Attempted suicide in youth: its relationship to school achievement, educational goals, and socioeconomic status

Genetic correlations between suicide attempts and psychiatric and intermediate phenotypes adjusting for mental disorders

BACKGROUND

Suicide attempts are a moderately heritable trait, and genetic correlations with psychiatric and related intermediate phenotypes have been reported. However, as several mental disorders as well as major depressive disorder (MDD) are strongly associated with suicide attempts, these genetic correlations could be mediated by psychiatric disorders. Here, we investigated genetic correlations of suicide attempts with psychiatric and related intermediate phenotypes, with and without adjusting for mental disorders.

METHODS

To investigate the genetic correlations, we utilized large-scale genome-wide association study summary statistics for suicide attempts (with and without adjusting for mental disorders), nine psychiatric disorders, and 15 intermediate phenotypes.

RESULTS

Without adjusting for mental disorders, suicide attempts had significant positive genetic correlations with risks of attention-deficit/hyperactivity disorder, schizophrenia, bipolar disorder, MDD, anxiety disorders and posttraumatic stress disorder; higher risk tolerance; earlier age at first sexual intercourse, at first birth and at menopause; higher parity; lower childhood IQ, educational attainment and cognitive ability; and lower smoking cessation. After adjusting for mental disorders, suicide attempts had significant positive genetic correlations with the risk of MDD; earlier age at first sexual intercourse, at first birth and at menopause; and lower educational attainment. After adjusting for mental disorders, most of the genetic correlations with psychiatric disorders were decreased, while several genetic correlations with intermediate phenotypes were increased.

CONCLUSIONS

These findings highlight the importance of considering mental disorders in the analysis of genetic correlations related to suicide attempts and suggest that susceptibility to MDD, reproductive behaviors, and lower educational levels share a genetic basis with suicide attempts after adjusting for mental disorders.

Using Boosted Machine Learning to Predict Suicidal Ideation by Socioeconomic Status among Adolescents

(1) Background: This study aimed to use machine learning techniques to identify risk factors for suicidal ideation among adolescents and understand the association between these risk factors and socioeconomic status (SES); (2) Methods: Data from 54,948 participants were analyzed. Risk factors were identified by dividing groups by suicidal ideation and 3 SES levels. The influence of risk factors was confirmed using the synthetic minority over-sampling technique and XGBoost; (3) Results: Adolescents with suicidal thoughts experienced more sadness, higher stress levels, less happiness, and higher anxiety than those without. In the high SES group, academic achievement was a major risk factor for suicidal ideation; in the low SES group, only emotional factors such as stress and anxiety significantly contributed to suicidal ideation; (4) Conclusions: SES plays an important role in the mental health of adolescents. Improvements in SES in adolescence may resolve their negative emotions and reduce the risk of suicide.

Associations Between Sad Feelings and Suicide Behaviors in the 2019 Youth Risk Behavior Survey: A Call for Action

Purpose: Suicide is the second leading cause of death among high school aged students in the United States. Significant risk factors for suicidal behaviors among youth include diagnoses of depression or other mental illnesses. The association between self-reported sad feelings and suicidal behaviors has been understudied in the literature among United States high school students. Methods: The 2019 National Youth Risk Behavior Survey (YRBS) school-based questionnaire, coordinated by the CDC, captured a nationally-representative sample (N = 13,677) of students' responses to health-related behaviors. National sex-stratified prevalences of sad feelings and suicidal behaviors were calculated. Adjusted weighted logistic regression was used to examine the association between self-reported sad feelings and suicidal behaviors. Results: Out of 13,677 high-school students, 35.8% of students self-reported sad feelings. Suicidal behaviors in the overall sample included 18.2% had seriously considered suicide, 15.2% made a plan on how they would attempt suicide, and 7.3% attempted suicide within the past 12 months. There was an 8-11-fold increased odds of all suicidal behaviors among those who reported sad feelings among both females and males. Conclusions: This study reveals a remarkably high prevalence of sad feelings among US youth, and underscores a significant association between self-reported sad feelings and suicidal behaviors among this population. The YRBS survey, routinely administered across US high school students, should be better leveraged to target interventions toward these high-risk youth in order to decrease the significant burden of suicidal behaviors among adolescents.

Etiopathogenesis of Suicide: A Conceptual Analysis of Risk and Prevention Within a Comprehensive, Deterministic Model

Suicide is a rising global health concern receiving disproportionate attention in comparison to other health conditions. In spite of substantial technological and scientific advancements, suicide research has continued to move slowly in terms of clinical translation due to the complexity of neural mechanisms, and subjective experiences that seem to underpin this complex human behavior. This paper analyzes the concepts of risk and prevention in the context of suicide in an attempt to bridge the large methodological and theoretical gaps between the biological, psychological, and sociological dimensions. This paper aims to accomplish the following objectives: (1) operationalize the concepts of suicide risk and prevention as they relate to current knowledge and capabilities; (2) synthesize and integrate suicide research across biological, psychological, and sociological dimensions; (3) discuss limitations of each dimension in isolation; (4) suggest a model of etiopathogenesis that incorporates extant literature and bridges unnecessary gaps between dimensions; and (5) suggest future directions for multidimensional research through the inclusion of principles from the physical sciences. Ultimately, this paper provides a basis for a comprehensive model of suicide within a deterministic, chaotic system.

Suicide in Brazilian indigenous communities: clustering of cases in children and adolescents by household

OBJECTIVE To estimate age and sex-specific suicide rates, compare suicide rates between indigenous communities, and quantify the frequency of intrafamilial suicide clustering. METHODS We performed a retrospective cohort study involving 14,666 indigenous individuals in reservations in Dourados, state of Mato Grosso do Sul, Brazil, from 2003 through 2013 using national and local census. RESULTS The overall suicide rate was 73.4 per 100,000 person-years. Adolescent males aged 15-19 and girls aged 10-14 had the highest rates for each sex at 289.3 (95%CI 187.5-391.2) and 85.3 (95%CI 34.9-135.7), respectively. Comparing the largest reservations, Bororo had a higher suicide rate than Jaguapiru (RR = 4.83, 95%CI 2.85-8.16) and had significantly lower socioeconomic indicators including income and access to electricity. Nine of 19 suicides among children under 15 occurred in household clusters. Compared with adult suicides, a greater proportion of child (OR = 5.12, 95%CI 1.89-13.86, p = 0.001) and adolescent (OR = 3.48, 95%CI 1.29-9.44, p = 0.017) suicides occurred within household clusters. CONCLUSIONS High rates of suicide occur among children and adolescents in these indigenous reservations, particularly in poor communities. Nearly half of child suicides occur within household clusters. These findings underscore the need for broad public health interventions and focused mental health interventions in households following a suicide.

Coping with stress in adolescents with self-harm and suicidal behavior

The paper presents the results of the study of coping specifics in adolescents at risk of self-injurious and suicidal behavior (N=174). We hypothesized that profiles of coping depended on the types of actual stress. We took into consideration the following types of stressful circumstances: parental divorce, death of relatives or loved ones, conflict with parents, serious somatic disease, academic failure and school problems, unrequited love, other, no actual stress. We discovered both common and stress-specific coping strategies. One of the common coping strategies is avoidance that is used more often in all stressful situations. Moreover, the sample was distinguished by increasing low-level strategies, rather than decreasing high-level strategies (such as planning or reappraisal). Applications to prevention measures are discussed.

Suicide attempts in children and adolescents: The place of clock genes and early rhythm dysfunction

Suicide remains one of the leading causes of death among young people, and suicidal ideation and behavior are relatively common in healthy and clinical populations. Suicide risk in childhood and adolescence is often approached from the perspective of nosographic categories to which predictive variables for suicidal acts are often linked. The cascading effects resulting from altered clock genes in a pediatric population could participate in biological rhythm abnormalities and the emergence of suicide attempts through impaired regulation of circadian rhythms and emotional states with neurodevelopmental effects. Also, early trauma and stressful life events can alter the expression of clock genes and contribute to the emergence of suicide attempts. Alteration of clock genes might lead to desynchronized and abnormal circadian rhythms impairing in turn the synchronization between external and internal rhythms and therefore the adaptation of the individual to his/her internal and external environment with the development of psychiatric disorders associated with increased risk for suicide attempts.

Assessing Suicide Risk and Emotional Distress in Chinese Social Media: A Text Mining and Machine Learning Study

BACKGROUND

Early identification and intervention are imperative for suicide prevention. However, at-risk people often neither seek help nor take professional assessment. A tool to automatically assess their risk levels in natural settings can increase the opportunity for early intervention.

OBJECTIVE

The aim of this study was to explore whether computerized language analysis methods can be utilized to assess one's suicide risk and emotional distress in Chinese social media.

METHODS

A Web-based survey of Chinese social media (ie, Weibo) users was conducted to measure their suicide risk factors including suicide probability, Weibo suicide communication (WSC), depression, anxiety, and stress levels. Participants' Weibo posts published in the public domain were also downloaded with their consent. The Weibo posts were parsed and fitted into Simplified Chinese-Linguistic Inquiry and Word Count (SC-LIWC) categories. The associations between SC-LIWC features and the 5 suicide risk factors were examined by logistic regression. Furthermore, the support vector machine (SVM) model was applied based on the language features to automatically classify whether a Weibo user exhibited any of the 5 risk factors.

RESULTS

A total of 974 Weibo users participated in the survey. Those with high suicide probability were marked by a higher usage of pronoun (odds ratio, OR=1.18, P=.001), prepend words (OR=1.49, P=.02), multifunction words (OR=1.12, P=.04), a lower usage of verb (OR=0.78, P<.001), and a greater total word count (OR=1.007, P=.008). Second-person plural was positively associated with severe depression (OR=8.36, P=.01) and stress (OR=11, P=.005), whereas work-related words were negatively associated with WSC (OR=0.71, P=.008), severe depression (OR=0.56, P=.005), and anxiety (OR=0.77, P=.02). Inconsistently, third-person plural was found to be negatively associated with WSC (OR=0.02, P=.047) but positively with severe stress (OR=41.3, P=.04). Achievement-related words were positively associated with depression (OR=1.68, P=.003), whereas health- (OR=2.36, P=.004) and death-related (OR=2.60, P=.01) words positively associated with stress. The machine classifiers did not achieve satisfying performance in the full sample set but could classify high suicide probability (area under the curve, AUC=0.61, P=.04) and severe anxiety (AUC=0.75, P<.001) among those who have exhibited WSC.

CONCLUSIONS

SC-LIWC is useful to examine language markers of suicide risk and emotional distress in Chinese social media and can identify characteristics different from previous findings in the English literature. Some findings are leading to new hypotheses for future verification. Machine classifiers based on SC-LIWC features are promising but still require further optimization for application in real life.

Suicidal Ideation vs. Suicide Attempts: Clinical and Psychosocial Profile Differences Among Depressed Patients: A Study on Personality Traits, Psychopathological Variables, and Sociodemographic Factors in 228 Patients

This study investigated whether personality traits, psychopathological characteristics, and sociodemographic factors in depressed patients differentiate patients with only suicidal thoughts from those who have attempted suicide. We investigated two groups of patients with an affective disorder: 198 patients with a suicide attempt within the last 3 months (sex ratio male to female, 1:1.3; mean age male to female, 44.8/44.7 years) and 30 patients without a suicide attempt but with suicidal thoughts (sex ratio male to female, 1:2; mean age male to female, 39.4/42.6 years) using a comprehensive measurement (Mini-International Neuropsychiatric Interview, Structured Clinical Interview for DSM-4 Axis II disorders, Hamilton Depression Scale, Beck Depression Inventory, State-Trait Anxiety Inventory, Hamilton Anxiety Scale, Brief Psychiatric Rating Scale, Clinical Global Impression Scale, Beck-Hopelessness Scale, Scale for Suicide Ideation, Impulsivity Rating Scale, Barratt Impulsivity Scale, Inventory for the Assessment of Aggression Factors, State-Trait Anger Expression Inventory, Ways of Coping Checklist). Several differences distinguished the two groups, namely, in personality traits such as anxiety or coping strategies and sociodemographics (e.g., education level). Personality traits, psychopathological characteristics, and sociodemographic factors are useful tools for assessing suicidal risk. Our findings encourage us to suggest that clinicians pay particular attention to sociodemographic variables such as separation/divorce and a lower education level when conducting risk assessments on suicidal patients.

The Experience of Sexual Stigma and the Increased Risk of Attempted Suicide in Young Brazilian People from Low Socioeconomic Group

This study was intended to analyze the intersection of experience of sexual stigma low-socioeconomic status, and suicide attempt amongst young Brazilians (11–24 years old). In each of the data collection periods (2004–2006: n = 7185; 2010–2012: n = 2734), participants completed a questionnaire-based instrument. Network analysis provided support for a Minority Stress Model, oriented around whether participants had experienced sexual stigma. Although suicide attempts decreased by 20% for participants who had not experienced sexual stigma, there was a 60% increase for those who had experienced sexual stigma. Of particular note were the increases in rates of reported community and familial physical assault, molestation, and rape for those who had experienced sexual stigma. An analysis of centrality statistics demonstrated that both experiences of this Minority Stress Model were fundamentally different, and that those disparities increased over the time frame observed in this study. At the center of this model, shortest paths statistics exhibited a direct conditioned connection between experiencing sexual stigma and suicide attempts. We discuss the social and historical contexts that contributed to these dynamics, and emphasize the need for policy change.

Adverse Childhood Experiences and Suicide Attempts: The Mediating Influence of Personality Development and Problem Behaviors

Adverse childhood experiences, comprised of forms of maltreatment and certain dysfunctional household environments, can affect the development of a child in a variety of different ways. This multitude of developmental changes may subsequently produce compounding harmful effects on the child's life and increase acutely maladaptive outcomes, including adolescent suicidal behavior. This study uses data collected from 2007 to 2012 for 64,329 Florida Department of Juvenile Justice youth (21.67 % female, 42.88 % African American, and 15.37 % Hispanic) to examine the direct and indirect effects of adverse childhood experiences on suicide attempts. Using a generalized structural equation model, the effects of adverse childhood experience scores are estimated on suicidal behavior through pathways of certain aspects of a child's personality development (aggression and impulsivity), as well as adolescent problem behaviors (school difficulties and substance abuse). The results show that a large proportion of the relationship between childhood adversity and suicide is mediated by the aforementioned individual characteristics, specifically through the youth's maladaptive personality development. These results suggest that, if identified early enough, the developmental issues for these youth could potentially be addressed in order to thwart potential suicidal behavior.

Validating Machine Learning Algorithms for Twitter Data Against Established Measures of Suicidality

BACKGROUND

One of the leading causes of death in the United States (US) is suicide and new methods of assessment are needed to track its risk in real time.

OBJECTIVE

Our objective is to validate the use of machine learning algorithms for Twitter data against empirically validated measures of suicidality in the US population.

METHODS

Using a machine learning algorithm, the Twitter feeds of 135 Mechanical Turk (MTurk) participants were compared with validated, self-report measures of suicide risk.

RESULTS

Our findings show that people who are at high suicidal risk can be easily differentiated from those who are not by machine learning algorithms, which accurately identify the clinically significant suicidal rate in 92% of cases (sensitivity: 53%, specificity: 97%, positive predictive value: 75%, negative predictive value: 93%).

CONCLUSIONS

Machine learning algorithms are efficient in differentiating people who are at a suicidal risk from those who are not. Evidence for suicidality can be measured in nonclinical populations using social media data.

The Association of Level of Internet Use with Suicidal Ideation and Suicide Attempts in South Korean Adolescents: A Focus on Family Structure and Household Economic Status

OBJECTIVE

To examine the association between the level of Internet addiction and suicidal ideation and suicide attempts in South Korean adolescents, focusing on the roles of family structure and household economic status.

METHODS

Data from 221 265 middle and high school students taken from the 2008-2010 Korea Youth Risk Behavior Web-based Survey were used in this study. To identify factors associated with suicidal ideation/attempts, multiple logistic regression analysis was performed. The level of Internet use was measured using the simplified Korean Internet Addiction Self-assessment Tool.

RESULTS

Compared with mild users of the Internet, high-risk users and potential-risk users were more likely to report suicidal ideation (nonuser, odds ratio [OR] 1.10, 95% confidence interval [CI] 1.05 to 1.15; potential risk, OR 1.49, 95% CI: 1.36 to 1.63; high risk OR 1.94, 95% CI 1.79 to 2.10) or attempts (nonuser, OR 1.33, 95% CI 1.25 to 1.42; potential risk, OR 1.20, 95% CI 1.04 to 1.38; high risk, OR 1.91, 95% CI 1.71 to 2.14). The nonuser group also had a slightly higher risk of suicidal ideation/attempts compared with mild users. This association appeared to vary by perceived economic status and family structure.

CONCLUSIONS

Our study suggests that it is important to attend to adolescents who are at high risk for Internet addiction, especially when they do not have parents, have stepparents, or perceive their economic status as either very low or very high.

Risk indicators of suicide ideation among on-reserve First Nations youth

BACKGROUND

Despite the known disparity in suicide rates in Canada, there is limited information on the independent risk indicators of suicide ideation among First Nations youth living on reserve.

OBJECTIVE

To determine the prevalence and adjusted risk indicators for suicide ideation among on-reserve First Nations youth.

METHODS

Saskatoon Tribal Council (Saskatchewan) First Nations students enrolled in grades 5 through 8 who were living on reserve were asked to complete a health survey using validated questionnaires. In total, 75.3% of the students completed the survey. The study was led by the Saskatoon Tribal Council with assistance from three departments at the University of Saskatchewan (Saskatoon, Saskatchewan).

RESULTS

Among on-reserve First Nations youth, 23% experienced suicide ideation within the past 12 months. In comparison, 8.5% of Saskatoon urban youth and 19% of Saskatoon urban Aboriginal youth within the same grades experienced suicide ideation. Wanting to leave home (OR 13.91 [95% CI 3.05 to 63.42]), having depressed mood (OR 2.98 [95% CI 1.16 to 7.67]) and not feeling loved (OR 3.85 [95% CI 1.49 to 9.93]) were independently associated with suicide ideation among on-reserve youth. None of the children with a father who was professionally employed reported suicide ideation.

CONCLUSIONS

Understanding the independent risk indicators associated with suicide ideation among First Nations youth living on reserve will hopefully aid in appropriate interventions.

Facteurs associés au risque suicidaire chez les jeunes consultants d’un centre de prévention sanitaire et sociale

The association between suicidal risk and various psychological or biographical factors in teenagers or young adults is already well documented. Yet, the role of stressful life events or contexts during childhood or of the recent past, as well as the respective weight of such determinants, has to be specified.

METHODS

One thousand one hundred and thirty-nine individuals, aged 16 to 25, who consecutively consulted in a preventive health center supported by the National Health Insurance System, located in Seine-Saint-Denis (a French department characterized by an unfavourable socio-economic context) on the occasion of a free work up were invited to fill out several self-administered questionnaires, aimed at assessing especially the level of psychosocial distress (Golberg's GHQ-28) and the level of hopelessness (Beck's hopelessness scale). They were also invited to meet a psychologist for a semi-structured interview, when the day of their consultation coincided with one of the three days a week the psychologist was present in the center; the interview was aimed at collecting information upon the biographical context and ancient or recent life events and to determine the level of suicidal risk, on the basis of a scale of suicidal ideation [Ducher's Suicidal Risk Scale (ERSD)]. The concurrent validity of the later has already been previously tested and positive correlation coefficients were found with Beck Depression Inventory, Hamilton's Depression Rating Scale and Beck's Hopelessness Scale.

RESULTS

One thousand and four records could be analysed, as regards self-administered questionnaires, and among those, 576 as regards the interview with the psychologist and data related to suicidal risk. The studied population included 61.3% of females and 59.3% of individuals aged 20 to 25: mean age was comparable in males and females. GHQ-28 global score and sub-scores (somatisation, anxiety, social dysfunction and depressive mood) were all higher in women (all the p<0.001). A high suicidal risk (ERSD score 4) was found in 24.1% of the studied population. Subjects presenting with a high suicidal risk were characterized by higher levels of GHQ-28 psychosocial distress and GHQ-28 sub-scores as well as hopelessness (all the p<0.001). Several biographical antecedents during childhood were significantly associated with suicidal risk: unknown father (p<0.001), death of parents (p<0.001), separation from parents (p<0.001), severe quarrel between parents (p<0.001), money problems within the family (p<0.007), disorders related with alcohol consumption in parents (p<0.016), drug addiction within the family (p<0.001). Other predictors were several recent stressful events or contexts: violence within the family (p<0.001), social isolation (p<0.001), lack of self-esteem of (p<0.002), school difficulties (p<0.001), educational failure (p<0.001); as well as the notion of a consumption of drugs (p=0,001) or medications: neuroleptics (p<0.015), antidepressants (p=0.001) and tranquilizers (p<0.001). A series of univariate regression analyses allowed to compute the Odds Ratios (OR) and the 95% Confidence Intervals (95% CI) of the sub-group characterized by a high suicidal risk for each socio-demographic, psychological and biographical independent variable, linked to suicidal risk at a threshold of p<0.10. A multiple regression analysis was then performed in 2 steps: in a first step, independent variables were pooled by blocks, according to their nature (psychological characteristics, relational deficiencies among biographical antecedents, other stressful conditions among antecedents, stressful conditions among recent biographical context, recent consumption of drugs or medications); in a second step, all the independent variables which still remained associated with suicidal risk within each block were included in a final multiple regression analysis. Five variables continued to independently predict a high suicidal risk: hopelessness at Beck's scale (OR=4.09), depressive mood at GHQ-28 (OR=3.75), the notion of an unknown father (OR=2.95), the notion of a recent destabilizing event other than a school problem or an aggression (OR=1.90) and the notion of an educational failure (OR=1.78).

CONCLUSION

These results confirm previous scientific data on this topic and underline that childhood context, educational course, psychological vulnerability and the occurrence of recent stressful life events combine their effects, enhancing the risk of a suicidal attempt. They can be useful for better sensitising educational as well as social and health care circles, for settling more efficient screening and preventive programs.

The prevalence of suicidal phenomena in adolescents: a systematic review of population-based studies

The results of a systematic review of the international literature on the prevalence of suicidal phenomena in adolescents, including the influence of survey method, gender, and ethnicity are reported. The literature was searched using six electronic databases to identify all population-based studies of self-reported suicidal phenomena; 128 studies were included, comprising 513,188 adolescents. The mean proportion of adolescents reporting they had attempted suicide at some point in their lives was 9.7% (95% CI, 8.5-10.9), and 29.9% (95% CI, 26.1-33.8) of adolescents said they had thought about suicide at some point. Females were significantly more likely than males to report most suicidal phenomena. A lower prevalence of some suicidal phenomena was found for Asian populations. The prevalence of suicidal phenomena varied depending on the terminology used and tended to be higher in studies employing anonymous questionnaires than in studies employing non-anonymous methods (questionnaires or interviews), although most of these differences were not statistically significant.

Factors associated with suicidal phenomena in adolescents: a systematic review of population-based studies

Suicidal phenomena (suicide attempts, deliberate self-harm, and suicidal plans, threats and thoughts) are common in adolescents. Identification of factors associated with these phenomena could play an important role in the development of school or community-based prevention and intervention programs. In this article, we report the results of a systematic review of the international literature on population-based studies of factors associated with suicidal phenomena in adolescents. These factors encompass psychiatric, psychological, physical, personal, familial and social domains. The quantity of evidence in support of associations between suicidal phenomena and specific factors is compared with the quantity of evidence against such associations. We conclude with a summary of the findings, including identification of new or neglected areas, which require further investigation. Methodological considerations are highlighted and implications of the findings for clinicians and other professionals concerned with prevention of suicidal behavior by adolescents are discussed.

Mania, hypomania, and suicidality: findings from a prospective community study

We examined prospectively whether mania and hypomania are associated with an elevated risk for suicidality in a community sample of adolescents and young adults. Baseline and four-year follow-up data were used from the Early-Developmental-Stages-of-Psychopathology (EDSP) Study, a prospective longitudinal study of adolescents and young adults in Munich. Suicidal tendencies (ideation/attempts), mania, and hypomania were assessed using the standardized Munich-Composite-International-Diagnostic-Interview. At baseline, mania/hypomania was associated to a different degree with suicidality (Odds ratios [OR] range from 1.9 to 13.7). In the prospective analyses, the risk for subsequent incident suicidal ideation was increased in the presence of prior mania (38.0% vs. 14.1%; OR = 4.4; 95% CI = 1.4-13.5). No associations could be found between prior mania/hypo-mania and incident suicide attempts. The prospective analyses revealed a remarkable relationship between preexisting mania and increased risk for subsequent suicidal ideation.

Is perceived failure in school performance a trigger of physical injury? A case-crossover study of children in Stockholm County

OBJECTIVES

To investigate whether perceived failure in school performance increases the potential for children to be physically injured.

SUBJECTS

Children aged 10-15 years residing in the Stockholm County and hospitalised or called back for a medical check up because of a physical injury during the school years 2000-2001 and 2001-2002 (n = 592).

METHODS

A case-crossover design was used and information on potential injury triggers was gathered by interview. Information about family socioeconomic circumstances was gathered by a questionnaire filled in by parents during the child interview (response rate 87%).

RESULTS

Perceived failure in school performance has the potential to trigger injury within up to 10 hours subsequent to exposure (relative risk = 2.70; 95% confidence intervals = 1.2 to 5.8). The risk is significantly higher among pre-adolescents and among children from families at a higher education level.

CONCLUSIONS

Experiencing feelings of failure may affect children's physical safety, in particular among pre-adolescents. Possible mechanisms are perceptual deficits and response changes occasioned by the stress experienced after exposure.

Uncovering the mystery: factors of African American suicide

Traditionally, African Americans have registered lower rates of suicide than other ethnic groups. In the last 20 years this pattern has changed, particularly among young African Americans. To date, the research conducted regarding this phenomenon has been limited for a variety of reasons and previous research has been inconclusive in determining risk factors of African American suicide. The purpose of this paper is to identify risk and protective factors specific to African American suicide. To determine the factors, the 1993 National Mortality Follow-back Survey was analyzed. The risk factors identified include being under age 35, southern and northeastern residence, cocaine use, firearm presence in home, and threatening others with violence. Some of the protective factors associated with African American suicide include rural residence and educational attainment. These results provide valuable information about completed African American suicides in relation to Whites. Several of these factors are unique to African Americans.

Equalisation of socioeconomic differences in injury risks at school age? A study of three age cohorts of Swedish children and adolescents

The objective of the study was to investigate whether there is equalisation of socioeconomic differences in injury risks among Swedish children and adolescents. Equalisation was defined as a reduction in relative differences in risks between socioeconomic groups. All Swedish children and adolescents aged 5-19 in 1990 were grouped into three age cohorts and allocated to four household socioeconomic statuses, considering boys and girls separately. Each cohort was then followed up over a 5-year period (1990-1994) with regard to three injury diagnosis groups (as registered in the national Hospital Discharge and Causes of Death registers) with documented socioeconomic differences: injuries due to traffic, interpersonal violence, and self-infliction. The Relative Index of Inequality was used to measure the magnitude of relative socioeconomic differences, for each year of observation. Where applicable, relative risks were computed in order to see whether equalisation benefited all socioeconomic groups. Tendencies of equalisation were found among girls for two of the diagnosis groups: in traffic injuries for the youngest cohort (aged 5-9 in 1990) and in the case of self-inflicted injuries within the two older cohorts (10-14 and 15-19, in 1990). In conclusion, this study provides limited evidence of equalisation in injury risks between socioeconomic groups among Swedish adolescents. Equalisation appears to be a gender-specific phenomenon, that is, among girls, and manifests itself around the age of 5-13 in traffic-related injuries, when girls are in first and second levels of compulsory school, and later on in self-inflicted injuries. Given the economic recession in Sweden at the time of the study period, whether the equalisation processes are attributable to school, peer group and youth culture effects-as hypothesised by West-is debatable, particularly in the case of self-inflicted injuries.

Psychiatric disorders, performance level at school and special education at early elementary school age

We assessed the relationship between psychological deviance and performance level at school among 8-year-old children. The use of special education among children with psychiatric disorders was also studied. In Stage 1, 5813 children were studied using the Rutter Parent Questionnaire (RA2), the Rutter Teacher Questionnaire (RB2) and the Children's Depression Inventory (CDI). In Stage 2, a subsample (n = 424) of these children were interviewed, using the Isle of Wight Interview. In Stage 1, more children defined as low achievers (LAs) came from low SES families than did average (NAs) and high achievers (HAs). They also had more psychiatric symptoms, and they scored above the cutoff (13 points on the RA2, nine points on the RB2 and 17 points on the CDI) more commonly than other children. In Stage 2, two thirds of children who received special education had some psychiatric disorder. The probability of a child with psychiatric disorder obtaining some extra tutoring or special education was 3.1-fold when compared with children without psychiatric disorders. Depressive children and children with attention deficit disorders most commonly had extra tutoring (4.8-fold) when compared with children without psychiatric disorders. The probability of getting special education was highest for attention deficit disorders (6.2-fold), thereafter for anxiety (3.1-fold), and for oppositional/conduct disorders (2.8-fold).

Childhood abuse and neglect: specificity of effects on adolescent and young adult depression and suicidality

OBJECTIVE

To investigate the magnitude and independence of the effects of childhood neglect, physical abuse, and sexual abuse on adolescent and adult depression and suicidal behavior.

METHOD

A cohort of 776 randomly selected children was studied from a mean age of 5 years to adulthood in 1975, 1983, 1986, and 1992 during a 17-year period. Assessments included a range of child, family, and environmental risks and psychiatric disorders. A history of abuse was determined by official abuse records and by retrospective self-report in early adulthood on 639 youths. Attrition rate since 1983 has been less than 5%.

RESULTS

Adolescents and young adults with a history of childhood maltreatment were 3 times more likely to become depressed or suicidal compared with individuals without such a history (p < .01). Adverse contextual factors, including family environment, parent and child characteristics, accounted for much of the increased risk for depressive disorders and suicide attempts in adolescence but not in adulthood (p < .01). The effects of childhood sexual abuse were largest and most independent of associated factors. Risk of repeated suicide attempts was 8 times greater for youths with a sexual abuse history (odds ratio = 8.40, p < .01).

CONCLUSIONS

Individuals with a history of sexual abuse are at greater risk of becoming depressed or suicidal during adolescence and young adulthood. Adolescence is the most vulnerable period for those youths who may attempt suicide repeatedly. Many of the apparent effects of neglect, in contrast, may be attributable to a range of contextual factors, suggesting broader focus for intervention in these cases.

Suicidal behavior as related to social support and assertiveness among Swedish and Turkish high school students: a cross-cultural investigation

Among 652 Swedish and 654 Turkish adolescents, the study found that 61 Swedish (9.4%) and 71 Turkish (10.9%) adolescents reported that they had made previous suicide attempts. Previous psychiatric contact, female gender, low perceived family support, and suicide attempts in the family for the Swedish group and suicide attempts in the family, low perceived family support, psychiatric disorder in the family, and previous psychiatric contact variables in the Turkish sample were found to be associated with previous attempts. Low perceived family support, previous suicide attempts, low perceived peer support, female gender, previous psychiatric contact, low positive assertion skills, and a small number of friends for the Swedish; and low perceived family support, previous suicide attempts, low perceived peer support, suicide attempts in the family, and previous psychiatric contact variables for the Turkish group were found to be significant predictors of current suicidal risk.

Suicide: a review of calls to an adolescent peer listening phone service

Calls about suicide to a teen peer listening phone service over a period of 5 1/2 years are described. The majority of those calling about suicide were females. The phone contacts were of longer duration and later in the evening than calls about other concerns. Those concerned with suicide also discussed other serious issues such as self-esteem, family problems, substance use, and abuse and were less likely to be calling "just to talk."

Discriminating suicide ideation among high-risk youth

This study examined the hypothesis that among one group of high-risk youth--potential high school dropouts--key psychosocial factors would distinguish adolescents endorsing high suicide ideation from those who do not. Survey data compared high-risk youth with high suicide ideation (n = 43) with randomly selected samples of high-risk (n = 43) and "typical" youth (n = 42) without high suicide ideation. Repeat sampling of comparison groups verified results. Compared to high-risk and typical youth without suicide ideation, high-risk youth with high suicide ideation reported more psychosocial distress, problems with drug involvement, and disrupted family relations. They also described more unmet school goals and perceived a greater likelihood of dropping out of school. Discriminant analysis revealed that depression and low self-esteem were most effective in distinguishing between high-risk youth with and without high suicide ideation; family strain, anger, stress, and drug involvement also were differentiating factors. Implications for school-based screening and prevention programs are discussed within the context of the findings.

Psychopathology, family functioning, and cognitive style in urban adolescents with suicide attempts

This study examined psychopathology, family functioning, and cognitive style in 121 African-American adolescents who attempted suicide. Group means suggested that these youths, when taken together, were not reporting significant psychological distress. However, after classifying the youths into three groups by level of depressive symptoms interesting findings emerged. Youth self-reports of depressive symptoms on the Children's Depression Inventory were associated with the presence of internalizing and externalizing disorders on the Youth Self-Report and Child Behavior Checklist, and with a maladaptive attributional style. Sixty-seven percent of participants classified their family types as maladaptive in terms of levels of cohesion and/or adaptability. In fact, the majority of adolescents and parents reported their families as disengaged. These findings are discussed from a culturally and developmentally sensitive framework which considers key demographic variables (race, socioeconomic status, age). Clinical implications are offered for individual and family interventions.

Suicidal attempts among older adolescents: prevalence and co-occurrence with psychiatric disorders

The prevalence of suicidal attempts and ideation and the co-occurrence of attempts with psychiatric disorders were examined in a community sample of 1710 older adolescents. Structured interviews using rigorous diagnostic criteria were conducted in two annual assessments. Lifetime prevalence of attempts was 7.1% and ideation was 21.1%. Almost 90% of those who attempted also evidenced suicidal ideation. Suicide attempts occurred in conjunction with depressive, substance use, and disruptive behavior disorders but not with panic disorders. Results indicate that risk factors for an attempt are the following: being female, from a home without a father, poor education of the father, previous attempts, suicidal ideation, and mental disorders.