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Sheehan AE, Salvador PY, Bounoua N, Sadeh N. Impulsive Decision-Making, Affective Experiences, and Parental History of Self-Injurious Thoughts and Behaviors within Parent-Adolescent Dyads. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01194-w. [PMID: 38647794 DOI: 10.1007/s10802-024-01194-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
Impulsive decision-making, particularly during states of affective intensity, is associated with greater risk of engagement in self-injurious thoughts and behaviors (SITBs) during adolescence. The proximal (dyadic parent-adolescent affect and impulsivity) and distal (family history of SITBs) risk factors that occur within the family system could be relevant processes at stake in the intergenerational transmission of risk. The current study tests the interdependence of parent-adolescent factors associated with risk for SITBs and probes the extent to which parent-adolescent affective states influence their own (actor-effects) and each other's (partner-effects) impulsive decision-making, and further whether these relationships are moderated by a parent's history of SITBs. Participants included 212 (106 dyads) community parents and their adolescents who completed self-report and behavioral tasks related to positive and negative affective states, impulsive decision-making, and lifetime history of SITBs. Application of the Actor-Partner Interdependence Model (APIM) revealed a partner-effect where greater parent negative affect in the past week was associated with elevated adolescent impulsive decision-making among families with a history of SITBs (Estimate = 0.66, Standard Error = 0.13, p < 0.001). In addition, a significant actor-effect was observed where greater positive affect was associated with decreased impulsive decision-making among adolescents (Estimate = -0.21, Standard Error = 0.10, p = 0.03), however, moderating effects of parent history of SITBs were not detected. Findings from the present study shed light on the interdependence of affect and impulsivity within parent-adolescent dyads, and the extent to which these interactions may be particularly salient for families with known vulnerabilities for SITBs.
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Affiliation(s)
- Ana E Sheehan
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19176, USA.
| | - Paula Yoela Salvador
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19176, USA
| | - Nadia Bounoua
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19176, USA
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Naomi Sadeh
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19176, USA
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2
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Hemmati M, Tohidi MR, Mohammadi A, Jahanpour F, Andayeshgar B, Fallah S. Poisoning in children and adolescents in Kermanshah city, Iran. BMC Pediatr 2024; 24:135. [PMID: 38383350 PMCID: PMC10882779 DOI: 10.1186/s12887-024-04631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Poisoning among children and adolescents is a public health problem worldwide. To take preventive measures, the pattern of this problem should be determined. This study aimed to describe the demographic characteristics of poisoning in children and to investigate the relationship between the types of poisoning and demographic factors in children in Kermanshah province. METHODS This cross-sectional, descriptive-analytical study was conducted on 250 children and adolescents under 18 years of age who were referred to Mohammad Kermanshahi Pediatric Hospital in Kermanshah province due to poisoning during 2019-2022. The demographic and epidemiological data of patients were extracted from their medical files and analyzed. RESULTS Out of 250 cases of poisoning, 173 (69.2%) cases were unintentional, 96 (55.5%) of whom were boys. Further, 77 (30.8%) cases of poisoning were intentional, of whom 49 (63.6%) were girls. There was a significant difference between gender and intentional and unintentional poisonings (p-value = 0.005). The median age of unintentional poisoning was 3 (IQR = 2.5) and that of intentional poisoning was 14 (IQR = 2). Most cases of poisoning were in cities, 145 (83.8%) of them were unintentional and 66 (85.7%) were intentional. Most cases of intentional and unintentional poisonings occurred in spring 2017 (35.1%) and autumn 2016 (34.6%), respectively. The most common causes of poisoning were narcotics (n = 36, 34.3%) and drugs (n = 35, 33.3%) in the age group 0-3 years and drugs (n = 46, 66.9) in the age group 11-18 years. CONCLUSIONS The most common causes of poisoning were narcotics and drugs in children and drugs in adolescents. To prevent poisoning in children, parents are required to increase their knowledge of the safe storage of narcotics and drugs, such as not storing methadone in a water bottle. Targeted evaluation and preventive measures are also needed in adolescent poisoning.
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Affiliation(s)
- Mitra Hemmati
- Department of Pediatrics, Associate professor of Kermanshah University of Medical Science, Kermanshah, Iran
| | - Mohamad Reza Tohidi
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Mohammadi
- Department of Health Information Technology, Paramedical School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Firozeh Jahanpour
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahareh Andayeshgar
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sahar Fallah
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Ellison KS, Jarzabek E, Jackson SLJ, Naples A, McPartland JC. Brief Report: Exploratory Evaluation of Clinical Features Associated with Suicidal Ideation in Youth with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:803-810. [PMID: 35616816 DOI: 10.1007/s10803-022-05575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/26/2022]
Abstract
There has been a heightened awareness of an increased risk of suicidality among individuals with autism spectrum disorder (ASD) due to high rates of suicidal ideation (SI) in this population (11-66%). The current study investigated the rate of parent-endorsed SI and associated clinical features in 48 youths with ASD (Age; M: 12.97 years, SD: 2.33). SI was endorsed in 18.75% of participants. Youth with SI exhibited significantly higher levels of affective problems, externalizing problems, feelings of humiliation and rejection, and symptoms related to perfectionism. Results indicate that co-occurring mental health problems are associated with suicidal ideation and provide relevant targets for psychotherapeutic intervention. This preliminary study in a modest sample suggests the value of further research in larger samples to replicate and generalize these findings.
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Affiliation(s)
- Kimberly S Ellison
- Child Study Center, School of Medicine, Yale University, 40 Temple Street, Suite 6A2, New Haven, CT, 06520, USA
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Elzbieta Jarzabek
- Child Study Center, School of Medicine, Yale University, 40 Temple Street, Suite 6A2, New Haven, CT, 06520, USA
| | - Scott L J Jackson
- Child Study Center, School of Medicine, Yale University, 40 Temple Street, Suite 6A2, New Haven, CT, 06520, USA
- Office of Assessment and Analytics, Southern Connecticut State University, 501 Crescent Street, New Haven, CT, 06515, USA
| | - Adam Naples
- Child Study Center, School of Medicine, Yale University, 40 Temple Street, Suite 6A2, New Haven, CT, 06520, USA
| | - James C McPartland
- Child Study Center, School of Medicine, Yale University, 40 Temple Street, Suite 6A2, New Haven, CT, 06520, USA.
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Dardiri ME, El-tantawy A, Elmoez KA, Sayed HH, Elbadry H, Ibrahim O. Suicide Risk among Patients with Substance Use Disorders, A Cross Sectional Study In Suez Canal Area Hospitals.. [DOI: 10.21203/rs.3.rs-3076857/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Abstract
Background: Substance Use Disorders are serious health issues that have been linked to numerous clinical correlations and mental health comorbidities. One of the most important health dangers linked to substance addiction was suicide. The current study aims to investigate the phenomena using a bio-psycho-social framework. The aim was to investigate the risk of suicide in a sample of substance use disorders patients. A case control comparison was performed between 190 substance abusers versus 30 controls. Addiction Severity Index, Beck Suicidal Ideation Scale, Arab Religiosity Scale, Socioeconomic Status Scale, as well as multiple historical variables, have been investigated.
Results: Suicidality was prevalent among alcohol and opioids abusers, poly substance abusers, those with a family history of suicide, and those with a history of a previous attempt. Having a positive family history of suicide could predict an 8.3 point rise in Beck Suicidal Ideation Scale score, while having any previous attempt of suicide could predict 9.04 point rise in Beck Suicidal Ideation Scale score. Suicidality scores correlated with Addiction Severity Index scores, and indirectly with socioeconomic status and Religiosity. Combinations of drugs with other mental illness showed a significant predictive effect on suicidality score.
Conclusion: Suicidality is expected among substance abusers, and is affected by multiple bio-psycho-social variables.
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Affiliation(s)
| | | | | | | | - Hytham Elbadry
- General organization of teaching hospital and institutes-Egypt. (GOTHI). Psychiatrist Registrar at KCMH
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Bete T, Birhanu A, Negash A, Yadeta E, Lemi M, Balcha T, Sertsu A, Birhanu B, Nigussie S, Gemechu K, Meseret F, Mohammed H, Alemu A, Dechasa DB, Asmerom H, Arkew M, Shewangizaw A, Mohamed A, Ahemed F, Wodaje D, Dessie Y, Debella A, Getachew T, Nigussie K, Eyeberu A. Suicidal ideation, attempt and associated factor among secondary school students in Harari regional state, Eastern Ethiopia. A multi-center cross-sectional study. Front Psychiatry 2023; 14:1069910. [PMID: 37215668 PMCID: PMC10196371 DOI: 10.3389/fpsyt.2023.1069910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/27/2023] [Indexed: 05/24/2023] Open
Abstract
Background Suicide is a major public health issue across the globe. It is the second leading cause of death in adolescents. Even though the rate of suicide has increased, no study has been conducted to investigate the determinants of suicide in the study area. Therefore, this study aimed to assess the magnitude of suicidal ideation, suicide attempts, and its associated factors among secondary school students in the Harari regional state of Eastern Ethiopia. Methods An institutional-based cross-sectional study was conducted among randomly selected 1,666 secondary school students. A structured-self-administered questionnaire was used for data collection. The WHO Composite International Diagnostic Interview (CIDI) was used to assess suicidal ideation and suicide attempts. The Depression Anxiety and Stress Scale (DASS) was also used to assess depression, anxiety, and stress. Data were entered into EpiData version 3.1 and exported to Stata version 14.0 for the analysis. A logistic regression analysis was performed to determine the association between the outcome and independent variables and the statistical significance was declared at a p-value of < 0.05. Result The overall magnitude of suicidal ideation and attempts was 13.82% at 95% confidence interval (CI): 12.16-15.66 and 7.61% at 95% CI: 6.37-9.07, respectively. Suicidal ideations and suicide attempts were significantly associated with undergoing depressive symptoms (adjusted odds ratio [AOR]: 1.54; 95% CI: 1.08-2.19 and AOR: 2.37; 95% CI: 1.46-3.86, respectively), experiencing anxiety symptoms (AOR: 1.80; 95% CI: 1.25-2.59 and AOR: 1.89; 95% CI: 2.14-10.65, respectively), being exposed to sexual violence (AOR: 3.36; 95% CI: 1.65-6.84), and having a family history of suicidal attempts (AOR: 2.12; 95% CI: 1.21-3.69 and AOR: 4.74; 95% CI: 2.14-10.65, respectively), whereas living in a rural residence (AOR: 1.65 95%, CI: 1.08-2.55) was significantly associated only with suicide attempts. Conclusion and recommendations Nearly one in six secondary school students had both suicidal ideation and attempted to take their own life. Suicide is one of the psychiatric emergencies that need immediate action. Therefore, the concerned body from either a governmental or a non-governmental organization should work in setting strategies to minimize sexual violence as well as depressive and anxiety symptoms.
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Affiliation(s)
- Tilahun Bete
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Negash
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Elias Yadeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Magarsa Lemi
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tegenu Balcha
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Sertsu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bekelu Birhanu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Shambel Nigussie
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Gemechu
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fentahun Meseret
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hanan Mohammed
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Deribe Bekele Dechasa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Haftu Asmerom
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mesay Arkew
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abayneh Shewangizaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Debre Birhan University, Debre Berhan, Ethiopia
| | - Ahmed Mohamed
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fila Ahemed
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawud Wodaje
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Nigussie
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Sher L, Oquendo MA. Suicide: An Overview for Clinicians. Med Clin North Am 2023; 107:119-130. [PMID: 36402494 DOI: 10.1016/j.mcna.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Most suicides have a diagnosable psychiatric disorder, most frequently, a mood disorder. Psychosocial issues and neurobiological abnormalities such as dysregulation in stress response systems contribute to suicidal behavior. All psychiatric patients need to be screened for the presence of suicidal ideation. Clinicians are expected to gather information about patient's clinical features and to formulate decisions about patient's dangerousness to self and the treatment plan. As psychiatric disorders are a major risk factor for suicide their pharmacologic and psychological treatment is of utmost importance to prevent suicide. Restriction of access to lethal means is important for suicide prevention.
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Affiliation(s)
- Leo Sher
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
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Duarte CDP, Moses C, Brown M, Kajeepeta S, Prins SJ, Scott J, Mujahid MS. Punitive school discipline as a mechanism of structural marginalization with implications for health inequity: A systematic review of quantitative studies in the health and social sciences literature. Ann N Y Acad Sci 2023; 1519:129-152. [PMID: 36385456 PMCID: PMC10929984 DOI: 10.1111/nyas.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Punitive school discipline deploys surveillance, exclusion, and corporal punishment to deter or account for perceived student misbehavior. Yet, education and legal scholarship suggests it fails to achieve stated goals and exacerbates harm. Furthermore, it is disproportionately imposed upon Black, Latinx, Native/Indigenous, LGBTQIA, and disabled students, concentrating its harms among marginalized young people. Its implications for health, however, are less clear. Using public health theories of sociostructural embodiment, we propose a framework characterizing pathways linking societal ideologies (e.g., racism) to punitive discipline with implications for health and health inequity and then present our systematic review of the punitive school discipline-health literature (N = 19 studies) conducted in accordance with PRISMA guidelines. Data were extracted on guiding theories, study characteristics, measurement, methods, and findings. This literature links punitive school discipline to greater risk for numerous health outcomes, including persistent depressive symptoms, depression, drug use disorder in adulthood, borderline personality disorder, antisocial behavior, death by suicide, injuries, trichomoniasis, pregnancy in adolescence, tobacco use, and smoking, with documented implications for racial health inequity. Using our adapted framework, we contextualize results and recommend avenues for future research. Our findings support demands to move away from punitive school discipline toward health-affirming interventions to promote school connectedness, safety, and wellbeing.
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Affiliation(s)
- Catherine dP Duarte
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California, USA
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Candice Moses
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Melissa Brown
- Health and Social Behavior, School of Public Health, University of California, Berkeley, California, USA
| | - Sandhya Kajeepeta
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Seth J Prins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Janelle Scott
- Graduate School of Education, University of California, Berkeley, California, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
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Cleary A. Emotional constraint, father-son relationships, and men's wellbeing. Front Sociol 2022; 7:868005. [PMID: 36176325 PMCID: PMC9513388 DOI: 10.3389/fsoc.2022.868005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/04/2022] [Indexed: 06/16/2023]
Abstract
Male rates of suicide exceed female rates and research findings indicate an association between particular practices of masculinity, specifically emotional constraint, and male suicide. This paper examines gender and family influences on men's wellbeing, based on in-depth interviews with a sample of fifty-two men, aged 18-30 years, who made a clinically serious or near-fatal suicide attempt and were recruited following presentation to hospital. Themes derived from the analysis included learning about masculinity which relates to the gender culture within the home, the regulation and enforcement of behavior by peers and father-son relationships. Results demonstrated that the men were generally from families where hegemonic ideals of masculinity, emphasizing strength and emotional stoicism, were practiced. This gender environment, which was reinforced in the neighborhood, restricted behavior and the expression of feeling, shaped communication between fathers and sons and affected the father's ability to emotionally engage with his son. Fathers were significant figures in these men's lives and were role models for demonstrating masculinity practices but there was an absence of positive, nurturing, relationships between fathers and sons and this influenced the son's gender learning and his wellbeing. Fathers who were emotionally distant, and particularly those who were abusive, gave rise to feelings of rejection, sadness and anger in their sons but problematic father-son relationships were not addressed nor ill-treatment in childhood disclosed due to gender-related constraints on expression. Restrictions on expression and prohibitions on revealing weakness denied the men a space to explore as well as manage the issues of their lives and prevented them from revealing distress. They coped by sublimating problems and disguising vulnerability and by seeking emotional comfort within intimate partnerships but these men were susceptible to situations which threatened their psychological security. Overall, the study demonstrated challenges for males raised in settings of hegemonic masculinity and the importance of nurturing father-son relationships for male wellbeing. The results imply the need for a focus on the benefits of positive fathering and the inclusion of more nuanced messaging relating to men's emotions in Public Health messaging.
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Affiliation(s)
- Anne Cleary
- UCD Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
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Cybulski L, Ashcroft DM, Carr MJ, Garg S, Chew-Graham CA, Kapur N, Webb RT. Risk factors for nonfatal self-harm and suicide among adolescents: two nested case-control studies conducted in the UK Clinical Practice Research Datalink. J Child Psychol Psychiatry 2022; 63:1078-1088. [PMID: 34862981 DOI: 10.1111/jcpp.13552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The characteristics of adolescents who die by suicide have hitherto been examined in uncontrolled study designs, thereby precluding examination of risk factors. The degree to which antecedents of nonfatal self-harm and suicide at young age differ remains unknown. METHOD We delineated two nested case-control studies of patients aged 10-19 years using the Clinical Practice Research Datalink with interlinked hospital and national mortality records. Cases were adolescents who between 1st January 2003 and 31st December 2018 had died from suicide (N = 324) - study 1; experienced their first self-harm episode (N = 56,008) - study 2. In both studies, cases were matched on sex, age and practice-level deprivation quintile to 25 controls. By fitting conditional logistic regression, we examined how risks varied according to psychiatric diagnoses, prescribed psychotropic medication, patterns of clinical contact and area-level deprivation. RESULTS Suicides occurred more often among boys (66%), but self-harm was more common in girls (68%). Most individuals who self-harmed or died from suicide presented to their GP at least once in the preceding year (85% and 75% respectively). Only a third of cases had one of the examined diagnostic categories recorded. Depression was most strongly associated with elevated risks for both outcomes (self-harm: OR 7.9; 95% CI 7.8-8.2; suicide: OR 7.4; 95% CI 5.5-9.9). Except for autism spectrum disorder, all other diagnostic categories were linked with similar risk elevations for self-harm as for suicide. Whilst self-harm risk rose incrementally with increasing levels of area-level deprivation, suicide risks did not. CONCLUSIONS We observed few marked differences in risk factor profiles for nonfatal self-harm versus suicide. As most adolescents who had harmed themselves or died by suicide were known to services in the preceding year, their underlying pathology may not be adequately identified and treated. Our findings highlight the need for a multiagency approach to treatment and prevention.
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Affiliation(s)
- Lukasz Cybulski
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Matthew J Carr
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Shruti Garg
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre (MAHSC), Manchester, UK.,Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation, Manchester, UK
| | - Carolyn A Chew-Graham
- Faculty of Medicine and Health Sciences, School of Primary, Community and Social Care, Keele University, Staffs, UK
| | - Nav Kapur
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Roger T Webb
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Aguinaldo LD, Coronado C, Gomes DA, Courtney KE, Jacobus J. Application of the RDoC Framework to Predict Alcohol Use and Suicidal Thoughts and Behaviors among Early Adolescents in the Adolescent Brain and Cognitive Development (ABCD) Study. Brain Sci 2022; 12:brainsci12070935. [PMID: 35884741 PMCID: PMC9315509 DOI: 10.3390/brainsci12070935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Alcohol use confers risk for suicidal thoughts and behaviors (ideation, attempt) in early adolescents. The Research Domain Criteria provides a framework for examination of multidimensional and modifiable risk factors. We examined distinct latent profiles based on patterns of positive valence (reward responsivity) and cognitive systems (neurocognition) from the ABCD Study (age 9−10, N = 10,414) at baseline enrollment. Longitudinal associations were determined between baseline positive valence and cognitive profiles and group classification (alcohol use, suicidal thoughts and behaviors, or their co-occurrence) two-years after initial assessment (ages 11−12). Three unique profiles of positive valence, cognition, alcohol use, and suicidal thoughts and behaviors were identified. Two baseline profiles predicted alcohol use and suicidal thoughts and behaviors, two-years after initial assessment. Low positive valence with high cognition (but low impulsivity) predicted alcohol use (OR = 1.414, p< 0.001), while high positive valence with low cognition (but high impulsivity) predicted suicidal thoughts and behaviors (OR = 1.25, p = 0.038), compared to average positive valence and cognition. Unique profiles of positive valence and cognitive systems among 9−12-year-olds may be predictive of alcohol use and suicidal thoughts and behaviors over a two-year period. Findings underscore the potential for trajectory research on positive valence and cognitive profiles to enhance prevention for early-adolescents.
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Zhang Y, Wang J, Xiong X, Jian Q, Zhang L, Xiang M, Zhou B, Zou Z. Suicidality in patients with primary diagnosis of panic disorder: A single-rate meta-analysis and systematic review. J Affect Disord 2022; 300:27-33. [PMID: 34963642 DOI: 10.1016/j.jad.2021.12.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/10/2021] [Accepted: 12/19/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND This study investigated the lifetime suicide attempt and ideation rates among patients with panic disorder (PD). METHODS Online databases regarding lifetime suicide attempt and ideation rates in patients with PD were searched up to May 2021. RESULTS The suicide attempt and ideation rates were 0.17 (95% CI: 0.16, 0.18) and 0.23 (95% CI: 0.22, 0.25). The suicide attempt rates among female and male patients were 0.17 (95% CI: 0.14, 0.20) and 0.15 (95% CI: 0.12, 0.19). When PD was comorbid with anxiety, depression, substance abuse, and personality disorders, the suicide attempt rates increased to 0.23 (95% CI: 0.20, 0.26), 0.23 (95% CI: 0.18, 0.27), 0.25 (95% CI: 0.20, 0.31), and 0.25 (95% CI: 0.23, 0.28), respectively. LIMITATIONS The suicide attempt and ideation by age, suicide ideation by sex, and suicide ideation by comorbidity with other mental disorders were passed in our meta-analysis as sample size was small. Stratification analysis on ethnicity, marital status, education levels, resident location, and severity of PD should be considered in the future. CONCLUSION The lifetime suicide ideation and attempt rates in patients with PD were higher than general populations but lower than patients with bipolar or depression. The lifetime suicide attempt rate in female patients was slightly higher than male patients. When PD was comorbid with one other mental illness, the lifetime suicide attempt rate increased by about 50%.
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Affiliation(s)
- Yuan Zhang
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | | | - Xuan Xiong
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Qiu Jian
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Lijuan Zhang
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Miao Xiang
- Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Bo Zhou
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China; Key Laboratory of psychosomatic medicine, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China.
| | - Zhili Zou
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China; Key Laboratory of psychosomatic medicine, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China.
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Crandal BR, Aguinaldo LD, Carter C, Billman GF, Sanderson K, Kuelbs C. Opportunities for Early Identification: Implementing Universal Depression Screening with a Pathway to Suicide Risk Screening in a Pediatric Health Care System. J Pediatr 2022; 241:29-35.e1. [PMID: 34695448 PMCID: PMC8792242 DOI: 10.1016/j.jpeds.2021.10.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To describe the implementation process and assess results of a large-scale universal depression screening program with pathways to suicide risk screening in a pediatric integrated delivery network. STUDY DESIGN This retrospective study analyzes depression and suicide risk screening data for 95 613 patients ages 12-17 years. RESULTS Of the 95 613 adolescent patients who were screened for depression, 2.4% (2266) screened positive for risk for moderate-severe depression (>10 Patient Health Questionnaire; 9-item version) and 4.1% (3942) endorsed elevated suicide risk (≥1 Columbia Suicide Severity Rating Scale). Overall, 51% of screened patients who present with a primary psychiatric concern screened positive for elevated risk of suicide (2132). Two percent of screened patients who presented with a primary medical concern screened positive for elevated risk of suicide. Nearly one-half (45.9%) of all elevated suicide risk screenings were from patients with a primary medical concern. CONCLUSIONS A large-scale universal depression screening program with a pathway to identify elevated suicide risk was implemented in a pediatric health care system using the Patient Health Questionnaire and the Columbia Suicide Severity Rating Scale. This screening program identified youth with moderate-severe depression and elevated risk for suicide with and without presenting psychiatric concerns across service settings.
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Affiliation(s)
| | | | | | | | | | - Cynthia Kuelbs
- Rady Children's Hospital, San Diego, San Diego, CA; Department of Pediatrics, University of San Diego, La Jolla, CA
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Choi J, Cho S, Ko I, Han S. Identification of Risk Factors for Suicidal Ideation and Attempt Based on Machine Learning Algorithms: A Longitudinal Survey in Korea (2007-2019). Int J Environ Res Public Health 2021; 18:12772. [PMID: 34886497 DOI: 10.3390/ijerph182312772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Abstract
Investigating suicide risk factors is critical for socioeconomic and public health, and many researchers have tried to identify factors associated with suicide. In this study, the risk factors for suicidal ideation were compared, and the contributions of different factors to suicidal ideation and attempt were investigated. To reflect the diverse characteristics of the population, the large-scale and longitudinal dataset used in this study included both socioeconomic and clinical variables collected from the Korean public. Three machine learning algorithms (XGBoost classifier, support vector classifier, and logistic regression) were used to detect the risk factors for both suicidal ideation and attempt. The importance of the variables was determined using the model with the best classification performance. In addition, a novel risk-factor score, calculated from the rank and importance scores of each variable, was proposed. Socioeconomic and sociodemographic factors showed a high correlation with risks for both ideation and attempt. Mental health variables ranked higher than other factors in suicidal attempts, posing a relatively higher suicide risk than ideation. These trends were further validated using the conditions from the integrated and yearly dataset. This study provides novel insights into suicidal risk factors for suicidal ideations and attempts.
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Grande E, Vichi M, Alicandro G, Simeoni S, Murianni L, Marchetti S, Zengarini N, Frova L, Pompili M. Suicide among adolescents in Italy: a nationwide cohort study of the role of family characteristics. Eur Child Adolesc Psychiatry 2021; 30:1037-1045. [PMID: 32617776 DOI: 10.1007/s00787-020-01591-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/26/2020] [Indexed: 01/16/2023]
Abstract
Suicide is a leading cause of death among adolescents and is recognized as a serious public health problem. This study aimed to investigate the relationship between family characteristics and the risk of suicide among adolescents in Italy using nationwide official data. We carried out a cohort study based on the record linkage between the 15th Italian Population Census, the Italian Population Register, and the National Register of Causes of Death. Suicides in adolescents aged 10-19 years from 2012 to 2016 were analyzed. Hazard ratios of mortality from suicide were estimated through a multivariable Cox regression model using time-on-study as the time scale. We included 8,284,359 children and adolescents (51% males, 49% females). Over the 5-year follow-up, we registered 330 deaths from suicides (74% males), mostly occurred in the age class 15-19 years (86%). The suicide rate was 1.71 per 100,000 person-years among males and 0.65 among females. We found some familial characteristics associated with a higher risk of dying by suicide, including: living in single-parent or reconstructed families (among boys), a 40-year or more age gap between mother and child (among girls), having highly educated parents, an age difference between parents greater than 5 years. Furthermore, the study showed a lower risk for boys living in urban areas and for both boys and girls living in South Italy. Our results could help in identifying adolescents at high risk of suicide who could benefit from the planning of targeted intervention strategies.
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Affiliation(s)
- Enrico Grande
- Integrated System for Health, Social Assistance and Welfare, National Institute of Statistics, Viale Liegi 13, 00198, Rome, Italy.
| | - Monica Vichi
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Gianfranco Alicandro
- Integrated System for Health, Social Assistance and Welfare, National Institute of Statistics, Viale Liegi 13, 00198, Rome, Italy
| | - Silvia Simeoni
- Integrated System for Health, Social Assistance and Welfare, National Institute of Statistics, Viale Liegi 13, 00198, Rome, Italy
| | - Laura Murianni
- Integrated System for Health, Social Assistance and Welfare, National Institute of Statistics, Viale Liegi 13, 00198, Rome, Italy
| | - Stefano Marchetti
- Integrated System for Health, Social Assistance and Welfare, National Institute of Statistics, Viale Liegi 13, 00198, Rome, Italy
| | - Nicolas Zengarini
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, TO, Italy
| | - Luisa Frova
- Integrated System for Health, Social Assistance and Welfare, National Institute of Statistics, Viale Liegi 13, 00198, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Kim JS, Choi SH, Lee SE, Lee CW, Kim WH, Bae JN, Lee JS, Maeng S, Son J, Kim H. Significant Domains of Life Satisfaction That Affect Suicidal Behavior in Adolescents. Soa Chongsonyon Chongsin Uihak 2021; 32:104-111. [PMID: 34285635 PMCID: PMC8262976 DOI: 10.5765/jkacap.210004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives Adolescent suicide is a serious national issue in Korea. Recently, life satisfaction has been recognized as a major factor related to this issue. The main purpose of this study was to identify the domains of life satisfaction that affect suicidal behavior in adolescence. Methods Data were collected from eight middle schools in Incheon, Korea. A total of 1297 students answered questions regarding their demographic characteristics, happiness, self-related life satisfaction domains (appearance, leisure time, physical health, and mental health), depressive symptoms, and suicidal behavior. Results In the Spearman correlation analysis, female sex, perceived socioeconomic status (SES), happiness, and all four self-related satisfaction scores showed significant correlations with depression and suicidality. Multivariate regression analysis suggested that suicidality was significantly affected by perceived SES, satisfaction with appearance, mental health satisfaction, and depression. Finally, depression was identified as a partial mediator of the association between mental health satisfaction and suicidality, and a complete mediator of the association between female sex and suicidality. Conclusion Perceived SES, satisfaction with appearance, and mental health satisfaction significantly affected students’ suicidality, with or without the effect of depression. Health authorities, educators, and family members must be aware of this to identify adolescents at suicide risk earlier.
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Affiliation(s)
- Ji Soo Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Seo-Hyun Choi
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Sang-Eun Lee
- Incheon Jung-gu Community Mental Health Center, Incheon, Korea.,Department of Nursing, Inha University College of Medicine, Incheon, Korea
| | - Chai Won Lee
- Incheon Jung-gu Community Mental Health Center, Incheon, Korea.,Department of Nursing, Inha University College of Medicine, Incheon, Korea
| | - Won-Hyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Jae Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Jeong Seop Lee
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Seri Maeng
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Jisung Son
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Hyeyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
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Zelazny J, Stanley B, Porta G, Mann JJ, Oquendo M, Birmaher B, Melhem N, Brent DA. Risk factors for pre-adolescent onset suicidal behavior in a high-risk sample of youth. J Affect Disord 2021; 290:292-9. [PMID: 34015624 DOI: 10.1016/j.jad.2021.04.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/20/2021] [Accepted: 04/25/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify risk factors for preadolescent onset suicidal behavior compared with adolescent/young adult onset suicidal behavior in a longitudinal sample of youth with parental history of mood disorders. METHODS The sample includes 545 youth who were age 21 years or less at the time of their baseline assessment. Participants underwent baseline and yearly study assessments. Observations were censored at the time point closest to the first episode of suicidal behavior for youth with suicidal behavior and at the time of last observation for youth without suicidal behavior. Youth were categorized into 3 groups: first onset of suicidal behavior before the age of 13 (n = 32), first onset of suicidal behavior between the ages of 13-21 (n = 51) and those without suicide related behaviors (n = 462). ANOVA, Chi-square, Fisher's exact test and multinomial regression were used to test the hypotheses. RESULTS Significant predictors of preadolescent onset suicidal behavior were diagnosis of depressive disorder (RRR = 11.41, p<.001) and diagnosis of ADHD (RRR = 2.86, p = .02). Adolescent onset was predicted by diagnosis of depressive disorder (RRR = 4.12, p = .008), female sex (RRR = 2.68, p = .02) and self-reported suicidal ideation (RRR = 1.48, p = .004). LIMITATIONS These results are most applicable to offspring of parents with significant mood disorders. CONCLUSIONS The strongest predictor of suicidal behavior in both groups was a diagnosis of depressive disorder, and the risk was nearly 3 times higher in preadolescents. ADHD was a significant predictor only for preadolescents, while female sex and self-reported suicidal ideation predicted suicidal behavior in adolescents.
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Abstract
In spite of the growing awareness on medical students' mental health in recent years, epidemiologic literature about the topic is scarce, particularly for what concerns suicide. Here, we collected cases of suicides among medical students enrolled at a local University in Italy and compared it to the general population of the same age group. Our sample was collected using records of suicides in the city of Pavia, Italy between the years of 2014 and 2019. This record was cross-referenced with enrolment numbers to the Medical Faculty of the city in order to select cases that involved medical students A time-window of 6 years was chosen for the evaluation. The odds ratio of suicide in medical students in comparison to the general population was of 14.58 (p value at the exact Poisson test <0.001). We then differentiated between native Italians and students from abroad. In this case, an odds ratio of 6.81 was observed (p value at the exact Poisson test 0.011). Our estimated suicide rates exceeded what was previously reported for the general population. We call for a closer attention on mental health in medical students, and an increased effort in collecting objective data on the topic.
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Aguinaldo LD, Goldstone A, Hasler BP, Brent DA, Coronado C, Jacobus J. Preliminary analysis of low-level alcohol use and suicidality with children in the adolescent brain and cognitive development (ABCD) baseline cohort. Psychiatry Res 2021; 299:113825. [PMID: 33713937 PMCID: PMC8224175 DOI: 10.1016/j.psychres.2021.113825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 02/21/2021] [Indexed: 12/21/2022]
Abstract
Cross-sectional analyses were conducted in the baseline cohort of the Adolescent Brain and Cognitive Development (ABCD) Study to determine if lifetime low-level alcohol use was associated with an increased likelihood of lifetime suicidality (N=10,773, ages 9-10). Among the lifetime suicide ideation and attempt groups, 37.7% and 36.2% reported lifetime low-level alcohol use, respectively; versus 22.2% in the non-suicidality group. Children reporting lifetime alcohol use (i.e., ≥ a sip) showed a nearly two-fold increase in their odds of lifetime suicidality compared to those with no previous alcohol use. Future prospective research with this cohort will continue to probe alcohol-suicidality associations.
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Affiliation(s)
- Laika D. Aguinaldo
- University of California San Diego, Department of Psychiatry, La Jolla, California, USA
| | - Aimee Goldstone
- SRI International, Human Sleep Research Program, Menlo Park, California, USA
| | - Brant P. Hasler
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania, USA
| | - David A. Brent
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania, USA
| | - Clarisa Coronado
- University of California San Diego, Department of Psychiatry, La Jolla, California, USA
| | - Joanna Jacobus
- University of California San Diego, Department of Psychiatry, La Jolla, California, USA.
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O'Brien KHM, Nicolopoulos A, Almeida J, Aguinaldo LD, Rosen RK. Why Adolescents Attempt Suicide: A Qualitative Study of the Transition from Ideation to Action. Arch Suicide Res 2021; 25:269-286. [PMID: 31608796 DOI: 10.1080/13811118.2019.1675561] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To ameliorate the public health problem of adolescent suicide, it is imperative to go beyond simply establishing which factors increase risk. Multiple factors often interact in such a way that escalates suicide risk, and some combinations may be particularly perilous. Therefore, it is essential to examine the sequence and interplay of these various contributors to understand how they interact to confer risk. To enhance our understanding of this process, we used qualitative in-depth interviews with 20 psychiatrically hospitalized adolescents who had recently made a suicide attempt to investigate the factors that contributed to their attempts. In this qualitative analysis we 1) identified 16 separate factors that contributed to their suicide attempts, and 2) focused on the sequence and interplay between these factors in order to better understand why adolescents attempt suicide, with specific attention to which factors facilitated the transition from suicide ideation to action. Findings demonstrated that the strain caused by historical, sociocultural, and interpersonal factors alone was not enough to result in adolescents attempting suicide. For all but two participants, it was the interaction of intrapersonal factors that appeared to distort cognitions and/or elevate emotions to the point where they became intolerable and suicide became a viable option. These intrapersonal factors appeared to be the catalyst in the process from suicide ideation to action. Our findings suggest the need for specific strategies that address cognitive distortions, emotion dysregulation, and feelings of invalidation and entrapment as potential targets for interventions and prevention practices with adolescents at risk for suicide.
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Muscara F, Ng O, Crossley L, Lu S, Kalisch L, Melvin G, Gronow S, Prakash C, Anderson V. The feasibility of using smartphone apps to manage self-harm and suicidal acts in adolescents admitted to an inpatient mental health ward. Digit Health 2020; 6:2055207620975315. [PMID: 33294207 PMCID: PMC7705813 DOI: 10.1177/2055207620975315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 10/29/2020] [Indexed: 11/21/2022] Open
Abstract
Objective The aim of this study is to assess the feasibility (uptake, retention and
adherence) and acceptability of a combination of smartphone apps to deliver
a digitized safety plan, BeyondNow, and personalized
management strategies, BlueIce, with adolescents discharged
from a mental health inpatient ward following self-harm, suicidal ideation
and/or behavior. Methods Participants in this pre-post pilot study included 20 adolescents between
13–18 years, presenting with self-harming or suicidal behaviors in an
inpatient psychiatric ward at a tertiary pediatric hospital. Participants
were familiarized with the apps and completed baseline measures prior to
discharge. They used the apps for six weeks before completing the follow-up
survey, which measured feasibility and acceptability of the apps, as well as
suicide resilience. Results Seventeen participants completed the pilot. Most of the sample accessed both
apps at least once, three accessed the BeyondNow safety plan five times or
more, and six used the BlueIce toolbox five times or more. A total of 73.5%
of the sample that experienced a crisis used at least one of the apps at
least once. Forty seven percent felt that the apps would not keep them safe
when in crisis, although almost all of the sample rated both apps as easy to
use (94% for BeyondNow, and 82% for BlueIce). Medium to large effect sizes
were also found with regard to improvements in suicide resilience. Conclusion Both apps were found to be feasible and acceptable in this population, and
easy to use, although no conclusions can be drawn regarding the clinical
efficacy of the apps.
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Affiliation(s)
- Frank Muscara
- Brain and Mind, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Olivia Ng
- Brain and Mind, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Louise Crossley
- Brain and Mind, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sinh Lu
- Brain and Mind, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lauren Kalisch
- Brain and Mind, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Sam Gronow
- Banksia Inpatient Ward, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
| | - Chidambaram Prakash
- Banksia Inpatient Ward, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
| | - Vicki Anderson
- Brain and Mind, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
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Baroud E, Al Rojolah L, Ghandour LA, Akoury Dirani L, Barakat M, Elbejjani M, Shamseddeen W, Brent D, Maalouf FT. Risk and protective factors for depressive symptoms and suicidality among children and adolescents in Lebanon: Results from a national survey. Journal of Affective Disorders Reports 2020; 2:100036. [DOI: 10.1016/j.jadr.2020.100036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Miklowitz DJ, Merranko JA, Weintraub MJ, Walshaw PD, Singh MK, Chang KD, Schneck CD. Effects of family-focused therapy on suicidal ideation and behavior in youth at high risk for bipolar disorder. J Affect Disord 2020; 275:14-22. [PMID: 32658817 DOI: 10.1016/j.jad.2020.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/30/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Youth who are at clinical and familial risk for bipolar disorder (BD) often have significant suicidal ideation (SI). In a randomized trial, we examined whether family-focused therapy (FFT) is associated with reductions in SI and suicidal behaviors in high-risk youth. METHODS Participants (ages 9-17 years) met diagnostic criteria for unspecified BD or major depressive disorder with active mood symptoms and had at least one relative with BD type I or II. Participants were randomly allocated to 12 sessions in 4 months of FFT or 6 sessions in 4 months of psychoeducation (enhanced care, EC), with pharmacotherapy as needed. Clinician- and child-rated assessments of mood, suicidal thoughts and behaviors, and family conflict were obtained at baseline and 4-6 month intervals over 1-4 years. RESULTS Participants (N=127; mean 13.2±2.6 yrs., 82 female) were followed over an average of 105.9±64.0 weeks. Youth with high baseline levels of SI who received FFT had lower levels of (and fewer weeks with) SI at follow-up compared to youth with high baseline SI who received EC. Participants in FFT had longer intervals without suicidal behaviors than participants in EC. Youths' ratings of family conflict significantly mediated the effects of treatment on SI at follow-up. LIMITATIONS Family conflict was based on questionnaires rather than observer ratings of family interactions. CONCLUSIONS Family psychoeducation with skill training can be an effective deterrent to suicidal thoughts and behaviors in youth at high risk for BD. Reducing parent/offspring conflict should be a central objective of psychosocial interventions for high-risk youth with SI.
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Kwon H, Hong HJ, Kweon YS. Classification of Adolescent Suicide Based on Student Suicide Reports. Soa Chongsonyon Chongsin Uihak 2020; 31:169-176. [PMID: 33110353 PMCID: PMC7584279 DOI: 10.5765/jkacap.200030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/09/2022] Open
Abstract
Exploring the risk factors of adolescent suicide is important for effective suicide prevention. This study explored the clustering of adolescent suicides based on six risk factors: mental disorder, broken family, depression, anxiety, previous suicide attempts, and deviant behaviors. Using 173 student suicide reports obtained from the Ministry of Education, we evaluated the associations between suicide and variables related to mental disorders; dysfunctional family life; depression and anxiety; previous suicide attempts; deviant behaviors such as drinking and smoking; and school life characteristics, including attendance and discipline, problems within the past year, and incidents prior to suicide. In addition, reports of warning signs just before suicide were included in the analysis. The two-stage cluster analysis classified the students into three clusters: the silent type (cluster 1; 48.55%), in which no risk factors were observed; environmental-risk type (cluster 2: 24.28%), which featured a high frequency of broken households, deviant behaviors such as smoking/drinking and running away from home; and depressive type (cluster 3: 27.17%), which featured a high frequency of mental health problems such as depression, anxiety, and suicide attempts. Identifying the sub-types of adolescent suicide may help to inform tailored suicide prevention and intervention strategies in school.
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Affiliation(s)
- Hoin Kwon
- Department of Counseling Psychology, Jeonju University, Jeonju, Korea
| | - Hyun Ju Hong
- Suicide and School Mental Health Institute, Hallym University, Chuncheon, Korea.,Department of Psychiatry, Hallym University Sacred Hospital, Hallym University, Anyang, Korea
| | - Yong-Sil Kweon
- Suicide and School Mental Health Institute, Hallym University, Chuncheon, Korea.,Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
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Wirrell EC, Bieber ED, Vanderwiel A, Kreps S, Weaver AL. Self-injurious and suicidal behavior in young adults, teens, and children with epilepsy: A population-based study. Epilepsia 2020; 61:1919-1930. [PMID: 32697369 PMCID: PMC10032032 DOI: 10.1111/epi.16618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Whereas studies in adult epilepsy patients have shown higher rates of suicidal ideation and attempt, such studies in children are limited. Using the Rochester Epidemiology Project database, we compared the risk of self-injurious behavior and suicidal ideation in a population-based cohort of childhood epilepsy to controls. METHODS We studied 339 cases with epilepsy and 678 age- and sex-matched controls followed to a median age of 24.7 and 23.4 years, and identified 98 subjects with self-injurious behavior or suicidal ideation (43 with epilepsy and 55 controls). All behaviors were categorized using the Columbia Suicide Severity Rating Scale. RESULTS Those with epilepsy had a significantly higher rate of any self-injurious behavior and suicidal ideation (hazard ratio [HR] = 1.56, 95% confidence interval [CI] = 1.04-2.35) and tended to have an increased risk of suicidal ideation and attempt (HR = 1.48, 95% CI = 0.93-2.37). The prevalence of preceding mood and substance abuse disorders was similarly high in both cases and controls with self-injurious behavior or suicidal ideation; however, preceding attention-deficit/hyperactivity disorder was more than twice as common in the epilepsy cases. Among cases with epilepsy, we did not identify any specific epilepsy-related variable that was significantly correlated with risk of self-injurious behavior or suicidal ideation. SIGNIFICANCE Children, teens, and young adults with a history of childhood epilepsy are at greater risk of self-injurious behavior, highlighting the need for careful screening of mental health concerns as part of routine epilepsy care.
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Affiliation(s)
- Elaine C. Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Ewa D. Bieber
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Alexander Vanderwiel
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Samantha Kreps
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Amy L. Weaver
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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25
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Correia R, Jackson D. Risk to self: identifying and managing risk of suicide and self-harm. BJPsych advances 2020. [DOI: 10.1192/bja.2020.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThis article summarises key areas of research informing understanding of vulnerability factors and risk assessment and management across the lifespan, with particular reference to risk to self (self-harm and suicide). It relates the discussion to people attending sexual assault referral centres (SARCs), but is applicable in a range of clinical settings. Although people accessing SARCs often present with mental health difficulties and various other vulnerabilities, SARC practitioners often do not have specialist training in working with mental health difficulties, including individuals at risk to self. We discuss developmental differences that should be considered when assessing and managing risk to self, and examine relationships between mental health difficulties, risk to self, and rape and/or sexual assault. Finally, we offer advice on how to respond to risk presented by individuals who have experienced sexual violence.
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Lee YJ, Keum MS, Kim HG, Cheon EJ, Cho YC, Koo BH. Defense Mechanisms and Psychological Characteristics According to Suicide Attempts in Patients with Borderline Personality Disorder. Psychiatry Investig 2020; 17:840-849. [PMID: 32791818 PMCID: PMC7449843 DOI: 10.30773/pi.2020.0102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE There have been many biological studies on suicide behaviors of borderline personality disorder (BPD), however few studies have sought to psychoanalytic characteristics including defense mechanisms. Therefore, we investigated psychological, symptomatic, and personality characteristics including defense mechanisms in suicide attempters and non-suicide attempters among patients with BPD. METHODS We enrolled 125 patients with BPD. Forty-two patients with a history of one or more suicide attempts formed the suicide attempters group and 83 patients with no such history formed the non-suicide attempters group. We collated the differences in clinical and psychological characteristics between the two groups by using the Symptom Checklist-90-Revised (SCL-90-R), the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Personality Disorder Questionnaire-4+ (PDQ-4+), and the Defense Style Questionnaire (DSQ). RESULTS The suicide attempters group scored higher on the hostility subscale of SCL-90-R. The suicide attempters group also scored higher on the Infrequency, Back Infrequency, Lie, Masculinity-femininity, Paranoia, Psychasthenia, and Schizophrenia scales of the MMPI-2. The incidence of paranoid and antisocial personality disorders, as assessed by the PDQ-4+, was significantly different in both groups. Maladaptive, self-sacrificing defense style, splitting and affiliation on the DSQ were also higher for the suicide attempters group. In the results of the logistic regression analysis, gender, the F(B) and L scales on the MMPI-2, and 'splitting of other's image' defense mechanism on the DSQ were the factors that significantly influenced to suicide attempts. CONCLUSION These findings suggest that impulsive psychiatric features and maladaptive defense style may be related to suicidal risk in patients with BPD. Therefore, our findings may help clinicians in estimating the risk of suicide in patients with BPD.
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Affiliation(s)
- Young-Ji Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Mu-Sung Keum
- Department of Psychiatry, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Hye-Geum Kim
- Department of Psychiatry, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Eun-Jin Cheon
- Department of Psychiatry, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | | | - Bon-Hoon Koo
- Department of Psychiatry, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Werbart Törnblom A, Sorjonen K, Runeson B, Rydelius P. Who Is at Risk of Dying Young from Suicide and Sudden Violent Death? Common and Specific Risk Factors among Children, Adolescents, and Young Adults. Suicide Life Threat Behav 2020; 50:757-777. [PMID: 32012342 PMCID: PMC7497083 DOI: 10.1111/sltb.12614] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/06/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Suicides and other sudden violent deaths are the most common causes of death among young people worldwide. This case-control study compared risk factors for suicide and other sudden violent death among young people. METHOD A total of 436 psychological autopsy interviews with next of kin were performed. The samples aged 10-25 years included 63 cases of suicide, 62 cases of other sudden violent death, and 104 matched living controls. Two stepwise multiple logistic regression analyses were performed. RESULTS The number of recent stressful life events was the only common risk factor for suicide and other sudden violent death. Specific risk factors for suicide were any form of addiction and being an inpatient in adult psychiatric care. Specific risk factors for other sudden violent death were lower elementary school results, lower educational level, and abuse of psychoactive drugs. CONCLUSIONS The suicide group seems to have been more vulnerable and exposed to different kinds of stressors, whereas the sudden violent death group seems to have been more acting out and risk-taking. Both groups must be the subject of prevention and intervention programs.
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Affiliation(s)
- Annelie Werbart Törnblom
- Department of Women's and Children's HealthCentre for Psychiatry ResearchKarolinska InstitutetStockholm County CouncilStockholmSweden
| | - Kimmo Sorjonen
- Division of PsychologyDepartment of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Bo Runeson
- Department of Clinical NeuroscienceCentre for Psychiatry ResearchKarolinska InstitutetStockholm County CouncilStockholmSweden
| | - Per‐Anders Rydelius
- Department of Women's and Children's HealthCentre for Psychiatry ResearchKarolinska InstitutetStockholm County CouncilStockholmSweden
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28
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Urrego Betancourt Y, Castro-Muñoz JA. Psychosocial Risk Factors: its Relation with Social Cognition, Emotional Regulation and Well-Being. Int J Psychol Res (Medellin) 2020; 12:17-28. [PMID: 32612791 PMCID: PMC7318385 DOI: 10.21500/20112084.3741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In Colombia, an increase of suicidal behavior in adolescents caused by personal and environmental factors is evidenced. This quantitative, descriptive, correlational research aimed to establish the existing relationship between social cognition, perception of the quality of relationships and emotional regulation with the variables of psychosocial risk, suicide risk and level of psychological well-being in adolescents in contexts of high socioeconomic vulnerability of Bogotá. A total of 155 adolescents were selected through non-probabilistic sampling at convenience, with ages between 13 and 17 years (M = 14.47 and DE = 1.03). The results allowed observing the existence of significant relationships between the study variables. From a linear regression analysis, the emotional bond and emotional self-regulation had a higher level of explanation about the perception of well-being and the psychosocial risk associated with suicide. Finally, the results and implications of a greater participation of the emotional bond in comparison to that of social cognition in adolescence are discussed, in order to formulate programs that promote well-being and prevent risk.
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Affiliation(s)
- Yaneth Urrego Betancourt
- Universidad Piloto de Colombia, Colombia. Universidad Piloto de Colombia Universidad Piloto de Colombia Colombia
| | - John Alexander Castro-Muñoz
- Universidad Piloto de Colombia, Colombia. Universidad Piloto de Colombia Universidad Piloto de Colombia Colombia
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Itzhaky L, Gratch I, Galfalvy H, Keilp JG, Burke AK, Oquendo MA, Mann JJ, Stanley BH. Psychosocial risk factors and outcomes associated with suicide attempts in childhood: A retrospective study. J Psychiatr Res 2020; 125:129-35. [PMID: 32278224 DOI: 10.1016/j.jpsychires.2020.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/04/2020] [Accepted: 03/13/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine factors differentiating individuals whose first suicide attempt was during childhood (ages 5-12 yrs) from those who first attempted suicide during adolescence (13-19 yrs) and during adulthood (≥20 yrs). METHOD A sample of 418 participants (ages 18-64 yrs) with a mood disorder and ≥1 lifetime suicide attempt was divided into three groups according to age of first suicide attempt (childhood: N = 43, adolescent: N = 149, adulthood: N = 226) and compared on demographics, childhood adversity, parental psychopathology, comorbid lifetime axis I diagnoses, self-harm and characteristics of first attempt. RESULTS Participants in the Childhood Attempt group were more likely to report childhood adversity, parental alcohol use disorder and subsequent suicide attempts than the two other groups. They were also more likely to have a depressed mother, non-suicidal self-injury (NSSI) during childhood and adolescence, lifetime PTSD and aggressive behavior than the Adulthood Attempt group. The Adolescent Attempt group had more childhood adversity, parental suicidal behavior, lifetime PTSD and NSSI during adolescence than the Adulthood Attempt group. The groups differed on methods of first attempt, and its lethality was related to age of attempt. CONCLUSIONS Early adversity and parental psychopathology are particularly prominent in those who make childhood suicide attempts, suggesting that this group may represent a suicidal behavior subtype.
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30
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Hill NTM, Robinson J, Pirkis J, Andriessen K, Krysinska K, Payne A, Boland A, Clarke A, Milner A, Witt K, Krohn S, Lampit A. Association of suicidal behavior with exposure to suicide and suicide attempt: A systematic review and multilevel meta-analysis. PLoS Med 2020; 17:e1003074. [PMID: 32231381 PMCID: PMC7108695 DOI: 10.1371/journal.pmed.1003074] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/21/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Exposure to suicidal behavior may be associated with increased risk of suicide, suicide attempt, and suicidal ideation and is a significant public health problem. However, evidence to date has not reliably distinguished between exposure to suicide versus suicide attempt, nor whether the risk differs across suicide-related outcomes, which have markedly different public health implications. Our aim therefore was to quantitatively assess the independent risk associated with exposure to suicide and suicide attempt on suicide, suicide attempt, and suicidal ideation outcomes and to identify moderators of this risk using multilevel meta-analysis. METHODS AND FINDINGS We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, ASSIA, Sociological Abstracts, IBSS, and Social Services Abstracts from inception to 19 November 2019. Eligible studies included comparative data on prior exposure to suicide, suicide attempt, or suicidal behavior (composite measure-suicide or suicide attempt) and the outcomes of suicide, suicide attempt, and suicidal ideation in relatives, friends, and acquaintances. Dichotomous events or odds ratios (ORs) of suicide, suicide attempt, and suicidal ideation were analyzed using multilevel meta-analyses to accommodate the non-independence of effect sizes. We assessed study quality using the National Heart, Lung, and Blood Institute quality assessment tool for observational studies. Thirty-four independent studies that presented 71 effect sizes (exposure to suicide: k = 42, from 22 independent studies; exposure to suicide attempt: k = 19, from 13 independent studies; exposure to suicidal behavior (composite): k = 10, from 5 independent studies) encompassing 13,923,029 individuals were eligible. Exposure to suicide was associated with increased odds of suicide (11 studies, N = 13,464,582; OR = 3.23, 95% CI = 2.32 to 4.51, P < 0.001) and suicide attempt (10 studies, N = 121,836; OR = 2.91, 95% CI = 2.01 to 4.23, P < 0.001). However, no evidence of an association was observed for suicidal ideation outcomes (2 studies, N = 43,354; OR = 1.85, 95% CI = 0.97 to 3.51, P = 0.06). Exposure to suicide attempt was associated with increased odds of suicide attempt (10 studies, N = 341,793; OR = 3.53, 95% CI = 2.63 to 4.73, P < 0.001), but not suicide death (3 studies, N = 723; OR = 1.64, 95% CI = 0.90 to 2.98, P = 0.11). By contrast, exposure to suicidal behavior (composite) was associated with increased odds of suicide (4 studies, N = 1,479; OR = 3.83, 95% CI = 2.38 to 6.17, P < 0.001) but not suicide attempt (1 study, N = 666; OR = 1.10, 95% CI = 0.69 to 1.76, P = 0.90), a finding that was inconsistent with the separate analyses of exposure to suicide and suicide attempt. Key limitations of this study include fair study quality and the possibility of unmeasured confounders influencing the findings. The review has been prospectively registered with PROSPERO (CRD42018104629). CONCLUSIONS The findings of this systematic review and meta-analysis indicate that prior exposure to suicide and prior exposure to suicide attempt in the general population are associated with increased odds of subsequent suicidal behavior, but these exposures do not incur uniform risk across the full range of suicide-related outcomes. Therefore, future studies should refrain from combining these exposures into single composite measures of exposure to suicidal behavior. Finally, future studies should consider designing interventions that target suicide-related outcomes in those exposed to suicide and that include efforts to mitigate the adverse effects of exposure to suicide attempt on subsequent suicide attempt outcomes.
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Affiliation(s)
- Nicole T. M. Hill
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Jo Robinson
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Karolina Krysinska
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Amber Payne
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Northeastern University, Boston, Massachusetts, United States of America
| | - Alexandra Boland
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Alison Clarke
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Allison Milner
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Katrina Witt
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Stephan Krohn
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Amit Lampit
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
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Kasen S, Chen H. Social context and change in suicide ideation in a community sample of youths. Soc Psychiatry Psychiatr Epidemiol 2020; 55:319-327. [PMID: 31501909 DOI: 10.1007/s00127-019-01772-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 09/03/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Adolescent suicide ideation (SI) often portends more grievous suicidal behavior; yet, long-term studies of what risk factors predict SI are limited. We employ a multi-wave longitudinal design to investigate the impact of earlier social contexts on change in SI. METHOD A community sample of 748 youths drawn from the Children in the Community (CIC) study was first assessed with the CIC Youth SI Scale at mean age 13.7 (range 9-18) (baseline) and in two follow-ups over 10 years. GEE Poisson Regression was used to estimate SI between ages 10 and 25 (intercept set at age midpoint of 17), and to examine associations between baseline measures of parent, peer, and school social contexts and subsequent change in SI. Analyses were controlled for demographic characteristics and known risks for SI: sexual or physical abuse before age 18 (obtained by official reports) and major depressive disorder (MDD, diagnosed by psychiatric interview at baseline and follow-ups). RESULTS SI declined significantly by age 17 with greater mother affection (β = - 0.091, SE = 0.037), peer friendship quality (β = - 0.115, SE = 0.034), peer social support (β = - 0.116, SE = 0.042), and school engagement (β = - 0.083, SE = 0.045, trend), but increased significantly with more parent punishment (β = 0.143, SE = 0.045) and school conflict (β = 0.168, SE = 0.042). SI associations with sexual or physical abuse (β = 0.299, SE = 0.137) and MDD (β = 0.777, SE = 0.130) were independent of other effects. CONCLUSIONS Earlier social contexts influence change in SI independent of each other and of known risks for SI in community youths, and may be a resource for intervention efforts to deter future SI.
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Affiliation(s)
- Stephanie Kasen
- Department of Psychiatry, Columbia University, New York, NY, USA. .,Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA.
| | - Henian Chen
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FLA, USA
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DeVille DC, Whalen D, Breslin FJ, Morris AS, Khalsa SS, Paulus MP, Barch DM. Prevalence and Family-Related Factors Associated With Suicidal Ideation, Suicide Attempts, and Self-injury in Children Aged 9 to 10 Years. JAMA Netw Open 2020; 3:e1920956. [PMID: 32031652 PMCID: PMC7261143 DOI: 10.1001/jamanetworkopen.2019.20956] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although suicide is a leading cause of death for children in the United States, and the rate of suicide in childhood has steadily increased, little is known about suicidal ideation and behaviors in children. OBJECTIVE To assess the overall prevalence of suicidal ideation, suicide attempts, and nonsuicidal self-injury, as well as family-related factors associated with suicidality and self-injury among preadolescent children. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study using retrospective analysis of the baseline sample from the Adolescent Brain Cognitive Development (ABCD) study. This multicenter investigation used an epidemiologically informed school-based recruitment strategy, with consideration of the demographic composition of the 21 ABCD sites and the United States as a whole. The sample included children aged 9 to 10 years and their caregivers. MAIN OUTCOMES AND MEASURES Lifetime suicidal ideation, suicide attempts, and nonsuicidal self-injury as reported by children and their caregivers in a computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia. RESULTS A total of 11 814 children aged 9 to 10 years (47.8% girls; 52.0% white) and their caregivers were included. After poststratification sociodemographic weighting, the approximate prevalence rates were 6.4% (95% CI, 5.7%-7.3%) for lifetime history of passive suicidal ideation; 4.4% (95% CI, 3.9%-5.0%) for nonspecific active suicidal ideation; 2.4% (95% CI, 2.1%-2.7%) for active ideation with method, intent, or plan; 1.3% (95% CI, 1.0%-1.6%) for suicide attempts; and 9.1% (95% CI, 8.1-10.3) for nonsuicidal self-injury. After covarying by sex, family history, internalizing and externalizing problems, and relevant psychosocial variables, high family conflict was significantly associated with suicidal ideation (odds ratio [OR], 1.12; 95% CI, 1.07-1.16) and nonsuicidal self-injury (OR, 1.09; 95% CI, 1.05-1.14), and low parental monitoring was significantly associated with ideation (OR, 0.97; 95% CI, 0.95-0.98), attempts (OR, 0.91; 95% CI, 0.86-0.97), and nonsuicidal self-injury (OR, 0.95; 95% CI, 0.93-0.98); these findings were consistent after internal replication. Most of children's reports of suicidality and self-injury were either unknown or not reported by their caregivers. CONCLUSIONS AND RELEVANCE This study demonstrates the association of family factors, including high family conflict and low parental monitoring, with suicidality and self-injury in children. Future research and ongoing prevention and intervention efforts may benefit from the examination of family factors.
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Affiliation(s)
- Danielle C DeVille
- Laureate Institute for Brain Research, Tulsa, Oklahoma
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Diana Whalen
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, Missouri
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
- Department of Radiology, Washington University in St Louis, St Louis, Missouri
| | | | - Amanda S Morris
- Laureate Institute for Brain Research, Tulsa, Oklahoma
- Department of Human Development and Family Science, Oklahoma State University, Tulsa
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, Missouri
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
- Department of Radiology, Washington University in St Louis, St Louis, Missouri
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33
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Júnior AC, Guadalupe Correa Fletes JFDD, Lemos T, Teixeira E, Souza MLD. Risk factors for suicide: Systematic review. Saudi J Health Sci 2020. [DOI: 10.4103/sjhs.sjhs_83_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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34
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Grendas LN, Rojas SM, Rodante DE, Puppo S, Vidjen P, Portela A, Daray FM. Differential Impact of Child Sexual Abuse and Family History of Suicidal Behavior in High-Risk Suicidal Patients. Arch Suicide Res 2020; 24:S251-S263. [PMID: 30955484 DOI: 10.1080/13811118.2019.1592040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The current study aimed to compare suicide-related variables as a function of 1) family history of suicidal behavior and 2) child sexual abuse among patients hospitalized for a suicide attempt or active suicidal ideation. Family history of suicidal behavior and child sexual abuse were examined independently and in combination as a diathesis for a high-risk suicidal phenotype. A multicenter cross-sectional study was designed to compare data obtained from 292 patients hospitalized for suicidal behavior. Demographic and clinical variables were compared among Group 1 (patients who reported both family history of suicidal behavior and child sexual abuse), Group 2 (patients who reported only family history of suicidal behavior), Group 3 (patients who reported only child sexual abuse), and Group 4 (patients who did not report family history of suicidal behavior or childhood sexual abuse). A multinomial logistic regression was used to examine suicide-related variables associated with each group and to compare differences between groups. Group 1 and 3 endorsed a higher number of previous suicide attempts and were more likely to be younger at the first suicide attempt compared to Group 4. Group differences remained after adjustment in a multinomial regression model. The current findings suggest that child sexual abuse may be more strongly related to suicide risk among high risk patients than family history of suicidal behavior.
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Affiliation(s)
- Leandro N Grendas
- Institute of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.,"Dr. Teodoro Álvarez" General Hospital. Dr. Juan Felipe Aranguren 2701, Buenos Aires, Argentina
| | - Sasha M Rojas
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | - Demián E Rodante
- Institute of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.,"Dr. Braulio A. Moyano" Neuropsychiatric Hospital, Buenos Aires, Argentina
| | - Soledad Puppo
- "José de San Martín" Hospital, Buenos Aires, Argentina
| | | | | | - Federico M Daray
- Institute of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.,"Dr. Braulio A. Moyano" Neuropsychiatric Hospital, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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Zeifman RJ, Palhano-Fontes F, Hallak J, Arcoverde E, Maia-Oliveira JP, Araujo DB. The Impact of Ayahuasca on Suicidality: Results From a Randomized Controlled Trial. Front Pharmacol 2019; 10:1325. [PMID: 31798447 PMCID: PMC6878725 DOI: 10.3389/fphar.2019.01325] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023] Open
Abstract
Suicide is a major public health problem. Given increasing suicide rates and limitations surrounding current interventions, there is an urgent need for innovative interventions for suicidality. Although ayahuasca has been shown to target mental health concerns associated with suicidality (i.e., depression and hopelessness), research has not yet explored the impact of ayahuasca on suicidality. Therefore, we conducted secondary analyses of a randomized placebo-controlled trial in which individuals with treatment-resistant depression were administered one dose of ayahuasca (n = 14) or placebo (n = 15). Suicidality was assessed by a trained psychiatrist at baseline, as well as 1 day, 2 days, and 7 days after the intervention. A fixed-effects linear mixed model, as well as between and within-groups Cohen's d effect sizes were used to examine changes in suicidality. Controlling for baseline suicidality, we found a significant effect for time (p < .05). The effect of the intervention (i.e., ayahuasca vs. placebo) trended toward significance (p = .088). At all time points, we found medium between-group effect sizes (i.e., ayahuasca vs. placebo; day 1 Cohen’s d = 0.58; day 2 d = 0.56; day 7 d = 0.67), as well as large within-group (ayahuasca; day 1 Cohen's d = 1.33; day 2 d = 1.42; day 7 d = 1.19) effect sizes, for decreases in suicidality. Conclusions: This research is the first to explore the impact of ayahuasca on suicidality. The findings suggest that ayahuasca may show potential as an intervention for suicidality. We highlight important limitations of the study, potential mechanisms, and future directions for research on ayahuasca as an intervention for suicidality. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02914769.
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Affiliation(s)
- Richard J Zeifman
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Fernanda Palhano-Fontes
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.,Onofre Lopes University Hospital, UFRN, Natal, Brazil
| | - Jaime Hallak
- Department of Neurosciences and Behaviour, University of Sa~o Paulo (USP), Ribeira~o Preto, Brazil
| | | | | | - Draulio B Araujo
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.,Onofre Lopes University Hospital, UFRN, Natal, Brazil
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King CA, Grupp-Phelan J, Brent D, Dean JM, Webb M, Bridge JA, Spirito A, Chernick LS, Mahabee-Gittens EM, Mistry RD, Rea M, Keller A, Rogers A, Shenoi R, Cwik M, Busby DR, Casper TC. Predicting 3-month risk for adolescent suicide attempts among pediatric emergency department patients. J Child Psychol Psychiatry 2019; 60:1055-1064. [PMID: 31328282 PMCID: PMC6742557 DOI: 10.1111/jcpp.13087] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incidence of adolescent suicide is rising in the United States, yet we have limited information regarding short-term prediction of suicide attempts. Our aim was to identify predictors of suicide attempts within 3-months of an emergency department (ED) visit. METHODS Adolescents, ages 12-17, seeking health care at 13 pediatric EDs (Pediatric Emergency Care Applied Research Network) and one Indian Health Service Hospital in the United States were consecutively recruited. Among 10,664 approached patients, 6,448 (60%) were enrolled and completed a suicide risk survey. A subset of participants (n = 2,897) was assigned to a 3-month telephone follow-up, and 2,104 participants completed this follow-up (73% retention). Our primary outcome was a suicide attempt between the ED visit and 3-month follow-up. RESULTS One hundred four adolescents (4.9%) made a suicide attempt between enrollment and 3-month follow-up. A large number of baseline predictors of suicide attempt were identified in bivariate analyses. The final multivariable model for the full sample included the presence of suicidal ideation during the past week, lifetime severity of suicidal ideation, lifetime history of suicidal behavior, and school connectedness. For the subgroup of adolescents who did not report recent suicidal ideation at baseline, the final model included only lifetime severity of suicidal ideation and social connectedness. Among males, the final model included only lifetime severity of suicidal ideation and past week suicidal ideation. For females, the final model included past week suicidal ideation, lifetime severity of suicidal ideation, number of past-year nonsuicidal self-injury (NSSI) incidents, and social connectedness. CONCLUSIONS Results indicate that the key risk factors for adolescent suicide attempts differ for subgroups of adolescents defined by sex and whether or not they report recent suicidal thoughts. Results also point to the importance of school and social connectedness as protective factors against suicide attempts.
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Affiliation(s)
- Cheryl A King
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jacqueline Grupp-Phelan
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Michael Webb
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey A Bridge
- Departments of Pediatrics, Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Lauren S Chernick
- Department of Emergency Medicine, Columbia University, New York, NY, USA
| | | | - Rakesh D Mistry
- Departments of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Margaret Rea
- Medical Center, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Allison Keller
- Department of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT, USA
| | - Alexander Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Rohit Shenoi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Mary Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danielle R Busby
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - T Charles Casper
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Mokhtari AM, Gholamzadeh S, Salari A, Hassanipour S, Mirahmadizadeh A. Epidemiology of suicide in 10-19 years old in southern Iran, 2011-2016: A population-based study on 6720 cases. J Forensic Leg Med 2019; 66:129-33. [PMID: 31299485 DOI: 10.1016/j.jflm.2019.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Globally, suicide is the second leading cause of death among young people. Although completed suicide is rare before puberty, the incidence of adolescent suicide has increased significantly at the late ages of 10-19. Hence, this study investigates the adolescent suicide, aged 10-19, in southern Iran. METHODS In this cross-sectional study, all data regarding the demographics, causes, methods, outcomes, past medical history of suicide attempts and suicide death were collected from the Mental Health and Suicide Surveillance Systems of Fars province between 2011 and 2016. RESULTS Overall 6-year incidence rate of suicide attempts and death were 193.49/100,000 and 7.91/100,000, respectively. Case-fatality rate was 4.09%. During the period of 6 years, an increasing trend has been observed for both the rates of suicide attempt and death. Family conflicts were the major cause and medication overdose was the main method of suicides. After controlling the effects of confounders by logistic regression, male gender, living in the rural area and age are among the risk factors of fatality in suicide attempts. CONCLUSIONS Suicide attempts and deaths have been increased in adolescents. Therefore, due to the vulnerability of this age group, we need to understand all components of suicide to educate families and to help policy makers.
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Baroud E, Ghandour LA, Alrojolah L, Zeinoun P, Maalouf FT. Suicidality among Lebanese adolescents: Prevalence, predictors and service utilization. Psychiatry Res 2019; 275:338-344. [PMID: 30954844 DOI: 10.1016/j.psychres.2019.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 12/31/2022]
Abstract
Suicide and self-harm in young people is a global public health issue, although epidemiological evidence remains scant in many parts of the world. The aims of the present study are to describe the prevalence, comorbidity patterns, and the clinical and demographic correlates of suicidality among a representative sample of adolescents from Beirut, Lebanon. We recruited 510 adolescents aged 11-17 and one of their parents/legal guardians using a multistage random cluster design. The validated Arabic version of the Development and Well-Being Assessment (DAWBA) was administered independently to the parent/legal guardian, and adolescents, who also self-completed the Strengths and Difficulties Questionnaire (SDQ), and the Peer-Relations Questionnaire (PRQ). The parent/legal guardian also completed the SDQ and provided demographic and clinical information. A total of 22 adolescents (4.3%) have experienced suicidal ideation or attempt. Correlates of suicidality were female gender, alcohol use in the past 4 weeks, lifetime exposure to a stressful life event, suffering from a major depressive disorder and having bipolar disorder within the last 4 weeks. Only 1 suicidal participant reported ever seeking professional mental health help. Our findings highlight an alarming treatment gap in Lebanese adolescents experiencing suicidality. Future studies should aim at investigating barriers to care and at developing community-based interventions to improve access to care.
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Affiliation(s)
- Evelyne Baroud
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Lilian A Ghandour
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon.
| | - Loay Alrojolah
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Pia Zeinoun
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Fadi T Maalouf
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon.
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Cottrell DJ, Wright-Hughes A, Collinson M, Boston P, Eisler I, Fortune S, Graham EH, Green J, House AO, Kerfoot M, Owens DW, Saloniki EC, Simic M, Tubeuf S, Farrin AJ. A pragmatic randomised controlled trial and economic evaluation of family therapy versus treatment as usual for young people seen after second or subsequent episodes of self-harm: the Self-Harm Intervention - Family Therapy (SHIFT) trial. Health Technol Assess 2019. [PMID: 29532784 DOI: 10.3310/hta22120] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Self-harm in adolescents is common and repetition rates high. There is limited evidence of the effectiveness of interventions to reduce self-harm. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of family therapy (FT) compared with treatment as usual (TAU). DESIGN A pragmatic, multicentre, individually randomised controlled trial of FT compared with TAU. Participants and therapists were aware of treatment allocation; researchers were blind to allocation. SETTING Child and Adolescent Mental Health Services (CAMHS) across three English regions. PARTICIPANTS Young people aged 11-17 years who had self-harmed at least twice presenting to CAMHS following self-harm. INTERVENTIONS Eight hundred and thirty-two participants were randomised to manualised FT delivered by trained and supervised family therapists (n = 415) or to usual care offered by local CAMHS following self-harm (n = 417). MAIN OUTCOME MEASURES Rates of repetition of self-harm leading to hospital attendance 18 months after randomisation. RESULTS Out of 832 young people, 212 (26.6%) experienced a primary outcome event: 118 out of 415 (28.4%) randomised to FT and 103 out of 417 (24.7%) randomised to TAU. There was no evidence of a statistically significant difference in repetition rates between groups (the hazard ratio for FT compared with TAU was 1.14, 95% confidence interval 0.87 to 1.49; p = 0.3349). FT was not found to be cost-effective when compared with TAU in the base case and most sensitivity analyses. FT was dominated (less effective and more expensive) in the complete case. However, when young people's and caregivers' quality-adjusted life-year gains were combined, FT incurred higher costs and resulted in better health outcomes than TAU within the National Institute for Health and Care Excellence cost-effectiveness range. Significant interactions with treatment, indicating moderation, were detected for the unemotional subscale on the young person-reported Inventory of Callous-Unemotional Traits (p = 0.0104) and the affective involvement subscale on the caregiver-reported McMaster Family Assessment Device (p = 0.0338). Caregivers and young people in the FT arm reported a range of significantly better outcomes on the Strengths and Difficulties Questionnaire. Self-reported suicidal ideation was significantly lower in the FT arm at 12 months but the same in both groups at 18 months. No significant unexpected adverse events or side effects were reported, with similar rates of expected adverse events across trial arms. CONCLUSIONS For adolescents referred to CAMHS after self-harm, who have self-harmed at least once before, FT confers no benefits over TAU in reducing self-harm repetition rates. There is some evidence to support the effectiveness of FT in reducing self-harm when caregivers reported poor family functioning. When the young person themselves reported difficulty expressing emotion, FT did not seem as effective as TAU. There was no evidence that FT is cost-effective when only the health benefits to participants were considered but there was a suggestion that FT may be cost-effective if health benefits to caregivers are taken into account. FT had a significant, positive impact on general emotional and behavioural problems at 12 and 18 months. LIMITATIONS There was significant loss to follow-up for secondary outcomes and health economic analyses; the primary outcome misses those who do not attend hospital following self-harm; and the numbers receiving formal FT in the TAU arm were higher than expected. FUTURE WORK Evaluation of interventions targeted at subgroups of those who self-harm, longer-term follow-up and methods for evaluating health benefits for family groups rather than for individuals. TRIAL REGISTRATION Current Controlled Trials ISRCTN59793150. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David J Cottrell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alex Wright-Hughes
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michelle Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Paula Boston
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ivan Eisler
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sarah Fortune
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Elizabeth H Graham
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Allan O House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael Kerfoot
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - David W Owens
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sandy Tubeuf
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amanda J Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Lee S, Dwyer J, Paul E, Clarke D, Treleaven S, Roseby R. Differences by age and sex in adolescent suicide. Aust N Z J Public Health 2019; 43:248-253. [PMID: 30786107 DOI: 10.1111/1753-6405.12877] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/01/2018] [Accepted: 01/01/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To compare demographic and psychosocial characteristics of completed suicide between younger and older adolescents, and by sex. METHODS Data was collected from the Victorian Suicide Register, which contains information on suicides reported to the Coroners Court of Victoria. RESULTS Between 2006 and 2015, there were 273 completed suicides aged 10-19 years, with none aged 10-12 years. There were 171 (63%) suicides in the older adolescent group (17-19 years), and 102 (37%) in the younger group (13-16 years). Males comprised 184 cases (67%) and females 89 (33%). A higher proportion of both younger and female adolescents had experienced abuse, peer conflict and bullying. There was also a higher incidence of previous self-harm in younger and female adolescents. Older adolescents were more likely to not be in formal education, employment or training. CONCLUSION Suicide in younger adolescents and females appear to share characteristics, and differ from older and male adolescents. Negative interpersonal relationships and previous self-harm with possible co-existenting mental illness appear to be key differentiating features. Implications for public health: Understanding completed suicide is an important step towards prevention, and our results suggest a need for developmentally and sex-specific suicide prevention strategies.
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Affiliation(s)
- Stephanie Lee
- Monash Children's Hospital, Victoria.,Coroners Prevention Unit, Coroners Court of Victoria
| | - Jeremy Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria.,Melbourne School of Population and Global Health, The University of Melbourne
| | - Eldho Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria
| | - David Clarke
- Department of Psychiatry, School of Clinical Sciences, Monash University, Victoria.,Monash Health, Victoria
| | - Sophie Treleaven
- Monash Children's Hospital, Victoria.,Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), Victoria
| | - Robert Roseby
- Monash Children's Hospital, Victoria.,Department of Paediatrics, School of Clinical Sciences, Monash University, Victoria
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R. Ryali VSS, Sreelatha P, Haritha G, Janakiraman R. Alcohol dependence syndrome in suicide attempters: A cross-sectional study in a rural tertiary hospital. Arch Med Health Sci 2019. [DOI: 10.4103/amhs.amhs_44_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Morrison KS, Hopkins R. Cultural Identity, Africultural Coping Strategies, and Depression as Predictors of Suicidal Ideations and Attempts Among African American Female College Students. Journal of Black Psychology 2018. [DOI: 10.1177/0095798418813511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Suicide prevention is a growing health concern in America for many minority groups. Although experts agree suicide is associated with cultural practices and beliefs, there is limited evidence on how African American women cultural values and practices influence their low rates of suicide. This study explores cultural identity, Africultural coping strategies, and depression as predictors of suicidal ideations and attempts among African American female college students. It was hypothesized that suicidal ideations and attempts are negatively related to cultural identity and Africultural coping styles, but positively related to depression. One hundred and thirty-seven African American female students were administered a battery of measures assessing cultural identity, coping strategies, and suicidal ideations and attempts. Results revealed that Africultural coping strategies and depression emerged as significant predictors of suicidal ideation and attempts. Results are discussed in terms of African American culture as a buffer to possible suicidal behavior in African American women.
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Abstract
Suicide rates and risk and protective factors vary across religions. There has been a significant increase in research in the area of religion and suicide since the article, "Religion and Suicide," reviewed these issues in 2009. This current article provides an updated review of the research since the original article was published. PsycINFO, MEDLINE, SocINDEX, and CINAHL databases were searched for articles on religion and suicide published between 2008 and 2017. Epidemiological data on suicidality and risk and protective factors across religions are explored. Updated general practice guidelines are provided, and areas for future research are identified.
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Affiliation(s)
- Robin Edward Gearing
- Graduate College of Social Work, University of Houston, 3511 Cullen Boulevard, 110HA, Houston, TX, 77204, USA.
| | - Dana Alonzo
- Graduate School of Social Service, Fordham University, New York, NY, USA
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Viana AG, Raines EM, Woodward EC, Hanna AE, Walker R, Zvolensky MJ. The relationship between emotional clarity and suicidal ideation among trauma-exposed adolescents in inpatient psychiatric care: does distress tolerance matter? Cogn Behav Ther 2018; 48:430-444. [DOI: 10.1080/16506073.2018.1536163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Andres G. Viana
- Department of Psychology, University of Houston, Houston, TX 77204, USA
| | | | - Emma C. Woodward
- Department of Psychology, University of Houston, Houston, TX 77204, USA
| | - Abigail E. Hanna
- Department of Psychology, University of Houston, Houston, TX 77204, USA
| | - Rheeda Walker
- Department of Psychology, University of Houston, Houston, TX 77204, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX 77204, USA
- Department of Behavioral Sciences, University of Texas, MD Anderson Cancer Center, Houston, TX, 77030, USA
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Abstract
El objetivo del estudio fue construir y validar una escala para la evaluación del riesgo suicida en adolescentes. Los ítems iniciales se elaboraron con base en la revisión bibliográfica y se sometió a evaluación de expertos con el fin de analizar aspectos teóricos y lingüísticos. La muestra fue de 537 adolescentes entre 13 y 18 años, con una media de 15.2 (DE = 1.1), 268 hombres (49.9 %) y 269 (50.1 %) mujeres. La consistencia interna total del instrumento fue de 0.934; las escalas mostraron alfa de Cronbach entre 0.71 y 0.929; se aplicó el omega de Mcdonald con el uso del software R y los resultados fueron muy similares. Se realizó análisis factorial exploratorio método VARIMAX y análisis factorial confirmatorio con el uso del programa estadístico AMOS. Los análisis de ítems, correlación y efectos de suelo y techo mostraron correlaciones entre 0.411** y 0.784** con el puntaje global. Las correlaciones de los ítems con las dimensiones fluctuaron entre 0.71** y 0.908**. Una vez obtenida la agrupación de los ítems en cuatro factores, se hallaron correlaciones significativamente altas entre las subescalas con el puntaje global (0.749**a 0.868**). En conclusión, el instrumento constituye una medida válida y confiable para la evaluación del riesgo suicida en adolescentes colombianos.
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Abstract
PURPOSE Existing theory and empirical work suggest that impoverished school contexts may increase the risk of mental health problems such as suicide. This study tests this hypothesis by investigating the longitudinal association between school income and attempted suicide among American adolescents. METHODS Logistic regression models were used to estimate the association between school income and suicidal attempts among all adolescents and among those with suicidal thoughts, respectively. Data come from the National Longitudinal Survey of Adolescent Health, a nationally representative sample of American adolescents across 132 middle and high schools (N = 12,920). RESULTS Among all adolescents, the prevalence of attempted suicide was higher in low-income schools compared to middle-income schools for boys but not girls. Among those with suicidal thoughts, the prevalence of attempted suicide was also higher in low-income schools compared to middle- and high-income schools for boys only. Differences between middle- and high-income schools were not observed, suggesting that school income may only impact attempted suicide when high levels of deprivation are present. These significant associations persisted after adjusting for established risk factors such as prior suicidal attempts. CONCLUSION Highly impoverished school contexts may increase the risk of attempted suicide for boys. Future research exploring the mechanisms underlying this association may help inform the development of more effective suicide-prevention interventions.
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Akkaya-Kalayci T, Kapusta ND, Winkler D, Kothgassner OD, Popow C, Özlü-Erkilic Z. Triggers for attempted suicide in Istanbul youth, with special reference to their socio-demographic background. Int J Psychiatry Clin Pract 2018; 22:95-100. [PMID: 28899223 DOI: 10.1080/13651501.2017.1376100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Suicidal behavior of young people is a topic of utmost importance because suicide is irreversible, and should be prevented. Knowing about the psychosocial background and the triggering events could help in preventing suicidal behavior. We therefore aimed at identifying psychosocial factors that may trigger suicidal behavior in youth. METHODS We analyzed retrospectively the standardized records of 2232 youths aged ≤25 years, who were treated after a suicide attempt at emergency units of public hospitals in Istanbul, Turkey during a period of 1 year. We describe this population according to sex and socio-economic conditions, like educational, occupational, relationship status and link them with their reported reasons for suicide attempts. RESULTS The majority of patients were female (81.6%, N = 1822 females, 18.4%, N = 410 males). Independent of their educational and occupational background, patients indicated most frequently intra-familial problems (females 45.8%, males 30.5%), intrapersonal problems (females 19.9%, males 18.5%), and relationship problems (females 11.3%, males 23.9%) as triggering reasons. CONCLUSIONS Because intra-familial problems were the most frequently reported triggers of suicide attempts, preventive measures should focus on handling intra-familial conflicts. As sex differences were observed for the second-most common trigger-reasons, prevention should also focus on differentially handling intrapersonal and relationship conflicts better.
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Affiliation(s)
- Türkan Akkaya-Kalayci
- a Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Nestor D Kapusta
- b Department of Psychoanalysis and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | - Dietmar Winkler
- c Department for Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Oswald D Kothgassner
- d Division of Clinical Psychology , Medical Directorate of the Vienna General Hospital - Medical University Campus , Vienna , Austria.,e Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Christian Popow
- e Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Zeliha Özlü-Erkilic
- a Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
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Todeshkchuei GG, Molaeinezhad M, Ghasemi Todeshkchuei S. Psychosocial Factors Associated with Suicidal Behavior among Iranian Women: A Meta-analysis. Adv Biomed Res 2018; 7:86. [PMID: 29930926 PMCID: PMC5991272 DOI: 10.4103/abr.abr_47_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Suicide is one of the public health problems worldwide, but it lacks regular relevant reporting system. This issue is more important among women who play an influential role in the family and society. Therefore, the assessment of recent relevant studies is important to detect suicide-related factors and to help make the decisions about public health. The aim of the current study was to determine socioeconomic and psychological factors of suicide attempts in Iranian women using a descriptive meta-analysis method. All domestic scientific databases were searched using "suicide" keyword. A search was also done using keywords of corresponding to Medical Subject Headings including "Iran," "suicide," "psychosocial determinants," "behavior," "suicide commitment," "suicide thoughts," and "women." Overall, 3061 articles were retrieved through the initial search. Finally, 69 studies from nine provinces were included for the analysis. All statistical analyses were performed using R software version 3.2.6 with Metafor package version 1.9-9. Using nine selected studies, frequency of urban family (prevalence = 85%, 95% confidence interval [CI] = 0.68-1.00), nonacademic education (prevalence = 53%, 95% CI = 0.45-0.61), and family problems (prevalence = 34%, 95% CI = 0.19-0.49) was identified as the most important related factor of suicide compared to any other related factors. According to the results, family problems and lower education are associated with suicide attempts. Thus, providing training programs and family consultant services are recommended to reduce the incidence of suicide attempts.
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Affiliation(s)
| | - Mitra Molaeinezhad
- Department of Sexual and Reproductive Health, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Hack J, Martin G. Expressed Emotion, Shame, and Non-Suicidal Self-Injury. Int J Environ Res Public Health 2018; 15:ijerph15050890. [PMID: 29710866 PMCID: PMC5981929 DOI: 10.3390/ijerph15050890] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/15/2018] [Accepted: 04/26/2018] [Indexed: 11/16/2022]
Abstract
A cross-sectional study examining relationships between perceived family Expressed Emotion and shame, emotional involvement, depression, anxiety, stress and non-suicidal self-injury, in 264 community and online adults (21.6% male). We compared self-injurers with non-self-injurers, and current with past self-injurers. Self-injurers experienced more family Expressed Emotion (EE) than non-injurers (t(254) = −3.24, p = 0.001), linear contrasts explaining 6% of between-groups variability (F(2, 254) = 7.36, p = 0.001, η2 = 0.06). Differences in EE between current and past self-injurers were not significant. Overall shame accounted for 33% of between-groups variance (F(2, 252) = 61.99, p < 0.001, η2 = 0.33), with linear contrasts indicating self-injurers experienced higher levels compared to non-injurers (t(252) = −8.23, p < 0.001). Current self-injurers reported higher overall shame than past self-injurers (t(252) = 6.78, p < 0.001). In further logistic regression, emotional involvement and overall shame were the only significant predictors of self-injury status. With every one-unit increase in emotional involvement, odds of currently engaging in self-injury decreased by a factor of 0.860. Conversely, a one-unit increase in overall shame was associated with an increase in the odds of being a current self-injurer by a factor of 1.05. The findings have important treatment implications for engaging key family members in intervention and prevention efforts.
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Affiliation(s)
- Jessica Hack
- Provisional Psychologist, Newcastle Mental Health Service, Newcastle, NSW 2300, Australia.
| | - Graham Martin
- Department of Psychiatry, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4066, Australia.
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Gould MS, Lake AM, Kleinman M, Galfalvy H, Chowdhury S, Madnick A. Exposure to Suicide in High Schools: Impact on Serious Suicidal Ideation/Behavior, Depression, Maladaptive Coping Strategies, and Attitudes toward Help-Seeking. Int J Environ Res Public Health 2018; 15:E455. [PMID: 29509702 PMCID: PMC5877000 DOI: 10.3390/ijerph15030455] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 02/22/2018] [Accepted: 02/28/2018] [Indexed: 11/16/2022]
Abstract
Adolescents' exposure to a peer's suicide has been found to be associated with, as well as to predict, suicidal ideation and behavior. Although postvention efforts tend to be school-based, little is known about the impact of a schoolmate's suicide on the school's student population overall. The present study seeks to determine whether there is excess psychological morbidity among students in a school where a schoolmate has died by suicide, and whether students' attitudes about coping and help-seeking strategies are more or less problematic in such schools. Students in twelve high schools in Suffolk and Westchester counties in New York State-2865 students at six schools where a student had died by suicide within the past six months, and 2419 students at six schools where no suicide had occurred within the current students' tenure-completed an assessment of their suicidal ideation and behavior, depressive symptoms, coping and help-seeking attitudes, stressful life events, and friendship with suicide decedent (if applicable). No excess morbidity (i.e., serious suicidal ideation/behavior and depression) was evident among the general student population after a schoolmate's death by suicide; however, the risk of serious suicidal ideation/behavior was elevated among students at exposed schools who had concomitant negative life events. There was a significant relationship between friendship with the decedent and morbidity, in that students who were friends, but not close friends, of the decedents had the greatest odds of serious suicidal ideation/behavior. Overall, students in exposed schools had more adaptive attitudes toward help-seeking; but this was not true of the decedents' friends or students with concomitant negative life events. The implications of the findings for postvention strategies are discussed.
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Affiliation(s)
- Madelyn S Gould
- Division of Child & Adolescent Psychiatry and Department of Epidemiology, Columbia University Medical Center and The New York State Psychiatric Institute, 1051 Riverside Drive, Unit 72, New York, NY 10032, USA.
| | - Alison M Lake
- Division of Child & Adolescent Psychiatry, The New York State Psychiatric Institute, 1051 Riverside Drive, Unit 72, New York, NY 10032, USA.
| | - Marjorie Kleinman
- Division of Child & Adolescent Psychiatry, The New York State Psychiatric Institute, 1051 Riverside Drive, Unit 72, New York, NY 10032, USA.
| | - Hanga Galfalvy
- Departments of Psychiatry and Biostatistics, Columbia University Medical Center, 722 West 168 Street, New York, NY 10032, USA.
| | - Saba Chowdhury
- Division of Child & Adolescent Psychiatry, The New York State Psychiatric Institute, 1051 Riverside Drive, Unit 72, New York, NY 10032, USA.
| | - Alison Madnick
- Division of Child & Adolescent Psychiatry, The New York State Psychiatric Institute, 1051 Riverside Drive, Unit 72, New York, NY 10032, USA.
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