This study examined the association between non-suicidal self-injury (NSSI) and suicide attempts among Chinese adolescents and college students.
A total sample of 2013 Chinese students were randomly selected from five schools in Wuhan, China, including 1101 boys and 912 girls with the age ranging between 10 and 24 years. NSSI, suicidal ideation, suicide attempts and depressive symptoms were measured by self-rated questionnaires. Self-reported suicide attempts were regressed on suicidal ideation and NSSI, controlling for participants' depressive symptoms, and demographic characteristics.
The self-reported prevalence rates of NSSI, suicidal ideation, suicide attempts were 15.5%, 8.8%, and 3.5%, respectively. Logistic regression analyses indicated that NSSI was significantly associated with self-reported suicide attempts. Analyses examining the conditional association of NSSI and suicidal ideation with self-reported suicide attempts revealed that NSSI was significantly associated with greater risk of suicide attempts in those not reporting suicidal ideation than those reporting suicidal ideation in the past year.
These findings highlight the importance of NSSI as a potentially independent risk factor for suicide attempts among Chinese/Han adolescents and college students.
Remarkably little is known regarding the temporal course of adolescent suicidal ideation and behavior, the prediction of suicidal attempts from changes in suicidal ideation, or the prediction of suicidal attempts after accounting for suicidal ideation as a predictor. A sample of 143 adolescents 12–15 years old was assessed during psychiatric inpatient hospitalization and again at 3, 6, 9, 15, and 18 months postdischarge through a series of structured interviews and parent- and adolescent-reported instruments. Symptoms of depression, posttraumatic stress disorder, externalizing psychopathology, hopelessness, and engagement in several forms of self-injurious/suicidal behaviors (i.e., suicide threats/gestures, plans, nonsuicidal self-injury [NSSI]) were assessed. Latent growth curve analyses revealed a period of suicidal ideation remission between baseline and 6 months following discharge, as well as a subtle period of suicidal ideation reemergence between 9 and 18 months postdischarge. Changes in suicidal ideation predicted suicide attempts. After accounting for the effects of suicidal ideation, baseline suicide threats/gestures also predicted future suicide attempts. Higher adolescent-reported depressive symptoms, lower parent-reported externalizing symptoms, and higher frequencies of NSSI predicted weaker suicidal ideation remission slopes. Findings underscore the need for more longitudinal research on the course of adolescent suicidality.
suicidal ideation; suicidal attempts; nonsuicidal self injury; adolescence; longitudinal methods
The present paper examined the prevalence and psychosocial correlates of adolescent deliberate self-harm (DSH) and suicidal behavior in a representative sample of 3,328 secondary school students in Hong Kong. With reference to the previous year, 32.7% of the students reported at least one form of DSH, 13.7% of the respondents had suicide thoughts, 4.9% devised specific suicidal plans, and 4.7% had actually attempted suicide. Adolescent girls had significantly higher rates of DSH and suicidal behavior than did adolescent boys. Having remarried parents was related to an increased likelihood of DSH and suicide. While high levels of family functioning, overall positive youth development, and academic and school performance predicted low rates of DSH and suicidal behavior, cognitive and behavioral competencies were unexpectedly found to be positively associated with DSH and suicidal behavior. Theoretical and practical implications of the findings are discussed.
Suicide is the third leading cause of death among US adolescents aged 15–24, with males incurring higher rates of completion than females. This study used hierarchical logistic regression analysis to test whether athletic participation was associated with lower rates of suicidal ideation and behavior among a nationally representative sample of over 16,000 US public and private high school students. Net of the effects of age, race/ethnicity, parental educational attainment, and urbanicity, high school athletic participation was significantly associated with reduced odds of considering suicide among both females and males, and reduced odds of planning a suicide attempt among females only. Though the results point to favorable health outcomes for athletes, athletic participation was also associated with higher rates of injury to male athletes who actually attempted suicide.
adolescence; athletic participation and gender; health; suicide
This study investigates the early manifestation of co-occurring depression and conduct disorders as a predictor of heightened risk for later suicidal ideation and behavior in a community sample of 521 adolescents. Self-reported symptoms of depression and conduct disorder were evaluated in early 6th grade. Suicidal thoughts and behaviors were tracked through multiple assessments carried out over the middle school years. Compared to adolescents with depression symptoms only, conduct disorder symptoms only, or low psychopathology, those with co-occurring depression and conduct disorder symptoms had the highest risk for subsequent suicidal ideation, recurrent suicidal behaviors, and suicide attempts.
Suicide rates among American Indians, especially adolescents, are higher than those for the general population. This paper summarizes the relevant literature on prevalence of, and risk factors for, suicide among American Indian groups, with a strong emphasis on adolescents. Data concerning risk of suicide for a sample of high school students attending an Indian boarding school are presented. Approximately 23 percent of these students had attempted suicide at some time in the past, and 33 percent reported suicidal ideation within the past month. Students at greatest risk for suicide include those who reported having either family or friends who had attempted suicide and those who reported on standardized psychological measures as having experienced greater depressive symptomatology, greater quantity and frequency of alcohol use, or little family support. In a 1988 survey of community-based programs for Indian adolescents, 194 were identified as carrying out significant suicide prevention activities. Forty-one of those programs were school-based; they emphasized early identification of students' mental health problems and reduction of specific risk factors such as substance abuse.
The aim of this study was to examine prospective predictors of suicide events, defined as suicide attempts or emergency interventions to reduce suicide risk, in 119 adolescents admitted to an in-patient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months.
Structured diagnostic interviews and self-report instruments were administered to adolescent participants and their parent(s) to assess demographic variables, history of suicidal behavior, psychiatric disorders, family environment and personality/temperament.
Baseline variables that significantly predicted time to a suicide event during follow-up were Black race, high suicidal ideation in the past month, post-traumatic stress disorder (PTSD), childhood sexual abuse (CSA), borderline personality disorder (BPD), low scores on positive affectivity, and high scores on aggression. In a multivariate Cox regression analysis, only Black race, CSA, positive affect intensity and high aggression scores remained significant.
Our findings suggest the following for adolescent populations: (1) in a very high-risk population, risk factors for future attempts may be more difficult to ascertain and some established risk factors (e.g. past suicide attempt) may not distinguish as well; and (2) cross-cutting constructs (e.g. affective and behavioral dysregulation) that underlie multiple psychiatric disorders may be stronger predictors of recurrent suicide events than psychiatric diagnoses. Our finding with respect to positive affect intensity is novel and may have practical implications for the assessment and treatment of adolescent suicide attempters.
Adolescent; aggression; impulsivity; positive affectivity; suicide
Suicide is the second-leading cause of death among college students in the US and is preventable. Approximately 1,100 college students die by suicide each year. This study examined the prevalence and predictors of one-time and persistent suicide ideation, plans, and attempts reported during college.
Data were gathered prospectively over four years. Face-to-face interviews were conducted with 1,253 first-year college students at one large mid-Atlantic university. Risk factors were measured in Year 1.
An estimated 12%wt of individuals experienced suicide ideation at some point during college, and of those individuals, 25% had more than one episode of ideation (persistent ideation; 2.6%wt of the overall sample). Ten individuals had a plan or attempt during college (0.9%wt of the sample). Risk factors for persistent suicide ideation included low social support, childhood or adolescent exposure to domestic violence, maternal depression, and high self-reported depressive symptoms. Persistent ideators differed from one-time ideators only by higher levels of depression (p=.027). Persistent ideators were no more likely than one-time ideators to have made a suicide plan or attempt during college (8% vs. 9%, respectively).
Although the sample size is large, only a small percentage of participants had persistent ideation, suicide plans or attempts during college.
These results have implications for programs aimed at identifying college students at risk for suicide. The accurate identification of college students at-risk for suicide is an important step toward suicide prevention.
College students; Depression; Family psychopathology; Social support; Suicidal behavior; Suicide ideation
We investigated correlates for suicidal expression among adolescents in the Seychelles. Data on 1,432 students (52% females) were derived from the Global School-based Health Survey. Participants were divided into three groups: those with no suicidal behavior (N = 1,199); those with suicide ideation/SI (N = 89); and those reporting SI with a plan to carry out a suicide attempt/SISP (N = 139), each within a 12-month recall period. Using multinomial logistic regression, we examined the strength of associations with social, behavioral and economic indicators while adjusting for covariates. Sixteen percent of school-attending adolescents reported a suicidal expression (10% with a plan/6.2% without). Those reporting SI were younger (relative risk ratio RRR = 0.81; CI = 0.68–0.96), indicated signs of depression (RRR = 1.69; CI = 1.05–2.72) and loneliness (RRR=3.36; CI =1.93–5.84). Tobacco use (RRR = 2.34; CI = 1.32–4.12) and not having close friends (RRR = 3.32; CI = 1.54–7.15) were significantly associated with SI. Those with SISP were more likely to be female (RRR = 0.47; 0.30–0.74), anxious (RRR = 3.04; CI = 1.89–4.88) and lonely (RRR = 1.74; CI = 1.07–2.84). Having no close friends (RRR = 2.98; 1.56–5.69) and using tobacco (RRR = 2.41; 1.48–3.91) were also strongly associated. Having parents who were understanding was protective (RRR = 0.50; CI = 0.31–0.82). Our results suggest that school health promotion programs may benefit from targeting multiple factors associated with suicidal expression. More research, particularly multilevel designs are needed to identify peer and family influences which may modify associations with suicidality.
suicidal expression; adolescent; school health; sub-Saharan Africa
To examine longitudinal associations between community violence exposure and suicide ideation and attempt, and whether depressive symptoms and aggressive behavior are intervening variables in this association.
Participants were 473 urban and predominantly African American adolescents who completed measures of community violence exposure, depressive symptoms, and suicide ideation and attempt in grades 6, 7, and 8; teachers reported about adolescents’ aggressive behaviors in grades 6, 7, and 8. Path analysis was used to examine direct and indirect associations between community violence exposure in grade 6 and suicide ideation and attempt in grade 8. Depressive symptoms and aggressive behavior were examined as part of an indirect path from grade 6 community violence exposure to later suicide ideation and attempt.
Results revealed an indirect association between community violence exposure and later suicide ideation for males and females; community violence exposure in grade 6 was associated with depressive symptoms in grade 7, which in turn were positively associated with suicide ideation in grade 8. For males, community violence exposure in grade 6 was associated with increases in aggressive behavior in grade 7, which in turn were associated with suicide attempts in grade 8.
Findings suggest indirect pathways between community violence exposure and later suicide ideation and attempt for male and female adolescents. Results highlight the necessity for reducing youth community violence exposure and enhancing strategies for managing the effects of community violence exposure in order to reduce risk for adolescent suicide.
adolescents; African American; community violence; suicide
Prior studies have reported that psychiatric disorders are among the strongest predictors of suicidal behavior (i.e., suicide ideation, plans, and attempts). However, surprisingly little is known about the independent associations between each disorder and each suicidal behavior due to a failure to account for comorbidity.
This study used data from a representative sample of 5,782 respondents participating in the Mexican National Comorbidity Survey (2001–2002) to examine the unique associations between psychiatric disorders and suicidality.
A prior psychiatric disorder was present in 48.8% of those with a suicide ideation and in 65.2% of those with an attempt. Discrete-time survival models adjusting for comorbidity revealed that conduct disorder and alcohol abuse/dependence were the strongest predictors of a subsequent suicide attempt. Most disorders predicted suicidal ideation but few predicted the transition from ideation to a suicide plan or attempt.
M-NCS is a household survey that excluded homeless and institutionalized people, andthe diagnostic instrument used did not include an assessment of all DSM-IV disorders which would increase the comorbidity discussed here.
These results reveal a complex pattern of associations in which diverse psychiatric disorders impact different parts of the pathway to suicide attempts. These findings will help inform clinical and public health efforts aimed at suicide prevention in Mexico and other developing countries.
suicide; suicide attempt; risk factors; epidemiology; survey; psychiatric disorder
Although there is a well-known link between adverse experiences and suicidal ideation, there has been little study of the effects of recent adverse experiences on suicidal ideation in teenagers. This study examined the association between recent adverse experiences and suicidal ideation in a sample of 740 at-risk 16-year-old youth in the LONGSCAN studies, as well as potential mediators. 8.9% of the youth reported suicidal ideation. Recent adverse experiences, as a class, were associated with suicidal ideation; both recent physical abuse and recent psychological maltreatment were uniquely associated with suicidal ideation. The links between recent adverse experiences and suicidal ideation were significantly mediated by psychological distress. There were also significant main effect associations between both internalizing behavioral problems and low positive achievement expectations and suicidal ideation. Recent adverse experiences are important in understanding suicidal ideation in high risk youth.
Information on history of suicidal thoughts and behaviors is critical in risk assessment, and multi-informant assessment has been recommended. Despite this, relatively little is known about parent-adolescent agreement regarding adolescent suicidality. To examine the extent and predictors of such agreement, 448 psychiatrically hospitalized adolescents and their parents were administered structured interviews assessing suicidal thoughts, plans, and attempts and completed measures of youth internalizing and externalizing behaviors, perceived family social support, and parental distress and psychopathology. Adolescents reported significantly more suicidal ideation, plans, and attempts than parents. Parental history of depression and adolescent perceived family support were associated with significantly greater agreement about suicidality. History of multiple suicide attempts was associated with greater disagreement about suicidality.
To investigate the association between parental war involvement and different indicators of psychosocial distress in a community sample of early adolescents ten years after the war in Croatia 1991-1995.
A total of 695 adolescents were screened with a self-report questionnaire assessing parental war involvement, sociodemographic characteristics, and alcohol and drug consumption. Personality traits were assessed with the Junior Eysenck Personality Questionnaire; depressive symptoms with the Children’s Depression Inventory (CDI); and unintentional injuries, physical fighting, and bullying with the World Health Organization survey Health Behavior in School-aged Children. Suicidal ideation was assessed with three dichotomous items. Suicidal attempts were assessed with one dichotomous item.
Out of 348 boys and 347 girls who were included in the analysis, 57.7% had at least one veteran parent. Male children of war veterans had higher rates of unintentional injuries (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.56 to 2.63) and more frequent affirmative responses across the full suicidal spectrum (thoughts about death – OR, 2.1; 95% CI, 1.02 to 4.3; thoughts about suicide – OR, 5; 95% CI, 1.72 to 14.66; suicide attempts – OR, 3.6; 95% CI, 1.03 to 12.67). In boys, thoughts about suicide and unintentional injuries were associated with parental war involvement even after logistic regression. However, girls were less likely to be affected by parental war involvement, and only exhibited signs of psychopathology on the CDI total score.
Parental war involvement was associated with negative psychosocial sequels for male children. This relationship is possibly mediated by some kind of identification or secondary traumatization. Suicidality and unintentional injuries are nonspecific markers for a broad range of psychosocial distresses, which is why the suggested target group for preventive interventions should be veteran parents as vectors of this distress.
Suicidal ideation, plans, and attempts have been found to be predictors of suicide. This study aims to estimate the suicidal behaviors in rural China. We studied 784 respondents as informants of suicide and 1,247 respondents as informants of community living controls, with the NCS-R measures on suicidal behaviors. The life-time prevalence of ideation, plans, and attempts among the informants of suicide was 18.1, 4.1, and 1.7%, and the 12-month prevalence was 12.1, 2.2, and 0.4%, respectively. The prevalence scores were higher for the family members than for friends of suicide. The risk factors for suicidal behaviors include being parents or spouse of the suicide, female gender, low education level, and being never married. As suicidal behaviors are more observed among those who have a suicide death in the family or among close friends, suicide screening and intervention efforts should be focused on this type of population.
Suicidal behavior; Effect of suicide death; Family; Friends; China
There is some evidence for an association between Cluster C Personality Disorders (CCPD) and suicidal behavior. We compared depressed inpatients with and without CCPD in terms of suicidal behavior and associated psychopathology. Cluster A or B personality disorder co-morbidity were exclusion criteria for both groups (cases and controls). Depressed inpatients with “pure” CCPD had higher levels of suicidal ideation but not more previous suicide attempts compared with patients without CCPD. Greater suicidal ideation in depressed patients with CCPD in our study was associated with more hostility. Future studies examining the relationship between suicidal ideation and hostility in CCPD may clarify whether treatment focused on hostility might be of use for decreasing suicidal ideation in depressed patients with CCPD (Spitzer, Williams, Gibbon et al., 1990).
cluster C personality disorders; depression; hostility; suicide
We aimed to estimate the prevalence of suicidal ideation and suicide attempt among prisoners in New South Wales, Australia; and, among prisoners reporting suicidal ideation, to identify factors associated with suicide attempt.
A cross-sectional design was used. Participants were a random, stratified sample of 996 inmates who completed a telephone survey. The estimated population prevalence of suicidal ideation and suicide attempt were calculated and differences by sex and Aboriginality were tested using χ2 tests. Correlates of suicidal ideation and suicide attempt were tested using logistic regression.
One-third of inmates reported lifetime suicidal ideation and one-fifth had attempted suicide. Women and Aboriginal participants were significantly more likely than men and non-Aboriginal participants, respectively, to report attempting suicide. Correlates of suicidal ideation included violent offending, traumatic brain injury, depression, self-harm, and psychiatric hospitalisation. Univariate correlates of suicide attempt among ideators were childhood out-of-home care, parental incarceration and psychiatric hospitalization; however, none of these remained significant in a multivariate model.
Suicidal ideation and attempts are highly prevalent among prisoners compared to the general community. Assessment of suicide risk is a critical task for mental health clinicians in prisons. Attention should be given to ensuring assessments are gender- and culturally sensitive. Indicators of mental illness may not be accurate predictors of suicide attempt. Indicators of childhood trauma appear to be particularly relevant to risk of suicide attempt among prisoners and should be given attention as part of risk assessments.
This is the first study to examine whether high-school students experiencing frequent bullying behaviors are at risk for later depression and suicidality. 236 students who reported frequent bullying behavior without depression or suicidality during a suicide screening were interviewed four years later to reassess depression, suicidal ideation, attempts, substance problems, and functional impairment and were compared to “at-risk” youth identified during the screen, including 96 youth who also experienced bullying behavior. Youth who only reported frequent bullying behaviors (as bullies, victims or both) did not develop later depression or suicidality and continued to have fewer psychiatric problems than students identified as at-risk for suicide. Students who experienced bullying behaviors and depression or suicidality were more impaired four years later than those who had only reported depression or suicidality. Thus, assessment of bullying behaviors in screening protocols is recommended.
bullying; adolescents; suicide; high school
Provide nationally representative data on the prevalence and psychiatric correlates of suicidal ideation and attempts among African American and Caribbean black adolescents in the United States.
Data on nonfatal suicidal behavior among 1,170 African American and Caribbean black adolescents aged 13 to 17 years are from the National Survey of American Life-Adolescent, a nationally representative household survey of adults with an attached adolescent sample conducted between February 2001 and June 2003.
Nationwide black adolescents reported having a lifetime prevalence of 7.5% for suicidal ideation and 2.7% for attempts. The 12-month prevalence of suicidal ideation and attempt was 3.2% and 1.4%, respectively. Among all respondents, 4% of black American adolescents and 7% of female subjects were projected to attempt suicide by age 17 years. African American adolescents were approximately five times more likely than Caribbean black adolescents to attempt suicide. Almost half of the National Survey of American Life-Adolescent respondents who reported a suicide attempt had never met criteria for any of the DSM-IV disorders by the time of their attempts.
Clinicians should be trained to screen for suicidal behavior, even among those without DSM-IV disorders, when treating black adolescents, particularly female subjects. In addition, preventive efforts should consider ethnic differences in suicide risk and targeting nonclinical settings.
attempted suicide; blacks; psychiatric disorders; risk factors
Suicidality represents one of the most important areas of risk for adolescents, with both internalizing (e.g., depression, anxiety) and externalizing/antisocial (e.g., substance use, conduct) disorders conferring risk for suicidal ideation and attempts (e.g., Bridge et al., 2006). However, no study has attended to gender differences in relationships between suicidality and different facets of psychopathic tendencies in youth. Further, very little research has focused on disentangling the multiple manifestations of suicide risk in the same study, including behaviors (suicide attempts with intent to die, self- injurious behavior) and general suicide risk marked by suicidal ideation/plans. To better understand these relationships, we recruited 184 adolescents from the community and those in treatment. As predicted, psychopathic traits and depressive symptoms in youth showed differential associations with components of suicidality. Specifically, impulsive traits uniquely contributed to suicide attempts and self- injurious behaviors, above the influence of depression. Indeed, once psychopathic tendencies were entered in the model, depressive symptoms only explained general suicide risk marked by ideation/plans but not behaviors. Further, callous/unemotional traits conferred protection from suicide attempts selectively in girls. These findings have important implications for developing integrative models that incorporate differential relationships between 1) depressed mood and 2) personality risk factors (i.e., impulsivity and callous-unemotional traits) for suicidality in youth.
Suicide risk; psychopathic tendencies; psychopathy; impulsivity; depression; callous/unemotional; gender; adolescence; youth; internalizing; externalizing
The present study was designed to examine the relationship between prior partner and non-partner aggression and suicidal ideation in patients seeking drug and alcohol treatment.
Patients entering drug and alcohol treatment (n = 488) were screened for prior partner and non-partner aggression as well as recent suicidal thoughts. We examined the association between aggression and suicidal ideation in bivariate and multivariate models.
Within the past two weeks, 33% (159/488) of the sample reported suicidal ideation. In bivariate analyses, neither psychological nor physical aggression towards a non-partner was related to suicidal ideation. Partner psychological aggression was related to suicidal ideation in bivariate but not multivariate analyses. Physical aggression towards a partner was consistently related to higher rates of suicidal ideation even after controlling for other known risk factors (OR = 1.8; CI = 1.1 - 2.7). Mediational analyses indicate that this relationship was no longer significant after accounting for current negative affect.
Suicidal ideation is common in patients seeking drug and alcohol treatment and particularly likely in those who report prior aggression towards a partner.
Suicide; alcohol; violence; depression; treatment
Suicide and suicidal expressions among young people represent a major public health problem worldwide. Most studies are from high-income countries, and it remains unclear whether prevalence and risk factors show a similar pattern in other settings. This study aims to assess the prevalence of suicidal expressions and serious suicidal expressions (ideation, plans and attempts) among adolescents in Nicaragua, in relation to previously reported risk factors, such as exposure to suicide in significant others (parents, siblings, partners or friends) and mental health problems.
368 adolescents aged 15-18 years were randomly selected from public secondary schools in León, Nicaragua. Data was collected using Attitude Towards Suicide (ATTS) and Youth Self-Report questionnaires (YSR). Bivariate and multivariate analyses were conducted.
Suicide ideation prevalence in the past year was 22.6%, suicide plans 10.3%, and suicide attempts 6.5%. Girls were significantly more likely to report suicidal ideation. Multivariate analyses showed that anxious/depressed, somatic complaints and exposure to suicidal behavior in significant others were significantly associated with own serious suicidal expressions.
The prevalence of serious suicidal expressions among young people in Nicaragua is within the range reported from Western high-income countries. An attempted or completed suicide in someone close, is associated with own suicidal expressions even in the absence of increased mental distress. Furthermore, somatic complaints should alert health care professionals of the possibility of increased suicide risk.
Suicidal expressions; youth self report; nicaragua; school based.
Suicide among young people is a global public health problem, but adequate information on determinants of suicidal expression is lacking in middle and low income countries. Young people in transitional economies are vulnerable to psychosocial stressors and suicidal expressions. This study explores the suicidal expressions and their determinants among high school students in Cambodia, with specific focus on gender differences.
A sample of 320 young people, consisting of 153 boys and 167 girls between 15-18 years of age, was randomly selected from two high schools in Cambodia. Their self-reported suicidal expressions, mental health problems, life-skills dimensions, and exposure to suicidal behavior in others were measured using the Youth Self-Report (YSR), Life-Skills Development Scale (LSDS)-Adolescent Form, and Attitude Towards Suicide (ATTS) questionnaires.
Suicidal plans were reported more often by teenage boys than teenage girls (M = 17.3%, F = 5.6%, p = 0.001), whereas girls reported more attempts (M = 0.6%, F = 7.8%, p = 0.012). Young men scored significantly higher on rule-breaking behavior than young women (p = 0.001), whereas young women scored higher on anxious/depression (p = 0.000), withdrawn/depression (p = 0.002), somatic complaints (p = 0.034), social problems (p = 0.006), and internalizing syndrome (p = 0.000). Young men exposed to suicide had significantly higher scores for internalizing syndrome compared to those unexposed (p = 0.001), while young women exposed to suicide scored significantly higher on both internalizing (p = 0.001) and externalizing syndromes (p = 0.012). Any type of exposure to suicidal expressions increased the risk for own suicidal expressions in both genders (OR = 2.04, 95% CI = 1.06-3.91); among young women, however, those exposed to suicide among friends and partners were at greater risk for the serious suicidal expressions (OR = 2.79, 95% CI = 1.00-7.74). Life skills dimension scores inversely correlated with externalizing syndrome in young men (p = 0.026) and internalizing syndrome in young women (p = 0.001).
The significant gender differences in suicidal expressions and their determinants in Cambodian teenagers highlight the importance of culturally appropriate and gender-specific suicide prevention programs. School-based life skills promotion may indirectly influence the determinants for suicidal expressions, particularly among young women with internalizing syndrome in Cambodia.
This paper reports the impact of two first- and second-grade classroom based universal preventive interventions on the risk of Suicide Ideation (SI) and Suicide Attempts (SA) by young adulthood. The Good Behavior Game (GBG) was directed at socializing children for the student role and reducing aggressive, disruptive behavior. Mastery Learning (ML) was aimed at improving academic achievement. Both were implemented by the teacher.
The design was epidemiologically based, with randomization at the school and classroom levels and balancing of children across classrooms. The trial involved a cohort of first-grade children in 19 schools and 41 classrooms with intervention at first and second grades. A replication was implemented with the next cohort of first grade children with the same teachers but with little mentoring or monitoring.
In the first cohort, there was consistent and robust GBG-associated reduction of risk for suicide ideation by age 19–21 years compared to youths in standard setting (control) classrooms regardless of any type of covariate adjustment. A GBG-associated reduced risk for suicide attempt was found, though in some covariate-adjusted models the effect was not statistically robust. No statistically significant impact on these outcomes was found for ML. The impact of the GBG on suicide ideation and attempts was greatly reduced in the replication trial involving the second cohort.
A universal preventive intervention directed at socializing children and classroom behavior management to reduce aggressive, disruptive behavior may delay or prevent onset of suicide ideation and attempts. The GBG must be implemented with precision and continuing support of teachers.
Suicide ideation; Suicide attempts; Adolescence; Developmental epidemiology; Universal prevention programs; Good behavior game
National surveys and other research on adolescent Latinas show that adolescent females have higher rates of suicidal ideation, planning, and attempts than other ethnic and racial minority youth. Internalizing behaviors and family conflicts are commonly associated with suicidality in research on adolescents. In the case of Latinas, we explore the connection between adolescent Hispanic cultural involvement, mother-adolescent mutuality, internalizing behaviors, and suicidality. This paper presents data from a study of 232 Latinas, some with a recent history of suicide attempts (n = 122). The results show that higher adolescent Hispanic cultural involvement was associated with greater mother-daughter mutuality and thus led to reduction in the likelihood of suicide attempts. The relationship between mother-daughter mutuality and suicide attempts among Latinas is mediated by specific internalizing behaviors (withdrawn depressive). Our findings highlight the positive effect that Latino cultural values have in the relationship between Latina adolescent and their mothers and confirm the importance that internalizing behaviors and the mother-daughter relationship have for suicide attempters.