Injection drug use is associated with suicide attempts but not ideation or plans in a sample of adolescents with depressive symptoms

Acquired Capability for Suicide: An Evolutionary Concept Analysis

While virtually all suicide attempters experience ideations, not all who think about suicide will attempt or die by suicide. The ideation-to-action framework has led to new theories distinguishing suicide ideators from suicide attempters. The framework suggests that suicide progresses on a spectrum of thoughts and behaviors with different identifiers and explanations. The concept of acquired capability for suicide (ACS), conceptualized by the Interpersonal Psychological Theory of Suicide, is the first to explain the movement from ideation to action. This concept analysis of ACS is timely and relevant for greater clarification of the role ACS has in the movement from ideation to action. Rodgers' evolutionary concept analysis method is used. The six-step evolutionary method highlights the concept's attributes, antecedents, and consequences and provides a basis for further inquiry and development rather than a final definition.

Why do adolescents attempt suicide? Insights from leading ideation-to-action suicide theories: a systematic review

Suicide is a leading cause of death among adolescents, and recent suicide theories have sought to clarify the factors that facilitate the transition from suicide ideation to action. Specifically, the Interpersonal Theory of Suicide (IPTS), Integrated Motivational-Volitional Model (IMV), and Three Step Theory (3ST) have highlighted risk factors central to the formation of suicidal ideation and suicidal behaviors, which is necessary for suicide death. However, these models were initially developed and tested among adults, and given core socioemotional and neurodevelopmental differences in adolescents, the applicability of these models remains unclear. Directly addressing this gap in knowledge, this systematic review aimed to (1) describe the evidence of leading ideation-to-action theories (i.e., IPTS, IMV, 3ST) as they relate to suicide risk among adolescents, (2) integrate ideation-to-action theories within prevailing biological frameworks of adolescent suicide, and (3) provide recommendations for future adolescent suicide research. Overall, few studies provided a complete test of models in adolescent samples, and empirical research testing components of these theories provided mixed support. Future research would benefit from integrating neurodevelopmental and developmentally sensitive psychosocial frameworks to increase the applicability of ideation-to-action theories to adolescents. Further, utilizing real-time monitoring approaches may serve to further clarify the temporal association among risk factors and suicide.

Exposure to potentially lethal weapons and drugs among U.S. adolescents with recent depressive symptoms or suicidality in the Adolescent Behaviors and Experiences Survey

The scope of lethal means exposure (i.e. guns, intravenous drugs, prescription drugs) relative to depressive symptoms and suicidality in adolescents is not well described. Using the Adolescent Behaviors and Experiences Survey (ABES), we found lethal means exposure increased in a dose dependent manner with increasing depressive symptoms, adjusting for age, sex, race, and ethnicity. Adolescent males were more than 6 times more likely to have exposure to guns and intravenous drugs compared to adolescent females.

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.

Legal Minors Who Inject: Differences in Socio-Demographics and Treatment Needs Compared to Adults in a Swedish National Sample of People with Injecting Drug Use

BACKGROUND

Injection drug use among legal minors is under-researched. Although the population may be small in absolute terms, treatment needs may be greater than for those who began injecting as adults. Such knowledge may help tailor services more effectively. Previous research tends to use selective samples or focuses solely on medical indicators. The present study uses a larger sample drawn from national register data in Sweden over a 9-year period (2013-2021) to analyze differences in medical and social treatment needs between people who began injecting as legal minors and their older counterparts.

METHOD

Data on first-time visitors to needle and syringe programmes (n = 8225, mean age 37.6, 26% women) were used. Historical socio-demographics and presenting treatment needs were compared between those with a debut injecting age under 18, and those who began injecting as adults.

RESULTS

The prevalence of injecting before 18 years was 29%. This group had more negative social circumstances, such as leaving school early, worse health, and greater service consumption, compared to those who began injecting as adults. In particular, they had been subjected to a greater level of control measures, such as arrest and compulsory care.

CONCLUSIONS

The present study shows that there are important health and social differences between those who inject prior to 18 and those who begin injecting as adults. This raises important questions for both child protection services and harm reduction approaches for legal minors who inject, who still qualify as 'children' in a legal and policy sense.

The epidemiology of non-suicidal self-injury: lifetime prevalence, sociodemographic and clinical correlates, and treatment use in a nationally representative sample of adults in England

BACKGROUND

Although the clinical importance of non-suicidal self-injury (NSSI) has received increasing recognition, relatively little is known about its epidemiology. The objective of this study was to estimate the lifetime prevalence of NSSI in adults and its association with sociodemographic characteristics, psychiatric disorders, and lifetime treatment for NSSI.

METHODS

A nationally representative face-to-face survey was conducted with 7192 adults aged ≥18 years in England. Respondents were interviewed about engagement in NSSI, psychiatric illness, suicidal thoughts and behavior, and treatment history for this behavior.

RESULTS

The estimated lifetime prevalence rate of NSSI was 4.86%. Younger age, growing up without biological parents in the household, being unmarried, and impoverished backgrounds were associated with NSSI. The majority of respondents with lifetime NSSI (63.82%) had at least one current psychiatric disorder. Most psychiatric conditions were associated with greater odds of lifetime NSSI in multivariate models. NSSI was strongly associated with suicidal ideation and suicide attempts, respectively, even after accounting for psychiatric disorders and sociodemographic covariates. A substantial proportion of respondents with NSSI history (30.92%) have engaged in medically severe self-harm, as indexed by requiring medical attention for this behavior. The majority of respondents with NSSI (56.20%) had not received psychiatric care for this behavior.

CONCLUSIONS

NSSI is prevalent in the general population and associated with considerable psychiatric comorbidity. A high rate of unmet treatment needs is evident among those with this behavior. Those at the greatest lifetime risk for NSSI may also be particularly limited in their resources to cope with this behavior.

Suicidal Behavior and Its Relationship with Postmortem Forensic Toxicological Findings

Suicide affects all sociodemographic levels, age groups, and populations worldwide. The factors that can increase the risk of suicidal tendencies are widely studied. The aim of this study was to analyze the types and combinations of toxics found in fatal suicide victims with different suicide mechanisms. A total of 355 autopsies were retrospectively studied, and 26 toxics were determined and related to mechanisms of suicide. Hanging (55%), drug overdose (22.7%), and jumping from a height (17.8%) were most represented suicide mechanisms with positive toxicology. Hanging was the most represented in men (50.3%; p = 0.019), while jumping from a height was more represented in women (29.7%, p = 0.028). Drugs of abuse were the most frequent toxics found in men (55.5%; p < 0.001), while medicines were the most frequent type found in women (70.3%, p < 0.001). Alcohol, nordiazepam, cocaine, and venlafaxine were the most consumed toxics. Benzodiazepines and venlafaxine were found in suicides involving drug overdose, hanging, and jumping from a height. In conclusion, most suicides were associated with drug abuse in men. Hanging was more represented in men and jumping from a height in women. Alcohol was present in combination with other toxics and medicines. The toxicological analysis is fundamental to understanding consumption patterns and establishing strategies and protocols for detecting and preventing suicide.

Adolescent suicide attempts in the United States: When suicide ideation and suicide capability interact

INTRODUCTION

Guided by the interpersonal theory of suicide, this study examined whether the relationship between level of suicide ideation and attempted suicide varies as a function of suicide capability.

METHODS

Cross-sectional data were obtained from the 2017 and 2019 Youth Risk Behavior Survey in which 28,442 respondents were sampled. Confirmatory factor analysis was conducted to create a latent suicide capability variable. Structural equation modeling was used to test the moderating effects of suicide capability on the relationship between level of suicide ideation and attempted suicide, adjusting for sociodemographic characteristics, sadness/hopelessness, and the sampling design.

RESULTS

Compared to adolescent with no reported ideation, those reporting single and dual ideation experienced increased odds of attempted suicide. The relationship between level of suicide ideation and attempted suicide significantly varied as a function of capability. While adolescents with dual suicide ideation experienced higher rates of attempted suicide at increasing levels of capability, faster rates of change of attempted suicide at increasing levels of capability were observed among those with single and no reported ideation.

CONCLUSION

Capability may heighten the risk of suicide attempts among youth, suggesting that treatment efforts could be directed at reducing exposure to painful and provocative experiences associated with suicide behaviors.

Suicidal ideation among women who engage in sex work and have a history of drug use in Kazakhstan

Suicide rates in Kazakhstan rank fourth worldwide. Suicidal ideation is a strong predictor of death by suicide. Yet there is limited information about factors associated with suicidal ideation among women who engage in sex work (WESW) with a history of drug use. Guided by the Diathesis-Stress Theory of Suicide, this study examined the risk and protective factors associated with suicidal ideation among WESW in Kazakhstan. Data drew from the baseline assessments from a sample of four hundred women who participated in a cluster randomized control trial comparing a treatment arm which received a combination of HIV Risk Reduction (HIVRR) and microfinance intervention, and a control arm which received HIVRR alone. Multiple logistic regression models controlling for sociodemographic characteristics examined the effects of risk and protective factors on suicidal ideation. More than half of the participants (52.5%) reported suicidal ideation in the past seven days. Women with vulnerabilities such as child sexual abuse and harmful alcohol use and stressors such as stigma were more likely to think about suicide compared with those who did not. Keeping income from sex work was associated with a lower risk of suicidal ideation. HIV interventions targeting WESW and use drugs must include a mental health component to decrease the risk of suicidal ideation among this group. Women's ability to keep income from sex work suggests the potential to strengthen women's financial stability as a source of empowerment, which may in turn lessen the detrimental effects of childhood adversities and life stressors experienced by WESW.

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.

Prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among people with substance use disorders: a systematic review and meta-analysis

We assessed the prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among patients with substance use disorders (SUD). Studies in English published from January 1, 1995 to December 31, 2020 were searched on PubMed, Scopus, Cochrane and Web of Science to identify studies on variables associated with suicidal behaviors (ideations and attempts) among patients with SUD. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria: (i) population: patients with SUD; (ii) intervention: suicide behaviors in the past year; (iii) comparator: SUD who had not suicide behaviors; (iv) outcome: suicide ideations or attempts in the last year; and (v) study type: cross-sectional, cohort, and case-control studies. Out of 10,810 articles, 48 studies met eligibility criteria. Our findings showed a pooled prevalence rate of suicide ideations of 35% (95% CI, 22% 48%) and suicide attempts of 20% (95% CI, 17% 23%) in the last year among patients with SUD. Smoking, previous history of sexual abuse, depression, and alcohol and cannabis use disorders were significantly associated with suicide ideations. Study findings also showed that being female, smoking, history of physical and sexual abuse, depression and alcohol, cannabis, cocaine, amphetamine use disorders, and polysubstance abuse were significantly associated with suicide attempts among patients with SUD. These findings have implications for developing prevention programs. Appropriate initiatives for reducing the risk of suicide behaviors like systematic assessments of changes in drug use pattern at the emergency departments or at other key health providers may be more broadly implemented. Motivational therapy to improve help-seeking, increased information on adverse consequences of heavy substance use, and crisis plan resolutions to face suicide behaviors could also be consolidated.

Suicidal thoughts and behaviors in preadolescents: Findings and replication in two population-based samples

INTRODUCTION

Given increasing concern in suicide in preadolescent children, this study aimed to characterize and identify potential indicators of risk for suicidal ideation (SI) and suicide attempts (SAs) in this population.

METHODS

Data were drawn from two population-based samples of preadolescents: the 2007 and 2010 Minnesota Student Survey and analyses were restricted to 11- and 12-year-olds. Sociodemographic characteristics, childhood maltreatment, parental relations, peer relations, and school climate were examined in relation to past-year SI and SA. To examine correlates of SI, unconfounded by risk for SA, individuals with a history of SA were excluded from SI analyses. Correlates of SA were examined among individuals with past-year SI. Logistic regression analyses were conducted with past-year SI and SA as criterion variables.

RESULTS

Results from the 2007 and 2010 data sets were highly consistent. The prevalence of past-year SI was 9.28% and 9.25% in 2007 and 2010, respectively. Of the total sample, 1.90% and 1.87% reported a past-year SA (17.00% and 16.78% of those with past-year SI). Overall, effect sizes were generally modest to medium. The strongest effects were observed for sexual and physical abuse, parental support, and perceived safety at school (ps < .001). In multivariate analyses of SI and SA, sexual and physical abuse had the largest effect sizes (ORSI  = 2.18 [95% CI = 1.90-2.51] to 2.96 [95% CI = 2.69-3.26]; ORSA  = 1.55 [95% CI = 1.29-1.86] to 2.26 [95% CI = 1.82-2.80]).

CONCLUSIONS

SI and SA occur at a concerning rate among preadolescent children. Screening for childhood sexual and physical abuse may be important for identifying those at risk for these clinical outcomes.

Suicidal behaviors among American Indian/Alaska Native firefighters: Evidence for the role of painful and provocative events

Firefighters represent a group at elevated suicide risk. Identifying segments of the fire service at increased risk may facilitate the targeted provision of suicide prevention initiatives. Among the general population, American Indian/Alaska Native (AI/AN) individuals report higher rates of suicide attempts. This study sought to examine suicide attempt rates among AI/AN firefighters and to determine if greater exposure to painful and provocative events and/or fearlessness about death explains the relationship between AI/AN identity and suicidal behaviors. A total of 917 US firefighters completed a web-based mental health survey (6.2% AI/AN). Participants completed a modified version of the Self-Injurious Thoughts and Behaviors Interview-Short Form, the Painful and Provocative Events Scale, and the Acquired Capability for Suicide Scale-Fearlessness About Death scale. Bootstrap mediation analyses were conducted, controlling for years of service as a firefighter. Although AI/AN firefighters accounted for only 6.2% of the sample, they accounted for 34.4% of the career suicide attempts. AI/AN firefighters were 16.31 (95% CI = 7.96, 33.42) times more likely to report a career suicide attempt history than non-AI/AN firefighters, adjusting for years of service as a firefighter. Painful and provocative events, but not fearlessness about death, was a statistically significant mediator of the relationship between AI/AN identity and suicide attempts. Firefighters identifying as AI/AN represent a subgroup within the fire service at increased risk for suicide. Findings suggest that greater exposure to painful and provocative events among AI/AN firefighters may explain the elevated suicide risk among this population.

Neuronal variability of Resting State activity in Eating Disorders: increase and decoupling in Ventral Attention Network and relation with clinical symptoms

Background:

Despite the great number of resting state functional connectivity studies on Eating Disorders (ED), no biomarkers could be detected yet. Therefore, we here focus on a different measure of resting state activity that is neuronal variability. The objective of this study was to investigate neuronal variability in the resting state of women with ED and to correlate possible differences with clinical and psychopathological indices.

Methods:

58 women respectively 25 with Anorexia Nervosa (AN), 16 with Bulimia Nervosa (BN) and 17 matched healthy controls (CN) were enrolled for the study. All participants were tested with a battery of psychometric tests and underwent a functional Magnetic Resonance Imaging (fMRI) resting state scanning. We investigated topographical patterns of variability measured by the Standard Deviation (SD) of the Blood-Oxygen-Level-Dependent (BOLD) signal (as a measure of neuronal variability) in the resting-state and their relationship to clinical and psychopathological indices.

Results:

Neuronal variability was increased in both anorectic and bulimic subjects specifically in the Ventral Attention Network (VAN) compared to healthy controls. No significant differences were found in the other networks. Significant correlations were found between neuronal variability of VAN and various clinical and psychopathological indices.

Conclusions:

We here show increased neuronal variability of VAN in ED patients. As the VAN is relevant for switching between endogenous and exogenous stimuli, our results showing increased neuronal variability suggest unstable balance between body attention and attention to external world. These results offer new perspective on the neurobiological basis of ED. Clinical and therapeutic implication will be discussed.

Association between illegal use of substances and suicidal behavior in school students: An integrative review of empirical data

PURPOSE

Investigation of the association between type of suicidal behavior and type and frequency of illegal use of substances (IUS) among school students (aged between 12 and 18 years), with a focus on gender differences.

DESIGN AND METHODS

A systematic review in PubMed, CINAHL, PsychINFO, and Scopus was performed. Identified articles were published between 2007 and 2018.

RESULTS

Twenty empirical studies confirmed the association between IUS and suicidality, strongly differentiated between males and females, highlighting the importance of gender-specific mediating factors.

CONCLUSIONS

Mental health nurses need to document gender factors, frequency, and motivation of IUS when screening adolescents experiencing suicidal behavior and IUS.

Differentiating Suicide Attempters from Suicide Ideators: The Role of Capability for Suicide

This study examined whether different components of capability for suicide (i.e., fearlessness about death, pain tolerance, pain insensitivity, preparation for suicide, suicide plan, and courage), as well as painful and provocative events, nonsuicidal self-injury, depressive symptoms, and hopelessness, could distinguish between suicide attempters, suicide ideators, and non-suicidal controls. A total of 930 Chinese adolescents completed questionnaires, and a multinomial logistic regression was conducted to identify factors that could distinguish among the 3 groups. We found that higher levels of pain tolerance, more detailed suicide plans, more positive attitudes towards suicide, as well as more painful and provocative experiences and more severe depressive symptoms were positively associated with increased likelihood of the engagement in both suicide ideation and suicide attempts. Only nonsuicidal self-injury increased the likelihood of falling in the suicide attempt group as compared to the suicide ideation group. Findings of this study emphasize the role of nonsuicidal self-injury in intervening suicidality.

Prospective prediction of first lifetime onset of suicidal ideation in a national study of substance users

Suicide rates have increased over the past several decades. Prior research has evaluated risk factors for suicidal behavior, but much of this work does not adequately differentiate between risk factors for suicidal ideation (SI) and suicide attempts, nor does it differentiate between first-onset SI and recurrent ideation. This study seeks to identify risk factors for first-onset SI among a high-risk group: individuals receiving treatment for substance use disorders. Data were drawn from the National Treatment Improvement Evaluation Study, a prospective study examining the impact of addiction treatment programs. Patients with no lifetime history of suicide attempts or ideation (n = 2560) were assessed at baseline and one year later for prospectively-occurring SI. Sociodemographic variables, mental health indices, interpersonal factors, and substance use severity indicators were evaluated as prospective predictors of first-onset SI in linear regression models. Current mental health problems (OR = 1.54, 95% CI = 1.19-2.01), current substance use problems (OR = 1.33, 95% CI = 1.04-1.70), and difficulty accessing treatment for substance use problems (OR = 1.90, 95% CI = 1.16-3.11) emerged as significant predictors of first-onset SI in a multivariate analysis, suggesting that individuals with current mental health or substance use related symptoms are among the most at risk for developing SI. Difficulty obtaining treatment remained significant, highlighting the importance of treatment accessibility. Future clinical work and research would benefit by addressing these issues, potentially by focusing on mental health treatment in substance abuse programs and evaluating barriers to treatment.

Emerging trends in adolescent suicide prevention research

A comprehensive public health strategy for adolescent suicide prevention includes upstream prevention strategies, strategies for risk recognition, and services for those at risk. Interpersonal trauma and substance use are important prevention targets as each is associated with risk for suicide attempts. Multiple prevention programs target these factors; however, the Family Check-Up, designed to reduce substance use and behavioral problems, also has been associated with reduced suicide risk. Several youth screening instruments have shown utility, and a large-scale trial is underway to develop a computerized adaptive screen. Similarly, several types of psychotherapy have shown promise, and sufficiently powered studies are underway to provide more definitive results. The climbing youth suicide rate warrants an urgent, concerted effort to develop and implement effective prevention strategies.

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

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

Longitudinal risk factors for suicidal thoughts in depressed and non-depressed young adolescents

OBJECTIVE

Evidence regarding the role of risk factors in the longitudinal course of suicidal ideation among young adolescents is lacking. We aimed to assess the effects of a range of risk factors, including obesity, academic performance, child-parent relationship, physical maltreatment, and depressive symptoms, on the development of suicidal ideation in young adolescents.

METHODS

A school cohort of seventh and eighth graders was followed for 1 year and differences in the risk factors distributions were examined between depressed and non-depressed adolescents. We further examined risk factors for newly developed suicidal ideation and persistent suicidal ideation in the groups of adolescents based on the presence of suicidal ideation at baseline.

RESULTS

A total of 1710 young adolescents were recruited, among whom 8.2% were categorised as having clinically significant depression. For depressed adolescents, being obese was associated with a three-fold increased risk of having suicidal ideation. For non-depressed adolescents, physical maltreatment, a feeling of not being cared about and sub-threshold depressive symptoms were the risk factors. The latter two remained robust in predicting newly developed suicidal ideation.

CONCLUSION

The current study may shed light on the differential strategies to address suicidal thoughts in depressed and non-depressed adolescents. We emphasise the importance of recognition and management of sub-threshold depressive symptoms and the relevance of obesity, physical maltreatment and a feeling of not being cared about to suicide prevention programmes in early adolescence.

Victimization, Suicidal Ideation, and Alcohol Use From Age 13 to 15 Years: Support for the Self-Medication Model

PURPOSE

Recent years have seen increased coverage of adolescent victimization and suicide. Both adolescent peer victimization and substance use have been associated with suicidal ideation, with evidence suggesting that all three factors are interrelated. There are at least four models which can explain the associations between these factors (i.e., self-medication, secondary mental disorder, bidirectional, and common factor). However, none of them is being empirically supported as the dominant model because few longitudinal studies have explored the association between these factors.

METHODS

The present study compared longitudinal paths of all four models simultaneously using a cross-lagged model. This was done using self-reported measures of peer victimization, suicidal ideation, and alcohol use at age 13, 14, and 15 years in a longitudinal sample of 238 adolescents.

RESULTS

All three variables were moderately stable across time. Significant cross-lagged associations were found, showing that frequent peer victimization at age 13 years was associated with higher odds of having suicidal ideation at age 14 years (odds ratio, 1.82; p < .05). In turn, presence of suicidal ideation at age 14 years was significantly associated with higher alcohol use frequency at age 15 years (β = .13; p < .05).

CONCLUSIONS

Results support previous literature suggesting that peer victimization predates alcohol use and extends it by showing clear directionality between suicidal ideation and alcohol use over 1 year, supporting the self-medication model. Clarifying the empirical basis of these underlying models could allow for earlier prevention strategies, by targeting the risk factor that appears the earliest in the model.

Adolescent self-injurers: Comparing non-ideators, suicide ideators, and suicide attempters

Adolescent non-suicidal self-injury (NSSI) and suicidality are serious health concerns; however, factors that contribute to the transition from NSSI to suicide ideation and suicide attempts are unclear. To address this gap, we investigated whether demographic characteristics, child maltreatment, and psychiatric factors are associated with the level suicidality among adolescents with a history of self-injury. Participants were three groups of adolescent inpatient self-injurers (n = 397, 317 female), aged 13-18 years (M = 15.44, SD = 1.36): (a) non-ideators (n = 96; no current suicide ideation and no lifetime suicide attempts), (b) suicide ideators (n = 149; current ideation and no lifetime attempts), and (c) suicide attempters (n = 152; current ideation and at least one lifetime attempt). Participants completed interviews assessing psychiatric diagnoses, suicidality, and NSSI characteristics, as well as questionnaires on childhood trauma, psychiatric symptoms, and risky behavior engagement. Depression severity was associated with greater odds being a suicide ideator (p < 0.001, OR = 1.04) and an attempter (p < 0.001, OR = 1.05) compared to a non-ideator. Suicide attempters used more NSSI methods and reported greater risky behavior engagement than non-ideators (p = 0.03, OR = 1.29 and p = 0.03, OR = 1.06, respectively) and ideators (p = 0.015, OR = 1.25 and p = 0.04, OR = 1.05, respectively); attempters used more severe NSSI methods (e.g., burning). Our results identify a wide range of risk markers for increasing lethality in a sample at high risk for suicide mortality; future research is needed to refine risk assessments for adolescent self-injurers and determine the clinical utility of using risk markers for screening and intervention.

Prospective prediction of first lifetime suicide attempts in a multi-site study of substance users

Although considerable empirical work has been devoted to identifying risk factors for suicide attempts, most longitudinal research has studied recurrent attempts rather than first lifetime attempts. The present study sought to examine prospective predictors of first lifetime suicide attempts among adults receiving treatment for substance use. Data were drawn from the National Treatment Improvement Evaluation Study, a study of addiction treatment programs. Data were collected at treatment intake, treatment exit, and one year post-treatment. Patients (n = 3518) with no lifetime history of suicide attempts at treatment intake were followed at treatment exit and one year post-treatment, when they reported on the occurrence of suicide attempts since the prior assessment. Prospective suicidal behavior was assessed using logistic regression in relation to sociodemographic variables, health-related work impairment, history of psychiatric treatment utilization, history of suicidal ideation, history of depressive symptoms, substance use, and childhood abuse, assessed at intake. Health-related work impairment, history of suicidal ideation, and childhood physical abuse significantly predicted first lifetime attempts in a multivariate analysis. Suicidal ideation, health-related functional impairments, and childhood physical abuse may be particularly important in assessing risk for first lifetime suicide attempts. Findings suggest that future clinical work and research would benefit from considering these factors when identifying individuals at heightened risk of making a first suicide attempt.

Injection drug use among children and adolescents in India: Ringing the alarm bells

INTRODUCTION

Injection drug use (IDU) is intricately linked to preventive aspects for human immunodeficiency virus from a public health perspective. No large-scale data are yet available for injectable drug use among children and adolescents in India, apart from few anecdotal reports.

AIMS AND METHODS

The present paper reports on the profile and substance use pattern of 509 child IDU users, among a total sample of over 4000 children using substances across 100 sites from 27 states and 2 UTs in India. It was undertaken in 2012-2013 by the National Commission of Protection for Child Rights in collaboration with the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. For inclusion, participants had to be 18 years or less, should have used at least one other substance besides tobacco in the last 1 year, and should be living at home/street, in or out of school. Data were gathered using a 95-item semi-structured questionnaire.

RESULTS

A large proportion of ever users of IDU also reported use in the past year (96.5%) and past month (92.7%). Apart from IDU, tobacco, alcohol, cannabis, and pharmaceutical opioids were the most common substances of abuse in order of frequency. There was an interval of about 3 years from the initiation of tobacco to the initiation of IDU. Average age of onset for IDU was a year lesser in males than female users. The street children initiated IDU earlier than out-of-school and schoolgoing children. No quit attempt was made by more than half of the children. More than 40% had frequent familial conflicts, more than half had a familial history of substance use, and three-fourths had drug-using peers.

CONCLUSION

The paper highlights the profile and pattern of children and adolescents using IDU across many parts of India, dispelling the myth that IDU is largely an adult phenomenon in India. There is a clear need to promote different harm reduction and preventive strategies across the "hard-to-reach" younger age groups using injecting drugs.

Predictors of depression outcomes among abstinent methamphetamine-dependent individuals exposed to an exercise intervention

BACKGROUND AND OBJECTIVES

This paper expands on a study investigating depression outcomes in response to an 8-week exercise intervention among methamphetamine (MA) dependent individuals in early recovery.

METHODS

A total of 135 MA-dependent individuals enrolled in residential treatment were randomly assigned to either a structured exercise intervention or a structured health education control group. Both groups were similar in format: 60-minute sessions, offered three times a week over an 8-week study period.

RESULTS

Results showed that at the 8-week trial endpoint, participants randomized to the exercise intervention showed significantly greater reduction in depression symptom scores than participants randomized to the health education group, and that participants who attended the greatest number of exercise sessions derived the greatest benefit. This paper further analyzes study data to uncover individual predictors of depression response to exercise and finds that among participants randomized to exercise treatment, individuals with the most severe medical, psychiatric, and addiction disease burden at baseline showed the most significant improvement in depressive symptoms by study endpoint.

CONCLUSIONS

Our findings suggest that exercise in moderate dose is effective at treating depressive symptoms in individuals in early recovery from addiction, and furthermore, that treatment with exercise appears to be particularly beneficial to individuals who suffer from severe medical, psychiatric, and addictive disorders.

Prevalence and correlates of suicidal ideation and suicide attempts among veterans in primary care referred for a mental health evaluation

BACKGROUND

The Veterans Health Administration has made concerted efforts to increase mental health services offered in primary care. However, few studies have evaluated correlates of suicidal ideation and suicide attempt in veterans in primary care-mental health integration (PCMHI). The purpose of the present study is to examine associations between suicidal ideation and suicide attempts as dependent variables and demographic and clinical factors as the independent variables.

METHODS

Veterans (n=3004) referred from primary care to PCMHI were contacted for further assessment, which included past-year severity of suicidal thoughts (none, low, high) and attempts using the Paykel Suicide Scale, mental health disorders, and illicit drug use. Multinomial logistic regression models were used to identify correlates of suicidal ideation and suicide attempts.

RESULTS

Thoughts of taking one's life was endorsed by 24% of participants and suicide attempts were reported in 2%. In adjusted models, depression, psychosis, mania, PTSD and generalized anxiety disorder were associated with high severity suicidal ideation, but not suicide attempt. Illicit drug use was not associated with suicidal ideation, but was the only variable associated with suicide attempt.

LIMITATIONS

The study was cross-sectional, focused on one clinical setting, and the suicide attempt analyses had limited power.

CONCLUSIONS

PCMHI is a critical setting to assess suicidal ideation and suicide attempt and researchers and clinicians should be aware that the differential correlates of these suicide-related factors. Future research is needed to identify prospective risk factors and assess the utility of follow-up care in preventing suicide.

Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: a meta-analysis

BACKGROUND

This meta-analysis addressed the association between substance use disorder (SUD) and suicide outcomes based on current evidence.

METHODS

We searched PubMed, Web of Science and Scopus until May 2015. We also searched the reference lists of included studies and Psycinfo website. We included observational (cohort, case-control, cross-sectional) studies addressing the association between SUD and suicide. Our outcomes of interest were suicide ideation, suicide attempt and suicide death. For each outcome, we calculated the odds ratio (OR) or risk ratio (RR) with 95% confidence intervals (CI) based on the random-effects model.

RESULTS

We identified a total of 12 413 references and included 43 studies with 870 967 participants. There was a significant association between SUD and suicidal ideation: OR 2.04 (95% CI: 1.59, 2.50; I² = 88.8%, 16 studies); suicide attempt OR 2.49 (95% CI: 2.00, 2.98; I² = 94.3%, 24 studies) and suicide death OR 1.49 (95% CI: 0.97, 2.00; I² = 82.7%, 7 studies).

CONCLUSIONS

Based on current evidence, there is a strong association between SUD and suicide outcomes. However, evidence based on long-term prospective cohort studies is limited and needs further investigation. Moreover, further evidence is required to assess and compare the association between suicide outcomes and different types of illicit drugs, dose-response relationship and the way they are used.

Ethnic Differences in Correlates of Suicidal Behavior Among Women Seeking Help for Intimate Partner Violence

Abstract. Background: Women abused by an intimate partner are at risk of engaging in nonfatal suicidal behavior and suicidal communication (NSBSC). No studies have examined ethnic differences in correlates of NSBSC among abused women. Aims: This secondary data analytic study examined whether correlates of NSBSC previously reported among a mixed ethnic sample of women seeking help for abuse by a male intimate partner differed for those who self-identified as Latina (N = 340), African American (N = 184), or European American (N = 67). Method: Logistic regression was used to examine correlates of NSBSC separately among Latina, African American, and European American women. Results: More severe violence by a male intimate partner, having a chronic or disabling illness, being younger, and being unemployed were positively associated with NSBSC in bivariate analyses among Latina women, but unemployment did not remain significantly associated with NSBSC in the multiple logistic regression. There were no significant correlates of NSBSC for African American women. Having a chronic illness was significantly associated with NSBSC among European American women. Conclusion: Findings suggest the need for culturally tailored suicide prevention interventions and studies that examine risk and protective factors for NSBSC among a diversity of women abused by male intimate partners