Risk Factors for Suicide Ideation Among Adolescents: Five-Year National Data Analysis

An Analysis of the Longitudinal Effects of Academic Stress, Insecure Attachment, and Sense of Community on Adolescent Suicidal Ideation

This study aimed to examine the independent influences of academic stress, insecure attachment, and sense of community on suicidal ideation among adolescents. In particular, the independent influence of the sense of community on adolescent suicide was verified by controlling for other variables. For this purpose, youth data (7324 persons) from the panel data of the 4th to 6th Korean Education Longitudinal Studies of the Korea Educational Development Institute were used. Statistical analyses were performed using a generalized estimation equation (GEE). The analysis revealed that gender, academic stress, insecure attachment, and sense of community significantly influenced suicidal ideation. Female students had higher suicidal ideation than male students, and the higher the academic stress and degree of insecure attachment, the higher the suicidal ideation. In particular, the independent influence of a sense of community on suicidal ideation was significant; the higher the sense of community, the lower the suicide ideation score. The implication of this study is to comprehensively consider the factors related to adolescent suicidal ideation in various systems based on Bronfenbrenner's ecological theory. This research suggests that helping schools and communities to increase their sense of community, which is a macrosystem factor, is important in preventing adolescent suicide.

Do Cybervictimizations Predict Suicide-Related Behaviors in Adolescents? Mediating Role of the "Escaping" Coping Strategy

The high prevalence of suicide-related behaviors (SRB) among adolescents is a concerning issue that calls for the identification of explanatory and mediating factors involved. This study examines, by gender: (1) the percentage of adolescents reporting SRB, cyberbullying, and cybersexual harassment; (2) the association between cyberbullying and cybersexual harassment with SRB; (3) the predictive power of cybervictimization in SRB; and (4) the mediating role of Escaping coping strategy between cybervictimization and SRB. One thousand and twenty-seven adolescents (62.5% girls) aged 13 to 18 years (M = 15.59, SD = 1.28) participated in the study and completed the Youth Self Report (for SRB), Juvenile Victimization Questionnaire (for cybervictimization), and Adolescent Coping Orientation for Problem Experiences, Spanish (for coping). About 16% of respondents (19% of girls and 8.9% of boys) reported SRB, about 18% reported Cyberbullying (20.8% of girls and 13.0% of boys), and near 23% reported Cybersexual harassment (28.7% of girls and 12.5% of boys). There is a significant association between cybervictimization and SRB, with the presence of cybervictimization increasing the likelihood of SRB by three to four times (especially in boys), and significantly predicting SRB. Escaping coping strategy partially mediates the relationship between cybervictimization and SRB only in girls. The findings that cybervictimization predicts SRB and that Escaping coping mediates this relationship provide insights for the implementation of prevention and intervention policies.

Examining the Effects of Strength Training with Load Progression on Sleep Parameters and Mental Health in College Students

Objective  To compare the effects of strength training with load progression after 4 weeks on sleep parameters and mental health in college students. Methods  A total of 17 university students (11 women, 6 men), ranging from 18 to 21 years old, were randomized into a strength training group (STG) and a control group (CG). The Pittsburgh sleep quality index (PSQI), insomnia severity questionnaire, hospital anxiety and depression (HAD) scale, profile of mood states (POMS), and chronotype were used to evaluate the main outcomes. Training consisted of 60 minute·d -1 (2 times/week, for 4-weeks), with 3 sets of 10 to 12 repetitions, and a 1-minute rest interval between sets and exercises. Baseline and postintervention differences were analyzed using generalized estimating equations (GEE). Results  After 4 weeks of ST, a significant time effect on the chronotype (β: 1.33; p  < 0.05) was observed in the STG. Additionally, there was a significant time and group effect in the reduction of tension (β: 5.00; p  < 0.05), depression (β: 15.41; p  < 0.05), anger (β: 8.00; p  < 0.05), and confusion (β: 6.50; p  < 0.05). For fatigue (β: 2.66; p  < 0.05), there was a significant time effect difference in its reduction. Vigor was meaningfully increased in the STG group (β: -1.75; p  < 0.05). Furthermore, a significant positive relationship was observed between sleep quality and anxiety (r = 0.54; p  = 0.03). Finally, insomnia was positively related with an increase in confusion (r = 0.70; p  = 0.04) and anxiety (r = 0.52; p  = 0.04), as well as with a decrease in vigor (r = -0.71; p  = 0.03). Discussion  Short-term strength training for 4 weeks was effective for improving mental health, helping achieve characteristics of a positive mood profile, that is, low values for negative factors and a high value for the positive factor.

Prevalence and network structure of depression, insomnia and suicidality among mental health professionals who recovered from COVID-19: a national survey in China

Psychiatric syndromes are common following recovery from Coronavirus Disease 2019 (COVID-19) infection. This study investigated the prevalence and the network structure of depression, insomnia, and suicidality among mental health professionals (MHPs) who recovered from COVID-19. Depression and insomnia were assessed with the Patient Health Questionnaire (PHQ-9) and Insomnia Severity Index questionnaire (ISI7) respectively. Suicidality items comprising suicidal ideation, suicidal plan and suicidal attempt were evaluated with binary response (no/yes) items. Network analyses with Ising model were conducted to identify the central symptoms of the network and their links to suicidality. A total of 9858 COVID-19 survivors were enrolled in a survey of MHPs. The prevalence of depression and insomnia were 47.10% (95% confidence interval (CI) = 46.09-48.06%) and 36.2% (95%CI = 35.35-37.21%), respectively, while the overall prevalence of suicidality was 7.8% (95%CI = 7.31-8.37%). The key central nodes included "Distress caused by the sleep difficulties" (ISI7) (EI = 1.34), "Interference with daytime functioning" (ISI5) (EI = 1.08), and "Sleep dissatisfaction" (ISI4) (EI = 0.74). "Fatigue" (PHQ4) (Bridge EI = 1.98), "Distress caused by sleep difficulties" (ISI7) (Bridge EI = 1.71), and "Motor Disturbances" (PHQ8) (Bridge EI = 1.67) were important bridge symptoms. The flow network indicated that the edge between the nodes of "Suicidality" (SU) and "Guilt" (PHQ6) showed the strongest connection (Edge Weight= 1.17, followed by "Suicidality" (SU) - "Sad mood" (PHQ2) (Edge Weight = 0.68)). The network analysis results suggest that insomnia symptoms play a critical role in the activation of the insomnia-depression-suicidality network model of COVID-19 survivors, while suicidality is more susceptible to the influence of depressive symptoms. These findings may have implications for developing prevention and intervention strategies for mental health conditions following recovery from COVID-19.

The effect of bullying and cyberbullying on predicting suicide risk in adolescent females: The mediating role of depression

This paper analyzed the role of depression as a mediator in the association between bullying, cyberbullying, and suicide risk in adolescent females. A total of 751 Colombian adolescent females (M= 13.71, SD=1.897), who were administered the Plutchik Suicide Risk Scale, the Beck Depression Inventory, the European Bullying Intervention Project Questionnaire and Cyberbullying. Bullying victimization and aggression and cyberbullying victimization were found to contribute statistically significant effects that explaining 22 % of the variance in depression. The variables of victimization in bullying and cyberbullying and depression explained 64 % of the variance in suicidal risk, and depression mediated the association between victim and aggressor roles in bullying and cyberbullying in predicting suicidal risk, whose total direct and indirect effects are statistically significant. The findings support the role of depression as a mediating variable between bullying and cyberbullying and suicidal risk in female adolescents and highlight the importance of focusing prevention and intervention efforts on risk factors for depression and suicidal behavior in cases of bullying and cyberbullying.

Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs

Adolescents are considered one of the most vulnerable groups affected by suicide. Rapid changes in adolescents' physical and mental states, as well as in their lives, significantly and undeniably increase the risk of suicide. Psychological, social, family, individual, and environmental factors are important risk factors for suicidal behavior among teenagers and may contribute to suicide risk through various direct, indirect, or combined pathways. Social-emotional learning is considered a powerful intervention measure for addressing the crisis of adolescent suicide. When deliberately cultivated, fostered, and enhanced, self-awareness, self-management, social awareness, interpersonal skills, and responsible decision-making, as the five core competencies of social-emotional learning, can be used to effectively target various risk factors for adolescent suicide and provide necessary mental and interpersonal support. Among numerous suicide intervention methods, school-based interventions based on social-emotional competence have shown great potential in preventing and addressing suicide risk factors in adolescents. The characteristics of school-based interventions based on social-emotional competence, including their appropriateness, necessity, cost-effectiveness, comprehensiveness, and effectiveness, make these interventions an important means of addressing the crisis of adolescent suicide. To further determine the potential of school-based interventions based on social-emotional competence and better address the issue of adolescent suicide, additional financial support should be provided, the combination of social-emotional learning and other suicide prevention programs within schools should be fully leveraged, and cooperation between schools and families, society, and other environments should be maximized. These efforts should be considered future research directions.

The developmental process of suicidal ideation among adolescents: social and psychological impact from a nation-wide survey

Suicidal ideation is a multifactorial phenomenon that is increasingly prevalent among adolescents, especially following the impact of Covid 19 pandemic on their mental health. Its analysis necessitates an interdisciplinary approach that simultaneously considers sociological and psychological perspectives, especially looking at the role of interpersonal relationships and structural inequalities. The present study, based on a face-to-face survey conducted with a representative sample of 4288 adolescents, aims to identify the factors that most differentiate individuals with and without suicidal ideation, proposing a descriptive model of development process of this phenomenon with reference to the Italian context. We analysed variables related to socio-demographic status, relational status, social interactions, and psychological well-being using multiple correspondence analysis and logistic regression models. The results provide evidence for the existence of a direct association between negative psychological status and suicidal ideation but clarify that the psychological aspects are associated with sociodemographic characteristics and have their origins in the social sphere.

The Association between Perceived Family Financial Stress and Adolescent Suicide Ideation: A Moderated Mediation Model

Nowadays, suicide (especially adolescents' suicide) has been an increasingly prominent social problem worldwide; suicide ideation, as an important predictor, has been the focus of relevant studies and practices. Against this background, the present study aimed to examine the association between perceived family financial stress and adolescents' suicidal ideation, as well as the potential roles of depression and parent-child attachment. A sample of 526 junior middle school students was recruited voluntarily to participate in this cross-sectional study, and the results indicated that the prevalence of suicidal ideation among junior high school students was 15.45%; perceived family financial stress was positively associated with suicidal ideation, and depression could significantly mediate this relation; parent-child attachment significantly moderated the mediating effect of depression (in particular, the relation between depression and suicidal ideation); specifically, this relation was stronger among adolescents with lower values of parent-child attachment. These findings could deepen our understanding of the influences of perceived family financial condition and the risky factors of adolescents' suicidal ideation, which could provide guidance for the prevention and intervention of adolescents' depression and suicidal ideation.

Factors Influencing Sleep Disturbances in Adolescent Smokers in South Korea

ABSTRACT

This study aimed to describe sleep disturbances and identify associated factors in adolescent smokers in South Korea. This study adopted a cross-sectional design and recruited 520 students aged 12-17 years from 35 schools to participate in a smoking cessation program. To compare demographic, smoking-related, psychological, and problem behavior characteristics between adolescent smokers with sleep disturbances and without sleep disturbances, chi-square tests and independent t tests were used. Logistic regression analysis was performed to identify the factors associated with sleep disturbances in adolescent smokers. Approximately 45.8% of adolescent smokers reported sleep disturbances. Sleep disturbances were more frequent among girls than among boys and more frequent among high school students than among middle school students. Other factors included cigarette use within 1 month, nicotine dependence, smoking cessation self-efficacy, depression, Internet addiction, and suicidal ideation. Gender (girls), school level (high school), depression, Internet addiction, and daily cigarette use (11 or more cigarettes) were significantly associated with sleep disturbances in adolescent smokers. To improve the sleep quality of adolescent smokers, health professionals should focus on sleep disturbances and associated factors and develop appropriate intervention programs.

Association Between Suicidal Behaviour and Cannabis and Tranquilizer use, Depression, Aggression and Other Borderline Personality Traits Among Students in Sincelejo, Colombia

OBJECTIVE

This objective of this study is to examine the association between suicidal behaviour and substance use, depression, aggressiveness and borderline personality traits among adolescents from Sincelejo, a rural city in the north of Colombia.

METHODS

This cross sectional study included 352 participants selected by purposive sampling, from a public and a private school located in Sincelejo, Sucre district, in the north of Colombia. Students ages ranged from 12 to 18 years old (mean, 15.09±1.82). The participants completed three screening tools: a socio-demographic questionnaire, a screening instrument to collect information related to the frequency of use of some substances, such as tobacco and cannabis, and a self-report inventory to assess various personality and psychopathology domains. A series of t-tests, ANOVA and linear regression analyses were conducted.

RESULTS

Physical aggression (t=7.74; p <0.01), cognitive depression (t=5.03; p <0.01), affective depression (t=8.24; p <0.01), affective instability (t=3.46; p <0.01), few social relationships (t=3.36; p <0.01), self-harm (t=3.45; p<.01), cannabis and tranquilizer use (t=2.83; p <0.05; and t=2.37; p <0.05) had a significant independent relationship with suicidal behaviour. Aggression (t=2.59; p <0.05), components of depression (t=9.03; p <0.01) and borderline personality traits (t=4.12; p <0.01) also predicted suicidal behaviour.

CONCLUSIONS

More longitudinal studies are needed in this area to identify the causal relations between the factors studied and the suicidal behaviour of young people in Sincelejo.

Longitudinal relationships between sub-clinical depression, sub-clinical eating disorders and health-related quality of life in early adolescence

OBJECTIVE

A comprehensive understanding of the relationship between depressive symptoms and eating disorder (ED) symptoms requires consideration of additional variables that may influence this relationship. Health-related quality of life (HRQOL) has been associated with both depression and EDs; however, there is limited evidence to demonstrate how all three variables interact over time. This study sought to explore the bi-directional relationships between depressive symptoms, ED symptoms and HRQOL in a large community sample of young adolescents METHOD: Adolescents (N = 1393) aged between 11 and 14 years (M = 12.50, SD = 0.38) completed an online survey measuring depressive symptoms, ED symptoms and HRQOL. Two-level autoregressive cross-lagged models with three variables (i.e., depressive symptoms, HRQOL and ED) assessed across two time points (T1 and T2) were created to address the study aims.

RESULTS

HRQOL was found to predict depressive symptoms and depressive symptoms were found to predict ED symptoms. Components of HRQOL (i.e., social relationships and ability to cope) were found to share a differential relationship with depressive symptoms. Inability to cope predicted depressive symptoms and depressive symptoms predicted negative social relationships. EDs were found to predict reduced HRQOL and negative social relationships.

DISCUSSION

Findings suggest prevention and early intervention programs designed to address adolescent depression should focus on improving HRQOL. Future research should assess the relationship between HRQOL and individual ED symptoms (e.g., body-related ED symptoms, restrictive symptoms) as a means of exploring relationships that may have been masked by assessing ED symptoms using a total score.

PUBLIC SIGNIFICANCE

This study sought to explore how eating disorders, depressive symptoms, and health-related quality of life (HRQOL) relate over time in a sample of young adolescents. Findings indicate adolescents who self-reported lower levels of HRQOL, including a reduced ability to cope, are at risk of experiencing depressive symptoms. Adolescents should be provided with the tools to develop problem-focused coping strategies as a means of reducing depressive symptoms.

Predictors of suicide ideation among South Korean adolescents: A machine learning approach

BACKGROUND

The current study developed a predictive model for suicide ideation among South Korean (Korean) adolescents using a comprehensive set of factors across demographic, physical and mental health, academic, social, and behavioral domains. The aim of this study was to address the pressing public health concerns of adolescent suicide in Korea and the methodological limitations of suicidal research.

METHODS

This study used machine learning methods (decision tree, logistic regression, naive Bayes classifier) to improve the accuracy of predicting suicidal ideation and related factors among a nationally representative sample of Korean middle school students (N = 6666).

RESULTS

Factors within all domains, including demographic characteristics, physical and mental health, and academic, social, and behavioral, were important in predicting suicidal thoughts among Korean adolescents, with mental health being the most important factor.

LIMITATIONS

The predictive model of the current research does not infer causality, and there may have been some loss of information due to measurement issues.

CONCLUSIONS

Study results provide insights for taking a multidimensional approach when identifying adolescents at risk of suicide, which may be used to further address their needs through intervention programs within the school setting. Considering the cultural stigma attached to disclosing suicidal ideation and behavior, the current study proposes the need for a preventive screening process based on the observation and assessment of adolescents' general characteristics and experiences in everyday life.

Psychosocial predictors of persistent suicidal ideation among Chinese adolescents: A longitudinal study

BACKGROUND

Suicide is the fourth leading cause of death among adolescents. Studies have shown that persistent suicidal ideation has a more important effect on suicidal behavior. The objective of this study was to identify predictors of persistent suicidal ideation.

METHODS

Data were collected from 4225 Chinese middle and high school students. These adolescents were assessed for suicidal ideation at baseline and the second year. We used multinomial logistic regression (n = 4171) for the predictive effect of these factors on persistent suicidal ideation. We controlled for gender, residence, clinical diagnosis, clinical diagnosis family, suicide planning, and suicide attempts.

RESULTS

Depressive symptoms are essential in predicting persistent suicidal ideation (OR = 14.0; p < 0.001). Persistent suicidal ideation was predicted by sleep disorders, such as poor sleep quality (OR = 2.3; p = 0.008), difficulty falling asleep (OR = 2.4; p = 0.005), frequently midnight awakening (OR = 1.9; p = 0.044), and frequent nightmares (OR = 2.1; p = 0.040). There was a significant association between concern with persistent ideation and parental-peer alienation (OR for father, 1.9[p = 0.024]; OR for mother, 3.1[p < 0.001]; OR for peer, 2.3[p = 0.003]).

LIMITATIONS

All measures are based on self-report rather than objective assessment or clinical diagnostic assessment.

CONCLUSIONS

Persistent suicidal ideation had a more important role in influencing suicide planning and attempt. Interventions targeting sleep disorders and attention to attachments in the home and school are particularly important in preventing persistent suicidal ideation in adolescents.

Suicidal Thoughts and Behaviors Among Adolescent Psychiatric Inpatients

BACKGROUND

Given low base rates of suicidal thoughts and behaviors (STBs) in national samples of adolescents, clarifying the sociodemographic and clinical correlates among psychiatric inpatients may afford insights into potential risk factors that predict STBs onset.

METHOD

Adolescents (N = 970; ages 12-19 years) admitted for acute, psychiatric inpatient care completed baseline clinical interviews and self-report measures assessing demographics and early life adversity. Lifetime and 12-month STBs prevalence were obtained, allowing for the estimate of STBs persistence (i.e., rates of those with both current and past STBs) and transition rates (i.e., proportion of ideators that transition to plans or attempts). Univariate and multivariate logistic regression tested sociodemographic and clinical correlates of STBs.

RESULTS

Age-of-onset for STBs occurred in early adolescence. Most patients reported suicide ideation with nearly half of patients making a plan and one-third a suicide attempt. Although relatively modest, the strongest correlates of lifetime attempts were depressive disorders, physical abuse, and non-suicidal self-injury. Knowing a peer that had attempted suicide also increased the likelihood of a suicide attempt, especially among attempters who transitioned from ideation to planned attempts.

CONCLUSION

STBs are highly prevalent among adolescents admitted for acute psychiatric inpatient treatment. The modest effects suggest that correlates, particularly those related to suicide attempts, are widely distributed. As a history of physical abuse and knowing a peer with a suicide attempt history are related to transitioning from ideation to action, these may be critical factors to target in the deployment of future suicide prevention and treatment programs. HIGHLIGHTSOne-third of adolescent inpatients report a lifetime history of suicide attempts.Approximately 65% of adolescent inpatients with a lifetime plan attempt suicide.Knowing peers who attempt suicide may facilitate the transition from ideation to action.

Parent experiences during and after adolescent suicide crisis: A qualitative study

Parents of adolescents who have suicide crises (i.e. suicide attempt and/or significant ideation) are often highly involved in the care management, treatment and preventing future suicides of their children. How they experience these suicide crises, and the period afterward, has not been well studied. The purpose of this study was to understand parents' (defined in this study as any legal guardian of an adolescent taking on a parental role) experience of adolescent suicide crises and its impact on themselves and the family system. Semi-structured interviews were conducted with parents (N = 18) of adolescents who had a suicide crisis in the past 3 years. Thematic analysis was used with a combined inductive-deductive coding approach, drawing from Diamond's conceptualization of family treatment engagement for suicidal youth and iterative close readings of transcripts. Five themes emerged related to parent experience: Trauma of the Experience (subtheme: Feelings of Failure); Living in Fear; Alone and Seeking Connection; Lasting Impact; and A New Normal (subtheme: Turn the Pain to Purpose). Parents experienced these events as traumatic, damaging their sense of self. They experienced long periods of time where fear and loneliness dominated their lives. Recovery was both an individual and a family process, occurring in tandem with, but distinct from, adolescent experiences. Descriptions and illustrative quotes illustrate parent experiences and their understanding of the impact on the family system. Results highlighted that parents require support both for themselves and as caregivers for adolescents around an adolescent's suicide crisis and that family-focused services are vital.

[What is the contribution of smoking to the increased risk of suicide in young smokers? A systematic review]

OBJECTIVES

The correlation between smoking and suicide is well documented in the general population: there is an increased risk of suicide among tobacco smokers. However, the association between smoking and suicidal behaviors (ideations, plans, attempts) in youth is poorly elucidated. This is a systematic review of the literature examined data on the relationship between active and passive smoking and suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among youth in the general population.

METHOD

Medline searches were performed for the period 1980-2020. Cross-sectional, case-control, prospective population-based studies of young people (age less than 18 years) were included in this review; studies of specific populations (patients with an identified pathology of any kind) were excluded.

RESULTS

This review included 43 studies: 23 studies on the association between active smoking and SI, SI and/or PS, TS; three studies on the association between passive smoking and suicidal behavior, three studies on the association between smoking and suicidal behavior in young people in psychiatric hospital settings, and five studies comparing the suicidal behavior of girls and boys. Analysis of the data collected lead to the conclusion that active or passive smoking is associated with suicidal behavior in young people. Smoking appears to contribute to psychopathological disorders, including depression, the use of other psychoactive substances, or psychosocial suffering which are often associated with an increased risk of suicide in young people. The correlations between smoking and the presence of mental disorders have been highlighted; tobacco use may contribute to the development of depression, anxiety and stress. Further studies are needed to verify the existence of a causal link between smoking and suicide.

CONCLUSION

Smoking is associated with the risk of suicidal behavior in young people; it should be included among the criteria for assessing suicidal risk in youth. Smoking cessation, which improves psychological well-being, should be further integrated into the prevention of suicidal behavior.

Relationship between suicide attempt and medical morbidity in adolescent girls

This study assessed whether suicide attempts before 20 years of age were associated with medical morbidity later in life. We carried out a cohort study of 169,806 girls under age 20 years between 1989 and 2019 in Quebec, Canada. The cohort included 8086 girls admitted for suicide attempts, matched on age and year with 161,720 girls with no attempt. Outcomes included hospitalization for medical conditions, such as infection, allergic disorders, autoimmune disease, cardiovascular disease, cancer, and death from nonpsychiatric causes during 31 years of follow-up. We computed hazard ratios (HR) and 95% confidence intervals (CI) for the association of adolescent suicide attempt with these health outcomes using Cox regression models adjusted for preexisting mental illness, substance use disorders, and socioeconomic deprivation. Compared with matched controls, adolescent girls with suicide attempts had a greater risk of hospitalization for infection (HR 1.55, 95% CI 1.44-1.68), allergic disorders (HR 1.72, 95% CI 1.45-2.05), cardiovascular disease (HR 1.31, 95% CI 1.12-1.52), and mortality (HR 3.11, 95% CI 1.69-5.70). Associations were present regardless of the age at the time of the suicide attempt, but were stronger for girls with repeated attempts. Associations were also more pronounced within the first 5 years of the attempt, although suicide attempts remained strongly associated with mortality throughout the 31-year follow-up period. The findings suggest that adolescent girls with suicide attempts have an elevated risk of medical morbidity and mortality and may benefit from closer clinical management to prevent adverse health outcomes.

Psychosocial determinants of adolescent suicide: A national survey

BACKGROUND

Suicide is a global health problem with considerable variability across countries in its prevalence and correlates. The aims of this study were to: (a) explore the prevalence and psychosocial determinants of adolescent suicidal ideation, and (b) explore the perceived stigma of suicide among adolescents.

METHOD

A nationally representative electronic survey was utilized to collect data from school adolescents. The Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data was used to design the survey. The study collected data on adolescents' suicidal ideation, depression, self-esteem, stigma of suicide, family functioning, educational stress, and anxiety levels. A representative sample of 647 Jordanian school adolescents was included.

RESULTS

The prevalence of suicidal ideation among school adolescents was 11%. Suicidal ideation was significantly higher among respondents who were boys and enrolled in public schools, had a mental health problem, a family history of suicidal attempt, a lower self-esteem, and higher depressive symptoms. The majority of school adolescents agreed with the descriptions of people who take their own lives as being "lost" (70%), "coward" (53%), "stupid" (51%), and "lonely" (49%).

CONCLUSION

There is no typical suicide victim, and there are no specific characteristics that can point out those who are suicidal. Suicide remains a complex phenomenon that is embedded in its sociocultural context. Collaborative efforts from Jordanian policy makers, healthcare providers, researchers, and educators are needed to develop culturally appropriate screening and prevention approaches to address suicide among adolescents. Nurses have a significant role in helping adolescents experiencing suicidal ideation and their families restore, maintain, and/or promote their mental health and wellbeing.

Does anime, idol culture bring depression? Structural analysis and deep learning on subcultural identity and various psychological outcomes

Subculture, includes animation, comics, games (ACG), and idol fan culture, is popular among young generations in Japan. Previous studies have shown different psychological outcomes within different subcultural groups; however, underlying mechanisms remain unclear. This study proposes that subcultural identity may play a crucial role in mental health outcomes by interweaving social support and reputation. We examined the interplay between subcultural identity, social support, reputation, and different psychological outcomes through structural equation modeling (N = 300). Furthermore, we trained neural networks (NN) by applying a deep learning algorithm to predict psychological outcomes of different subcultures. The results suggest identity related to anime, idol, and hip-hop was positively associated with anxiety, aggression, depressive symptoms, and suicidal tendencies. By contrast, fashion and sports identities associated with no adverse or positive psychological outcomes. Perceived reputation mediates adverse psychological outcomes in the ACG, idol, and hip-hop groups. The highest accuracy in our NN reached 71%, indicating that NN could be an effective tool for predicting mental problems. Our work points up an urgent need to improve the mental health of the young generation by de-stigmatizing discriminated cultural groups.

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Identity related to anime, idol, and hip-hop was positively associated with adverse psychological outcomes.

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Identity related to fashion and sports had no association with positive or adverse psychological outcomes.

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Perceived reputation mediates adverse psychological outcomes.

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Neural network can predict psychological problems based on cultural preference.

Suicidal Behaviour Among Nigerian Undergraduates: Associations with Gambling Disorder and Emotional Dysregulation

Background: There is a high prevalence of suicidal behavior among Nigerian youths. However, the connections between suicidal behavior and precipitating factors, such as gambling disorder and emotional dysregulation (ED) in this population, are not well researched. Objectives: The present study examined the associations between gambling disorder, ED, and suicidal behavior in Nigerian university undergraduate students. Methods: This study was carried out during October 2020 - April 2021 on 1338 undergraduates with a mean ± SD age of 19.84 ± 3.22 years selected using random and purposive sampling for the universities and participants respectively. Participants responded to the Attitudes Towards Gambling Scale, Difficulties in Emotion Regulation Scale, and Redeemer's University Suicidality Scale. Descriptive statistics (simple percentages) and inferential statistics (Pearson’s correlation and regression analysis) were used for data analysis. Results: The Pearson's correlation revealed that suicidal behaviour had significant positive correlations with the nonacceptance of emotional responses or distress (r = 0.22, P = 0), difficulties engaging in goal-directed behaviours (r = 0.21, P = 0), difficulties in impulse control (r = 0.27, P = 0), the lack of emotional awareness (r = 0.14, P = 0), limited access to emotional regulation strategies (r = 0.33, P = 0), the lack of emotional clarity (r = 0.32, P = 0), and difficulties in emotional regulation (r = 0.4, P = 0). Problematic gambling (PG) independently predicted suicidal behavior, while PG and ED dimensions jointly predicted suicidal behavior. The ED dimensions contributed 15% incrementally to the prediction of suicidal behavior and beyond the 2% variance accounted for PG in undergraduates. Conclusions: Our results showed positive links between PG, ED, and suicidal behavior among Nigerian undergraduates. It suggests that the combination of PG and ED increases the severity of suicidal behavior among students.

A Comprehensive Review of the Literature on Sleep Difficulties and Suicidality in Youth to Inform an Integrative Developmental Model and Future Directions

Purpose of Review

Suicide is currently the second leading cause of death among youth. Identification of modifiable near-term risk factors can inform suicide prevention strategies. One promising, readily assessed factor is sleep. We critically review the literature on sleep and suicidal thoughts and behaviors among youth.

Recent Findings

Most studies examining the youth sleep-suicidality relationship are from epidemiological samples in which both sleep problems and suicidality were assessed over variable timeframes using limited items from scales not designed to measure these constructs. Nonetheless, these data overwhelmingly support an association between suicidality and a range of sleep difficulties (e.g., insomnia, short/long sleep, weekend oversleep), above and beyond depressive symptoms. Limited studies include clinical samples or prospective designs. We review potential mechanisms and present a developmentally-informed integrative model.

Summary

Literature supports a clear association between sleep difficulties and youth suicidality. Future directions include prospective longitudinal studies and targeted prevention efforts.

Effects of Aerobic Exercise and High-Intensity Interval Training on the Mental Health of Adolescents Living in Poverty: Protocol for a Randomized Controlled Trial

Background

The increasing rate of mental health issues among adolescents has recently been a considerable concern in Hong Kong. In particular, adolescents with low socioeconomic status (SES) are likely to experience poor mental health, including low self-esteem and high levels of anxiety, anger, and depression. Previous research has found that physical activities have a positive impact on improving mental health outcomes among adolescents. However, approximately 96% of adolescents in Hong Kong do not engage in regular exercise, which potentially increases the risk of poor mental health.

Objective

In this study, we aim to examine whether changes in the 3 indicators (reduced ill-being, enhanced well-being, and cognitive functions) of mental health among adolescents with low SES are evident before and after exercise. In addition, this study compares the effectiveness of aerobic exercise and high-intensity interval training on these indicators among adolescents with low SES.

Methods

A total of 78 participants from low-income families aged between 12 and 15 years from 3 to 4 secondary schools will be recruited for this study. They will be randomly assigned to either an aerobic exercise group (26/78, 33%), a high-intensity interval training group (26/78, 33%), or a control group (26/78, 33%). Participants in the first 2 groups will take part in a 10-week training program period. Participants in the control group will participate in other physical activities during the same intervention period. The training sessions will be conducted 3 times per week on nonconsecutive days. A range of neuropsychological tests and psychometric scales will be used to measure the executive functions and indicators of psychological well-being and ill-being, including enjoyment, self-efficacy, mood, depression, anxiety, and stress at pretest, posttest, and follow-up assessments.

Results

The project was funded in 2021 by the Research Matching Grant Scheme, through the University Grants Committee of the Hong Kong Special Administrative Region Government. Ethical approval has been obtained from the author’s institution. Participant recruitment will begin in January 2022 and continue through to April 2022. Data collection and follow-up are expected to be completed by the end of 2022. The results are expected to be submitted for publication in 2023.

Conclusions

The findings will help inform policy makers and practitioners in promoting the importance of physical exercise to enhance mental health.

Trial Registration

ClinicalTrials.gov NCT050293888; https://clinicaltrials.gov/ct2/show/record/NCT05029388

International Registered Report Identifier (IRRID)

PRR1-10.2196/34915

Suicidal ideation, plans, and attempts and the use of psychoactive substances by adolescents

Introduction: Suicidal behavior and substance abuse constitute a serious public health problem.

Aim: The study was to analyze the relationships between suicidal behaviors (ideation, plans, attempts) and substance abuse in adolescents. The authors also took into account the respondents’ motivation to attempt suicide and use psychoactive substances, as well as some demographic variables.

Participants: The study involved 3493 secondary school students aged 16-17 years. The group included 69.41% girls and 30.59% boys.

Methods: The participants were surveyed with a self-report questionnaire designed by one of the authors.

Results: Statistically significant relationships were found between the respondents’ suicidal behaviors and the risky use of alcohol, cannabis, amphetamine, and designer drugs.

Conclusions: 1. The use of psychoactive substances increases the risk of suicidal ideation and plans, as well as suicidal attempts in adolescents and young adults.

2. Significantly more respondents who report suicidal ideation, plans and attempts, in comparison to those who do not report such thoughts and behaviours, abuse alcohol and consumer cannabis, amphetamine and designer drugs to cope with problems and olster self-confidence.

3. In the group of respondents who report suicidal behaviour, psychoactive substances are consumed by significantly more men than women and by significantly more city inhabitants than people living in the country.

4. Young people, who report suicidal thoughts, plans, and attempts, are initiated into alcohol consumption at an earlier age than their non-suicidal peers.

A Social-Ecological Approach to Understanding the Relationship between Cyberbullying Victimization and Suicidal Ideation in South Korean Adolescents: The Moderating Effect of School Connectedness

Background: Cyberbullying victimization and suicidal ideation are both ongoing deleterious social problems in South Korea. Using the social-ecological approach, this study examined the association between cyberbullying victimization and suicidal ideation as well as the buffering role of school connectedness in this relationship. Methods: A nationally representative sample of 7333 adolescents from the 2016 Korean Children and Youth Right Study participated in the study. Data were analyzed using descriptive statistics, Wald chi-square test, bivariate correlations, and multivariate logistic regression analyses. Results: Nearly 17.7% of adolescents were cyberbullied, and 28.4% had suicidal ideation in the past 12 months. Cyberbullying victims were at an increased risk of suicidal ideation. The results also found that parental abuse, family dysfunction, and perceived peer relationship stress were positively associated with suicidal ideation, while parental support for autonomy was negatively associated with suicidal ideation. Further, school connectedness moderated on the relationship between cyberbullying victimization and adolescent suicidal ideation. Conclusions: These findings suggest that various stakeholders should consider interventions and preventive programs that address school connectedness when working with adolescents who are victims of cyberbullying and exhibit suicidal behavior.

Association of heated tobacco product use and secondhand smoke exposure with suicidal ideation, suicide plans and suicide attempts among Korean adolescents: A 2019 national survey

INTRODUCTION

The consumption of heated tobacco products (HTPs) is increasing among adolescents worldwide. Although suicide and HTP use are linked, the association between suicide-related behavior, HTP use, and indirect smoking exposure are not yet properly studied. This study examined the association of HTP use and exposure to secondhand smoke (SHS) with suicidal ideation, suicide plans, and suicide attempts among South Korean adolescents.

METHODS

Data from 57303 respondents (95.3% response rate) were obtained from the 2019 Korean Youth Risk Behavior Web-based Survey. Chi-squared tests and multivariable logistic regression analyses were used to examine the association of HTP use and SHS exposure with suicidal ideation, suicide plans, and suicide attempts among adolescents. Multivariable logistic regression analyses included: Model 1, which was adjusted for demographic characteristics such as sex, school type, perceived school performance, economic status, and residence type; and Model 2, which was adjusted for demographics, depression, and drug use.

RESULTS

The risk of suicidal ideation was 1.37 (95% CI: 1.10–1.70) and 1.44 (95% CI: 1.18–1.75) times higher among HTP users who were exposed to SHS at home and at public places, respectively, compared to non-users. The risk of suicide attempts was 1.88 (95% CI: 1.37–2.57), 1.45 (95% CI: 1.63–2.00), and 2.21 (95% CI: 1.63–3.00) times higher among HTP users exposed to SHS at home, school, and at public places, respectively.

CONCLUSIONS

HTP use, and SHS exposure are likely indicators of risk behaviors. Our findings suggest possible directions for initiating, implementing, and evaluating programs and services to monitor HTP use and SHS exposure among Korean adolescents.

Longitudinal predictors of suicidal ideation: Emerging to early adulthood

Few studies have examined the longitudinal trajectory of suicidal ideation (SI) in community samples, particularly during emerging adulthood. Additionally, there is scant data on predictors of longer-term course of SI across this period. We examined multiple domains of adolescent psychosocial and clinical functioning as predictors of SI trajectory and explored whether biological sex moderates those associations. The data came from the Oregon Adolescent Depression Project. Participants completed self-reports of psychosocial and clinical functioning and interviews assessing psychopathology in mid-late adolescence. SI was assessed using up to seven annual mailer assessments spanning ages 19-31. Multilevel growth models found that SI declined across emerging adulthood. Multiple indices of adolescent functioning were associated with higher levels of SI three years later. Few adolescent functioning constructs predicted faster reductions in SI, and no constructs predicted slower longitudinal reductions (or increases) in SI. Similar associations were found when controlling for adolescent SI. Lastly, we found little evidence for sex differences in these associations. This work shows that adolescent functioning is largely associated with initial and enduring levels of SI. Moreover, associations were similar between sexes. Given the modest associations found across long periods of time, future research should focus on proximal risk factors for SI.

Electronic cigarette use and suicidal behaviors among adolescents

BACKGROUND

The aim of this study was to investigate the association of the use of e-cigarettes, which are regarded as alternatives to traditional cigarettes and are easy to purchase, with suicidal behaviors in adolescents.

METHODS

Data for 5405 middle and high school students aged 13-18 years who had used e-cigarettes were extracted from the 2016 Korean Youth Risk Behavior Web-Based Survey and analyzed using multiple logistic regression.

RESULTS

Among those who used e-cigarettes for 1-30 days in the past 30 days, suicidal ideation (odds ratio [OR] = 1.58, 95% CI, 1.31-1.89), suicidal plans (OR = 2.44, 95% CI, 1.94-3.08), suicidal attempts (OR = 2.44, 95% CI, 1.85-3.22) and serious attempts (OR = 3.09, 95% CI, 1.51-6.32) were higher compared to those who did not use an e-cigarette in the past 30 days.

CONCLUSIONS

Suicidal behaviors are significantly higher among current adolescent e-cigarette smokers than adolescents who have not used an e-cigarette in the past 30 days. Therefore, comprehensive intervention is needed to protect adolescents' mental health.

Black Youth's Experiences With Feelings of Worthlessness, Parent Relationships, and Suicide: Findings From a National Probability Survey

PURPOSE

Suicide has been a leading cause of death for Black youth in the U.S. since the 1980s. Yet, empirical investigations that examine correlates of suicidality and assess within-group differences among Black boys and girls are scant. The current study therefore sought to rectify this gap by assessing whether feelings of worthlessness and parent relationships were associated with suicidality for Black adolescents, while also examining whether youth's experiences are consistent across gender groups.

METHODS

Data from the 2004-2018 National Survey on Drug Use and Health (NSDUH) were analyzed using multivariate logistic regression. The NSDUH is a nationally representative probability sample of households in the U.S. Predicted probabilities were plotted to aid interpretation of odds ratios.

RESULTS

Black girls reported more suicide ideation and attempt. Black girls also reported more feelings of worthlessness, while boys reported fewer fights with their parents. Results from the gender-stratified logistic regression analyses revealed that feelings of worthlessness were associated with significantly greater odds of suicide ideation, planning, and attempt both for Black girls and boys. The frequency of fighting with parents was associated with greater odds of all three suicide outcomes for girls and ideation only for boys. Receiving verbal affirmation from parents was associated with significantly lower odds of suicide ideation among girls only.

CONCLUSIONS

Findings indicate that some intrapersonal and interpersonal factors are differentially associated with suicide in boys and girls. As such, affirming Black youth of their self-worth and promoting positive relationships with their parents will be imperative in working to prevent suicide among this population.

Association Between Suicidal Behaviour and Cannabis and Tranquilizer use, Depression, Aggression and Other Borderline Personality Traits Among Students in Sincelejo, Colombia

OBJECTIVE

This objective of this study is to examine the association between suicidal behaviour and substance use, depression, aggressiveness and borderline personality traits among adolescents from Sincelejo, a rural city in the north of Colombia.

METHODS

This cross sectional study included 352 participants selected by purposive sampling, from a public and a private school located in Sincelejo, Sucre district, in the north of Colombia. Students ages ranged from 12 to 18 years old (mean, 15.09±1.82). The participants completed three screening tools: a socio-demographic questionnaire, a screening instrument to collect information related to the frequency of use of some substances, such as tobacco and cannabis, and a self-report inventory to assess various personality and psychopathology domains. A series of t-tests, ANOVA and linear regression analyses were conducted.

RESULTS

Physical aggression (t=7.74; p <0.01), cognitive depression (t=5.03; p <0.01), affective depression (t=8.24; p <0.01), affective instability (t=3.46; p <0.01), few social relationships (t=3.36; p <0.01), self-harm (t=3.45; p<.01), cannabis and tranquilizer use (t=2.83; p <0.05; and t=2.37; p <0.05) had a significant independent relationship with suicidal behaviour. Aggression (t=2.59; p <0.05), components of depression (t=9.03; p <0.01) and borderline personality traits (t=4.12; p <0.01) also predicted suicidal behaviour.

CONCLUSIONS

More longitudinal studies are needed in this area to identify the causal relations between the factors studied and the suicidal behaviour of young people in Sincelejo.

Suicide among adolescents in Italy: a nationwide cohort study of the role of family characteristics

Suicide is a leading cause of death among adolescents and is recognized as a serious public health problem. This study aimed to investigate the relationship between family characteristics and the risk of suicide among adolescents in Italy using nationwide official data. We carried out a cohort study based on the record linkage between the 15th Italian Population Census, the Italian Population Register, and the National Register of Causes of Death. Suicides in adolescents aged 10-19 years from 2012 to 2016 were analyzed. Hazard ratios of mortality from suicide were estimated through a multivariable Cox regression model using time-on-study as the time scale. We included 8,284,359 children and adolescents (51% males, 49% females). Over the 5-year follow-up, we registered 330 deaths from suicides (74% males), mostly occurred in the age class 15-19 years (86%). The suicide rate was 1.71 per 100,000 person-years among males and 0.65 among females. We found some familial characteristics associated with a higher risk of dying by suicide, including: living in single-parent or reconstructed families (among boys), a 40-year or more age gap between mother and child (among girls), having highly educated parents, an age difference between parents greater than 5 years. Furthermore, the study showed a lower risk for boys living in urban areas and for both boys and girls living in South Italy. Our results could help in identifying adolescents at high risk of suicide who could benefit from the planning of targeted intervention strategies.

Prevalence, risk factors and clinical correlates of suicidal ideation in adolescent patients with depression in a large sample of Chinese

BACKGROUND

Suicidal ideation (SI) has a high risk in adolescents and is now a significant concern due to its problematic outcome. However, few systemic studies of suicidal ideation have been conducted in adolescent patients. Therefore, the current study was aimed to assess the prevalence and its clinical correlate of suicidal ideation among adolescent patients with depression.

METHODS

A total of 1635 adolescent patients (748 males/ 887 females) with depression were recruited in this study. The clinical and demographic data were collected by a self-administered questionnaire. Suicidal ideation was assessed by interview. Children's Depression Inventory (CDI) was used to evaluate depressive symptoms, Adolescent Self-Rating Life Events Check List (ASLEC) was used to assess the stressful life events.

RESULTS

The study showed that the prevalence of suicidal ideation in adolescent depression patients was 38.2% (625/1635). Compared to the non-SI patients, SI patients had greater scores on CDI and ASLEC, had inadequate sleeping time, and were more likely to be females. Further logistic regression analysis indicated that suicidal ideation in adolescent patients with depression was significantly associated with females, inadequate sleeping time, the severity of depression, and higher learning pressure.

LIMITATIONS

No causal relationship could be drawn due to the cross-sectional design.

CONCLUSIONS

Our results suggest a high prevalence of suicidal ideation in adolescents with depression. Moreover, the severity of depression, sex, sleep time, and learning pressure are all related to suicidal ideation. Early recognition and treatment of suicidal ideation can effectively prevent the occurrence of suicide among adolescent patients.

Prevalence of Suicide Thoughts and Behaviours among Female Garment Workers Who Survived the Rana Plaza Collapse: An In-Depth Inquiry

The Rana Plaza building collapse occurred on 24 April 2013 in Savar, near the capital city of Bangladesh, killing more than 1130 garment workers and injured about 2500, mostly females. Those who survived face ongoing challenges, including socio-cultural constraints, economic hardship, post-traumatic stress disorders (PTSD), depression, and critical health issues, which may lead to suicidal ideation and death. The aim of this article is to explore why and how female garment workers who survived the Rana Plaza collapse are now at risk of suicide thoughts and behaviours, and suicide death. Unstructured face-to-face interviews were held from April to July 2018 with 11 female garment workers who survived the Rana Plaza building collapse. Interviews continued until data saturation was reached. The interviews were tape-recorded and transcribed verbatim while simultaneously being translated into English from Bengali/Bangla. Transcripts were coded and thematically analysed. The study found that all participants were living with multiple risk factors of suicidal ideation (including low socio-economic status, poverty, social stigma, psychological distress, and trauma) which the participants directly linked to the collapse of the Rana Plaza building. Our analysis uses the three-step theory of suicide (3ST, Klonsky & May, 2015) to understand female Rana Plaza survivors' suicide risk. Female survivors' overall vulnerability requires urgent attention while taking the socio-cultural setting of Bangladesh into account. In addition, a lifelong caring system (combining financial security and free healthcare) needs to be initiated to accommodate the female survivors with mainstream society to avoid possible future suicides. They require long-term social and economic security and psychological support.

High School Pupils' Relationships with Their Parents, Schoolmates, and Friends, and Health-Related Risk Behaviors

Purpose

The aims of this study were to evaluate high school pupils’ relationships with their parents, schoolmates, and friends, and the presence of health-related risk behaviors among the family members and friends on the pupils’ smoking and binge drinking status.

Materials and Methods

The study was a cross-sectional population-based study that involved a questionnaire, and the sample involved 2908 pupils at high schools in Timis county, Romania. In our study, the following factors related to family members and friends and the living environment were identified. First, there were issues with the relationships with parents among some pupils, with 23.2% being neither satisfied nor unsatisfied and 4.9% being unsatisfied. Second, there were also issues regarding some pupils’ satisfaction with the financial situation of their family, with 21.8% being neither satisfied nor unsatisfied and 16.4% being unsatisfied. An odds ratio (OR) is a statistic that quantifies the strength of the association between two events.

Results

There were 1495 (51.5%) girls and 1407 (48.5%) boys aged 14–20 years, and 79.2% came from organized families. Among the pupils, 71.1% reported that they were satisfied with their relationship with their parents, while 4.9% were unsatisfied. Additionally, 46.2% were satisfied with the financial status of their families, while 16.4% were unsatisfied. Moreover, 59.2% were satisfied with their relationship with their schoolmates and 80.2% were satisfied with their relationship with their friends, while only 1.8% were unsatisfied with their relationship with their friends. The logistic regression model of the pupils’ smoking status identified two moderate predictive factors: this was defined “>1” friends who smoke (odds ratio [OR]=2.875) and smoking status of siblings (OR=2.222). The major predictive factor in the logistic regression model of occasional alcohol consumption in high quantities by pupils was male gender (OR=5.148).

Conclusion

The predictive model of pupils’ smoking status identified the following moderate predictors: high number of friends who smoke and smoking status of siblings. The major predictor in the model of occasional alcohol consumption in high quantities by pupils was male gender.

A pilot study of 17 wrist-cutting suicide injuries in single institution: perspectives from a hand surgeon

Background

Self-cutting is a special type of emergency in hand surgery. Despite its low mortality rate, it is clinically significant because there is a possibility of permanent disability and repeated suicide attempts are likely to occur. Therefore, we aim to understand the characteristics of self-inflicted wrist injuries and share the perspectives from a hand surgeon in order to inform those who face these patients primarily in the emergency room.

Methods

We reviewed 17 patients with self-inflicted wrist injuries who were referred to the Department of Hand surgery from the Emergency Medicine Department from 2013 to 2017. We investigated the differences in demographic features (age, gender, psychological diagnosis, alcohol consumption, prior suicide attempts) and clinical features (injury side, injury pattern, anatomical structures, distance from wrist crease).

Results

Among the patients, 4 were female and 13 were male. 70.6% of patients (12/17) had injuries on the left wrist and 94.1% of patients (16/17) had injuries on the flexor side. The average distance from the wrist crease to the injured site was 3.43 cm and 90.5% (19/21) of total injuries had an average distance of was less than 5 cm. The most frequently injured structures were palmaris longus tendon (58.5%, 10/17). 52.9% (9/17) of patients, among which 6 of the 8 patients with deep injuries and 3 of the 9 patients with superficial injuries, had a history of a psychiatric disorder.

Conclusions

We conclude that a male with a previously diagnosed psychiatric disorder has a higher chance of inflicting a deeper injury. In addition, self-cutting injuries are highly predictable because most of these injuries occur on the flexor side of the left wrist and are limited to a distance of 5 cm from the wrist crease. In terms of the implements used in self-inflicted injuries, we can predict the type of damage to some degree depending on the type of implement used. In view of these characteristics, more appropriate evaluation can be implemented in the emergency room and those who deal with these patients primarily can cope more effectively for better long-term results.

Associations between the Type of Tobacco Products and Suicidal Behaviors: A Nationwide Population-Based Study among Korean Adolescents

The relationships between multiple tobacco products, such as heated tobacco products (HTPs), electronic cigarettes (ECs), and combustible cigarettes (CCs), and suicide-related behaviors among adolescents have not been extensively researched. This study examined the associations between the type of tobacco products used and suicidal thoughts, plans, and attempts among Korean adolescents. Data from the 2019 Korea Youth Risk Behavior Web-Based Survey were analyzed, and participants included 57,069 individuals aged 13–18 years. A multivariable logistic regression analysis was performed. Of the total participants, 13.0%, 4.0%, and 2.9% reported suicidal thoughts, suicidal plans, and suicidal attempts, respectively. After adjusting for confounding variables, all tobacco product users showed a greater likelihood of having suicidal behavior. However, compared with never users, dual users of CCs and HTPs were not significantly associated with having suicidal thoughts and attempts. Among tobacco product users, dual users of ECs and HTPs and triple users of CCs, ECs, and HTPs showed a greater likelihood of having suicidal behavior. Considering the prevalence of suicide and the increasing trend of using multiple tobacco products among Korean adolescents, tobacco control policies should monitor the effects of different products.

Examining Profiles of Latinx Sexual Minority Adolescents Associated with Suicide Risk

Few studies have focused on within-group heterogeneity about specific factors that make lesbian, gay, or bisexual (LGB) Latinx adolescents at greater odds than other LGB adolescents for suicide We take a unique mixture-modeling approach by creating profiles of Latinx LGB adolescents based on suicide risk factors used in previous investigations (bullying, alcohol, sleep, social media, and poor grades). We use these profiles in a logistic regression to investigate suicidality A sample of 686 LGB, Latinx adolescents were used in a latent profile analysis yielding four distinct profiles. Class 4 represented the highest risk, with high rates of bullying, alcohol, poor grades, and use of electronics, while class 3 represented the lowest risk with low rates of bullying and alcohol Results speak to the need to address suicidal ideation through multiple factors, noting the strong association that both bullying and alcohol have with suicidal ideation.

Self-injurious and suicidal behavior in young adults, teens, and children with epilepsy: A population-based study

OBJECTIVE

Whereas studies in adult epilepsy patients have shown higher rates of suicidal ideation and attempt, such studies in children are limited. Using the Rochester Epidemiology Project database, we compared the risk of self-injurious behavior and suicidal ideation in a population-based cohort of childhood epilepsy to controls.

METHODS

We studied 339 cases with epilepsy and 678 age- and sex-matched controls followed to a median age of 24.7 and 23.4 years, and identified 98 subjects with self-injurious behavior or suicidal ideation (43 with epilepsy and 55 controls). All behaviors were categorized using the Columbia Suicide Severity Rating Scale.

RESULTS

Those with epilepsy had a significantly higher rate of any self-injurious behavior and suicidal ideation (hazard ratio [HR] = 1.56, 95% confidence interval [CI] = 1.04-2.35) and tended to have an increased risk of suicidal ideation and attempt (HR = 1.48, 95% CI = 0.93-2.37). The prevalence of preceding mood and substance abuse disorders was similarly high in both cases and controls with self-injurious behavior or suicidal ideation; however, preceding attention-deficit/hyperactivity disorder was more than twice as common in the epilepsy cases. Among cases with epilepsy, we did not identify any specific epilepsy-related variable that was significantly correlated with risk of self-injurious behavior or suicidal ideation.

SIGNIFICANCE

Children, teens, and young adults with a history of childhood epilepsy are at greater risk of self-injurious behavior, highlighting the need for careful screening of mental health concerns as part of routine epilepsy care.

Identification of influencing factors for suicidal ideation and suicide attempts among adolescents: 11-year national data analysis for 788,411 participants

Suicide is one of the most common causes of death in adolescents. This study identified trends in the prevalence of and factors influencing suicidal ideation and attempts among Korean adolescents. Data were drawn from the third through the thirteenth (2007-2017) annual Korean Youth Risk Behavior Web-based Surveys. Participants included stratified, multistage clustered samples selected from 400 middle schools and 400 high schools annually. Depression, suicidal ideation, and suicide attempts were binary dependent variables (requiring answers of yes or no). A total of 818,684 adolescents were targeted and 788,411 adolescents completed the survey. The prevalence rates of both suicidal ideation and attempts gradually decreased from 23.7% and 5.8%, respectively, in 2007 to 12.1% and 2.6%, respectively, in 2017. Overall, 16.8% of participants had suicidal ideation and 3.9% had suicide attempts during the survey period. During logistic regression analysis, depression was most strongly associated with suicidal ideation (adjusted odds ratio: 5.78 [95% confidence interval: 5.64-5.88]) and suicide attempts (adjusted odds ratio: 5.56, [95% confidence interval: 5.22-5.83]). Despite decreasing trends, the high rate of suicidal behaviors remains a critical public health problem. Depression most strongly predicts suicidal behaviors. Early interventions are essential to treat depression and reduce or prevent suicide.

Identifying Distinct Subgroups of Lesbian, Gay, and Bisexual Youth for Suicide Risk: A Latent Profile Analysis

PURPOSE

The purpose of the study was to identify profiles of lesbian, gay, and bisexual (LGB) youth who are at risk for suicidal behavior.

METHOD

Data were collected through the Youth Risk Behavior Surveillance System (N = 2,738). We used latent profile analysis to create identity profiles using variables associated with suicide, including bullying, alcohol use, poor grades, electronics use, and sleep hours.

RESULTS

The LPA revealed a 6-class solution. Class 6 represented the highest risk profile with the highest scores in alcohol, bullying, poor grades, electronics use, and the least sleep and were 17 times more likely to attempt suicide compared to class 2 (the lowest-risk class). Classes 1, 3, 4, and 5 had a mixture of both high and low risk mean scores across the variables, with class 3 showing the strongest relationship to suicide (7 times more likely than class 2).

CONCLUSION

Because high-risk classes in our study had multiple factors contributing to associations to suicide, programming aimed at attenuating youth suicide among LGB youth may benefit from addressing multiple issues simultaneously (e.g., substance use and bullying). This would be a departure from more traditional programs for LGB youth which are predicated on one specific risk behavior, such as coping with bullying or substance use separately.

Increasing Trend and Characteristics of Korean Adolescents Presenting to Emergency Department for Self-Harm: A 5-Year Experience, 2015 to 2019

PURPOSE

Emergency department (ED) is a common treatment setting for adolescents with clinically serious self-harm. Here, we investigated the clinical characteristics and trends of adolescents with self-harm who visited the ED in one Korean university hospital. We also compared patients with a single ED visit to those with multiple ED visits to identify the risk factor of repeated visits.

MATERIALS AND METHODS

We retrospectively identified patients aged 12 to 18 years who presented to ED for self-harm from January 2015 to December 2019, based on electronic medical records. Self-harm included all thoughts and behaviors indicating intents to harm or hurt oneself, regardless of the degree of such attempt.

RESULTS

A total of 168 individuals (male:female=31:137; average 15.99±1.64 years) presented to ED following 304 episodes (45 and 259 episodes in males and females, respectively). The number of episodes steeply increased between 2016 and 2019, and the overall number during the study showed an increasing trend (p=0.043). Repeated ED visitors with self-harm showed more history of psychiatric treatment/admission (58.3% vs. 85.4%, p=0.002; 14.2% vs. 43.9%, p<0.001), history of child abuse (32.3% vs. 53.7%, p=0.013), and familial psychiatric history (13.4% vs. 31.7%, p=0.008) compared to those with a single visit.

CONCLUSION

Among Korean adolescents, the number of ED visits and repetition of ED visits for self-harm is on the rise. For adolescents presenting to ED with self-harm, the history of psychiatric treatment/admission, child abuse, and familial psychiatric history should be properly obtained to identify the risk for multiple ED visits.

The Neglected Role of Physical Education Participation on Suicidal Ideation and Stress in High School Adolescents from South Korea

Adolescents are at high risk of suicidal ideation and stress. This study aimed to investigate how physical education participation predicts suicidal ideation and stress in South Korean high school students. Data from the Twelfth Korea Youth Risk Behaviour Web-Based Survey 2016 (KYRBS) were used for analyses. Two multiple logistic regressions were performed to determine the influence of selected factors on suicidal ideation and stress (model 1: subjective health, social support, body mass index, academic achievement, perceived economic status of family, and physical education participation; model 2: adjusting for school type and year). Model 2 revealed negative associations between subjective health, academic achievement, perceived economic status of family, social support, physical education participation (≥2 times/weekly), and suicidal ideation for male students. Female students exhibited negative associations between subjective health, social support, and academic achievement, along with a positive association between body mass index and suicidal ideation. For both genders, stress was negatively associated with subjective health, social support, academic achievement, perceived economic status of family, and physical education participation (≥2 times/weekly). These findings suggest that participating in physical education can mitigate the risk of suicidal ideation and stress among high school students.

Mental health challenges in academia: comparison between students of the various educational levels in Ghana

BACKGROUND

Students continue to face significant mental health challenges that vary in severity and type. It is, therefore, imperative that researchers and clinicians pay more attention to efforts aimed at improving the mental well-being of students.

AIMS

This study examined the differences between Ghanaian students of the various educational levels on some mental health variables and the psychosocial factors of suicidal ideation.

METHODS

Three hundred and fifty-seven (357) participants consisting of junior (92 students) and senior (99 students) high school students, undergraduates (86 students) and postgraduates (80 students) were involved in this cross-sectional study.

RESULTS

The study revealed that high school students had higher academic stress, depression and suicidal ideation and they used more coping strategies compared to university students. Depression, age, and educational levels were the factors that facilitated suicidal ideation, with spiritual and ritual centred coping strategy and religion (Islam) serving as a buffer for suicidal ideation among students. These factors varied with different educational levels.

CONCLUSIONS

High school students experienced significant mental health problems compared to university students-this has direct implications on their academic and psychosocial development. The study recommends that mental health facilities be provided and managed by professionals, especially in high schools.

Victimization, Poverty, and Resilience Resources: Stress Process Considerations for Adolescent Mental Health

Growing evidence suggests that exposure to early life adversity poses risk to youth development, with impaired mental health a central concern. This population-representative study of adolescent students (n=11,222) investigates the effects of two key forms of early adversity- victimization and poverty-on adolescent mental health in a step-wise fashion, also accounting for mutable and accessible resilience resources. Victimization and poverty prevalence reflected social patterning wherein being female, racial and ethnic minority youth, and those with lower resilience resources all reported significantly higher levels of victimization and family poverty. Greater levels of these adversities were significantly associated with lower levels of resilience resources. Poverty and particularly victimization demonstrated significant cumulative and distinct contributions across three indicators of compromised mental health-depression, suicidality, and broader psychological well-being. Resilience resources of family bondedness, school engagement, and sleep sufficiency all carried significant effects and accompanied lesser explanatory strength of victimization and family poverty. In separate analyses, each of four forms of victimization-adult maltreatment, bullying, dating violence, and feeling unsafe at school-were significant contributors to mental health, with cumulative exposure conveying the strongest unique effects. Implications and opportunities for prevention and remedial strategies are discussed, with particular attention to school-based responding.

Exploring the Association between Suicidality and Smoking Behavior among School-Based Children in Lao People's Democratic Republic (PDR)

This study examines the relationship between suicidality and smoking behavior. Specifically, it examines how and the degree to which suicide ideation and plan are associated with the probability of being a regular smoker among school-based children. Data come from Lao Student Health Survey (2017), a project funded by the National Research Foundation of Korea. Using primary hierarchically nested data (students clustered in classrooms across schools), we investigate the complex interplay between suicidality and smoking behavior in Lao PDR, a low-income country located in Southeast Asia. Results from fitting two-level random intercept models show that net of controls (e.g., gender, age, parental regulation, self-rated health, household SES), the likelihood of daily smoking is higher among students who have seriously considered committing suicide or have planned a suicide attempt. Controlling for individual-level factors, significant classroom-level contextual effects are also found with respect to peer relations. Finally, we observe a cross-level interaction: the positive association between suicide intent and odds of smoking is weaker in classrooms with better peer relations.

Suicidal ideation and suicide attempts among Tunisian adolescents: prevalence and associated factors

Introduction

Studies directed on suicidal behavior in North African adolescents are rare. This study was conducted to estimate the prevalence of suicidal thoughts and attempts among high school students in Tunisia and to determine factors associated with this suicidal behavior.

Methods

This is an analytical cross-sectional study composed of a population containing 821 high school students obtained through cluster sampling. The participants completed a pre-established form related to socio-demographic characteristics and anxiety symptoms, the Suicide Behavior Questionnaire-Revised, the Beck depression scale, and the Rosenberg self-esteem scale.

Results

The mean age of the adolescents was 17.7±0.97 years. Prevalence of suicidal behavior was 26.9% for brief passing suicidal thoughts, 9.6% for serious suicidal thoughts, and 7.3% for suicide attempts. Six determining factors of suicidal behavior were found: female gender (OR=2.56 (1.32-4.95); p= 0.005), personal history of depression (OR=2.29 (1.38-3.80); p=0.001), tobacco smoking (OR=3.59 (1.61-8.01); p=0.002), current depression symptoms (OR=5.50 (2.14-14.11); p<0.001), history of non-suicidal self-injurious behavior (OR= 3.16 (2.05-4.86); p<0.001), and low self-esteem (OR=2.74 (1.71-4.38); p<0.001).

Conclusion

Suicidal ideation and attempts are frequent among Tunisian adolescents and represent a serious public health problem. An urgent national prevention program is required.

Sleep difficulties and suicidality in youth: current research and future directions

Studies have established a clear relationship between subjective sleep problems and the continuum of suicidality in adolescents. These studies are primarily cross-sectional in nature and conducted with epidemiological and depressed clinical samples. More recent studies focus on prospective data. Herein, we provide an update on current studies on the sleep-suicide association among youth. To further the critical mission of youth suicide prevention, future directions include more nuanced study of sleep employing a sleep health framework, longitudinal studies employing both objective and subjective sleep measures, fine-grained temporal associations between these constructs and their fluctuations over time, as well as enhanced understanding of the mechanisms underlying these associations.

Stressful life events, insomnia and suicidality in a large sample of Chinese adolescents

AIMS

This study aimed to examine the associations between stressful life events, insomnia, and suicidality including suicidal ideation (SI), suicide plan (SP) and suicide attempt (SA) in a large sample of Chinese adolescents.

METHODS

A total of 11,831 adolescents who participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort were included for the analysis. Participants were sampled from 8 middle/high schools in 3 counties of Shandong, China. Participants completed a structured behavior and health questionnaire, including suicidality, demographics, depression/anxiety, stressful life events (SLEs), and insomnia in November-December 2015. A series of logistic regression models and mediation analyses were performed to examine the associations between SLEs, insomnia and suicidality.

RESULTS

The prevalence rates of overall suicidality, SI, SP and SA in the last year were 13.1%, 12.5%, 3.3%, and 1.5%, respectively. SLEs were significantly associated with overall suicidality, SI, and SP. Insomnia was an independent risk factor of suicidality and a mediator of the association between SLEs and suicidality. The total effect of SLEs on overall suicidality was 0.597 (95%CI: 0.534-0.661), including 0.457 (95%CI: 0.391-0.523) for direct effect and 0.158 (95%CI: 0.138-0.178) for indirect effect. Insomnia also mediated the associations of SLEs with SI, SP and SA, respectively.

LIMITATIONS

Causal relationship could not be concluded because this study is cross-sectional.

CONCLUSIONS

Stressful life events and insomnia are directly associated with suicidality in adolescents. The association between SLEs and suicidality is partially mediated by insomnia.

Lifestyle Interventions and Prevention of Suicide

Over the past years, there has been a growing interest in the association between lifestyle psychosocial interventions, severe mental illness, and suicide risk. Patients with severe mental disorders have higher mortality rates, poor health states, and higher suicide risk compared to the general population. Lifestyle behaviors are amenable to change through the adoption of specific psychosocial interventions, and several approaches have been promoted. The current article provides a comprehensive review of the literature on lifestyle interventions, mental health, and suicide risk in the general population and in patients with psychiatric disorders. For this purpose, we investigated lifestyle behaviors and lifestyle interventions in three different age groups: adolescents, young adults, and the elderly. Several lifestyle behaviors including cigarette smoking, alcohol use, and sedentary lifestyle are associated with suicide risk in all age groups. In adolescents, growing attention has emerged on the association between suicide risk and internet addiction, cyberbullying and scholastic and family difficulties. In adults, psychiatric symptoms, substance and alcohol abuse, weight, and occupational difficulties seems to have a significant role in suicide risk. Finally, in the elderly, the presence of an organic disease and poor social support are associated with an increased risk of suicide attempt. Several factors may explain the association between lifestyle behaviors and suicide. First, many studies have reported that some lifestyle behaviors and its consequences (sedentary lifestyle, cigarette smoking underweight, obesity) are associated with cardiometabolic risk factors and with poor mental health. Second, several lifestyle behaviors may encourage social isolation, limiting the development of social networks, and remove individuals from social interactions; increasing their risk of mental health problems and suicide.

Deliberate Self-harm among Young People Begins to Increase at the Very Early Age: a Nationwide Study

BACKGROUND

Suicide in young people is one of most common cause of death; and deliberate self-harm (DSH) is important indicator of suicide. It is currently unclear how old the rate begins to increase or when it reaches to the same level with adults. The purpose of this study was to find beginning age of DSH and compare their characteristics with adults.

METHODS

This study retrospectively reviewed 5 years of nationwide prospective registry named Emergency Department-based Injury In-depth Surveillance (EDIIS) registry composed of all injured patients who were admitted to twenty tertiary university hospital emergency departments. Injured patients aged 29 years or younger from January 1, 2011 to December 31, 2015 were included. Incidence rate of DSH in all age was described. Patients were stratified by age: early teenage (11-15 years), late teenage (16-19 years), and early adulthood (20-29 years). Data of early teenage group were compared to those of other groups for examining their characteristics.

RESULTS

Among 588,549 injury patients, 8,400 patients reported DSH. The rate began to rise at age 11 and reach at age 16 which was equivalent to that of age 20 to 29. Early teenage had significantly higher excess mortality ratio based injury severity score (EMR-ISS) and had almost same level without significant difference in operation incidence or mortality compared to late teenage and early adulthood.

CONCLUSION

DSH rate began to rise at age 11, reaching adulthood level at age 16 in Korea.