Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies

Co-occurring Intimate Partner Violence, Mental Health, Human Immunodeficiency Virus, and Parenting Among Women: A Scoping Review

Little research exists on the human immunodeficiency virus (HIV)-intimate partner violence (IPV)-mental health (MH) syndemic impact on parenting. The objective of this scoping review is to identify and summarize the available evidence regarding the syndemic relationship between HIV or Acquired Immune Deficiency Syndrome (AIDS), IPV, and poor MH among mothers and caregivers who identify as women. We conducted the review according to the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and meta-analyses extension for scoping reviews guidelines, a comprehensive search was conducted from 2001 to September 2023. The inclusion criteria targeted studies examining at least two of the HIV, IPV, or MH epidemics among participants and their syndemic impact on parenting. Both qualitative and quantitative studies were included. Covidence software was used to screen and extract data. Twenty-three studies were included in the analysis. Most of the studies were conducted in the United States. Furthermore, all the studies used quantitative research designs, with most being longitudinal. Most of the research was concentrated on the IPV-MH syndemic with no research found on the HIV-IPV syndemic impact on parenting. Research on the HIV-IPV-MH syndemic found that an HIV diagnosis exacerbated the negative impacts of IPV-MH on parenting. Research on IPV-MH showed that this syndemic significantly influences parenting, leading to less nurturing and more punitive behaviors. Studies did not find a direct association between IPV and harsh parenting practices, the relationship was mediated by poor MH. Studies examining the HIV-MH syndemic found that anxiety and maternal depression were the most frequent MH disorders. The review revealed that living with the different syndemics, (IPV-MH-HIV, HIV-MH, and IPV-MH) adversely affects parenting practices, resulting in harsher parenting.

Large Language Models Versus Expert Clinicians in Crisis Prediction Among Telemental Health Patients: Comparative Study

BACKGROUND

Due to recent advances in artificial intelligence, large language models (LLMs) have emerged as a powerful tool for a variety of language-related tasks, including sentiment analysis, and summarization of provider-patient interactions. However, there is limited research on these models in the area of crisis prediction.

OBJECTIVE

This study aimed to evaluate the performance of LLMs, specifically OpenAI's generative pretrained transformer 4 (GPT-4), in predicting current and future mental health crisis episodes using patient-provided information at intake among users of a national telemental health platform.

METHODS

Deidentified patient-provided data were pulled from specific intake questions of the Brightside telehealth platform, including the chief complaint, for 140 patients who indicated suicidal ideation (SI), and another 120 patients who later indicated SI with a plan during the course of treatment. Similar data were pulled for 200 randomly selected patients, treated during the same time period, who never endorsed SI. In total, 6 senior Brightside clinicians (3 psychologists and 3 psychiatrists) were shown patients' self-reported chief complaint and self-reported suicide attempt history but were blinded to the future course of treatment and other reported symptoms, including SI. They were asked a simple yes or no question regarding their prediction of endorsement of SI with plan, along with their confidence level about the prediction. GPT-4 was provided with similar information and asked to answer the same questions, enabling us to directly compare the performance of artificial intelligence and clinicians.

RESULTS

Overall, the clinicians' average precision (0.7) was higher than that of GPT-4 (0.6) in identifying the SI with plan at intake (n=140) versus no SI (n=200) when using the chief complaint alone, while sensitivity was higher for the GPT-4 (0.62) than the clinicians' average (0.53). The addition of suicide attempt history increased the clinicians' average sensitivity (0.59) and precision (0.77) while increasing the GPT-4 sensitivity (0.59) but decreasing the GPT-4 precision (0.54). Performance decreased comparatively when predicting future SI with plan (n=120) versus no SI (n=200) with a chief complaint only for the clinicians (average sensitivity=0.4; average precision=0.59) and the GPT-4 (sensitivity=0.46; precision=0.48). The addition of suicide attempt history increased performance comparatively for the clinicians (average sensitivity=0.46; average precision=0.69) and the GPT-4 (sensitivity=0.74; precision=0.48).

CONCLUSIONS

GPT-4, with a simple prompt design, produced results on some metrics that approached those of a trained clinician. Additional work must be done before such a model can be piloted in a clinical setting. The model should undergo safety checks for bias, given evidence that LLMs can perpetuate the biases of the underlying data on which they are trained. We believe that LLMs hold promise for augmenting the identification of higher-risk patients at intake and potentially delivering more timely care to patients.

Early life adversities, psychopathologies and novel pharmacological strategies

Exposure to adversities during early life stages (early life adversities - ELA), ranging from pregnancy to adolescence, represents a major risk factor for the vulnerability to mental disorders. Hence, it is important to understand the molecular and functional underpinning of such relationship, in order to develop strategies aimed at reducing the psychopathologic burden associated with ELA, which may eventually lead to a significant improvement in clinical practice. In this review, we will initially recapitulate clinical and preclinical evidence supporting the link between ELA and psychopathology and we will primarily discuss the main biological mechanisms that have been described as potential mediators of the effects of ELA on the psychopathologic risk, including the role for genetic factors as well as sex differences. The knowledge emerging from these studies may be instrumental for the development of novel therapeutic strategies aimed not only at correcting the deficits that emerge from ELA exposure, but also in preventing the manifestation of a full-blown psychopathologic condition. With this respect, we will specifically focus on adolescence as a key time frame for disease onset as well as for early therapeutic intervention. We believe that incorporating clinical and preclinical research data in the context of early life adversities can be instrumental to elucidate the mechanisms contributing to the risk for psychopathology or that may promote resilience. This will ultimately allow the identification of 'at risk' individuals who may benefit from specific forms of interventions that, by interfering with disease trajectories, could result in more benign clinical outcomes.

Childhood adversity and suicidal ideation in older Korean adults: unraveling the mediating mechanisms of mental health, physical health, and social relationships

BACKGROUND

Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation.

METHODS

The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships.

RESULTS

The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation.

CONCLUSIONS

Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults.

Suicidal ideation, suicide attempt, and self-injury among American Indian, Alaskan Native, and Native Hawaiian college students in the United States from 2015 to 2019

Background

Suicide is a major driver of mortality among college students and is the leading cause of death among American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) young adults.

Methods

Data on suicidal ideation, suicide attempt, and self-injury among AI/AN/NH college students (n = 8103) were analyzed via multivariable logistic regressions employing the American College Health Association National College Health Assessment survey from 2015 to 2019. Adjusted odds ratios (aORs) were used to assess how opioid misuse may act as a risk or protective factor for suicidality and self-injury.

Results

Between 2015 and 2019, suicidal ideation was the most prevalent dimension of suicidality affecting AI/AN/NH college students (ranges from 12.69% to 18.35%), followed by self-injury (7.83%-11.41%) and suicide attempt (2.40%-4.10%). AI/AN/NH college students who reported opioid misuse were significantly more likely to experience suicidal ideation (aOR: 1.417; 95% confidence interval [CI]: 1.154-1.740) and self-injury (aOR: 1.684; 95% CI: 1.341-2.116) than those who did not engage in such behavior.

Conclusions

We identified opioid misuse as a potential risk factor for suicidal ideation and intentional self-injury among populations of AI/AN/NH college students. Programs seeking to reduce suicide prevalence among Indigenous college students may benefit from the inclusion of evidence-based interventions that prevent and treat issues related to opioid use.

Suicidal ideation risk among LGB Spanish university students: The role of childhood and adolescence adversities and mental disorders

BACKGROUND

Childhood/adolescence adversities and mental disorders are higher among LGB youths.

AIMS

To evaluate the role of childhood maltreatment, bullying, and mental disorders on the association between sexual orientation and suicidal ideation (SI); and the role of mental disorders on the association between sexual orientation discrimination and SI.

METHODS

Baseline and 12-month follow-up online surveys of Spanish first-year university students (18-24-year-olds). Multivariable logistic regression models assessed the effects of childhood/adolescence adversities and mental disorders in the relationship between sexual orientation, discrimination and SI.

RESULTS

A total of 1224 students were included (16.4 % LGBs). Risk factors of lifetime SI were sexual orientation (OR 2.4), any bullying (OR 2.4), any childhood maltreatment (OR 4.0), and any mental disorders (OR 3.8). Final model Area Under the Curve (AUC) 0.78. Among homosexual and bisexual students, discrimination showed increased risk of 12-month SI (OR 2.2), but this effect was no longer statistically significant when any 12-month mental disorder was added (OR 7.8). Final model AUC 0.72.

LIMITATIONS

Sample of interest was relatively small. But it was similar to comparable studies and statistical adjustments have been performed. Assessment of mental disorders and SI was not based on clinical assessment. However, validated scales showing good diagnostic agreement with clinical judgement were used.

CONCLUSIONS

Childhood/adolescence adversities and mental disorders interact in the association between sexual orientation and SI. Mental disorders may mediate the association between sexual orientation discrimination and SI. Further research using larger samples and causal modelling approach assessing the mediators of SI risk among LGBs is needed.

24-Hour warning signs for adolescent suicide attempts

BACKGROUND

Little is known about when youth may be at greatest risk for attempting suicide, which is critically important information for the parents, caregivers, and professionals who care for youth at risk. This study used adolescent and parent reports, and a case-crossover, within-subject design to identify 24-hour warning signs (WS) for suicide attempts.

METHODS

Adolescents (N = 1094, ages 13 to 18) with one or more suicide risk factors were enrolled and invited to complete bi-weekly, 8-10 item text message surveys for 18 months. Adolescents who reported a suicide attempt (survey item) were invited to participate in an interview regarding their thoughts, feelings/emotions, and behaviors/events during the 24-hours prior to their attempt (case period) and a prior 24-hour period (control period). Their parents participated in an interview regarding the adolescents' behaviors/events during these same periods. Adolescent or adolescent and parent interviews were completed for 105 adolescents (81.9% female; 66.7% White, 19.0% Black, 14.3% other).

RESULTS

Both parent and adolescent reports of suicidal communications and withdrawal from social and other activities differentiated case and control periods. Adolescent reports also identified feelings (self-hate, emotional pain, rush of feelings, lower levels of rage toward others), cognitions (suicidal rumination, perceived burdensomeness, anger/hostility), and serious conflict with parents as WS in multi-variable models.

CONCLUSIONS

This study identified 24-hour WS in the domains of cognitions, feelings, and behaviors/events, providing an evidence base for the dissemination of information about signs of proximal risk for adolescent suicide attempts.

Service utilization among adolescents seeking trauma-related care: Differences by risk for suicide and ethnoracial background

Adolescents from ethnoracially minoritized backgrounds increasingly report high rates of attempted suicide, trauma exposure, and limited access to mental healthcare services. However, less is known regarding their use of services across different youth-serving systems. This study examines the associations and interactions between self-injurious thoughts and behaviors (SITBs), race/ethnicity, and service sector utilization (mental healthcare, general healthcare, school, and social services) among a sample of trauma-exposed and treatment-seeking adolescents. Participants were treatment-seeking adolescents (N = 4406) ages 12-17 from the National Child Traumatic Stress Network Core Data Set who had available data for SITBs, race/ethnicity, services utilized, and other key variables. Mixed effects logistic regression was used to examine main and interactive effects for whether adolescents' race/ethnicity and SITBs were associated with service utilization in each of the identified service sectors. SITBs were associated with adolescents' utilization of mental healthcare (OR = 1.38 p < 0.001), general healthcare (OR = 2.30; p < 0.001), and school services (OR = 1.38 p < 0.001). NH Black adolescents reporting SITBs were less likely to use mental health services than other NH Black youths (OR = 0.53; p = 0.004). Hispanic adolescents reporting SITBs were more likely to utilize healthcare services than other Hispanic youths (OR = 1.51; p = 0.039). Trauma-exposed adolescents reporting SITBs are more likely to utilize mental healthcare, general healthcare, and school-based services than other trauma-exposed adolescents. However, NH Black adolescents experiencing SITBs may face additional barriers to utilizing mental healthcare services. Findings can be used to develop nursing practices and policies to address barriers faced by adolescents reporting SITBs.

Emergency department presentations for deliberate self-harm and suicidal ideation in 25-39 years olds following agency-notified child maltreatment: results from the Childhood Adversity and Lifetime Morbidity (CALM) study

AIMS

To compare prospective reports of child maltreatment (CM) with emergency department (ED) presentations for deliberate self-harm (DSH) and suicidal ideation in individuals aged between 25 and 39 years old.

METHODS

Linked records between the Mater-University of Queensland Study of Pregnancy birth cohort and Queensland administrative health data were used, which included notifications to child protection agencies for CM. ED presentations for individuals aged between 25 and 39 years of age for suicidal ideation, suicidal behaviour or poisoning by paracetamol or psychotropic medications where the intention was unclear were examined using logistic regression analyses.

RESULTS

A total of 609 (10.1%) individuals were the subject of one or more CM notifications for neglect or physical, sexual or emotional abuse before the age of 15 years. Of these, 250 (4.1%) presented at least once to ED for DSH and/or suicidal ideation between 25 and 39 years of age. In adjusted analysis, any notification of CM was associated with significantly increased odds of presenting to ED for these reasons (aOR = 2.80; 95% CI = 2.04-3.84). In sensitivity analyses, any notification of CM increased the odds of the combined outcome of DSH and suicidal ideation by 275% (aOR = 2.75; 95% CI = 1.96-4.06) and increased the odds of DSH alone by 269% (aOR = 2.69; 95% CI = 1.65-4.41).

CONCLUSIONS

All CM types (including emotional abuse and neglect) were associated with ED presentations for DSH and suicidal ideation in individuals between 25 and 39 years of age. These findings have important implications for the prevention of DSH, suicidal ideation and other health outcomes. They also underscore the importance of trauma-informed care in ED for all individuals presenting with DSH and suicidal ideation.

Assessing Survey Items on Social Norms Relating to Dating and Relationship Violence and to Gender: Cognitive Interviews with Young People in England

Widespread among adolescents in England, dating and relationship violence (DRV) is associated with subsequent injuries and serious mental health problems. While DRV prevention interventions often aim to shift harmful social norms, no established measures exist to assess relevant norms and their role in mediating DRV outcomes. We conducted cognitive interviews exploring the understandability and answerability of candidate measures of social norms relating to DRV and gender roles, informing measure refinement. In all, 11 participants aged 13 to 15 from one school in England participated. Cognitive interviews tested two items assessing descriptive norms (beliefs about what behaviors are typical), three assessing injunctive norms (beliefs about what is socially acceptable), and (for comparison) one assessing personal attitudes. Findings were summarized by drawing on interview notes. Summaries and interview notes were subjected to thematic analysis. For some participants, injunctive norms items required further explanation to clarify that items asked about others' views, not their own. Lack of certainty about, and perceived heterogeneity of, behaviors and views among a broad reference group detracted from answerability. Participants were better able to answer items for which they could draw on concrete experiences of observing or discussing relevant behaviors or social sanctions. Data suggest that a narrowed reference group could improve answerability for items assessing salient norms. Findings informed refinements to social norms measures. It is possible to develop social norms measures that are understandable and answerable for adolescents in England. Measures should assess norms that are salient and publicly manifest among a cohesive and influential reference group.

Association between traumatic events with suicidality among adolescents: A large-scale cross-sectional study of 260,423 participants

Traumatic events have significant negative impacts throughout one's life. We aimed to comprehensively examine the early associations between traumatic events and suicidality among adolescents. In a cross-sectional sample of 260,423 adolescents in Deyang, China in September 2021, we assessed individual traumatic events, cumulative types, and patterns, alongside suicide risk scores and ideation, attempts, or plans. Linear and Poisson regression models adjusted for demographic confounders evaluated the association. Robust associations existed between interpersonal violence-related traumatic events and higher suicidality, with physical abuse demonstrating the strongest correlation. Moreover, suicide risk scores displayed a clear trend, indicating a progressively stronger association with suicidality as cumulative traumatic event types increased. Four distinct traumatic patterns emerged, including low traumas, high physical abuse, high death/serious injuries of a loved one, and multiple traumas, with the latter showing the strongest association with suicidality. Notably, the stratified analysis showed these associations were more pronounced in females, urban residents, only children, left-behind children, and those aged 13-15, while weaker in participants from families with intact parental relationships and middle socioeconomic status. Understanding the role of demographic factors and traumatic patterns in identifying at-risk youth can enable early detection and targeted interventions for suicide-related concerns.

Examining the integrated model of the interpersonal-psychological theory of suicide and intersectionality theory among Black male adolescents

INTRODUCTION

Guided by Opara et al.'s (2022), Integrated Model of the Interpersonal Psychological Theory of Suicide and Intersectionality Theory, the current study examined contextual stressors experienced disparately by Black youth (racial discrimination, poverty, and community violence) as moderators of the association between individual motivating factors for suicidal thoughts and behaviors (perceived burdensomeness, thwarted belongingness, and hopelessness) and active suicidal ideation.

METHOD

Participants were 457 Black adolescent boys (mean age = 15.31, SD = 1.26) who completed self-report surveys.

RESULTS

As predicted, the association between perceived burdensomeness and active suicidal ideation was significantly moderated by economic stress. In addition, the association between peer belongingness and suicidal ideation was significantly moderated by racial discrimination, but there were no moderating effects for school belongingness. Finally, the association between hopelessness and suicidal ideation was significantly moderated by both racial discrimination and witnessing community violence.

CONCLUSION

These findings highlight the need for research, interventions, and policy work devoted to using integrated approaches of individual and socioeconomically relevant patterns of suicidal thoughts and behaviors to support Black youth exposed to various forms of structural oppression.

Interpersonal violence and suicide risk: Examining buffering effects of school and community connectedness

Background

Exposure to interpersonal violence is associated with elevated suicide risk. Preventing suicide among high-risk adolescents is most often discussed from a clinical treatment perspective, resulting in a gap in research examining whether school and community connectedness can buffer the relationships between forms of interpersonal violence and suicide risk in clinical samples of adolescents.

Methods

Baseline data from 294 adolescents who received substance use treatment were analyzed to help fill this gap in research. Adolescents in this sample were at greater risk for suicidal thoughts and behaviors given their histories of substance use disorders and high rates of interpersonal violence, with 57% reporting experiencing at least one form of abuse/violence. Independent variables included lifetime exposure to physical abuse, sexual abuse, and weapon violence; moderators included various measures of school and community connectedness. Multinomial logistic regression models were estimated to examine the main and interaction effects predicting a three-category measure of suicide risk: non-suicidal, suicidal ideation only, and prior suicide attempts.

Results

Sexual abuse survivors had the highest predicted probability of a prior suicide attempt when reporting lower levels of teacher support, school-based positive peer interactions, or neighborhood social connection, but at higher levels of these protective factors, their predicted probability was similar to those not exposed to sexual abuse. The same protective pattern was observed for physical abuse survivors with high neighborhood social connection.

Conclusion

The buffering effects observed in this study identified dimensions of school and community social connectedness as protective factors for youth exposed to abuse. Although promoting social connectedness is often cited as a universal suicide prevention approach, tailored efforts to enhance connectedness within this population may also be a promising secondary prevention strategy. Thus, in addition to clinical treatment, more emphasis should be placed on systems-level approaches to reducing risk among youth most vulnerable to suicide.

Global Prevalence and Mental Health Outcomes of Intimate Partner Violence Among Women: A Systematic Review and Meta-Analysis

The aim of this systematic review was to assess the magnitude of the association between types of intimate partner violence (IPV) and mental health outcomes and shed light on the large variation in IPV prevalence rates between low- to middle-income countries and high-income countries. The study is a systematic review and meta-analysis. The following databases were searched for this study: Cochrane, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and the Applied Social Sciences Index and Abstracts. The inclusion criteria for this study are as follows: quantitative studies published from 2012 to 2020 on IPV exposure in women aged 16+, using validated measures. Random effects meta-analyses and subgroup analysis exploring heterogeneity across population groups in different economic contexts are used in this study. In all, 201 studies were included with 250,599 women, primarily from high-income countries. Higher prevalence rates were reported for women's lifetime IPV than past year IPV. Lifetime psychological violence was the most prevalent form of IPV. Women in the community reported the highest prevalence for physical, psychological, and sexual violence in the past year compared to clinical groups. Perinatal women were most likely to have experienced lifetime physical IPV. Prevalence rates differed significantly (p = .037 to <.001) for "any IPV" and all subtypes by income country level. Meta-analysis suggested increased odds for all mental health outcomes associated with IPV including depression (odds ratio [OR] = 2.04-3.14), posttraumatic stress disorder (PTSD) (OR = 2.15-2.66), and suicidality (OR = 2.17-5.52). Clinical and community populations were exposed to high prevalence of IPV and increased likelihood of depression, PTSD, and suicidality. Future research should seek to understand women's perspectives on service/support responses to IPV to address their mental health needs. Work with IPV survivors should be carried out to develop bespoke services to reduce IPV in groups most at risk such as pregnant and/or help-seeking women.

Social Norms About Dating and Relationship Violence and Gender Among Adolescents: Systematic Review of Measures Used in Dating and Relationship Violence Research

Adolescent dating and relationship violence (DRV) is widespread and associated with increased risk of subsequent poor mental health outcomes and partner violence. Shifting social norms (i.e., descriptive norms of perceived behavior and injunctive norms of acceptable behavior among a reference group of important others) may be important for reducing DRV. However, few DRV studies assess norms, measurement varies, and evidence on measure quality is diffuse. We aimed to map and assess how studies examining DRV measured social norms concerning DRV and gender. We conducted a systematic review of DRV literature reporting on the use and validity of such measures among participants aged 10-18 years. Searches included English peer-reviewed and grey literature identified via nine databases; Google Scholar; organization websites; reference checking; known studies; and expert requests. We identified 24 eligible studies from the Americas (N = 15), Africa (N = 4), and Europe (N = 5) using 40 eligible measures of DRV norms (descriptive: N = 19; injunctive: N = 14) and gender norms (descriptive: N = 1; injunctive: N = 6). No measure was shared across studies. Most measures were significantly associated with DRV outcomes and most had a defined reference group. Other evidence of quality was mixed. DRV norms measures sometimes specified heterosexual relationships but rarely separated norms governing DRV perpetrated by girls and boys. None specified sexual-minority relationships. Gender norms measures tended to focus on violence, but missed broader gendered expectations underpinning DRV. Future research should develop valid, reliable DRV norms and gender norms measures, and assess whether interventions' impact on norms mediates impact on DRV.

Risk and protective factors for self-harm in adolescents and young adults: An umbrella review of systematic reviews

We conducted an umbrella review to synthesise the evidence from systematic reviews and meta-analyses that examined the risk and protective factors for self-harm in young people. We searched six different databases and used the AMSTAR-2 checklist for quality assessment. The importance of each risk and protective factor was determined based on (1) the number of times it was identified by general reviews examining any risk or protective factor, and (2) the effect sizes from meta-analyses. There were 61 systematic reviews included in this review. The most frequently identified risk factors for self-harm in young people included childhood abuse, depression/anxiety, bullying, trauma, psychiatric illnesses, substance use/abuse, parental divorce, poor family relationships, lack of friends, and exposure to self-harm behaviour in others. The risk factors with the strongest evidence for an association with self-harm were behavioural disorders, personality disorders and depression or anxiety. There was a dearth of systematic reviews examining protective factors but good family/friend relationships were most frequently identified. There was also evidence to show that non-suicidal and suicidal self-harm shared many of the same risk factors. Clinicians and other professionals who work with young people should be particularly cognisant of the psychiatric and adverse life event risk factors as well as the substance use, education-related and individual-level (e.g. being LGB) risk factors for self-harm. Knowledge of risk factors for self-harm can potentially be used to inform the design and implementation of prevention measures and further research is needed on the protective factors for self-harm.

Child maltreatment among victims of violent death: an analysis of national violent death reporting system data, 2014-2018

BACKGROUND

Limited information is known about the impact of childhood maltreatment on lifetime risk of violent death. This study aimed to compare manner of death, demographics, age at time of death, and the presence of a mental health or substance use disorder among decedents of violent deaths with a history of child maltreatment to those without.

METHODS

This cross-sectional study compared characteristics of pediatric and adult violent deaths with and without a history of child maltreatment that were captured in the National Violent Death Reporting System from 2014 through 2018.

RESULTS

Decedents who were male, multiracial, and had adulthood substance or mental health disorders were more likely to have a history of maltreatment. All-age decedents with a history of maltreatment were more likely to die by homicide. Adult decedents with a history of maltreatment were more likely to die by suicide. Maltreated decedents died significantly younger than non-maltreated decedents.

CONCLUSIONS

Among victims of violent deaths, an identified history of child maltreatment was associated with increased risk of homicide across the lifespan, adult suicide, and earlier death. A history of child maltreatment was also associated with mental health and substance use disorders, which may reflect one of the pathways through which the child maltreatment-to-death association functions.

Molecular Changes Associated with Suicide

Suicide is a serious global public health problem, with a worrying recent increase in suicide rates in both adolescent and adult populations. However, it is essential to recognize that suicide is preventable. A myriad of factors contributes to an individual's vulnerability to suicide. These factors include various potential causes, from psychiatric disorders to genetic and epigenetic alterations. These changes can induce dysfunctions in crucial systems such as the serotonergic, cannabinoid, and hypothalamic-pituitary-adrenal axes. In addition, early life experiences of abuse can profoundly impact an individual's ability to cope with stress, ultimately leading to changes in the inflammatory system, which is a significant risk factor for suicidal behavior. Thus, it is clear that suicidal behavior may result from a confluence of multiple factors. This review examines the primary risk factors associated with suicidal behavior, including psychiatric disorders, early life adversities, and epigenetic modifications. Our goal is to elucidate the molecular changes at the genetic, epigenetic, and molecular levels in the brains of individuals who have taken their own lives and in the plasma and peripheral mononuclear cells of suicide attempters and how these changes may serve as predisposing factors for suicidal tendencies.

The development of Non-Suicidal Self-Injury (NSSI) during adolescence: A systematic review and Bayesian meta-analysis

BACKGROUND

Despite a surge in research on self-injury in the last decade, a summary of research findings about the development of Non-Suicidal Self-Injury (NSSI) over time in community youth samples is not yet present in the scientific literature. This study aims to summarize the empirical literature on this topic, examining both the occurrence (Study 1) and frequency (Study 2) of NSSI over time, and for this reason, a Systematic Review and Bayesian Meta-Analysis were conducted.

METHODS

Following the PRISMA guidelines, the longitudinal studies included in the systematic review consisted of 41 papers (Study 1 = 16; Study 2 = 25). Only studies with available data were included in the meta-analysis (Study 1 = 12; Study 2 = 11).

RESULTS

First, the findings highlight limits related to methodological aspects, the design of the studies, and the availability of data. Meta-analytic results shows that across development, the frequency (i.e., not the occurrence) of NSSI increases for the group of younger adolescents, remains stable in the group of middle adolescents, and it decreases for older adolescents.

LIMITATIONS

This study highlights some limitations that can be summarized in three different macro categories: the first refers to methodological aspects (e.g., the lifetime prevalence of NSSI), the second to the design of the studies (e.g., not homogeneous cohort; short-term covered), and the third to the availability of data.

CONCLUSIONS

The current meta-analysis tries to shed light on the longitudinal research on NSSI behavior and how this behavior develops in terms of both occurrence and frequency, providing practical and methodological indications for future research.

Sexual abuse during childhood and all-cause mortality into middle adulthood: an Australian cohort study

OBJECTIVE

To compare mortality from all causes, internal causes (eg, cancers, circulatory and respiratory system diseases), and external causes (eg, suicide, accidents, assault) among people who were sexually abused during childhood with mortality for the general population.

DESIGN

Historical cohort study.

SETTING, PARTICIPANTS

2759 people (2201 women, 79.8%) who had experienced medically assessed contact sexual abuse in Victoria while aged 16 years or younger during 1964-1995, as recorded in Victorian Institute of Forensic Medicine records.

MAIN OUTCOME MEASURES

Mortality rate, based on linked National Death Index data (1980-2020), by five-year age group; sex- and age-standardised mortality ratios; comparison of rates with age- and sex-adjusted rates for the general Victorian population (incident rate ratio [IRR]).

RESULTS

We included 115 deaths of people under 50 years of age in our analysis (4.2% of people sexually abused as children; 79 women, 36 men); 56 deaths were attributed to external, 56 to internal causes (cause of death information missing in three cases). In each age group from 15-19 years, the mortality rates for people sexually abused as children were higher than for the general population; age- and sex-standardised all-cause mortality ratios were highest for people aged 25-29 years (men: 16.5; 95% confidence interval [CI], 11.0-22.0; women: 19.2; 95% CI, 14.3-24.2). The age- and sex-adjusted mortality rate for people sexually abused as children was higher than in the general population for all-cause (IRR, 8.25; 95% CI, 5.92-11.5), internal cause (IRR, 5.92; 95% CI, 3.89-9.01), and external cause deaths (IRR, 12.6; 95% CI, 9.61-16.6); the differences in external cause mortality were greater for people who had experienced penetrative (IRR, 14.9; 95% CI, 10.9-20.5) than for those who had experienced non-penetrative sexual abuse as children (IRR, 8.92; 95% CI, 5.35-14.9).

CONCLUSIONS

Sexual abuse during childhood is associated with higher mortality rates into mid-adulthood. Preventing child sexual abuse and intervening early to reduce the damage it inflicts is not only essential for the welfare of the child, but could also help reduce avoidable deaths later in life.

Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management

Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.

Systematic Review and Meta-analysis: International Prevalence of Suicidal Ideation and Attempt in Youth

OBJECTIVE

Globally, rates of youth suicide vary considerably. Suicidal thoughts and behaviors (STB) are consistently associated with risk of death by suicide. However, international trends in STB have not yet been compared. To address this gap, an international meta-analysis of epidemiological and school-based studies that report on STB in youth was conducted.

METHOD

Systematic searches were conducted in PubMed and PsycINFO through April 2022. Eligible studies included prevalence of active suicidal ideation (SI) or suicide attempts (SA) in community youth younger than age 22. All studies were coded by 2 authors. Mixed models accounting for shared methods and including hypothesized moderators were conducted using the metafor package in R.

RESULTS

There were 371 effect sizes for SI, 94 for SI with a plan, and 316 for SA, representing 149 regions. Year of data collection ranged from 1981 to 2021. Participants were 6 to 21 years old. The prevalence of SI ranged across regions from 14.3% to 22.6%; the prevalence of SA ranged from 4.6% to 15.8%. Year was not associated with increasing STB prevalence except for studies from the United States, which showed increasing rates of SI and SA since 2007.

CONCLUSION

This is the most comprehensive meta-analysis of STB in youth, providing valuable data about how risk factors most commonly associated with suicide vary internationally and over time. International rates of STB among youth are not improving and may be getting worse in the United States, despite efforts to reduce suicide risk. Most studies did not report rates of SI or SA separately for LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others) youth and youth of color. A better understanding of proximal risk at the individual level will be important to informing future prevention efforts, especially for high-risk groups.

A Three-Way Interaction of Sex, PER2 rs56013859 Polymorphism, and Family Maltreatment in Depressive Symptoms in Adolescents

The prevalence of depressive symptoms in adolescents is 12-18% and is twice as frequent in females. Sleep problems and thoughts of death are depressive symptoms or co-occurrent phenomena. Family maltreatment is a risk factor for later depressive symptoms and the period circadian regulator (PER) has been studied in relation to neurotransmitters, adaptation to stress, and winter depression. The purpose of this work was to study the relation of the three-way interactions of sex, PER2 rs56013859, and family maltreatment in relation to core depressive symptoms, sleep complaints, and thoughts of death and suicide in self-reports from a cohort of Swedish adolescents in 2012, 2015, and 2018. Cross-sectional and longitudinal analyses with linear and logistic regressions were used to study the relationships to the three outcomes. The three-way interaction was related to core depressive symptoms at both baseline and six years later. In contrast, the model did not show any relation to the other dependent variables. At 13-15 years, a sex-related differential expression was observed: females with the minor allele C:C/C:T exposed to family maltreatment showed higher levels of core depressive symptoms. Six years later, the trend was inverted among carriers of minor alleles.

Non-Disclosure and Suicidal Ideation in Adolescent Victims of Bullying: An Analysis from the Family and School Context

In recent years, suicide rates among bullying victims have raised much concern among educators and health professionals. Suicide is the fourth leading cause of preventable death among adolescents, data that warn about the need to monitor the signs before victims' suicidal behavior to prevent this fatal outcome. In the present study, the role of victims' silence about their victimization situation was analysed, as well as the particular impact of family and school environments. More specifically, we examined the mediating role of the victim's non-disclosure between the parental styles (observing the father's and mother's roles separately) and the school climate, concerning suicidal ideation in victims. The sample consisted of 2,977 adolescents (48.5% boys), aged 11-17 years (M = 14.1, SD = 1.42), of whom 635 (21.3%) reported having been victims of bullying in the past year. The results showed that parental styles of rejection and indifference were positively related to victims' non-disclosure of bullying and suicidal ideation. Conversely, a positive school climate showed a negative relationship with victims' disclosure of the bullying situation and suicidal ideation. The findings also indicated that non-disclosure mediates the relationship between the mother's parental style and suicidal ideation. These findings expand knowledge about the role of bullying victims' social context and the variable disclosure with regards to suicidal ideation in adolescents victimized by peers at school.

Non-lethal suicidal behavior in university students of Spain during COVID-19

Background

Suicide is the fourth external cause of death in the world, in persons between the ages of l5 and 29. The objectives of this study were to measure the prevalence of suicidal behavior in university students and analyze the relationship of suicide risk with psychological distress, resilience, and family and social support.

Methods

An observational and transversal study wherein the students at the University of Malaga (Spain) completed an online questionnaire which included items from different scales, sociodemographic and academic questions, and the subjective impact of the COVID-19 pandemic. Descriptive analyses and prevalence rates of suicidal behavior were calculated, and bivariate analyses, multiple linear regression, and a mediation and moderation analyses were conducted.

Results

A total of 2,212 students completed the questionnaire. The prevalence of the last 6 months was 30.4% wishing for death, 14.7% suicidal ideation, 5% self-harm injuries, and 0.5% suicide attempts. Psychological distress, family and social support were linked to the risk of suicide. Lastly, resilience and family support measure and moderate the relation between psychological stress and suicide risk.

Conclusion

Psychological distress is a risk factor for suicidal behavior, while resilience and family and social support are linked to a lower risk of suicide.

Profiles of Suicidal Ideation Among Black Male Adolescents: Examination of Individual and Socioecological Predictors

OBJECTIVE

The current study utilized latent profile analysis to identify distinct profiles of suicidal ideation among Black male adolescents and compared profiles on socioecological determinants of suicide and psychological symptoms.

METHOD

A sample of 457 Black male adolescents (mean age = 15.31, SD = 1.26) completed self-report measures of suicidal ideation, racial discrimination, community violence exposure, anxiety symptoms, depressive symptoms, and posttraumatic stress symptoms.

RESULTS

Results of the latent profile analysis revealed a three-profile model: a low ideation profile, with low levels of all forms of suicidal ideation; a general death ideation profile with elevated general thoughts of death and dying; and a high, concealed ideation profile with high levels on all suicidal ideation items, except communicating the ideation to others. ANOVAs revealed that levels of psychological symptoms were significantly different for each profile, with the high, concealed ideation profile showing the highest levels. The low ideation profile had significantly lower scores than the two other profiles on community violence exposure, but the other two profiles did not differ significantly from one another. Further, the general death ideation profile had significantly higher scores on racial discrimination than the other two profiles, but the other two profiles did not differ significantly from one another.

CONCLUSIONS

The current study supports recent socio-cultural theories of suicidal ideation and behavior in Black youth and highlights the need for increased access to care and services for Black boys who are exposed to socioecological factors that heighten suicidal ideation.

Association of childhood bullying victimisation with suicide deaths: findings from a 50-year nationwide cohort study

BACKGROUND

Bullying victimisation has been associated with increased risk of suicide ideation and attempt throughout the lifespan, but no study has yet examined whether it translates to a greater risk of death by suicide. We aimed to determine the association of bullying victimisation with suicide mortality.

METHODS

Participants were drawn from the 1958 British birth cohort, a prospective follow-up of all births in 1 week in Britain in 1958. We conducted logistic regressions on 14 946 participants whose mothers reported bullying victimisation at 7 and 11 years with linked information on suicide deaths through the National Health Service Central Register.

RESULTS

Fifty-five participants (48 males) had died by suicide between the age 18 and 52 years. Bullying victimisation was associated with suicide mortality; a one standard deviation increases in bullying victimisation linked to an increased odds for suicide mortality [odds ratio (OR) 1.29; 1.02-1.64] during adulthood. The OR attenuated by 11% after adjustment for individual (e.g. behavioural and emotional problems) and familial characteristics (e.g. adverse childhood experiences, 1.18; 0.92-1.51). Analysis of bullying victimisation frequency categories yields similar results: compared with individuals who had not been bullied, those who had been frequently bullied had an increased odds for suicide mortality (OR 1.89; 0.99-3.62).

CONCLUSION

Our study suggests that individuals who have been frequently bullied have a small increased risk of dying by suicide, when no other risk factors is considered. Suicide prevention might start in childhood, with bullying included in a range of inter-correlated vulnerabilities encompassing behavioural and emotional difficulties and adverse experiences within the family.

Typologies of child maltreatment and peer victimization and the associations with adolescent substance use: A latent class analysis

BACKGROUND

Child maltreatment and peer victimization are pervasive public health problems associated with adolescent substance use. Although child maltreatment has been identified as a risk factor for peer victimization, few studies have investigated their co-occurrence (i.e., polyvictimization). The study objectives were to: examine sex differences in the prevalence of child maltreatment, peer victimization, and substance use; identify polyvictimization patterns; and examine the associations between the identified typologies and adolescent substance use.

METHODS

Data were self-reported from a sample of adolescents aged 14 to 17 years (n = 2910) who participated in the provincially-representative 2014 Ontario Child Health Study. Latent class analysis with distal outcomes was conducted to identify typologies of six types of child maltreatment and five types of peer victimization and examine the associations between the polyvictimization typologies and use of cigarettes/cigars, alcohol, cannabis, and prescription drugs.

RESULTS

Four typologies were identified: Low victimization (76.6 %), Violent home environment (16.0 %), High verbal/social peer victimization (5.3 %), and High polyvictimization (2.1 %). The Violent home environment and High verbal/social peer victimization typologies were associated with increased odds of adolescent substance use (adjusted odds ratio range: 2.06-3.61). The High polyvictimization typology showed increased, but non-significant, odds of substance use.

CONCLUSIONS

Adolescent-serving health and social services professionals should be aware of polyvictimization patterns and the impact on substance use. For some adolescents, polyvictimization may include exposure to multiple child maltreatment and peer victimization types. Upstream strategies to prevent child maltreatment and peer victimization are needed, which may also contribute to reductions in adolescent substance use.

Pathways from childhood trauma to suicidal ideation: mediating through difficulties in emotion regulation and depressive symptoms

OBJECTIVE

Suicidal ideation is a clinical exigency heightening the risk of suicide at different levels of suicidal behavior. This study sought to explore crucial correlates of this phenomenon with a structural equation modeling approach. Accordingly, the mediating role of depressive symptoms and difficulties in emotion regulation between childhood trauma and suicidal ideation were explored.

METHOD

The sample consisted of 372 university students (57.3% females, M = 20.75, SD = 2.25) who completed self-report measures examining experiences of childhood trauma, depressive symptoms, difficulties in emotion regulation, and suicidal ideation. Structural equation modeling was employed, and mediation analysis was conducted. Confirmatory factor analysis was used to test the measurement model of each construct before evaluating the conceptual mediated model.

RESULTS

Findings indicate that depressive symptoms with difficulties in emotion regulation had the strongest association (r = 0.60, P = 0.001), then depressive symptoms and suicidal ideation (r = 0.58, P = 0.001), suicidal ideation with difficulties in emotion regulation (r = 0.45, P = 0.001) then suicidal ideation with childhood trauma (r = 0.39, P = 0.001), difficulties in emotion regulation with childhood trauma (r = 0.36 P = 0.001) and finally depressive symptoms and childhood trauma (r = 0.35, P = 0.001). Regarding indirect paths, difficulties in emotion regulation and depression function together (in a sequential path) to mediate the association between childhood trauma and suicidal ideation ( χ²(68) = 216.86, P < 0.01, CFI = 0.95, TLI = 0.93, RMSE = 0.077, CI [0.066 to 0.089], SRMR = 0.049).

CONCLUSION

Results demonstrate that childhood trauma, depressive symptoms, and difficulties in emotion regulation are linked to suicidal ideation, highlighting the necessity of recognizing and addressing suicidal ideation as well as the factors that contribute to suicidal ideation. Emotion regulation interventions can be effective in reducing the negative effects of childhood trauma and lowering the risk of suicide. These interventions can help in reducing depressive symptoms and improve overall mental well-being, leading to a lower risk of suicide.

Overlap Between Exposure to Suicidal Behavior and Indirect Interpersonal Violence: Evidence for a More Integrated Approach to Violence Research

This study examines the overlap between indirect exposure to forms of interpersonal violence and suicidal behavior, and the impact of the co-occurrence of these exposures on indicators of depressed mood and substance use among adolescents. Participants were a national sample of 3,917 youth aged 14-15 years, recruited online between June 2018 and March 2020, including an oversample of sexual and gender minority youth. Eight in ten (81.3%) youth reported exposure to indirect interpersonal violence and/or suicidal behavior in their lifetimes: 39.5% reported only interpersonal violence exposure, 5.9% only suicidal behavior exposure, and 35.9% reported both. Youth who reported exposure to interpersonal violence were almost three times more likely (adjusted odds ratio [OR] = 2.78, p < .001) to also report suicidal behavior exposure. Compared with youth having no indirect violence exposure, those with only interpersonal violence exposure were 2.25 times more likely (p < .001), those with only exposure to suicidal behavior 2.93 times more likely (p < .001), and those with both were 5.63 times more likely to report recent depressed mood. The unadjusted odds of any substance use was significantly elevated for each type of indirect violence exposure, with the highest odds seen among youth with dual interpersonal violence and suicide exposure (OR = 4.87, p < .001). For both outcomes, significant findings remained but were attenuated after adjusting for demographic characteristics, non-victimization adversity exposure, and cumulative direct victimization. Findings suggest that the combination of exposure to interpersonal violence and suicidal behavior appears to be particularly impactful. Results highlight that assessment of trauma exposure among adolescents needs to be more comprehensive and include not only direct and indirect interpersonal violence, but also knowledge of other people's suicidal thoughts and behaviors.

The association among childhood maltreatment, sleep duration and suicide behaviors in Chinese young people

BACKGROUND

Substantial evidence shows that childhood maltreatment and sleep duration play important roles in the development of suicide. However, the role of sleep duration in the relationship between childhood maltreatment and suicide behaviors, including suicide ideation, plan and attempt, was not fully understood. This study investigated the association among childhood maltreatment, sleep duration and suicide behaviors.

METHODS

13,454 students from a polytechnic college in Shenzhen of China participated in this cross-sectional study. Multivariate logistic regression model was established to analyze the relationship among childhood maltreatment, sleep duration and suicide behaviors.

RESULTS

The most reported subtype of childhood maltreatment was physical neglect, which were reported by 41.57 % of males, 28.59 % of females. The positive association of physical abuse with suicide behaviors was observed. In females, emotional abuse and neglect were positively associated with suicide behaviors. In addition, almost all childhood maltreatment was significantly associated to decreased sleep duration. Moreover, compared to the sleep duration <6 h group, sleep duration was inversely associated to suicide behaviors.

CONCLUSION

Childhood maltreatment was positively associated with suicide ideation, plan and attempt in Chinese young adults. Meanwhile, childhood maltreatment was negatively associated with sleep duration, which were negatively associated with suicide ideation, plan and attempt.

A Cross-Cultural Sequential Model of the Association Between Young Spanish and Colombian Women Victims of Power Imbalance and Suicide Risk: The Mediating Role of Dating Violence and Rumination

For young women, the power imbalance in favor of males in dating relationships has been related to dating violence (DV) victimization. In addition, the use of rumination to cope with DV may increase their psychological distress. The purpose of the current study was to examine whether experiences of DV and rumination mediate the association between power imbalance and suicide risk (SR). The sample comprised 1,216 young women aged between 18 and 28 years from Colombia (n = 461) and Spain (n = 755), in a heterosexual dating relationship, not married or cohabiting with a partner and without children. The following scales were applied: The Sexual Relationship Power Scale-Modified, The Dating Violence Questionnaire--R (DVQ-R); Cyberdating Abuse Questionnaire, Measure of Affect Regulation Scale (MARS), and The Spanish Suicide Risk Scale. A sequential mediation paths model was tested. Results indicated that power imbalance was associated with DV victimization. Furthermore, DV was associated with more rumination, which was also linked to a greater SR in both countries. Rumination may be a mechanism through which experiences of DV victimization negatively influence mental health in young women and is an important variable related cross-culturally to SR. The findings suggest an equality approach, addressing the power imbalance in dating relationships, empowering girls to prevent DV, and teaching coping strategies for dealing with victimization and its consequences.

“How Am I Supposed to Act?”: Adapting Bronfenbrenner’s Ecological Systems Theory to Understand the Developmental Impacts of Multiple Forms of Violence

Experiences of and exposures to violence impact older adolescents and young adults in a myriad of ways. While typically conceptualized as interpersonal, other forms of violence, namely, structural and symbolic, can be harmful to development for this population. This study utilized qualitative methodologies, including ethnographic field notes and interviews, to capture the ways in which 12 young persons aged 16 to 20 from Philadelphia experience and conceptualize multiple forms of violence across neighborhood contexts. In total, 85 interviews and over 100 hours of field observations were conducted and analyzed using thematic analysis. Findings from this study demonstrate that multiple forms of violence are experienced and impact how young adults make meaning of their life experiences. Importantly, our study explores how these forms of violence occur in tandem across contexts. Whereby, aspects of young adult development and well-being are shaped by violence across the micro, meso, and macro systems with which they interact. Implications of this work include adapting Bronfenbrenner’s Ecological Systems Theory to include multiple forms of violence so that practitioners and researchers can better understand how forms of violence are enacted and the associated impacts on young adults.

[What is the contribution of smoking to the increased risk of suicide in young smokers? A systematic review]

OBJECTIVES

The correlation between smoking and suicide is well documented in the general population: there is an increased risk of suicide among tobacco smokers. However, the association between smoking and suicidal behaviors (ideations, plans, attempts) in youth is poorly elucidated. This is a systematic review of the literature examined data on the relationship between active and passive smoking and suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among youth in the general population.

METHOD

Medline searches were performed for the period 1980-2020. Cross-sectional, case-control, prospective population-based studies of young people (age less than 18 years) were included in this review; studies of specific populations (patients with an identified pathology of any kind) were excluded.

RESULTS

This review included 43 studies: 23 studies on the association between active smoking and SI, SI and/or PS, TS; three studies on the association between passive smoking and suicidal behavior, three studies on the association between smoking and suicidal behavior in young people in psychiatric hospital settings, and five studies comparing the suicidal behavior of girls and boys. Analysis of the data collected lead to the conclusion that active or passive smoking is associated with suicidal behavior in young people. Smoking appears to contribute to psychopathological disorders, including depression, the use of other psychoactive substances, or psychosocial suffering which are often associated with an increased risk of suicide in young people. The correlations between smoking and the presence of mental disorders have been highlighted; tobacco use may contribute to the development of depression, anxiety and stress. Further studies are needed to verify the existence of a causal link between smoking and suicide.

CONCLUSION

Smoking is associated with the risk of suicidal behavior in young people; it should be included among the criteria for assessing suicidal risk in youth. Smoking cessation, which improves psychological well-being, should be further integrated into the prevention of suicidal behavior.

Suicidal Behaviour as an Emerging Factor in Female Victims of Gender-Based Violence within a Relationship: An Exploratory Study

Intimate partner violence (IPV), in addition to being an important public health problem, is a risk factor for suicidal behaviour (SB). The objective of this study was to explore the risk of suicidal behaviour associated with the different forms of abuse and the consequences derived from it. This exploratory study was conducted on a sample of women who experienced IPV (N = 70) in the Extremadura Region (Spain). Demographic factors, abuse experience, suicidal ideation (SI), suicidal communication (SC), and suicide attempts (SAs) were analysed according to the type of abuse. We found that a very high prevalence of psychological violence (IPVp) was accompanied, in most cases, by some other type of abuse (IPVp+). Additionally, a significant relationship was found between IPV and SB. Logistic regression revealed a greater risk of SI and SA in the IPVp+ group. The results of this study could be useful to healthcare service professionals in preventing suicidal behaviour.

Potential paths to suicidal ideation and suicide attempts among high-risk women

Although men are more likely to die by suicide, women experience a greater and more rapidly increasing rate of suicidal ideation (SI) and are 3 times more likely to attempt suicide than men. Despite this increased risk, little is known about factors that contribute to SI or suicide attempts (SA) among women. We examined factors associated with SI and SA among women and identified mood-related symptoms that differentiate women who reported attempting suicide from those who did not. Women at elevated risk for depression from across the U.S. (N = 3372; age 18 to 90) completed a survey regarding depression, anxiety, sociodemographic and reproductive status, behavioral/mental health history, and exposure to adversity. Structural equation modeling and logistic regression were used to analyze the data. Variables with the most significant relationships to SI were severity of depression (OR = 5.2, p = 0.000) and perceived stress (OR = 1.18, p = 0.000) while frequency of suicidal thoughts (OR = 3.3, p = 0.000), family history of a depression diagnosis (OR = 1.6, p = 0.000) and exposure to violence (OR = 1.9, p = 0.000) had the strongest association with SA. Childhood abuse/trauma was associated with SA (OR = 1.13, p = 0.000) but not SI. 'Feeling bad about themselves, a failure, or having let themselves or their family down' was the symptom that most clearly differentiated women who attempted suicide from women who reported suicidal ideation but no SA. The salience of childhood abuse and domestic/community violence to women's risk for a suicide attempt reinforces previous findings that these adversities may differentiate suicide risk for women versus men. Continued research is essential to understand varied paths that may lead to suicidal behavior among women, some which appear unrelated to the frequency or intensity of their suicidal thoughts.

Is Violence, Violence no Matter Where it Strikes? Adjudicated Boys, Thwarted Belongingness, Perceived Burdensomeness, and Acquired Capability for Suicide

This study explores treating violence against others as a precursor to self-directed violence. It tests the utility of including violence against others in the measure of acquired capability to test assumptions from the interpersonal theory of violence. Four theoretical hypotheses are assessed that are consistent with the theory: (1) thwarted belongingness (parental abandonment and rejection) and perceived burdensomeness (exposure to parental interpersonal violence and child abuse) independently increase the likelihood of suicidal ideation; (2) the interaction of thwarted belongingness and perceived burdensomeness increases the likelihood of suicidal ideation controlling for other pertinent variables; (3) the three-way interaction of thwarted belongingness, perceived burdensomeness, and acquired capability (violence against others and prior suicidal attempts) increases the likelihood of suicidal attempts controlling for other pertinent variables; and (4) self-harm responds to the theoretical variables and similarly, to attempts. Subjects are court-adjudicated males (ages 13-18) who were residents for up to 1 year at the Ocean Tides School and rehabilitation center from 1975-2019. The data span 44 years and include 2195 youth. Depression, drug/alcohol use, race, ethnicity, socioeconomic status, and interaction terms between SES and race and SES and ethnicity are also examined. Backward conditional logistic regression analyses find mixed support for the hypotheses, but strong support for including violence against others in the concept of acquired capability. Support is also found for conceptualizing child abuse and exposure to parental interpersonal violence as perceived burdensomeness in tests of this theory as well as measures of depression. Major implications for programming in the treatment and rehabilitation of delinquent boys include conceptualizing and approaching violence against others as a precursor to suicidal attempts and other self-directed harm.

Exposure to Recurring Community Violence Scale: A validity and reliability study in Turkey

Recent years have witnessed a substantial increase in the interest in violence occurring at home or school, as well as in neighborhoods. Yet, there is no standardized instrument to measure community violence in Turkey. Thus, the present study aimed to adapt the Exposure to Recurring Community Violence Scale into Turkish and explore its psychometric properties. The sample consisted of 210 participants (57% were females) between 18 and 64 years (Mage = 38.33, SD = 10.67). For criterion-related validity, we evaluated the participants' scores on the Brief Symptom Inventory (BSI), the Traumatic Life Events Form, the Relationship Quality Scale, and a Demographic Information Form. We performed all statistical analyses using the FACTOR and SPSS v.20 programs. Exploratory factor analysis revealed a 2-factor structure for the scale (victimization and witnessing), explaining 52% of the total variance. As expected, the witnessing and victimization scores were correlated with the subscales of the BSI, the number of traumatic life events, and the subscales of The Relationship Quality Scale. For reliability concerns, we calculated Cronbach's α coefficients to be 0.79 for the victimization and 0.90 for the witnessing. Besides, the findings revealed acceptable psychometric properties for the Turkish version of the Exposure to Recurring Community Violence Scale. Thereby, we concluded that the scale can be used as a reliable and valid measure in the Turkish context. Overall, the scale will likely allow further research to scrutinize the risk factors and consequences of community violence.

Family Factors Related to Suicidal Behavior in Adolescents

Objective: This research aims to investigate what type of family patterns (specifically attachment, bonding and family functioning) and stressful life events can trigger or protect adolescents from developing suicidal behavior. Methods: For these purposes, a case-control study (adolescents with suicidal behavior vs. paired adolescents with no suicidal behavior) was conducted with one hundred 12 to 17-year-old adolescents (50 controls, 50 cases, 74% females), assessed between 2018 and 2020. Results: Negligent (p < 0.001) or affection-less control bonding (p < 0.001), insecure attachment (p = 0.001) and stressful life events (p < 0.001) revealed to be significant risk factors for suicidal behavior. On the contrary, parents’ care (p < 0.001) and security (p < 0.001) were revealed as protective factors for suicidal behavior. Conclusions: Considering these results, family interventions and improving coping skills seem to be two essential targets for any suicide prevention intervention in adolescents.

Childhood adversities and suicidal thoughts and behaviors among first-year college students: results from the WMH-ICS initiative

PURPOSE

To investigate the associations of childhood adversities (CAs) with lifetime onset and transitions across suicidal thoughts and behaviors (STB) among incoming college students.

METHODS

Web-based self-report surveys administered to 20,842 incoming college students from nine countries (response rate 45.6%) assessed lifetime suicidal ideation, plans and attempts along with seven CAs: parental psychopathology, three types of abuse (emotional, physical, sexual), neglect, bully victimization, and dating violence. Logistic regression estimated individual- and population-level associations using CA operationalizations for type, number, severity, and frequency.

RESULTS

Associations of CAs with lifetime ideation and the transition from ideation to plan were best explained by the exact number of CA types (OR range 1.32-52.30 for exactly two to seven CAs). Associations of CAs with a transition to attempts were best explained by the frequency of specific CA types (scaled 0-4). Attempts among ideators with a plan were significantly associated with all seven CAs (OR range 1.16-1.59) and associations remained significant in adjusted analyses with the frequency of sexual abuse (OR = 1.42), dating violence (OR = 1.29), physical abuse (OR = 1.17) and bully victimization (OR = 1.17). Attempts among ideators without plan were significantly associated with frequency of emotional abuse (OR = 1.29) and bully victimization (OR = 1.36), in both unadjusted and adjusted analyses. Population attributable risk simulations found 63% of ideation and 30-47% of STB transitions associated with CAs.

CONCLUSION

Early-life adversities represent a potentially important driver in explaining lifetime STB among incoming college students. Comprehensive intervention strategies that prevent or reduce the negative effects of CAs may reduce subsequent onset of STB.

Days with and without self-injurious thoughts and behaviors: Impact of childhood maltreatment on adolescent online social networking

INTRODUCTION

Among adolescents, an increasing rate of interpersonal interactions occurs online. Previous research has shown that interpersonal context exerts a robust impact on suicidal thoughts or behaviors, yet little attention has focused on examining the content of online interactions surrounding self-injurious thoughts or behaviors. As such, the present study sought to compare online social networking behaviors among adolescents on days with and without experiencing self-injurious thoughts or behaviors, as influenced by childhood maltreatment history.

METHOD

Adolescents aged 13-18 hospitalized for self-injurious thoughts or behaviors were recruited as part of an ongoing longitudinal study. A subsample (N = 22) of adolescents provided data from their online social networking platforms (i.e., text messages, Facebook, Instagram, and Twitter). Using a mixed-methods approach, online social networking data on days of experiencing self-injurious thoughts or behaviors and days of not experiencing self-injurious thoughts or behaviors were compared.

RESULTS

Results indicate the frequency and content of online social networking messaging do not change by day of self-injurious thoughts or behaviors or history of childhood maltreatment. However, childhood maltreatment predicts received conflictual messages as well as sent symptomatic messages on days of experiencing self-injurious thoughts or behaviors.

CONCLUSIONS

Childhood maltreatment may play a role in the content of adolescent online behaviors, particularly on days when they experience self-injurious thoughts or behaviors. Implications for intervention are discussed.

Father-Daughter Relationships among Latina Adolescents Who Attempted Suicide: An Exploratory Dyadic Analysis

Among adolescents, Latinas are at an increased risk of experiencing suicidal ideation and attempts compared to non-Hispanic, White youth. Previous research indicates that family dynamics are influential as both protective and risk factors. Although significant research has been conducted over the past several decades examining the mother-daughter relationship, few studies have examined the father-daughter relationship among Latina adolescent suicide attempters. The relationship dynamics between fathers and daughters of Latina descent are both similar and unique compared to mother-daughter relationships. Given this, an in-depth analysis is warranted. To address this gap, the present study utilized dyadic thematic analysis to describe father-daughter relationships (N = 10 dyads, 20 individual interviews) and fathers' reactions to their Latina daughters' suicide attempt(s). Three themes emerged from the results (a) dynamic proximity, which describes the variation in emotional and physical closeness between fathers and daughters; (b) father as protector, which describes fathers' roles in protecting or failing to protect their daughters; (c) responses to the suicide attempt, which describes the various ways fathers responded to daughters' suicide attempts, ranging from helpful action to apathy. Themes gleaned from in-depth interviews informed a deeper understanding of these complex, multifaceted relationships, and how they may be linked to fathers' responses to daughters' suicide attempts. Implications for future research and clinical practice with youth at risk for suicidal ideations and behaviors, along with the impact of such experiences on families, are discussed.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Adolescent health outcomes: associations with child maltreatment and peer victimization

Background

Child maltreatment (CM) and peer victimization (PV) are serious issues affecting children and adolescents. Despite the interrelatedness of these exposures, few studies have investigated their co-occurrence and combined impact on health outcomes. The study objectives were to determine the overall and sex-specific prevalence of lifetime exposure to CM and past-month exposure to PV in adolescents, and the impact of CM and PV co-occurrence on non-suicidal self-injury, suicidality, mental health disorders, and physical health conditions.

Methods

Adolescents aged 14–17 years (n = 2,910) from the 2014 Ontario Child Health Study were included. CM included physical, sexual, and emotional abuse, physical neglect, and exposure to intimate partner violence. PV included school-based, cyber, and discriminatory victimization. Logistic regression was used to compare prevalence by sex, examine independent associations and interaction effects in sex-stratified models and in the entire sample, and cumulative effects in the entire sample.

Results

About 10% of the sample reported exposure to both CM and PV. Sex differences were as follows: females had increased odds of CM, self-injury, suicidality, and internalizing disorders, and males had greater odds of PV, externalizing disorders, and physical health conditions. Significant cumulative and interaction effects were found in the entire sample and interaction effects were found in sex-stratified models, indicating that the presence of both CM and PV magnifies the effect on self-injury and all suicide outcomes for females, and on suicidal ideation, suicide attempts, and mental health disorders for males.

Conclusions

Experiencing both CM and PV substantially increases the odds of poor health outcomes among adolescents, and moderating relationships affect females and males differently. Continued research is needed to develop effective prevention strategies and to examine protective factors that may mitigate these adverse health outcomes, including potential sex differences.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13310-w.

Prevalence of Suicide in Immigrants/Refugees: A Systematic Review and Meta-Analysis

OBJECTIVE

In recent years, there has been an increase in immigrant populations worldwide. This study aims to present the global prevalence of suicide between immigrants and refugees as well as to report the prevalence of suicide ideation, suicide mortality, suicide attempts, and plan of suicide.

METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA's) rules were used as a guide in the current research path. PubMed and EMBASE were targeted for the study until December 2019. After collecting the data, the number of events and sample size extracted for each study and also pooled odds ratio and confidence interval (CI) were used to investigate the suicide ratio among immigrants and refugees compared to the native population.

RESULTS

Fifty-one studies were included in the meta-analysis to investigate suicide prevalence or suicide odds ratio. The prevalence of suicidal ideation was 16% (CI: 0.12-0.20, I² = 99.4%), for attempted suicide was 6% (CI: 0.05-0.08, I² = 98.0%), and for suicide plan prevalence was 4% (CI: 0.00-0.08, I² = 96.8%). The prevalence of suicidal ideation was 10% (CI: 0.04-0.17, I² = 0.0%) in men and 17% (CI: 0.10-0.24, I² = 96.8%) in women. The prevalence of attempted suicide was 1% (CI: 0.01-0.02, I² = 0.0%) in men and 7% (CI: 0.03-0.10, I² = 94.4%) in women. The odds ratio of suicide mortality among immigrants was 0.91 (CI: 0.90-0.93, p < 0.001; I² = 97.6%) and for attempted suicide was 1.15 (CI: 1.10-1.20, p < 0.001; I² = 92.0%). Begg's test (p = 0.933) (Egger test; p = 0.936) rejected publication bias.

CONCLUSION

Given the high prevalence of suicide, especially suicide ideation and suicide attempts in immigrants, increased attention needs to be paid to the mental health of this population.

Intimate Partner Violence-Related Fatalities Among U.S. Youth Aged 0-24 Years, 2014-2018

INTRODUCTION

Little is known about intimate partner violence-related fatalities among young people. This study comprehensively identifies and describes intimate partner violence-related homicides, homicide-suicides, legal intervention deaths, and suicides among young people.

METHODS

Data from the 2014-2018 National Violent Death Reporting System were analyzed for all decedents aged 0-24 years in 38 states, the District of Columbia, and Puerto Rico with known circumstances of death (n=29,702). Intimate partner violence-related deaths were identified using National Violent Death Reporting System variables across all manners of death and supplementary narrative review for suicides. This article reports the proportion of intimate partner violence versus non-intimate partner violence-related deaths by manner of death, descriptive statistics, and rate of intimate partner violence-related death per 100,000 person years. To examine disparities in intimate partner violence-related deaths, generalized estimating equations were used with robust standard errors to account for clustering of deaths within states and fixed effects for years. Statistical analyses were conducted May and August 2021.

RESULTS

A total of 1,927 intimate partner violence-related deaths were identified, which represents 6.5% of violent deaths with known circumstances, at a rate of 0.35 per 100,000 person years. Supplementary narrative review identified 44.7% of all intimate partner violence-related deaths. There were significant differences by race/ethnicity and whether a firearm inflicted the fatal injury for male and female decedents by manner of death.

CONCLUSIONS

If the National Violent Death Reporting System does not assess whether intimate partner violence was a precipitating factor across all death manners, the true magnitude of intimate partner violence's contribution to violent death will be underestimated. Future research that identifies factors associated with all manners of intimate partner violence-related deaths among young people will help inform intervention and prevention strategies to save young lives.