Youth at risk: suicidal thoughts and attempts in Vietnam, China, and Taiwan

Incidence and correlates of suicide attempts in adolescents with major depressive versus bipolar disorders: A cross-sectional study

BACKGROUND

Major depressive disorders (MDD) and bipolar disorders (BD) are the most common psychiatric diagnoses of suicide attempts (SA) in adolescents. However, little is known regarding the differences in incidence and clinical-related features of SA between these two disorders. The study aims to examine the SA incidence and related factors in adolescents with MDD versus BD.

METHOD

A retrospective survey was conducted in outpatients. SA incidence, demographic characteristics and substance use history were collected. Symptom Checklist-90 was used to measure the severity of symptoms. The Revised Chinese internet addiction scale and Barratt Impulsiveness Scale-11 were utilized to assess the presence of internet addiction and impulsiveness. The Childhood Trauma Questionnaire was used to measure childhood maltreatment subtypes.

RESULTS

295 MDD and 205 BD adolescents were recruited. The incidence of SA for MDD and BD were 52.5 % and 56.4 %, respectively. BD adolescents who attempted suicide showed worse symptoms, higher rates of nicotine and alcohol use, higher motor and non-planning impulsivity, and a more childhood physical abuse proportion than MDD adolescents with SA. Physical abuse in childhood was found to be associated with SA in both disorders (OR = 1.998 for MDD; OR = 2.275 for BD), while higher anxiety (OR = 1.705), and alcohol use (OR = 2.094) were only associated with SA in MDD.

LIMITATIONS

Retrospective, cross-sectional design cannot draw causality, and biases in self-report measurements cannot be ignored.

CONCLUSIONS

The findings revealed some difference between BD and MDD for adolescents with SA, and it emphasize significance of prompt identification and exact distinction between BD and MDD in adolescents.

Psychosocial risk factors of youth suicide in the Western Pacific: a scoping review

INTRODUCTION

 The Western Pacific region accounts for 25% of global suicide rates globally. In the last decade, however, there is a rising concern over the rate of youth suicides in the region. In line with the regional vision of reducing the rate of non-communicable diseases by 2025, the study contributes to the literature by utilizing a scoping review approach to identify psychosocial risk factors associated with youth suicide in the region.

METHOD

Publications on youth suicide in the Western Pacific region between 2010 and 2021 were reviewed. A total of 43 publications met the inclusion criteria and were read in full.

RESULTS

Psychosocial risk factors associated with suicide in each publication were identified and thematically classified into five themes: interpersonal factors, history of abuse, academic factors, work factors, and minority status.

DISCUSSION

Findings showed discrepancies in youth suicide research across member nations in the Western Pacific. Implications for regional policies on suicide prevention and future research were discussed.

Prevalence of Suicidal Behavior Among Students in South-East Asia: A Systematic Review and Meta-Analysis

OBJECTIVES

Estimation of rates of suicidal behaviors (ideation, plan, and attempt) would help to understand the burden and prioritize prevention strategies. However, no attempt to assess suicidal behavior among students was identified in South-East Asia (SEA). We aimed to assess the prevalence of suicidal behavior (ideation, plan, and attempt) among students in SEA.

METHODS

We followed PRISMA 2020 guidelines and registered the protocol in PROSPERO (CRD42022353438). We searched in Medline, Embase, and PsycINFO and performed meta-analyses to pool the lifetime, 1-year, and point prevalence rates for suicidal ideation, plans, and attempts. We considered the duration of a month for point prevalence.

RESULTS

The search identified 40 separate populations from which 46 were included in the analyses, as some studies included samples from multiple countries. The pooled prevalence of suicidal ideation was 17.4% (confidence interval [95% CI], 12.4%-23.9%) for lifetime, 9.33% (95% CI, 7.2%-12%) for the past year, and 4.8% (95% CI, 3.6%-6.4%) for the present time. The pooled prevalence of suicide plans was 9% (95% CI, 6.2%-12.9%) for lifetime, 7.3% (95% CI, 5.1%-10.3%) for the past year, and 2.3% (95% CI, 0.8%-6.7%) for the present time. The pooled prevalence of suicide attempts was 5.2% (95% CI, 3.5%-7.8%) for lifetime and 4.5% (95% CI, 3.4%-5.8%) for the past year. Higher rates of suicide attempts in the lifetime were noted in Nepal (10%) and Bangladesh (9%), while lower rates were reported in India (4%) and Indonesia (5%).

CONCLUSIONS

Suicidal behaviors are a common phenomenon among students in the SEA region. These findings call for integrated, multisectoral efforts to prevent suicidal behaviors in this group.

Youth and suicidality: Correlates among clients attending youth mental health promotion clinics in India

BACKGROUND

Suicidality among youth is one of the most challenging public health issues. A thorough understanding of the risk factors that contribute to youth suicidality is necessary. The main aim of the study is to estimate the proportion of suicidality and understand factors associated with suicidality amongst clients attending youth mental health promotion clinics in Karnataka, India.

METHODS

A retrospective cross-sectional case record analysis was performed utilising data from real-time digitised management information system specifically developed for the programme. All case records of clients aged 15 to 35 years who received mental health promotion (MHP) services between January 2017 and December 2020 across 30 districts of Karnataka were included in this analysis. Multivariate logistic regression analysis was performed with suicidality among clients as outcome. Socio-demographic characteristics, issues reported, feelings/emotions that indicate underlying mental health issue/crisis, being aware of suicidality among friends and family and personal habits (smoking/chewing tobacco and drinking alcohol) were considered potential exposure variables.

FINDINGS

Overall proportion of suicidality among youth presenting to youth mental health promotion clinics in Karnataka was 3.5% (357/10,340). Among factors associated with suicidality, the strongest association was found among those clients who reported attempted suicide among friends (AOR 8.94; 95% CI 5.95-13.45), family members (AOR 5.50; 95% CI 3.66-8.29), being anxious (AOR 4.90; 95% CI 3.43-6.99), inability to trust anyone (AOR 4.07; 95% CI 2.75-6.03), had issues of Gender, Sex and Sexuality (AOR 3.16; 95% CI 1.93-5.17) and relationship issues (AOR 2.77; 95% CI 2.05-3.73).

CONCLUSION

The results alert all institutions, organisations and departments that cater to services and development of youth, to be sensitive towards risk factors of suicidality. The study advocates youth mental health promotion clinics to be equipped with measures/interventions to identify and manage such risk factors. This study has implications for Youth mental health promotion in India and other similar South-East Asian countries.

Parental Phubbing, Self-Esteem, and Suicidal Ideation among Chinese Adolescents: A Longitudinal Mediational Analysis

Parental phubbing refers to a phenomenon in which parents are distracted by their smartphones when they interact with their children. It has become a common concern and linked to adolescents' internalizing and externalizing behavior problems. However, much remains unclear about reciprocal associations among parental phubbing, self-esteem, and suicidal ideation and the potential mechanisms underlying these associations. To address these gaps, the current study tested bidirectional relationships among parental phubbing, self-esteem, and suicidal ideation, as well as the mediating role of self-esteem. In addition, the present study examined whether these relationships varied by extraversion, gender, and perceived economic stress across three time points using a cross-lagged design. A total of 2407 Chinese adolescents (50.23% girls, M_age = 12.75, SD = 0.58 at baseline) participated in the study. The results showed that parental phubbing was associated with self-esteem as well as with suicidal ideation, and there were bidirectional relationships between self-esteem and suicidal ideation. Self-esteem significantly mediated the association between parental phubbing and suicidal ideation. Extraversion moderated the link between parental phubbing and suicidal ideation as well as self-esteem and suicidal ideation during the first year. Gender and perceived economic stress did not play a moderating role. The results indicate that parental phubbing is a new risk factor for adolescents' suicidal ideation. Parents concerned about adolescents' self-esteem and suicidal ideation should focus on minimizing the frequency of smartphone use and teach adolescents some social skills to seek more sources of social support.

Race Differences in Opioid Misuse and Adolescent Suicidality

Purpose

The rise of the opioid epidemic coincided with the increased risk of suicide as the leading causes of death among adolescents in the United States. Past research has linked non-medical prescription opioid use (NMPOU) with adolescent suicide. Less focus has been placed on race and ethnic differences among adolescents impacted by the opioid epidemic. This study examined the relationship of adolescent NMPOU and suicidality, stratified by race.

Method

The 2016 National Survey on Drug Use and Health (NSDUH) was used for this study. Weighted multivariate logistic regression analyses were conducted on a sample of 11,489 adolescent respondents to examine the effect of past-year NMPOU with the odds for serious thoughts of suicide, having a suicide plan, and making a suicide attempt.

Results

Findings indicated a higher prevalence of suicidality among adolescents who engaged in NMPOU compared to non-users. Adolescent opioid misuse was associated with 68% higher odds for having a suicide plan in the past year (OR = 1.68, 95% CI: [1.07, 2.63], p < 0.05). Interaction analysis found that among Asian adolescents, NMPOU was associated with higher odds for having a suicide plan compared to other race groups (OR=1.53, 95% CI: [1.04, 2.23], p < 0.05).

Discussion

Results indicated that adolescent opioid misuse is a risk factor for suicide, and Asians compared to other race groups were at greater risk. Social workers can serve as a nexus point in effectively engaging at-risk adolescents in substance use and mental health prevention and recovery services.

The Impact of Early Life War Exposure on Mental Health among Older Adults in Northern and Central Vietnam

Most Vietnamese young adults who experienced the American War were exposed to war-related violence, which can exert a lifelong impact. We analyze survey data collected among northern and central Vietnamese older adults in the 2018 Vietnam Health and Aging Study (N = 2,447) to examine the association between various war traumas, psychological distress, and suicidal ideation. Informed by life course and stress process perspectives, we use structural equation models with multiple mediators to analyze the relationship between mental health outcomes and five types of wartime stress exposure: loss of family and friends, witnessing death, malevolent living conditions, life threat, and moral injury. Our findings reveal enduring mental health impacts of war among survivors. Wartime stress exposure's influence on mental health is mediated by recent comorbidities and stressful life events. Loss of family members, witnessing death, and malevolent living conditions during war are particularly salient risks for psychological distress.

Voicing Jordanian Adolescents' Suicide

BACKGROUND

Studies focusing on adolescent suicide in Arab countries are particularly scarce, with the few available undertaken from within an epidemiological paradigm.

OBJECTIVE

This study aimed to understand Jordanian adolescents' perceptions, beliefs, and attitudes toward suicide.

METHODS

A qualitative design using 12 dual-moderator focus group discussions was conducted in public schools. Participants were selected from the three main regions of the country (rural southern, urban central, and suburban northern). Participants included Jordanian adolescent boys and girls, aged 14-17 years, who reported experiencing mild to moderate depressive symptoms. A relational content analysis approach was used for coding data, and a content analysis was used to identify salient thematic categories. Data were analyzed using NVivo software.

RESULTS

Four themes emerged, including perceived risk factors, perceived protective factors, active and passive suicidal ideations, and e-games and Internet influences. Main risk factors were depression; anxiety; stigma, shame, and isolation; family issues; life pressures; and guilt. Conversely, religiosity, perceived positive family functioning, and availability of long-term goals seemed to confer resilience to adolescents' suicidal ideation and behavior. Passive suicidality (having death wishes without any plans to complete suicide) was noticed most among participants who feared jeopardizing the family's reputation if they committed suicide. Several boys with active suicidal ideations used the Blue Whale Challenge e-game to learn how to complete suicide and relinquish their problems.

DISCUSSION

Suicide is a multifactorial problem requiring multimodal strategies. Evidence from this research suggests that those most passionate about the outcome of interest are encouraged to redouble efforts to reduce modifiable risk factors, enrich protective factors, target the underlying psychiatric illness that informs suicidal ideations and behavior, and research the effect of social media and Internet activity more deeply. Parents are advised to monitor the online activities of their children and familiarize themselves with the digital applications they use.

Depressive symptoms and suicidal ideation among Vietnamese students aged 13-17: Results from a cross-sectional study throughout four geographical regions of Vietnam

We conducted a cross-sectional study in four provinces located in four different geographical areas in Vietnam to examine the prevalence and associated factors of depression and suicide ideation among school students aged 13-17. A sample of 6407 students from secondary school and high school participated in our survey to complete self-reported questionnaires. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression scale (CES-D). Suicidal ideation and associated factors were measured by the Global School Student Health Survey (GSHS) questionnaire. We found that 31.7% of students had depressive symptoms, and 11% reported suicidal ideation during the last year. Female students and older students were more at risk of experiencing depressive symptoms and suicidal ideation than male students and younger students. Bullying, violence, smoking, and alcohol consumption appear as risk factors, while a good relationship with parents/guardians may protect school students from having depressive symptoms and suicidal ideation.

The effect of adverse childhood experiences on depression, psychological distress and suicidal thought in Vietnamese adolescents: Findings from multiple cross-sectional studies

Exposing to adverse childhood experiences (ACEs) has been identified as one of the major contributing factors to poor mental health and suicide in adolescents. However, little is known about this relationship in Vietnamese adolescents. This study aimed to evaluate the effect of ACEs on depression, psychological distress and suicidal thought among Vietnamese adolescents across different areas in Vietnam. Cross-sectional surveys were conducted among 4957 secondary school and high school students aged 13-20 in urban area, rural area, border area and mountainous area. The students were asked to complete a self-report questionnaire which included the Center for Epidemiological studies - Depression, the Kessler-10 and ACE questionnaire from the WHO Adverse Childhood Experiences Study. Suicidal thought was evaluated by a single question from the U.S. Youth Risk Behavior Survey. Among 4720 students included in the analysis, 54.4% were female. The prevalence of depression, psychological distress and suicidal thought was 22.9%, 30.6% and 10.9% respectively. About 86% of participants experienced at least one type of ACEs and nearly 56% reported multiple types of ACEs. Students with four or more types of ACEs had 6.98 (95% CI 5.09 -9.56), 4.72 (95 % CI 3.58-6.23) and 6.43 (95 % CI 4.45-9.30) times higher in odds of having depression, psychological distress and suicidal thought respectively. In conclusion, ACEs are common in Vietnamese adolescents and are strongly associated with depression, psychological distress and suicidal thought. Our finding indicates urgent needs for interventions targeting both ACEs and depression, psychological distress in Vietnamese adolescents.

Suicidal behaviors and depression "among adolescents in Hanoi, Vietnam: A multilevel analysis of data from the Youth Risk Behavior Survey 2019

This study described the prevalence of suicidal behaviors and depression among adolescents in Hanoi, Vietnam, and examines the associated factors. In 2019, a school-based survey was conducted in three high schools in Hanoi and 661 high students were included into the study. We found that the prevalence of 12-month suicidal thoughts, suicide plans, and suicide attempts were 14.2%, 5.5%, and 3.0% respectively. Notably, the depression score mean was 16.1±4.9, among major predictors of suicidal ideation. Therefore, developing psychological care services in school is imperative to the early detection of mental disorders and the prevention of suicidal behaviors for the students.

Theoretical frameworks informing the relationship between parental death and suicidal behaviour: A scoping review

Background

Exposure to parental death in childhood has been strongly associated with offspring suicide although few studies have applied theoretical models to conceptualise this relationship.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Scoping Reviews guidelines, we conducted a scoping review of primary studies that identified a theory/framework explaining the aetiology of suicidal behaviour in adulthood, following childhood exposure to external-cause parental death, including suicide.

Results

The search yielded 1598 articles. Following full-text screening, 23 studies were identified as meeting inclusion criteria. Data extraction was then completed and found that the studies collectively referenced nine theories. The specific theories identified covered a range of biopsychosocial frameworks and included attachment theory, familial transmission of suicide, conservation of resources framework, diathesis-stress model, social integration theory, socio-ecological model, social learning theory, critical period hypothesis or life course approach and the developmental model of antisocial behaviour.

Limitations

It was beyond the scope of this review to conduct rigorous testing and evaluation of the theories identified. Future research could extend on this study by developing criteria to assess the range of theories and frameworks on suicide exposure, as well as the studies providing evidence for these theories, in order to guide more advanced theory development as well as policies, programs and interventions.

Conclusions

Based on these theories, the authors proposed that using an integrated biopsychosocial model will provide a more comprehensive understanding of the diverse risk and protective factors for suicidal behaviour following parental death.

A person-centered approach to studying associations between psychosocial vulnerability factors and adolescent depressive symptoms and suicidal ideation in a Canadian longitudinal sample

This study used a person-centered approach to identify subgroups of adolescents who are at risk for depression and suicidal ideation. Latent class analysis was first applied to 1,290 adolescents from a Canadian cohort study in order to identify latent vulnerability subtypes based on 18 psychosocial vulnerability factors. Logistic regression analyses were conducted to study the associations between class membership and depressive symptoms and suicidal ideation 2 years later. The moderating role of sex in the associations between latent classes and depressive symptoms was explored. Five latent classes were identified: Low Vulnerability (42%), Substance Use Only (13%), Moderate Vulnerability (28%), Conduct Problems (8%) and High Vulnerability (9%). Compared with the Low Vulnerability class, the probabilities of presenting depressive symptoms were higher for the Substance Use Only class, OR = 1.93, 95% CI [1.21, 3.06], the Moderate Vulnerability class, OR = 2.96, 95% CI [2.09, 4.20], the Conduct Problems class, OR = 3.03, 95% CI [1.84, 4.98], and the High Vulnerability class, OR = 5.4, 95% CI [3.42, 8.53]. Furthermore, interaction effects with sex were identified in relation to depressive symptoms only. The probability of presenting suicidal ideation was higher only for the High Vulnerability class, OR = 4.51, 95% CI [2.41, 8.43]. This study highlights the importance of a person-centered perspective that considers both vulnerability subtypes and sex because these associations are complex rather than linear or additive.

A systematic review on the relationship between childhood exposure to external cause parental death, including suicide, on subsequent suicidal behaviour

BACKGROUND

Exposure to parental death in childhood has been associated with offspring suicide risk, although the strength of this association is unclear. The primary aim of this systematic review was to synthesise primary studies on the relationship between childhood exposure to external cause parental death, including suicide, and subsequent suicidal behaviour in adulthood. The secondary objective was to compare suicide-related outcomes of exposure to parental suicide with the outcomes of exposure to other external cause parental deaths.

METHODS

A systematic review was conducted using guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ovid MEDLINE, Cochrane Library, Ovid PsycINFO, Web of Science, CINAHL and EMBASE were searched from January 2008 until November 2018. Two researchers independently screened the articles, performed data extraction and assessed quality of evidence using the Newcastle-Ottawa Scale.

RESULTS

Of the 618 studies identified, 26 were included for review. Only one study found no significant association between childhood exposure to suicide and increased suicide risk in adulthood. Four studies suggested the risk of suicidality in adulthood was greater for those exposed to parental suicide compared to other external cause deaths.

LIMITATIONS

The use of national registers in many studies did not allow for all variables of interest to be examined. Selective samples also limited the generalizability of findings.

CONCLUSIONS

A strong association between parental suicide and suicidal behaviour in adult offspring exists. Interventions for bereaved youth should consider the long-term effects of parental suicide and target individual and environmental-level risk factors for subsequent suicidality.

Risk factors for suicidal tendency in adult patients with epilepsy in China

OBJECTIVE

The major cause of premature mortality in people with epilepsy (PWE) is suicide. Actual data on the risk of suicidal tendency in adult PWE in China are scarce. In our study, associations between possible risk factors and suicidal tendency in adult PWE in China were investigated.

METHODS

People with epilepsy (n = 251) were recruited, and their demographic and clinical characteristics were evaluated. Suicide risk was examined using the suicidality module (SM) of the Mini International Neuropsychiatric Interview (MINI) Plus Chinese Version 5.0.0.

RESULTS

Suicidal tendency was present in 36 (14.3%) of the 251 PWE. On the basis of the results of univariate analyses, family relationship (P < 0.001), age at epilepsy onset (P = 0.037), seizure-free period (P = 0.041), seizures/month (P = 0.015), depressive disorders (P < 0.001), and number of antiepileptic drugs (AEDs) (P = 0.017) were associated with suicidal tendency. Multivariate analysis revealed that moderate or poor family relationships (odds ratio (OR): 6.468, 95% confidence interval (CI): 2.418-17.300) and depressive disorders (OR: 3.548, 95% CI: 1.575-7.995) were associated with high odds of suicidal tendency.

CONCLUSION

Suicidal tendency is common among adult PWE. This study reveals that family relationships and depressive disorders are independent risk factors for suicidal tendency among adult PWE. Therefore, while maintaining treatment of epilepsy, more attention should be directed to the social support and mental state of PWE to prevent suicide.

Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people

PURPOSE

Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high income countries, but this association is not established in low- and middle-income countries (LMIC).

METHODS

We investigated the association of SEP with suicidal behaviour in a prospective cohort study of 168,771 Sri Lankans followed up for episodes of attempted suicide and suicide. SEP data were collected at baseline at the household and individual level at the start of the follow-up period. We used multilevel Poisson regression models to investigate the association of SEP at community, household and individual levels with attempted suicide/suicide.

RESULTS

Lower levels of asset ownership [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [suicide 3.16 (1.06, 9.45); attempted suicide 2.51 (1.70, 3.72)] were associated with an increased risk of suicidal behaviour. The association of these measures of SEP and attempted suicide was stronger in men than women. Individuals living in deprived areas [1.42 (1.16, 1.73)] and in households with a young female head of household [1.41 (1.04, 1.93)] or a temporary foreign migrant [1.47 (1.28, 1.68)] had an elevated risk of attempted suicide. Farmers and daily wage labourers had nearly a doubling in risk of attempted suicide compared to other occupations.

CONCLUSIONS

Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households.

Impact of parent-adolescent bonding on school bullying and mental health in Vietnamese cultural setting: evidence from the global school-based health survey

Background

The mental well-being of adolescents is a crucial issue affecting lives of both adults and young people. Bullying and mental health problems are important factors that can have a negative impact on the mental well-being of adolescents. Public awareness of mental health problems among adolescents is rapidly growing in Vietnam. However, current approaches to identifying risk factors influencing mental health problems do not pay attention to potentially protective factors. This study was performed to examine the associations between parent–adolescent bonding and mental health outcomes as protective elements during the adolescent period.

Methods

Data collected from 3331 respondents in grade 8–12 as part of the Vietnam Global School-based Student Health Survey (GSHS) 2013 was used for the analysis. A three-stage cluster sample design was used to produce data representative of students. Multivariate logistic regression analysis was performed to examine the association of demographic characteristics and data regarding parent–adolescent bonding associations with status of mental health problems in adolescents.

Results

Parental understanding, parental monitoring were significantly associated with reduced likelihood of being bullied and mental health problems (P < 0.05). However, parental control was significantly associated with greater likelihoods of being physically attacked (adjusted odd ratio (aOR) = 1.36, 95%CI, 1.06, 1.75) and mental health problems, such as suicidal ideation, and loneliness (aOR = 1.96, 95%CI, 1.49, 2.57, aOR = 2.35, 95%CI, 1.75, 3.15, respectively), after adjusting for potential confounders.

Conclusions

The study indicated the significant associations between parental understanding, monitoring and control in a proxy of parent–adolescent bonding and mental well-being during the period of adolescent rebellion. Thus, parent–adolescent bonding in Southeast Asian cultural context may provide an effective means to promote the mental well-being of adolescents.

Prevalence of suicide attempts and their risk factors in school-aged patients with epilepsy: a population-based study

Suicide prevention is a critical issue for young people. However, no large body of representative data on the risk of suicide attempts in school-aged patients with epilepsy in Taiwan or other developing countries is available. Patients aged ≤ 18 years who received a diagnosis of epilepsy between 2000 and 2012 were included in the epilepsy cohort (N = 9801). The comparison cohort was matched to the epilepsy cohort at a ratio of 4:1. We calculated the adjusted hazard ratio and 95% confidence intervals (CIs) for suicide attempts after adjustment for age, sex, urbanization level, parental occupation category, comorbidities, and follow-up time. Further analysis was performed to assess the dose-response effect on the risk of attempting suicide based on the average frequency of medical visits for epilepsy. The overall incidence rates of suicide attempts in the epilepsy and comparison cohorts were 15.7 and 5.89 per 100,000 people per year, respectively. The epilepsy cohort had a 2.34-fold higher risk of suicide being attempted (95% CI 2.17-2.52) than did the comparison cohort. Male sex, over 12 years of age, and parental occupation of office work were found to be the major risk factors for suicide attempts. Epilepsy might be an independent factor predisposing school-aged patients to suicide attempts. The results of this study could provide clinicians and governments with vital information on suicide prevention for young people with epilepsy in Taiwan and other developing countries.

Parental involvement could mitigate the effects of physical activity and dietary habits on mental distress in Ghanaian youth

Introduction

Parental involvement in physical activity and dietary habits have been found to play a substantial role in the mental health of young people. However, there is little evidence about the associations between parental involvement, health behaviours and mental health among Ghanaian youth. This study sought to examine the role of parental involvement in the association between physical activity, dietary habits and mental health among Ghanaian youth.

Methods

Data were obtained from the 2012 Ghana Global School-based Student Health Survey (GSHS). The study population consisted of 1,984 school going youth in high schools with a median age of 15 years old, (53.7%) males. Bivariate and multivariate logistic regression statistical models using complex samples method were performed.

Results

The prevalence of mental distress was 18.1%, 16.6% and 23% for loneliness, feeling worried and suicidal ideation respectively. Younger students were more likely to feel lonely, worried and have suicidal ideation than older students. Students from low socio-economic backgrounds were significantly more likely to report loneliness, worry and suicidal ideation. After adjusting for socio-demographic characteristics, some physical activity and eating habits were associated with experiencing loneliness, worry and suicidal ideation but after introducing parental involvement, there was a decrease in the likelihood of some health behaviour factors in both physical activity and dietary habits to be associated with loneliness, worry and suicidal ideation.

Conclusion

Physical inactivity and poor dietary habits could have a negative effect on mental distress, however, parental involvement could mitigate the impact of these lifestyle habits on mental distress and should therefore be taken into consideration in efforts aimed at encouraging positive lifestyle habits for good mental health among Ghanaian youth.

Cultural versus classic risk and protective factors for suicide

The current study examined the predictive value of cultural versus classic risk and protective factors for suicide in a community sample of 322 ethnic, sexual, and gender minority adults. Cultural factors played a significant and substantial role in predicting suicide attempts (explained 8% of variance in attempts and correctly classified 8.5% of attempters) over and above the classic factors of hopelessness, depression, and reason for living (which explained 17% of variance in attempts and correctly classified 14.1% of attempters). Findings suggest that cultural factors are important to include in standard suicide practice.

Substance use and suicidal ideation and behaviour in low- and middle-income countries: a systematic review

Background

Understanding relationships between substance use and suicidal ideation and behaviour (SIB) has important public health implications for suicide prevention in low- and middle-income countries (LMICs), where 75% of suicides occur. This systematic review explored the associations between substance use and SIB in LMICs.

Methods

We searched five databases using a combination of keywords for substance use, SIB and LMICs to identify English-written quantitative studies published between January 2006 and February 2016. Data were extracted to provide an overview of what is known about the topic, highlight gaps in the literature, and explore the implications of current knowledge for suicide prevention. Studies included in the review were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network checklist.

Results

Analysis of included studies (N = 108) demonstrated a consistent positive association between substance use and SIB across all substances (i.e. alcohol, tobacco, cannabis, illicit drugs, non-medical use of prescription drugs), all substance use dimensions (i.e. intoxication, use, and pathological use) and all SIB dimensions (i.e. suicidal ideation, non-fatal suicidal behaviour, and suicide). Most of the available research evidence comes from upper-middle-income countries, only 22% comes from lower-middle-income and low-income countries. Most studies focused on alcohol and tobacco, while neglecting substances such as cannabis, opioids, sedatives, stimulants, misuse of prescription medication, inhalants, and hallucinogens. Most of the studies employed a cross-sectional design, were conducted within a risk-factor paradigm, and provided little information about the potential interaction between variables.

Conclusions

Public health suicide prevention policy and research in LMICs should take account of the fact that: substance use is a potentially modifiable risk factor; assessment and management of substance use is integral to the care of at-risk patients; reducing consumption and hazardous use of substances in LMICs is important for suicide prevention; and research needs to be expanded to include more theory driven research that focuses on all substance use dimensions and SIB dimensions, while employing more sophisticated statistical methods.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5425-6) contains supplementary material, which is available to authorized users.

Mental health status, and suicidal thoughts and behaviors of migrant children in eastern coastal China in comparison to urban children: a cross-sectional survey

PURPOSE

Although adolescents' mental health problems and self-injurious thoughts and behaviors (SITBs) have been a serious public health concern worldwide, descriptions of risk factors for SITBs often fail to take migration into account. There are roughly 35.8 million migrant children in China who, with their parents, moved from original rural residence to urban areas. Little is known about migrant children's mental health status and levels of SITBs. This study aims to explore the mental health status and SITBs of migrant children living in eastern coastal China in comparison to their urban counterparts.

METHODS

This study was a cross-sectional survey conducted in 13 schools. Mental health status and SITBs were measured via self-administered questionnaires. Associations between strengths and difficulties questionnaire outcomes and SITBs were investigated.

RESULTS

Data from 4217 students (1858 migrant children and 2359 urban children) were collected. After controlling for gender, age, family economic status, parent's education level and parents' marital status, migrant children scored higher for total difficulties (p < 0.001) and externalizing problems (p < 0.001) than did urban children and reported higher rates of suicidal ideation (p < 0.05) and self-injurious behaviors (p < 0.05).

CONCLUSIONS

Migrant children, compared with urban children, have a higher risk of externalizing problems and SITBs. It is urgent to address these problems by providing both mental health services at migrant-exclusive schools and equitable education and social welfare to migrant children.

Gender differences and stage-specific influence of parent-adolescent conflicts on adolescent suicidal ideation

This study examined familial and peer related factors as predictors of suicidal ideation in school students. Total 2896 participants were included from Taiwan Youth Project released data, a longitudinal survey of adolescent suicidal ideation at ages 15, 18, and 20. Logistic regression analysis risk factors associated with adolescent suicidal ideation reveled differences during the developmental stages. After adjusted for psychological symptoms, effect of quarrels with parents on suicidal ideation lasts in early and middle stages; in the late adolescent stage, only cigarette or alcohol use remained significant. Girls who reported quarrels with parents had the highest level of suicidal ideation before age 18. Stage- and gender-specific differences may provide appropriate intervention strategies for parents and teachers preventing adolescent suicidal ideation.

Anorexia nervosa, depression and suicidal thoughts among Chinese adolescents: a national school-based cross-sectional study

Background

Although there is much literature on adolescent suicide, combined effects of depression and anorexia nervosa on suicide were rarely investigated. The aims of this study are to examine the association between anorexia nervosa and suicidal thoughts and explore the interaction between anorexia nervosa and depression.

Methods

This is a cross-sectional study, in the study, a sample of 8,746 Chinese adolescents was selected by multistage stratified method in 2012/2013 from 20 middle schools in 7 provinces across China Mainland. Multilevel logistic model was introduced to explore association between anorexia nervosa and suicidal thoughts. And subgroup analyses were conducted on participants with or without depression.

Results

Multilevel logistic model revealed that demographic variables, including academic achievement, were not the predictive risk factors of suicidal thoughts. Those who suffered from worse severity of perceived anorexia nervosa were at increased risk of thinking about suicide. The interaction between depression and anorexia nervosa was significant, however, subgroup analyses showed that the associations were significant only among the adolescents without depression.

Conclusions

Our results indicate that all levels of anorexia nervosa serve as predictable indicators of suicidal thoughts in Chinese adolescents, and the effects of anorexia nervosa are modified by depression status.

Suicidal behaviors and associated factors among university students in six countries in the Association of Southeast Asian Nations (ASEAN)

A large data gap remains on suicidal behaviors among youth in the Association of Southeast Asian Nations (ASEAN) countries, despite the increasing rates of suicide in Asian cultures that may be related to rapid economic changes and the loss of social stability. This study was therefore conducted to explore the prevalence of and factors associated with suicidal ideation and suicide attempts among university students in six ASEAN member states. Data were collected in a cross-sectional survey of 4675 undergraduate university students, mean age 20.6 years (SD=2.7), range of 18-30 years, from Cambodia, Indonesia, Malaysia, Myanmar, Thailand and Vietnam. The overall prevalence of ever suicidal ideation and ever suicide attempt among students in this study was 11.7% and 2.4%, respectively. Different rates of these suicidal behaviors were observed across the countries. In multivariable logistic regression models, suicidal ideation was significantly associated with psychosocial factors including childhood sexual abuse, depressive symptoms, involvement in physical fights, and poor academic performance as well as socio-environmental factors including living with parents or guardians and low involvement in organized religious activity. Suicide attempt was significantly associated with childhood sexual abuse, depressive symptoms, low involvement in organized religious activity and being underweight or overweight. Our findings suggest that individual-level strategies for suicide prevention should be targeted toward students with poor academic performance, mental health problems and a history of adverse childhood experiences. Particular attention should be paid to the role of families that could be a potential stressor in the lives of university students.

Is socioeconomic position associated with risk of attempted suicide in rural Sri Lanka? A cross-sectional study of 165 000 individuals

BACKGROUND

Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high-income countries, but this association is unclear in low-income and middle-income countries.

METHODS

We investigated the association of SEP with attempted suicide in a cross-sectional survey of 165 233 Sri Lankans. SEP data were collected at the household (assets, social standing (highest occupation of a household member), foreign employment and young (≤40 years) female-headed households) and individual level (education and occupation). Respondent-reported data on suicide attempts in the past year were recorded. Random-effects logistic regression models, accounting for clustering, were used to investigate the association of SEP with attempted suicide.

RESULTS

Households reported 398 attempted suicides in the preceding year (239 per 100 000). Fewer assets (OR 3.2, 95% CI 2.4 to 4.4) and having a daily wage labourer (ie, insecure/low-income job; OR 2.3, 95% CI 1.6 to 3.2) as the highest occupation increased the risk of an attempted suicide within households. At an individual level, daily wage labourers were at an increased risk of attempted suicide compared with farmers. The strongest associations were with low levels of education (OR 4.6, 95% CI 2.5 to 8.4), with a stronger association in men than women.

CONCLUSIONS

We found that indicators of lower SEP are associated with increased risk of attempted suicide in rural Sri Lanka. Longitudinal studies with objective measures of suicide attempts are needed to confirm this association.

TRIAL REGISTRATION NUMBER

NCT01146496; Pre-results.

Inflammatory markers and suicidal attempts in depressed patients: A review

Major depressive disorder is a chronic and invalidating psychiatric illness and is associated with a greater risk of suicidal behaviors. In recent decades many data have supported a biological link between depressive states and inflammation. Pro-inflammatory cytokines have been found to rise, first of all TNF-α and IL-6. Suicidal behaviors have been consistently associated with increased levels of IL-6 and decreased levels of IL-2. The aim of this review is to investigate the relationship between inflammatory markers in depressed patients with or without suicidal attempts compared to healthy controls.

Problem-Solving Coping and Social Support as Mediators of Academic Stress and Suicidal Ideation Among Malaysian and Indian Adolescents

This study examined whether productive coping styles and social support were significant mediators of the relationship between academic stress and suicidal ideation. The survey was performed on a sample of 300 Malaysian and 300 Indian college students. The participants completed psychological assessments of productive coping styles, social support, academic stress, and suicidal ideation. Significant cultural and demographic differences emerged. Indian students reported higher suicidal ideation and academic stress than did Malaysian students, and Malaysian students received more social support and had better problem-solving coping styles than did Indian students. Overall, students who were male, non-religious, and from low-income families reported more academic stress and more suicidal ideation. Productive coping styles and overall social support strongly affected the relationship between academic stress and suicidal ideation among both countries' participants.

Association of socio-economic position and suicide/attempted suicide in low and middle income countries in South and South-East Asia - a systematic review

BACKGROUND

Forty percent of the world's suicide deaths occur in low and middle income countries (LAMIC) in Asia. There is a recognition that social factors, such as socioeconomic position (SEP), play an important role in determining suicidal risk in high income countries, but less is known about the association in LAMIC.

METHODS

The objective of this systematic review was to synthesise existing evidence of the association between SEP and attempted suicide/suicide risk in LAMIC countries in South and South East Asia. Web of Science, MEDLINE, MEDLINE in Process, EMBASE, PsycINFO, and article reference lists/forward citations were searched for eligible studies. Epidemiological studies reporting on the association of individual SEP with suicide and attempted suicide were included. Study quality was assessed using an adapted rating tool and a narrative synthesis was conducted.

RESULTS

Thirty-one studies from nine countries were identified; 31 different measures of SEP were reported, with education being the most frequently recorded. Most studies suggest that lower levels of SEP are associated with an increased risk of suicide/attempted suicide, though findings are not always consistent between and within countries. Over half of the studies included in this review were of moderate/low quality. The SEP risk factors with the most consistent association across studies were asset based measures (e.g. composite measures); education; measures of financial difficulty and subjective measures of financial circumstance. Several studies show a greater than threefold increased risk in lower SEP groups with the largest and most consistent association with subjective measures of financial circumstance.

CONCLUSION

The current evidence suggests that lower SEP increases the likelihood of suicide/attempted suicide in LAMIC in South and South East Asia. However, the findings are severely limited by study quality; larger better quality studies are therefore needed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2014: CRD42014006521.

Global trends in teenage suicide: 2003-2014

The object of this article is to review the past decade of research on teenage suicide, with a particular emphasis on epidemiologic trends by age, gender and indigenous ethnicity. As such, a review of research literature from 2003 to 2014 was conducted via a comprehensive search of relevant psychological and medical databases. Wide gaps in our knowledge base exist concerning the true extent of teenage suicide due to lack of data, particularly in developing countries, resulting in a Western bias. The gender paradox of elevated suicidality in females with higher completed suicide rates in males is observed in teenage populations worldwide, with the notable exceptions of China and India. Native and indigenous ethnic minority teens are at significantly increased risk of suicide in comparison to general population peers. Often those with the highest need for mental health care (such as the suicidal adolescent) have least access to therapeutic support.Globally, suicide in teenagers remains a major public health concern. Further focused research concerning completed suicides of youth below the age of 18 is required across countries and cultures to understand more about risk as children progress through adolescence. Gender and ethnic variations in suicidality are embedded within cultural, historical, psychological, relational and socio-economic domains. Worldwide, the absence of child/adolescent-specific mental health policies may delay the development of care and suicide prevention. Overall, it is vital that clinicians adopt a holistic approach that incorporates an awareness of age and gender influences, and that cultural competency informs tailored and evaluated intervention programmes.

The roles of emotional competence and social problem-solving in the relationship between physical abuse and adolescent suicidal ideation in China

The study investigated the relationship among physical abuse, positive psychological factors including emotional competence and social problem-solving, and suicidal ideation among adolescents in China. The possible moderating effects of emotional competence and social problem-solving in the association between physical abuse and adolescent suicidal ideation were also studied. A cross-sectional survey employing convenience sampling was conducted and self-administered questionnaires were collected from 527 adolescents with mean age of 14 years from the schools in Shanghai. Results showed that physical abuse was significantly and positively related to suicidal ideation in both male and female adolescents. Emotional competence was not found to be significantly associated with adolescent suicidal ideation, but rational problem-solving, a sub-scale of social problem-solving, was shown to be significantly and negatively associated with suicidal ideation for males, but not for females. However, emotional competence and rational problem-solving were shown to be a significant and a marginally significant moderator in the relationship between physical abuse and suicidal ideation in females respectively, but not in males. High rational problem-solving buffered the negative impact of physical abuse on suicidal ideation for females. Interestingly, females with higher empathy and who reported being physically abused by their parents have higher suicidal ideation. Findings are discussed and implications are stated. It is suggested to change the attitudes of parents on the concept of physical abuse, guide them on appropriate attitudes, knowledge and skills in parenting, and enhance adolescents' skills in rational problem-solving.

Association between suicidal ideation and exposure to suicide in social relationships among family, friend, and acquaintance survivors in South Korea

Exposure to suicide in social relationships may be associated with suicidal ideation among survivors. In South Korea, which is known for having the highest suicide rate among OECD countries, exposure to suicide in social relationships can have serious consequences as social relationships are greatly emphasized in the society. The purpose of this study was to examine the association between survivors' suicidal ideation and their exposure to suicide in close relationships. Data collected through a telephone survey of a total of 1,000 men and women selected from across the nation using a stratified sampling method were analyzed. The results show that individuals who lost a family member, friend, or acquaintance in their lifetime are 4.5 times, 3.7 times, 2.2 times, respectively, more likely to have suicidal ideation in the past year compared to those without such experience. These findings suggest that special intervention for suicide survivors should be considered for those who experience suicide in close relationships.

Internet use and web communication networks, sources of social support, and forms of suicidal and nonsuicidal self-injury among adolescents: different patterns between genders

The relationships of Internet use, web communication, and sources of social support with adolescent self-injurious thoughts and behaviors (SITBs) in Taiwan were investigated. The study sample of 391 12 to 18-year-olds was selected from nine public high schools. Findings show that girls are more likely to have SITBs, except for suicide gestures. Web communication is a risk factor for SITBs in boys but not in girls. Family support is protective in both genders. Support from friends is protective and support from significant others was a risk factor for suicide plans in girls. Support from virtual social communities can have both positive and negative effects on adolescent SITBs, with different effects by gender.

Duration of U.S. residence and suicidality among racial/ethnic minority immigrants

PURPOSE

The immigration experience embodies a range of factors including different cultural norms and expectations, which may be particularly important for groups who become racial/ethnic minorities when they migrate to the U.S. However, little is known about the correlates of mental health indicators among these groups. The primary and secondary aims were to determine the association between duration of U.S. residence and suicidality, and 12-month mood, anxiety, and substance use disorders, respectively, among racial/ethnic minority immigrants.

METHODS

Data were obtained from the National Survey of American Life and the National Latino and Asian American Survey. Multivariable logistic regression was used to determine the association between duration of US residence, and suicidality and 12-month psychopathology.

RESULTS

Among Afro-Caribbeans, there was a modest positive association between duration of U.S. residence and 12-month psychopathology (P linear trend = 0.016). Among Asians there was a modest positive association between duration of US residence and suicidal ideation and attempts (P linear trend = 0.018, 0.063, respectively). Among Latinos, there was a positive association between duration of US residence, and suicidal ideation, attempts and 12-month psychopathology (P linear trend = 0.001, 0.012, 0.002, respectively). Latinos who had been in the U.S. for >20 years had 2.6 times greater likelihood of suicidal ideation relative to those who had been in the U.S. for <5 years (95% CI 1.01-6.78).

CONCLUSIONS

The association between duration of US residence and suicidality and psychopathology varies across racial/ethnic minority groups. The results for Latino immigrants are broadly consistent with the goal-striving or acculturation stress hypothesis.

Quarrelsome family environment as an enhanced factor on child suicidal ideation

Suicide is a leading cause of death in adolescents, and develops through a process leading from depression to suicidal ideation and self-injury. In this study, we analyzed and compared suicidal ideation among elementary school children from distinct families and school-related backgrounds. We conducted a cross-sectional study to investigate suicidal ideation in elementary school children in Miaoli County of Western Taiwan. Our study included 979 eligible participants and collected data, including suicidal ideation, depression scores, demographic characteristics, and family and school variables. The results revealed that 175 students (17.9%) exhibited depression, and 146 students (14.9%) had contemplated suicide. A quarrelsome family environment was found to be an important independent factor in child suicidal ideation after controlling for depression status. Children living in quarrelsome families showed a 3.7-fold risk of suicidal ideation compared with children in a harmonious family. Among boys living in quarrelsome family environments, suicidal ideation risk was 7.4-fold higher than for girls living in harmonious families. A 27-fold high increased suicidal ideation risk was also observed among the depressed children who living in the quarrelsome family environment, compared with the non-depressed in the harmonious family environment. This study provides novel evidence indicating the enhanced effects of a quarrelsome family environment combined with depression symptoms and among boys on suicidal ideation. These findings suggest of quarrels in a family environment playing an important role on elementary school children's psychological development, and may help parents in improving their mental health.

Sexual orientation and risk factors for suicidal ideation and suicide attempts: a multi-centre cross-sectional study in three Asian cities

Purpose

Despite robust empirical and theoretical evidence for higher rates of suicide among lesbian, gay, and bisexual (LGB) youths, little is known about the relationship between suicide and sexual orientation among Asian youths. This study examined differences in prevalence of suicidal ideation and suicide attempts between LGB and heterosexual youths in the cities of Hanoi, Shanghai, and Taipei, China.

Methods

The data are from a community-based multi-centre cross-sectional study conducted from 2006 to 2007, with a sample of 17 016 youths aged 15–24 years from Hanoi, Shanghai, and Taipei. Chi-square test and logistic regression were used to evaluate correlates of suicidal ideation and suicide attempts.

Results

The overall prevalence of suicidal ideation and suicide attempts in the preceding 12 months in LGB youths were both higher than in heterosexual youth (12.8% vs. 8.1% and 4.0% vs. 2.4%, respectively). Stratified by city, the prevalence of suicidal ideation was lowest in Hanoi (2.2%), followed by Shanghai (8.0%) and Taipei (17.0%). Similar trends were observed in the prevalence of suicide attempts, which was lowest in Hanoi (0.3%), followed by Shanghai (1.2%) and Taipei (2.5%). Of note, however, multivariate logistic regression results revealed that LGB youth were at a higher risk for suicidal ideation than heterosexual youth only in Taipei (odds ratio 1.65).

Conclusions

Suicidality is common among Asian youth, with higher prevalence observed in urbanized cities. LGB youths are at greater risk of suicidal ideation than their heterosexual counterparts in Taipei than in the other two examined cities.

The molecular bases of the suicidal brain

Suicide ranks among the leading causes of death around the world and takes a heavy emotional and public health toll on most societies. Both distal and proximal factors contribute to suicidal behaviour. Distal factors - such as familial and genetic predisposition, as well as early-life adversity - increase the lifetime risk of suicide. They alter responses to stress and other processes through epigenetic modification of genes and associated changes in gene expression, and through the regulation of emotional and behavioural traits. Proximal factors are associated with the precipitation of a suicidal event and include alterations in key neurotransmitter systems, inflammatory changes and glial dysfunction in the brain. This Review explores the key molecular changes that are associated with suicidality and discusses some promising avenues for future research.

Socioeconomic and clinical characteristics associated with repeat suicide attempts among young people

PURPOSE

Repeat suicidal behaviors in young people are a critical public health concern. The study investigates individual socioeconomic and episode-dependent clinical factors predicting repeat suicide attempts among youth by gender.

METHODS

Using a retrospective cohort study, we identified a total of 4,094 male and 3,219 female youths who had the index suicide episode at the ages of 15-24 years from the 1996-2007 National Health Insurance Research Database in Taiwan. The recurrence of suicide attempt was assessed within 1 year after the index suicide. Information pertaining to suicide management and postsuicide treatment was obtained from healthcare records. Repeated event survival analyses were used to estimate episode-dependent risk of suicide attempt.

RESULTS

The occurrence of repeat suicide attempts was more common in males, yet the phenomenon of risk aggravation appears more prominent in females. The estimate for peak hazard of the second repeat attempt was 2-fold higher than that of the first repeat event in males, and approximately 6-fold in females. Socioeconomic (e.g., labor market participation: adjusted Hazard Ratio [aHR] = 1.14, 95% CI = 1.01-1.28) and index suicide management characteristics (e.g., receiving treatment at clinic, aHR = 1.54, 95% CI = 1.19-1.99) were found to play important roles for repeat suicide attempts in males. For females, postsuicide treatment of mental disorders appears more influential.

CONCLUSIONS

The relationships between socioeconomic and clinical factors with repeat suicide attempts in young people vary by gender. School/workplace-based post suicide attempt consultation and clinical management for youth may be planned and delivered on a gender-appropriate basis.

Is parenting style a predictor of suicide attempts in a representative sample of adolescents?

BACKGROUND

Suicidal ideation and suicide attempts are serious but not rare conditions in adolescents. However, there are several research and practical suicide-prevention initiatives that discuss the possibility of preventing serious self-harm. Profound knowledge about risk and protective factors is therefore necessary. The aim of this study is a) to clarify the role of parenting behavior and parenting styles in adolescents' suicide attempts and b) to identify other statistically significant and clinically relevant risk and protective factors for suicide attempts in a representative sample of German adolescents.

METHODS

In the years 2007/2008, a representative written survey of N = 44,610 students in the 9th grade of different school types in Germany was conducted. In this survey, the lifetime prevalence of suicide attempts was investigated as well as potential predictors including parenting behavior. A three-step statistical analysis was carried out: I) As basic model, the association between parenting and suicide attempts was explored via binary logistic regression controlled for age and sex. II) The predictive values of 13 additional potential risk/protective factors were analyzed with single binary logistic regression analyses for each predictor alone. Non-significant predictors were excluded in Step III. III) In a multivariate binary logistic regression analysis, all significant predictor variables from Step II and the parenting styles were included after testing for multicollinearity.

RESULTS

Three parental variables showed a relevant association with suicide attempts in adolescents - (all protective): mother's warmth and father's warmth in childhood and mother's control in adolescence (Step I). In the full model (Step III), Authoritative parenting (protective: OR: .79) and Rejecting-Neglecting parenting (risk: OR: 1.63) were identified as significant predictors (p < .001) for suicidal attempts. Seven further variables were interpreted to be statistically significant and clinically relevant: ADHD, female sex, smoking, Binge Drinking, absenteeism/truancy, migration background, and parental separation events.

CONCLUSIONS

Parenting style does matter. While children of Authoritative parents profit, children of Rejecting-Neglecting parents are put at risk - as we were able to show for suicide attempts in adolescence. Some of the identified risk factors contribute new knowledge and potential areas of intervention for special groups such as migrants or children diagnosed with ADHD.

Effects of life satisfaction and psychache on risk for suicidal behaviour: a cross-sectional study based on data from Chinese undergraduates

OBJECTIVES

To examine predictive power of psychache and life satisfaction on risks for suicidal ideation and suicide attempt among young people.

DESIGN

A cross-sectional study.

SETTING

Data were collected from an online survey in Wuhan, China.

PARTICIPANTS

5988 university students from six universities were selected by a stratified cluster sampling method.

PRIMARY AND SECONDARY OUTCOME MEASURES

Suicidal ideation and suicide attempt at some point of the students' lifetime were the outcomes of interest.

RESULTS

Students with suicidal ideation or attempted suicide reported a lower level of life satisfaction and high degree of psychache than counterparts without suicidal ideation or attempt. Regression analyses indicated that life satisfaction and psychache were significantly associated with the risk of suicidal ideation and the risk of suicidal attempt. Though psychache showed a relatively stronger predictive power than life satisfaction, the effect of the two factors remained significant when they were individually adjusted for personal demographic characteristics. However, when the two factors were included in the model simultaneously to adjust for each other, psychache could fully explain the association between life satisfaction and suicidal attempt. Life satisfaction remained to contribute unique variance in the statistical prediction of suicidal ideation.

CONCLUSIONS

Psychache and life satisfaction both have a significant predictive power on risk for suicidal behaviour, and life satisfaction could relieve the predictive power of psychache when suicidal behaviour is just starting. Shneidman's theory that psychache is the pre-eminent psychological cause of suicide is perhaps applicable only to a more serious form of suicidal behaviour.

Filicide-suicide ideation among Taiwanese parents with school-aged children: prevalence and associated factors

This study explored the prevalence of filicide-suicide ideation among Taiwanese parents with school-aged children. Multiple risk factors associated with filicide-suicide ideation were assessed, and the potential effect of traditional family values was evaluated. A random sample of 1,564 parents was recruited from 21 elementary schools in a rural area of Taiwan. Potential risk factors, including demographics, family finance, psychological maladjustment, family interaction, and cultural beliefs, were further examined using a hierarchical logistic regression. Overall, 14.6% of the respondents reported having filicide-suicide ideation during the past year. The hierarchical logistic regression analysis showed that demographic factors including age, gender, and ethnicity had no significant effect. Family finances, depression, and conflict with the respondent's spouse were positively associated with filicide-suicide ideation. Finally, the parents' beliefs in traditional family values had a positive effect on filicide-suicide ideation. In other words, filicide-suicide thoughts were more common among those who upheld a strong parental responsibility for care giving and family solidarity. This study revealed a substantial prevalence of filicide-suicide ideation among local parents and identified a number of risk factors associated with those thoughts, namely family financial status, parental depression, and conflict with one's spouse. More importantly, the results highlighted the effect of traditional family values in the process. The potential intention of filicide-suicide as mercy killing and its cultural relevance were discussed.

Suicidal behaviour and related risk factors among school-aged youth in the Republic of Benin

INTRODUCTION

Research on factors associated with suicidal ideation and suicide attempts has been conducted largely in developed countries. Research on West African countries in particular is lacking.

METHODS

Data were obtained from the Global School-based Health Survey conducted in Benin in 2009. This was a cross-sectional study of three grades, spanning Junior and Senior High, which sampled a total of 2,690 adolescents. Data on the occurrence of demographic, psycho-social and socio-environmental risk factors were tested using multinomial logistic regression for their association with suicidal ideation and suicide attempts.

RESULTS

The survey indicated that 23.2% had thought about suicide and 28.3% had made a suicide attempt in the previous year. Anxiety, loneliness, being bullied, alcohol misuse, illicit drug use, and lack of parental support were independently related to the ideation outcomes, suicidal ideation without planning and suicidal ideation with planning. Multinomial regression analysis, using one suicide attempt and multiple suicide attempts as outcomes, revealed that female sex, anxiety, loneliness, being physically attacked, and illicit drug use were associated these outcomes.

DISCUSSION

The prevalence of suicide attempts reported in the survey is relatively high. It is possible that there are cultural factors that could explain this finding. Our research indicates that many factors are related to the occurrence of suicidal ideation and suicide attempts among youth in Benin. Illicit drug use and violence in particular are associated with a high rate of suicide attempts in Benin. Measures to address these issues may reduce the risk of self-inflicted violence.

Association between problematic cellular phone use and suicide: the moderating effect of family function and depression

BACKGROUND

Suicidal ideation and attempt among adolescents are risk factors for eventual completed suicide. Cellular phone use (CPU) has markedly changed the everyday lives of adolescents. Issues about how cellular phone use relates to adolescent mental health, such as suicidal ideation and attempts, are important because of the high rate of cellular phone usage among children in that age group. This study explored the association between problematic CPU and suicidal ideation and attempts among adolescents and investigated how family function and depression influence the association between problematic CPU and suicidal ideation and attempts.

METHODS

A total of 5051 (2872 girls and 2179 boys) adolescents who owned at least one cellular phone completed the research questionnaires. We collected data on participants' CPU and suicidal behavior (ideation and attempts) during the past month as well as information on family function and history of depression.

RESULTS

Five hundred thirty-two adolescents (10.54%) had problematic CPU. The rates of suicidal ideation were 23.50% and 11.76% in adolescents with problematic CPU and without problematic CPU, respectively. The rates of suicidal attempts in both groups were 13.70% and 5.45%, respectively. Family function, but not depression, had a moderating effect on the association between problematic CPU and suicidal ideation and attempt.

CONCLUSION

This study highlights the association between problematic CPU and suicidal ideation as well as attempts and indicates that good family function may have a more significant role on reducing the risks of suicidal ideation and attempts in adolescents with problematic CPU than in those without problematic CPU.

A conceptual framework for early adolescence: a platform for research

Early adolescence (ages 10-14 years) is among the most neglected stages of development, yet there are few stages during the life course where changes are as dramatic. The present conceptual framework proposes four central goals to be achieved by early adolescence: engagement with learning, emotional and physical safety, positive sense of self/self-efficacy, acquisition of life/decision-making skills. The framework proposes an ecological model where the macro level factors (economic forces, historical events, national priorities, laws/policies/norms and values, national events, and political realities) all set the contexts that influence community, family, school and peer factors that all in turn influence the adolescent. Existing indicators for points of development are noted as are future areas of research priority.

Young adults remain worse off than adolescents

On a broad range of indicators pertaining to risk taking and access to care, young adults fare worse than younger adolescents or older adults. Vulnerable groups, such as those facing chronic illness and those with unstable living arrangements, fare especially poorly as they transition to adulthood. Fortunately, a confluence of factors, particularly the changing nature of the transition to adulthood in modern society, has led to renewed interest in this critical period of the life cycle. Health science research is increasingly focused on issues faced by young adults, and public health policies designed specifically to address the health and well-being of young adults--notably the Patient Protection and Affordable Care Act in the United States--are now being implemented. Successful efforts at improving the health and well-being of adolescents should be mirrored in efforts to support young adults. A new report based on a broad range of United States national datasets lays out the challenges that must be addressed in these efforts.

Association of child marriage with suicidal thoughts and attempts among adolescent girls in Ethiopia

PURPOSE

Little information exists on the mental health implications of child marriage in Africa. This study examined the association between child marriage and suicidal ideation and suicide attempt among girls aged 10-17 years.

METHODS

Data were drawn from a 2007 cross-sectional survey conducted in the Amhara region, Ethiopia. Multilevel logistic regression was used to analyze risk factors for suicidality.

RESULTS

Approximately 5.2% of girls reported ever being married, 5.4% were promised in marriage, and 9.3% reported receiving marriage requests. Girls who were ever married (odds ratio [OR] = 1.81; 95% confidence interval [CI] = 1.03-3.18), were promised in marriage (OR = 2.35; 95% CI = 1.38-4.01) or had received marriage requests (OR = 2.29; 95% CI = 1.46-3.59) were significantly more likely than girls who were never in the marriage process to have had suicidal thoughts in the past 3 months. Residence in communities with high involvement in stopping child marriage was protective of suicidal ideation. The odds of suicide attempt were twice as high among girls with marriage requests as among those with none.

CONCLUSIONS

Child marriage was associated with increased odds of suicidality. Findings call for stronger community engagement in child marriage prevention and mental health support for child brides.

Suicidal expression among school-attending adolescents in a middle-income sub-Saharan country

We investigated correlates for suicidal expression among adolescents in the Seychelles. Data on 1,432 students (52% females) were derived from the Global School-based Health Survey. Participants were divided into three groups: those with no suicidal behavior (N = 1,199); those with suicide ideation/SI (N = 89); and those reporting SI with a plan to carry out a suicide attempt/SISP (N = 139), each within a 12-month recall period. Using multinomial logistic regression, we examined the strength of associations with social, behavioral and economic indicators while adjusting for covariates. Sixteen percent of school-attending adolescents reported a suicidal expression (10% with a plan/6.2% without). Those reporting SI were younger (relative risk ratio RRR = 0.81; CI = 0.68-0.96), indicated signs of depression (RRR = 1.69; CI = 1.05-2.72) and loneliness (RRR=3.36; CI = 1.93-5.84). Tobacco use (RRR = 2.34; CI = 1.32-4.12) and not having close friends (RRR = 3.32; CI = 1.54-7.15) were significantly associated with SI. Those with SISP were more likely to be female (RRR = 0.47; 0.30-0.74), anxious (RRR = 3.04; CI = 1.89-4.88) and lonely (RRR = 1.74; CI = 1.07-2.84). Having no close friends (RRR = 2.98; 1.56-5.69) and using tobacco (RRR = 2.41; 1.48-3.91) were also strongly associated. Having parents who were understanding was protective (RRR = 0.50; CI = 0.31-0.82). Our results suggest that school health promotion programs may benefit from targeting multiple factors associated with suicidal expression. More research, particularly multilevel designs are needed to identify peer and family influences which may modify associations with suicidality.