Quarrelsome family environment as an enhanced factor on child suicidal ideation

A bibliometric analysis of anxiety and depression among primary school students

Background

Rising anxiety and depression in primary school students adversely affect their development and academics, burdening families and schools. This trend necessitates urgent, focused research within this young demographic. This alarming trend calls for a systematic bibliometric analysis to develop effective preventative and remedial strategies.

Objectives

This study aims to identify and analyze the prevailing research hotspots and emerging trends concerning anxiety and depression in primary school students, thereby furnishing a foundational reference for future academic endeavors in this area.

Methods

This study uses the Web of Science (WOS) Core Collection database as the data source, focusing on literature published between 2013 and 2023 concerning anxiety and depression in primary school students. An initial search identified 1852 articles, which were then manually screened to exclude duplicates, conferences, announcements, and unrelated literature, resulting in 1791 relevant articles. The analysis, executed on December 31, 2023, employed CiteSpace and Vosviewer tools to assess various bibliometric indicators including authorship, country, institutional affiliations, publication trends, keyword frequency, and citation analysis.

Results

The analysis revealed a corpus of 1,791 English-language articles, with a discernible upward trend in publications over the decade. The USA and China were the leading countries in this field, with 482and 272 papers, respectively. The research predominantly addresses the etiological factors of anxiety and depression, various intervention strategies, and the comorbidities associated with these conditions in the target population. Key research focuses have been identified in areas such as suicidal thoughts, bullying in schools, the impact of COVID-19, mindfulness interventions, and anxiety related to mathematics. Future research is projected to increasingly focus on the effects of mathematics anxiety on the psychological and behavioral outcomes in students.

Conclusion

This study provides a critical visual and analytical overview of the key research areas and trends in the field of anxiety and depression among primary school students. It underscores the necessity of concentrating on the underlying causes and potential interventions. Such focused research is imperative for mitigating the mental health challenges faced by young students and enhancing their educational and developmental outcomes.

Informant Discrepancies in Suicidality Screening Tools Among School Age Youth

As the rate of death by suicide in youth ages 6 to 12 rises, it is imperative to better understand informant discrepancies when screening for suicidality. Accordingly, this study investigated associations among youth-, caregiver-, and clinician-reports of youth's suicidality and their associations with youth- and caregiver-reports of youth's depressive symptoms. Participants were 161 6- to 12-year-old youth presenting for outpatient psychological services at a Midwest training clinic between 2014 and 2019. More than 1 in 4 youth had at least one informant report some suicidal concerns. Results indicated that all informants' reports of suicidality were correlated with one another, with youth- and clinician-report being most strongly linked and caregiver- and clinician-report having the weakest correlation. Clinician- and youth-reports of suicidality were associated with youth-report, (but not caregiver-report) of depressive symptoms. Caregiver-report of suicidality was not associated with youth- or caregiver-report of depressive symptoms. When youth-report of depressive symptoms was regressed on sex, age, and youth-, caregiver-, and clinician-reports of suicidality, there was a trend that youth-report of suicidality was positively associated with youth-report of depressive symptoms. No informant's report of suicidality was uniquely associated with caregiver-report of depressive symptoms. Findings indicate that youth- and clinician-reports at intake are more strongly linked with one another than with caregiver-reports. Further, youth-reports on suicidality screening tools are more strongly associated with depressive symptoms than caregiver-report, suggesting that caregiver-reports are insufficient to assess concerns of suicidality at intake among school age youth.

Associations between Suicidal Ideation and Relatives' Physical and Mental Health among Community Residents: Differences between Family Members and Lineal Consanguinity

(1) Background: Despite the verified relationship between relatives’ characteristics and individual suicidal ideation, few studies have discussed the role of family members and lineal consanguinity independently according to whether they live together with the individuals or not. (2) Methods: The data in this study were collected in November 2019 and identified rural adults over 18 years old in Shandong as the survey objects, with a total of 879 valid cases included in this survey. Logistic regression analysis was employed to examine the risk factors affecting adults’ suicidal ideation and differentiate the effects of a family member and lineal consanguinity’s physical and mental health. Relatives’ physical and mental health were estimated by three aspects: whether they were suffering from chronic diseases, mental illness, or alcoholism. (3) Results: The study showed that a family member’s physical (OR = 2.303, p < 0.01) and mental health (OR = 5.877, p < 0.05) was related to suicidal ideation, but the association between lineal consanguinities’ physical and mental health and suicidal ideation were not supported. People over 40 years old (OR = 6.528, p < 0.05), from only-child families (OR = 4.335, p < 0.01), with household indebtedness (OR = 2.992, p < 0.001), or difficulty falling asleep (OR = 3.165, p < 0.001) had risk factors of suicidal ideation. (4) Conclusions: The physical and mental health of individuals’ family members are related to their suicidal ideation, and their lineal consanguinities’ physical and mental health are not related to suicidal ideation. These findings imply the different associations between family environment, genetic factors, and suicidal ideation. Family members’ health should be considered as a factor to prevent and control suicidal behaviors, including suicidal ideation.

Longitudinal associations among academic achievement and depressive symptoms and suicidal ideation in elementary schoolchildren: disentangling between- and within-person associations

Prior cross-sectional and unidirectional longitudinal research has investigated the associations among academic achievement, depressive symptoms, and suicidal ideation without distinguishing between-person effects from within-person effects. Our study aimed to examine the longitudinal relations among academic achievement, depressive symptoms, and suicidal ideation in a sample of elementary school children at the within-person level using cross-lagged panel models (CLPMs) and random intercept cross-lagged panel models (RI-CLPMs). Also, multiple models replicated these findings by using three measures of academic achievement (i.e., objective academic achievement, subjective academic achievement, and teacher-assigned academic achievement). A sample of 715 Chinese elementary schoolchildren completed self-report measures of subjective academic achievement, depressive symptoms, and suicidal ideation on five occasions, using 6-month intervals. Objective academic achievement data were obtained from school records and teacher-assigned academic achievement data were reported by teachers. The results showed that: (a) In CLPMs, objective academic achievement negatively predicted suicidal ideation. However, RI-CLPMs supported the negative effect of suicidal ideation on objective academic achievement. (b) The CLPMs revealed reciprocal associations between subjective and teacher-assigned academic achievement and depressive symptoms, respectively. However, RI-CLPMs only provided support for the negative effect of depressive symptoms on subjective academic achievement. (c) Both the CLPMs and the RI-CLPMs showed bidirectional relations between depressive symptoms and suicidal ideation. These findings highlight that mental health problems (e.g., depressive symptoms and suicidal ideation) serve as antecedents of academic performance and that it is beneficial to distinguish between between-person and within-person effects in research informing the development of prevention and intervention programs.

Prevalence and Correlates of Suicide and Nonsuicidal Self-injury in Children: A Systematic Review and Meta-analysis

IMPORTANCE

Considerably less is known about self-injurious thoughts and behaviors (SITBs) in preadolescence than older age groups, owing partly to the common view that young children are incapable of suicidal thoughts. Yet, preadolescent suicide has increased in recent years and is now the fifth leading cause of death in this age group, leading the National Institute of Mental Health to identify it as a priority for research and intervention.

OBJECTIVE

To assess prevalence estimates of preadolescent SITBs, identify correlates of these outcomes, and conduct head-to-head comparisons of preadolescent and adolescent SITBs in terms of associated characteristics.

DATA SOURCES

MEDLINE, PsycINFO, and Embase were systematically searched from inception through December 23, 2021, for studies on the prevalence and correlates of preadolescent SITBs. The search was restricted to English language publications and peer-reviewed journals.

STUDY SELECTION

Two reviewers independently identified studies providing data on prevalence and correlates of preadolescent SITBs.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data from each study, and the Joanna Briggs Institute Checklist for Prevalence Studies was used to assess study quality. Pooled prevalence and Cohen d were derived from random-effects meta-analyses. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed.

MAIN OUTCOMES AND MEASURES

Prevalence and correlates of suicidal ideation, suicide attempts, suicide deaths, and nonsuicidal self-injury among preadolescents.

RESULTS

Fifty-eight studies with 626 486 590 individuals were included. Lifetime prevalence of suicide in the general population was 0.79 per 1 million children. Prevalence for lifetime suicidal thoughts, suicide attempts, and nonsuicidal self-injury among preadolescents were 15.1%, 2.6%, and 6.2%, respectively, in community samples. These data suggest that approximately 17.0% of preadolescents with suicidal ideation transition to attempting suicide. Across several analyses, male individuals appear more likely to have SITBs in preadolescence than adolescence. Correlate data were modest for SITBs other than suicidal ideation, but among specific disorders, attention-deficit/hyperactivity disorder (suicidal ideation: d = 0.54 [95% CI, 0.34-0.75]) and depression (suicidal ideation: d = 0.90 [95% CI, 0.71-1.09]; suicide attempts: d = 0.47 [95% CI, 0.26-0.68]) emerged as the strongest correlates. Among interpersonal factors, child maltreatment (suicidal ideation: d = 2.62 [95% CI, 1.56-3.67]) and parental support (suicidal ideation: d = -0.34 [95% CI, -0.46 to -0.22]) yielded the largest effect sizes.

CONCLUSIONS AND RELEVANCE

In this systematic review anda meta-analysis, although preadolescent suicide deaths were rare, other SITB types occur with concerning frequency. Male individuals were at greater risk for SITBs in preadolescence relative to adolescence. Attention-deficit/hyperactivity disorder, child maltreatment, and parental support were especially relevant to suicidal ideation, as well as depression for suicidal thoughts and behaviors, in this age group. Further study, especially of SITBs other than suicidal ideation, is needed.

Characterizing children hospitalized for suicide-related thoughts and behaviors

BACKGROUND

Despite alarming increases in suicide deaths among preadolescent children, knowledge of the precipitants of suicide risk and the characteristics of children who seek treatment for suicidality is limited. This study's purpose is to describe children (ages 6-12) hospitalized for suicide-related concerns and compare demographic and diagnostic differences between children and adolescent (ages 13-18) patients.

METHODS

This retrospective study analyzed medical records of 502 children and adolescents ages 6-18 admitted for suicide-related risk to one psychiatric inpatient hospital in southeastern United States between 2015 and 2018.

RESULTS

Patients were predominantly White (63.5%), female (64.5%), and non-Hispanic/Latino (85.1%). We conducted descriptive analyses and a series of logistic regressions comparing children and adolescents with data extracted from discharge summaries, (i.e. primary reasons for admission, environmental stressors, and diagnostic categories). Common environmental stressors included school (63.2%) and family (60.7%), and the most common diagnosis included depressive disorders. Compared to adolescents, children were more likely to be Black (OR = 1.99), male (OR = 1.94), and receive neurodevelopmental disorder (aOR = 3.0) or trauma and stress-related disorder (aOR = 2.6) diagnoses, but less likely to be diagnosed with a depressive disorder (aOR = 0.4). Across both age-groups, Black patients were more likely to be diagnosed with neurodevelopmental disorders and less likely to receive internalizing disorder diagnoses.

CONCLUSIONS

Characteristics of children hospitalized for suicide-related risk are relatively similar to characteristics of children dying by suicide. Compared to adolescents, hospitalized children are more likely to be Black, male, and have a neurodevelopmental disorder diagnosis. Proactively identifying and providing strengths-based supports for Black boys and families appear critical for suicide prevention in children.

Characteristics and Precipitating Circumstances of Suicide Among Children Aged 5 to 11 Years in the United States, 2013-2017

IMPORTANCE

Suicide is the eighth leading cause of death among children aged 5 to 11 years, with rates increasing during the past decade. A better understanding of factors associated with childhood suicide can inform developmentally appropriate prevention strategies.

OBJECTIVE

To examine characteristics and precipitating circumstances of childhood suicide.

DESIGN, SETTING, AND PARTICIPANTS

This qualitative study examined restricted-use data from the National Violent Death Reporting System (NVDRS) regarding child suicide decedents aged 5 to 11 years in the US from 2013 to 2017. The NVDRS is a state-based surveillance system that collects data on suicide and violent deaths in 50 states, with restricted-use data available from 37 states. Details and context related to suicide deaths were identified through a content analysis of case narratives from coroner or medical examiner and law enforcement reports associated with each incident.

EXPOSURES

Characteristics and precipitating circumstances associated with suicide cited in the coroner, medical examiner, and law enforcement case narratives.

MAIN OUTCOMES AND MEASURES

Suicide incidence and risk factors for suicide including mental health, prior suicidal behavior, trauma, and peer, school, or family-related problems.

RESULTS

Analyses included 134 child decedents (101 [75.4%] males; 79 [59.0%] White individuals; 109 [81.3%] non-Hispanic individuals; mean [SD] age, 10.6 [0.8] years). Most suicides occurred in the child's home (95.5% [n = 128]), and more specifically in the child's bedroom. Suicide by hanging or suffocation (78.4% [n = 105]) was the most frequent method, followed by firearms (18.7% [n = 25]). Details on gun access were noted in 88.0% (n = 22) of suicides by firearm, and in every case, the child obtained a firearm stored unsafely in the home. Findings revealed childhood suicide was associated with numerous risk factors accumulated over time, and suggest a progression toward suicidal behavior, especially for youth with a history of psychopathology and suicidal behavior. An argument between the child and a family member and/or disciplinary action was often a precipitating circumstance of the suicide.

CONCLUSIONS AND RELEVANCE

This qualitative study found that childhood suicide was associated with multiple risk factors and commonly preceded by a negative precipitating event. Potential prevention strategies include improvements in suicide risk assessment, family relations, and lethal means restriction, particularly safe firearm storage. Future research examining the myriad aspects of childhood suicide, including racial/ethnic and sex differences, is needed.

Detecting risk of suicide attempts among Chinese medical college students using a machine learning algorithm

BACKGROUND

Suicide has become one of the most prominent concerns for public health and wellness; however, detecting suicide risk factors among individuals remains a big challenge. The aim of this study was to develop a machine learning algorithm that could effectively and accurately identify the probability of suicide attempts in medical college students.

METHODS

A total of 4,882 medical students were enrolled in this cross-sectional study. Self-report data on socio-demographic and clinical characteristics were collected online via website or through the widely used social media app, WeChat. 5-fold cross validation was used to build a random forest model with 37 suicide attempt predictors. Model performance was measured for sensitivity, specificity, area under the curve (AUC), and accuracy. All analyses were conducted in MATLAB.

RESULTS

The random forest model achieved good performance [area under the curve (AUC) = 0.9255] in predicting suicide attempts with an accuracy of 90.1% (SD = 0.67%), sensitivity of 73.51% (SD = 2.33%) and specificity of 91.68% (SD = 0.82%).

LIMITATION

The participants are primarily females and medical students.

CONCLUSIONS

This study demonstrates that the random forest model has the potential to predict suicide attempts among medical college students with high accuracy. Our findings suggest that application of the machine learning model may assist in improving the efficiency of suicide prevention.

Psychopathological mechanisms of early neglect and abuse on suicidal ideation and self-harm in middle childhood

Informed by diathesis-stress models of suicide risk, this longitudinal study examines the psychopathological mechanisms through which early maltreatment increases the risk for suicidal ideation and self-harm in middle childhood. The sample included 2958 families from the Fragile Families and Child Wellbeing Study, who participated in interviews at child's ages of 3 and/or 5, and 9. Via the Child Behavior Checklist, primary caregivers reported on the child's suicidal ideation and self-harm at age 9 and on clinically elevated depressive/anxious symptoms, aggressive behaviors, attention problems, and comorbid aggression and depressive/anxious symptoms at age 5. Past year neglect and physical/psychological abuse were measured via the Parent-Child Conflict Tactics Scale at age 3. Multivariate structural equation models indicated that early neglect had a significant indirect effect on suicidal ideation via clinically elevated depressive/anxious symptoms (OR = 1.57, 95% CI 1.09-2.25) and comorbid symptomatology (OR = 1.28, 95% CI 1.02-1.62), and on self-harm also via clinically elevated depressive/anxious symptoms (OR = 1.39, 95% CI 1.04-1.84) and comorbid symptomatology (OR = 1.20, 95% CI 1.01-1.43). Early physical/psychological abuse had a significant indirect effect on self-harm via clinically elevated attention problems (OR = 1.09, 95% CI 1.01-1.21). Unique developmental pathways for suicidal ideation and self-harm emerged among children exposed to abuse or neglect. For those exposed to early neglect, interventions should target depressive/anxious symptoms, especially when comorbid with aggression, to prevent suicidal ideation and self-harm. For children exposed to early physical/psychological abuse, problems with attention and impulsivity may be targets for reducing the risk for self-harm.

The Role of Interpersonal Problems and Family Environment in the Association Between Impulsivity and Suicidal Ideation: A Moderate Mediation Model

Impulsivity, interpersonal problems, and family environment are important factors in the development of suicidal ideation, but the pathway of these factors on suicidal ideation is not clear. This study constructed a moderated mediation model to examine whether interpersonal problems mediated the relationship between impulsivity and suicidal ideation and whether this mediating process was moderated by family environment. For this purpose, 902 college students from Tianjin Normal University located in the north of China were recruited to participate in this study with Barratt Impulsiveness Scale, Adolescent Self-Rating Life Events Check List, Family Environment Scale, and Beck Scale for Suicidal Ideation. Impulsivity could significantly predict suicidal ideation, and the relationship between impulsivity and suicidal ideation was significantly mediated by interpersonal problems; furthermore, the mediating effect and the directing effect were significantly moderated by family environment. These findings contribute to our understanding of a comprehensive interpretation of both environmental and individual factors' impacts on suicidal ideation.

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.

The mediating effects of depressive symptoms and sleep quality on the relationship between the non-medical use of prescription drugs and suicidal behaviors among Chinese adolescents

BACKGROUND

The nature of the relationship between the non-medical use of prescription drugs (NMUPD) and suicide has not been clearly elucidated. Some studies have suggested that the relationship between substance use and suicidal ideation may be spurious and could be explained by other variables.

METHODS

A school-based cross-sectional study was performed in Guangzhou. A total of 5853 students completed questionnaires and were included in the study. NMUPD, alcohol use, illicit drug use, depressive symptoms, sleep quality, and suicidal behaviors were assessed. The mediating effects of depressive symptoms and sleep quality on the relationship between NMUPD and suicidal behaviors were examined using a structural equation model.

RESULTS

In the simple model without mediation, a positive relationship between NMUPD and suicidal behaviors in adolescents was found, which was independent of effects from the use of other substances. Both depressive symptoms and sleep quality were significant mediators of this relationship.

CONCLUSION

Public health and educational professionals should survey depressive symptoms and sleep quality and provide interventions when managing suicidal behaviors among adolescents engaging in NMUPD.

Interparental Conflict Relative to Suicidal Ideation in Chinese Adolescents: The Roles of Coping Strategies and Meaning in Life

The aim of this study was to explore the paths between interparental conflict and Chinese adolescents’ suicidal ideation. Altogether 931 adolescents (M_age = 17.84, SD = 0.77, females = 531) completed the Dyadic Consensus Scale, Self-Report Coping Scale, Meaning in Life Questionnaire, and Positive and Negative Suicide Ideation questionnaires. Mediation analyses were conducted, focusing on the relations between interparental conflict and suicidal ideation along with coping styles and a sense of meaning in life. The results showed that interparental conflict indirectly predicted adolescents’ suicidal ideation via three mediators: coping-approach strategies, presence of meaning, and the joint serial effects of coping-approach strategies and presence of meaning in Chinese adolescents. In addition, boys were more likely to be at risk for suicidal ideation than girls, so were 10th graders compared to 11th graders. These findings supported a combined distress-to-meaninglessness line of thinking along with the use of coping-approach strategies to depress self-harm ideation. Generally, interparental conflict should be kept out of youngsters’ immediate vicinity as a preventive measure of suicidal ideation.

Suicidal ideation, plans and attempts among medical college students in china: The effect of their parental characteristics

Medical college students are a high-risk population of suicidal ideation, plan and attempt. However, few studies discuss the effect of parental characteristics on suicidal ideation, plans and attempts among medical college students in China. A total of 2198 respondents answered the questionnaires referring social-demographic characteristics, psychological conditions, parental characteristics, suicidal ideation, plan and attempt. The prevalence of suicidal ideation, plan and attempt among the subjects were 17.9%, 5.2% and 4.3%, respectively. The results of multiple logistic regression showed that male, mother's education level, mother's parenting style, relationship in parents and psychological condition were associated with lifetime suicidal ideation. Male, mother's vocation, mother's parenting style, relationship in parents and psychological conditions were associated with suicide plan. Male, relationship in parents and psychological condition were associated with suicide attempt. Those imply that mother may play more roles on suicidal ideation and plan than father among medical college students in China. Psychological condition has a very strong association with suicidal ideation, plan and attempt.

Effects of pubertal timing on alcohol and tobacco use in the early adulthood: A longitudinal cohort study in Taiwan

We aimed to examine the effects of pubertal timing on adolescents' alcohol and tobacco use from late adolescence to young adulthood. In addition, we separately explored associative factors of the use of these substances stratified by pubertal timings. A longitudinal cohort of 7th- and 9th-grade students was recruited in Taiwan. Pubertal timing was classified according to the Pubertal Developmental Scale. Effects of pubertal timing on self-reported drinking and smoking at age 20 were evaluated using generalized estimating equation analysis. Furthermore, we assessed the predictive roles of parental monitoring, parent-child relationships, peer influence, and school adhesion among participants, stratified by pubertal timing using multiple logistic regression analysis. A survey of 2290 participants was analyzed, with 51.2% being female. The smoking rate is 19.2% (adjusted odds ratio [OR] 1.43, 95% confidence interval [CI] 1.03-2.00) and the alcohol drinking rate is 41.6% (adjusted OR 1.34, 95% CI 1.07-1.69) for early maturing adolescents as compared to 12.3% and 41.6% respectively for on-time peers. A satisfactory parent-child relationship is a protective factor and strict parental monitoring is a risk factor for future tobacco and alcohol use in logistic regression analyses. Early maturation confers risk for cigarette smoking and alcohol consumption in young adulthood. Health professionals and parents should be advised of the potential associative factors with future substance use among adolescents with different maturation tempo. Emphasis could be placed on promoting positive parenting strategies and intra-familial interactions.