The role of perfectionism and depressive cognitions in understanding the hopelessness experienced by adolescent suicide attempters

Suicidality and Personality Pathology in Adolescence: A Systematic Review

This work presents a review of research papers examining the role of emerging personality pathology in suicidal ideation and behaviours in adolescence. Initially, 226 studies were selected in line with PRISMA guidelines, and 33 articles were finally included in this review. The data show percentages of any personality disorder diagnosis ranging from 19.5 to 22.8% in suicide attempters, while in autopsy studies, the rate of personality disorder diagnosis varied between 29.6 and 42.1%. The overwhelming majority of the studies focus on the role of borderline personality disorder (BPD) in suicidal behaviours, also highlighting its predictive role at a longitudinal level. Furthermore, the literature review shows that personality traits supposed to underlie BPD, such as affective instability, impulsivity and identity diffusion, have specific predictive links with suicidal conduct. Other personality pathology dimensions, such as aggressiveness, sadism and perfectionism that are associated with other personality disorders, namely, antisocial and narcissistic personality disorders, have also shown a significant mediating role for suicidal risk. Overall, these results seem to parallel the role of personality pathology in predicting suicide in adulthood and point to the relevance of assessing the presence of emerging patterns of personality disorders for the clinical management of suicidal risk in adolescence.

The Road from Pathological Narcissism to Suicidality in Adolescence: An Empirical Study

Background: Clinical and empirical research evidenced a complex link between pathological narcissism and the suicidal process in adulthood. Given the relevance of suicidality and the peculiar narcissistic vicissitudes of adolescence, the proposed research investigated the relationship between pathological narcissism analyzed from the multi-dimensional perspective of the Diagnostic Interview for Narcissism (DIN) and suicidal ideation conducted in a sample of Italian Adolescents. Methods: One hundred and three Italian male and female adolescents between 12 and 18 were administered the DIN, SCIDII, CSSRS, and Kiddie-SADS with six months follow-up. Results: The correlation, t-test, multiple regression analyses evidenced the association of narcissistic affective states and mood with both suicidal ideation and lethality of conduct. The increase in the dimension of grandiosity is associated with the passage to potentially highly lethal suicidal gestures. Conclusions: Suicidal ideation and conduct seem to serve the function of restoring a sense of control and self-esteem in narcissistic individuals experiencing a state of affective dysregulation. Narcissistic pathological functioning seems to play an important role in the adolescent suicidal process, quite like adulthood. Assessing an adolescent’s narcissistic functioning may provide useful clinical information in understanding and managing the suicidal risk in this phase of life.

Additional Value of Peer Informants in Psychological Autopsy Studies of Youth Suicides

In this study, we examined the feasibility and added value of including peer informants in a psychological autopsy study of youth suicides. Peer semi-structured interview data from 16 cases were analyzed qualitatively and compared to parent data. Results show that peers added information to parents' narratives in general and particularly on social relationships, bullying, school experiences, social media, and family relations. Peers also provided additional information on the presence of certain issues (such as social media contagion) as well as on the emotional impact from certain adverse events that seemed to have functioned as precipitating factors. We conclude that including peers in psychological autopsy studies of youth suicides is feasible and of added value but that more research is desirable. The results initially can be used in the design of psychological autopsies so that the maximum amount of information about each suicide will be learned.

Disordered Eating Attitudes, Anxiety, Self-Esteem and Perfectionism in Young Athletes and Non-Athletes

Eating disorders are associated with short and long-term consequences that can affect sports performance. The purposes of this study were to investigate whether female athletes, particularly gymnasts and footballers, exhibit more eating problems compared to female non-athletes, and to identify individual personality characteristics including anxiety, self-esteem, and perfectionism as possible contributors to eating disorder risk. In a sample of 120 participants, 80 adolescent female athletes were compared to a control condition of 40 non-athletes (mean age 17.2 ± 2.82). Participants responded to a questionnaire package to investigate the presence of disordered eating (SCOFF) and psychological variables in relation to disordered eating symptoms or eating disorder status. Subsequently, anthropometric measures were obtained individually by trained staff. There were statistically significant differences between conditions. One of the most important results was the score in SCOFF (Mann-Whitney = 604, p < 0.05; Cohen's d = 0.52, r = 0.25), being higher in control than in the gymnast condition. These results suggest that non-athlete female adolescents show more disturbed eating behaviours and thoughts than female adolescents from aesthetic sport modalities and, therefore, may have an enhanced risk of developing clinical eating disorders.

The Study of Motivation in the Suicidal Process: The Motivational Interview for Suicidality

Introduction: Suicide is the outcome of a process starting with the experiences of an unbearable pain or hopelessness, passing from suicidal ideation and planning, to possible para-suicidal behaviors or actual attempts. Recent studies have evidenced the necessity to integrate approaches based on the identification of psychopathological diagnoses and other variables as possible predictors of suicidal conduct with a more clinically based approach. A clinical assessment is needed that focuses on the patients' mental state with respect to thoughts concerning death and suicide. In particular, a qualitative assessment of motivations underlying the suicidal process could represent an effective guide for clinicians engaged in the difficult field of preventing adolescents' suicidal gestures. Most instruments investigating the suicidal motivation are self-report measures, possibly resulting in a lack of sufficiently valid assessment of this area. In the present work, we present the Motivational Interview for Suicidality in Adolescence (MIS-A) aiming at identifying the motivational areas sustaining suicidal ideation and gestures in this phase of development. Materials and Methods: The identification of the different areas derives from a thorough review of the empirical literature subsequently vetted by expert clinicians who selected specific reasons behind suicidal ideation and gesture. Result: The MIS is a semi-structured clinician-report interview. The interview is composed of seven areas and 14 sub-areas, evaluated on a four-point Likert scale: illness motivated attempts area, chronic presence of internal pessimistic criticism area, sense of defeat and entrapment area, relational area, external motivated crisis area, extreme and unusual cases area, and lack of control area. Conclusions: The path followed in the creation of the MIS reflects both an empirically orientated and a clinically informed approach. Creating this MIS is the first step within a wider research project that will allow one to test the reliability of the instrument.

The Assessment Effect of Spiritual Care on Hopelessness and Depression in Suicide Attempts

The purpose of this study was to assess the effect of spiritual care on hopelessness and depression among suicide attempts. This semi-experimental study that 60 suicide attempts and these samples were divided in to two cases and control groups. For case group, service package of spiritual care was designed and conducted during their visits to psychiatrists' offices. Findings showed that there was a significant difference after performing spiritual care in depression in both groups (X² = 22, P = 0.002) and their hopelessness (X² = 20, P = 0.001). The use of spiritual intervention is suggested in order to implement holistic nursing care during treatment should be considered as a matter of principle.

Adolescent perfectionism: Structural features of the Frost Multidimensional Perfectionism Scale and correlates with attachment and psychopathology

OBJECTIVES

Perfectionism is recognized as a significant risk factor for psychopathology. Emerging research links attachment to perfectionism in adult and college-age samples. The Frost Multidimensional Perfectionism Scale (FMPS) has been used in adults and adolescents with a variety of factor structures found. This study sought to establish the factor structure in a general adolescent sample prior to testing for associations between perfectionism, attachment, and psychopathology in the same sample.

DESIGN

A cross-sectional survey design was used. Confirmatory factor analysis, and correlational and regression analyses were employed.

METHODS

A total of 290 adolescents, aged 12-18 years, were recruited from a state secondary school. All completed the FMPS along with brief measures of attachment and psychopathology.

RESULT

Exploratory and confirmatory factor analyses failed to replicate previously published models, and a new six-item, 1-factor model representing perfectionism was found instead. This new variable was then used to establish a role for perfectionism and attachment anxiety in predicting internalizing problems. Perfectionism also correlated with conduct problems and hyperactivity.

CONCLUSION

This study established a novel factor structure for the FMPS, allowing proof of principle of the role of perfectionism in a relationship with attachment and psychopathology, which after replication, may inform new interventions for perfectionism. Caution is noted about the use of extant perfectionism measures that are not properly developmentally informed and which do not capture the dynamic nature of adolescence and adolescent perfectionism.

PRACTITIONER POINTS

Perfectionism is a feature of adolescent psychopathology, including internalizing and externalizing problems. Perfectionism is associated with attachment anxiety and together contributes to internalizing problems. Current conceptualizations of perfectionism may not capture the specific developmental and dynamic aspects of adolescence and should not be regarded as a stable personality trait.

Psychological Vulnerability and Subjective Happiness: The Mediating Role of Hopelessness

The current study examined the mediating role of hopelessness on the relationship between psychological vulnerability and subjective happiness. It was anticipated that hopelessness may act as a mediator in the relationship between psychological vulnerability and subjective happiness. Two hundred sixty-nine (150 women and 119 men) university students completed the Psychological Vulnerability Scale, the Subjective Happiness Scale and the Beck Hopelessness Scale. Data have been collected in the 2013-2014 academic year. The present study was designed as a cross-sectional study. Correlational results indicated that psychological vulnerability and hopelessness were significantly negatively associated with subjective happiness. Results using structural equation modelling showed that hopelessness fully mediated the relationship between psychological vulnerability and subjective happiness. Implications for future research and limitations of the present study are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

Pathways From Bullying Perpetration, Victimization, and Bully Victimization to Suicidality Among School-Aged Youth: A Review of the Potential Mediators and a Call for Further Investigation

In the wake of several highly publicized adolescent suicides attributed to bullying victimization, national attention has been brought to bear on the profound public health problem of bullying. This article reviews the extant literature on the associations between bullying perpetration, victimization, and thoughts of or attempts at suicide and proposes five potential mediators, namely depression, anxiety, low self-esteem, loneliness, and hopelessness, that may explain this relationship. Numerous studies have found empirical support for the interrelations between internalizing behaviors and both bullying perpetration and victimization and suicide. We find that further longitudinal research needs to be conducted to more conclusively determine the role and causal ordering these various psychosocial factors may play in bullying perpetration, victimization, and suicide. Although the research literature implies causal directions among all these potential mediators, untangling the unique influence of bullying perpetration, victimization, and bully victimization on suicide and its mechanisms of action has major research and practice implications.

Perfectionism in pediatric anxiety and depressive disorders

Although perfectionism has been identified as a factor in many psychiatric disorders across the life span, it is relatively understudied in pediatric anxiety and depressive disorders. Furthermore, there exists little cohesion among previous research, restricting the conclusions that can be made across studies. In this review, research associating perfectionism with pediatric anxiety and depression is examined and a framework is presented synthesizing research to date. We focus on detailing the current understanding of how perfectionism develops and interacts with other developmental features characteristic of anxiety and depression in children and potential pathways that result in anxiety and depressive disorders. This includes: how perfectionism is measured in children, comparisons with relevant adult literature, the development of perfectionism in children and adolescents, mediators and moderators of the link between perfectionism and anxiety and depression, and the role of perfectionism in treatment and prevention of these disorders. We also present research detailing perfectionism across cultures. Findings from these studies are beginning to implicate perfectionism as an underlying process that may contribute broadly to the development of anxiety and depression in a pediatric population. Throughout the review, difficulties, limitations, and gaps in the current understanding are presented while offering suggestions for future research.

Personality vulnerabilities in adolescent suicidality: The mediating role of psychological distress

The research literature consistently indicates that self-criticism is related to suicidality. Evidence for the role of dependency, however, is more controversial. This study examines the extent to which these personality vulnerabilities are mediated by psychological distress in the prediction of suicidality. As part of a study of adolescent psychopathology, a sample of 260 Portuguese adolescents (148 [56.9 %] female and 112 [43.1%] male), ranging in age from 15 to 18 years (M = 16.32, SD = 1.19) completed measures of personality, suicidal behavior, and current distress, in counterbalanced order. The measures were: self-criticism and dependency from the Depressive Experiences Questionnaire for Adolescents; two psychological distress scales, social withdrawal from the Youth Self Report and depression from the Center for Epidemiologic Studies of Depression Scale; and a measure of suicidality from the Suicide Behaviors Questionnaire Revised. Structural equation modeling indicated that self-criticism and dependency were both significantly associated with suicidality. Psychological distress, however, as measured by withdrawal and depression, fully mediated these relationships, but did not moderate them. The authors conclude that adolescents with higher levels of self-criticism and dependency are at greater risk for experiencing intense psychological distress-high levels of social withdrawal and depression-that account for their vulnerability to suicide risk.

An exploratory study of nonsuicidal self-injury and suicidal behaviors in adolescent Latinas

To date, there is little research to validate empirically differences between nonsuicidal self-injurious behavior (NSSI) and attempted suicide among Latina adolescents. Understanding the characteristics and contextual features of self-harmful behaviors among Latina teens is a critical public health and social justice matter given the disproportionate rates of attempted suicide and anticipated population growth of this vulnerable group. In this article, we draw on an ecodevelopmental model to focus attention on factors in the sociocultural environment that shape suicidal behaviors and NSSIs. Through analysis of qualitative interviews conducted with girls who used NSSI (n = 18), attempted suicide (n = 29), used NSSI and attempted suicide (n = 8,) and had no reported lifetime history of self-harm (n = 28), we describe the sociocultural factors that shaped psychosocial vulnerabilities and gave rise to decisions to use NSSI or attempt suicide. Our analysis revealed that adolescents who engaged in NSSI perceived their negative feelings as something that could be controlled through self-injurious acts, whereas powerlessness was a theme underlying the emotional states of girls who attempted suicide. When NSSI ceased to function as a mechanism for control, girls came to sudden decisions to attempt suicide. Most teens identified specific, and often multiple, situations that induced intense affective states and shaped decisions to inflict self-harm. Two situational experiences emerged as particularly salient and promising for subsequent studies on self-harmful behaviors among Latina adolescents: transnational stress and bullying. We describe each of these and offer suggestions for future research and practice.

Negative cognitive styles synergistically predict suicidal ideation in bipolar spectrum disorders: a 3-year prospective study

Rates of suicidal ideation and behavior are extremely high in bipolar spectrum disorders (BSDs). However, relatively little work has evaluated potentially synergistic relationships between cognitive and emotion-regulatory processes proposed by theoretical models of suicidality in BSDs. The present study evaluated whether negative cognitive style and subtypes of rumination would exacerbate the impact of self-criticism on suicidal ideation in a prospective study of individuals with BSDs. Seventy-two young adults with BSDs (bipolar II, bipolar NOS, or cyclothymia) completed diagnostic interviews and trait measures of self-criticism, negative cognitive style, and brooding and reflective rumination at a baseline assessment. The occurrence of suicidal ideation was assessed as part of diagnostic interviews completed every 4 months for an average of 3 years of follow-up. Negative cognitive style and reflective rumination strengthened the association between self-criticism and the prospective occurrence of suicidal ideation across follow-up. Individuals with high levels of self-criticism in conjunction with negative cognitive style or reflective rumination were most likely to experience the onset of suicidal ideation. Self-criticism may work synergistically with negative cognitive style and rumination to confer risk for suicidal ideation in bipolar spectrum disorders. These results support theoretical models of suicidality in BSDs and indicate that evaluating and understanding negative cognitive styles may help to identify individuals who are at risk of suicide.

The Destructiveness of Perfectionism Revisited: Implications for the Assessment of Suicide Risk and the Prevention of Suicide

Although perfectionism is recognized as a factor that is linked with suicide, we maintain that the role of perfectionism as an amplifier of the risk of suicide has been underestimated due to several factors. In the current article, contemporary research on the role of perfectionism in suicide is reviewed and summarized. Several themes are addressed, including: (a) consistent evidence linking suicide ideation with chronic exposure to external pressures to be perfect (i.e., socially prescribed perfectionism); (b) the roles of perfectionistic self-presentation and self-concealment in suicides that occur without warning; and (c) how perfectionism contributes to lethal suicide behaviors. We also summarize data showing consistent links between perfectionism and hopelessness and discuss the need for a person-centered approach that recognizes the heightened risk for perfectionists who also tend to experience hopelessness, psychache, life stress, overgeneralization, and a form of emotional perfectionism that restricts the willingness to disclose suicidal urges and intentions. It is concluded that when formulating clinical guidelines for suicide risk assessment and intervention and public health approaches to suicide prevention, there is an urgent need for an expanded conceptualization of perfectionism as an individual and societal risk factor. We also discuss why it is essential to design preventive programs tailored to key personality features with specific components that should enhance resilience and reduce levels of risk among perfectionists who hide behind a mask of apparent invulnerability.

The role of socially prescribed perfectionism in the link between perceived racial discrimination and African American adolescents' depressive symptoms

Research examining the social origins of perfectionism has focused on negative evaluative experiences in the family, with less attention to negative social evaluations in other contexts and situations relevant for African American adolescents. The experience of racial discrimination is common for African American youth, and may trigger maladaptive perfectionistic beliefs if the youth perceive that they do not meet others' standards (socially prescribed perfectionism) or internalize discriminatory messages. Thus, the present study examined longitudinal associations among racial discrimination, socially prescribed perfectionism, and depressive symptoms among a community sample of urban and predominantly low income African American adolescents (n = 492; 46.7 % female). In each of grades 7, 8 and 9, participants reported their experiences with racial discrimination, perfectionistic beliefs, and depressive symptoms. Analyses revealed that experiences with racial discrimination in grade 7 were associated with socially prescribed perfectionism in grade 8 which, in turn, was linked with depressive symptoms in grade 9. Results suggest that prospective associations between the experience of racial discrimination and depressive symptoms are due, in part, to increased socially prescribed perfectionism. Implications for interventions targeting depression in African American are discussed.

Hopelessness and Suicide Proneness in U.S. and Japanese College Students

Few empirical studies have focused on the associations among suicide proneness, hopelessness, and depression cross-culturally. The current study examined the potential to determine differences in the overall expression of suicide proneness between Japanese ( n = 396) as compared with U.S. ( n = 417) college students. Depressive symptoms were considered as a potential mediator of the relation between hopelessness and suicide proneness in both samples of students. Preliminary analyses focused on estimates of internal consistency reliability and differential item functioning (DIF) on the measures of hopelessness, depressive symptoms, and suicide proneness. Results of the primary analyses revealed that Japanese students reported more suicide proneness, greater hopelessness, and higher levels of depressive symptoms than did U.S. students. As expected, hopelessness and depressive symptoms were significantly associated with suicide proneness in both cultures. Additionally, the hopelessness–suicide proneness link was significantly mediated by depressive symptoms in both samples. Implications are offered for improved identification and treatment of college students at risk of suicidal behaviors both in the United States and in Japan.

Shame behind the masks: the parents' perspective on their sons' suicide

Suicides are more frequent among boys than girls. A tentative, conceptual model of processes behind suicide among boys and young men (aged 12-25), grounded in their parents' views, is presented. Extensive interviews with parents in 33 cases of suicide were analyzed using grounded-theory methodology. Family alliances, coalitions, and secrets interacted with the boy concealing problems and "hiding behind a mask," while the professionals did not understand the emergency. Four interwoven paths to suicide were found: the boy was hunted and haunted, addicted, depressed, or psychotic. Different forms of shame were hidden behind the masks of "the clown," "the warrior," and "the prince." Future preventive programs need to address barriers to communication among all parties involved.

Are suicide attempts by young Latinas a cultural idiom of distress?

The high rates of suicide attempts among adolescent Hispanic females in the United States have been well established by epidemiological and clinical studies. In this paper, we review the research history of Latina suicide attempts and their characteristics. Then we apply multi-faceted conceptual and empirical criteria found in the anthropological and psychiatric literature about cultural idioms of distress to the suicide attempts of young Latinas. We contrast the suicide-attempt phenomenon to the well-known ataque de nervios and propose that the phenomenon may reflect a developmental or cultural variant of the ataque. The attempt-as-idiom proposition is intended to invite discussion that can deepen our understanding of the cultural roots of the suicide attempts and their possible designation as cultural idiom. Establishing the meaning of suicide attempts within a cultural perspective can assist psychological and psychiatric research and clinical interventions.

Socially Prescribed and Self-Oriented Perfectionism as Predictors of Depressive Diagnosis in Preadolescents

Perfectionism has been shown to be related to depressive symptomatology in both adult and child populations. However, there are no known studies of levels of socially prescribed (SPP) and self-oriented perfectionism (SOP) in nonclinical children versus those with a clinically diagnosed depressive disorder. Therefore, the aim of the current study was to examine SPP and SOP as predictors of depressive diagnoses in a sample of 10- to 11-year-old children. Seven hundred and eighty-six children (390 boys, 396 girls) from primary schools in low socio-economic metropolitan areas completed the Children's Depression Inventory (CDI) and the Child and Adolescent Perfectionism Scale (CAPS) as part of a larger study. Children who scored above the clinical cut-off for the CDI also completed part of the Diagnostic Interview for Children and Adolescents–IV. Fifty children met criteria for a diagnosis of a depressive disorder. Binary logistic regression analysis was used to predict diagnostic status from SPP, SOP, gender, and intervention group. SPP was the only significant predictor of diagnostic status. Implications for the treatment and prevention of childhood depression are discussed.

Sexual attraction status and adolescent suicide proneness: the roles of hopelessness, depression, and social support

This study explored the relationship between sexual attraction status (same-sex, both-sex, and opposite-sex) and suicidal behavior in a diverse sample of adolescents (N = 1,533 youth). Adolescents with attractions to both sexes reported greater suicide proneness, recent and lifetime suicidal ideation, and past suicide attempts than those with exclusively opposite-sex attractions; individuals reporting same-sex attractions generally demonstrated moderate elevations on these variables. As hypothesized, both hopelessness and depression mediated the relationship between sexual attraction status and suicide proneness. Social support moderated the mediating effect of depression but not hopelessness in the sexual attraction status-suicide proneness link. Targeting the distress that can be associated with experiencing same-sex or both-sex attractions may enhance suicide prevention efforts, particularly in U.S. youth with reduced social support.

Dysfunctional attitudes scale perfectionism: a predictor and partial mediator of acute treatment outcome among clinically depressed adolescents

The effect of perfectionism on acute treatment outcomes was explored in a randomized controlled trial of 439 clinically depressed adolescents (12-17 years of age) enrolled in the Treatment for Adolescents with Depression Study (TADS) who received cognitive behavior therapy (CBT), fluoxetine, a combination of CBT and FLX, or pill placebo. Measures included the Children's Depression Rating Scale-Revised, the Suicidal Ideation Questionnaire-Grades 7-9, and the perfectionism subscale from the Dysfunctional Attitudes Scale (DAS). Predictor results indicate that adolescents with higher versus lower DAS perfectionism scores at baseline, regardless of treatment, continued to demonstrate elevated depression scores across the acute treatment period. In the case of suicidality, DAS perfectionism impeded improvement. Treatment outcomes were partially mediated by the change in DAS perfectionism across the 12-week period.

Predicting depression, anxiety and self-harm in adolescents: the role of perfectionism and acute life stress

Despite the growing evidence that perfectionism is associated with adolescent psychological distress, few studies have investigated this relationship prospectively with measures designed for use in adolescent populations. In the present study, within a diathesis-stress framework, we investigated the extent to which perfectionism and acute life stress predict depression, anxiety and self-harm among adolescent school children (n = 515) over a 6 month period (Time 1-Time 2). Socially prescribed perfectionism (SPP), self-oriented perfectionism-critical (SOP-critical) and the associated interactions with acute life stress differentially predicted anxiety, depression and self-harm. Acute life stress was an independent predictor of depression, anxiety and self-harm. SPP predicted depression and interacted with acute life stress to predict self-harm. SOP-critical and the SOP-critical by acute life stress interaction predicted anxiety. Self-oriented perfectionism-striving (SOP-striving) did not predict any of the Time 2 measures of distress. The dimensions of perfectionism are differentially associated with psychological distress. Tailored clinical interventions focused on adolescent perfectionism should offer promise in tackling psychological morbidity in adolescence.

Predictors of hopelessness among clinically depressed youth

BACKGROUND

Factors that distinguish depressed individuals who become hopeless from those who do not are poorly understood.

METHOD

In this study, predictors of hopelessness were examined in a sample of 439 clinically depressed adolescents participating in the Treatment for Adolescents with Depression Study (TADS). The total score of the Beck Hopelessness Scale (BHS) was used to assess hopelessness at baseline. Multiple regression and logistic regression analyses were conducted to evaluate the extent to which variables were associated with hopelessness and determine which cluster of measures best predicted clinically significantly hopelessness.

RESULTS

Hopelessness was associated with greater depression severity, poor social problem-solving, cognitive distortions, and family conflict. View of self, view of the world, internal attributional style, need for social approval, positive problem-solving orientation, and family problems consistently emerged as the best predictors of hopelessness in depressed youth.

CONCLUSIONS

Cognitive and familial factors predict those depressed youth who have high levels of hopelessness.

Specific depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence

OBJECTIVE

To examine the role of depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence.

METHOD

A representative sample of Norwegian school students (N = 2464, mean age 13.7 years) in grades 8 and 9 was reassessed after one year (T2) with the same questionnaire. All high scorers of depressive symptoms on the Mood and Feelings Questionnaire (MFQ) at T2 were defined as cases. One control from low or middle scorers, matched for age and gender, was randomly assigned to every two cases. This subset (n = 345) was diagnostically assessed by face-to-face K-SADS-PL interviews (mean age = 14.9 years). The same subset was reassessed after 5 years (T3) by using the same questionnaire (n = 252, mean age = 20.0 years) and telephone K-SADS-PL interviews (n = 242). The participation rate was 76.9% (n = 265).

RESULTS

Cognitive symptoms dominated the depressive symptom profile among suicide attempters, irrespective of age and time. Among younger adolescents, suicidal thoughts and acts of self-harm without suicidal intent were associated with suicidal acts. Recurrent thoughts about death, hopelessness, disturbed concentration and middle insomnia were associates of suicidal acts among older adolescents. Worthlessness by 15 years was a significant predictor of suicidal acts between 15 to 20 years. MDD and a depressive episode, not otherwise specified, continued to be significant associates among younger adolescents, while dysthymia by 15 years remained a predictor of suicidal acts between 15 to 20 years, even when controlled for depressive symptoms.

CONCLUSIONS

Self-harm without suicidal intent, middle insomnia, cognitive depressive symptoms and a formal psychiatric diagnosis of any depressive disorder should alert professionals in the risk assessment of suicidal adolescents.

The relations between perfectionism and suicidality: a systematic review

Since the 1980s, there has been a 300 percent increase in the number of published papers on perfectionism. Given the inconsistent findings in the literature, this systematic review examines, for the first time, the nature of the relationship between perfectionism and suicidality. To this end, the three main psychological and medical databases (PsychInfo 1887-May 2006, Medline 1966-May 2006 and Web of Knowledge 1981-May 2006) were searched. Twenty nine papers of perfectionism and suicidality were found. There is considerable evidence that selfcritical evaluative concerns perfectionism (i.e., socially prescribed perfectionism, self-criticism, concern about mistakes, and doubts about action) is correlated with suicidality. The methodological implications for future research are examined. In addition, the clinical implications for treatment and how these findings relate to the current conceptual debate on the nature of perfectionism are discussed.

Self-oriented perfectionism in eating disorders

OBJECTIVE

To assess perfectionism dimensions in eating disorders in comparison with other psychiatric disorders and subjects from the general population.

METHOD

The Child and Adolescent Perfectionism Scale (CAPS), the Eating Disorders Inventory (EDI-2), and the Eating Attitudes Test (EAT) were administered to a group of 108 female eating-disordered patients (75 anorexia nervosa and 33 bulimia nervosa), to a group of 86 female psychiatric patients with anxiety (N = 32), depressive (N = 38), or adaptive disorders (N = 16), and to 213 healthy female participants.

RESULTS

Both bulimic and anorexic patients scored higher on Self-Oriented Perfectionism (p < 0.001) than the other two groups but not on Socially-Prescribed Perfectionism (p = 0.054). Among patients with eating disorder, 17.6% obtained a score two standard deviations higher than the mean in the healthy comparison group on self-oriented perfectionism; this percentage was significantly higher than in the other two groups. The percentage of eating disorder patients with high socially-prescribed perfectionism was similar to that found in other psychiatric disorders. Moreover, self-oriented perfectionism was a predictor of an eating disorder.

CONCLUSION

Self-oriented perfectionism is more specific to eating disorders than to depressive or anxiety disorders.

Assessing potential suicide risk of young adults burned as children

This study examines potential for suicide risk among young adults burned as children and examines characteristics associated with potential risk. Eighty-five young adults were administered the Suicide Probability Scale, which contains four clinical subscales: suicide ideation, hopelessness, negative self-evaluation, and hostility; the 16 Personality Factor Questionnaire; and the Family Environment Scale. Burn survivors reported more feelings of hopelessness in comparison to the reference group. High anxiety was positively associated with hopelessness, suicide ideation, hostility and negative self-evaluation whereas high extroversion was inversely related with hopelessness, negative self-evaluation, and hostility. Multiple regression analyses revealed emotional stability explained 29% of the variance, self-reliance 17% of the variance, and both 38% of the variance in relation to Suicide Probability Scale scores; and increased family conflict 12% of the variance. Results suggest that high anxiety, emotional reactivity, and family conflict correlate with increased potential suicide risk; whereas, extroversion correlates with decreased risk.

Self-criticism and depressive symptomatology interact to predict middle school academic achievement

Although previous research has implicated adolescent depression in academic difficulties, few studies have explored the role of cognitive/personality factors in this area. To address this gap, the present study examines the role of self-criticism in academic functioning among early adolescent students over a 1-year interval. We hypothesized and found that adolescent self-criticism and depressive symptomatology interacted to predict decreased grade point average (GPA) over time, an interaction that was found predominantly in boys. This finding illustrates the need to integrate research on personality and psychopathology into educational psychology.

Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review

OBJECTIVE

Involvement of personality traits in susceptibility to suicidality has been the subject of research since the 1950s. Because of the diversity of conceptual and methodological approaches, the extent of their independent contribution has been difficult to establish. Here, we review conceptual background and empirical evidence investigating roles of traits in suicidal behaviors.

METHOD

We selected original studies published in English in MEDLINE and PsycINFO databases, focusing on suicidal ideation, suicide attempts, or suicide completions, and using standardized personality measures.

RESULTS

Most studies focused on investigating risk for suicide attempts. Hopelessness, neuroticism, and extroversion hold the most promise in relation to risk screening across all three suicidal behaviors. More research is needed regarding aggression, impulsivity, anger, irritability, hostility, and anxiety.

CONCLUSION

Selected personality traits may be useful markers of suicide risk. Future research needs to establish their contributions in relation to environmental and genetic variation in different gender, age, and ethnocultural groups.

Why do so many latina teens attempt suicide? A conceptual model for research

Rates of suicide attempts among adolescent Latinas have been reported to be higher than for their non-Hispanic counterparts. Yet researchers know very little about the attempts, their antecedents, and why the girls attempt suicide. Latina girls have been included in research on suicidal adolescents and typically show higher rates of attempts relative to similar psychopathology when compared with other young women. A few small studies have focused on Latinas, but none have explored why suicide attempt rates are higher. The authors constructed a conceptual model to provide a formulation of this phenomenon on the basis of a review of the literature on suicide attempts among Latinas and their clinical experience. This model can serve as a framework to guide research on the unique sociocultural processes present in Latina adolescent suicide attempts and may also benefit the work of clinicians.

Psychological dimensions associated with suicidal ideation and attempts in the National Comorbidity Survey

Three important psychological dimensions in the suicide literature (neuroticism, self-criticism, and hopelessness) were examined in relation to suicidal ideation and attempts in the U.S. National Comorbidity Survey (Kessler et al., 1994; n = 5,877), after first controlling for the effects of previously identified sociodemographic and psychiatric variables related to suicidality in this nationally representative sample (Kessler, Borges, & Walters, 1999). Analyses were conducted separately for lifetime, current (12-month), and past history of suicidal ideation and attempts. Brief indices of self-criticism and hopelessness were robustly associated with suicide attempts across all three time frames. The results support the value of examining psychological individual differences over sociodemographic and psychiatric diagnoses alone in the comprehensive assessment of factors associated with suicidality in the general population.

An interactive-synergetic approach to the assessment of personality vulnerability to depression: Illustration using the adolescent version of the Depressive Experiences Questionnaire

Research on personality vulnerability to depression is characterized by a "main effect" approach, often at the expense of examining interactions among various dimensions of vulnerability. To compare the "main effect" and "interactive-synergetic" approaches, we utilized data from a longitudinal study of adolescent adjustment. Focusing on dependency, self-criticism, and efficacy, the three factors of the adolescent version of the Depressive Experiences Questionnaire (DEQ; Blatt, Schaffer, Bers, & Quinlan, 1992), we found support for the interactive-synergetic approach. Dependency and self-criticism interacted in predicting changes in depressive and internalizing symptoms (under low efficacy), and among boys-changes in internalizing and externalizing symptoms. Results illuminate the synergetic interplay among dimensions of risk and resilience in clinical research and practice.

Personality predictors of outcome for adolescents hospitalized for suicidal ideation

OBJECTIVE

Recent cross-sectional studies of adolescents have noted an association between the personality traits of perfectionism and self-criticism and suicidal ideation. The present study was undertaken to examine the relationship between personality dimensions and the outcome of treatment of adolescents hospitalized for suicidal ideation or behavior.

METHOD

The study group was composed of 78 adolescents who were admitted to an adolescent psychiatric inpatient unit for suicidal ideation or attempts. Subjects completed measures of self-criticism, interpersonal dependency, self-oriented perfectionism, and socially prescribed perfectionism as well as the broad, higher-order trait neuroticism. Depression symptoms, hopelessness, and suicidal ideation were assessed at the beginning (time 1) and end (time 2) of their inpatient treatment. Readmissions were identified by review of medical records 1 year after hospital discharge.

RESULTS

After controlling for baseline symptoms, neuroticism was associated with posttreatment depression and suicidal ideation. After controlling for time 1 symptoms and neuroticism in multiple regression analyses, self-criticism was associated with post-treatment hopelessness and depression. Logistic regression analysis was used to identify predictors of readmission. Baseline suicidal ideation and neuroticism were predictive of psychiatric readmission within 1 year of discharge.

CONCLUSIONS

Neuroticism and self-criticism are potentially useful predictors of outcome in suicidal adolescents and can be assessed quickly and reliably. Therapeutic interventions directed at self-criticism (e.g., cognitive-behavioral therapy) may be useful in the treatment of suicidal adolescents.

Ten-year review of rating scales. III: scales assessing suicidality, cognitive style, and self-esteem

OBJECTIVE

This is the third article in a series of 10-year reviews of rating scales. Here, the authors review scales that are useful in tapping the affective disturbances experienced with various psychiatric disorders, including suicidality, cognitive style, and self-esteem.

METHOD

The authors sampled articles incorporating these constructs over the past 25 years and selected scales with established uses or new development. Those presented here have adequate psychometric properties and high utility for efficiently elucidating youths' functioning, plus either wide literature citations or a special niche.

RESULTS

These scales were developed bimodally. Many were developed in the 1980s when internalizing disorders were elucidated, but there has been a resurgence of interest in these constructs. Scales assessing suicidality have clear constructs, whereas scales of cognitive style demonstrate deficits in developmental relevance, and scales of self-esteem suffer from lax constructs.

CONCLUSIONS

The constructs underlying these scales tap core symptoms of internalizing disorders, mediate the expression of affective disturbances associated with various disorders, and depict the impairments resulting from these disorders. Overall, the psychometrics of these scales are adequate. These scales provide a broader representation of youths' functioning than that conveyed with diagnostic scales alone.

Perfectionism and psychopathology: a review of research and treatment

Clinical experience suggests that perfectionism can impede the successful treatment of psychological disorders. This review examines the concept of perfectionism, critically evaluates its assessment, reviews the association between existing measures of perfectionism and psychopathology, and considers the impact of perfectionism on treatment. It is concluded that existing measures do not reflect the original construct of perfectionism and that, consequently, new measures are needed. The evidence reviewed indicates that high personal standards are specifically elevated in patients with eating disorders and beliefs about others' high standards for the self are associated with a broad range of psychopathology. The importance of examining mean scares across studies (as well as associations between variables within studies) is emphasized. There has been no systematic evaluation of the treatment of perfectionism despite existing cognitive-behavioral treatment protocols.