Co-occurring risk behaviors among White, Black, and Hispanic US high school adolescents with suicide attempts requiring medical attention, 1999-2007: implications for future prevention initiatives

24-Hour warning signs for adolescent suicide attempts

BACKGROUND

Little is known about when youth may be at greatest risk for attempting suicide, which is critically important information for the parents, caregivers, and professionals who care for youth at risk. This study used adolescent and parent reports, and a case-crossover, within-subject design to identify 24-hour warning signs (WS) for suicide attempts.

METHODS

Adolescents (N = 1094, ages 13 to 18) with one or more suicide risk factors were enrolled and invited to complete bi-weekly, 8-10 item text message surveys for 18 months. Adolescents who reported a suicide attempt (survey item) were invited to participate in an interview regarding their thoughts, feelings/emotions, and behaviors/events during the 24-hours prior to their attempt (case period) and a prior 24-hour period (control period). Their parents participated in an interview regarding the adolescents' behaviors/events during these same periods. Adolescent or adolescent and parent interviews were completed for 105 adolescents (81.9% female; 66.7% White, 19.0% Black, 14.3% other).

RESULTS

Both parent and adolescent reports of suicidal communications and withdrawal from social and other activities differentiated case and control periods. Adolescent reports also identified feelings (self-hate, emotional pain, rush of feelings, lower levels of rage toward others), cognitions (suicidal rumination, perceived burdensomeness, anger/hostility), and serious conflict with parents as WS in multi-variable models.

CONCLUSIONS

This study identified 24-hour WS in the domains of cognitions, feelings, and behaviors/events, providing an evidence base for the dissemination of information about signs of proximal risk for adolescent suicide attempts.

COVID-19-Specific Suicidal Thoughts and Behaviors in Psychiatrically Hospitalized Adolescents

This study examined the presence and correlates of COVID-specific suicidal thoughts and behaviors (i.e., thoughts of or engaging in intentional COVID-19 exposure with associated suicidal intent) among psychiatrically hospitalized adolescents. Adolescents (N = 143) completed study measures as part of the standard intake process between March 13th and August 14th, 2020. Participants answered questionnaires assessing COVID-specific passive and active suicidal ideation (SI) and suicidal behavior, as well as COVID-related stressors and emotions, and public health guidance compliance. Findings highlights that COVID-specific SI is common in high-risk youth. COVID-specific SI was associated with COVID-19-related negative emotions, elevated stress, and decreased public health guidance compliance. Results suggest that COVID-specific suicidal thoughts and behaviors, and risk correlates, should be assessed within high-risk populations to facilitate prevention of risky behavior associated with intentional COVID-19 exposure.

Advances in Research on Adolescent Suicide and a High Priority Agenda for Future Research

Suicide is the second leading cause of death for adolescents in the United States, yet remarkably little is known regarding risk factors for suicidal thoughts and behaviors (STBs), relatively few federal grants and scientific publications focus on STBs, and few evidence-based approaches to prevent or treat STBs are available. This "decade in review" article discusses five domains of recent empirical findings that span biological, environmental, and contextual systems and can guide future research in this high priority area: (1) the role of the central nervous system; (2) physiological risk factors, including the peripheral nervous system; (3) proximal acute stress responses; (4) novel behavioral and psychological risk factors; and (5) broader societal factors impacting diverse populations and several additional nascent areas worthy of further investigation.

Effects of polygenic risk for suicide attempt and risky behavior on brain structure in young people with familial risk of bipolar disorder

Bipolar disorder (BD) is associated with a 20-30-fold increased suicide risk compared to the general population. First-degree relatives of BD patients show inflated rates of psychopathology including suicidal behaviors. As reliable biomarkers of suicide attempts (SA) are lacking, we examined associations between suicide-related polygenic risk scores (PRSs)-a quantitative index of genomic risk-and variability in brain structures implicated in SA. Participants (n = 206; aged 12-30 years) were unrelated individuals of European ancestry and comprised three groups: 41 BD cases, 96 BD relatives ("high risk"), and 69 controls. Genotyping employed PsychArray, followed by imputation. Three PRSs were computed using genome-wide association data for SA in BD (SA-in-BD), SA in major depressive disorder (SA-in-MDD) (Mullins et al., 2019, The American Journal of Psychiatry, 176(8), 651-660), and risky behavior (Karlsson Linnér et al., 2019, Nature Genetics, 51(2), 245-257). Structural magnetic resonance imaging processing employed FreeSurfer v5.3.0. General linear models were constructed using 32 regions-of-interest identified from suicide neuroimaging literature, with false-discovery-rate correction. SA-in-MDD and SA-in-BD PRSs negatively predicted parahippocampal thickness, with the latter association modified by group membership. SA-in-BD and Risky Behavior PRSs inversely predicted rostral and caudal anterior cingulate structure, respectively, with the latter effect driven by the "high risk" group. SA-in-MDD and SA-in-BD PRSs positively predicted cuneus structure, irrespective of group. This study demonstrated associations between PRSs for suicide-related phenotypes and structural variability in brain regions implicated in SA. Future exploration of extended PRSs, in conjunction with a range of biological, phenotypic, environmental, and experiential data in high risk populations, may inform predictive models for suicidal behaviors.

Role of Sleep Duration in the Association Between Socioecological Protective Factors and Health Risk Behaviors in Adolescents

OBJECTIVE

The purpose of this study was to examine the associations of sleep duration and socioecological protective factors with patterns of adolescent risk behaviors in Fairfax County, VA-one of the largest public school districts in the United States.

METHODS

A total of 21,360 and 20,330 students in 10th and 12th grades who completed the Youth Risk Behavior Survey were included in this cross-sectional analysis. Sleep duration was measured by self-report of the average number of hours of sleep on a school night. Ten socioecological protective factors included peer-individual, family, school, and community domains. Latent class analysis was used to classify 7 risk behaviors (alcohol use, cigarette use, illicit drug use, inappropriate prescription drug use, risky sexual behavior, deviant behavior, and academic failure) into 4 class memberships (low, some, moderate, and high). Multinomial regression models were adjusted for age, sex, and race.

RESULTS

Adolescents who reported sleeping the recommended 8 to 9 hours were significantly less likely to belong to the class memberships of greater risk behaviors compared with those who reported short and long sleep duration after controlling for age, sex, race, and survey year. There was a significant inverse relationship between the number of socioecological protective factors and risk behaviors for both 10th and 12th graders. Potential risks of age, sex, and race on risk behaviors were observed. No significant interaction between sleep duration and protective factors was found in either grade.

CONCLUSION

This study highlights the significant associations between sleep duration and risk behaviors in adolescents with diverse socioecological protective factors. Prioritization of prevention-focused resources should consider sleep duration in addition to the socioecological protective factors commonly cited in the literature when addressing adolescent risk behaviors.

Developmental Pathways to BPD-Related Features in Adolescence: Infancy to Age 15

The self-damaging behaviors central to borderline personality disorder (BPD) become prominent in adolescence. Current developmental theories cite both early family processes and childhood dysregulation as contributors to BPD, but longitudinal data from infancy are rare. Using the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development database (SECCYD; N = 1,364), we examined path models to evaluate parent and child contributors from infancy/preschool, middle childhood, and adolescence to adolescent BPD-related features. In addition, person-centered latent class analyses (LCA) investigated whether adolescent BPD-related features were more strongly predicted by particular patterns of maladaptive parenting. Path modeling identified unique influences of maternal insensitivity and maternal depression on BPD-related features, first, through social-emotional dysregulation in middle childhood, and second, through continuity from infancy in maternal insensitivity and depression. LCA results indicated that early withdrawn parenting was particularly predictive of BPD-related features in adolescence. Results suggest multiple points of intervention to alter pathways toward adolescent borderline psychopathology.

Five Profiles of Adolescents at Elevated Risk for Suicide Attempts: Differences in Mental Health Service Use

OBJECTIVE

Adolescents at risk for suicide are highly heterogeneous in terms of psychiatric and social risk factors, yet there has been little systematic research on risk profiles, which would facilitate recognition and the matching of patients to services. Our primary study aims were to identify latent class profiles of adolescents with elevated suicide risk, and to examine the association of these profiles with mental health service use (MHSU).

METHOD

Participants were 1,609 adolescents from the Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) cohort. Participants completed baseline surveys assessing demographics, MHSU, and suicide risk. Telephone follow-up interviews were conducted at 3 months to assess suicide attempts. Participants met pre-established baseline criteria for suicide risk.

RESULTS

Using latent class analysis, we derived 5 profiles of elevated suicide risk with differing patterns of eight risk factors: history of multiple suicide attempts, past-month suicidal ideation, depression, alcohol and drug misuse, impulsive-aggression, and sexual and physical abuse. In comparison to adolescents who did not meet baseline criteria for suicide risk, each profile was associated with increased risk of a suicide attempt within 3 months. The MHSU was lowest for adolescents fitting profiles with previous (but no recent) suicidal thoughts and behavior, and for adolescents from racial and ethnic minority groups.

CONCLUSION

Adolescents at elevated risk for suicide present to emergency departments with differing profiles of suicide risk. MHSU varies across these profiles and by race/ethnicity, indicating that targeted risk recognition and treatment linkage efforts may be necessary to reach some adolescents at risk.

Exposure to maternal depressive symptoms and growth in adolescent substance use: The mediating role of delay discounting

Maternal depression is associated with instability within the family environment and increases in offspring substance use across adolescence. Rates of delay discounting, or the tendency to select smaller rewards that are immediately available relative to larger, but delayed rewards, are also associated with steeper increases in substance use among youth. Moreover, recent research suggests that early unstable environments may reinforce youths' propensity towards opportunistic decision making and delay discounting specifically. The current prospective, longitudinal study examined links between maternal depressive symptoms, adolescent delay discounting, and subsequent substance use. Participants included 247 adolescents and their mothers who were assessed annually over a 6-year period (from ages 13 to 19 years). Results supported a small but significant mediation effect. Specifically, maternal depressive symptoms predicted increases in adolescent delay discounting, which, in turn, predicted steeper increases in adolescent substance use over time. Thus, youth decision making may represent a mechanism linking maternal depression and adolescent risk behaviors. Findings indicate the potential for interventions targeting parental psychopathology to prevent subsequent adolescent substance use.

Predictors of Traumatic Suicide Attempts in Youth Presenting to Hospitals with Level I Trauma Centers

BACKGROUND

Limited research exists examining the predictors of suicide attempts by mechanism.

OBJECTIVE

The purpose of this study was to examine predictors of traumatic suicide attempts in youth.

METHODS

Data came from patients 5-18 years of age presenting because of a suicide attempt at 2 hospitals in Central Texas with level I trauma centers. Univariate logistic regression examined the association between traumatic suicide attempts and variables describing the patient's demographic, mental health, and social information. We used the Mann-Whitney U test to examine the association between traumatic suicide attempts and the continuous variable of age.

RESULTS

Of 231 patients included in this study, most were female (75.8%), non-Hispanic white (48.1%), and had a median age of 15.0 years (interquartile range 14-16). Compared with patients presenting because of an intentional overdose, patients presenting because of traumatic suicide attempts were associated with a reported criminal history (odds ratio [OR] 14.50 [95% confidence interval {CI} 3.84-54.82]), reported Child Protective Services history (OR 3.26 [95% CI 0.99-10.77]), being publicly insured or uninsured (OR 1.80 [95% CI 1.02-3.19]), male (OR 2.37 [95% CI 1.28-4.38]), and identifying as Hispanic (OR 2.01 [95% CI 1.10-3.68).

CONCLUSIONS

Our findings inform targeted preventative resources and education efforts to populations of greatest need.

Co-occurring risk factors among U.S. high school students at risk for suicidal thoughts and behaviors

BACKGROUND

Suicidal thoughts and behaviors (STBs) are increasing among adolescents in the United States and are challenging to predict and prevent.  The current study identifies subtypes of youth at risk for suicidal thoughts and behaviors (STBs) in school-based settings.

METHOD

Data are from the CDC's 2015 and 2017 National Youth Risk Behavior Survey of US high school students. Among students reporting depression symptoms, latent class analysis is used to identify subtypes at risk for STBs based on personal characteristics, risk behaviors and environments.

RESULTS

Two distinct subtypes of youth were found to be at high risk for STBs: The first, larger subtype (22%) is predominately females in early high school, many of whom identify as bisexual, experienced past-year bullying, and are likely to have experienced sexual victimization.  These students have low levels of externalizing risk behaviors making them difficult to detect.  The second high-risk subtype (7%) is characterized by students with significant social integration challenges, with extremely high levels of substance abuse, fighting, physical and sexual victimization and poor academic performance.  Many of these students have low English fluency, and identify as sexual minority.

LIMITATIONS

Due to attrition or language barriers, experiences of some students at high-risk for STBs may not have been captured by this survey.

CONCLUSION

Universal screening in clinical settings, and universally focused suicide prevention programs in school-based settings are needed and should be introduced early on. Interventions should be tailored to reach high-risk students with language, cultural and social integration challenges.

Risk-taking behaviors and stressors differentially predict suicidal preparation, non-fatal suicide attempts, and suicide deaths

Negative life events are elevated in suicidal populations. Diathesis-stress and kindling effects models suggest different mechanisms by which negative life events increase suicide risk. Different forms of negative life events - risk-taking behaviors and stressors - may have different effects on non-fatal suicide attempts and suicide. We assessed the effects of risk-taking behaviors and stressors on suicide, history of non-fatal suicide attempts, and active preparation for suicide in a sample of adults who died by suicide or other causes (N = 377). Psychological autopsy procedures using family member interviews and collateral record review were used to complete a risk-taking behaviors composite measure from the Structured Interview for DSM-IV Personality Disorders, the Modified Life Experiences Scale, and the planning subscale of the Suicide Intent Scale. Stressors were significantly associated with death by suicide, even when accounting for demographic and diagnostic characteristics. Risk-taking behaviors were significantly associated with non-fatal suicide attempts, even when accounting for demographic and diagnostic characteristics. Suicide decedents who did not actively prepare for suicide showed significantly higher risk-taking scores than suicide decedents who actively planned for suicide. Our results suggest that risk-taking behaviors and stressors impact suicide risk through separate mechanisms. Risk-taking behaviors may represent a longstanding vulnerability to act impulsively on suicidal thoughts. Stressors may impact risk for fatal suicidal behaviors in mood disordered populations.

Exploratory analysis of mediators of the relationship between childhood maltreatment and suicidal behavior

INTRODUCTION

Suicide is a major public health concern. One consistently cited risk factor for suicide is childhood maltreatment, which also may play a role in the transition from suicidal ideation to suicidal behavior.

METHOD

The current study aimed to examine the relationship between childhood maltreatment and suicide attempts during adolescence (N = 4834; 52.1% female; 67.5% Caucasian). Data from the U.S. National Longitudinal Study of Adolescent Health were utilized. Forty-six theoretically-relevant risk factors were explored as potential mediators of this relationship using an exploratory mediation data analytic method.

RESULTS

Results demonstrated a significant childhood maltreatment - suicide attempt relationship only among females. After considering demographics and suicidal ideation, having received counseling in the previous 12 months was the most influential mediator, followed by having a friend attempt suicide in the previous 12 months.

CONCLUSIONS

These findings highlight potential gender differences in the relationship between childhood maltreatment and later suicide attempts, and, moreover, the importance of assessing for recent exposure to peer suicidal behavior in suicide risk assessments.

Accounting for Diversity in Suicide Research: Sampling and Sample Reporting Practices in the United States

Research on suicidal thoughts and behaviors (STB) has identified many risk factors, but whether these findings generalize to diverse populations remains unclear. We review longitudinal studies on STB risk factors over the past 50 years in the United States and evaluate the methodological practices of sampling and reporting sample characteristics. We found that articles frequently reported participant age and sex, less frequently reported participant race and ethnicity, and rarely reported participant veteran status or lesbian, gay, bisexual, and transgender status. Sample reporting practices modestly and inconsistently improved over time. Finally, articles predominantly featured White, non-Hispanic, young adult samples.

Latina Adolescents Health Risk Behaviors and Suicidal Ideation and Suicide Attempts: Results from the National Youth Risk Behavior Survey 2001-2013

Suicidal ideation and suicide attempts are more common in Latina adolescents than White or African-American adolescents. Several health risk behaviors have been identified as being associated with Latina adolescent suicides. However, to date, no study has identified the consistency and stability of these risk behaviors over time. This study utilized the national Youth Risk Behaviors Survey from 2001 to 2013 to estimate the prevalence of suicidal ideation, suicide attempts, and health risk behaviors associated with suicidal behaviors in Latina adolescents. Our analysis found the prevalence of suicidal ideation and suicide attempts varied significantly over the 13-year study span, decreasing from 2001 to 2009 and increased from 2011 to 2013. The analyses found 11 health risk behaviors that were significantly associated with both suicidal ideation and suicide attempts that did not vary over time. The stability of these 11 health risk behaviors associated with suicidal behaviors could be useful to school personnel to identify early at risk Latina adolescents who may benefit from school and community mental health resources.

Risk-Taking Behavior and Suicidality: The Unique Role of Adolescent Drug Use

Research has supported an association between suicidal thoughts/behaviors and risk taking, which may be particularly strong during adolescence when risk taking is known to increase. However, extant research has focused on individual risk-taking behaviors (e.g., alcohol use), limiting our ability to evaluate the unique association between different risk-taking behaviors and suicidal thoughts/behaviors. The current study aimed to fill this gap by examining the simultaneous influence of multiple risk-taking behaviors (i.e., risky sexual behavior, tobacco/alcohol use, illicit drug use, delinquent behavior, violent behavior) on adolescent suicidal thoughts/behaviors. Data from the National Longitudinal Study of Adolescent Health was utilized. The sample consisted of 4,834 adolescents who completed home interviews at two time points. At the first time point, participants' mean age was 15.15, with 48% (n = 2,315) identifying as male. Participants provided information about suicidal thoughts/behaviors and multiple risk-taking behaviors at an initial interview and at a second interview, approximately 11 months later. When independently examined, nearly all assessed risk-taking behaviors were independently associated with suicidal ideation concurrently and prospectively, and with suicide attempts concurrently. When all risk-taking behaviors were examined simultaneously, illicit drug use was the only significant concurrent and significant prospective, albeit negative, predictor of suicidal thoughts and only concurrent predictor of suicidal behavior. The current findings suggest that illicit drug use may have a stronger association with suicidal thoughts and behaviors than other risk-taking behavior. These findings have implications for prevention and intervention programs for adolescents.

Suicidal ideation and behavior in institutions of higher learning: A latent class analysis

Suicide is the second leading cause of death among undergraduate students, with an annual rate of 7.5 per 100,000. Suicidal behavior (SB) is complex and heterogeneous, which might be explained by there being multiple etiologies of SB. Data-driven identification of distinct at-risk subgroups among undergraduates would bolster this argument. We conducted a latent class analysis (LCA) on survey data from a large convenience sample of undergraduates to identify subgroups, and validated the resulting latent class model on a sample of graduate students. Data were collected through the Interactive Screening Program deployed by the American Foundation for Suicide Prevention. LCA identified 6 subgroups from the undergraduate sample (N = 5654). In the group with the most students reporting current suicidal thoughts (N = 623, 66% suicidal), 22.5% reported a prior suicide attempt, and 97.6% endorsed moderately severe or worse depressive symptoms. Notably, LCA identified a second at-risk group (N = 662, 27% suicidal), in which only 1.5% of respondents noted moderately severe or worse depressive symptoms. When graduate students (N = 1138) were classified using the model, a similar frequency distribution of groups was found. Finding multiple replicable groups at-risk for suicidal behavior, each with a distinct prevalence of risk factors, including a group of students who would not be classified as high risk with depression-based screening, is consistent with previous studies that identified multiple potential etiologies of SB.

Parent-Adolescent Acculturation Gap and Suicidal Ideation among Adolescents from an Emergency Department

The objective of this article is to examine the impact of parent-adolescent acculturation gap on vulnerability to suicidal ideation among adolescents presenting to an emergency department with suicidal behavior. A multiethnic sample of adolescents (n = 43) and their parents (n = 43) completed an acculturation measure, and adolescents reported on emotion reactivity, hopelessness, depressive symptoms, and suicidal ideation. The direction of the association between suicidal ideation and vulnerability variables varied depending on the size of the acculturation gap. Emotion reactivity was more negatively associated with suicidal ideation the larger the parent-adolescent acculturation gap, while hopelessness was more strongly associated with suicidal ideation the smaller the gap, adjusting for depressive symptoms. Assessments of racial/ethnic minority adolescents at risk for suicidal behavior should address parent-adolescent acculturation gaps.

Health-Related Issues in Latina Youth: Racial/Ethnic, Gender, and Generational Status Differences

PURPOSE

Few studies have examined the early development of a broad range of health issues of importance in adolescence in Latina (female) youth, despite their being potentially a vulnerable group. This study compared suicide and depressive symptoms, substance use, violence exposure, injury prevention, obesity, and health-related quality of life among Latina, African-American, and white females as well as Latino (male) youth in fifth grade, as well as differences related to immigrant generational status for Latinas.

METHODS

Data were from the Healthy Passages study, including 3,349 African-American, Latina, and white females as well as Latino male fifth graders in three U.S. metropolitan areas. Self-report items and scales were used to compare status on health-related issues. Generational status was classified based on the parent report of birth location. Logistic and linear regression analyses were conducted, including adjustment for sociodemographic differences.

RESULTS

Latinas showed higher vulnerability than white females for several health issues, whereas few remained after adjustments for sociodemographic differences (higher obesity, lower bike helmet use, and lower physical health-related quality of life). Latina's lower vulnerability compared with African-American females generally persisted after adjustments. Third generation Latinas, after adjustments, reported lower prevalence of alcohol use and fewer friends using alcohol, yet higher future intentions of alcohol use, than first and second generation Latinas. There were few differences between Latina and Latino youth.

CONCLUSIONS

Latina youth generally report low vulnerability across health issues in preadolescence. To the extent they appear at higher vulnerability than white females, this may be related to their disadvantaged sociodemographic status.

Combined Patterns of Risk for Problem and Obesogenic Behaviors in Adolescents: A Latent Class Analysis Approach

BACKGROUND

Several studies have used latent class analyses to explore obesogenic behaviors and substance use in adolescents independently. We explored a variety of health risks jointly to identify distinct patterns of risk behaviors among adolescents.

METHODS

Latent class models were estimated using Youth Risk Behavior Surveillance System (YRBSS) 2011 data. Behaviors in the models included substance use, physical fights, physical activity (PA), sedentary activity, sleep, fruit and vegetables (F&V) consumption, and weight-related variables. Models were estimated separately by sex. Constrained and unconstrained models were computed for race. Age and perceived and calculated weight status were compared among emergent latent classes using latent multinomial logistic regressions.

RESULTS

Four and 5 latent class solutions emerged for boys and girls, respectively. Healthy, sedentary, and physically active (PA) groups were common in both boys and girls. The sample of boys also included a health risk behavior (HRB)/PA group and the sample of girls included HRB and HRB/F&V groups.

CONCLUSIONS

The results confirm that obesogenic and HRBs should be conceptualized as combined patterns of risk. Health education programming in schools should adopt a multiple health behavior approach to target the continuum of risks adolescents engage in simultaneously.

Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department

The pediatric emergency department (ED) is a critical location for the identification of children and adolescents at risk for suicide. Screening instruments that can be easily incorporated into clinical practice in EDs to identify and intervene with patients at increased suicide risk is a promising suicide prevention strategy and patient safety objective. This study is a retrospective review of the implementation of a brief suicide screen for pediatric psychiatric ED patients as standard of care. The Ask Suicide Screening Questions (ASQ) was implemented in an urban pediatric ED for patients with psychiatric presenting complaints. Nursing compliance rates, identification of at-risk patients, and sensitivity for repeated ED visits were evaluated using medical records from 970 patients. The ASQ was implemented with a compliance rate of 79 %. Fifty-three percent of the patients who screened positive (237/448) did not present to the ED with suicide-related complaints. These identified patients were more likely to be male, African American, and have externalizing behavior diagnoses. The ASQ demonstrated a sensitivity of 93 % and specificity of 43 % to predict return ED visits with suicide-related presenting complaints within 6 months of the index visit. Brief suicide screening instruments can be incorporated into standard of care in pediatric ED settings. Such screens can identify patients who do not directly report suicide-related presenting complaints at triage and who may be at particular risk for future suicidal behavior. Results have the potential to inform suicide prevention strategies in pediatric EDs.

Psychopathology profiles of acutely suicidal adolescents: Associations with post-discharge suicide attempts and rehospitalization

BACKGROUND

Suicidal adolescents are heterogeneous, which can pose difficulties in predicting suicidal behavior. The Youth Self-Report (YSR) psychopathology profiles predict the future onset of psychopathology and suicide-related outcomes. The present study examined the prevalence and correlates of YSR psychopathology profiles among suicidal adolescents and prospective associations with post-discharge rates of suicide attempts and psychiatric rehospitalization.

METHODS

Participants were acutely suicidal, psychiatrically hospitalized adolescents (N=433 at baseline; n=355 at follow-up) who were enrolled in a psychosocial intervention trial during hospitalization. Psychopathology profiles were assessed at baseline. Suicide attempts and rehospitalization were assessed for up to 12 months following discharge.

RESULTS

Latent profile analysis identified four psychopathology profiles: subclinical, primarily internalizing, and moderately and severely dysregulated. At baseline, profiles differed by history of non-suicidal self-injury (NSSI) and multiple suicide attempts (MA) as well as severity of suicide ideation, hopelessness, depressive symptoms, anxiety symptoms, substance abuse, and functional impairment. The dysregulation profiles predicted suicide attempts within 3 months post-discharge. The internalizing profile predicted suicide attempts and rehospitalization at 3 and 12 months.

LIMITATIONS

This study's participants were enrolled in a randomized trial and were predominantly female, which limit generalizability. Additionally, only a history of NSSI was assessed.

CONCLUSIONS

The dysregulation profile was overrepresented among suicidal youth and associated with impairment in several domains as well as suicide attempts shortly after discharge. Adolescents with a severe internalizing profile also reported adverse outcomes throughout the study period. Psychopathology profiles warrant further examination in terms of their potential predictive validity in relation to suicide-related outcomes.

Insomnia symptoms and suicidality in the National Comorbidity Survey - Adolescent Supplement

OBJECTIVE

In this paper, we examined the relationship between insomnia symptoms and suicidality in a national sample of US adolescents, while controlling for several psychiatric disorders that are known to be associated with suicidality. Additionally, we examined whether insomnia symptoms interact to affect any suicidality variables.

METHODS

Study participants were 10,123 adolescents between the ages of 13-18 from the National Comorbidity Survey - Adolescent Supplement (NCS-A).

RESULTS

In bivariate analyses, all insomnia symptoms (i.e., difficulty falling asleep, difficulty staying asleep, and early morning awakening) were associated with suicide ideation, plan and attempts. In multivariate analyses, controlling for substance use, mood and anxiety disorders, as well as important covariates, difficulties falling and staying asleep had a significant relationship with 12-month and lifetime suicide variables while early morning awakening did not.

CONCLUSIONS

Two of the three insomnia symptoms had a significant association with suicide thoughts and plan even after controlling for psychiatric disorders that were known to affect suicidality. Having trouble falling sleeping or staying asleep had both direct and indirect relationships (via substance use, mood and anxiety disorders) on suicidal behavior. Assessment and treatment of sleep disturbances may reduce the risk for suicidality in adolescents.

Suicide Ideation and Attempts Among Adolescents Engaged in Risk Behaviors: A Latent Class Analysis

This study addressed gaps in the literature regarding how different profiles of adolescent risk behavior relate to suicide. Data came from the 2010 Minnesota Student Survey of 9th and 12th grade students. Latent class analysis derived a set of four classes reflecting unique patterns of eight behaviors: maladaptive dieting, prescription drug misuse, illegal drug use, marijuana use, problem drinking, risky sexual behavior, perpetration of interpersonal violence, and self-injury. A class demonstrating high engagement in all risk behaviors, and a class highest on self-injury and maladaptive dieting but low on several other risk behaviors, showed high risk for suicide. Practitioners should carefully monitor adolescents engaging in multiple risk behaviors for suicide, especially if self-injury and maladaptive dieting are present.

A Cross-National Comparison of Suicide Attempts, Drug Use, and Depressed Mood Among Dominican Youth

We compared suicide attempts, depressed mood, and drug use of 1,710 Dominican public high school students in New York City (NYC) and 9,573 in the Dominican Republic (DR) in 2009. Compared to DR Dominicans, NYC Dominicans were more likely to have reported lifetime marijuana use (27.6% vs. 1.5%), lifetime inhalant use (11.0% vs. 7.6%), lifetime other drug use (9.9% vs. 3.0%), depressed mood (31.3% vs. 27.2%), and suicide attempt (13.8% vs. 8.8%). The results of this study supported the hypothesis that substantial increases in illicit drug use, especially cocaine, heroin, ecstasy, and methamphetamines, among NYC Dominican youth account for their increased risk for suicide attempts compared to their DR Dominican counterparts. It also identified suicide attempts as a public health problem among NYC Dominicans, the largest NYC Latino immigrant population.

Racial/ethnic differences in youth depression indicators: An item response theory analysis of symptoms reported by White, Black, Asian, and Latino youths

Accurate assessment of dysfunction is central to clinical psychological science, essential for valid conclusions about prevalence, risk, and appropriate intervention. Measures applied without adjustment across diverse racial/ethnic groups may risk errors if measurement equivalence has not been established. We tested this possibility in the domain of youth depression, applying item response theory (IRT) and differential item functioning (DIF) analyses to reports by White, Black, Latino, and Asian youths (N = 2,335) on the most widely-used measure of symptoms, the Children's Depression Inventory (CDI). Analyses revealed that 77% of CDI items were non-equivalent indicators of symptom severity across groups. CDI sum scores exhibited marked over-estimations of group differences and inappropriate classification as "clinically-elevated" for 29% of Latino, 23% of Black, and 10% of Asian youths. Applying DIF adjustment corrected these errors. The study demonstrates a useful strategy for ethnically sensitive assessment, applicable to other symptom domains and ethnic groups.

Physical dating violence among adolescents and young adults with alcohol misuse

BACKGROUND

This study determined prevalence and correlates of physical dating violence (victimization or aggression) among male and female youth with alcohol misuse and seeking emergency department (ED) care.

METHODS

Patients age 14-20 seeking care at a single large university-based ED completed a computerized, self-administered, cross-sectional survey. Measures included demographics, alcohol and substance use, mental health problems, health service use, peer influences, parent support, and community involvement. Bivariate and multivariate regression assessed physical dating violence correlates.

RESULTS

Among 842 male and female youth seeking ED care who screened positive for alcohol misuse, 22.3% (n=188) reported dating violence in the past year. Multivariate analyses showed variables associated with dating violence were female gender (AOR 2.17, CI 1.46-3.22), Caucasian race (AOR 0.59, CI 0.37-0.93), receipt of public assistance (AOR 1.82, CI 1.16-2.87), AUDIT Score (AOR 1.06, CI 1.02-1.10), older age of drinking onset (AOR 0.86, CI 0.77-0.96), suicidal ideation or attempt (AOR 1.95, CI 1.13-3.37), frequency of ED visits (AOR 1.22, CI 1.05-1.46), negative peer influences (AOR 1.05, CI 1.01-1.10), and positive peer influences (AOR 0.86, CI 0.80-0.93).

CONCLUSIONS

Nearly 1 in 4 youth with alcohol misuse seeking ED care report dating violence. Key correlates of dating violence included alcohol use severity, suicidal ideation, ED services, and peer influences. Evidence-based dating violence interventions addressing these correlates are needed for youth with alcohol misuse seeking ED care.

Exploring risk and protective factors with a community sample of American Indian adolescents who attempted suicide

American Indian adolescents are at disproportionate risk for suicide, and community-based studies of this population, which allow a deeper understanding of risks and resilience to inform interventions, are rare. This is a cross-sectional study of N = 71 Apache adolescents. Strengths include the role of the community and American Indian paraprofessionals in the design, implementation, and interpretation of findings. Participants were M = 16.0 years old, 65% female, and 69% multiple attempters. Risks included suicidal behavior among peers and family (68%), caregivers with substance problems (62%), and participant substance use history, namely alcohol (91%) and marijuana (88%). Areas of resiliency included lower depression scores (M = 23.1) and cultural activity participation. A multi-tiered intervention at individual, family, and community levels is needed.

Screening Incarcerated Juveniles Using the MAYSI-2

The high prevalence of mental health disorders among incarcerated juveniles is a matter of national and global concern. Juvenile justice personnel need accurate screening measures that identify youth requiring immediate mental health services. The purpose of this study was threefold: (a) to examine the utility of the Massachusetts Youth Screening Instrument, Version 2 (MAYSI-2) in identifying juveniles with mental health concerns in a large sample of juveniles (N = 4,009), (b) to provide data regarding rates of identified mental health needs in incarcerated youth, and (c) to provide descriptive comparisons to other studies using the MAYSI-2. Mean scores of subscales were compared with the MAYSI-2 normative samples and other recent studies. Results indicated that this population has a high occurrence of mental health symptoms and there is high variability in the severity of the symptoms. In addition, a multivariate analysis of variance test found significant differences in mental health problems across ethnic groups.

Suicidal ideation in adolescents: A structural equation modeling approach

The purpose of this study is to test a model linking adolescents' experience of violence and peer support to their happiness and suicidal ideation. The participants were high school students in Seoul, and in Kyungi, and Chungnam Provinces in Korea. The Conflict Tactics Scale, School Violence Scale, Oxford Happiness Inventory, and Suicidal Ideation Questionnaire were administered to just over 1000 adolescents. The model was tested using a path analysis technique within structural equation modeling. The model fit indices suggest that the revised model is a better fit for the data than the original hypothesized model. The experience of violence had a significant negative direct effect and peer support had a significant positive direct effect on their happiness. Happiness had a significant negative effect and the experience of violence had a significant positive effect on suicidal ideation. These findings demonstrate the fundamental importance of reducing exposure of violence to adolescents, and that increasing peer support and their happiness may be the key to adolescent suicidal ideation prevention.

Suicide attempts in a emergency hospital

This study aimed to characterize the profiles of suicide attempts that were attended to in the Hospital of Alagoas in the year 2010. Four hundred sixty-one charts and service bulletins were analyzed. Patients attempting suicide were predominately female. There were significant difference for suicide attempts (SAs) among men and women in the age of 10 to 19 years and 60 to 69 years. Women have tried more suicide aged between 10 and 19 years and men between 60 and 69 years. The ingestion of drugs was the most frequent method for women; and poisoning, use of sharp objects and hanging for men. The results of this study may contribute to elaboration, planning and implementation of preventive measures to reduce cases of SAs.

Nonsuicidal self-harm and suicide attempts in adolescents: differences in kind or in degree?

PURPOSE

The purpose of the present study was to measure the prevalence of self-harm (SH) behaviours and examine potential differences in characteristics among adolescents reporting on self-harm (SH), depending on whether they had attempted suicide (SA), performed nonsuicidal self-harm (NSSH), or both.

METHODS

Cross-sectional survey of 11,440 adolescents aged 14-17 years in the city of Oslo, Norway. Responses regarding measures of lifetime SH and risk factors were collected. The response rate was 92.7%. Data were analysed by segregating SH responses into the categories of NSSH, SA, and NSSH + SA.

RESULTS

Among all respondents, 4.3% reported NSSH, 4.5% reported SA, 5.0% reported both NSSH and SA, and 86.2% reported no SH. The group reporting to have engaged in both behaviours comprised more girls and reported more suicidal ideation, problematic lifestyles, poorer subjective health, and more psychological problems compared with the other groups. The four groups could be distinguished by one discriminant function that accounted for most of the explained variance.

CONCLUSIONS

Our findings suggest that NSSH and SA are parts of the same dimensional construct in which suicidal ideation carries much of the weight in adolescents from a school-based sample. They also indicate the group of adolescents who seems to alternate between NSSH and SA is more burdened with mental ill-health and behavioural problems compared with others. These adolescents should therefore be targeted by clinicians and school health personnel for identification and provision of adequate help and services.

The prospective relationship between sleep problems and suicidal behavior in the National Longitudinal Study of Adolescent Health

OBJECTIVE

Previous research has found a longitudinal relationship between sleep problems and suicidal behavior while controlling for depression and other important covariates in a high risk sample of adolescents and controls. In this paper, we replicated this longitudinal relationship in a national sample and examined whether the relationship was partially mediated by depression, alcohol-related problems and other drug use.

METHODS

Study participants were 6504 adolescents from the National Longitudinal Study of Adolescent Health (ADD HEALTH).

RESULTS

In bivariate analyses, sleep problems (i.e., having trouble falling asleep or staying asleep) at Wave 1 were associated with suicidal thoughts and suicide attempts at Waves 1, 2, and 3 (W1, 2 and 3). In multivariate analyses, controlling for depression, alcohol problems, illicit drug use, and important covariates such as gender, age, and chronic health problems, sleep problems at a previous wave predicted suicidal thoughts and suicide attempts at a subsequent wave. In mediation analyses, W2 depression significantly mediated the effect of W1 sleep problems on W3 suicide thoughts. Moreover, W2 suicidal thoughts also significantly mediated the effect of W1 sleep problems on W3 suicidal attempts.

CONCLUSIONS

Sleep problems appear to be a robust predictor of subsequent suicidal thoughts and attempts in adolescence and young adulthood. Having trouble falling sleeping or staying asleep had both direct and indirect effects (via depression and suicidal thoughts) on suicidal behavior. Future research could determine if early intervention with sleep disturbances reduces the risk for suicidality in adolescents and young adults.