Psychiatric diagnoses in minority female adolescent suicide attempters

The Effectiveness of Predicting Suicidal Ideation through Depressive Symptoms and Social Isolation Using Machine Learning Techniques

(1) Background: Social isolation is a major risk factor for suicidal ideation. In this study, we investigated whether the evaluation of both depression and social isolation in combination could effectively predict suicidal ideation; (2) Methods: A total of 7994 data collected from community residents were analyzed. Statistical analysis was performed using age, the Patient Health Questionnaire-9, and the Lubben Social Network Scale as predictors as the dependent variables for suicidal ideation; machine learning (ML) methods K-Nearest Neighbors, Random Forest, and Neural Network Classification were used; (3) Results: The prediction of suicidal ideation using depression and social isolation showed high area under the curve (0.643–0.836) and specificity (0.959–0.987) in all ML techniques. In the predictor model (model 2) that additionally evaluated social isolation, the validation accuracy consistently increased compared to the depression-only model (model 1); (4) Conclusions: It is confirmed that the machine learning technique using depression and social isolation can be an effective method when predicting suicidal ideation.

Detecting suicidal risk using MMPI-2 based on machine learning algorithm

Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a widely used tool for early detection of psychological maladjustment and assessing the level of adaptation for a large group in clinical settings, schools, and corporations. This study aims to evaluate the utility of MMPI-2 in assessing suicidal risk using the results of MMPI-2 and suicidal risk evaluation. A total of 7,824 datasets collected from college students were analyzed. The MMPI-2-Resturcutred Clinical Scales (MMPI-2-RF) and the response results for each question of the Mini International Neuropsychiatric Interview (MINI) suicidality module were used. For statistical analysis, random forest and K-Nearest Neighbors (KNN) techniques were used with suicidal ideation and suicide attempt as dependent variables and 50 MMPI-2 scale scores as predictors. On applying the random forest method to suicidal ideation and suicidal attempts, the accuracy was 92.9% and 95%, respectively, and the Area Under the Curves (AUCs) were 0.844 and 0.851, respectively. When the KNN method was applied, the accuracy was 91.6% and 94.7%, respectively, and the AUCs were 0.722 and 0.639, respectively. The study confirmed that machine learning using MMPI-2 for a large group provides reliable accuracy in classifying and predicting the subject's suicidal ideation and past suicidal attempts.

A Longitudinal Study of Racial Discrimination and Risk for Death Ideation in African American Youth

Although multiple studies have found that African Americans commonly experience racial discrimination, available studies have yet to examine how perceived racism might be related to suicide vulnerability in African American youth. The purpose of this study was to examine a framework for how perceived racial discrimination contributes to symptoms of depression and anxiety as well as subsequent suicide ideation and morbid ideation. Data were obtained from 722 African American youth at mean age 10.56 years (SD = 0.64); a second wave of data was obtained 2 years later. Results revealed both a direct effect and mediated effects of perceived racism on later suicide and morbid ideation. For boys and girls, the effect of perceived racism was mediated by symptoms of depression. However, the association was mediated by anxiety for girls, but not for boys in the current sample. Implications for future research and interventions are discussed.

Characteristics of 61 Mexican American Adolescents Who Attempted Suicide

A total of 61 Mexican American adolescents who were consecutively admitted to an inpatient psychiatric unit after a suicide attempt were studied. They were given structured interviews to study their demographic, personal, and family characteristics. The intent of the suicide attempts was measured with the Pierce Suicide Intent Scale. Compared to subjects in the low-intent group, those in the high-intent group showed a history of more frequent previous suicide attempts (p < .03), had lived with both biological parents for a longer time (p < .04), usually had at least one biological parent at home at the time of the suicide attempts (p < .001), and had lived in the United States for a shorter period of time (p < .04). Psychosocialfactors including the phenomenon of acculturation are reviewed in the discussion of these results.

Fatal and non-fatal suicidal behavior in Israeli adolescent males

The objective of this study is examine the similarities and differences between adolescent suicide completers, adolescents with non-fatal suicidal symptoms, and non-suicidal psychiatric controls in an epidemiologic sample. Using the central Israeli military medical registry, 214 18-21 year old males from the same national service cohort were identified, consisting of 43 consecutive completed suicides and 171 consecutive central psychiatric clinic outpatients presenting with near-fatal suicide attempts, serious suicide attempts, para-suicidal gestures, threats, ideation, or other non-suicidal complaints. Systematic pre-induction and service data were available for all subjects, with detailed postmortem inquest data for suicides. Systematic clinical data, including the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS), Hamilton Depression Scale, and Eysenck Personality Inventory were obtained on all clinic subjects. Major depression was present in half of completers, near-lethal attempters, and ideators, but absent in the other clinic groups, whose commonest diagnosis was adjustment disorder. Depression scores increased across groups with increasing intent; ideators also had high scores. Completers and near-lethal attempters had higher I.Q. and medical fitness ratings and were in more demanding assignments than other groups. Prior attempts were commonest in completers, near-lethal attempters, and gesturers. Disciplinary history, ethnicity, family intactness, immigrant status, and Eysenck Personality Inventory scores did not differentiate the groups. The findings may not be generalizable to female adolescents or to other countries or time periods. The findings thus point to contrasts, as well as similarities, between groups of adolescents with different types of suicidal symptoms.

The suicidal child: assessment and management of adolescents after a suicide attempt

It has been estimated that for each completed suicide, there are 15 to 20 nonfatal suicide attempts. A prior suicide attempt can create a major elevation in the risk of subsequent attempt. A prior suicide attempt also is a strong predictor for eventual completed suicide. Consequently, management of an adolescent who attempts suicide is important. In this article, the authors examine various issues related to suicide risk in adolescents. The article focuses on key issues that should be included in a thorough assessment of adolescents who are referred for an evaluation during a suicidal crisis. The empirical literature is used as a guide for identifying risk factors that should be monitored and managed as part of a comprehensive treatment plan.

A follow-up study of adolescent attempted suicide in Israel

OBJECTIVES

(1) To compare the outcome of adolescent subjects who have made a suicide attempt with the outcome of matched controls, using their psychological and psychometric screening tests for military service at age 16.5 years. Their subsequent performance during military service between ages 18 and 21 was also evaluated. (2) To compare the prognosis of those attempters who received intensive psychiatric inpatient evaluation in a general hospital with the prognosis of those who received emergency room treatment only.

METHOD

The computerized military records of 216 adolescents, who had been treated between 1987 and 1988 for attempted suicide in a general hospital emergency room, prior to their induction into the army, were evaluated. They were rated on the following tests: cognitive/educational performance and psychosocial adaptation, psychiatric and psychological health diagnoses, and performance during their military service between 1989 and 1992.

RESULTS

Although the female attempters had slightly more problems in the military than the controls, their overall prognosis was surprisingly good. The male suicide attempters did very poorly in their subsequent military service. There was no long-term advantage in having had a psychiatric evaluation performed in a hospital over a brief emergency room evaluation. Most differences between attempters and controls were in service performance, rather than in cognitive and psychometric tests.

CONCLUSIONS

There may be marked differences between the sexes in the significance of attempted suicide and in the indications for intervention. The policy of mandatory general hospitalization for suicide attempters may need reevaluation.

Correlates of suicidal behaviors among Asian American outpatient youths

Medical record abstraction was conducted at an ethnic-specific mental health outpatient clinic to identify correlates of suicidal behaviors in a sample of 285 Asian American youths. Some risk factors, such as parent-child conflict and age, which have been associated with suicidality in majority group youths, predicted suicidality in this sample, whereas other risk factors, such as gender, did not generalize to this sample. Acculturation interacted with the risk factor of parent-child conflict to predict suicidality. Less acculturated Asian youths were at proportionally greater risk for suicidality under conditions of high parent-child conflict than were their more acculturated counterparts. This finding underscores the importance of culture as a context for determining the relevance of stressors for potentiating psychopathology.

Children in group homes: family dynamics, adolescent suicide attempts and drug use

Three hundred children age 10-20 living in group homes for children were assessed for behaviors related to alcohol and other drug consumption, suicide attempts, frequency of punishment, attention from parents, conflicts with parents, and other family dynamics. Children who used substances were significantly more likely to have attempted suicide more frequently. Children who had attempted suicide were more likely to perceive that they had not received enough parental attention, to have had more conflicts with parents, and to have run away from home. This seminal article indicates inter-related prevalences of family factors, suicide and substance abuse issues and suggests the need for strong institutional and agency policy development for this understudied "at risk" population.

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.

Microanalysis of adolescent suicide attempters and ideators during the acute suicidal episode

OBJECTIVE

To compare psychological and event-related contingencies that characterize and differentiate adolescent suicidal ideation and attempts.

METHOD

Thirty-five ideators and 32 attempters (aged 12 to 17 years) consecutively referred to the suicide disorders clinic were evaluated with a semistructured interview about current and past emotional, cognitive, and behavioral states.

RESULTS

Before the precipitant stressor (baseline), attempters reported significantly more hopelessness than ideators (odds ratio [OR] = 4.2, p < .05). During the suicidal episode, attempters, relative to ideators, spent more time ideating (OR = 4.3, p < .05), were more likely to isolate themselves (OR = 5.8, p < .01), and were less likely to tell anyone what they were thinking (OR = 4.5, p < .05). In contrast, ideators reported significantly more residual anger after the episode than did attempters (OR = 4.0, p < .05). All the episodes of ideation and attempts were preceded by a stress event. No differences were found between the groups on Beck Depression inventory scores.

CONCLUSIONS

Preexisting hopelessness, a tendency toward isolation, not talking about ideation, and longer length of time ideating during suicidal episodes discriminated suicide attempters from suicide ideators. Knowledge of these factors may be helpful in preventive and treatment efforts with suicidal adolescents.

Management of suicidal behavior in children and adolescents

Many therapeutic approaches to managing suicidal behavior among youth have been used, including in-school education programs, screening programs, telephone hotlines, cognitive behavioral therapies, medication management, and inpatient milieux treatment programs. These interventions have been applied based on educational and therapeutic principles drawn from prior work with adolescents in varied scholastic and psychiatric settings. This article reviews: the assessment of risk factors among suicide attempters, emotional states, family, social isolation, interpersonal loss, substance and alcohol abuse, and treatment strategies.

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.

Suicidality correlates in Mexican American teens

This study was conducted to determine the relationships between suicidality and life stress, coping, depression, and family dysfunction in Mexican American teens. The research question was: What are the magnitude of the relationships between suicidality and life stress, coping, depression, and family dysfunction in Mexican American teenagers? The investigators discuss the findings of the study from the perspective of the Mexican American culture, followed by specific conclusions and recommendations drawn from the results of the study. In this article, the term teen is used interchangeably with the terms teenager, youth, and adolescent; suicidality is used interchangeably with suicide risk.

Childhood circumstances, adolescent adjustment, and suicide attempts in a New Zealand birth cohort

OBJECTIVE

To estimate the prevalence of attempted suicide during adolescence in a birth cohort of New Zealand children studied to the age of 16 years and to examine the relationships among adolescent problems of adjustment, psychopathology, childhood circumstances, and risks of adolescent suicide attempts.

METHOD

Attempted suicide, adolescent problems of adjustment, psychopathology, and childhood circumstances were assessed as part of a longitudinal study of a birth cohort of 954 New Zealand children studied at annual intervals to the age of 16 years.

RESULTS

By 16 years, 3.0% of the sample (4.2% of girls and 1.9% of boys) reported having made a suicide attempt. There were strong associations between attempted suicide and rates of adolescent problem behaviors or psychopathology; teenagers having problems of adjustment or psychiatric disorders were up to 22 times more likely to attempt suicide. Risks of attempted suicide were also higher among children from disadvantaged or dysfunctional family backgrounds. A loglinear model fitted to the measures of attempted suicide, adolescent psychopathology, problems of adjustment, and childhood circumstances suggested the presence of a causal chain process in which childhood problems were significantly (p < .005) related to increased risks of later psychopathology and problems of personal adjustment which were, in turn, related to significantly (p < .05) increased rates of attempted suicide.

CONCLUSIONS

A common pathway that leads to increased vulnerability to suicidal behavior involves early disadvantageous childhood and family circumstances, which lead to increased risks of adolescent psychopathology and problems of adjustment, which lead to increased risks and vulnerability to adolescent suicidal behaviors.

Epidemiology of suicidal behavior among Korean adolescents

The purpose of this study was to estimate the prevalence of suicidal behaviors and their relation to background characteristics, social integration, academic stress, psychological distress, and substance use in a stratified random sample of 9886 high school students in Korea. In a multiple logistic regression, we found that depression was the strongest predictor of suicidal behaviors. The other factors significantly associated with suicidal behaviors were gender, academic stress, hostility and substance use. These results indicate that early identification of risk factors for suicidal behaviors may have potential for reducing possible future suicides.

Psychopathology, family functioning, and cognitive style in urban adolescents with suicide attempts

This study examined psychopathology, family functioning, and cognitive style in 121 African-American adolescents who attempted suicide. Group means suggested that these youths, when taken together, were not reporting significant psychological distress. However, after classifying the youths into three groups by level of depressive symptoms interesting findings emerged. Youth self-reports of depressive symptoms on the Children's Depression Inventory were associated with the presence of internalizing and externalizing disorders on the Youth Self-Report and Child Behavior Checklist, and with a maladaptive attributional style. Sixty-seven percent of participants classified their family types as maladaptive in terms of levels of cohesion and/or adaptability. In fact, the majority of adolescents and parents reported their families as disengaged. These findings are discussed from a culturally and developmentally sensitive framework which considers key demographic variables (race, socioeconomic status, age). Clinical implications are offered for individual and family interventions.

Are adolescent suicide attempters noncompliant with outpatient care?

The outpatient clinic attendance patterns of 115 consecutively referred 10- to 18-year-old suicide attempters and of 110 nonattempters were compared. The two groups did not differ in number of appointments scheduled or missed, but attempters kept significantly fewer appointments than did nonattempters. Seventy-seven percent of each group dropped out of treatment, but attempters dropped out significantly faster. Attendance and dropout were unrelated to age, reason for referral, or previous attempts. Girls missed more appointments than did boys, and Hispanic patients kept a smaller percentage of scheduled appointments than did other ethnic groups. We conclude that adolescent attempters are not more likely to drop out of treatment but keep fewer appointments and remain in care more briefly than do other outpatients. Recommendations for triage and brief case management are made.

Psychopathology in urban female minority adolescents with suicide attempts

This study examines the level of psychopathology in 53 African-American females who attempted suicide by ingestion. Parents completed a measure of adolescent psychopathology, and the youths completed measures of depression and psychopathology. Overall, the results suggested that these youths were not experiencing significant emotional distress. However, after classifying the youths into four groups by their self-reported level of depression, the incidence of parent- and youth-reported psychopathology varied. More significant levels of depression corresponded to significant internalizing difficulties, as reported by the adolescent, and myriad psychopathological difficulties, as reported by the parents. These results are discussed from a clinical perspective with a developmentally and culturally sensitive focus. Disposition decisions must consider the level of psychopathology reported by child and parent, the family's willingness to participate in outpatient treatment, and the degree to which the adolescent and her family acknowledge the significance of the suicide attempt.