[Suicide in children and adolescents]

Predictors of suicidal behavior in a high school student population: a cross-sectional study

AIM

To examine high school students' suicidal behavior and to identify predictors of suicide attempt among adolescents in Timis County, Romania. We hypothesized that suicide attempt is associated with other health-risk behaviors.

METHODS

In this cross-sectional study we included 2908 high school students in grades 9 to 12. The students were asked to complete an anonymous structured questionnaire during a normal class. We examined the relationship between having attempted suicide and engaging in other health-risk or problem behaviors.

RESULTS

During the previous 12 months, 15.4% of the students had had suicidal ideation, 7.5% had made a suicide plan and 6.1% reported that they had attempted suicide. Based on logistic regression multivariate analysis, attempted suicide was associated with feeling sad or hopeless almost every day for two or more consecutive weeks (OR = 4.74; 95% CI: 3.07-7.31), being forced to have sexual intercourse (OR = 3.18; 95% CI: 1.83-5.50), being physically aggressed by his or her father (OR = 4.28; 95% CI: 1.96-9.34), performing poorly at school (OR = 4.22; 95% CI: 1.51-11.74), having an impaired relationship with parents (OR = 2.45; 95% CI: 1.17-5.12), not eating for 24 hours or more to lose weight or to avoid gaining weight during the past 30 days (OR = 2.23; 95% CI: 1.40-3.53), being female (OR = 1.91; 95% CI: 1.21-2.99) and carrying a weapon (OR = 2.44; 95% CI: 1.53-3.90).

CONCLUSION

This study suggests that suicide attempts are associated with other risk behaviors. These behaviors may help to evaluate suicide risk and should be considered when establishing preventive programs.

Genetics of suicide: a systematic review of twin studies

OBJECTIVES

Convergent evidence from a multitude of research designs (adoption, family, genomescan, geographical, immigrant, molecular genetic, surname, and twin studies of suicide) suggests genetic contributions to suicide risk. The present account provides a comprehensive and up-to-date review of the twin studies on this topic.

METHODS

A total of 32 studies (19 case reports, 5 twin register-based studies, 4 population-based epidemiological studies, 4 studies of surviving co-twins) located through extensive literature search strategies are summarized and discussed here. This literature corpus was published between 1812 and 2006 in six languages and reports data from 13 countries.

RESULTS

A meta-analysis of all register-based studies and all case reports aggregated shows that concordance for completed suicide is significantly more frequent among monozygotic than dizygotic twin pairs. The results of co-twin studies rule out exclusively psychosocially based explanations of this pattern. Population-based epidemiological studies demonstrate a significant contribution of additive genetic factors (heritability estimates: 30-55%) to the broader phenotype of suicidal behavior (suicide thoughts, plans and attempts) that largely overlaps for different types of suicidal behavior and is largely independent of the inheritance of psychiatric disorders. Nonshared environmental effects (i.e. personal experiences) also contribute substantially to the risk of suicidal behavior, whereas effects of shared (family) environment do not.

CONCLUSIONS

The totality of evidence from twin studies of suicide strongly suggests genetic contributions to liability for suicidal behavior. To further research progress in this area, an extensive discussion of design limitations, shortcomings of the literature and further points is provided, including sources of bias, gaps in the literature, errors in previous reviews, age and sex effects and twin-singleton differences in suicide risk, and notes from a history-of-science view.

Surname study of suicide in Austria: differences in regional suicide rates correspond to the genetic structure of the population

OBJECTIVES

There is convergent evidence from adoption, family, geographical, immigrant, molecular genetic, twin and, most recently, surname studies of suicide for genetic contributions to suicide risk. Surnames carry information about genetic relatedness or distance and, in patrilineal surname systems, are a close substitute for Y-chromosome markers and haplotypes, since surname transmission is similar to the transmission of the nonrecombining part of the Y chromosome. This study investigated whether differences in regional suicide rates correspond to the genetic structure of the Austrian population.

METHODS

Differences in district-level standardized suicide rates 1988-94 between the five major surname regions identified for Austria were analyzed. The surname regions used in the analysis reflect the contemporary population structure and closely follow the natural borders found in the topography of Austria, less so its administrative division into nine states.

RESULTS

Surname region accounted for a significant (P < 0.001) and substantial (38%) portion of the variance in district-level suicide rates. Adjusting the suicide rates for a set of five social and economic indicators that are established ecological correlates of suicide prevalence (income, and rates of the divorced, unemployed, elderly and Roman Catholics) left the results essentially unchanged.

CONCLUSIONS

Regional differences in suicide rates within Austria correspond to the genetic structure of the population. The present evidence adds to related findings from geographical and surname studies of suicide that suggest a role for genetic risk factors for suicidal behavior. Genetic differences between subpopulations may partially account for the geography of suicide. Study limitations and directions for future research are discussed.

Suicidal ideation among Viennese high school students

OBJECTIVE

Suicidality spans a spectrum ranging from suicidal thoughts to suicidal acts, and suicidal ideation is more prevalent in youth populations, suggesting important developmental issues. We assessed the prevalence of lifetime suicidal ideation and associated psychosocial factors among Viennese high school students.

METHOD

An anonymous self-report survey assessing demographic characteristics and the major psychiatric risk factors of teenage suicide was completed by students at three Viennese high schools (n = 214; mean age 15.4 years).

RESULTS

Eighty-one (37.9%) high school students reported having had suicidal thoughts at some point in their lives, girls significantly more often than boys (48.5% vs. 29.1%, P = 0.004). Furthermore, lifetime suicidal ideation in Viennese high school students was associated with living in broken-home families, cigarette smoking, substance problems (alcohol/drugs), self-reported depression, and high school type (the highest prevalence was in grammar school). After adjusting for confounders, we found that female gender, substance problems, school type and cigarette smoking were significantly associated with lifetime suicidal ideation in Viennese high school students.

CONCLUSIONS

The psychosocial factors associated with adolescent suicidal ideation require attention in the contexts of suicide prevention and mental health promotion.