Exposure to suicide and suicidal behaviors among Hong Kong adolescents

The relationship between suicide bereavement and suicide ideation: Analysis of the mediating effect of complicated grief

People who have experienced suicide bereavement within social relationships are known to have high risk for suicide, which means that their suicide ideation is high. However, little is known about how suicide bereavement leads to suicide ideation. Therefore, this study aims to understand the pathway of suicide bereavement on suicide ideation by analyzing the mediating effect of complicated grief, which does not abate over time and is known to be highly related to suicide ideation. Data of 1224 people aged 19 or older with bereavement (636 bereaved by suicide and 585 by other causes) were obtained from the Longitudinal study on Suicide Survivors' Mental Health (LoSS) WAVE I [2015-2018], the first nationally-representative longitudinal study in South Korea. Suicide ideation, the dependent variable, was measured by the Scale for Suicide Ideation (SSI), and complicated grief, severe grief that does not abate over time, was measured by the Korean version of the Inventory of Complicated Grief (K-ICG). The results show that suicide bereavement was found to have a significant effect on suicide ideation, and that complicated grief plays a mediating role in the path of suicide bereavement to suicide ideation (Effect = 0.667, [0.387, 0.981]). Based on these findings, clinical and policy suggestions were discussed to understand and prevent suicide ideation of people with suicide bereavement.

Neighborhood collective efficacy in stressful events: The stress-buffering effect

Although research on neighborhood effects has shown positive outcomes of collective efficacy in mental health, few studies have examined whether its protective role is universally applicable to all residents or the vulnerable population. Building on a stress-buffering model, this study examines whether or not neighborhood collective efficacy serves as a stress buffer to ameliorate the deleterious effects of exposure to stressful events across different population groups. Analyses are conducted based on a city-wide representative sample in Hong Kong linked to suicide events through spatial and temporal information. Neighborhood-level collective efficacy is constructed by the aggregated mean score of individual perceived collective efficacy within the same residential neighborhoods. Results from the logistic regression models show that individuals exposed to suicide in the residential surroundings have a higher risk of mental distress symptoms. Moreover, neighborhood-level collective efficacy tends to alleviate the mental distress upon exposure, but such a stress-buffering effect is only observed in older adults. Our findings provide a new perspective informed by the variation of stress-buffering effect across population groups. Thus, this study contributes to the understandings of neighborhood collective by demonstrating the stress-buffering effects among the vulnerable population.

Association Between Exposure to Suicidal Behaviors and Suicide Attempts Among Adolescents: The Moderating Role of Prior Psychiatric Disorders

Theories suggest that adolescents exposed to suicide attempts and/or deaths are at higher risk of attempting suicide, themselves. However, research findings have been mixed, with most studies not accounting for psychiatric vulnerability. We examined past psychiatric diagnosis as a moderator of the association between lifetime exposure to suicide attempts and/or deaths and adolescents' suicide attempts. Adolescents (N = 518; 60% female; 45% White), ages 12-21, reported on prior suicide ideation and attempts, and mood, anxiety, and substance use disorders at baseline. Suicide attempts since baseline and exposure to suicidal behaviors were assessed 4-6 years later. Lifetime exposure to family suicide attempts and/or suicide deaths, but not to suicidal behaviors of peers/friends or others, was associated with a suicide attempt at follow-up among those with prior psychiatric disorders. Psychologically vulnerable adolescents may require additional support after exposure to suicidal behaviors of a family member to reduce their risk of attempting suicide.

Suicidal behavior in the social environment: Does exposure moderate the relationship between an individual's own suicidal ideation and behavior?

INTRODUCTION

Suicidal behavior still cannot be sufficiently predicted. Exposure to suicidal behavior in the personal social environment is assumed to moderate the individual's transition from suicidal ideation to suicidal behavior within the Integrated Motivational-Volitional Model of Suicidal Behavior (IMV-model). This study aimed to investigate this moderating effect in a German high-risk sample.

METHODS

We interviewed 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.9, SD = 14.30) admitted after attempted suicide (53%) or due to an acute suicidal crisis (47%) regarding exposure events in their social environment. Four types of exposure events were analyzed using moderation analyses: familial suicides/suicide attempts, non-familial suicides/suicide attempts. Additionally, the numbers of reported exposure events were compared between patients with and without a recent suicide attempt as well as between patients with lifetime suicide attempts and lifetime suicidal ideation.

RESULTS

Neither moderating effects of exposure events on the relationship between lifetime suicidal ideation and recent suicidal behavior nor group differences between suicidal ideators and suicide attempters regarding the exposure events were found.

CONCLUSIONS

Exposure events might have differential and possibly protective effects on suicidal behavior - depending on type and quality (intensity, personal relevance, and recency) of event - and on the outcome (suicide vs. suicide attempt).

Problematic Internet use and the risk of suicide ideation in Chinese adolescents: A cross-sectional analysis

To evaluate the relationships between problematic Internet use (PIU) and suicidal ideation (SI) among adolescents, we encompassed 12,507 participants (16.6 ± 0.8 years). The occurrence of mood disorders, quality of life (QOL), personality traits and SI were compared in adolescents with and without PIU. Multilevel logistic regression models, trend analysis and interaction analysis were employed. A total of 2,809 (22.46%) adolescents reported SI. PIU was assessed using Internet Addiction Test score (IATs), and 3,442 (27.52%) participants met the criteria for PIU (IATs ≥ 40). PIU was significantly and independently associated with SI [AOR for suicidal ideation (vs. IATs < 40): 1.00 for 40-59 points; 1.3 (CI, 1.2-1.5): 60-79 points; 1.7 (CI, 1.4-2.1): 80-100 points; and 2.2 (CI, 1.2-3.9)]. Trend analysis demonstrated that PIU increased the risk of SI in each of the subgroups (p for trend ≤ 0.001 for each). Interaction analysis showed an association of PIU and SI that were dependent on mood disorders, QOL, impulsivity and aggression (p-value for interaction < 0.05). These findings highlight the need for a range of cross disciplinary health interventions to afflicted families, students, and clinicians, to increase the awareness of adverse PIU effects.

Relationship between Internet addiction, susceptible personality traits, and suicidal and self-harm ideation in Chinese adolescent students

BACKGROUND AND AIMS

Internet addiction (IA) is common among young students. This study aimed to examine the influence and mechanisms of IA and susceptible personality traits on the impact of suicidal ideation in adolescent students in China.

METHODS

This cross-sectional study (09/2012-09/2015) used stratified cluster sampling with "school type" for stratification; 136,266 students from 63 schools completed the questionnaire. Logistic regression analysis was performed to estimate the effect of IA (Young's Internet Addiction Test) and susceptible personality (Barratt impulsiveness scale, Buss & Perry Aggression Questionnaire; and Eysenck Personality Questionnaire-R Short Scale) on suicidal ideation (Scale of Suicidal Ideation).

RESULTS

Suicidal ideation was observed in 20,218 (14.77%) of the students, and IA was detected in 28,836 (21.16%) subjects. Compared with those without IA, students with IA had a higher prevalence of suicidal ideation (P < 0.0001). No planning impulsiveness had a predictive effect on suicidal ideation in the impulsive personality trait, while in the aggressive personality trait, hostility and self-aggression had a predictive effect on suicidal ideation (all P < 0.0001). High psychoticism and neuroticism were impact factors for suicidal ideation, but extroversion was a protective factor (all P < 0.0001).

DISCUSSION

These results highlight the importance of assessing personality traits and reducing IA as a possible means of lessening suicidal ideation. Susceptible personality (such as high psychoticism, high neuroticism, and low extroversion) play a prominent role in influencing the probability of having suicidal behavior among those recently exposed to IA.

CONCLUSIONS

IA and susceptible personality traits were significantly correlated with suicidal and self-harm ideation among adolescent students.

The relationships between mobile phone use and depressive symptoms, bodily pain, and daytime sleepiness in Hong Kong secondary school students

INTRODUCTION

Studies have found that increased mobile phone use (MPU) is associated with multiple health issues such as depression, disordered sleep and pain. However, the current situation and interrelationships of these problems remain unexplored in the Hong Kong population.

OBJECTIVES

This study aimed to understand the situation and problematic use of mobile phones by Hong Kong secondary school students and to investigate depressive symptoms, bodily pain and daytime sleepiness and the associations of these factors with MPU in Hong Kong secondary school students.

METHODS

This quantitative cross-sectional design study was based on self-administered questionnaires completed at five secondary schools. The questionnaire comprised five sections: MPU as measured by the Chinese version of the 10-Item Mobile Phone Problem Use Scale (CMPPUS-10); depressive symptoms according to the Depression Anxiety Stress Scale-21 Chinese Version (DASS-21); bodily pain according to the Brief Pain Inventory Short Form Chinese (BPISF-C); daytime sleepiness as measured using the Chinese version of the Epworth Sleepiness Scale (CESS) and socio-demographic questions.

RESULTS

A total of 686 students were recruited. The CMPPUS-10 score correlated positively with the average daily duration of MPU and the presence of depression, daytime sleepiness and bodily pain. Problematic mobile phone users received significantly higher scores for depression severity, bodily pain and daytime sleepiness. Health problems were significantly more severe in female than in male students. Bodily pain and daytime sleepiness mediated the relationship of MPU with depression.

CONCLUSIONS

Problematic MPU was associated with depression, bodily pain and daytime sleepiness. These findings will inform further studies of MPU-related health problems.

Self-Harm and Suicide Among Children and Adolescents in Hong Kong: A Review of Prevalence, Risk Factors, and Prevention Strategies

This paper reviews the prevalence, risk factors, and effectiveness of prevention programs for self-harm and suicide among children and adolescents in Hong Kong. Youth suicide rates declined gradually over the past two decades, but it is alarming to see that self-harm, suicidal thoughts, and attempts are quite common among junior secondary students. Local studies identify psychopathology (especially depression) and family relationship issues as the most common risk factors of suicide and self-harm, and impulsive control issues are an additional factor contributing to self-harm. In the second part, this paper reviews the evidence for six types of universal and selective prevention strategies identified from local and overseas literature: (1) restriction of access to means of suicide; (2) guidelines for responsible media reporting of suicides; (3) provision of quality mental healthcare to at-risk populations; (4) school-based screening and prevention programs; (5) online prevention, monitoring, and support programs; and (6) life skills training programs. Research evidence supports that the provision of high-quality mental health services to at-risk populations and some school-based prevention programs (awareness and screening, and gatekeeper training) are effective in suicide prevention. Further research efforts are needed to verify the impact of the other four strategies. Practitioners could make better use of new prevention programs through the internet and instant messaging platforms, which have the potential to alter attitude toward suicide and self-harm as well as promoting help seeking behavior among young people.

Association between personality traits and risk of suicidal ideation in Chinese university students: Analysis of the correlation among five personalities

The purpose of our study was to determine the incidence of suicidal ideation among Chinese college students and to explore the risk factors for suicidal ideation. A large-sample epidemiological survey was conducted in 13 colleges in Chongqing, China (n = 69,790). Suicidal ideation was reported by 13.03% of the college students who were surveyed. The participants with suicidal ideation were more likely to be female, to come from rural areas, and to have poor life quality and psychological disorder compared to those without suicidal ideation. Moreover, this study revealed that neuroticism, psychoticism, impulsivity, and aggression are risk factors for suicidal ideation, while extroversion has a protective effect on suicidal ideation. We found that four personality traits of students with suicidal ideation, including impulsivity, aggression, psychoticism, and neuroticism, are positively correlated. However, there is a negative correlation between extroversion and the other four traits. These findings highlight the need for further exploration of personality traits in the risk of suicidal ideation.

Youth Exposure to Suicide Attempts: Relative Impact on Personal Trauma Symptoms

INTRODUCTION

The purpose of this study is to report the prevalence of youth lifetime exposure to suicide attempts by people close to them, and its association with personal nonvictimization adversities, suicidal ideation, thoughts of self-harm, and trauma symptoms.

METHODS

Data were collected as part of the National Surveys of Children's Exposure to Violence, comprising three cross-sectional studies conducted in 2008, 2011, and 2014 in the U.S. assessing the experiences of children ages 1 month to 17 years. The current analyses utilized the self-report data from youth, ages 10-17 years (n=6,366), and was analyzed in 2017.

RESULTS

Twelve percent (n=779) of youth said someone close to them had tried to kill themselves. Exposure varied by age: 4% of youth aged 10-12 years, 13% of youth aged 13-15 years, and 21% of youth aged 16-17 years reported such exposure. Exposure to suicide attempts also varied by sex with 8% of males and 16% of females reporting this experience. After adjusting for the total number of other types of adversity experienced, the association between exposure to suicide attempts and trauma symptoms (β=0.5, 95% CI=0.3, 0.7, p≤0.001); suicidal ideation (OR=2.4, 95% CI=1.4, 4.1, p≤0.001); and thoughts of self-harm (OR=3.1, 95% CI=1.9, 5.1, p≤0.001) remained significant, although attenuated.

CONCLUSIONS

Study findings that youth exposure to suicidal behavior is associated with negative emotional distress, and that it often co-occurs with other adversities and social risk factors, highlight the need to better understand the causal pathways among these risk factors to improve youth suicide prevention and response interventions.

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.

Psychological distress and risk for suicidal behavior among university students in contemporary China

BACKGROUND

Psychological distress and suicidal behavior are important mental health problems among university students and warrant research to inform strategies for effective prevention in this young population. The present study aimed to assess psychological distress and suicidal behavior and to unravel their associations among university students.

METHODS

A total of 5972 undergraduate students, randomly selected from six universities in central China, comprised the sample. The Chinese version of the Symptom Checklist-90-revised (SCL-90-R) was used to assess various psychological symptoms. Logistic regression analysis was used to examine the relationship between psychological distress and risk for suicidal behavior.

RESULTS

40.7% of the university students reported positive in a least one of the 9 psychological symptom dimensions assessed by the SCL-90-R. 7.6% of the students reported suicidal behavior in the previous twelve months. The risk of suicidal behavior was significantly associated with psychological symptoms of all types, but there were notable differences by sex. For male students, depression and phobic anxiety increased the risk of suicidal behavior. Meanwhile, depression and obsessive-compulsiveness were positively associated with suicidal behavior in female students. Furthermore, increasing risk of suicidal behavior was associated with increasing positive symptom total (PST) score and a statistically significant trend was observed.

LIMITATIONS

Data collected from a cross-sectional survey does not allow any examination of causal inference.

CONCLUSIONS

Psychological distress and suicidal behavior were both common among university students; and psychological distress was highly associated with suicidal behavior. The findings underscore the importance of mental health care for university students.

Estimating Incidence Rate of Hospital-Treated Self-Harm in Hong Kong Using Capture-Recapture Approach

BACKGROUND

A surveillance system for self-harm has not been established in Hong Kong. The existing data source has an unknown degree of underreporting, and therefore a capture-recapture method has been proposed to correct for the incompleteness.

AIMS

To assess the underestimation of the incidence of self-harm cases presenting to hospital in Hong Kong using a capture and recapture method.

METHOD

Two different yet overlapping hospital administrative datasets of self-harm were obtained from all public hospitals in Hong Kong. From 2002 to 2011, 59,473 distinct episodes involving 36,411 patients were identified. A capture-recapture model considering heterogeneous capture probabilities was applied to estimate the number of self-harm episodes.

RESULTS

The estimated number of self-harm incidence was 79,923, equally shared by females and males. Cases of self-harm by females were more likely to be ascertained than those by males. The estimated annual incidence rate of self-harm in Hong Kong from 2002 to 2011 ranged from 96.4 in 2010 to 132.7 in 2002.

LIMITATIONS

The proposed method does not include patients who required no medical attention and those where the patient consulted private doctors.

CONCLUSION

The capture-recapture model is a useful method for adjusting the underestimation of self-harm cases from existing databases when surveillance system is not available and to reveal some hidden patterns.

Mental Health Symptomatology and Exposure to Non-Fatal Suicidal Behavior: Factors That Predict Vulnerability and Resilience Among College Students

Despite efforts to identify risk factors following exposure to completed suicide, research has paid less attention to the associations between exposure to non-fatal suicide behavior (NFSB) and mental health symptomatology-factors that may underlie one's susceptibility to future suicidal thoughts and behaviors. This study examined differences in mental health symptomatology among 192 college students exposed to NFSB and 202 exposed to general stressors. Results indicated that students exposed to NFSB had significantly higher levels of depression and anxiety compared to those exposed to a variety of other stressors but not NFSB. Furthermore, among those exposed, a number of risk and protective factors emerged in relation to psychological sequelae, such as emotional stability, social support, and the quality of the relationship between the exposed and suicidal individual. These findings highlight the importance of enhancing provisions of support for those exposed to NFSB.

Is Exposure to Suicide Beyond Kin Associated with Risk for Suicidal Behavior? A Systematic Review of the Evidence

Suicide bereavement and postvention literature often espouses risk for subsequent suicidal behavior among those previously exposed to a suicide death. Most often risk is discussed in relation to kin; however, many more individuals are exposed to suicide, and the impact of this exposure is important to understand in relation to targeting postvention. This review examined the research literature (1990-2014) to determine the evidence base for risk among those exposed to suicide. The findings demonstrate that risk of suicidal behaviors among those exposed to the suicide is significantly higher than those unexposed. These results are discussed within the context of current research in the field of postvention, and suggestions for future research are suggested.

Prevalence of exposure to suicide: A meta-analysis of population-based studies

Those exposed to suicide are at increased risk of adverse outcomes including mental illness, impaired social functioning, and fatal and non-fatal suicidal behavior. However, it is unclear how many people are exposed to suicide in the general community. This first meta-analysis of population-based studies aimed to provide pooled estimates of past-year and lifetime prevalence of exposure to suicide among family, friends/peers, and all relationships. In addition, the study examined prevalence of exposure to suicide by age group: adolescents and adults. Systematic searches of the literature in Embase, Medline and PsycINFO identified eighteen studies that were included in the analysis. Pooled past-year prevalence was 4.31% (CI: 2.50 to 6.58) and life-time prevalence 21.83% (CI: 16.32 to 27.90). Both past-year and lifetime prevalences of exposure to suicide among friends and peers were significantly higher than the prevalence of exposure within families; there were no differences in the prevalence of exposure to suicide between adolescents and adults. Heterogeneity was highly significant. Future research should be conducted with large national representative samples and use standardised assessment instruments. Given the increased risks of adverse outcomes among those exposed to suicide, the high rate of exposure to suicide reported here has important ramifications for public health and mental health service delivery.

Exposure to suicidal behaviors: A common suicide risk factor or a personal negative life event?

BACKGROUND

Numerous suicide risk factors have been proposed but not adequately validated for epidemiology, treatment and prevention efforts.

AIMS

Exposures to suicidal behaviors (ESB), from family and friend suicide attempts and completions, were tested for validity as a suicidal risk factor and also for measurement and construct adequacy.

METHODS

An anonymous online survey yielded 713 participants (aged 18-71), who reported ESB, completed the Suicidal Affect-Behavior-Cognition Scale (SABCS), and comprised a broad spectrum on those variables.

RESULTS

Tests of dimensionality and internal consistency showed the four ESB variables (attempts/completions through family/friends) were independent and did not form a common factor or an identifiable ESB latent trait. ESB variables were, however, associated with demographic and psychiatric histories. A battery of tests revealed no meaningful associations between ESB and total suicidality or suicide risk factors (social support, depression, anxiety, stress, satisfaction with life and emotional stability). In addition, in contrast to previous reports, young adults ( n = 200; aged 18-20) showed no increased suicidality due to ESB.

CONCLUSION

Results showed no validity for ESB as a common risk factor for suicidality or other psychopathology, or as a latent trait. ESB showed evidence as a personal negative life event with individual effects and interpretations.

Spatiotemporal study of elderly suicide in Korea by age cohort

OBJECTIVES

This study analyzed the spatiotemporal pattern and spatial diffusion of elderly suicide by age cohort, in Korea.

STUDY DESIGN

The research investigated the elderly suicide rates of the 232 municipal units in South Korea between 2001 and 2011.

METHODS

The Gi* score, which is a spatially weighted indicator of area attributes, was used to identify hot spots and the spatiotemporal pattern of elderly suicide in the nation during the last 10 years. The spatial Markov matrix and spatial dynamic panel data model were employed to identify and estimate the diffusion effect.

RESULTS

The suicide rate among elderly individuals 75 years and older was substantially higher than the rate for those between 65 and 74 years of age; however, the spatial patterns of the suicide clusters were similar between the two groups. From 2001 to 2011, the spatial distribution of elderly suicide hot spots differed each year. For both age cohorts, elderly suicide hot spots developed around the north area of South Korea in 2001 and moved to the mid-east area and the mid-western coastal area over 10 years. The spatial Markov matrix indicates that the change in the suicide rate of one area was affected by the suicide rates of neighbouring areas from the previous year, which suggests that suicide increase in one area inflates a neighbouring area's suicide rate over time. Using a spatial dynamic panel data model, elderly suicide diffusion effects were found to be statistically significant for both age cohorts even after economic and demographic indicators and a time variable are included. For individuals 75 years and older, the diffusion effect appeared to be larger.

CONCLUSIONS

This study demonstrates that elderly suicide can spread spatially over time in both age cohorts. Thus, it is necessary to design a place-based and age-differentiated intervention policy that precisely considers the spatial diffusion of elderly suicide.

Rising youth suicide and the changing cultural context in South Korea

BACKGROUND

South Korean society faces a serious challenge in the increasing rates of youth suicidal behavior. There is a need both to gain a better understanding of the causes of this behavior and to develop strategies for responding to this critical public health issue.

AIMS

This article analyzes how psychological, sociopsychological, and subcultural factors influence suicidal proneness among Korean youth as well as makes suggestions for developing social policies that could reduce Korean youth suicidal behaviors.

METHOD

Correlation and multivariate regression analyses on suicide proneness and depression were employed using a sample of 172 South Korean youths (aged 18-24) selected from the 2009 General Social Survey collected through face-to-face interviews.

RESULTS

Young people's suicidal proneness is associated with depression, a tolerant attitude toward suicide, strained family relations, living in rural areas, being female, and being closely related to survivors of suicide or potential suicides.

CONCLUSION

The findings from this study reveal the significance of social and cultural factors as influences on recent youth suicidal behavior in Korea. The analysis suggests that the underlying risk factors of suicidal behavior are embedded in the changing social and cultural context of Korean society. Thus, suicide prevention efforts should involve more than merely treating any underlying psychiatric disorders.

Influence of personal social network and coping skills on risk for suicidal ideation in Chinese university students

BACKGROUND

Personal social network and coping skills have important influences on suicidality of young people and such influences must be understood in the context of other factors. This study aims to assess the influences of social contacts and coping skills on risk for suicidal ideation and to disentangle their possible pathways using a large sample of university students from China.

METHODS

5972 students, randomly selected from 6 universities in China, completed the questionnaire survey for the study. Logistic regression was performed to estimate individual effect of social contacts and coping skills on risk for suicidal ideation. A partial least squares path model (PLSPM) was used to probe possible paths of their effects in the context of psychopathology.

RESULTS

Of the 5972 students, 16.39% reported the presence of suicidal ideation. Poor social contacts were significantly associated with an increased risk for suicidal ideation. The influence of coping skills varied by coping styles adapted toward problems. A high score of skills on seeking guidance and support, problem solving as well as seeking alternative rewards was associated with a reduced risk of suicidal ideation; whereas a high score of acceptance or resignation, emotional discharge as well as logical analysis was associated with a significantly increased risk. Modeling the data with PLSPM indicated that the avoidance coping skills conferred the most important dimensional variable in suicidal ideation prediction, followed by the approach coping skills and social network.

CONCLUSIONS

Poor social contacts and deficient coping skills are strong risk factors for suicidal ideation in young students. Prevention program focusing on these problems may have an enduring effect on reducing suicidal behavior in this population.

Clinical characteristics and precipitating factors of adolescent suicide attempters admitted for psychiatric inpatient care in South Korea

OBJECTIVE

We aimed to examine the rates, correlates, methods, and precipitating factors of suicide attempts among adolescent patients admitted for psychiatric inpatient care from 1999 to 2010 in a university hospital in Korea.

METHODS

The subjects consisted of 728 patients who were admitted for psychiatric inpatient care in a university hospital over a 12-year period and who were aged 10-19 years at the time of admission. We retrospectively investigated the information on suicidal behaviors and other clinical information by reviewing the subjects' electronic medical records. Whether these patients had completed their suicide on 31 December 2010 was determined by a link to the database of the National Statistical Office.

RESULTS

Among 728 subjects, 21.7% had suicidal ideation at admission, and 10.7% admitted for suicidal attempts. Female gender, divorced/widowed parents, and the presence of mood disorders were associated with a significantly increased likelihood of suicide attempts. Most common method of suicide attempts was cutting, and most common reason for suicide attempts was relationship problems within the primary support group. A diagnosis of schizophrenia was associated with increased risk of death by suicide after discharge.

CONCLUSION

These results highlight the role of specific psychosocial factor (e.g., relational problems) and psychiatric disorders (e.g., mood disorders) in the suicide attempts of Korean adolescents, and the need for effective prevention strategies for adolescents at risk for suicide.

Suicide ideation, psychological adjustment and mental health service support: A screening study in an Irish secondary school sample

Objective: The aim of this exploratory study was to investigate the extent of suicide ideation, psychological maladjustment and views of mental health service support in a sample of secondary school pupils.

Method: A cross-sectional survey was conducted on a purposive sample of participants (n=93) recruited from a secondary school located in the south east of Ireland. Participants completed a Background Information Questionnaire (BIQ); the Suicide Ideation Questionnaire (SIQ); and the Reynolds Adolescence Adjustment Screening Inventory (RAASI).

Results: Approximately ten percent of participants displayed high levels of suicide ideation whilst one third reported having previously had suicidal thoughts; one quarter reported psychological adjustment difficulties, although these varied by age and sex. Participants' drug use and their levels of parental closeness were both individual factors that significantly predicted both suicide ideation and psychological adjustment. Females reported higher levels of parental closeness than males. Forty percent of respondents rated mental health support services as insufficient to meet their needs.

Conclusion: The findings raise serious concerns about the extent of suicidal thoughts amongst young people in Ireland; they also highlight a potentially important role for parents in this regard. Further research should ascertain national prevalence rates whilst appropriate school-based mental health education/promotion and support services should also be implemented.

Effects of suicide bereavement on mental health and suicide risk

Between 48 million and 500 million people are thought to experience suicide bereavement every year. Over the past decade, increased policy attention has been directed towards suicide bereavement, but with little evidence to describe the effect of exposure or to provide appropriate responses. We used a systematic approach to carry out a narrative review of studies of the effect of suicide bereavement on mortality, mental health, and social functioning, and compared them with effects from other bereavements. We found 57 studies that satisfied strict inclusion criteria. Results from these studies suggested that exposure to suicide of a close contact is associated with several negative health and social outcomes, depending on an individual's relationship to the deceased. These effects included an increased risk of suicide in partners bereaved by suicide, increased risk of required admission to psychiatric care for parents bereaved by the suicide of an offspring, increased risk of suicide in mothers bereaved by an adult child's suicide, and increased risk of depression in offspring bereaved by the suicide of a parent. Some evidence was shown for increased rejection and shame in people bereaved by suicide across a range of kinship groups when data were compared with reports of relatives bereaved by other violent deaths. Policy recommendations for support services after suicide bereavement heavily rely on the voluntary sector with little input from psychiatric services to address described risks. Policymakers should consider how to strengthen health and social care resources for people who have been bereaved by suicide to prevent avoidable mortality and distress.

Differences between non-suicidal self injury and suicide attempt in Chinese adolescents

PURPOSE

Self-harm behaviors are predominant health risks among adolescents. This study aimed to elucidate the lifetime prevalence and differences in social psychological factors between non-suicidal self-injury (NSSI) and suicide attempt (SA) among Chinese adolescents.

METHOD

Data were collected from 2131 middle school students with a mean age of 13.92 (SD 1.63) years (49.1% girls). Participants were asked to self-report NSSI and SA over their lifetime. Post hoc tests pairwise comparisons and multinomial logistic regression analyses were conducted to investigate differences and similarities between subjects with NSSI and attempted suicide.

RESULTS

The prevalence of lifetime NSSI and SA endorsed by the participants were 23.2% and 3.2%, respectively, and the co-occurrence of these two behaviors (NSSI+SA) was reported to 2.3%. Boys were comparable with girls in the prevalence rate of NSSI, but not in the rate of SA. It revealed that single-child was not the risk factor for self-harm behavior in Mainland China, but lower higher family cohesion and adaptability. Factors that distinguished the NSSI+SA group from the NSSI only group were female gender, lower grade, impulsivity, health risk behaviors and family cohesion. Being female gender, single-parent family, depressive symptoms and impulsivity were factors differentiating attempted suicide from NSSI.

CONCLUSIONS

Our findings suggest that Chinese adolescents engaging both in NSSI and SA had severe suicidal attempts and were different from those who engaged in NSSI alone.

The impact of exposure to peer suicidal self-directed violence on youth suicidal behavior: a critical review of the literature

There is considerable evidence that being exposed to the suicide or suicidal behavior of another can increase the risk for suicide. Significant relationships between media coverage and youth suicide have been documented in the professional literature. Exposure to familial suicidal behavior has also been established as a risk factor for youth suicidal behavior; However, peer suicide exposure is not as clear cut as research results in this area have been mixed. In the current paper the empirical literature focused on the associations between exposure to peer suicides and suicide attempts and youth suicidal behavior is critically reviewed. Effect sizes were computed for each of the 23 studies included in the review to allow for cross-study comparisons. The results demonstrate that having a friend or acquaintance attempt suicide is significantly related to risk for suicidal thoughts and behavior. However, the support for the relationship between the suicide of a peer and youth suicidal behavior was less consistent. Implications for clinical practice and suicide postvention as well as areas of future research are discussed.

Exposure to suicide and suicidality in Korea: differential effects across men and women?

BACKGROUND

Little is known about whether exposure to suicide within close social networks is associated with the suicidality in exposed individuals, and potential gender differences regarding this association.

AIMS

This study examines the effect of exposure to suicide on the suicidality in exposed individuals.

METHODS

The data were drawn from the 2009 Korean General Social Survey, a nationally representative interview survey. Suicidality was measured by the suicidality module in the Mini International Neuropsychiatric Interview (MINI), with exposure to suicide being determined by asking about the experience of a failed or completed suicide attempt by a closely related person.

RESULTS

Exposure to the suicide of someone close was significantly associated with higher suicidality in exposed individuals. While the effect of a failed attempt became non-significant after controlling for psychological factors, that of exposure to a completed act of suicide remained significant. A subsample analysis by gender indicated a significant gender difference: with control for demographic and psychological factors, exposure to a completed suicide had a significant effect on the suicidality of females only. The effect of exposure to a failed attempt became non-significant both in males and females after controlling for other factors.

CONCLUSIONS

Findings suggest the necessity of screening for prior exposure to suicide in suicide risk assessment and the need for gender-tailored suicide-prevention strategies.

Self-injurious behavior and suicide attempts among Indonesian college students

This study reports the prevalence of self-injurious behavior and suicide attempts among college students in Indonesia and examines risk factors distinguishing between 3 groups: self-injury with suicide attempt, non-suicidal self-injury, and non-self-injury. Self-report questionnaires measuring self-injury and suicide attempts, negative mood regulation expectancies (NMRE), depression, and childhood trauma were administered to 314 students. Of participants, 38% had deliberately injured themselves; among those, 21% also reported a suicide attempt. The 3 groups differed significantly on NMRE, depression, and child neglect. More self-injury and suicide attempts were associated with weaker NMRE and greater depression and child neglect.

Changes in and Challenges for Intentional Injury in Vietnam

Objective. To describe the current situation of intentional injury among Vietnamese youth as well as risk and protective factors. Method. The Sample of Survey Assessment of Vietnamese Youth 2009 (SAVY2) involving 10 044 youth aged 14 to 25 in 2009 was used and compared with SAVY1 in this study. The data were analyzed using bivariate and multivariate statistical techniques. Results. Of the sample in 2009, 3% of the young people reported that they had been injured by a family member. The proportion who were intentionally injured by others outside their home was 7.6%. Youth who were most likely to hurt others included urban males, those who had ever been drunk, those who had been intentionally injured by others, and those who had weak family connectedness. Having suicidal thoughts (both sexes) is related to alcohol consumption. Conclusions. The rate of violent behaviors was low, but several risk and protective factors were found and confirmed.

Risk factors related to suicidal ideation and attempted suicide: comparative study of Korean and American youth

Suicidal trends and related characteristics such as sociodemographic factors, psychological factors, and health behaviors can differ between countries. This study investigated the predictors of suicidal ideation and attempted suicide including health behaviors among American and Korean youth from two national representative data sets. In both countries, depression was the most predominant predictor to suicidal ideation and attempted suicide. Unique predictors of suicidal youth in each country were also found. In America, attempted suicide was predicted by poor body image, whereas in Korea attempted suicide was predicted by medical diagnosis such as asthma, concern about weight, and alcohol consumption. The value of our approach lies in the comparative analysis of analogous and unique characteristics of suicidal youths in these two huge data sets from different countries. These results should be helpful for school and mental health care providers to plan interventions for youth at risk of suicide to prevent suicidal completion in these nations.

Relationships among mental health, self-esteem and physical health in Chinese adolescents: an exploratory study

This study explored the relationships among mental health, self-esteem and physical health in Hong Kong Chinese adolescents. Chinese students (N = 1945) between the ages of 12 and 19 from four secondary schools of different regions were invited to participate in the study. This study revealed that a significant number of adolescents in Hong Kong are experiencing depressive symptoms. The overall results indicated that self-esteem of adolescents was correlated to and a predictor of their physical and mental health. Health care professionals should take a more assertive role in promoting relevant health education to the community with emphasis on helping adolescents develop positive self-esteem.

Effect of exposure to suicidal behavior on suicide attempt in a high-risk sample of offspring of depressed parents

OBJECTIVE

Exposure to suicidal behavior in peers and relatives is thought to increase risk for suicidal behavior in vulnerable individuals, possibly as a result of imitation or modeling. This study examines exposure to suicidal behavior and likelihood of suicide attempt in a high-risk cohort of offspring of a depressed parent.

METHOD

A total of 449 offspring of 255 probands with a mood disorder were enrolled in a family study. Probands and offspring were assessed for psychopathology and suicide attempt history, and offspring for suicide exposure. Generalized estimating equations (GEE) and generalized least squares models were used to compare suicide attempt history in exposed and nonexposed offspring as well as characteristics of exposure in exposed offspring suicide attempters and exposed nonattempters. GEE was used to compare exposure occurring before first attempt in attempter offspring and exposure occurring before the same age in matched nonattempter offspring.

RESULTS

Offspring reporting exposure to suicidal behavior were four times more likely to report a lifetime suicide attempt compared with unexposed offspring, controlling for age. Suicide attempt status was not associated with age at first exposure, total number or degree (attempt or threat) of exposures, or relationship. Analysis of exposure occurring before age at first suicide attempt found no association between exposure and suicide attempt.

CONCLUSIONS

Offspring exposed to suicidal behavior are more likely to report a lifetime suicide attempt than nonexposed offspring. However, when examining the temporal sequence of exposure and attempt, the association is no longer significant, suggesting that imitation is not sufficient explanation.

Suicidality in Chinese adolescents in Hong Kong: the role of family and cultural influences

BACKGROUND

Adolescent suicidal ideation has found to predict suicidal behaviors and psychopathology in adulthood. Previous studies focused solely on the medical and environmental risk factors, which were insufficient to give a holistic picture of adolescent suicidality.

OBJECTIVES

To assess the role of affective and cognitive attributes in the identification and prevention of adolescent suicidal ideation.

METHOD

A community sample of 511 participants (age 15-19 years) were asked to indicate their suicidality in the 12 months and in their lifetime. Generalized estimating equation regression models were used to examine the effect of psychosocial and socio-environmental correlates in relation to adolescent suicidal ideation.

RESULTS

The data show that perceived responsibilities for family was the only protective factor, while a coping mechanism by behavioral disengagement, severity of depressive symptoms, a history of deliberate self-harm, chronic physical illness or pain, media reporting of suicide news, and low household income were the risk factors for adolescent suicidal ideation.

CONCLUSIONS

The results suggest that a multilayer effort for preventing adolescent suicide is needed by providing support for children in deprived families; enhancing life skills in the teens; strengthening family relationship; improving mental and health services; and promoting responsible media reporting on suicide.

Perfectionism, Depression, Loneliness, and Life Satisfaction

This study investigates the cross-cultural construct validity of perfectionism using the Chinese translation of the Almost Perfect Scale—Revised (APS-R; Slaney, Mobley, Trippi, Ashby, & Johnson, 1996) with 509 Chinese high school students from Hong Kong. The factor structure of the Chinese APS-R and correlations between the APS-R subscales and measures of Depression, Satisfaction with Life, and Loneliness are examined. Participants are grouped into three clusters—adaptive and maladaptive perfectionists and nonperfectionists. A comparison of group means revealed that adaptive perfectionists reported higher Satisfaction with Life scores and lower Depression scores than the other two groups. This sample of Chinese students also reported higher Discrepancy scores compared to U.S. students' scores in previous studies. Similarities and differences in comparison to previous studies using U.S. participants are examined. Finally, the limitations of this study and implications for future research with Chinese participants are discussed.

Factor structure of the Center for Epidemiological Studies Depression Scale in Hong Kong adolescents

We present data from the Center for Epidemiological Studies-Depression Scale (CES-D; Radloff, 1977) for 2 samples of Hong Kong community adolescents (combined N = 1,385). The 4 positive affect items related poorly to the remainder of the scale. Using 16 items, the data were consistent with 2 models with highly correlated factors: (a) a 2-factor model, 1 of which merged somatic and affective items, and (b) a 3-factor model separating somatic, depressed, and interpersonal items. Correlations with related constructs provide preliminary support of validity. Hong Kong adolescents are influenced both by traditional concepts of mind-body holism and Western psychological models separating psychological and somatic symptoms.

Impact of modeling on adolescent suicidal behavior

The evidence to date suggests that suicide modeling is a real phenomenon, although of a smaller effect size than other psychiatric and psychosocial risk factors for adolescent suicide. Multiple lines of inquiry provide converging evidence, including studies on suicide clusters, media influence on suicide (particularly coverage of nonfictional suicides), and peer influence on suicidality. Despite variations in study setting and methodology, the body of literature is consistent with a modeling hypothesis. Although advances in documentation of suicide modeling have been made over the past decade, we are still confronted by unresolved issues regarding the underlying mechanisms. Prevention and postvention strategies can be optimized to avert modeling of suicidal behavior only once research addresses the complexities and uncertainties of this phenomenon.

CORRELATES OF SUICIDE RISK AMONG SECONDARY SCHOOL STUDENTS IN CAPE TOWN

The aim of this study was to assess correlates of suicide risk in a South African school-based population (N = 1,157) from three secondary schools in Cape Town. Results indicated that using the Suicide Risk Screen (SRS; Eggert, Herting, & Thompson, 1995) a high rate of learners screened in at possible suicide risk (31.6%). Anger control problems, low self-esteem, perceived stress and unmet school goals were identified as predictors for suicide risk, while gender, age, drug involvement (alcohol and drug use, drug control problems and adverse consequences from alcohol and drug abuse), parental alcohol and/or drug abuse problems, perceived school performance, serious conflicts and tension with parents and unmet family goals were not associated with suicide risk.

Repeat suicide attempts in Hong Kong community adolescents

It has been well documented that a history of suicide attempts confers risk for subsequent attempts; however, efforts to explain how variables may change after a previous attempt and in turn relate to future suicide attempts are rare in the literature. This study presents longitudinal data on adolescent suicide attempts in Hong Kong, and examines whether the data support the "crescendo" model to explain repeat suicide attempts. One thousand and ninety-nine community adolescents aged 12-18 years were evaluated at two assessment points 12 months apart (T1 and T2). The study assessed (1) risk factors at T1 for a suicide attempt between T1 and T2, (2) whether a suicide attempt during the 12 months prior to T1 predicted an attempt between the two assessment points, and (3) whether the indicators of distress worsened from T1 to T2 if an attempt had taken place in the interim. The results indicated that: (1) depressive symptoms, substance use, and suicidal ideation measured at T1 were independent predictors of a suicide attempt between T1 and T2; (2) suicide attempt in the year prior to T1 predicted suicide attempt between T1 and T2 after controlling for other predictors; and (3) suicide attempt between T1 and T2 was a predictive factor for a negative change from T1 to T2 in substance use, suicidal ideation, family relationships, depression, anxiety, and life stress. These findings are consistent with the "crescendo" model proposing that the risk of repeat attempts is enhanced following a previous suicide attempt.

Depression moderated the effect of exposure to suicide news on suicidality among college students in Taiwan

The present study was designed to examine whether age, gender, and depression level may moderate the effect of exposure to suicide news on the suicidality of college students in Taiwan. A representative sample of 3,222 college students were recruited from Southern Taiwan with a total of 2,602 useable surveys returned. Results showed that only depression level reached a significant moderating effect and further examination showed that the exposure to suicide news significantly predicted suicidality solely in the severely depressed group.

Risk factors associated with suicide attempts and other self-injury among Hong Kong adolescents

This study examined 1,361 Chinese adolescents who reported self-injurious behaviors. Groups A and B both acknowledged deliberate self-injury, but only Group A had made a suicide attempt. Group C reported accidental self-injury. Deliberate self-injurers (Groups A and B) were more frequently girls, older, and with more suicidal ideation. Group A had more psychopathology, environmental and suicide-related risk factors than group B and C. Group C had higher depressive symptoms than noninjured controls. The study clarifies differences among self-injurious behavior groups based on expressed deliberate self-injury and self-reported suicide attempt. These three groups appear to present a continuum of risk.

[Experience of parent-related negative life events, mental health, and delinquent behavior among Korean adolescents]

OBJECTIVES

This study examined the relationship of parent-related negative life events with mental health and delinquent behaviors among Korean adolescents.

METHODS

A total of 2,976 high school first-grade pupils (1,498 boys & 1,478 girls) taking part in the third wave of Korean Youth Panel Survey completed a self-administered questionnaire regarding parent-related life events, depressive feelings, suicidal ideation, delinquent behaviors, demographic characteristics, parental socioeconomic status, social support, and social capital. Data analyses were conducted using multivariate logistic regression.

RESULTS

After adjusting for all covariates, the more parent-related negative life events adolescents experienced throughout their whole life, the more likely adolescent were to have mental and behavioral problems. A significant dose-response relationship between them was more clearly observed in girls than in boys. The experience of parent-related negative events during childhood was significantly associated with suicidal ideation and delinquent behaviors for boys, and with depressive feelings for girls during adolescence. Indeed, parental social support, social capital, and having a close friend with delinquent behaviors, especially for girls, partially mediated the relationship between parent-related negative life events and both outcomes.

CONCLUSIONS

The study showed a clear dose-response relationship of frequency of parent-related negative life events with poor mental and behavioral health for both genders. The residual effect of being exposed to parent-related events during childhood on mental health and delinquent behaviors during adolescence still remained.

Deliberate self-harm in adolescents

PURPOSE OF REVIEW

To review literature on young people who deliberately harmed themselves that was published between March 2005 and December 2006 in English language journals.

RECENT FINDINGS

Recent follow-up studies have confirmed that deliberate self-harm at a young age is an important indication of mental health problems in later life, including a strongly increased risk of subsequent suicidal behavior. Main recent research includes study of risk factors and predictors of deliberate self-harm, and continuing study of the effects of pharmacological treatment, in particular selective serotonin reuptake inhibitors, in children and adolescents.

SUMMARY

Recent findings regarding risk factors of adolescent deliberate self-harm confirm the importance of depressive disorders, deficient problem solving, exposure to suicidal behavior and familial characteristics. More biological studies of young people are required to provide evidence regarding neurobiological correlates of risk factors of suicidality in young people. The association between the use of antidepressants in depressed children and adolescents and the emergence of suicidal behavior continues to be a matter of debate due to the conflicting evidence from ecological or observational studies and meta-analyses. Although psychotherapeutic approaches have been examined less extensively, the results regarding cognitive behavior therapy in depressed and suicidal young people are clearly positive. Measures to prevent suicidal behavior in young people require further research.