Dimensions of adolescent psychopathology and relationships to suicide risk indicators

Suicide While Locked Up in Texas: Risk Factors for Death by Suicide in Custody

In the United States, suicide is a leading cause of death in prisons and jails, with incarcerated individuals being nine times more likely to die by suicide than the general population. Identifying vulnerabilities at each stage of custody (prebooking, jail, prison) and factors that increase suicide risk can improve prevention efforts. A hierarchical binary logistic regression was conducted on data from the Texas Justice Initiative's Deaths in Custody Report. Variables included race/ethnicity, sex, age at death, days in custody, classification of crime as violent or nonviolent, and custody type of prebooking, jail, or prison. Among main effects, when compared to suicide rates in prison, jail suicide deaths were over three and a half times more likely (OR = 3.61), and the period of prebooking emerged as a period of staggering risk of suicide death, with suicides being over 5,000% more likely than at other stages of custody (OR = 50.86). When interactions were entered, Latinx individuals were at a particularly increased risk of suicide death (OR = 10.46), likelihood of suicide death decreased with each year of age (OR = .89), nonviolent offenders were just under three and a half times more likely to die by suicide when compared to violent offenders (OR = 3.45), and each stage of custody was shown to affect the relationship between age-related rates of suicide in different ways. Results call for further investigation into suicide among understudied populations in corrections, such as Latinx individuals, juveniles in the prison system, and nonviolent offenders, to identify the groups at the highest risk of premature death in correctional systems.

Evaluation of suicide probability in children and adolescents with epilepsy

BACKGROUND

We aimed to examine suicide probability, factors affecting suicide, and personality traits of children and adolescents diagnosed with epilepsy, and to compare their results with those of children without epilepsy.

METHODS

Fifty-six children diagnosed with epilepsy and 56 control children, aged 11-16 years, were evaluated by using the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria, the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version, the Child Depression Inventory, the Suicide Probability Scale (SPS), and the Personality Inventory for DSM-5 - Brief Form - Children (PID-5-BF) scales. Factors predicting suicide risk in children with epilepsy were analyzed.

RESULTS

The mean age, SPS total score, and hopelessness subscale score, PID-5-BF total score as well as disinhibition and psychoticism subscale scores of the epilepsy group were significantly higher than those of the control group (P < 0.05). There was no significant difference between the groups in terms of the Child Depression Inventory, and other subscales of the Suicide Probability Scales and PID-5-BF scales. The SPS total score was higher in patients with comorbid psychiatric diseases, those using psychiatric drugs, and girls (P < 0.05). An ANCOVA analysis indicated that the most important factor that predicted the probability of suicide and its subscale scores was the level of depression, and the presence of epilepsy was not predictive.

CONCLUSIONS

We found a high probability of suicide and personality pathology in children with epilepsy but the main predictor of suicide probability was the level of depression, not the presence of epilepsy.

Children and Adolescents' Psychological Well-Being Became Worse in Heavily Hit Chinese Provinces during the COVID-19 Epidemic

In light of the novel coronavirus’s (COVID-19’s) threat to public health worldwide, we sought to elucidate COVID-19’s impacts on the mental health of children and adolescents in China. Through online self-report questionnaires, we aimed to discover the psychological effects of the pandemic and its associated risk factors for developing mental health symptoms in young people.

We disseminated a mental health survey through online social media, WeChat, and QQ in the five Chinese provinces with the most confirmed cases of COVID-19 during the late stage of the country-wide lockdown. We used a self-made questionnaire that queried children and adolescents aged 6 to 18 on demographic information, psychological status, and other lifestyle and COVID-related variables.

A total of 17,740 children and adolescents with valid survey data participated in the study. 10,022 (56.5%), 11,611 (65.5%), 10,697 (60.3%), 6868 (38.7%), and 6225 (35.1%) participants presented, respectively, more depressive, anxious, compulsive, inattentive, and sleep-related problems compared to before the outbreak of COVID-19. High school students reported a greater change in depression and anxiety than did middle school and primary school students. Despite the fact that very few children (0.1%) or their family members (0.1%) contracted the virus in this study, the psychological impact of the pandemic was clearly profound. Fathers’ anxiety appeared to have the strongest influence on a children’s psychological symptoms, explaining about 33% of variation in the child’s overall symptoms. Other factors only explained less than 2% of the variance in symptoms once parents’ anxiety was accounted for.

The spread of COVID-19 significantly influenced the psychological state of children and adolescents in participants’ view. It is clear that children and adolescents, particularly older adolescents, need mental health support during the pandemic. The risk factors we uncovered suggest that reducing fathers’ anxiety is particularly critical to addressing young people’s mental health disorders in this time.

Depression, Non-Suicidal Self-Injury, and Suicidality in Adolescents: Common and Distinct Precursors, Correlates, and Outcomes

Depression, non-suicidal self-injury (NSSI), and suicidal thoughts and behaviors (STB) often emerge during adolescence. Despite considerable overlap in clinical presentation, risk factors, and implicated neurobiology, there is also evidence for divergence in terms of precursors, correlates, and outcomes. The complex interrelationships amongst these three clinical domains require considering both shared and divergent patterns of risk for depression, NSSI, and STB; a clearer understanding of these developmental trajectories will be needed to guide optimization and tailoring of early interventions.

Parent-Reported Rates and Clinical Correlates of Suicidality in Children with Autism Spectrum Disorder: A Longitudinal Study

This study investigated rates of suicidal ideation (SI) and suicidal and/or self-injurious behaviour (SSIB) reported by parents on the Child Behavior Checklist for 178 children with ASD over four annual assessments (ages 7-11 years). Analyses examined the frequency and persistence of SI and SSIB, and the association of SI and SSIB at any time point with child characteristics and internalizing and externalizing problems at age 7. SI occurred in 9.6% of children and was associated with fewer ASD symptoms and better adaptive functioning at age 7. SSIB occurred in 14.6% and was associated with poorer adaptive functioning and more externalizing behaviour at age 7. Internalizing problems were not associated with SI or SSIB at any time point. SI and SSIB rarely co-occurred (4%).

Psychosocial Factors Correlated with Undisclosed Suicide Attempts to Significant Others: Findings from the Adolescence SEYLE Study

OBJECTIVE

Suicide attempt (SA) is recognized as one of the risk factors for completed suicides. The concealment of this behavior often hinders detection and management of suicide risk. Thus, in this study, we sought to shed light on adolescents' psychosocial processes that could facilitate disclosure of SAs. Specifically, we sought to identify antecedents of adolescent SAs that had not been revealed to significant others.

METHOD

A high school sample) N = 990 (completed a self-report questionnaire tapping psychiatric, personal, and interpersonal characteristics, as well as suicidality, as part of the SEYLE project. Twenty-seven adolescents acknowledged having made an SA without disclosing it to parents or to other significant others. They were compared with 47 adolescents who made SAs that were communicated to others and with a control group of 916 adolescents having no history of suicidal behavior.

RESULTS

Compared with disclosures and controls, non-disclosing suicide attempters were characterized by higher levels of suicide ideation, distress, and victimization. Low levels of self-disclosure and parental support were significantly associated with undisclosed SAs.

CONCLUSIONS

Interpersonal difficulties may be related to loneliness and a thwarted sense of belongingness, which may explain the failure to disclose SAs. Implications related to assessment and prevention are discussed.

Predictors of Suicidal Behaviors in Canadian Adolescents with No Recent History of Depression

We examined risk factors for suicidal behaviors (i.e., suicidal ideation and suicide attempts) in the absence of depression during adolescence. Using 6,788 adolescents from the National Longitudinal Survey of Children and Youth (NLSCY), we identified participants with "no recent history of depression." We then tested the effects of risk factors at age 14-15 on suicidal behaviors at age 16-17. Absence of recent depression history negatively predicted both suicidal ideation and suicide attempt. However, among those with no history of depression, substance use and the presence of a chronic illness both increased the risk of suicidal behaviors. Suicidal behavior in adolescents in the absence of depression history may be explained by factors such as substance use and chronic illness.

Suicidal Ideation and Behavior in Youth in the Juvenile Justice System: A Review of the Literature

Suicide is prevalent among youth, especially those involved in the juvenile justice system. Although many studies have examined suicidal ideation and behavior in delinquent youth, prevalence rates vary widely. This article reviews studies of suicidal ideation and behavior in youth in the juvenile justice system, focusing on the point of contact: incarceration status and stage of judicial processing. Suicidal ideation and behavior are prevalent and increase with greater involvement in the juvenile justice system. Depression, sexual abuse, and trauma were the most commonly identified predictors of suicidal ideation and behavior. Prevalence rates of suicidal ideation and behavior vary by gender and race/ethnicity, indicating the need for gender-specific and culturally relevant interventions.

Are students prone to depression and suicidal thoughts?

INTRODUCTION

Depression may affect up to 9.8% of adolescents and young adults and is associated with significant life-long consequences. The aim of our study was to assess the association between symptoms of depression and demographic factors such as gender, having brothers or sisters, background (rural/small town or urban permanent place of residence), perceived financial status, current living arrangements, year and major area of study.

MATERIAL AND METHODS

One thousand one hundred eighty-three students of medical or similar faculties, 71% of whom were females, anonymously answered the Kutcher Adolescent Depression Scale (KADS) and completed a demographic questionnaire.

RESULTS

We found that 6.5% of all participants (n = 77) had depression according to Kutcher's criteria whereas 1.5% of them (n = 18) reported suicidal thoughts. We also observed the influence of such factors as gender (p < 0.009), year (p < 0.001), major area of study (p < 0.034), and financial status (p < 0.000-0.003), on depression scores. Moreover, depressive symptomatology was most frequent in subjects who were only children, in freshmen and in students of psychology (11.5%, 13.2% and 16.7% respectively). However, we did not observe an impact of such agents as students' permanent place of residence (p = 0.929) or current living arrangements on depressive symptoms (p = 0.940).

CONCLUSIONS

Susceptibility to depression fluctuates throughout the course of study and depends on factors associated with the study itself such as the student's major or year of study and other socio-demographic agents, i.e. gender or self-reported financial status.

Pathways to suicide-related behavior in offspring of mothers with depression: the role of offspring psychopathology

OBJECTIVE

Offspring of mothers with depression are a high-risk group for the development of suicide-related behavior. These offspring are therefore a priority for preventive interventions; however, pathways contributing to risk, including specific aspects of offspring psychopathology, remain unclear. The aim of this study was to examine whether offspring symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), disruptive behavior disorder (DBD), attention-deficit/hyperactivity disorder (ADHD), and alcohol abuse independently mediate the association between maternal depression and offspring suicide-related behavior.

METHOD

Data were used from a population-based birth cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC). Three distinct classes of depression symptoms across the mothers' first 11 years of their child's life were identified (minimal, moderate, chronic-severe). Offspring psychopathology was assessed at age 15 years and suicide-related behavior at age 16 years. Data were analyzed using structural equation modeling.

RESULTS

There was evidence for increased risk of suicidal ideation in offspring of mothers with chronic-severe depression symptoms in comparison to offspring of mothers with minimal symptoms (odds ratio = 3.04, 95% CI = 2.19, 4.21). This association was independently mediated by offspring MDD, GAD, and DBD symptoms. The same mechanisms were found for offspring of mothers with moderate depression symptoms over time. Results were similar for offspring suicide attempt except for additional evidence of an indirect effect through offspring ADHD symptoms.

CONCLUSION

Findings highlight that suicide prevention efforts in offspring of mothers with depression should not only be targeted at offspring with MDD; it is also important to consider offspring with other forms of psychopathology.

Connectedness and suicidal ideation among adolescents involved with child welfare: a national survey

Using data from the National Survey of Child and Adolescent Well-Being, this study examined the relationship between connectedness in major social domains (i.e., caregiver, peers, deviant peers, and school) and suicidal ideation among adolescents (11-17 years old) investigated by child welfare agencies (N=995). Weighted logistic regression models were used to evaluate the relationships between connectedness variables and suicidal ideation, after adjusting for covariates. Youths with a stronger connection to caregivers were much less likely to report suicidal ideation, whereas youths with stronger deviant peer relationships were significantly more likely to report suicidal ideation. Significant associations found between primary caregiver and deviant peer connectedness and suicidal ideation highlight the need for attentive consideration of these relationships when working with this highly vulnerable population. Identifying domain-specific connectedness factors related to suicidal ideation presents an opportunity for the development of targeted early intervention for child welfare-involved youths.

Beyond butterflies: generalized anxiety disorder in adolescents

A generalized anxiety disorder diagnosis must include thorough history-taking, the use of age-appropriate screening tools, and physical assessment. Research and development into the use of screening tools and effectiveness of treatment strategies for generalized anxiety disorder is needed to better manage adolescents with the disorder.

Suicide risks among adolescents and young adults in rural China

Background: In China, suicide is one of the major causes of death among adolescents and young adults aged 15 to 34 years. Aim: The current study examines how risk factors vary by age groups in rural China, referring to those aged 15 to 24 years and those aged 25 to 34 years. Method: A case-control psychological autopsy (PA) study is conducted in sixteen counties from three Chinese provinces, including 392 suicide cases and 416 community living controls in the sample. Results: In China, young adults aged 25 to 34 years have a higher risk for suicide than adolescents aged 15 to 24 years, and it holds true even controlling for relevant social factors. In addition, age-related factors such as education, marital status, whether having children, status in the family, physical health, and personal income all have varying degrees of impact on suicide risks for rural youth. Conclusions: This study shows that there are some age-related risk factors for suicide at certain life stages and emphasizes that young adults in rural China aged 25 to 34 years have an increased risk of suicide as a result of experiencing more psychological strains with age.

Basic psychological needs, suicidal ideation, and risk for suicidal behavior in young adults

Associations between the satisfaction of basic psychological needs of autonomy, competence, and relatedness with current suicidal ideation and risk for suicidal behavior were examined. Two logistic regressions were conducted with a cross-sectional database of 440 university students to examine the association of need satisfaction with suicidal ideation and risk for suicidal behavior, while controlling for demographics and depressive symptoms. Suicidal ideation was reported by 15% of participants and 18% were found to be at risk for suicidal behavior. A one standard deviation increase in need satisfaction reduced the odds of suicidal ideation by 53%, OR (95% CI) = 0.47 (0.33-0.67), and the odds of being at risk for suicidal behavior by 50%, OR (95% CI) = 0.50 (0.37-0.69). Young adults whose basic psychological needs are met may be less likely to consider suicide and engage in suicidal behavior. Prospective research is needed to confirm these associations.

Strain, depressed mood and suicidal thoughts among maltreated adolescents in the United States

Almost one-fourth of maltreated adolescents report they have thought about killing themselves in the last two weeks. We draw on Agnew's strain theory to develop a model to account for variability in suicidal thoughts among this high-risk group. We used data from a nationally representative sample of 572 maltreated adolescents, aged 11-15. One dimension of relational strain (poorer relationship with peers) and greater depressed mood were directly related to whether adolescents did or did not think about suicide. Depressed mood mediated the relationship between two strain variables (relationship with caregiver and with school) and suicidal thoughts. Child maltreatment strain (being severely harmed) and substance use were not directly related to suicidal thoughts; however, depressed mood appeared to mediate the relationship between drug use and suicidal thoughts. Adolescents who experience child maltreatment and who appear to be disconnected from caregivers, friends and school should be screened for depression and suicidal thoughts.

The impact of exposure to peer suicidal self-directed violence on youth suicidal behavior: a critical review of the literature

There is considerable evidence that being exposed to the suicide or suicidal behavior of another can increase the risk for suicide. Significant relationships between media coverage and youth suicide have been documented in the professional literature. Exposure to familial suicidal behavior has also been established as a risk factor for youth suicidal behavior; However, peer suicide exposure is not as clear cut as research results in this area have been mixed. In the current paper the empirical literature focused on the associations between exposure to peer suicides and suicide attempts and youth suicidal behavior is critically reviewed. Effect sizes were computed for each of the 23 studies included in the review to allow for cross-study comparisons. The results demonstrate that having a friend or acquaintance attempt suicide is significantly related to risk for suicidal thoughts and behavior. However, the support for the relationship between the suicide of a peer and youth suicidal behavior was less consistent. Implications for clinical practice and suicide postvention as well as areas of future research are discussed.

Adolescent suicide in Australia: rates, risk and resilience

Adolescent suicide rates in Australia have fallen significantly during recent years. The incidence, however, clearly remains a serious concern for young people, parents, professionals and policy makers. Some groups of Australian youth appear to be at heightened risk. Adolescents within the welfare system, indigenous, rural and refugee youth, along with same sex attracted young people often need very careful monitoring and support. Young men continue to take their lives more frequently than young women. Prevention programmes in Australia aim to develop resilience in young people, families and communities that can serve as protection against self harm and suicide. The improvement of mental health literacy, a fostering of adolescent self-efficacy and better access to early intervention strategies are currently privileged in national and state policies related to young people in Australia. More work is needed, however, to achieve a well integrated mental health framework capable of effectively addressing adolescent suicide prevention into the twenty-first century.

Sexual abuse and substance abuse increase risk of suicidal behavior in Malaysian youth

INTRODUCTION

The aim of this study was to determine the association between sexual abuse, substance abuse and socio-demographic factors with suicidal ideation (SI), plans (SP) and deliberate self-harm (DSH) and propose steps to prevent youth suicidal behavior.

METHODS

This was a cross-sectional study of 6786 adolescents aged 17-18 years, selected randomly from all Malaysian adolescents to undergo compulsory youth camps located in Selangor, Malaysia (2008-2009). Participants were assessed using self-administered questionnaires developed to reflect the local cultural setting. However, only 4581 subjects were analyzed after excluding incomplete data.

RESULTS

The rates of SI, SP and DSH were 7.6%, 3.2% and 6.3%, respectively. The multivariable-adjusted odds ratio showed that sexual abuse was associated with SI 1.99 (95% CI: 1.56-2.55), SP 1.57 (95% CI: 1.09-2.27) and DSH 2.26 (95% CI: 1.75-2.94); illicit drug use was associated with SI 4.05 (95% CI: 2.14-7.67), SP 2.62 (95% CI: 1.05-6.53) and DSH 2.06, (95% CI: 1.05-4.04); for alcohol use DSH was 1.34 (95% CI: 1.00-1.79). Being female was associated with all suicidal behaviors: SI 2.51 (95% CI: 1.91-3.30), SP 2.07 (95% CI: 1.39-3.08) and DSH 1.59 (95% CI: 1.19-2.11).

DISCUSSION

Given the well-founded concern of increasing risk of suicidal behavior among youth, preventive efforts should adopt a more comprehensive approach in dealing with sexual abuse and substance abuse, and their sequelae, especially in girls.

The impact of abuse and gender on psychopathology, behavioral disturbance, and psychotropic medication count for youth in residential treatment

This study examined the relationship between gender, abuse history, and clinical change in a residential treatment program for youth with emotional and behavioral disturbance. Admission data and data collected after 1 year of treatment or at discharge were examined for 1,303 youth. Measures included the Suicide Probability Scale, Child Behavior Checklist, and the Diagnostic Interview Schedule for Children. Data also included medication count, demographic data, and history of sexual or physical abuse or both. At intake, girls scored significantly more pathologically than boys on 9 out of 12 measures. At intake, abused youth indicated more hostility, anxiety, and mood disorder symptoms as well as psychotropic medication usage than nonabused youth. Youth improved significantly on all outcome measures with treatment, although interaction effects indicate some differing treatment responses by abuse history or gender. After treatment, girls still scored significantly higher than boys on 6 of 8 outcome measures, and abused youth, especially youth experiencing both sexual and physical abuse, had significantly higher anxiety, affective, behavior, and eating disorder symptom counts and were on more psychotropic medications than nonabused youth. Although behaviorally focused treatment was associated with improvement on every measure, the most important implication of our study is that a singular treatment approach does not fit all youth completely as reflected by continuing treatment needs in our most troubled youth. Additional symptom-focused treatment and research attention must be given to girls and abused youth in residential care to maximize their therapeutic outcomes.