Heterogeneity of suicidal adolescents

Evidence for Altered Electroencephalography Coherence in Depressed Adolescents with Suicidal Ideation and Behaviors

Introduction: Major depressive disorder (MDD) is a primary risk factor for suicide, which is one of the leading causes of death among adolescents worldwide. Understanding the heterogeneity of suicidality in adolescents with MDD is critical for suicide prevention and intervention discovery. Quantitative electroencephalography (EEG) is a promising tool to address the knowledge gaps related to the neurophysiological characteristics of depression and suicidality. This study sought to examine resting-state EEG coherence differences in adolescents with MDD and suicidal ideation (SI)/behaviors (SB) and healthy controls (HC) to assess the utility of coherence as a biomarker of suicide. Methods: Twenty-six adolescents with MDD who were hospitalized for suicidality and 30 HC were recruited. The clinical sample was divided into SI (n = 9) and SB (n = 19) subgroups. Eyes closed resting-state EEG were recorded, and coherence was calculated. Depression severity and suicidality were assessed with the Children's Depression Rating Scale Revised and the Columbia Suicide Severity Rating Scale, respectively. Results: There were intrahemispheric differences in the right hemisphere across multiple electrode pairs. Delta, alpha, and beta coherence were higher in the SB group over the right prefrontofrontal and left parietooccipital electrode pairs, while alpha coherence was higher in the HC group over the right centroparietal electrode pair. There were no significant differences between HC and SI groups in any electrode pair. Conclusions: Patients with recent SB showed increased coherence in right frontal regions compared with patients with SI, suggesting altered cognitive states between those with SB and SI. These findings may have implications for suicide prevention in adolescents and could serve as useful biomarkers in clinical settings, but larger studies are needed to confirm the results.

A within-person approach to risk for suicidal ideation and suicidal behavior: Examining the roles of depression, stress, and abuse exposure

OBJECTIVE

This study tests a novel, within-person model that reexamines depression and stress as risk factors for suicidal ideation and behavior among adolescent girls with and without sexual/physical abuse histories.

METHOD

This longitudinal study includes data from 220 adolescent girls between 12 and 16 years of age (M = 14.69 years, SD = 1.37; 61% White). At baseline, adolescents reported the presence or absence of prior abuse as part of a clinical interview. At baseline and every 3 months for 18 months, adolescents completed measures of suicidal ideation and behavior, depressive symptoms, and stress.

RESULTS

Multilevel models examined within-person mean, deviations from within-person mean, depression, and stress and their interactions with abuse as predictors of suicidal ideation and behavior. In addition to within-person mean depression, higher-than-usual depression (odds ratio [OR] = 1.99) and higher-than-usual stress (OR = 1.53) predicted greater risk of suicidal ideation at each follow-up assessment. Periods of higher-than-usual stress (1 SD increase) and periods of higher-than-usual depression (1 SD increase) were associated with an 82% and 57% increase in the odds of suicidal behavior, respectively, but only among those with abuse histories.

CONCLUSION

Depression, stress, and abuse are well-known risk factors for suicidal ideation and behavior; however, it has been unclear for whom, and when, these factors have their greatest impact. These results show that depression and stress are potent risk factors among those with a history of abuse and that within-person elevations in these risk factors signal increased short-term risk of suicidal ideation and behavior. (PsycINFO Database Record

Toward an Understanding of Suicide Risks in Young Hispanic Females

Hispanic adolescents in the United States have been virtually neglected in the literature on youth suicide. Among Hispanic youth, adolescent females constitute a subgroup at risk for depression and suicidal behavior. The author reviews extant literature on adolescent suicide, and discusses such psychosocial and cultural factors as socioeconomic disadvantage, traditional gender-role socialization, acculturation, cultural identity, and intergenerational conflict within the context of suicide attempts among adolescent Hispanic females. It is proposed that the interactive effects of these factors may contribute to suicide attempts among low income, first and second-generation Hispanic adolescent females.

Internalized and Externalized Anger in Adolescent Suicide Attempters

Anger can play an important role in adolescent suicidal behavior However, there is disagreement over the relative importance of internalized versus externalized anger The present study evaluated mode of anger expression in 104 adolescent suicide attempters and 323 high school students. The suicide attempters also completed measures of depression and hopelessness. Results indicated that suicidal adolescents displayed an increased likelihood of experiencing anger, reported significantly higher levels of both internalized and externalized anger, and displayed reduced tendencies for impulse control. Hierarchical multiple regression analyses found that the general inclination to experience anger was most closely related to externalized anger and poor impulse control. Among the adolescent suicide attempters, depression and hopelessness were related to internalized but not externalized anger Thus, it may be useful to assess the mode of anger expression when evaluating adolescents for suicide risk.

Perceived family and peer invalidation as predictors of adolescent suicidal behaviors and self-mutilation

OBJECTIVE

The present study investigates the longitudinal relationship between perceived family and peer invalidation and adolescent suicidal events (SE) and self-mutilation (SM) in a 6 month follow-up (f/u) study of adolescents admitted to an inpatient psychiatric unit for suicide risk.

METHODS

Adolescents (n=119) and their parent(s) were administered interviews and self-report assessments at baseline and at a 6 month f/u, with 99 (83%) completing both assessments. The Adolescent Longitudinal Interval Follow-Up Evaluation (A-LIFE) was modified to provide weekly ratings (baseline and each week of f/u) for perceived family and peer invalidation. Regression analyses examined whether: 1) Prospectively rated perceived family and peer invalidation at baseline predicted SE and SM during f/u; and 2) chronicity of perceived invalidation operationalized as proportion of weeks at moderate to high invalidation during f/u was associated with SE and SM during f/u.

RESULTS

Multiple regression analyses, controlling for previously identified covariates, revealed that perceived family invalidation predicted SE over f/u for boys only and perceived peer invalidation predicted SM over f/u in the overall sample. This was the case for both baseline and f/u ratings of perceived invalidation.

CONCLUSIONS

Our results demonstrate the adverse impact of perceived family and peer invalidation. Specifically, boys who experienced high perceived family invalidation were more likely to have an SE over f/u. Both boys and girls who experienced high perceived peer invalidation were more likely to engage in SM over f/u.

Adolescent Peer Victimization, Peer Status, Suicidal Ideation, and Nonsuicidal Self-Injury: Examining Concurrent and Longitudinal Associations

This study examined concurrent and longitudinal associations among peer victimization, peer status, and self-injurious thoughts and behaviors (i.e., suicidal ideation and nonsuicidal self-injury [NSSI]) over a 2-year period. A community sample of 493 adolescents (51% girls) in Grades 6-8 participated in the study. Participants completed measures of suicidal ideation and NSSI at three time points. Measures of peer victimization (overt and relational) and peer status (preference-based and reputation-based popularity) were collected by using a standard sociometric procedure. The hypothesized model was examined by using a multiple group (by gender) latent growth curve analysis. Results suggested that high levels of overt victimization were associated with increases in suicidal ideation over time for girls. No effects were revealed for relational victimization in the prediction of concurrent or longitudinal associations with suicidal ideation for boys or girls. With respect to peer status, low levels of preference-based popularity were associated with increases in suicidal ideation over time. Implications for understanding the complex patterns of association among different forms of peer victimization, self-injurious thoughts and behaviors, and peer group status are discussed.

Deliberate self-harm and suicide in adolescents

Deliberate self-harm (DSH) is a widespread yet often hidden problem in adolescents and young adults. Though most DSH can be classified as "non-suicidal self-cutting", some do go on to commit suicide. In this paper, deliberate self-harm is examined, including its prevalence, etiology, management, and future research directions using self-cutting and self-burning as examples. This article reviews recent literature to help understand what is known about self-cutting behavior and its potential relationship to suicide as well as provide direction for research. Research shows that different ecological factors at the individual, family, peer, and societal levels are related to deliberate self-harm. Although there is an association between some self-injurers and drug abuse (including alcohol abuse) as well as eating disorders, there are various subgroups of self-cutters and most are not at high risk for suicide. However, all acts of self-injury should be taken seriously by health care professionals and comprehensive therapy offered to any adolescent with a history of DSH. Future research directions on deliberate self-harm are also discussed.

Low self-worth and anger as components of the depressive experience in young adolescents

The present study sought to examine two issues related to the phenomenological experience of depression in a normative sample of young, middle-school adolescents. The first hypothesis was that self-reported depressed affect would be highly related to low global self-worth. The second hypothesis was that depression is experienced as a blend of sadness and anger, where anger can be directed toward either the self or others. The findings revealed a strong correlation (r = .81) between global self-worth and affect (along a continuum of cheerful to depressed). With regard to the second issue, depression is clearly experienced by adolescents as a blend of affects. Eighty percent reported that depression represents a mix of sadness and anger. In addition, the vast majority reported that the anger is directed toward others, either as the only target or in conjunction with anger toward the self. Findings also revealed that the primary causes of depression involve actions of others against the self, thereby making the anger component realistic. Discussion focused on the role of self-deprecatory ideation in depression and on the issue of the comorbidity of internalizing and externalizing symptoms manifest in depression.

Coping mechanisms, stressful events and suicidal behavior among youth admitted to juvenile justice and child welfare services

This study examines the relationship between coping mechanisms and suicide attempts among 84 adolescents in the Quebec youth residential services. A new measure based on in-depth interviews is used to identify coping mechanisms. The suicidal youths used fewer adequate coping mechanisms than nonsuicidal youths when faced with comparable stressful events. Negative cognitive reframing, anger, and blaming others were more frequently reported by the suicidal youths. Contrary to certain theoretical conceptions, coping mechanisms were not stable and varied according to the context of the suicidal crisis. These findings indicate the usefulness of this approach to measure coping mechanisms and support the importance of programs aimed at developing coping skills for suicide prevention.

Jugendliche in stationärer psychiatrischer Behandlung: Parasuizidale Symptome und psychische Störungen

Zusammenfassung. Psychische Störungen zählen zu den wichtigsten Ursachen für Parasuizide und Suizide. Dies gilt für das Erwachsenenalter und mit gewissen Abstrichen auch für das Jugendalter. Die häufigsten psychischen Störungen im Zusammenhang mit Suizidalität im Jugendalter sind akute Belastungsreaktionen, affektive Störungen, Substanzmissbrauch sowie Borderline-Syndrome und andere beginnende Persönlichkeitsstörungen. Essstörungen und Schizophrenien sind dagegen im Jugendalter noch nicht mit erhöhten Parasuiziden verknüpft. Anhand einer Gesamtstichprobe von 537 konsekutiv aufgenommenen und nach ICD-10 diagnostizierten stationär behandelten jugendpsychiatrischen Patienten konnten 163 mit parasuizidalen Symptomen bei Aufnahme ermittelt werden, die etwa zur Hälfte aus parasuizidalen Gedanken und parasuizidalen Handlungen bestanden. Der Anteil parasuizidaler Jugendlicher auf der Aufnahmestation lag bei etwa 66 %, auf der Therapiestation (Rottmannshöhe) bei etwa 30 %. Dies spricht für die Relevanz von Selektionsfaktoren bei Häufigkeits- und vermutlich auch Schweregradangaben von Suizidalität im stationären jugendpsychiatrischen Bereich.

Suicidal ideation and behavior in children's homes

The aim of this cross-sectional study is to report the self-destructive and suicidal behavior of 98 children and adolescents in child welfare institutions. The children were evaluated using the Child Behavior Checklist (CBCL), the Children's Global Assessment Scale (CGAS) and questionnaires about suicidal and violent behavior, filled in by the child's key worker. Thirty-two per cent of the sample had presented suicidal thoughts, threats or suicide attempts during the previous 6 months. Suicidality was associated with low general functioning level (CGAS<61), self-mutilating behavior and violence. Furthermore, suicidal children had significantly higher CBCL total, externalizing, internalizing, anxious-depressive and aggressive scores. Children with suicide attempts (8% of the sample) had a significantly higher number of different types of traumatic experiences before the placement and higher somatization syndrome scores compared to children with suicidal ideation or non-suicidal children.

Anxiety contributes to suicidality in depressed adolescents

Several studies have suggested a positive association between anxiety symptoms and suicidality in adults. However, relatively little is known about this topic in adolescents. To investigate this issue, we examined a group of adolescents admitted to our psychiatric inpatient unit. Fifty-six adolescents (mean age = 14.8 +/- 1.4; females = 34, males = 22; race = 95% Caucasians) participated in the study. Diagnoses were made using the DSM-III-R criteria and a diagnostic interview. Anxiety was found to significantly correlate with depression (r = .60; P = < .05) and suicidality (r = .72; P < .05). A multiple regression analysis revealed that anxiety and depression together accounted for more than half (55%) of the variance in suicidal ideation [F(2,46) = 28.4; P < .0001]. In addition, anxiety had an independent ability to predict suicidality (t = 5.01; P < .0001). Self-rated but not clinician-rated suicidality was positively correlated with both anxiety and depression. Clinical and research implications of these findings are discussed.

Peer functioning, family dysfunction, and psychological symptoms in a risk factor model for adolescent inpatients' suicidal ideation severity

Examined models of suicidal ideation severity that include two psychosocial risk factors (i.e., peer and family functioning) and four domains of psychological symptoms (i.e., generalized anxiety, depression, conduct problems, and substance abuse/dependence). Participants were 96 psychiatric inpatients (32 boys, 64 girls), ages 12 to 17, who were hospitalized because of concerns of suicidality. Adolescents completed a structured diagnostic interview, measures of suicidal ideation, and several dimensions of family and peer functioning. Results supported a model in which greater levels of perceived peer rejection and lower levels of close friendship support were associated directly with more severe suicidal ideation. In addition, indirect pathways included deviant peer affiliation and global family dysfunction related to suicidal ideation via substance use and depression symptoms. The results are among the first to demonstrate relations between suicidal ideation and several areas of adolescent peer functioning, as well as divergent processes for peer and family predictors of suicidal ideation.

Risk factors for suicide and attempted suicide among young people

OBJECTIVE

Suicide rates in young people have increased during the past three decades, particularly among young males, and there is increasing public and policy concern about the issue of youth suicide in Australia and New Zealand. This paper summarises current knowledge about risk factors for suicide and suicide attempts in young people.

METHOD

Evidence about risk factors for suicidal behaviour in young people was gathered by review of relevant English language articles and other papers, published since the mid-1980s.

RESULTS

The international literature yields a generally consistent account of the risk factors and life processes that lead to youth suicide and suicide attempts. Risk factor domains which may contribute to suicidal behaviour include: social and educational disadvantage; childhood and family adversity; psychopathology; individual and personal vulnerabilities; exposure to stressful life events and circumstances; and social, cultural and contextual factors. Frequently, suicidal behaviours in young people appear to be a consequence of adverse life sequences in which multiple risk factors from these domains combine to increase risk of suicidal behaviour.

CONCLUSIONS

Current research evidence suggests that the strongest risk factors for youth suicide are mental disorders (in particular, affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology, indicating that priorities for intervening to reduce youth suicidal behaviours lie with interventions focused upon the improved recognition, treatment and management of young people with mental disorders.

Child and adolescent suicide deaths in New Mexico, 1990-1994

The suicide death rate in New Mexico is consistently higher than the national rate. Among adolescents, suicide is the third leading cause of death nationally, but in New Mexico it is the second leading cause of death. This study describes the pattern of adolescent suicide deaths in New Mexico. We conducted a retrospective review of all medical examiner autopsies for adolescent suicides (ages 20 years and younger) in New Mexico from 1990-1994. Records were reviewed for demographics and possible contributing factors such as depression, previous attempts, and alcohol and drug use. We identified 184 suicide deaths among children and adolescents ages 9-20 years for an overall rate of 12.9 per 100,000. Our rates for ages 5-9 years (0.2), 10-14 years (3.8), and 15-19 years (22.3) are over twice the U. S. rates. Suicide deaths resulted primarily from firearms (67%), hanging (16%), poisoning (6%), inhalation (4%), and other methods (7%). Method varied by ethnicity (p = .01) and gender (p = .03); males and non-Hispanic Whites were overrepresented among firearm deaths. Firearm ownership was known in 60 (48%) of the firearm deaths. Of these, 53% of the firearms belonged to a family member, 25% to the decedent, and 22% to a friend. Over one-third of decedents (41%) experienced mental disorders, primarily depressed mood and clinical depression. Previous suicide attempts were noted for 15% of the decedents. Some 50% of the decedents had alcohol or drugs present at the time of death; among American Indians/Alaska Natives, 74% had drugs or alcohol present (p = .003). Targeted interventions are needed to reduce adolescent suicide in New Mexico. We suggest raising awareness about acute and chronic contributing factors to suicide; training physicians to look for behavioral manifestations of depression; and involving physicians, teachers, and youth activity leaders in efforts to limit firearm accessibility, such as advising parents to remove firearms from their households.

Suicide attempts among adolescents in Switzerland: prevalence, associated factors and comorbidity

Switzerland has one of the highest rates of adolescent suicide in Europe, but the prevalence of suicidal thoughts and attempts is unknown. The objective of this paper is to assess the prevalence of suicidal ideation and behaviour among Swiss teenagers and to identify the factors associated with suicide attempts. A self-administered anonymous questionnaire was distributed to a representative sample of 9268 15- to 20-year-old adolescents attending school or college. Six items focused on suicidal ideation and conduct. Multivariate analyses were performed to identify the health variables associated with suicide attempts. About 55% of the adolescents had no suicidal concerns; 26% reported suicidal thoughts, 15% reported suicidal plans and 3% reported suicide attempts. Suicide attempters reported significantly more problems in four areas, namely health behaviour, life events, social relationships and mental health. In conclusion, many factors associated with suicide attempts represent detectable behaviours. Thus health professionals could use this knowledge to be more effective in suicide prevention among adolescents.

[Suicidal behavior in adolescents in Switzerland: role of physicians]

INTRODUCTION

In most industrialized countries, suicide represents the second leading cause of death among adolescents. Swiss teenagers exhibit one of the highest death rates by suicide in Europe; however, the prevalence of suicidal conducts (suicidal ideas, projects and attempts) in Switzerland is not known.

OBJECTIVES

To assess the prevalence of suicidal conducts among Swiss adolescents and to compare these figures with available data from other countries. To establish how suicidal adolescents use health services in comparison with non-suicidal adolescents.

METHODS

Bivariate analyses have been performed using data from the "SMASH" study (Swiss Multicenter Adolescent Survey on Health), a national survey on the health and lifestyles of 9,268 15 to 20 years in-school youth (3,993 girls et 5,275 boys). Within a self-administered anonymous questionnaire of 80 items, five specific questions focused on suicidal conducts and lead to the distribution of respondents in four groups: no suicidal concern, suicidal ideas, suicidal plans, suicide attempt.

RESULTS

Regarding the last 12 months, 5,144 teenagers (55.5%) report no suicide preoccupation at all; 2,376 (25.6%) report suicide ideas only, 1,366 (14.7%) report suicidal projects and 274 (3%) report suicide attempts. Only 40% of respondents who report a suicide attempt have talked about it to someone in their circle of family or friends. Moreover, less than 20% have spoken of their suicide with a psychologist, and although they see physicians as often as the rest of the sample, only 10% have discussed their attempt with one of them. In comparison with those free of suicidal concerns, suicidal adolescents report significantly more health problems and concerns: they feel more often tired or depressed and use medication more often. They also seem to exhibit more deviant behaviors like alcohol and drug use or runaway.

CONCLUSION

Suicidal conducts, especially suicide attempts are much more prevalent among Swiss adolescents, but a small minority is acknowledged and treated by the medical profession. Physicians should be aware of this pathology and better trained both in term of detection and treatment.

Affect regulation and suicide attempts in adolescent inpatients

OBJECTIVE

To examine the relationship between affect dysregulation and self-destructive behaviors in adolescent suicide attempters.

METHOD

Measures of affect dysregulation, number of risk-taking behaviors in past year, presence of self-mutilative behaviors in past year, and number of different types of self-mutilative behaviors in past year were individually administered to adolescents admitted to an inpatient unit who were either suicide ideators (n = 25) or suicide attempters (n = 35).

RESULTS

Suicide attempters reported significantly higher levels of affect dysregulation and a greater number of different types of self-mutilative behaviors in the past year than suicide ideators. In addition, the number of different types of self-mutilative behaviors in the past year had the strongest relationship to suicide attempts.

CONCLUSION

Suicidal behavior among adolescent psychiatric patients is related to poor affect regulation. A risk factor for suicidal behavior in adolescents is a broad range of self-mutilative acts in the year preceding the suicide attempt.

Preventing suicide in young people: what is known and what is needed

In the UK the suicide rate for male adolescents has nearly doubled since 1975. With a similar increase reported from other countries it is not surprising that preventing suicide in young people has become a priority for many health professionals and policy makers. Unfortunately despite advances in our understanding of suicide in young people there are still deficiencies and inconsistencies in our knowledge. There are also problems in transforming our knowledge of suicide and suicidal behaviour in young people and our understanding of theoretically possible approaches to prevention into effective suicide prevention strategies. To increase the chance of preventing suicide in young people we need to be aware of the problems of putting theory into practice and evaluate all interventions that are undertaken to determine their appropriateness and effectiveness.

Hospitalization in a pediatric ward of adolescent suicide attempters admitted to general hospitals

PURPOSE

Considering the growing interest of pediatricians in the adolescent patient, one might hypothesize that adolescent suicide attempters might receive superior treatment in a pediatric unit than in other in-patient settings.

METHODS

In order to examine this hypothesis, we compared sociodemographic and psychosocial characteristics of patients admitted to pediatric wards (n = 174) with those admitted to other departments (n = 251), based on data from a survey of 430 adolescents aged 13-19 years hospitalized following a suicide attempt.

RESULTS

Patients admitted to pediatric units tended to be younger and were more often described as manifesting depression and sleep disturbances. However, no differences were found between the two groups for the other factors investigated (sex, socio-professional category of parents, academic level, family situation, psychiatric problems, social problems, etc.). We then examined differences between the two groups with respect to hospital care (length of stay, psychiatric consultations) and follow-up course (coordination with the family doctor and/or social services, recommended after-care). Our findings showed that for a similar psychosocial profile, pediatric units contact the family doctors more often and proposed a more extensive follow-up. The role in patient management of depression, family, social and school problems is also discussed.

CONCLUSION

Compared with other departments to which adolescent suicide attempters could be admitted, pediatric wards appear to show better performance.

Alcohol consumption in relation to other predictors of suicidality among adolescent inpatient girls

This study of 54 adolescent inpatient girls examined alcohol consumption in relation to depression severity and family dysfunction as predictors of suicidal ideation and behavior. Although alcohol consumption, depression severity, and family dysfunction were intercorrelated, regression analyses revealed their differential importance to the prediction of self-reported suicidal ideation and severity of clinician-documented suicidal ideation or behavior (none, ideation, intent, gesture, attempt). Self-reported ideation was strongly predicted by depression severity and family dysfunction; severity of clinician-documented suicidal ideation or behavior was predicted by alcohol consumption and family dysfunction. Implications for assessment and treatment are discussed.

Gender role in adolescent suicidal behavior: observations and therapeutic implications

We analyzed the relative seriousness of suicide attempts by boys based on 430 hospitalized suicide attempters ages 13 to 19 years. A comparison by sex of adolescent suicide attempters with a school population of non-suicidal adolescents of the same age group shows greater differences in the areas of school failure, psychosomatic and distress-related symptoms and substance abuse between suicidal and non-suicidal boys than between suicidal and non-suicidal girls. These findings suggest that compared with non-suicidal boys and girls, suicidal boys show more deviant behavior than girls. The question then arises as to whether there are differences in the treatment received by male and female suicide attempters. On hospital admission, more boys than girls are sent to psychiatric wards, and boys are proposed follow-up care more frequently than girls. On the other hand, boys and girls are not treated differently with respect to psychiatric consultations during hospitalization or coordination with outside physicians (family doctor, school doctor, other physicians) and the social services. These findings could serve as the basis for the development of specific treatment plans to meet the needs of suicidal boys.

Sex differences in suicidal behaviour of referred adolescents

Reports of suicidal behaviour from four countries using the same measures were higher for girls than for boys, and higher in self-reports than in parent reports for both referred and normal adolescents. In a sample of 480 referred adolescents, patterns of 'low' and 'high' suicidal scores were different when age, sex and diagnosis were considered. The probability of high scores for girls showed only a marginal increase with age, while there was a striking rise for boys. An affective diagnosis doubled the probability of high scores for both boys and girls, while it had no effect on low scores. Psychosocial stressors also increased the probability of high suicidal scores, particularly in adolescents with an affective disorder. Sex differences in suicidal behaviour were marked in the low-scoring groups.

Mortality and aggressiveness in a 30-year follow-up study in child guidance clinics in Stockholm

The mortality rate and aggressiveness in a cohort of 2364 former patients of the child guidance clinics in Stockholm were studied during a 30-year follow-up period; 106 died during this observation period. This frequency is significantly higher than the calculated mortality rate in a reference population. In all, 82% of the total deaths were caused by suicide, accidents, or abuse of alcohol or drugs. Among the patients that died of suicide and abuse, more mental disorders, abuse and criminality were found in their parents during the initial evaluation. Significantly more males than females died as a result of accidents and alcohol or drug abuse. Aggressive feelings and acts, both against oneself and others, were overrepresented in the initial contacts with the child guidance clinics. To prevent these deaths, an alternative approach during the first contact with a child psychiatric centre is discussed, as well as more extensive help and intervention at an early stage.

Characteristics of suicide attempters in a population-based sample of Dutch adolescents

The characteristics of suicide attempters were ascertained in a sample of 9393 Dutch students aged 14-20. Broken homes and use of drugs and alcohol were found more often among attempters. Attempters more frequently lived with a single parent, in children's homes or foster homes, were disproportionately of female sex, reported more deaths of friends or relatives, and more often had an unemployed father. Thoughts of suicide and of death were reported more frequently, they were more depressed and hopeless, and had less self-esteem. They were less rational and perceived relationships with parents as poor.