Violent victimization and perpetration as distinct risk factors for adolescent suicide attempts

Why do adolescents attempt suicide? Insights from leading ideation-to-action suicide theories: a systematic review

Suicide is a leading cause of death among adolescents, and recent suicide theories have sought to clarify the factors that facilitate the transition from suicide ideation to action. Specifically, the Interpersonal Theory of Suicide (IPTS), Integrated Motivational-Volitional Model (IMV), and Three Step Theory (3ST) have highlighted risk factors central to the formation of suicidal ideation and suicidal behaviors, which is necessary for suicide death. However, these models were initially developed and tested among adults, and given core socioemotional and neurodevelopmental differences in adolescents, the applicability of these models remains unclear. Directly addressing this gap in knowledge, this systematic review aimed to (1) describe the evidence of leading ideation-to-action theories (i.e., IPTS, IMV, 3ST) as they relate to suicide risk among adolescents, (2) integrate ideation-to-action theories within prevailing biological frameworks of adolescent suicide, and (3) provide recommendations for future adolescent suicide research. Overall, few studies provided a complete test of models in adolescent samples, and empirical research testing components of these theories provided mixed support. Future research would benefit from integrating neurodevelopmental and developmentally sensitive psychosocial frameworks to increase the applicability of ideation-to-action theories to adolescents. Further, utilizing real-time monitoring approaches may serve to further clarify the temporal association among risk factors and suicide.

Childhood adversity and mental health admission patterns prior to young person suicide (CHASE): a case-control 36 year linked hospital data study, Scotland UK 1981-2017

BACKGROUND

Childhood adversity is associated with increased later mental health problems and suicidal behaviour. Opportunities for earlier healthcare identification and intervention are needed.

AIM

To determine associations between hospital admissions for childhood adversity and mental health in children who later die by suicide.

METHOD

Population-based longitudinal case-control study. Scottish in-patient general and psychiatric records were summarised for individuals born 1981 or later who died by suicide between 1991 and 2017 (cases), and matched controls (1:10), for childhood adversity and mental health (broadly defined as psychiatric diagnoses and general hospital admissions for self-harm and substance use).

RESULTS

Records were extracted for 2477 'cases' and 24 777 'controls'; 2106 cases (85%) and 13 589 controls (55%) had lifespan hospitalisations. Mean age at death was 23.7; 75.9% were male. Maltreatment or violence-related childhood adversity codes were recorded for 7.6% cases aged 10-17 (160/2106) versus 2.7% controls (371/13 589), odds ratio = 2.9 (95% CI, 2.4-3.6); mental health-related admissions were recorded for 21.7% cases (458/2106), versus 4.1% controls (560/13 589), odds ratio = 6.5 (95% CI, 5.7-7.4); 80% of mental health admissions were in general hospitals. Using conditional logistic models, we found a dose-response effect of mental health admissions <18y, with highest adjusted odds ratio (aOR) for three or more mental health admissions: aORmale = 8.17 (95% CI, 5.02-13.29), aORfemale = 15.08 (95% CI, 8.07-28.17). We estimated that each type of childhood adversity multiplied odds of suicide by aORmale = 1.90 (95% CI, 1.64-2.21), aORfemale = 2.65 (95% CI, 1.94-3.62), and each mental health admission by aORmale = 2.06 (95% CI, 1.81-2.34), aORfemale = 1.78 (95% CI, 1.50-2.10).

CONCLUSIONS

Our lifespan study found that experiencing childhood adversity (primarily maltreatment or violence-related admissions) or mental health admissions increased odds of young person suicide, with highest odds for those experiencing both. Healthcare practitioners should identify and flag potential 'at-risk' adolescents to prevent future suicidal acts, especially those in general hospitals.

Protective factors for suicidal ideation among Black adolescents indirectly exposed to community violence

OBJECTIVE

Community violence exposure has been identified as a risk factor for Black youth suicide ideation. However, little is known about factors that protect community violence exposed youth against suicide ideation. The current study examined associations between knowledge of family member and peers' community violence exposure and Black youth's subsequent suicidal ideation, and investigated self-worth and social support as protective factors.

METHOD

Participants were a community sample of Black youth (N = 447, 47.4% female; Mage = 11.77, SD = 0.35) who reported about community violence exposure, self-worth, social support, and suicide ideation in grades 6 and 7.

RESULTS

Regression analyses revealed that grade 6 knowledge of family member and peers' community violence exposure was associated with increases in suicide ideation assessed in grade 7. Self-worth attenuated the association between knowledge of others' community violence exposure and suicide ideation for male adolescents. For female adolescents, social support attenuated the association between knowledge of others' community violence and suicide ideation.

CONCLUSIONS

Findings highlight the consequential impact of knowledge about community violence for Black youth's suicidal ideation. Enhancing protective factors for Black youth is an important target for intervening with exposure to violence and reducing suicide ideation.

Distinguishing prisoners who think about suicide from those who attempt suicide

BACKGROUND

Many people who consider suicide do not translate these intentions into action. Although prisoners constitute a particularly high-risk group for suicide, little is known about the factors that distinguish those who think about suicide from those who attempt suicide.

METHODS

Participants were 1326 adult offenders (1203 men) randomly selected from 15 Belgian prisons, representing 14% of the national prison population. Multivariate regression analysis compared prisoners who attempted suicide (n = 277) with those who thought about suicide but never made an attempt (n = 312) on a range of established risk factors.

RESULTS

Among the 589 participants reporting a lifetime history of suicidal ideation (44% of the total sample), almost half (47%) had made a suicide attempt. Relative to those who only thought about suicide, participants who attempted suicide were more likely to be violent offenders (aOR 2.33, 95% CI 1.49-3.62) and have a history of non-suicidal self-injury (aOR 3.19, 95% CI 2.09-4.86). The presence of self-reported mental disorder diagnosis (aOR = 2.84, 95% CI 1.91-4.24) and illicit substance abuse (aOR = 2.01, 95% CI 1.24-3.28) also independently differentiated prisoners who attempted v. considered suicide.

CONCLUSION

This study provides preliminary evidence that behavioural and mental health factors are implicated in the transition from thoughts to acts of suicide in prisoners. Prospective studies are warranted to explore whether these risk factors predict progression from ideation to action over time.

What Differentiates Prisoners Who Attempt Suicide from Those Who Experience Suicidal Ideation? A Nationally Representative Study

OBJECTIVE

Many people who think about suicide do not engage in suicidal behavior. Identifying risk factors implicated in the process of behavioral enaction is crucial for suicide prevention, particularly in high-risk groups such as prisoners.

METHOD

Cross-sectional data were drawn from a nationally representative sample of 17,891 prisoners (79% men) in the United States. We compared prisoners who attempted suicide (attempters; n = 2,496) with those who thought about suicide but never made an attempt (ideators; n = 1,716) on a range of established risk factors.

RESULTS

More than half (59%) of participants who experienced suicidal ideation had also attempted suicide. Violent offending, trauma, brain injury, alcohol abuse, and certain mental disorders distinguished attempters from ideators.

CONCLUSION

Our results fit within recent ideation-to-action theories that emphasize the role of a capability for suicide in the transition from thoughts to acts of suicide.

Qualitative Process Evaluation of Rural Schools: Uptake of Change Processes and Contextual Factors Influencing Implementation Within a Primary Prevention Program for Youth

Sexual violence (SV), homophobic name-calling, and bullying commonly occur in school settings. As such, comprehensive school-based violence prevention strategies are needed. Recent calls in prevention science argue that investigations of preventive interventions must move beyond simply testing if programs work; rather, they must also examine how interventions work. The purpose of this study was to explore the differential uptake of salient change mechanisms of a school-based primary prevention program, Sources of Strength (Sources) in rural schools, and examine contextual factors that may influence implementation outcomes in rural contexts. As a supplement to a randomized controlled trial of Sources in 20 high schools in Colorado, the present project utilized a rigorous qualitative design to conduct staff focus groups and student interviews within four schools (two intervention and two waitlist schools) that participated in the RCT. Results suggest variability in uptake of Sources key processes (expansion of networks to build connections, school-wide activities, and staff support) in intervention schools. While these were indicated as non-formalized processes in waitlist schools, there was also variability in these reports. Furthermore, results revealed specific contextual factors including cultural norms, degree of rurality, and school-level buy-in/investment that impacted implementation outcomes for intervention and waitlist schools (e.g., pre-implementation readiness). Implications are discussed around alignment of a school's policies, procedures, and values with the preventative intervention in effort to support strong implementation.