Trajectories of suicide attempts from early adolescence to emerging adulthood: prospective 11-year follow-up of a Canadian cohort

Childhood maltreatment, peer victimization, borderline personality feature, suicidal risk in adolescents: Direct and indirect associations among developmental trajectories

INTRODUCTION

Childhood maltreatment, peer victimization, and borderline personality traits have all been shown to be linked to suicidal risk. However, there remains a need to illuminate the possible direct and indirect pathways among them from a developmental perspective that could serve as intervention targets. This study thus aimed to investigate the direct and indirect relationships among developmental trajectories of childhood maltreatment, peer victimization, borderline personality feature, and suicidal risk in adolescents.

METHODS

A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69; SD = 0.82) in junior middle schools completed self-report measures on three-time points across 1 year. Latent growth curve modeling was used to evaluate the direct and indirect relationships among the developmental trajectories of the aforementioned study variables.

RESULTS

The developmental trajectories of childhood maltreatment, peer victimization, and borderline personality feature were positively and directly related to the developmental trajectory of suicidal risk; and the developmental trajectories of childhood maltreatment, peer victimization were indirectly related to the developmental trajectory of suicidal risk through the mediating effect of the developmental trajectory of borderline personality feature.

CONCLUSIONS

The findings elucidated the direct and indirect longitudinal relationships among childhood maltreatment, peer victimization, borderline personality feature, and suicidal risk, highlighting that interventions should target childhood maltreatment, peer victimization, and borderline personality feature to decrease suicidal risk in adolescents with a developmental perspective.

Suicide attempts and non-suicidal self-injury in Chinese adolescents: Predictive models using a neural network model

INTRODUCTION

Suicide attempts (SA) are a significant contributor to suicide deaths, and non-suicidal self-injury (NSSI) can increase the risk of SA. Many adolescents experience both NSSI and SA, which are affected by various factors. This study aimed to identify the risk factors and essential warning signs of SA, establish a predictive model for SA using multiple dimensions and large samples, and provide a multidimensional perspective for clinical diagnosis and intervention.

METHODS

A total of 9140 participants aged 12-18 years participated in an online survey; 6959 participants were included in the statistical analysis. A multilayer perceptron algorithm was used to establish a prediction model for adolescent SA (with or without); adolescents with NSSI behavior were extracted as a subgroup to establish a prediction model.

RESULTS

Both the prediction model performance of the SA group and the NSSI-SA subgroup were strong, with high accuracy, and AUC values of 0.93 and 0.88, indicating good discrimination. Decision curve analysis (DCA) demonstrated that the clinical intervention value of the prediction results was high and that the clinical intervention benefits of the NSSI-SA subgroup were greater than those of the SA group.

CONCLUSIONS

Our study demonstrated that the predictive model has a high degree of accuracy and discrimination, thereby identifying significant factors associated with adolescent SA. As long as adolescents exhibit NSSI behavior, relative suicide interventions should be implemented to prevent future hazards. This study can provide guidance and more nuanced insights for clinical diagnosis as well as a foundation for clinical treatment.

Developmental pathways from insomnia to suicidality: A resilience perspective

BACKGROUND

Insomnia has been identified as a potential risk factor for suicidality. However, to date, few studies using the longitudinal-design have examined the underlying mechanism of this relationship. Based on a resilience perspective, this study aimed to investigate the dynamic longitudinal relationships between insomnia, resilience, and suicidality.

METHODS

A total of 5785 freshmen were sampled from a large-scale health-related cohort among Chinese college students. This study spanned six waves, covering the period from 2020 to 2022. Data from T1 to T4 were used because resilience was not measured at baseline (T0) and T5. The cross-lagged panel models and the latent growth curve mediation model were used to examine the longitudinal dynamic relationships between insomnia, resilience, and suicidality.

RESULTS

The results showed that insomnia symptoms and suicidality mutually predicted each other, and resilience played a longitudinal mediating role in linking insomnia symptoms and suicidality.

CONCLUSIONS

Given that resilience served as a mediator in the relation between insomnia symptoms and suicidality, some resilience-oriented prevention and intervention programs will be helpful in reducing the risk of suicide among university students.

Unveiling Adolescent Suicidality: Holistic Analysis of Protective and Risk Factors Using Multiple Machine Learning Algorithms

Adolescent suicide attempts are on the rise, presenting a significant public health concern. Recent research aimed at improving risk assessment for adolescent suicide attempts has turned to machine learning. But no studies to date have examined the performance of stacked ensemble algorithms, which are more suitable for low-prevalence conditions. The existing machine learning-based research also lacks population-representative samples, overlooks protective factors and their interplay with risk factors, and neglects established theories on suicidal behavior in favor of purely algorithmic risk estimation. The present study overcomes these shortcomings by comparing the performance of a stacked ensemble algorithm with a diverse set of algorithms, performing a holistic item analysis to identify both risk and protective factors on a comprehensive data, and addressing the compatibility of these factors with two competing theories of suicide, namely, The Interpersonal Theory of Suicide and The Strain Theory of Suicide. A population-representative dataset of 173,664 Norwegian adolescents aged 13 to 18 years (mean = 15.14, SD = 1.58, 50.5% female) with a 4.65% rate of reported suicide attempt during the past 12 months was analyzed. Five machine learning algorithms were trained for suicide attempt risk assessment. The stacked ensemble model significantly outperformed other algorithms, achieving equal sensitivity and a specificity of 90.1%, AUC of 96.4%, and AUCPR of 67.5%. All algorithms found recent self-harm to be the most important indicator of adolescent suicide attempt. Exploratory factor analysis suggested five additional risk domains, which we labeled internalizing problems, sleep disturbance, disordered eating, lack of optimism regarding future education and career, and victimization. The identified factors provided stronger support for The Interpersonal Theory of Suicide than for The Strain Theory of Suicide. An enhancement to The Interpersonal Theory based on the risk and protective factors identified by holistic item analysis is presented.

Perception of social inclusion/exclusion and response inhibition in adolescents with past suicide attempt: a multidomain task-based fMRI study

The occurrence of suicidal behaviors increases during adolescence. Hypersensitivity to negative social signals and deficits in cognitive control are putative mechanisms of suicidal behaviors, which necessitate confirmation in youths. Multidomain functional neuroimaging could enhance the identification of patients at suicidal risk beyond standard clinical measures. Three groups of adolescents (N = 96; 78% females, age = 11.6-18.1) were included: patients with depressive disorders and previous suicide attempts (SA, n = 29); patient controls with depressive disorders but without any suicide attempt history (PC, n = 35); and healthy controls (HC, n = 32). We scanned participants with 3T-MRI during social inclusion/exclusion (Cyberball Game) and response inhibition (Go-NoGo) tasks. Neural activation was indexed by the blood-oxygenation-level dependent (BOLD) of the hemodynamic response during three conditions in the Cyberball Game ("Control condition", "Social Inclusion", and "Social Exclusion"), and two conditions in Go-NoGo task ("Go" and "NoGo" blocks). ANCOVA-style analysis identified group effects across three whole-brain contrasts: 1) NoGo vs. Go, 2) Social inclusion vs. control condition, 3) Social exclusion vs. control condition. We found that SA had lower activation in the left insula during social inclusion vs. control condition compared to PC and HC. Moreover, SA compared to PC had higher activity in the right middle prefrontal gyrus during social exclusion vs. control condition, and in bilateral precentral gyri during NoGo vs. Go conditions. Task-related behavioral and self-report measures (Self-reported emotional reactivity in the Cyberball Game, response times and number of errors in the Go-NoGo Task) did not discriminate groups. In conclusion, adolescent suicidal behaviors are likely associated with neural alterations related to the processing of social perception and response inhibition. Further research, involving prospective designs and diverse cohorts of patients, is necessary to explore the potential of neuroimaging as a tool in understanding the emergence and progression of suicidal behaviors.

Symptoms characteristics of personality disorders associated with suicidal ideation and behaviors in a clinical sample of adolescents with a depressive disorder

Introduction

Pathological personality traits have repeatedly been identified as important risk factors for suicidal ideation and behaviors. Moreover, impulsive-aggressive traits, have shown a consistent association with suicidal behaviors across the lifespan. Adolescence represents a critical period for the emergence of different personality traits, mood disorders, and suicidal behaviors, but the relationship between these variables remain poorly understood.

Methods

These variables were examined in a cross-sectional case-control design involving three groups: 30 adolescents with a depressive disorder and past suicide attempt (Mean Age = 16.2, Females = 26), 38 adolescents with a depressive disorder but without past suicide attempt (Mean age = 16.0, Females = 29), and 34 healthy adolescent controls (Mean age = 15.2, Females = 22). Suicidal ideations were indexed using Suicidal Behavior Questionnaire (SBQ-R), psychiatric disorder assessed using a semi-structured questionnaire (K-SADS-PL), depressive symptoms with the Beck Depressive Inventory (BDI), symptoms characteristics of personality disorders with the Scheduled Clinical Interview for the DSM-IV (SCID-II) screening questionnaire, and impulsivity with the Barratt Impulsivesness Scale (BIS).

Results

Findings showed that impulsivity (F = 11.0, p < 0.0001) and antisocial symptoms characteristics of personality disorders (p < 0.001, d = 0.70) displayed the most robust association with adolescent suicide attempts. Borderline symptoms characteristics of personality disorders did not discriminate attempters from non-attempters but presented high correlations with suicidal ideation and depression severity. In an item-wise analysis, suicide attempt status was uniquely correlated with symptoms characteristics of an antisocial personality disorder. Suicide attempt status also correlated with non-suicidal self-injury and a chronic feeling of emptiness.

Discussion

The caveats of this cross-sectional study include the stability of symptoms characteristics of personality disorders in adolescence and the limited sample size. In sum, suicidal behaviors were characteristically correlated with increased impulsivity and antisocial symptoms characteristics of personality disorders, but other symptoms characteristics of personality disorders were relevant to adolescent depression and suicidal ideation. Understanding the emergence of symptoms characteristics of personality disorders and suicidal behaviors in a developmental context can ultimately inform not only the neurobiological origin of suicidal behaviors, but also provide new avenues for early detection and intervention.

The longitudinal relationship between bullying victimization and depressive symptoms for middle school students: A cross-lagged panel network analysis

BACKGROUND

Previous research about the relationship between bullying victimization and adolescent depressive symptoms was mostly based on latent variable modeling. This study, instead, applied item-level analysis to explore the cross-sectional relationship and longitudinal development between bullying victimization and adolescent depressive symptoms with network models.

METHODS

This study used Olweus Bully/Victim Questionnaire and Children's Depression Inventory to collect data. A total of 1911 middle school students (55.2 % female; Mage = 12.98 ± 0.60 at T1) completed measures on four occasions at 6-month intervals. Nine network analysis models were employed to better understand the relationship between variables.

RESULTS

(1) "Being threatened or intimidated" was the most influential bullying behavior within bullying victimization items; (2) "being excluded", "being spoken ill of" and "negative mood" were the bridge items between bullying victimization and adolescent depressive symptoms; (3) the most influential bullying victimization item on adolescent depressive symptoms was "being robbed or blackmailed" for short-term development and "being excluded" for long-term development. While the most affected depressive symptom by bullying victimization was "anhedonia" for short-term development and "negative mood" for long-term development.

LIMITATIONS

Self-report measure is adopted for all variables in the study, and there may be some deviation. Due to the questionnaires, the items of bullying behaviors and depressive symptoms included in the network analysis are limited.

CONCLUSIONS

From the item level, this study found more specific relationships between bullying victimization and adolescent depressive symptoms. These findings highlight depressed mood and anhedonia are depressive symptoms that should be more paid attention to in clinical intervention for bullying victims.

Profiles, Transitions, and Resilience Factors of Suicide Risk in Early Chinese Adolescents

As a severe public health concern directly endangering life safety, adolescent suicide has been extensively investigated in variable-centered studies. However, gaps remain in the knowledge of heterogeneous suicide risk patterns and their developmental nature. Additionally, little is known about protective factors associated with suicide risk patterns and changes. This study applied person-centered approaches to explore suicide risk profiles and transitions over time in early Chinese adolescents, along with their protective factors. A total of 1518 junior high school students (49.6% girls, Mage = 13.57, SD = 0.75) participated in two surveys within a 12-month interval. Latent Profile Analysis and Latent Transition Analysis were used to model the profiles and transitions of suicide risk. Three risk profiles were identified at both time points: low risk profile (73.9, 78.3%), medium risk-high threat profile (16.2, 10.2%), and high risk profile (9.9, 10.2%). Low risk profile was stable, while medium risk-high threat and high risk profiles showed great transitions over 12 months. Sense of control, meaning in life, and regulatory emotional self-efficacy served as protective factors against suicide risk profiles and transitions. Findings underscore the importance of comprehensively illustrating suicide risk states from multiple aspects, as well as understanding the fluid nature of transitions between different risk states. Prevention and intervention strategies aimed at enhancing resilience, such as increasing sense of control, perceived meaningfulness, and belief in emotional regulation, may contribute to reducing the risk of suicide among adolescents.

More than the aggregation of its components: Unveiling the associations between anxiety, depression, and suicidal behavior in adolescents from a network perspective

BACKGROUND

Facing multiple changes, adolescents are prone to have anxiety and depression concurrently, which would accompany a particularly high risk for suicide. However, most previous studies have ignored the heterogeneity of the components and used latent variable methods to explore the associations between these core variables, resulting in a lack of component-level discussions.

METHOD

Using a large sample of 9300 adolescents (Mean_age = 13.51; SD_age = 1.33; 49.82 % females), two network pathways of anxiety and depression and the associations between these variables and suicidal behavior were constructed. The central components and the stability of both networks were also identified.

RESULTS

Considering the network of anxiety and depression, there were two strong bridging symptoms of sleep problems and palpitation or tachycardia. The symptoms of depression showed a more vital centrality than anxiety, and the central symptoms were tachycardia, worthlessness, fatigue, and feeling of choking. For the network of suicidal behavior and symptoms of anxiety and depression, besides sleep problems, the edge linking lifetime suicide ideation and attempt and the frequency of suicide ideation in the past year was also a strong edge. Worthlessness connected symptoms of anxiety and depression with suicidal behavior. The central components were tachycardia, worthlessness, the frequency of suicidal ideation over the past year, and fatigue. Additionally, both networks had higher stability in terms of edge and centrality.

CONCLUSION

Based on the identified relevant strong bridging and central components, effective therapies would target these components first, which would lead to the alleviating effects on other components.

COVID-19 Pandemic Has Changed the Psychiatric Profile of Adolescents Attempting Suicide: A Cross-Sectional Comparison

The COVID-19 pandemic is having a major impact on the mental health of adolescents, leading to suicidal behaviors. However, it remains to be clarified whether the COVID-19 pandemic has changed the psychiatric profile of adolescent suicide attempters.

METHODS

a retrospective observational analytical study was conducted to assess age, gender and clinical characteristics of adolescents attempting suicide during the year before and the year after the global lockdown.

RESULTS

ninety adolescents (12-17 y.o.) were recruited consecutively from February 2019 to March 2021 at the emergency ward for having attempted suicide. Fifty-two (57.8%) attended before the lockdown (pre-pandemic group) and thirty-eight (42.2%) the year after (pandemic group). There were significant differences in diagnostic categories between the periods (p = 0.003). Adjustment and conduct disorders were more frequent in the pre-pandemic group, while anxiety and depressive disorders were more prevalent during the pandemic. Although the severity of suicide attempts did not show significant differences between the two study periods (0.7), the generalized linear model showed that the suicide attempt severity was significantly associated with current diagnosis (p = 0.01).

CONCLUSIONS

the psychiatric profile of adolescents attempting suicide was different before and during the COVID-19 pandemic. During the pandemic, the proportion of adolescents with a prior psychiatric history was lower, and most of them were diagnosed with depressive and anxiety disorders. These diagnoses were also associated with a greater severity in the intentionality of suicide attempt, regardless of the study period.

Childhood externalizing, internalizing and comorbid problems: distinguishing young adults who think about suicide from those who attempt suicide

BACKGROUND

While childhood externalizing, internalizing and comorbid problems have been associated with suicidal risk, little is known about their specific associations with suicidal ideation and attempts. We examined associations between childhood externalizing, internalizing and comorbid problems and suicidal ideation (without attempts) and attempts by early adulthood, in males and females.

METHOD

Participants were from the Quebec Longitudinal Study of Kindergarten Children, a population-based study of kindergarteners in Quebec from 1986 to 1988 and followed-up until 2005. We captured the co-development of teacher-rated externalizing and internalizing problems at age 6-12 using multitrajectories. Using the Diagnostic Interview Schedule administered at age 15 and 22, we identified individuals (1) who never experienced suicidal ideation/attempts, (2) experienced suicidal ideation but never attempted suicide and (3) attempted suicide.

RESULTS

The identified profiles were no/low problems (45%), externalizing (29%), internalizing (11%) and comorbid problems (13%). After adjusting for socioeconomic and familial characteristics, children with externalizing (OR 2.00, CI 1.39-2.88), internalizing (OR 2.34, CI 1.51-3.64) and comorbid (OR 3.29, CI 2.05-5.29) problems were at higher risk of attempting suicide (v. non-suicidal) by age 22 than those with low/no problems. Females with comorbid problems were at higher risk of attempting suicide than females with one problem. Childhood problems were not associated with suicidal ideation. Externalizing (OR 2.01, CI 1.29-3.12) and comorbid problems (OR 2.28, CI 1.29-4.03) distinguished individuals who attempted suicide from those who thought about suicide without attempting.

CONCLUSION

Childhood externalizing problems alone or combined with internalizing problems were associated with suicide attempts, but not ideation (without attempts), suggesting that these problems confer a specific risk for suicide attempts.

Association between Suicidal Behaviors in Adolescence and Negative Emotions, the Level of Stress, Stress Coping Strategies and the Quality of Sleep

Suicidal behaviors in adolescents stem from complex processes deeply rooted in various spheres of life and functioning. The study was aimed at assessing the relationship between selected negative emotions, the quality of sleep, the level of perceived stress as well as stress coping strategies and suicidal ideation and attempts among high school students. The examined group consisted of adolescents aged 16-18 recruited by social-media groups in Poland. The study was based on a diagnostic survey with the application of CAWI method. The other research tools applied in the study included: Hospital Anxiety and Depression Scale-Modified, Perceived Stress Scale-10, How do you cope?-Questionnaire, Athens Insomnia Scale as well as the authors' own questionnaire on suicidal ideation and suicide attempts. Anxiety, depression, aggression and insomnia as well as a high level of stress were statistically more common in girls than in boys (p < 0.001). The high level of negative emotions and insomnia, in turn, increased the risk of suicidal ideation (OR = 3.59, 95% CI: 2.13-6.06 and OR = 2.35, 95% CI: 1.60-3.46), as well as suicide attempts (OR = 6.29, 95% CI: 2.93-14.80 and OR = 3.29, 95% CI: 2.07-5.35). Additionally, high level of stress was associated with more than twice larger odds of suicidal ideation (OR = 2.26, 95% CI: 1.13-4.63). Significantly higher prevalence of suicidal ideation (p = 0.017) and suicide attempts (p = 0.016) was observed in girls. A high level of negative emotions and stress accompanied by a low quality of sleep are factors predisposing people to suicidal ideation and attempted suicide.

The longitudinal course of childhood bullying victimization and associations with self-injurious thoughts and behaviors in children and young people: A systematic review of the literature

INTRODUCTION

Bullying victimization has consistently been highlighted as a risk factor for self-injurious thoughts and behaviors (SITBs) in young people. This systematic review of prospective, community-based studies explored associations between bullying victimization (traditional/face-to-face and cyber) across the full spectrum of self-harm and suicidality, in children and young people aged up to (and including) 25 years. Importantly, associations by sex/gender were explored.

METHODS

MEDLINE, Embase, PsycINFO, CINAHL and Scopus were searched for articles meeting the inclusion criteria. Articles were screened by title, abstract and full text. Quality appraisal was performed using the Newcastle-Ottawa Scale for cohort studies. Data were synthesized narratively. The protocol is registered on PROSPERO (CRD42021261916) and followed PRISMA 2020 guidelines.

RESULTS

A total of 35 papers were included, across 17 countries. Results were presented by bullying type: traditional/face-to-face (n = 25), cyber (n = 7) and/or an aggregate of both types (n = 7). Outcomes included suicidal ideation (n = 17), self-harm (n = 10), suicide attempt (n = 4), NSSI (n = 4), other (n = 7). Studies measured outcomes in under 18s (n = 24), 18-25-year-olds (n = 8) and both under 18s and 18-25-year-olds (n = 3). Studies exploring the role of sex/gender (20%) found some interesting nuances.

CONCLUSIONS

Some weak to strong associations between bullying and SITBs were found yet conclusions are tentative due to study heterogeneity (e.g., methods used, conceptualizations and operationalisations of exposures/outcomes). Future research should address methodological issues raised in this review, and further explore gender differences in bullying, including by bullying sub-types (e.g., overt or relational) and victim status (e.g., victim or bully-victim).

A Longitudinal Network Analysis of the Interactions of Risk and Protective Factors for Suicidal Potential in Early Adolescents

Few studies have applied the "ideation-to-action" theories and the buffering hypothesis of resilience to suicide in early adolescents, and existing research is primarily cross-sectional. This study examined the interactions between risk factors (i.e., thwarted belongingness, perceived burdensomeness, and hopelessness), protective factors (i.e., resilience, self-efficacy, and subjective happiness), and suicidal potential (i.e., family distress, anxious-impulsive depression, and suicidal ideation or acts) in early adolescents. The participants (N = 1615; 55.6% females; M _age = 10.93, SD _age = 1.14, range: 9-15) who were recruited from four primary and four secondary schools in Hong Kong completed the survey in 2020 and 2021. The contemporaneous networks suggested that perceived burdensomeness and hopelessness were positively associated with suicidal potential. Protective factors were negatively associated with risk factors studied and suicidal potential. The node with the greatest centrality strength was anxious-impulsive depression. The nodes most likely to connect with other constructs were self-efficacy and hopelessness. A temporal network suggested the predictive effect of hopelessness and the protective effect of subjective happiness on future suicidal ideation or acts. Moreover, self-efficacy was found to buffer the impact of hopelessness on future suicidal ideation or acts. These findings highlighted the contribution of hopelessness to suicidal potential among early adolescents and the buffering effects of subjective happiness and self-efficacy.

Distinct trajectories of suicidal behaviors throughout the university stage and associated risk and protective factors: A large-scale prospective study

BACKGROUND

Suicide is a major public health concern, especially among adolescents and young adults. Although research has begun to explore the developmental trajectories of suicide-related outcomes, most have thus far focused on children and adolescents. The current study extends existing literature by identifying subgroup trajectories and related factors of college students over a two-year period.

METHODS

The data used in this study was obtained from an ongoing longitudinal study in Guangdong, China. A total of 3871 students participated in assessments performed at three time points at one-year assessment intervals. Growth mixture modeling (GMM) was used to estimate trajectory classes for suicidal behaviors, followed by multivariable logistic regression to explore the association between predictive factors and classes.

RESULTS

GMM analyses extracted two distinct trajectories of suicidal behaviors: a low-decreasing group (n = 3669, 94.8 %) and a high-increasing group (n = 202, 5.2 %). Multivariate logistic regression analyses revealed that depressive symptoms, non-suicidal self-injury, hopelessness, and childhood emotional abuse served as risk factors for the high-increasing group, while reasons for living served as protective factors.

CONCLUSIONS

Psychological interventions aimed at reducing the influence of risk factors and bolstering reasons to live may help to decrease the risk of suicide behaviors in college students.

HIV and suicide risk across adolescence and young adulthood: an examination of socio-demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area

Introduction

As children become adolescents and young adults (AYA), their risk for attempting suicide increases dramatically, with chronic health conditions an important risk factor. This study examined correlates of suicidality across development in AYA living with perinatally acquired HIV (AYALPHIV) and those perinatally HIV‐exposed but uninfected (AYAPHEU).

Methods

Data come from an ongoing longitudinal New York City‐based study (N = 339) with AYALPHIV and AYAPHEU interviewed every 12–18 months from 2003 to 2019 (mean enrolment age = 12 years; current mean age = 27 years). The Diagnostic Interview Schedule for Children (adolescent or young adult version) assessed psychiatric disorders and first‐reported suicide attempt. Generalized estimating equations were used to examine associations between first‐reported suicide attempt and socio‐demographic, contextual and psychosocial correlates measured concurrently across six timepoints.

Results

At enrolment, 51% of participants were female, 72% heterosexual, 60% Black and 50% Latinx. Attempted suicide was significantly higher among AYALPHIV (27%, CI 21–33%) compared to AYAPHEU (16%, CI 10–22%), with an OR of 1.74 (CI 1.04–2.92) in a model adjusting for age. For AYALPHIV, anxiety (OR 2.66, CI 1.46–4.85), mood (OR 3.62, CI 1.49–8.81) and behaviour disorders (OR 5.05, CI 2.15–11.87) and past‐year arrest (OR 3.05, CI 1.26–7.4), negative life events (OR 1.27, CI 1.11–1.46), city stress (OR 2.28, CI 1.46–3.57), pregnancy (OR 2.28, CI 1.08–4.81) and HIV stigma (OR 2.46, CI 1.27–4.75) were associated with increased odds of attempted suicide, while identifying as heterosexual (OR 0.27, CI 0.14–0.52), higher personal (OR 0.45, CI 0.26–0.80) and family self‐concept (OR 0.36, CI 0.22–0.57) were protective. Interactions by HIV status and age were found: substance use was more strongly associated with attempted suicide among AYAPHEU than AYALPHIV, while negative life events and higher religiosity were more strongly associated with increased odds of attempted suicide among AYA ≥ 19 versus ≤ 18 years.

Conclusions

AYALPHIV compared to AYAPHEU faced unique risks for attempted suicide as they age into adulthood, with the highest risk among AYALPHIV experiencing HIV stigma or pregnancy and the highest risk among AYAPHEU with substance use. Assessing for suicide risk and correlates with attention to ageing can inform preventive interventions tailored to meet AYALPHIV and AYAPHEU needs.

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.

Editorial: The Enigma of Suicide Risk in Childhood and Its Evolution Across Development

The problem of suicide can appear incomprehensible at any stage of the life cycle, but little is more puzzling than suicidal thinking and behavior in young children. Despite preadolescent suicide being rare in comparison to suicide later in life, it is the fifth leading cause of death for children ages 5 to 12 in the United States¹ and a serious public health problem deserving of study. The study of preadolescent suicide risk also has potential to inform our understanding of suicide across the lifespan. In an important effort to expand our limited understanding of the developmental aspects of suicidal thoughts and behaviors (STBs), Whalen and colleagues² report on the longitudinal trajectories of STBs for a sample of more than 300 preschool children recruited between the ages of 3 and 6 years and followed prospectively through age 17 years. Longitudinal studies allow researchers to collect more detailed information than could be obtained from a single cross-sectional survey and can offer insights into how psychopathology and associated risks evolve over time. This study is relatively unique in prospectively assessing STBs and associated risk and protective factors from the preschool period through adolescence.

Perinatal adversity profiles and suicide attempt in adolescence and young adulthood: longitudinal analyses from two 20-year birth cohort studies

BACKGROUND

We aimed to identify groups of children presenting distinct perinatal adversity profiles and test the association between profiles and later risk of suicide attempt.

METHODS

Data were from the Québec Longitudinal Study of Child Development (QLSCD, N = 1623), and the Avon Longitudinal Study of Parents and Children (ALSPAC, N = 5734). Exposures to 32 perinatal adversities (e.g. fetal, obstetric, psychosocial, and parental psychopathology) were modeled using latent class analysis, and associations with a self-reported suicide attempt by age 20 were investigated with logistic regression. We investigated to what extent childhood emotional and behavioral problems, victimization, and cognition explained the associations.

RESULTS

In both cohorts, we identified five profiles: No perinatal risk, Poor fetal growth, Socioeconomic adversity, Delivery complications, Parental mental health problems (ALSPAC only). Compared to children with No perinatal risk, children in the Poor fetal growth (pooled estimate QLSCD-ALSPAC, OR 1.89, 95% CI 1.04-3.44), Socioeconomic adversity (pooled-OR 1.42, 95% CI 1.08-1.85), and Parental mental health problems (OR 1.74, 95% CI 1.27-2.40), but not Delivery complications, profiles were more likely to attempt suicide. The proportion of this effect mediated by the putative mediators was larger for the Socioeconomic adversity profile compared to the others.

CONCLUSIONS

Perinatal adversities associated with suicide attempt cluster in distinct profiles. Suicide prevention may begin early in life and requires a multidisciplinary approach targeting a constellation of factors from different domains (psychiatric, obstetric, socioeconomic), rather than a single factor, to effectively reduce suicide vulnerability. The way these factors cluster together also determined the pathways leading to a suicide attempt, which can guide decision-making on personalized suicide prevention strategies.

Emotional and attention-deficit/hyperactivity disorder symptoms of preterm vs. full-term children during COVID-19 pandemic restrictions

BACKGROUND

Preterm children are at higher risk of developing mental health problems than full-term children. Deterioration of children's mental health was observed during COVID-19 pandemic restrictive measures. Our study compared emotional and attention-deficit/hyperactivity disorder (ADHD) symptoms during school closure between preterm and full-term children.

METHODS

Data from two French birth cohorts-ELFE and EPIPAGE-2-were used. In 2011, infants born ≥22 weeks' gestation were recruited. Parents completed the Strengths and Difficulties Questionnaire when the children were 9 years old and experiencing school closure. Multivariate multinomial logistic regression models were used.

RESULTS

Subjects included 4164 full-term and 1119 preterm children. In univariate analyses, compared to full-term children: extremely and very preterm children more frequently had abnormal and borderline ADHD scores (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.50-2.30, OR 1.42, 95% CI 1.08-1.85, respectively) and abnormal emotional scores (OR 1.86, 95% CI 1.43-2.40); moderate to late preterm children more often had abnormal ADHD scores (OR 1.33, 95% CI 1.01-1.78). The associations did not remain when previous symptoms at 5 years old were considered.

CONCLUSIONS

School closure during lockdown did not appear to increase the risk of mental health problems in preterm compared to full-term children.

IMPACT STATEMENT

Preterm children are at higher risk of developing mental health problems than full-term children. Deterioration in children's mental health was observed during COVID-19 pandemic restrictions. However, whether preterm children were a particularly vulnerable subgroup during school closure is unclear. In univariate analyses, extremely and very preterm children more often had abnormal and borderline ADHD symptoms and abnormal emotional symptom scores than full-term children. The associations did not remain significantly associated when previous symptoms were considered. Preterm compared to full-term children more often suffer from ADHD and emotional symptoms, but school closure during lockdown did not appear to increase this risk.

Associations of bullying victimisation in different frequencies and types with suicidal behaviours among school-going adolescents in low- and middle-income countries

Aims

Adolescent suicide is a severe public health problem in low- and middle-income countries (LMICs), and adolescents who are victims of bullying have a higher risk of suicidal behaviours. However, detailed global data concerning the association between bullying victimisation and suicide are lacking; thus, further multicontinental studies exploring the association of bullying victimisation at different frequencies and types with suicidal behaviours are urgent.

Methods

The data were extracted from the Global School-based Student Health Survey (GSHS) (2010–2017) conducted in 40 LMICs (n = 151 184, mean age: 14.77 years, s.d.: 1.59, 54.2% females). Data concerning past-30-day bullying victimisation, past 12-month suicidal behaviours (suicidal ideation, suicidal plans and suicidal attempts) and other adverse health behaviours or outcomes were collected. Chi-square tests were used to explore the correlations among the main variables. A multivariable logistic regression and stratified logistic regressions were conducted to assess the associations.

Results

The overall prevalence of bullying victimisation, suicidal ideation, suicidal plans and suicidal attempts were 28.72, 12.64, 11.84 and 10.79%, respectively. The results showed a positive association of different frequencies and types of bullying victimisation with suicidal behaviours: suicidal ideation (odds ratio (OR) = 2.43, 2.06–2.87), suicidal plans (OR = 2.69, 2.28–3.17) and suicidal attempts (OR = 3.23, 2.73–3.82). Adolescents also reported the effects of being made fun of because of their religion: suicidal ideation (OR = 1.63, 1.41–1.88), suicidal plans (OR = 1.44, 1.24–1.66) and suicidal attempts (OR = 1.73, 1.50–1.98). Moreover, these associations varied among teenagers of different gender and body mass indexes (BMIs) and were stronger among males and adolescents who were underweight, overweight or obese.

Conclusions

Different types of bullying victimisation were positively related to suicidal behaviours; these associations varied among adolescents by gender and BMI. This study offers a theoretical basis for the identification of adolescents at a high risk of suicide and is beneficial for informing effective psychological interventions for constructing sound school environments, improving adolescents’ mental health and reducing the risk of suicide to promote health in LMICs and globally.

Predictors of Attempted Suicide Among Youth Living With Perinatal HIV Infection and Perinatal HIV-Exposed Uninfected Counterparts

BACKGROUND

Suicide is a leading cause of death among adolescents and young adults (AYA). AYA living with perinatally acquired HIV infection (AYALPHIV) are at higher risk of attempted suicide when compared with AYA who were perinatally HIV-exposed but uninfected (AYAPHEU). To inform interventions, we identified risk and protective factors of attempted suicide among AYALPHIV and AYAPHEU.

SETTING

Data were obtained from a longitudinal New York City-based study of AYALPHIV and AYAPHEU (n = 339; enrollment age 9-16 years) interviewed approximately every 12-18 months.

METHOD

Our main outcome was suicide attempt at any follow-up. The DISC was used to assess psychiatric disorder diagnoses and attempted suicide and the Child Depression Inventory to assess depressive symptoms. Psychosocial and sociodemographic risk factors were also measured. Analyses used backward stepwise logistic regression modeling.

RESULTS

At enrollment, 51% was female individuals, 49% Black, 40% Latinx, and 11% both Black and Latinx. Attempted suicide prevalence was significantly higher among AYALPHIV compared with AYAPHEU (27% vs 16%, P = 0.019), with AYALPHIV having 2.21 times the odds of making an attempt [95% confidence interval: (1.18 to 4.12), P = 0.013]. Higher Child Depression Inventory scores were associated with an increased risk of attempted suicide in both groups and the total sample. The presence of DISC-defined behavior disorder increased the risk of attempted suicide in the total sample and the AYALPHIV subgroup. Religiosity was protective of attempted suicide in AYALPHIV.

CONCLUSIONS

AYALPHIV had increased suicide attempts compared with AYAPHEU. Religiosity was protective in AYALPHIV. Highlighting a need for prevention of early mental health challenges was associated with risk.

Identifying environmental pathways between irritability during childhood and suicidal ideation and attempt in adolescence: findings from a 20-year population-based study

BACKGROUND

Irritable children are at increased risk of suicidal ideation and suicide attempt, but the underlying environmental mechanisms accounting for these associations are largely unknown. We aimed to investigate the mediating role of peer victimization and harsh parenting in the association between childhood irritability and adolescent suicidal ideation and attempt.

METHOD

N = 1,483 participants from the Québec Longitudinal Study of Child Development followed up from 5 months until 20 years of age (2018) with annual or biannual assessments. Irritability was operationalized using assessments of teacher-reported temper tantrums and reactive aggression. Suicidal ideation and suicide attempt at ages 13, 15, 17, and 20 years were self-reported. Peer victimization (self-reported at age 13) and harsh parenting (mothers reported at age 13) were considered as potential mediators.

RESULTS

We identified four trajectories of teacher-reported irritability symptoms from 6 to 12 years: low (74.8%), rising (12.9%), declining (7.3%), and persistent (4.9%). In adjusted models, children in the persistent and rising trajectories had, respectively, 2.81-fold (CI, 1.27-6.22) and 2.14-fold (CI, 1.20-3.81) increased odds of suicide attempt in adolescence, but not suicidal ideation. We found that a significant proportion of the association between irritability trajectories and suicide attempt was mediated by peer victimization (33% and 35% for rising and persistent, respectively), but there was no mediation via harsh parenting.

CONCLUSIONS

Our findings suggest that peer victimization may be a key mechanism explaining the increased suicide attempt risk of children presenting with persistently high or increasing irritability. Interventions to reduce peer victimization may be helpful to reduce suicide risk among irritable children.

Adolescent social networks matter for suicidal trajectories: disparities across race/ethnicity, sex, sexual identity, and socioeconomic status

BACKGROUND

Examining social networks, characterized by interpersonal interactions across family, peer, school, and neighborhoods, offer alternative explanations to suicidal behaviors and shape effective suicide prevention. This study examines adolescent social networks predicting suicide ideation and attempt trajectories transitioning to adulthood, while revealing differences across racial/ethnic, sex, sexual identity, and socioeconomic status.

METHODS

Participants included 9421 high school students (Mage = 15.30 years; 54.58% females, baseline) from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health, 1994-2008. Latent class growth analyses were conducted to identify suicide ideation and attempt trajectories. Multivariate multinomial logistic regressions examined the relationships between social network characteristics during adolescence and suicidal trajectories. Interaction terms between social networks and sociodemographic characteristics were included to test moderation effects.

RESULTS

Three suicidal ideation trajectories (low-stable, high-decreasing, moderate-decreasing-increasing) and two suicide attempt trajectories (low-stable, moderate-decreasing) were identified. Greater family cohesion significantly reduced the probability of belonging to high-decreasing (Trajectory 2) and moderate-decreasing-increasing (Trajectory 3) suicidal ideation trajectories, and moderate-decreasing (Trajectory 2) suicide attempt trajectory. Race/ethnicity, sex, and sexual identity significantly moderated the associations between social networks (household size, peer network density, family cohesion, peer support, neighborhood support) and suicidal trajectories.

CONCLUSIONS

Social networks during adolescence influenced the odds of belonging to distinct suicidal trajectories. Family cohesion protected youth from being in high-risk developmental courses of suicidal behaviors. Social networks, especially quality of interactions, may improve detecting adolescents and young adults at-risk for suicide behaviors. Network-based interventions are key to prevent suicidal behaviors over time and suicide intervention programming.

The Role of New Technologies to Prevent Suicide in Adolescence: A Systematic Review of the Literature

Background and objectives: Suicide in adolescents represents a major public health concern. To date, a growing number of suicide preventive strategies based on the use of new technologies are emerging. We aimed to provide an overview of the present literature on the use of new technologies in adolescent suicide prevention. Materials and methods: An electronic search was run using the following keywords: Technology OR Technologies OR APP OR Application OR mobile application) AND (Adolescent OR youth OR puberty) AND (Suicid* OR Self-harm OR self-destruction). Inclusion criteria were: English language, published in a peer-reviewed journal, suicide prevention with the use of new technologies among adolescents. Results: Our search strategy yielded a total of 12 studies on the use of telemedicine, 7 on mobile applications, and 3 on language detection. We also found heterogeneity regarding the study design: 3 are randomized controlled trials (RCT), 13 are open-label single group trials, 2 are randomized studies, and 1 is a cross-sectional study. Telemedicine was the most adopted tool, especially web-based approaches. Mobile applications mostly focused on screening of depressive symptoms and suicidal ideation, and for clinical monitoring through the use of text messages. Although telepsychiatry and mobile applications can provide a fast and safe tool, supporting and preceding a face-to-face clinical assessment, only a few studies demonstrated efficacy in preventing suicide among adolescents through the use of these interventions. Some studies suggested algorithms able to recognize people at risk of suicide from the exploration of the language on social media posts. Conclusions: New technologies were found to be well accepted and tolerated supports for suicide prevention in adolescents. However, to date, few data support the use of such interventions in clinical practice and preventive strategies. Further studies are needed to test their efficacy in suicide prevention among adolescents and young adults.

Effects of mindfulness interventions on depressive symptoms in adolescents: A meta-analysis

BACKGROUND

Depression among adolescents is rising globally and is the leading cause of illness and disability among adolescents. While antidepressants and psychotherapy are effective, only about 40% of depressed adolescents receive treatments due to lack of professionals and barriers such as cost and personal obstacles including stigma, lack of motivation, and negative perceptions of treatment. Use of alternative and complementary treatments for depression is growing. One such treatment is mindfulness meditation.

OBJECTIVE

We examined the effects of mindfulness interventions on depression among adolescents and explored the moderator effects of participants, methods, and intervention characteristics.

METHODS

We searched 17 databases from their inception to April 2019 to identify studies written in English. Search terms included depress* AND mindful* OR meditat* AND adolescen* OR student*; 29 studies met inclusion criteria. Two researchers independently coded data from all primary studies. Discrepancies were discussed with a third researcher to reach consensus. Using the random effects model, we computed the effect sizes (ESs) of mindfulness interventions on depression using standardized mean differences (Hedge's g) with 95% confidence intervals (CI). Funnel plot, Q statistics, and I² were used to test the heterogeneity across studies. We examined moderators to explore sources of heterogeneity.

RESULTS

Across 29 studies (N=3688), 1839 adolescents participated in mindfulness interventions; 1849 served as controls. Mean ages ranged from 10.2 to 19.5 years. Mindfulness groups showed reduced depression compared to control groups (g=.14, 95%CI[.01-.28], p<.042). Funded studies showed greater improvement in depression (g=.34, 95%CI[.09-.58], p<.008) compared to unfunded (g=.05, 95%CI[-.12-.22], p<.554). Interestingly, while only two research teams studied mindfulness-based cognitive therapy, they showed trends toward improvement (p=0.09) in depression (g=.76, 95%CI[.18-1.34], p<.010, s=2) compared to adapted mindfulness interventions (g=.13, 95%CI[-.04-.30], p<.140, s=16) or mindfulness-based stress reduction (g=.07, 95%CI[-.16-.29], p<.559, s=11). Mindfulness interventions with individual counseling tended (p=0.09) to improve depression (g=.46, 95%CI[.07-.85], p<.021, s=3) more than without (g=.10, 95%CI[-.04-.24], p<.168, s=26). Depression improved more when follow-up measures occurred further from the intervention (Slope=.002, τ²=.74, Q_between=4.10, p=.043, s=29). No quality indicators moderated the ES of mindfulness interventions on depression.

CONCLUSION

Mindfulness interventions are mildly effective interventions to reduce depressive symptoms among adolescents. Clinicians trained in mindfulness interventions might encourage mindfulness meditation as adjunctive/alternative treatment for adolescents with mild or moderate depressive symptoms as well as for at-risk adolescents to prevent depression. Funding, type of mindfulness interventions, individual counseling, and time to follow up were moderators of the effects of mindfulness interventions on depression in adolescents.