectional design.

CONCLUSIONS

Our results suggest a high prevalence of suicidal ideation in adolescents with depression. Moreover, the severity of depression, sex, sleep time, and learning pressure are all related to suicidal ideation. Early recognition and treatment of suicidal ideation can effectively prevent the occurrence of suicide among adolescent patients.

An Assessment of the Role of Parental Incarceration and Substance Misuse in Suicidal Planning of African American Youth and Young Adults

Suicide rates among youth are increasing, and African American youth are becoming the most likely group to die by suicide in the USA. We utilized ecodevelopmental theory to investigate the relationship between parental incarceration and substance misuse and their association with suicidal planning in a sample of African American youth and young adults. Participants consisted of 190 African American youth and young adults living in public housing in a mid-Atlantic city in the USA who completed a youth health-risk behavior measure, and parental incarceration and substance misuse measures. Findings indicate males were significantly more likely than females to have devised a plan to die by suicide, especially if their mothers were incarcerated or their fathers had an alcohol problem. The findings of this study suggest several implications for health prevention and intervention efforts to reduce suicide-related risks among African American youth and young adults, including strategies that promote family-centered, evidence-based interventions that are culturally tailored to provide further insight into the best practices in suicide prevention.

Psychotic Experiences and Schizotypy in Early Adolescence Predict Subsequent Suicidal Ideation Trajectories and Suicide Attempt Outcomes From Age 18 to 38 Years

Subclinical risk markers for schizophrenia predict suicidality, but little is known about the nature of the relationship. Suicidal ideation is often considered homogenous, but distinguishing passive from active ideation (ie, thoughts of death vs thoughts of killing oneself) and different temporal patterns may further the understanding of risk factors. We tested whether schizotypy and psychotic experiences (PEs) in early adolescence predict subsequent growth trajectories of suicidal ideation and suicide attempt outcomes. Participants were 1037 members of the population-representative Dunedin Study cohort. PE was measured at 11 years and schizotypy at 13 and 15 years. Outcomes were passive and active suicidal ideation, and suicide attempt, measured at 18, 21, 26, 32, and 38 years. Passive ideation was best represented by 2 trajectories, including persistent and transient ideation classes. Schizotypy predicted membership in the smaller persistent class (odds ratio [OR] = 1.21, P = .041), whereas PE was not associated with class membership. The probability of suicide attempts was 13.8% in the persistent ideation class, compared with 1.8% in the transient class. Active ideation was best represented by a 1-class model, the intercept of which was predicted by schizotypy (OR = 1.23, P = .015). Suicide attempts were predicted by schizotypy (OR = 1.53, P = .040) and PE (OR = 3.42, P = .046), and this was partially mediated by indirect effects via the active ideation trajectory. Findings indicate that adolescent schizotypy and PE are related to subsequent suicidal ideation and attempts. Suicidal ideation is heterogeneous, and schizotypy is specifically related to a persistent passive ideation subgroup.

Associations between the Type of Tobacco Products and Suicidal Behaviors: A Nationwide Population-Based Study among Korean Adolescents

The relationships between multiple tobacco products, such as heated tobacco products (HTPs), electronic cigarettes (ECs), and combustible cigarettes (CCs), and suicide-related behaviors among adolescents have not been extensively researched. This study examined the associations between the type of tobacco products used and suicidal thoughts, plans, and attempts among Korean adolescents. Data from the 2019 Korea Youth Risk Behavior Web-Based Survey were analyzed, and participants included 57,069 individuals aged 13–18 years. A multivariable logistic regression analysis was performed. Of the total participants, 13.0%, 4.0%, and 2.9% reported suicidal thoughts, suicidal plans, and suicidal attempts, respectively. After adjusting for confounding variables, all tobacco product users showed a greater likelihood of having suicidal behavior. However, compared with never users, dual users of CCs and HTPs were not significantly associated with having suicidal thoughts and attempts. Among tobacco product users, dual users of ECs and HTPs and triple users of CCs, ECs, and HTPs showed a greater likelihood of having suicidal behavior. Considering the prevalence of suicide and the increasing trend of using multiple tobacco products among Korean adolescents, tobacco control policies should monitor the effects of different products.

Exposure to violence and suicidal ideation among school-going adolescents

Objective: Despite growing international interest in the area of violence and suicidal ideation among school-going adolescents, epidemiological data are scant in Portugal. The objective of this study was to measure the prevalence of suicidal ideation among Portuguese adolescents from 7th to 12th grade and to estimate the association of violence exposure with suicidal ideation. Method: A cross-sectional survey was conducted among 2 602 adolescents enrolled in public schools in Porto, Portugal. Sampling was performed in four school groups consisting of seven schools, during the 2014/2015 academic year. Results: The results revealed that 11.4% of Portuguese school-going adolescents reported suicidal thoughts during the past 12 months. Moreover, adolescents who had been involved in physical fighting were two times more likely to have suicidal thoughts. These odds substantially increased when bullying and cyberbullying victimisation were included. Conclusion: Effective interventions with multidisciplinary efforts involving parents, school teachers, principals, and mental health professionals, should be integrated into school-based programmes to improve adolescents' mental health and strengthen them against suicidal ideation.

Suicide Attempts and Course of Suicidal Ideation among Puerto Rican Early Adolescents

Suicidal behavior increases substantially during early adolescence, a critical understudied developmental period. This study reports on the prevalence of suicidal ideation, suicide attempts, and course of suicidal ideation among Puerto Rican early adolescents, a high-risk group for suicidal behavior in adulthood. Gender differences and the prospective association of psychiatric disorders with course of suicidal ideation are examined. Participants were 1228 Puerto Rican adolescents (ages 10-13 at wave 1; 48% female) and parents, selected through probability-based sampling, assessed yearly across three waves. Adolescents and parents reported via Diagnostic Interview Schedule for Children-IV about 12-month suicide attempts and suicidal ideation (further categorized as never present, onset, recurrence, and remission), mood and anxiety disorders; parents reported on disruptive disorders. Over the three waves, 9.5% early adolescents thought about suicide and 2.1% attempted suicide. In adjusted multinomial regression models, compared to those with never present suicidal ideation, female gender was related to onset of suicidal ideation (OR = 2.60; 95% CI, 1.22-5.55). Disruptive disorders were related to onset (OR = 5.80; 95% CI, 2.06-16.32) and recurrence of suicidal ideation (OR = 5.07, 95% CI, 1.14-22.47), mood disorders were related to remission (OR = 14.42, 95% CI, 3.90-53.23), and anxiety disorders to onset of suicidal ideation (OR = 3.68, 95% CI, 1.75-7.73). Our findings inform strategies tailored for early adolescents. To address onset of suicidal ideation, prevention should focus on girls and those with anxiety or disruptive disorders. When ideation is recurrent, interventions oriented to reduce disruptive behavior and its consequences may help achieve remission.

Identification of influencing factors for suicidal ideation and suicide attempts among adolescents: 11-year national data analysis for 788,411 participants

Suicide is one of the most common causes of death in adolescents. This study identified trends in the prevalence of and factors influencing suicidal ideation and attempts among Korean adolescents. Data were drawn from the third through the thirteenth (2007-2017) annual Korean Youth Risk Behavior Web-based Surveys. Participants included stratified, multistage clustered samples selected from 400 middle schools and 400 high schools annually. Depression, suicidal ideation, and suicide attempts were binary dependent variables (requiring answers of yes or no). A total of 818,684 adolescents were targeted and 788,411 adolescents completed the survey. The prevalence rates of both suicidal ideation and attempts gradually decreased from 23.7% and 5.8%, respectively, in 2007 to 12.1% and 2.6%, respectively, in 2017. Overall, 16.8% of participants had suicidal ideation and 3.9% had suicide attempts during the survey period. During logistic regression analysis, depression was most strongly associated with suicidal ideation (adjusted odds ratio: 5.78 [95% confidence interval: 5.64-5.88]) and suicide attempts (adjusted odds ratio: 5.56, [95% confidence interval: 5.22-5.83]). Despite decreasing trends, the high rate of suicidal behaviors remains a critical public health problem. Depression most strongly predicts suicidal behaviors. Early interventions are essential to treat depression and reduce or prevent suicide.

Association of atopic dermatitis with suicide risk among 788,411 adolescents: A Korean cross-sectional study

BACKGROUND

Atopic dermatitis (AD) is known to negatively influence the mental health of patients. However, only a few studies have explored the influencing factors for psychiatric problems among adolescents with AD.

OBJECTIVE

To assess the association of AD and suicidal behaviors among adolescents by analyzing data from the 3rd through the 13th annual Korean Youth Risk Behavior Web-based Surveys (completed from 2007 to 2017).

METHODS

Survey data were obtained from a stratified, multistage, clustered sample. Students self-reported AD if they had received a diagnosis of AD by a physician. Influencing factors for suicidal behaviors were tested by logistic regression models.

RESULTS

A total of 788,411 adolescents completed the survey. The proportion of participants with AD was 22.2%. Those reporting suicide ideation and suicide attempts were 19.0%, and 4.5%, respectively. Compared with adolescents without AD, those with AD were more likely to be female, to skip breakfast less frequently, to exercise less frequently, to drink less alcohol, and to not be current smokers and were statistically significantly more likely to have negative mental health states. In the multivariable model, perceived unhappiness and suicidal ideation were the strongest influencing factors for suicidal ideation (adjusted odds ratio, 4.90; 95% CI, 4.31-5.57) and for suicidal attempts (adjusted odds ratio, 48.01; 95% CI, 42.69-53.09), respectively.

CONCLUSION

Adolescents with AD had a meaningful prevalence of suicidal behaviors. Although further research is needed to clarify this association, adolescents with AD with influencing factors for negative mental health state may need intervention from practitioners who use a multidisciplinary team approach to prevent suicide.

The Effect of Peer Leadership on Suicidal Ideation in Senior High School Teenagers

This study aimed to determine the effect of peer leadership training on suicidal ideation in senior high school teenagers. This study followed a quasi-experimental pretest-posttest design without a control group. We obtained 43 respondents using a purposive sampling technique. An intervention was provided in the form of peer leadership training sessions. Measurements were conducted twice-once pre- and once post-intervention-using the Beck Scale for Suicidal Ideation. The analysis used was the Wilcoxon t-test. Suicidal ideation decreased significantly (p value <0.05) after peer leadership training. Providing peer leadership training could reduce suicidal ideation in adolescents from severe categories into mild ones. Peer leadership training was an effective method for reducing suicidal ideation in adolescents and should be recommended by mental health nurses for adolescents at school.

Psychopathological mechanisms of early neglect and abuse on suicidal ideation and self-harm in middle childhood

Informed by diathesis-stress models of suicide risk, this longitudinal study examines the psychopathological mechanisms through which early maltreatment increases the risk for suicidal ideation and self-harm in middle childhood. The sample included 2958 families from the Fragile Families and Child Wellbeing Study, who participated in interviews at child's ages of 3 and/or 5, and 9. Via the Child Behavior Checklist, primary caregivers reported on the child's suicidal ideation and self-harm at age 9 and on clinically elevated depressive/anxious symptoms, aggressive behaviors, attention problems, and comorbid aggression and depressive/anxious symptoms at age 5. Past year neglect and physical/psychological abuse were measured via the Parent-Child Conflict Tactics Scale at age 3. Multivariate structural equation models indicated that early neglect had a significant indirect effect on suicidal ideation via clinically elevated depressive/anxious symptoms (OR = 1.57, 95% CI 1.09-2.25) and comorbid symptomatology (OR = 1.28, 95% CI 1.02-1.62), and on self-harm also via clinically elevated depressive/anxious symptoms (OR = 1.39, 95% CI 1.04-1.84) and comorbid symptomatology (OR = 1.20, 95% CI 1.01-1.43). Early physical/psychological abuse had a significant indirect effect on self-harm via clinically elevated attention problems (OR = 1.09, 95% CI 1.01-1.21). Unique developmental pathways for suicidal ideation and self-harm emerged among children exposed to abuse or neglect. For those exposed to early neglect, interventions should target depressive/anxious symptoms, especially when comorbid with aggression, to prevent suicidal ideation and self-harm. For children exposed to early physical/psychological abuse, problems with attention and impulsivity may be targets for reducing the risk for self-harm.

Trajectories of Suicidal Ideation from Middle Childhood to Early Adolescence: Risk and Protective Factors

Suicidal ideation is considered to be the first step on the pathway to suicide. Despite the fact that suicidal ideation is surprisingly prevalent among preadolescent children in China and elsewhere, and despite its possible increase during the transition into adolescence, its developmental patterns and predictors during this period are unclear, thus precluding a meaningful understanding of its determinants and possible trajectories. Thus, this study aimed to identify suicidal ideation trajectories and multisystemic predictors covering the transition from middle childhood to early adolescence. A total of 715 Chinese elementary school students (M_age = 8.95, SD = 0.71; 54.5% was male) participated in assessments at six time points, using six-month assessment intervals. Growth mixture modeling analyses extracted three distinct trajectories of suicidal ideation: "low-stable" (86.4%), "moderate-increasing" (7.1%) and "high-start" (6.5%). Multivariate logistic regression analyses revealed that social anxiety and academic anxiety served as risk factors for the adverse developmental trajectories of suicidal ideation; whereas self-esteem, life satisfaction, and academic achievement served as protective factors for the positive developmental trajectory of suicidal ideation. The identification of three subgroups with unique predictors highlights the importance of individual difference considerations in understanding the progression of suicidal ideation in childhood and adolescence and the need for specific programs tailored to the unique characteristics of the relevant trajectories. Furthermore, given that suicidal ideation may start in a proportion of middle childhood youths and continue into adolescence, the middle childhood period should provide an important window of opportunity for large-scale screening and prevention of the escalation of suicidality in adolescence.

Ethnic Variations of Trajectories in Suicide Ideation and Attempt: From Middle School to High School

The purpose of this study was to compare patterns of suicide ideation and suicide attempt in three ethnic groups. We analyzed data from 463 students with ethnic backgrounds of African American (AA), Asian American (ASA), and European American (EA) for 6 years. The best fit model was a three-trajectory class model for all groups. The majority of adolescents belonged in the nonideators trajectory. The high level of ideation was found in the high ideators (4%), high-fluctuating ideators (8%), and high-decreasing ideators (4%) trajectory in AA, ASA, and EA, respectively. In the AA group, being a member of ideators was not a significant predictor of suicide attempt. In the ASA group, being a member of high-fluctuating ideators was a significant predictor. In the EA group, being a member of both ideators predicted suicide attempt. The timing of onset, patterns of change, and peak time in the ideators trajectories in the three ethnic groups were markedly different. The high level of attempts found in the ASA-AA group was not explained by having suicide ideation. Findings suggest the need for in-depth examination of suicide behaviors across ethnic groups and culturally adapted preventive efforts with distinct developmental timing for adolescents from different ethnic backgrounds.

Change Pathways in Indigenous and Nonindigenous Youth Suicide

Multivariate dynamic relationships among suicide attempts, anxiety and/or depressive symptoms, hope, and help-seeking were examined across time in Native Hawaiian and non-Hawaiian adolescents, using data from a 5-year longitudinal cohort study (N = 7,317). The rate of suicide attempts decreased over time, but this reduction was significantly less among Native Hawaiian youth than their non-Hawaiian peers. There were also significant differences between groups in hope and help-seeking, with Native Hawaiian youth increasing help-seeking and decreasing hope to a greater degree. Youth-centered, cultural approaches to suicide prevention are essential in enhancing well-being in indigenous communities.

Suicidal ideation and behaviors within the school context: Perceived teacher, peer and parental support

School-related factors have been found to be associated with adolescents' suicidal ideation and behaviors, including teacher and peer support. Research has tended to ignore the nested nature of school-related data, which may be critical in this context. The current study implemented a multi-level approach on data from the 2013-14 Health Behaviors in School-aged Children (HBSC-WHO) Israeli survey among high school children (N = 4241; 56% female). Participants completed measures of teacher-, peer-, and parental-support (coded reversely from 1 = high to 5 = low), and suicidal ideation and behaviors in the last 12 months. Hierarchical Linear Modeling (HLM), controlling for gender and age, revealed that classroom-level teachers' support was significantly related to students' suicidal ideation and behaviors (OR = 1.71, 95% CI = 1.20-2.44; OR = 1.39, 95% CI = 1.04-1.86; respectively), whereas parental (OR = 1.56, 95% CI = 1.40-1.75; OR = 1.41, 95% CI = 1.30-1.55; respectively) and peer support (OR = 1.21, 95% CI = 1.12-1.31; OR = 1.11, 95% CI = 1.02-1.21; respectively) were significant at the individual-level. The school environment can play a significant role in reducing risk for suicidal ideation and behaviors. Findings can inform future research and practice in planning and implementing evidence-based intervention programs within schools.

Attempted suicide among adolescents in Mexico: prevalence and associated factors at the national level

Objective

To determine the prevalence and associated factors of attempted suicide (AS) in a sample of Mexican adolescents between 10 and 19 years of age.

Methods

A cross-sectional study was conducted with data from the 2012 National Health and Nutrition Survey (ENSANUT 2012 by its initials in Spanish). Based on multi-stage stratified probability sampling, ENSANUT 2012 canvassed 50 528 households including 21 519 adolescents. A logistic regression model was used to identify the factors associated with AS. The model was selected based on the maximum likelihood test.

Results

Lifetime prevalence of AS amounted to 2.7% and was heterogeneously distributed across Mexico. Women showed significantly higher risk for AS than men (ORA(adjusted OR)) 6.3, 95% confidence interval CI 4.94 to 8.06), and individuals who experienced damage to health caused by violence over the last 12 months were 4.35 times (ORA 4.35, 95% CI 3.27 to 5.80) more likely to engage in AS than those who did not. The likelihood of engaging in AS was 1.5 times higher (ORA1.5 (95% CI 1.12 to 2.01)) among subjects with mild and 4.22 times higher (95% CI 3.21 to 5.54) among subjects with moderate eating disorders compared to those with no eating disorders. Other AS-associated factors included age, smoking, consuming alcohol and living with relatives other than parents.

Conclusions

Awareness of the risk factors associated with AS can help identify the populations who are exposed to injury or death by suicide. This can orient the actions of the health sector towards those who are most vulnerable. Actions must be matched by more qualitative and quantitative research on the subject.

A Risk Algorithm for the Persistence of Suicidal Thoughts and Behaviors During College

OBJECTIVE

The primary aims of this study are to (a) identify patterns of suicidal thoughts and behaviors (STB) during college among students with lifetime pre-matriculation STB and (b) develop a risk-screening algorithm for persistence of pre-matriculation STB during college.

METHODS

Data come from the Leuven College Surveys, a series of prospective cohort studies of all incoming KU Leuven University freshmen. In the academic year 2012-2013, 4,889 incoming freshmen (73.2% response rate) provided baseline data on sociodemographic variables, childhood-adolescent traumatic experiences, 12-month stressful experiences, 12-month mental disorders, 12-month STB, and severity markers of pre-matriculation STB. A total of 2,566 students (69.3% conditional response rate) participated in 12- and 24-month follow-up surveys during the first 2 college years.

RESULTS

Thirteen percent (weighted n = 535) of incoming freshmen reported lifetime pre-matriculation STB. Of those, 28.0% reported 12-month STB in 1 follow-up assessment, and another 27.7%, in both follow-up assessments. High persistence of STB (ie, 12-month STB in 2 follow-up assessments) was most strongly associated with severity markers of pre-matriculation STB, with odds ratios in the 2.4-10.3 range and population attributable risk proportions between 9.2% and 50.8%. When the aim was for less than 50% of false-positive cases (positive predictive value = 54.4%), a multivariate predictive risk algorithm (cross-validated area under the curve = 0.79) situated 59.9% of highly persistent cases among the 30% respondents with highest baseline predicted risk.

CONCLUSIONS

An individualized web-based screening approach is a promising strategy to identify students at the time of university entrance who may be at high risk for STB persistence during their academic career.

Risk Factors for Suicide Ideation Among Adolescents: Five-Year National Data Analysis

This study identified risk factors for suicide ideation among adolescents through a secondary analysis using data collected over five years from the 5th-9th Korea Youth Risk Behavior Survey. We analyzed 370,568 students' responses to questions about suicidality. The risk factors for suicide ideation included demographic characteristics, such as gender (girls), low grades, low economic status, and not living with one or both parents. Behavioral and mental health risk factors affecting suicide ideation were depression, low sleep satisfaction, high stress, alcohol consumption, smoking, and sexual activity. Health care providers should particularly target adolescents manifesting the above risk factors when developing suicide prevention programs for them.

First onset of suicidal thoughts and behaviours in college

BACKGROUND

College students are a worldwide increasing group of young people at risk for suicidal thoughts and behaviours (STB). However, no previous studies have prospectively investigated the first onset of STB during the college period.

METHODS

Using longitudinal data from the Leuven College Surveys, 2337 (response rate [RR]=66.6%) incoming freshmen provided baseline data on STB, parental psychopathology, childhood-adolescent traumatic experiences, 12-month risk for mental disorders, and 12-month stressful experiences. A total of 1253 baseline respondents provided data on 12-month STB in a two-year annual follow-up survey (conditional RR=53.6%; college dropout adjusted conditional RR=70.2%).

RESULTS

One-year incidence of first-onset STB was 4.8-6.4%. Effect sizes of the included risk factors varied considerably whether viewed from individual-level (ORs=1.91-17.58) or population-level perspective (PARPs=3.4-34.3%). Dating violence prior to the age of 17, physical abuse prior to the age of 17, and 12-month betrayal by someone else than the partner were most strong predictors for first-onset suicidal ideation (ORs=4.23-12.25; PARPs=8.7-27.1%) and plans (ORs=6.57-17.58; PARPs=15.2-34.3%). Multivariate prediction (AUC=0.84-0.91) revealed that 50.7-65.7% of first-onset STB cases were concentrated in the 10% at highest predicted risk.

LIMITATIONS

As this is a first investigation of STB onset in college, future studies should use validation samples to test the accuracy of our multivariate prediction model.

CONCLUSIONS

The first onset of STB in college appears to be higher than in the general population. Screening at college entrance is a promising strategy to identify those students at highest prospective risk, enabling the cost-efficient clinical assessment of young adults in college.

Trajectories of Suicidal Ideation in People Seeking Web-Based Help for Suicidality: Secondary Analysis of a Dutch Randomized Controlled Trial

BACKGROUND

Suicidal ideation (SI) is a common mental health problem. Variability in intensity of SI over time has been linked to suicidal behavior, yet little is known about the temporal course of SI.

OBJECTIVE

The primary aim was to identify prototypical trajectories of SI in the general population and, secondarily, to examine whether receiving Web-based self-help for SI, psychiatric symptoms, or sociodemographics predicted membership in the identified SI trajectories.

METHODS

We enrolled 236 people, from the general Dutch population seeking Web-based help for SI, in a randomized controlled trial comparing a Web-based self-help for SI group with a control group. We assessed participants at inclusion and at 2, 4, and 6 weeks. The Beck Scale for Suicide Ideation was applied at all assessments and was included in latent growth mixture modeling analysis to empirically identify trajectories.

RESULTS

We identified 4 SI trajectories. The high stable trajectory represented 51.7% (122/236) of participants and was characterized by constant high level of SI. The high decreasing trajectory (50/236, 21.2%) consisted of people with a high baseline SI score followed by a gradual decrease to a very low score. The third trajectory, high increasing (12/236, 5.1%), also had high initial SI score, followed by an increase to the highest level of SI at 6 weeks. The fourth trajectory, low stable (52/236, 22.0%) had a constant low level of SI. Previous attempted suicide and having received Web-based self-help for SI predicted membership in the high decreasing trajectory.

CONCLUSIONS

Many adults experience high persisting levels of SI, though results encouragingly indicate that receiving Web-based self-help for SI increased membership in a decreasing trajectory of SI.

Developmental Trajectories of Suicidal Thoughts and Behaviors From Adolescence Through Adulthood

OBJECTIVE

Little is known about the patterns among individuals in the long-term course of suicidal thoughts and behaviors (STBs). The objective of this study was to identify developmental trajectories of STBs from adolescence through young adulthood, as well as risk and protective covariates, and nonsuicidal outcomes associated with these trajectories.

METHOD

A total of 180 adolescents (ages 12-18 years at recruitment) were repeatedly assessed over an average of 13.6 years (2,273 assessments) since their psychiatric hospitalization. Trajectories were based on ratings of STBs at each assessment. Covariates included psychiatric risk factors (proportion of time in episodes of psychiatric disorders, hopelessness, trait anxiety, impulsivity, and aggression in adulthood, sexual and physical abuse, parental history of suicidal behavior), protective factors (survival and coping beliefs, social support in adulthood, parenthood), and nonsuicidal outcomes (social adjustment and functional impairment in adulthood, school drop-out, incarcerations).

RESULTS

Using a Bayesian group-based trajectory model, 4 trajectories of STBs were identified: an increasing risk class (11%); a highest overall risk class (12%); a decreasing risk class (33%); and a low risk class (44%). The 4 classes were associated with distinct patterns of correlates in risk and protective factors and nonsuicidal outcomes.

CONCLUSION

Adolescents and young adults have heterogeneous developmental trajectories of STBs. These trajectories and their covariates may inform strategies for predicting STBs and targeting interventions for individuals at risk for suicidal behavior.