Associations between risk behaviors and suicidal ideation and suicide attempts: do racial/ethnic variations in associations account for increased risk of suicidal behaviors among Hispanic/Latina 9th- to 12th-grade female students?

Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis

BACKGROUND

Adolescence is characterized by complex and dynamic changes, often involving experimentation, including the use of psychotropic substances. Although it is well-established that recreational psychotropic drugs are associated with suicide ideation in adults, evidence of this association in adolescents remains limited.

OBJECTIVE

To investigate the relationship between suicide ideation and psychotropic recreational drug use among adolescents.

DESIGN AND SETTING

Systematic review with meta-analysis developed at Universidade Federal de Uberlândia (UFU) and Universidade Estadual de Campinas (UNICAMP), Brazil.

METHODS

A search across eight electronic databases for observational studies, without language or publication year restrictions, was conducted. The Joanna Briggs Institute tool was used to assess the risk of bias. Random-effects meta-analyses and odds ratios were used to measure the effects.

RESULTS

The search yielded 19,732 studies, of which 78 were included in the qualitative synthesis and 32 in the meta-analysis. The findings indicated that suicidal ideation was 1.96 times more likely (95% confidence interval, CI = 1.47; 2.61) for adolescents who used some drug recurrently and 3.32 times more likely (95%CI = 1.86; 5.93) among those who abused drugs. Additionally, adolescents who used cannabis were 1.57 times more likely (95%CI = 1.34; 1.84) to experience suicide ideation compared with non-users, while cocaine users had 2.57 times higher odds (95%CI = 1.47; 4.50).

CONCLUSIONS

Psychotropic recreational drug use is associated with suicidal ideation among adolescents regardless of current or previous use, abuse, or type of substance used.

SYSTEMATIC REVIEW REGISTRATION

Registered in the PROSPERO database under the identification number CRD42021232360. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232360.

Suicidal Ideation among Adolescents: A Case of Bullying Victimization and Emotional Intelligence

This paper attempted to examine suicidal ideation among adolescents in terms of bullying victimization and emotional intelligence. It had been observed that adolescents have to face the challenge of suicidal ideation through bullying and reduce it through emotional intelligence. A sample of 1017 adolescents was sampled from public sector primary schools in the district of Gujrat, Punjab, Pakistan to conduct the cross-sectional survey. For this study, the scale of bullying victimization (Illinois Bullying Scale by Espelage & Holt, 2001), emotional intelligence (Emotional Intelligence Scale for Children & Adolescents by Batool & Hayat, 2018) and suicidal ideation (Suicidal Ideation Attribution Scale by Van Spijker, 2014) had been used to measure the responses of the students. The study findings pointed out that emotional intelligence was a significant negative predictor of suicidal ideation. Similarly, the analysis showed that bullying victimization was a significant predictor of suicidal ideation among adolescents.

Oral contraceptive use and risk of suicidal behavior among young women

BACKGROUND

Oral contraceptive use has been previously associated with an increased risk of suicidal behavior in some, but not all, samples. The use of large, representative, longitudinally-assessed samples may clarify the nature of this potential association.

METHODS

We used Swedish national registries to identify women born between 1991 and 1995 (N = 216 702) and determine whether they retrieved prescriptions for oral contraceptives. We used Cox proportional hazards models to test the association between contraceptive use and first observed suicidal event (suicide attempt or death) from age 15 until the end of follow-up in 2014 (maximum age 22.4). We adjusted for covariates, including mental illness and parental history of suicide.

RESULTS

In a crude model, use of combination or progestin-only oral contraceptives was positively associated with suicidal behavior, with hazard ratios (HRs) of 1.73-2.78 after 1 month of use, and 1.25-1.82 after 1 year of use. Accounting for sociodemographic, parental, and psychiatric variables attenuated these associations, and risks declined with increasing duration of use: adjusted HRs ranged from 1.56 to 2.13 1 month beyond the initiation of use, and from 1.19 to 1.48 1 year after initiation of use. HRs were higher among women who ceased use during the observation period.

CONCLUSIONS

Young women using oral contraceptives may be at increased risk of suicidal behavior, but risk declines with increased duration of use. Analysis of former users suggests that women susceptible to depression/anxiety are more likely to cease hormonal contraceptive use. Additional studies are necessary to determine whether the observed association is attributable to a causal mechanism.

Emotion dysregulation and hazardous drinking in relation to suicidal ideation among Spanish-speaking Latinx daily-smokers

OBJECTIVE

Suicidal ideation has increased among Latinx individuals in the last decade. Smoking increases the likelihood of suicidal ideation but work on Latinx smokers is minimal. Hazardous drinking and emotion dysregulation could be factors related to suicidal ideation among Latinx smokers, as has been evident in non-Latinx White samples. The current study sought to examine the main and interactive effects of emotion dysregulation and hazardous drinking in relation to suicidal ideation among Latinx daily-smokers.

METHODS

Participants were 371 Spanish-speaking daily-smokers (58.8% female; M_age = 33.3; SD_age = 9.8) recruited from the United States through Qualtrics. We used structural equation modeling (SEM) to test an interactive model of emotion dysregulation and hazardous alcohol consumption in relation to suicidal ideation; we also tested the effect of emotion dysregulation on suicidal ideation as a function of hazardous drinking status.

RESULTS

Results indicated that latent emotional dysregulation was associated with greater suicidal ideation (p < 0.001); however, hazardous drinking was not related to suicidal ideation (p = 0.186). The interactive term of emotional dysregulation and hazardous drinking was significantly related to suicidal ideation (p = 0.017). Specifically, greater emotion dysregulation was significantly related to suicidal ideation among Latinx smokers who engaged in hazardous drinking (p < 0.001) but not those who did not engage in hazardous drinking (p = 0.123).

CONCLUSIONS

The current findings suggest that smoking combined with hazardous drinking may be related to increased suicidal ideation among Latinx smokers. Findings are discussed in relation to the potential role of intervention strategies that focus on emotion dysregulation and hazardous drinking among Latinx current daily smokers to mitigate suicidal risk among this established health disparities population.

The role of temperament in the onset of suicidal ideation and behaviors across adolescence: Findings from a 10-year longitudinal study of Mexican-origin youth

Suicide among young people is an increasingly prevalent and devastating public health crisis around the world. To reduce the rate of suicide, it is important to identify factors that can help us better predict suicidal ideation and behaviors. Adolescent temperament (effortful control, negative emotionality, positive emotionality) may be a source of risk and resilience for the onset of suicidal ideation, plans, and attempts. The present study uses longitudinal data from a large, community sample of Mexican-origin youth (N = 674), assessed annually from age 12 to 21, to examine how temperament is associated with the onset of suicidal ideation and behaviors during adolescence and young adulthood. Results indicate that higher levels of effortful control (activation control, inhibitory control, attention) are associated with decreased probability of experiencing the onset of suicidal ideation, plans, and attempts, whereas higher levels of negative emotionality (particularly aggression, frustration, and depressed mood) are associated with increased probability of experiencing the onset of suicidal ideation and behaviors. Positive emotionality (surgency, affiliation) was not associated with the onset of suicidal ideation and behaviors. Supplemental analyses showed conceptually similar findings for the Big Five, with Conscientiousness associated with decreased risk, Neuroticism associated with increased risk, and the other three dimensions showing largely null results. The findings did not vary significantly for boys and girls or for youth born in the U.S. versus Mexico. Overall, these findings suggest that adolescent temperament serves as both a protective factor (via effortful control/Conscientiousness) and a risk factor (via negative emotionality/Neuroticism) for suicidal ideation and behaviors in Mexican-origin youth. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effects of polygenic risk for suicide attempt and risky behavior on brain structure in young people with familial risk of bipolar disorder

Bipolar disorder (BD) is associated with a 20-30-fold increased suicide risk compared to the general population. First-degree relatives of BD patients show inflated rates of psychopathology including suicidal behaviors. As reliable biomarkers of suicide attempts (SA) are lacking, we examined associations between suicide-related polygenic risk scores (PRSs)-a quantitative index of genomic risk-and variability in brain structures implicated in SA. Participants (n = 206; aged 12-30 years) were unrelated individuals of European ancestry and comprised three groups: 41 BD cases, 96 BD relatives ("high risk"), and 69 controls. Genotyping employed PsychArray, followed by imputation. Three PRSs were computed using genome-wide association data for SA in BD (SA-in-BD), SA in major depressive disorder (SA-in-MDD) (Mullins et al., 2019, The American Journal of Psychiatry, 176(8), 651-660), and risky behavior (Karlsson Linnér et al., 2019, Nature Genetics, 51(2), 245-257). Structural magnetic resonance imaging processing employed FreeSurfer v5.3.0. General linear models were constructed using 32 regions-of-interest identified from suicide neuroimaging literature, with false-discovery-rate correction. SA-in-MDD and SA-in-BD PRSs negatively predicted parahippocampal thickness, with the latter association modified by group membership. SA-in-BD and Risky Behavior PRSs inversely predicted rostral and caudal anterior cingulate structure, respectively, with the latter effect driven by the "high risk" group. SA-in-MDD and SA-in-BD PRSs positively predicted cuneus structure, irrespective of group. This study demonstrated associations between PRSs for suicide-related phenotypes and structural variability in brain regions implicated in SA. Future exploration of extended PRSs, in conjunction with a range of biological, phenotypic, environmental, and experiential data in high risk populations, may inform predictive models for suicidal behaviors.

Positive Relationships with Adults and Resilience to Suicide Attempt among New Mexico Hispanic Adolescents

Suicide is a leading cause of adolescent death and has increased in recent years. The purpose of this study was to examine the effect that relationships with adults at home and in the community had on the probability of suicide attempts of Hispanic teenagers in New Mexico. Data from the 2019 New Mexico Youth Risk and Resiliency Survey were analyzed to identify the ways in which relationships with adults influenced suicide attempts among Hispanic adolescent students. The examined factors included: relationships with adults in the home and in the community and with same-age friends, and participation in hobbies or organizations outside of school. The resiliency factors were similar for male and female Hispanic students. As positive relationships with adults at home or in the community increased, the probability of suicide attempts decreased by 37–54%. Positive relationships with same-age friends were also associated with reduced suicide attempts. Community organization involvement and hobbies affected males and females differently. Adults at home and in the community can decrease the risk of suicide for Hispanic teenagers through supportive relationships. Hybrid programs focusing on adolescent health, positive communication, and academic support, which integrate adults from home and community environments, show promise in reducing suicidal thoughts and other risk behaviors.

Worse for girls?: Gender differences in discrimination as a predictor of suicidality among Latinx youth

INTRODUCTION

Gender and ethnic differences exist in suicidal ideation, plan, and attempt among adolescents in the U.S. However, limited research has used theoretically-informed approaches to integrate how cultural and classic risk factors together account for suicide-related pathways among vulnerable populations. Informed by the interpersonal theory of suicide, the present cross-sectional study examined gender differences in the association between a cultural (i.e., discrimination) and classic (i.e., depressive symptomatology) risk factor, and suicidality among youth of Latin American heritage.

METHODS

A total of 390 Latinx adolescents (ages 13-18; 50% female) attending a high school in Southern California, U.S.A. completed a series of questionnaires that included measures of depressive symptoms, suicidality (including ideation, past attempts, and likelihood of future behavior), perceived discrimination, and demographics.

RESULTS

We found that discrimination was associated with increased suicidality among Latinx adolescents. The discrimination-suicidality association was stronger for girls versus boys, such that girls who experienced greater discrimination demonstrated the highest levels of suicidality. Although depression was also significantly associated with suicidality, the discrimination x gender interaction was found above and beyond the main effect of depressive symptomatology and covariates. Additional analyses revealed significant gender and moderation effects only for suicidal ideation and not for attempts.

CONCLUSIONS

These findings indicate that the relationship between discrimination and suicidality (particularly ideation) is more pronounced for Latinx girls than boys. This study also highlights the importance of drawing on theory-driven and culturally informed work that incorporates classic and cultural correlates of suicidality among diverse subpopulations.

Suicidal behaviors and sedentary lifestyles among adolescents: A cross-sectional epidemiological study in Latin American and Caribbean countries

OBJECTIVES

To verify the association between suicidal behaviors (ideation, planning, and attempts) and sedentary behaviors among adolescents from four Latin American and Caribbean countries.

METHODS

A cross-sectional epidemiological study was conducted in four countries in Latin America and the Caribbean (Bahamas, Curação, El Salvador, and Guatemala). The sample comprised 6,813 adolescents aged 11-18 years, of which, 3,559 were females. The three suicidal behaviors considered were ideation, planning, and attempts. Sedentary behavior was regarded as the time that adolescents spent sitting, excluding time at school. Crude and adjusted logistic regression were used to estimate the odds ratio (OR) and 95% confidence interval (CI).

RESULTS

Suicidal ideation was present in 10.7% of males and 22.7% of females. Suicidal planning was present in 8.6% of males and 16.3% of females. Suicidal attempt was present in 9.3% of males and 16.3% of females. Sedentary behavior was present in 39.6% of males and 45.7% of females. It was identified that male adolescents who reported spending ≥3 hours/day in sedentary behavior were more likely to have suicidal ideation (OR: 1.42; 95% CI: 1.13-1.80), whereas female adolescents who reported spending ≥3 hours/day in sedentary behavior were more likely to have suicidal ideation (OR: 1.55; 95% CI: 1.30-1.83), planning (OR: 1.54; 95% CI: 1.28-1.86), and attempts (OR: 1.31; 95% CI: 1.09-1.57).

CONCLUSION

Adolescents of both sexes who reported spending ≥3 hours/day in sedentary behaviors were more likely to have some suicidal behaviors than those who spent less time in sedentary behaviors.

Prevalence and Predisposing Factors of Suicidal Ideation Among the University Students in Bangladesh: A Single-Site Survey

Recently, suicide among Bangladeshi university students has become a serious problem. However, to date, there have been no studies assessing suicidal behaviors among Bangladeshi students. Therefore, the present study investigated suicidal ideation (SI) and its risk factors among this population. A classroom-based convenience sampling method was utilized to survey 665 students of a university in Bangladesh (67.5% males; aged 21.16 years: SD ± 1.6). In addition to socio-demographic questions, the survey also included the Smartphone Application-Based Addiction Scale, Bergen Facebook Addiction Scale, and Depression Anxiety Stress Scale–21. Results showed that the prevalence of suicidal ideation was 2.3% in the past 24 h, 4.8% in the past 15 days, 6.9% in the past month, 14.7% in the past year, and 61.1% in the lifetime. The unadjusted regression model showed that being divorced (or separated) from a partner (OR = 4.486, 95% CI = 1.972–10.207, p < 0.0001), Facebook addiction (OR = 1.550, 95% CI = 1.006–2.388, p = 0.047), depression (OR = 1.657, 95% CI = 1.677–4.211, p < 0.0001), anxiety (OR = 2.649, 95% CI = 1.624–4.320, p < 0.0001), and stress (OR = 2.626, 95% CI = 1.673–4.122, p < 0.0001) were the risk factors of past-year SI. Compared with global prevalence rates, the present study reported higher levels of SI prevalence. Therefore, supportive suicide prevention programs are needed to tackle SI and alongside comorbid psychopathology.

Impulsivity and Impulsivity-Related Endophenotypes in Suicidal Patients with Substance Use Disorders: an Exploratory Study

Suicidal behavior (SB) is a major problem in patients with substance use disorders (SUDs). However, little is known about specific SB risk factors in this population, and pathogenetic hypotheses are difficult to disentangle. This study investigated some SB and SUD-related endophenotypes, such as impulsivity, aggression, trait anger, and risk-taking behaviors (RTBs), in forty-eight patients with SUDs in relation to lifetime history of suicide attempts (SAs). Disorders related to alcohol, cannabis, cocaine, opiates, and hallucinogenic drugs were included. Lifetime SAs was significantly associated with both higher impulsivity and higher aggression, but not with trait anger. A higher number of RTBs were associated with lifetime SAs and higher impulsivity, but not with aggression and trait anger. Assessing these endophenotypes could refine clinical SB risk evaluation in SUDs patients by detecting higher-risk subgroups. An important limitation of this study is exiguity of its sample size. Its primary contribution is inclusion of all SUD types.

"I Just Kept It to Myself": The Shaping of Latina Suicidality Through Gendered Oppression, Silence, and Violence

Suicide is a critical issue among Latina youth. In this study, we use family case analysis to explore how gendered oppression, silencing, and violence shape suicidal behaviors among a sample of Latina daughters (n = 10), and their parents. For comparison, we include family narratives from Latina adolescents with no histories of suicide attempts (n = 10). Results suggest how secrets and silence, as indicative of gendered oppression, may catalyze a suicide attempt. The risks are particularly salient when daughter and mother both have experienced violence that conflicts with gendered cultural scripts. Findings highlight the importance of parental engagement and exploration of histories of violence in the treatment of Latina suicide attempters. Future research should incorporate the risk factors of gendered oppression and violence to better understand the development of suicidality among Latina women.

A latent class analysis of health lifestyles and suicidal behaviors among US adolescents

BACKGROUND

Previous studies have documented the link between individual health behaviors and suicide, but little is known about the influence of health lifestyles on suicide among adolescents. This study aims to identify the unobserved patterns of health behaviors and to examine their associations with adolescent suicidal behaviors to inform screening of suicidality.

METHODS

Data were derived from a nationally representative sample of adolescents (n = 14,506, ages 12-18, 50.9% female) in the national school-based 2017 Youth Risk Behavior Survey. Latent class analysis was performed based on 13 health behaviors related to diet (e.g., frequency of consuming breakfast, fruits/vegetables, soda), physical activity (frequencies of physical activity, sports team participation), sleep, and media use (TV/computers). Suicidal behaviors were measured by three dichotomized variables, including suicidal ideation, plan, and attempts. Multivariate logistic regressions were used to examine associations between identified classes and suicidal behaviors.

RESULTS

Four classes of health lifestyles were identified. Class 1 (23.6%) consistently engaged in health-promoting behaviors, including eating breakfast daily, high intake of fruits/vegetables, physically active, and infrequent use of TV/computers. Class 2 (37.7%) had an irregular diet, moderate exercise, and high computer use. Class 3 (31.8%) had moderate diet, frequent exercise, and moderate sleep. Class 4 (6.9%) had the lowest engagement in health-promoting behaviors. Class 4 had higher odds of suicide plan than Class 1 (OR = 1.50, 95% CI = 1.10-2.05). Notably, Class 2 and 3 were less likely to attempt suicide than Class 1 (OR = 0.74, 95% CI = 0.57-0.95 for Class 2; OR = 0.65, 95% CI = 0.48-0.89 for Class 3).

LIMITATIONS

Due to the cross-sectional design, no causal inference can be drawn.

CONCLUSIONS

Both Class 1 (consistent) and Class 4 (lowest) engagement in health-promoting behaviors were associated with increased suicidal behaviors. Suicide prevention efforts that examine both lifestyles are keys to early detection of suicidal ideation and plans, and prevention of suicide attempts.

Measurement invariance of depression symptom ratings across African American, Hispanic/Latino, and Caucasian adolescent psychiatric inpatients

The Beck Depression Inventory-II (BDI-II) is widely used to assess adolescent depressive symptom severity. Psychometric investigations, including factor-analytic studies, with adolescents support the reliability and validity of the BDI-II. However, a major limitation of this research is that samples have been predominantly Caucasian/White. This is critical because depressive illness is highly prevalent across race and ethnicity, and the extent to which reliability and findings generalize to non-Caucasian populations is in question. The present study recruited African American/Black (n = 96), Hispanic/Latino(a) (n = 151), and Caucasian/White (n = 97) adolescent psychiatric inpatients (Mage = 14.73) to test the measurement invariance of the BDI-II, using Osman and colleagues' two-factor solution while also assessing within-group reliability and concurrent validity by examining associations with other symptom measures. Across groups, the two-factor solution, factor loadings, and indicator thresholds were invariant. Within-group reliability estimates were adequate, and the concurrent validity was supported. This suggests BDI-II symptom comparisons between African American/Black, Hispanic/Latino(a), and Caucasian/White adolescent inpatients are valid. Critical extensions of this work may include the examination of potential invariance across depressive symptom clusters via network analysis and invariance testing of depression symptom ratings over time in ethnoracially diverse children and adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Suicide Risk among Immigrants and Ethnic Minorities: A Literature Overview

Recent studies have demonstrated that immigrants and ethnic minorities may be at higher risk of suicidal behaviour as compared to the general population. We conducted a literature search to identify studies in English from 1980 to 2017 related to suicide risk among immigrants and ethnic minorities. Six hundred and seventy-eight reports were screened, and 43 articles were included in the qualitative synthesis of the review. Some studies reported lower rates of suicide attempts, while other findings suggested higher rates of suicidal behaviour and deaths among immigrants as compared to the native population. Also, a positive correlation was found between suicidal behaviour and specific countries of origin. Non-European immigrant women were at the highest risk for suicide attempts, a group which included young women of South Asian and black African origin. Risk factors among migrants and ethnic minorities were found to be: language barriers, worrying about family back home, and separation from family. The lack of information on health care system, loss of status, loss of social network, and acculturation were identified as possible triggers for suicidal behaviour. Overall, results suggest that specific migrant populations and ethnic minorities present a higher risk of suicidal behaviour than native populations, as well as a higher risk of death by suicide.

Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

OBJECTIVES

Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP.

METHODS

We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of ≤3 foci of the article) or "minimal" (ie, one of ≥4 foci of the article).

RESULTS

Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%).

CONCLUSIONS

This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic.

Latina Adolescents Health Risk Behaviors and Suicidal Ideation and Suicide Attempts: Results from the National Youth Risk Behavior Survey 2001-2013

Suicidal ideation and suicide attempts are more common in Latina adolescents than White or African-American adolescents. Several health risk behaviors have been identified as being associated with Latina adolescent suicides. However, to date, no study has identified the consistency and stability of these risk behaviors over time. This study utilized the national Youth Risk Behaviors Survey from 2001 to 2013 to estimate the prevalence of suicidal ideation, suicide attempts, and health risk behaviors associated with suicidal behaviors in Latina adolescents. Our analysis found the prevalence of suicidal ideation and suicide attempts varied significantly over the 13-year study span, decreasing from 2001 to 2009 and increased from 2011 to 2013. The analyses found 11 health risk behaviors that were significantly associated with both suicidal ideation and suicide attempts that did not vary over time. The stability of these 11 health risk behaviors associated with suicidal behaviors could be useful to school personnel to identify early at risk Latina adolescents who may benefit from school and community mental health resources.

Life is Precious: A Community-Based Program to Reduce Suicidal Behavior in Latina Adolescents

Latina adolescents have high rates of suicidal behavior. Life is Precious (LIP), a community-based program in New York City, helps adolescents and families address risk factors facing Latinas. Participants are assessed for suicidal ideation, depressive and other psychiatric symptoms, and family functioning, at program entry and every 4 months during participation. Demographic characteristics and suicide attempts are also tracked. In the study period, there were no attempted or completed suicides in this high-risk population. Suicidal ideation, depressive symptoms, anger, and posttraumatic stress symptoms decreased significantly during participation. The LIP model shows promise for helping to address suicidal risk factors facing Latinas. However, in the absence of a comparison group, participants' improvement may be due to their engagement in mental health treatment more generally, or to the passage of time, rather than specifically to LIP. Nevertheless, as very little is known about how to address risk factors unique to Latina adolescents, these early findings may be of interest to the community serving Latina adolescents and the lessons may be of interest to programs serving adolescents from other racial/ethnic groups. Future research should develop comparison groups and test LIP implementation in other settings.

Perceived health and alcohol use in individuals with HIV and Hepatitis C who use drugs

BACKGROUND

Individuals who use illicit drugs are at heightened risk for HIV and/or Hepatitis C Virus (HCV). Despite the medical consequences of drinking for drug-using individuals with these infections, many do drink. In other studies, how individuals perceive their health relates to their engagement in risk behaviors such as drinking. However, among drug-using individuals with HIV and HCV, whether perceived health relates to drinking is unknown.

OBJECTIVE

We examine the association between perceived health and drinking among drug-using individuals with HIV and/or HCV.

METHODS

In a large, cross-sectional study, we utilized samples of individuals with HIV (n=476), HCV (n=1145), and HIV/HCV co-infection (n=180), recruited from drug treatment centers from 2005 to 2013. In each sample, we investigated the relationship between perceived health and drinking, using ordinal logistic regressions. We present uncontrolled models as well as models controlled for demographic characteristics.

RESULTS

Among samples of drug using individuals with HIV and with HCV, poorer perceived health was associated with risky drinking only when demographic characteristics were taken into account (Adjusted Odds Ratios: 1.32 [1.05, 1.67] and 1.16 [1.00, 1.34], respectively). In the smaller HIV/HCV co-infected sample, the association of similar magnitude was not significant (AOR=1.32 [0.90, 1.93]).

CONCLUSIONS

Drug using patients with HIV or HCV with poor perceived health are more likely to drink heavily, which can further damage health. However, when demographics are not accounted for, these effects can be masked. Patients' reports of poor health should remind providers to assess for health risk behaviors, particularly heavy drinking.

Life Is Precious: Views of Adolescents and Their Mothers on Methods to Reduce Suicidal Behavior in Latinas

Life is Precious (LIP) was developed to help reduce suicidal behavior in Latina adolescents. As part of an external evaluation of the LIP program, we conducted focus groups with adolescent participants and mothers to learn whether participants and families believe that the activities of LIP address risks for suicidal behavior. Four focus groups were conducted: three with Latina adolescent LIP participants ( n = 31) and one with mothers ( n = 8). Transcripts were analyzed using ATLAS.ti. A grounded theory approach was used to identify themes and subthemes. The following themes emerged: (1) challenges contributing to suicidal behavior and self-harm among Latina adolescents, (2) how respondents believe that LIP is helping to reduce suicidal behavior, and 3) ongoing challenges. Participants say that the LIP program helps adolescents feel better and improve social relationships, academic performance, and relationships with their family. School nurses may wish to identify community-based programs offering similar services.

Smoking and Suicide: A Meta-Analysis

BACKGROUND

Many studies have reported a positive association between smoking and suicide, but the results are inconsistent. This meta-analysis was carried out to estimate the association between smoking and suicidal ideation, suicide plan, suicide attempt, and suicide death.

METHODS

Major electronic databases including PubMed, Web of Science, Scopus, and ScienceDirect were searched until May 2015. The reference lists of included studies were screened too. Epidemiological studies addressing the association between smoking and suicidal behaviors were enrolled. The heterogeneity across studies was explored by Q-test and I2 statistic. The possibility of publication bias was assessed using Begg's and Egger's tests and Trim & Fill analysis. The results were reported based on risk ratio (RR) and odds ratio (OR) with 95% confidence intervals (CI) using a random-effects model.

RESULTS

We identified a total of 8062 references and included 63 studies with 8,063,634 participants. Compared to nonsmokers, the current smokers were at higher risk of suicidal ideation (OR = 2.05; 95% CI: 1.53, 2.58; 8 studies; I2 = 80.8%; P<0.001), suicide plan (OR = 2.36; 95% CI: 1.69, 3.02; 6 studies; I2 = 85.2%; P<0.001), suicide attempt (OR = 2.84; 95% CI: 1.49, 4.19; 5 studies; I2 = 89.6%; (P<0.001), and suicide death (RR = 1.83; 95% CI: 1.64, 2.02; 14 studies; I2 = 49.7%; P = 0.018).

CONCLUSIONS

There is sufficient evidence that smoking is associated with an increased risk of suicidal behaviors. Therefore, smoking is a contributing factor for suicide. Although this association does not imply causation, however, smoking prevention and cessation should be the target of suicide prevention programs.

The Influence of School-Based Health Centers on Adolescents' Youth Risk Behaviors

INTRODUCTION

Youth risk behaviors that are developed during adolescence are likely to continue into adulthood, increasing chances of morbidity, mortality, and chronic health conditions. The Centers for Disease Control and Prevention identified six critical risk behaviors (unintentional injuries and violence, sexual behaviors leading to pregnancies and infections, alcohol and other drug use, tobacco use, poor dietary habits, and insufficient physical activities) and developed the Youth Risk Behavior Survey to monitor them. The purpose of this quantitative study was to investigate which health risk behaviors were affected by a new school-based health center (SBHC), using two urban school systems in the Mid-Atlantic region.

METHOD

The Youth Risk Behavior Survey was administered at two schools in 2007 and 2011. Logistic regression was used to predict whether the dependent variables had changed based on the new SBHC.

RESULTS

Overall, the new SBHC did not have a significant effect on the student's risk behaviors.

DISCUSSION

Schools remain a critical part of adolescents' development, and access to SBHCs offers a safety net to students whose families may not have health insurance.

A School-Level Proxy Measure for Individual-Level Poverty Using School-Level Eligibility for Free and Reduced-Price Meals

BACKGROUND

Socioeconomic status (SES) impacts health outcomes. The Youth Risk Behavior Survey (YRBS), like many school-based data sources, lacks individual-level poverty information. We propose using school-level percentages of student eligibility for free/reduced-price meals (%FRPM) as a proxy for individual-level poverty.

METHODS

Using the New York City (NYC) 2009 YRBS, we created school-level poverty quartiles to append to individual YRBS records by ranking schools by %FRPM. We compared this with 2 other school-level poverty measures using students' home and school neighborhood-level poverty and measured the association of these 3 school-level proxies with individual's household income. Last, we evaluated health outcomes by race/ethnicity and poverty to demonstrate the importance of accounting for poverty.

RESULTS

The school-level measure that used %FRPM had the strongest association with household income. When the school-level individual poverty proxy was included in illustrative analyses using YRBS data, patterns by poverty within race/ethnicity emerged that were not seen when looking at race/ethnicity alone.

CONCLUSIONS

Using a poverty measure to analyze school-based data will provide a better understanding of the impact of SES on health outcomes. Based on our evaluation, when individual-level information is not available, we propose using school-level %FRPM, which are publicly available throughout the United States.

A comparison of risk factors associated with suicide ideation/attempts in American Indian and White youth in Montana

We examined racial/ethnic and gender-specific associations between suicide ideation/attempts and risky behaviors, sadness/hopelessness, and victimization in Montana American Indian and White youth using 1999-2011 Youth Risk Behavior Survey data. Logistic regression was used to calculate odds ratios and 95% confidence intervals in stratified racial/ethnic-gender groups. The primary results of this study show that although the American Indian youth had more statistically significant suicidal thoughts and attempts than the White youth, they had fewer statistically significant predictors compared to the White youth. Sadness/hopelessness was the strongest, and the only statistically significant, predictor of suicide ideation/attempts common across all four groups. The unhealthy weight control cluster was a significant predictor for the White youth and the American Indian/Alaska Native girls; the alcohol/tobacco/marijuana cluster was a significant predictor for the American Indian boys only. Results show important differences across the groups and indicate directions for future research targeting prevention and intervention.

Stressful psychosocial school environment and suicidal ideation in Chinese adolescents

PURPOSE

Suicide is one of the leading causes of death during adolescence worldwide. This study, using a sample of Chinese adolescents, examines associations of a stressful psychosocial school environment with suicidal ideation, which were rarely investigated so far.

METHODS

A total of 1,004 Chinese students (468 boys and 536 girls) from Grade 7-12 were recruited into our questionnaire survey. Psychosocial school environment was measured by the effort-reward imbalance questionnaire adapted to the school setting, and suicidal ideation was assessed by a standardized question. Multivariate logistic regression was applied, adjusting odds ratios for age, gender, grade, smoking, alcohol drinking, physical activity, family wealth, and self-rated health.

RESULTS

In school settings, 10.86% students reported suicidal ideation during the last 6 months, which was found to be significantly related to both effort and reward. Remarkably, effort-reward imbalance was associated with elevated risk of suicidal ideation (odds ratio = 1.77, 95% confidence interval = 1.34-2.35).

CONCLUSIONS

This study finds significant associations between a stressful psychosocial school environment in terms of effort-reward imbalance and suicidal ideation in Chinese adolescents. Preventive actions aiming at reducing this imbalance may define a promising approach towards a healthy psychosocial school environment.

Differentiating suicide ideators from attempters: violence--a research note

Which factors distinguish suicide attempters from suicide ideators is a relatively neglected question in suicidology. Data from the 2001 Youth Risk Behavior Survey, encompassing 1,439 youth suicide ideators and 1,097 attempters, was used to explore which factors best differentiate suicide attempters from ideators, with a focus on violence involvement. Measures of violence include the contexts of fights, dating, and weapons carrying. Controls were incorporated for psychiatric disorders, risky sexual behavior, school integration, and demographics. Controlling for the other variables, violence differentiated attempts from ideation: fighting (OR = 2.18) and weapon carrying (OR = 1.13). Psychiatric factors that predicted attempts over ideation included major depression (OR = 1.86), use of cocaine (OR = 2.34), and having a suicide plan (OR = 2.69), while demographic factors included gender, age, residence in the Midwest, and Hispanic, African American, or Asian ethnicity. A supplementary analysis (N = 11,546) determined that violence also helped to differentiate suicide ideators from nonsuicidal youth. Four factors (including violence involvement, eating disorders, and gender consistently) differentiated both between suicide attempts and ideation, and also between suicide ideators and nonsuicidal youth. The link between violence involvement and suicidality is interpreted in terms of the capability for suicide from the interpersonal theory of suicide.

Risk and protective factors that distinguish adolescents who attempt suicide from those who only consider suicide in the past year

Data from the 2010 Minnesota Student Survey was analyzed to identify risk and protective factors that distinguished adolescents across three groups: no suicidality, suicidal ideation only, and suicide attempt. The population-based sample included 70,022 students in grades 9 and 12. Hopelessness and depressive symptoms emerged as important risk factors to distinguish youth who reported suicidal ideation or behavior from those without a history of suicidality. However, these factors were not as important in differentiating adolescents who attempted suicidal from those who considered suicide but did not act on their thoughts. Instead, for both genders, self-injury represented the most important factor to distinguish these youth. Other risk factors that differentiated the latter groups, but not the former groups, for males were dating violence victimization and cigarette smoking, and for females was a same-sex sexual experience. Running away from home also seemed to increase the risk of a suicide attempt among youth in this study. Parent connectedness and academic achievement emerged as important protective factors to differentiate all the groups, yet neighborhood safety appeared to protect against the transition from suicidal thoughts to behavior. Findings from this study suggest risk and protective factors practitioners should target in clinical assessments and intervention programs to help prevent suicidal behavior among youth at greatest risk.

Suicidal thoughts and attempts among u.s. High school students: trends and associated health-risk behaviors, 1991-2011

PURPOSE

To describe secular trends in suicidal thoughts and attempts and the types of health-risk behaviors associated with suicidal thoughts and attempts among U.S. high school students.

METHODS

Data were analyzed from 11 national Youth Risk Behavior Surveys conducted biennially during 1991-2011. Each survey employed a nationally representative sample of students in grades 9-12 and provided data from approximately 14,000 students. Using sex-stratified logistic regression models that controlled for race/ethnicity and grade, we analyzed secular trends in the prevalence of suicidal thoughts and attempts. Adjusted prevalence ratios (APR) were calculated to measure associations between suicide risk and a broad range of health-risk behaviors.

RESULTS

During 1991-2011, among female students, both suicidal thoughts (seriously considered suicide; made a plan to attempt suicide) and attempts (any attempt; attempt with injury requiring medical treatment) decreased significantly; among male students, only suicidal thoughts decreased significantly. During 2011, compared with students with no suicidal thoughts or attempts, the health-risk behaviors most strongly associated with suicide attempts among female students were injection drug use (APR = 12.8), carrying a weapon on school property (APR = 9.7), and methamphetamine use (APR = 8.7); among male students, the strongest associations were for IDU (APR = 22.4), using vomiting/laxatives for weight control (APR = 17.1), and having been forced to have sex (APR = 14.8).

CONCLUSIONS

School-based suicide prevention programs should consider confidential screening for health-risk behaviors that are strongly associated with suicide attempts to help identify students at increased risk for suicide and provide referrals to suicide and other prevention services (e.g., substance abuse and violence prevention) as appropriate.

Adolescent suicidal behavior across the excess weight status spectrum

OBJECTIVE

Relative suicidal behavioral risks (ideation, attempts) for overweight, obese, and extremely obese adolescents (vs. healthy weight) and who did/did not accurately perceive themselves as overweight were examined in this study.

DESIGN AND METHODS

A new variable (weight status/accuracy) was computed that combined actual weight status (based on BMI) with weight perception accuracy. To evaluate the effect of weight status/accuracy on each suicidal risk behavior, logistic regression was performed to calculate odds-ratios and 95% confidence intervals (CI). Potential model covariates included gender, age, race, survey year, and whether they had felt sad/hopeless.

RESULTS

Weight perception accuracy increased as the degree of excess weight increased. Relative to healthy weight, being obese or extremely obese (but not overweight) was associated with significantly greater risk for adolescent engagement in suicidal ideation, but was unrelated to suicide attempts. Adolescents in all excess weight categories who were accurate in their weight perception were at significantly greater odds of suicidal ideation, whereas those who were inaccurate were of no greater odds of suicidal ideation than healthy weight youth who accurately perceived their weight. Findings regarding suicide attempts varied based on actual weight/weight perception accuracy and race/ethnicity.

CONCLUSION

The present findings are both important and clinically relevant. While widely accepted that there are multiple pathways to suicide, our understanding of adolescent suicidal behavior risks and accordingly, prevention efforts, will be informed by comprehensive prospective studies that should also, from here forward, consider categorization of the entire weight spectrum (e.g., extreme obesity).

Latina Teen Suicide and Bullying

Latina adolescents experience depression and suicidal ideations in a disproportionate manner compared to their non-Latina counterparts. We investigate suicide and depressive symptoms among a state-wide sample ( N = 650) of adolescent Latina girls with a focus on bullying as a predictor. Bullying rates are higher than previous studies have found for victimization at school (23%), cybervictimization (26%), school bully (18%), and cyberbully (18%). Rates for depressive symptoms (49%), suicide ideation (23%), suicide plan (17%), and suicide attempt(s; 13%) are higher than national averages. After controlling for depressive symptoms, girls who have been bullied were 1.5 times more likely to attempt suicide compared to girls who have not been victims. However, being a bully increased likelihood of suicide ideation (1.5) and suicide plan (1.4) compared to not being a bully. There is a continued need to prevent depressive symptoms and suicide among Latina girls and to further investigate the effects of bullying.

Perceptions of social support, empowerment and youth risk behaviors

This study examined the association of perceived social support and community empowerment among urban middle-school students living in Matamoros, Mexico and the risk behaviors of fighting, alcohol and tobacco use, and sexual activity. Middle school students (n = 1,181) from 32 public and private Mexican schools were surveyed. Weighted multiple logistic regression analyses were conducted. Among girls, lack of parent/teacher interactions regarding school increased odds for fighting, alcohol and tobacco use. Among boys, lack of empowerment increased odds of alcohol and tobacco use and lack of parent/teacher interactions regarding school increased odds for sexual activity. Community empowerment and perceived social support are uniquely associated with risk behaviors for girls and boys. Additionally, perceived social support from individuals most immediate to the youth are associated with protection against risk for some behaviors, while perceived social support from individuals more removed from youth have mixed association with risk behaviors.

Suicidal Ideation and Alcohol Use Among Ethiopian Adolescents in Israel

Recent figures point to alarming rates of suicidal tendencies and risk behaviors among Ethiopian adolescents (first and second generation) in Israel. This study tries to understand this phenomenon through an examination of the relationship between ethnic identity (Israeli and Ethiopian) and parental support with suicidal ideation and alcohol use. Two hundred adolescents aged 15–18 years from the Ethiopian community in Israel completed questionnaires examining the degree to which they felt a sense of (positive) Israeli and Ethiopian identity and parental support as well as suicidal ideation, drinking behavior, and depression. Results showed significant correlations between both Israeli and Ethiopian identities and suicidal ideation and alcohol use and a significant relationship between suicidal ideation and parental support. Regression analysis highlighted the pivotal role of a strong and positive heritage (Ethiopian) identity in lower levels of suicidal ideation and alcohol use. Results suggest the important role of ethnic identity for well-being among immigrant and minority youth, in particular in the ability of minority youth to consolidate a coherent ethnic identity incorporating a positive connection to their heritage culture as providing a protective role against suicidal tendencies and risk behaviors.