The influence of family factors on time to suicidal ideation onsets during the adolescent developmental period

Perceived COVID-19 Stress and Suicidal Ideation Among College Students: Meditation Roles of Family Cohesion and Unmet Interpersonal Needs

Purpose: Few studies examined variables that might explain the link between perceived COVID-19 stress and suicidal ideation. The present study tested a multiple-sequence mediation model with family cohesion, thwarted belongingness, and perceived burdensomeness as mediators. Methods: The current study surveyed 1098 college students in China using questionnaires concerning perceived COVID-19 stress, family cohesion, unmet interpersonal needs, and suicide ideation. Results: Perceived COVID-19 stress was significantly associated with family cohesion, thwarted belongingness, perceived burdensomeness, and suicidal ideation. Family cohesion, thwarted belongingness, and perceived burdensomeness mediated the relationship between perceived COVID-19 stress and suicidal ideation separately. These factors also had multiple sequence-mediated effects between perceived COVID-19 stress and suicidal ideation. Conclusion: The study revealed pathways from perceived COVID-19 stress to suicidal ideation and suggested that interventions to increase family cohesion and reduce one's unmet interpersonal needs were beneficial in decreasing individuals' suicidal ideation.

An RDoC-based approach to adolescent self-injurious thoughts and behaviors: The interactive role of social affiliation and cardiac arousal

Recent theoretical models have posited that increases in self-injurious thoughts and behaviors (SITBs) during adolescence may be linked to failures in biological stress regulation in contexts of social stress. However, there is a lack of data examining this hypothesis during the transition to adolescence, a sensitive period of development characterized by changes across socioaffective and psychophysiological domains. Building on principles from developmental psychopathology and the RDoC framework, the present study used a longitudinal design in a sample of 147 adolescents to test whether interactions among experiences of social (i.e., parent and peer) conflict and cardiac arousal (i.e., resting heart rate) predicted adolescents' engagement in SITBs (i.e., nonsuicidal self-injury, NSSI; and suicidal ideation; SI) across 1-year follow-up. Prospective analyses revealed that adolescents experiencing a combination of greater peer, but not family, conflict and higher cardiac arousal at baseline showed significant longitudinal increases in NSSI. In contrast, social conflict did not interact with cardiac arousal to predict future SI. Findings indicate that greater peer-related interpersonal stress in adolescents may increase risk for future NSSI among youth with physiological vulnerabilities (i.e., higher resting heart rate) that may be markers of maladaptive stress responses. Future research should examine these processes at finer timescales to elucidate whether these factors are proximal predictors of within-day SITBs.

Deficits in psychological resilience and problem-solving ability in adolescents with suicidal ideation

OBJECTIVES

This study aimed to explore differences between psychological resilience and problem-solving ability in grade one junior middle school adolescents with and without suicidal ideation, focusing on the relationship between these factors and suicidal ideation.

METHODS

Ninety-nine adolescents (aged 10 to 14) were divided into Suicidal Ideation (SI, n = 49) and Non-Suicidal Ideation (NSI, n = 50) grouped by the Self-rating Idea of Suicide Scale (SIOSS). The Psychological Resilience Scale (PRS) and Tower of Hanoi task (TOH) were applied to assess psychological resilience and problem-solving ability, respectively.

RESULTS

The SI group scored significantly lower than the NSI group on PRS (p < 0.001) and performed more poorly on TOH than the NSI group, with more mistakes in the number of errors index (p < 0.001) and requiring a longer time in the task completion time index (p < 0.05). Among all the participants in this study, a significant negative correlation was observed between PRS and SIOSS (r = - 0.413, p < 0.01). The sub-dimensions of PRS including emotional control, family support, and interpersonal assistance were significantly negatively correlated with the SIOSS total score (r = - 0.361, - 0.360, - 0.382; p < 0.01).

CONCLUSIONS

This study profiled the characteristics and differences in psychological resilience and problem-solving ability between adolescents with and without suicidal ideation. The data suggested adolescents with SI might have deficits in psychological resilience and problem-solving ability, which may serve as potential targets for suicide intervention.

Affiliation to a Social Group as a Preventive Factor in Suicidal Behaviors in Children and Adolescents during the COVID-19 Pandemic

Suicide is one of the most common causes of death in the population of children and adolescents. Available data show the continuous growth of this phenomenon and the ineffectiveness of prevention programs. Additionally, the COVID-19 pandemic significantly affected young people's mental health, including an increased risk of suicidal behaviors due to limited direct contact with the school and peer groups in favor of the home environment. Therefore, the aim of this narrative review was to consider the risk factors and protective factors for suicidal behavior in the under-18 population, with a particular focus on the importance of belonging to a social group and building identification with it as a phenomenon protecting against suicidal behavior. Additionally, in this review, we evaluate how the COVID-19 pandemic affected these relationships. The PubMed database was used in the search with the following keywords: suicide, suicide behaviors, child and adolescent suicide behaviors, group affiliation, family affiliation, ethnicity, religious affiliation, and the COVID-19 pandemic, with articles published between 2002 and 2022 analyzed. Research conducted to date indicates that both sustained and stable family and peer relationships, as well as a sense of identification and belonging, noticeably reduce the risk of suicidal behavior. Ethnic or cultural affiliation seems to have been particularly important during the isolation in the home environment caused by the COVID-19 pandemic. Additionally, it has been shown that while in lockdown, contact through social media with individuals' identification groups was associated with a reduced chance of emotional crises. Furthermore, regardless of cultural background, attachment to a particular group correlates with enhanced psychiatric state of children and adolescents. Thus, available data highlight the need for building and maintaining affiliations with suitable groups as a protective factor against suicidal behaviors.

Identifying and Managing Suicidality in Children and Adolescents with Chronic Pain: Evidence-Based Treatment Strategies

Children and adolescents with chronic pain are at an increased risk of suicidality. This narrative review article aims to inform clinical practice in the assessment and management of suicidality in youth with chronic pain. The article begins with a survey of the background and prevalence of youth with chronic pain. A review of the current evidence behind the increased risk of suicidality in youth with chronic pain follows. Contextualization of this data with general tenets of child and adolescent suicide risk and risk assessment is provided. Suicidology theory including the interpersonal theory of suicide is overviewed to help clinicians to conceptualize the reviewed data. Guiding parameters for the suicide risk assessment and management planning is presented. Concluding recommendations are made to guide clinical practice in the assessment and management of suicidality in youth with chronic pain.

The effects of peer bullying and poverty on suicidality in Chinese left behind adolescents: The mediating role of psychotic-like experiences

AIM

This study investigated the influence of childhood adversity, such as peer bullying and socioeconomic status, on the suicidal behaviour of left-behind Chinese adolescents to determine whether psychotic-like experiences (PLEs) mediated the associations between these childhood adversities and suicidality; suicidal ideation (serious thoughts about taking one's own life), suicide plans, and suicide attempts.

METHODS

A representative group of rural adolescents (n = 3346) was recruited from 16 rural high schools in China. Suicidality was assessed using the suicide module from the Mini International Neuropsychiatric Interview Kid. Participants also completed questionnaires on bullying, socioeconomic status, left-behind characteristics, and PLEs. Structural equation modelling was then employed to explore the relationships between these variables.

RESULTS

Peer bullying, poverty, and left-behind status were all found to significantly increase adolescent suicide risk, the relationships between which were mediated by PLEs. Peer bullying was found to play the most significant role in the PLEs and suicidality, with the risk of suicide increasing with the length of time a child had been left behind.

CONCLUSION

Adverse life events can lead to a high risk of PLEs, which in turn can increase the risk of suicide. These results could assist in identifying individuals at risk of suicidality and the design of appropriate interventions. The results also highlighted the role PLEs play in suicidality and highlighted the need for further research in this area.

Aberrant brain dynamics in major depressive disorder with suicidal ideation

BACKGROUND

Suicidal ideation (SI) is a common symptom of major depressive disorder (MDD). Accumulating studies demonstrated that MDD with SI was associated with static alterations in brain activity and functional connectivity. However, given that brain is a highly dynamic system, the changes of brain dynamic patterns in MDD with SI remain unknown.

METHODS

We included 60 MDD patients with SI (MDD-SI), 58 MDD patients without SI (MDD-NSI), and 58 healthy controls (HCs) who underwent resting-state functional magnetic resonance imaging. The sliding-window approach was used to calculate the dynamic fractional amplitude of low-frequency fluctuation (dfALFF) and dynamic degree centrality (dDC) to characterize the temporal dynamic regional activity and distant functional connectivity. We compared dfALFF and dDC across groups and further conducted correlations between abnormal dynamic metrics and the severity of suicidality.

RESULTS

In terms of the dynamic regional activity, MDD-SI showed decreased dfALFF in the left lingual gyrus and right middle occipital gyrus compared with MDD-NSI; in terms of the dynamic distant connectivity, MDD-SI showed decreased dDC in the right middle frontal gyrus compared with MDD-NSI. The decreased dDC in the right middle frontal gyrus was correlated with increased severity of suicidality.

LIMITATIONS

The relatively small sample size.

CONCLUSIONS

We demonstrate the specific brain dynamic patterns of MDD-SI in regional activity and distant functional connectivity compared to MDD-NSI. Especially the decreased temporal variability of the distant connectivity in the middle frontal gyrus was associated with SI. These altered dynamic patterns may represent a potential neurobiological diathesis of SI in MDD.

Predictors of Suicide Re-Attempt in a Spanish Adolescent Population after 12 Months' Follow-Up

Background: This study aims to identify the main predictive factors that allow for the recognition of adolescents with a higher risk of re-attempting suicide. Method: A longitudinal 12-month follow-up design was carried out in a sample of 533 Spanish adolescents between 12 and 17 years old. The data collection period comprised September 2013 to November 2016, including a one-year follow-up after hospital discharge. Results: A statistically significant regression model was obtained to predict suicide re-attempt at 12-months’ follow-up (χ2 = 34.843; p < 0.001; Nagelkerke R2 = 0.105), including personal history of self-injury (OR = 2.721, p < 0.001, 95% CI [1.706, 4.340]) and age (OR = 0.541, p = 0.009, 95% CI [0.340, 0.860]), correctly classifying 82.6% of the sample. Our results show that having a personal history of self-injury and being younger than 14 years old were predictors of suicide re-attempt during the first year after an adolescent’s first admission to emergency services. Conclusions: Considering these factors could contribute to the design of more tailored and effective interventions to prevent suicidal behavior in adolescents at high risk of re-attempting suicide.

Parental education and youth suicidal behaviours: a systematic review and meta-analysis

AIMS

Lower parental education has been linked to adverse youth mental health outcomes. However, the relationship between parental education and youth suicidal behaviours remains unclear. We explored the association between parental education and youth suicidal ideation and attempts, and examined whether sociocultural contexts moderate such associations.

METHODS

We conducted a systematic review and meta-analysis with a systematic literature search in PubMed, PsycINFO, Medline and Embase from 1900 to December 2020 for studies with participants aged 0-18, and provided quantitative data on the association between parental education and youth suicidal ideation and attempts (death included). Only articles published in English in peer-reviewed journals were considered. Two authors independently assessed eligibility of the articles. One author extracted data [e.g. number of cases and non-cases in each parental education level, effect sizes in forms of odds ratios (ORs) or beta coefficients]. We then calculated pooled ORs using a random-effects model and used moderator analysis to investigate heterogeneity.

RESULTS

We included a total of 59 articles (63 study samples, totalling 2 738 374 subjects) in the meta-analysis. Lower parental education was associated with youth suicidal attempts [OR = 1.12, 95% Confidence Interval (CI) = 1.04-1.21] but not with suicidal ideation (OR = 1.05, 95% CI = 0.98-1.12). Geographical region and country income level moderated the associations. Lower parental education was associated with an increased risk of youth suicidal attempts in Northern America (OR = 1.26, 95% CI = 1.10-1.45), but with a decreased risk in Eastern and South-Eastern Asia (OR = 0.72, 95% CI = 0.54-0.96). An association of lower parental education and increased risk of youth suicidal ideation was present in high- income countries (HICs) (OR = 1.14, 95% CI = 1.05-1.25), and absent in low- and middle-income countries (LMICs) (OR = 0.91, 95% CI = 0.77-1.08).

CONCLUSIONS

The association between youth suicidal behaviours and parental education seems to differ across geographical and economical contexts, suggesting that cultural, psychosocial or biological factors may play a role in explaining this association. Although there was high heterogeneity in the studies reviewed, this evidence suggests that the role of familial sociodemographic characteristics in youth suicidality may not be universal. This highlights the need to consider cultural, as well as familial factors in the clinical assessment and management of youth's suicidal behaviours in our increasingly multicultural societies, as well as in developing prevention and intervention strategies for youth suicide.

A rapid review of emergency department interventions for children and young people presenting with suicidal ideation

BACKGROUND

Suicidal ideation is an increasingly common presentation to the paediatric emergency department. The presence of suicidal ideation is linked to acute psychiatric hospital admission and increased risk of suicide. The paediatric emergency department plays a critical role in reducing risk of suicide, strengthening protective factors and encouraging patient engagement with ongoing care.

AIMS

This rapid review aims to synthesise evidence on interventions that can be implemented in the paediatric emergency department for children and adolescents presenting with suicidal ideation.

METHOD

Six electronic databases were searched for studies published since January 2010: PubMed, Web of Science, Medline, PsycINFO, CINAHL and Cochrane. Outcomes of interest included suicidal ideation, engagement with out-patient services, incidence of depressive symptoms, hopelessness, family empowerment, hospital admission and feasibility of interventions. The Cochrane risk-of-bias tool was used to evaluate the quality of studies.

RESULTS

Six studies of paediatric emergency department-initiated family-based (n = 4) and motivational interviewing interventions (n = 2) were narratively reviewed. The studies were mainly small and of varying quality. The evidence synthesis suggests that both types of intervention, when initiated by the paediatric emergency department, reduce suicidal ideation and improve patient engagement with out-patient services. Family-based interventions also showed a reduction in suicidality and improvement in family empowerment, hopelessness and depressive symptoms.

CONCLUSIONS

Paediatric emergency department-initiated interventions are crucial to reduce suicidal ideation and risk of suicide, and to enhance ongoing engagement with out-patient services. Further research is needed; however, family-based and motivational interviewing interventions could be feasibly and effectively implemented in the paediatric emergency department setting.

Future Directions in Suicide and Self-Injury Revisited: Integrating a Developmental Psychopathology Perspective

The recent rise in suicide rates among children and adolescents has made suicide prevention in youth a major focus of government agencies and mental health organizations. In 2012, Nock presented future directions in the study of self-injurious thoughts and behavior (SITBs), highlighting the need to better examine which risk factors are associated with "each part of the pathway" to suicidal and non-suicidal self-injury in order to inform prevention and intervention efforts. Over the past decade, we have made important advances in understanding the development of SITBs and effective interventions. However, there are still major gaps of knowledge in our understanding of how to prevent suicide. Researchers have recently called for more studies focusing particularly on the pathway from suicidal ideation to suicidal behavior. However, we caution against prioritizing only a part of the suicide risk continuum (e.g., the transition from suicidal ideation to suicidal behavior) while minimizing research focusing on earlier developmental points of the pathway to suicide (e.g., the first development of suicidal ideation). We emphasize that childhood and adolescence represent a critical opportunity to intervene and prevent SITBs by altering developmental trajectories toward persistent and escalating SITBs over time. We advocate for integrating a developmental psychopathology perspective into future youth suicide research that focuses on how and when risk for SITBs first emerges and develops across childhood into emerging adulthood. This research is critical for informing interventions aimed at bending developmental pathways away from all SITBs. Here, we describe the need for future research that integrates key developmental psychopathology principles on 1) the identification of the continuum from developmentally typical to atypical as SITBs first emerge and develop, particularly among young children in early to middle childhood, 2) the way in which expressions of and risk for SITBs change across development, 3) how SITBs dynamically move along a continuum from typical to atypical over time, and 4) suicide prevention efforts. We also offer recommendations for future directions that focus on identifying disparities in SITBs occurring among minoritized youth within a developmental psychopathology perspective.

Parents parenting styles differences were associated with lifetime suicidal ideation: Evidences from the Chinese medical college students

This study aims to explore the association between parents parenting styles differences and lifetime suicidal ideation (LSI). The sample included 2598 Chinese medical students. Results showed that 10.5% of students reported LSI. Moreover, total differences in parenting styles (OR = 1.04, 95% CI = 1.02, 1.06), parental nurture rejects differences (OR = 1.11, 95% CI = 1.04, 1.18), parental emotional warmth differences (OR = 1.08, 95% CI = 1.03, 1.14), and parental overprotective differences (OR = 1.11, 95% CI = 1.06, 1.16), obtain a scholarship, physical disease and mental health were associated with LSI. The major finding reminds us of the importance of consistent parenting style for suicide prevention.

Study on prevalence of suicidal ideation and risk factors of suicide among patients visiting psychiatric OPD at Shree Birendra Hospital, Kathmandu Nepal

INTRODUCTION

Suicide is a global public health issue. Several environmental, psychosocial, behavioral factors along with physical, sexual, and emotional abuse have been associated with suicidal ideation and attempts. Childhood physical, sexual abuse, and health risk behaviors are also associated with suicidal attempts. The suicidal ideation prevalence varied from 1 to 20% and it varied with study population, geography, age group, gender, and other factors. The Beck suicidal ideation scale is an effective tool for assessing the major suicidal ideation with a six cut-off score.

MATERIALS AND METHOD

160 patients who met the inclusion criteria were enrolled into this cross-sectional study after random sampling among the patients visiting the Psychiatric OPD of Shree Birendra Hospital, Kathmandu, Nepal. The Semi-Structured Interview Schedule (SSIS), Beck Scale for Suicide Ideation (BSS), and Kuppuswamy's Scale were used to collect the data from the patients enrolled in the study. The Chi-square test and binary logistic regression analyses were used to identify and differentiate the factors associated with high suicidal risk.

RESULTS

Out of total 160 patients, 65% (n = 104) were female, 92.5% (n = 148) were married, 61.9% (n = 99) were residing in urban area, 93.1% (n = 148) were Hindus, 74.4% (n = 119) patients were living in the nuclear family, 5% (n = 8) patients had family history of psychiatric illness and 10.6% (n = 17) patients were using the substance of abuse. In the Beck scale for suicidal ideation questionnaire, 87.5% (n = 140) patients had moderate to strong wish to live, 89.4% (n = 143) patients responded as they would take precautions to save a life, 88.8% (n = 142) patients had such ideation/wish for brief, 96.3% (n = 154) had not considered for specificity/planning of contemplated suicidal attempt, 91.9% (n = 147) patients stated that they would not attempt active suicide because of a deterrent example from family, religion, irreversibility of the act and 98.1% (n = 157) patients had revealed ideas of deception/concealment of contemplated suicide openly. 16.9% (n = 27) of participants were categorized as high risk for suicide while 83.1% (n = 133) patients were as a low-risk category for suicide based on the Beck scale for suicidal ideation scoring.

CONCLUSION

In conclusion, this study found that most of the suicidal attempts were done as an act of impulse and it is higher among female and married individuals residing in the urban areas. This study did not establish any statistically significant association or differences among independent variables with the higher risk scoring in the Beck suicidal ideation scale.

Parent-adolescent relationships and their associations with adolescent suicidal behaviours: Secondary analysis of data from 52 countries using the Global School-based Health Survey

BACKGROUND

Despite the potential benefits of parents-adolescent relationships on suicidal behaviours among adolescents, research on these topics are importantly limited by lack of comprehensiveness, difficulties in cross-country comparisons, and limited generalisability, among others. We aimed to estimate the prevalence of various aspects of parents-adolescent relationships and suicidal behaviours by sex and region, and to investigate their associations.

METHODS

We used data from the Global School-based Health Survey (GSHS) from 52 countries in 2009-2015 for 120 858 adolescents (53.9% girls) aged 12-15 years. Using meta-analysis with random effects, we estimated the prevalence of parents-adolescent relationships (i.e. understanding problems, monitoring academic and leisure time activities, and respecting privacy) and suicidal behaviours (i.e. suicidal ideation, suicide planning, and suicide attempt). Multi-level mixed-effect logistic regressions were used to investigate their associations.

FINDINGS

Overall, boys and girls reported similar levels of parental understanding of problems (35.8% vs. 36.8%), monitoring academic activities (41.8% vs. 41.1%), and respecting privacy (69.6% vs. 69.7%), whereas girls reported higher level of parental monitoring of leisure time activities than boys (44.9% vs. 40.0%). Adolescents in the Western Pacific region reported the lowest level of parental understanding of problems and monitoring activities, while those in South-East Asia region least reported that their parents respected their privacy. The overall prevalence of any suicidal behaviour was higher in girls than boys (26.2% vs. 23.0%). Suicidal behaviour was less likely in adolescents if their parents understood their problems (odds ratio, 95% confidence intervals: 0.70, 0.68-0.73), monitored their academic (0.81, 0.78-0.84) and leisure time activities (0.73, 0.71-0.75), and respected their privacy (0.83, 0.80-0.86). There was evidence of heterogeneity in those associations by sex and regions.

INTERPRETATIONS

Although the prevalence of parents-adolescent relationships and adolescent suicidal behaviours varied particularly by sex and region, there were strong and independent associations among them.

Impact of suicide mortality on life expectancy in the United States, 2011 and 2015: age and sex decomposition

OBJECTIVES

This study examined (1) potential differences in life expectancy when suicide as a cause of death was discounted and (2) suicide's contributions to changes in life expectancy by age group and sex.

METHODS

Data were from the 2011 and 2015 National Violent Death Reporting System on all suicide decedents aged 10 years or older in 17 US states. Life tables were constructed based on the total population and all-cause mortality data from the Centers for Disease Control and Prevention. Differences in life expectancy were calculated using Arriaga's decomposition method.

RESULTS

The numbers of suicide deaths in both 2011 and 2015 were 3-4 times higher among males than females in all age groups. The highest impact for both males and females was in the 55-64 age group, with changes in life expectancy of 1.64 years in 2011 and 1.60 years in 2015 for men, and 1.30 years in 2011 and 1.27 years in 2015 for women. Between 2011 and 2015, the percent change in suicide mortality rates for all age groups was 7.44% in males and 15.72% in females. However, the groups that negatively impacted changes in life expectancy due to significant increases in suicide mortality were males aged 25-34 (22.80%) and 55-64 (15.45%) and females aged 15-19 (34.74%) and 55-64 (23.15%). Eliminating suicide as a cause of death would have increased life expectancy at birth by 1.92 years for males and 1.36 years for females from 2011 to 2015.

CONCLUSIONS

This study updates information on suicide and adds to calls for more effective suicide prevention efforts, especially for older adolescent girls, young men, and middle-aged men and women.

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.

Suicidal behaviours among Chinese adolescents exposed to suicide attempt or death

AIMS

Suicidal behaviours in adolescents are prevalent and multifactorial. This study was conducted to examine the associations between exposure to suicide attempt (ESA) or suicide death (ESD) and suicidal behaviours in a large sample of Chinese adolescents.

METHODS

Participants included for the analysis were 11 831 adolescent students who participated in the baseline survey of the Shandong Adolescent Behavior and Health Cohort (SABHC). Participants were sampled from five middle and three high schools in three counties of Shandong province, China. A self-administered structured questionnaire was used to collect data on demographics, behavioural and emotional problems, family environment, suicidal behaviours (suicidal thought, plan and attempt), and history of ESA or death of a family member, relative, friend or close acquaintance. Based on the sources of exposure, the participants were divided into four groups: non-exposure, exposure from relatives only, exposure from friends/close acquaintances only (EFO) and exposure from both relatives and friends (ERF). Logistic regressions were used to examine the associations between ESA or ESD and suicidal behaviours.

RESULTS

Mean age of the participants was 14.97 ± 1.46 years and 50.9% were boys. Of the participants, 9.4% reported having ESA, and 6.6% reported having ESD. The prevalence rates of suicidal behaviours were significantly higher in adolescents who had been exposed to suicide attempt or death than those who had not. Multivariate logistic regressions showed that ESA and ESD were both significantly associated with increased risks of suicidal thought (ESA: OR = 1.96, 95% CI = 1.66-2.31; ESD: OR = 1.59, 95% CI = 1.31-1.94), plan (ESA: OR = 2.37, 95% CI = 1.84-3.05; ESD: OR = 1.62, 95% CI = 1.18-2.23) and attempt (ESA: OR = 2.73, 95% CI = 1.92-3.89; ESD: OR = 1.82, 95% CI = 1.18-2.82), respectively. When participants were exposed to suicide attempt, ERF and EFO groups had significantly higher risks of suicidal thought (ERF: OR = 2.61, 95% CI = 1.28-1.64; EFO: OR = 1.96, 95% CI = 1.64-2.36), plan (ERF: OR = 3.72, 95% CI = 2.04-6.78; EFO: OR = 2.31, 95% CI = 1.74-3.01) and attempt (ERF: OR = 4.83, 95% CI = 2.30-10.17; EFO: OR = 2.57, 95% CI = 1.73-3.81), respectively.

CONCLUSIONS

ESA or ESD was associated with increased risks of suicidal behaviours in adolescents. Exposure to suicidal behaviours of relatives and friends/close acquaintances appeared to have different influence on adolescent suicidal behaviours. Further research is warranted to examine the biological and psychosocial mechanisms between suicidal exposure and subsequent suicidal behaviours in adolescents.