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Zalewski M, Byrd AL, Vine V, Hernandez AC, Stepp SD. Maternal suicide risk predicts preschooler emotional and behavioral problems. Psychiatry Res 2024; 337:115969. [PMID: 38772159 PMCID: PMC11189097 DOI: 10.1016/j.psychres.2024.115969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 02/27/2024] [Accepted: 05/14/2024] [Indexed: 05/23/2024]
Abstract
Maternal history of suicidal thoughts and behaviors (STBs) has been identified as a robust risk factor for offspring emotional and behavioral problems, including risk for offspring STBs. The impact of maternal history of STBs has been well-documented in adolescent and young adult samples, with emerging research highlighting the need to examine early clinical correlates of risk in young children, prior to the emergence of STBs. In an extension of prior work, the current study examined associations between maternal history of STBs and previously identified emotional and behavioral correlates of STBs (negative affect, internalizing problems, attention problems, aggressive behavior) in young children. These associations were examined in a mother-preschooler sample (n = 158, mean preschooler age=41.52 months) with approximately half of mothers endorsing a history of STBs and 20 % of the sample scoring at the threshold that indicates suicide risk. In multivariate models, maternal history of STBs was significantly associated with preschooler aggressive behavior, assessed via mother- (β=0.19) and teacher-report (β=0.21), as well as mother-reported negative affect (β=0.22). Results document a link between maternal history of STBs and increased risk for heightened negative affect and aggressive behavior at home and school during the sensitive preschool period. Findings are discussed within the context of enhancing models of intergenerational transmission suicide risk.
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Affiliation(s)
| | - Amy L Byrd
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Vera Vine
- Queens University, Kingston, ON K7L 3N6, Canada
| | | | - Stephanie D Stepp
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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2
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Kaurin A, Wright AGC, Porta G, Hamilton E, Poling K, Bero K, Brent D, Goldstein TR. Weekly links among irritability and suicidal thoughts and behaviors in high-risk youth. J Child Psychol Psychiatry 2024. [PMID: 38651278 DOI: 10.1111/jcpp.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Previous studies demonstrate a link between irritability and suicidal thoughts and behaviors (STBs) in youth samples. However, they have mostly assessed irritability in community samples and as a largely dispositional (i.e. trait-like) construct. Thus, it remains unclear to what extent links between irritability and STBs reflect within-person processes of elevated risk in clinically meaningful time periods. METHODS The present study used clinical data from 689 adolescents aged 12-19 years attending a total of 6,128 visits at a specialty Intensive Outpatient Program for depressed and suicidal youth to examine patterns in weekly assessments of irritability and STBs throughout treatment, including associations among trends and fluctuations departing from these trends via multilevel structural equation modeling. Youth completed self-report measures of irritability, depression, and STBs weekly as part of standard IOP clinical care. RESULTS Overall, two-thirds of variance in weekly irritable mood was accounted for by between-person differences and the remaining portion by weekly fluctuations. After controlling for depression, during weeks when youth were more irritable they experienced increased STBs. Rates of change in irritability and STBs tended to track together at early stages of treatment, but these effects were generally accounted for by depression severity. CONCLUSIONS Our results suggest that although changes in STBs are best accounted for by depression, irritability can be understood as a specific, proximal risk factor for youth STBs that exacerbates youth STBs in clinically informative timeframes above and beyond depression.
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Affiliation(s)
- Aleksandra Kaurin
- Department of Psychology, University of Wuppertal, Wuppertal, Germany
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Giovanna Porta
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Edward Hamilton
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kimberly Poling
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kelsey Bero
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David Brent
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tina R Goldstein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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3
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Bacaro V, Miletic K, Crocetti E. A meta-analysis of longitudinal studies on the interplay between sleep, mental health, and positive well-being in adolescents. Int J Clin Health Psychol 2024; 24:100424. [PMID: 38125984 PMCID: PMC10730350 DOI: 10.1016/j.ijchp.2023.100424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Objective This review aimed to summarize longitudinal research about the interplay between sleep, mental health, and positive well-being in adolescents. Method Multiple search strategies were applied until 28th January 2023 to identify relevant research published in peer-reviewed journal articles or available grey literature. A final set of 63 studies were included in the systematic review and 42 in the meta-analysis. Results Results highlighted that long sleep duration, good sleep quality, and low insomnia symptoms were bidirectionally related to lower internalizing (Sleep T1 → Internalizing symptoms T2: r = -.20, p < .001; Internalizing symptoms T1 → Sleep T2: r = -.21, p < .001) and externalizing (Sleep T1 → Externalizing symptoms T2: r = -.15, p < .001; Externalizing symptoms T1→ Sleep T2: r = -.17, p < .001) symptoms, and to higher levels of psychological well-being (Sleep T1 → Psychological well-being T2: r = .15, p < .001; Psychological well-being T1 → Sleep T2: r = .15, p < .05). Moreover, good sleep was positively related to higher subjective well-being at a later time point (r = .18, p < .001). Conclusions Overall, these findings suggest a bidirectional relation between different aspects of sleep, mental health, and positive well-being.
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Affiliation(s)
- Valeria Bacaro
- Department of Psychology “Renzo Canestrari”, University of Bologna, Italy
| | - Katarina Miletic
- Department of Psychology “Renzo Canestrari”, University of Bologna, Italy
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Gifuni AJ, Spodenkiewicz M, Laurent G, MacNeil S, Jollant F, Renaud J. Symptoms characteristics of personality disorders associated with suicidal ideation and behaviors in a clinical sample of adolescents with a depressive disorder. Front Psychiatry 2023; 14:1269744. [PMID: 38146283 PMCID: PMC10749562 DOI: 10.3389/fpsyt.2023.1269744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/16/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction Pathological personality traits have repeatedly been identified as important risk factors for suicidal ideation and behaviors. Moreover, impulsive-aggressive traits, have shown a consistent association with suicidal behaviors across the lifespan. Adolescence represents a critical period for the emergence of different personality traits, mood disorders, and suicidal behaviors, but the relationship between these variables remain poorly understood. Methods These variables were examined in a cross-sectional case-control design involving three groups: 30 adolescents with a depressive disorder and past suicide attempt (Mean Age = 16.2, Females = 26), 38 adolescents with a depressive disorder but without past suicide attempt (Mean age = 16.0, Females = 29), and 34 healthy adolescent controls (Mean age = 15.2, Females = 22). Suicidal ideations were indexed using Suicidal Behavior Questionnaire (SBQ-R), psychiatric disorder assessed using a semi-structured questionnaire (K-SADS-PL), depressive symptoms with the Beck Depressive Inventory (BDI), symptoms characteristics of personality disorders with the Scheduled Clinical Interview for the DSM-IV (SCID-II) screening questionnaire, and impulsivity with the Barratt Impulsivesness Scale (BIS). Results Findings showed that impulsivity (F = 11.0, p < 0.0001) and antisocial symptoms characteristics of personality disorders (p < 0.001, d = 0.70) displayed the most robust association with adolescent suicide attempts. Borderline symptoms characteristics of personality disorders did not discriminate attempters from non-attempters but presented high correlations with suicidal ideation and depression severity. In an item-wise analysis, suicide attempt status was uniquely correlated with symptoms characteristics of an antisocial personality disorder. Suicide attempt status also correlated with non-suicidal self-injury and a chronic feeling of emptiness. Discussion The caveats of this cross-sectional study include the stability of symptoms characteristics of personality disorders in adolescence and the limited sample size. In sum, suicidal behaviors were characteristically correlated with increased impulsivity and antisocial symptoms characteristics of personality disorders, but other symptoms characteristics of personality disorders were relevant to adolescent depression and suicidal ideation. Understanding the emergence of symptoms characteristics of personality disorders and suicidal behaviors in a developmental context can ultimately inform not only the neurobiological origin of suicidal behaviors, but also provide new avenues for early detection and intervention.
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Affiliation(s)
- Anthony Joseph Gifuni
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Michel Spodenkiewicz
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, QC, Canada
- INSERM UMR-1178, Moods Team, CESP, Le Kremlin-Bicêtre, France
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Geneviève Laurent
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sasha MacNeil
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Fabrice Jollant
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Johanne Renaud
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, QC, Canada
- Division of Child Psychiatry, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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5
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Gray AL, Viljoen JL. Violence and Suicidal/Nonsuicidal Self-Injury Among Adolescents Undergoing Residential Treatment: An Examination of the Predictive Validity of the SAVRY, START:AV, and VRS-YV. CRIMINAL JUSTICE AND BEHAVIOR 2023; 50:931-952. [PMID: 37323998 PMCID: PMC10265301 DOI: 10.1177/00938548231165531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Using a retrospective study design, predictive validity of the Structured Assessment of Violence Risk in Youth, Short-Term Assessment of Risk and Treatability: Adolescent Version (START: AV), and the Violence Risk Scale-Youth Version (VRS-YV) was examined among 87 adolescents referred to a residential treatment program. With few exceptions, moderate to high accuracy was achieved for the three measures in predicting violence and suicidal/nonsuicidal self-injury occurring during the adolescents' time in treatment. Accuracy of the measures peaked within 90 days for violence and gradually increased over the 180-day follow-up for suicidal/nonsuicidal self-injury. Dynamic factors were more predictive of repeated events involving violence relative to static/historical factors, whereas only factors from the START: AV were predictive of repeated events involving suicidal/nonsuicidal self-injury. These results emphasize the need for further examining the risk of adverse outcomes beyond violence among adolescents.
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Donnelly HK, Han Y, Kim S, Lee DH. Predictors of suicide ideation among South Korean adolescents: A machine learning approach. J Affect Disord 2023; 329:557-565. [PMID: 36828148 DOI: 10.1016/j.jad.2023.02.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND The current study developed a predictive model for suicide ideation among South Korean (Korean) adolescents using a comprehensive set of factors across demographic, physical and mental health, academic, social, and behavioral domains. The aim of this study was to address the pressing public health concerns of adolescent suicide in Korea and the methodological limitations of suicidal research. METHODS This study used machine learning methods (decision tree, logistic regression, naive Bayes classifier) to improve the accuracy of predicting suicidal ideation and related factors among a nationally representative sample of Korean middle school students (N = 6666). RESULTS Factors within all domains, including demographic characteristics, physical and mental health, and academic, social, and behavioral, were important in predicting suicidal thoughts among Korean adolescents, with mental health being the most important factor. LIMITATIONS The predictive model of the current research does not infer causality, and there may have been some loss of information due to measurement issues. CONCLUSIONS Study results provide insights for taking a multidimensional approach when identifying adolescents at risk of suicide, which may be used to further address their needs through intervention programs within the school setting. Considering the cultural stigma attached to disclosing suicidal ideation and behavior, the current study proposes the need for a preventive screening process based on the observation and assessment of adolescents' general characteristics and experiences in everyday life.
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Affiliation(s)
- Hayoung Kim Donnelly
- Boston University, Department of Counseling Psychology and Applied Human Development, USA.
| | - Yoonsun Han
- Seoul National University, Department of Social Welfare, South Korea.
| | - Suna Kim
- Seoul National University, Department of International Studies, South Korea.
| | - Dong Hun Lee
- Sungkyunkwan University, Traumatic Stress Center, Department of Education, South Korea.
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Xuan L, Hua S, Lin L, Jianli Y. Gender differences in the predictive effect of depression and aggression on suicide risk among first-year college students. J Affect Disord 2023; 327:1-6. [PMID: 36736787 DOI: 10.1016/j.jad.2023.01.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Depression and aggression are related to the risk of suicide. Previous studies have associated different characteristics with depression and aggression in separate gender groups. The main aim of this study was to investigate the gender differences in the predictive effect of depression and aggression on suicide risk among first-year college students. METHODS A total of 2004 first-year undergraduates (80.5 % female, mean age = 19.4 ± 0.8 years) were surveyed by a battery of questionnaires that contained the Chinese version of the Beck scale for Suicide Ideation, the Chinese version of the 12-item Aggression Questionnaire, and the Center for Epidemiologic Studies Depression scale. RESULTS (1) Depression severity was significantly associated with the suicidality risk (r = 0.090, p < 0.01). (2) Suicide risk correlated positively with physical aggression, verbal aggression, anger, and hostility in the aggression questionnaire (r = 0.308, 0.227, 0.284, 0.277, p < 0.01). (3) A possible gender difference was noted for suicide risk in that depression degree was a significant risk factor for females but not males (R2 = 0.095, F = 41.554, p < 0.01), whereas anger was a significant predictor of suicide risk for males but not for females (R2 = 0.21, F = 25.75, p < 0.01). CONCLUSIONS Gender differences exist in the predictive effect of depression and aggression on suicide risk among first-year college students.
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Affiliation(s)
- Li Xuan
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Shao Hua
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lin Lin
- Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China
| | - Yang Jianli
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China.
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Stepanova E, Langfus JA, Youngstrom EA, Evans SC, Stoddard J, Young AS, Van Eck K, Findling RL. Finding a Needed Diagnostic Home for Children with Impulsive Aggression. Clin Child Fam Psychol Rev 2023; 26:259-271. [PMID: 36609931 DOI: 10.1007/s10567-022-00422-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/09/2023]
Abstract
Aggressive behavior is one of the most common reasons for referrals of youth to mental health treatment. While there are multiple publications describing different types of aggression in children, it remains challenging for clinicians to diagnose and treat aggressive youth, especially those with impulsively aggressive behaviors. The reason for this dilemma is that currently several psychiatric diagnoses include only some of the common symptoms of aggression in their criteria. However, no single diagnosis or diagnostic specifier adequately captures youth with impulsive aggression (IA). Here we review select current diagnostic categories, including behavior and mood disorders, and suggest that they do not provide an adequate description of youth with IA. We also specifically focus on the construct of IA as a distinct entity from other diagnoses and propose a set of initial, provisional diagnostic criteria based on the available evidence that describes youth with IA to use for future evaluation.
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Affiliation(s)
- Ekaterina Stepanova
- Virginia Commonwealth University, 1308 Sherwood Ave, Richmond, VA, 23220, USA.
| | - Joshua A Langfus
- University of North Carolina at Chapel Hill, 235 E Cameron Ave, CB# 3270, Chapel Hill, NC, 27514, USA
| | - Eric A Youngstrom
- University of North Carolina at Chapel Hill, 103 Westchester Pl, Chapel Hill, NC, 27514-5237, USA
| | - Spencer C Evans
- University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA
| | - Joel Stoddard
- University of Colorado Anschutz Medical Campus, Aurora, 13123 East 16Th Ave, Aurora, CO, 80045, USA
| | - Andrea S Young
- Johns Hopkins University, 1800 Orleans Street, Bloomberg 12N, Baltimore, MD, 21287, USA
| | - Kathryn Van Eck
- Johns Hopkins University, 1800 Orleans Street, Bloomberg 12N, Baltimore, MD, 21287, USA
| | - Robert L Findling
- Virginia Commonwealth University, 501 N 2Nd St 4Th Floor, PO Box 980308, Richmond, VA, 23298-0308, USA
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Van Hove L, Baetens I, Van Leeuwen K, Roelants M, Roeljan Wiersema J, Lewis SP, Heath N. Passive Suicidal Ideation in Childhood. CRISIS 2023; 44:100-107. [PMID: 34915734 DOI: 10.1027/0227-5910/a000835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: A growing body of empirical research shows that suicidal behaviors are prevalent in childhood. Yet, few studies have examined risk factors related to suicidal ideation (SI) among children aged 12 and younger. Aims: The current study addresses this gap. Method: A questionnaire was filled out by 1,350 Flemish primary caregivers (94.7% mothers) of 9-year-old children (50.4% boys, Mage = 9.45). Their responses were analyzed using logistic regression and independent samples t tests. Results: The presence of passive SI was reported in 10.5% of the children. A psychiatric, developmental, or behavioral condition (or multiple conditions), a learning disorder, impulsivity, aggression, and experiencing multiple stressful family life events were discovered as potential risk factors of passive SI in childhood. Limitations: The cross-sectional nature of this study meant that causality could not be inferred. In addition, it was based on reports of primary caregivers, rather than on reports from the children themselves. Conclusion: These new empirical findings can be used for the development of prevention programs and be taken into account in risk assessments of SI in clinical practice. Confirmation of our findings in a longitudinal child-reported study is needed.
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Affiliation(s)
- Lisa Van Hove
- Faculty of Psychology and Educational Sciences, Free University of Brussels, Belgium
| | - Imke Baetens
- Faculty of Psychology and Educational Sciences, Free University of Brussels, Belgium
| | | | - Mathieu Roelants
- Department of Public Health and Primary Care, KU Leuven, Belgium
| | - J Roeljan Wiersema
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | | | - Nancy Heath
- Faculty of Education, McGill University, Montreal, QC, Canada
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10
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Carlson GA, Singh MK, Amaya-Jackson L, Benton TD, Althoff RR, Bellonci C, Bostic JQ, Chua JD, Findling RL, Galanter CA, Gerson RS, Sorter MT, Stringaris A, Waxmonsky JG, McClellan JM. Narrative Review: Impairing Emotional Outbursts: What They Are and What We Should Do About Them. J Am Acad Child Adolesc Psychiatry 2023; 62:135-150. [PMID: 35358662 DOI: 10.1016/j.jaac.2022.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health care systems, emergency departments, schools, and juvenile justice programs. However, the prevalence, outcome, and impact of outbursts are difficult to quantify because they are transdiagnostic and not explicitly defined by current diagnostic nosology. Research variably addresses outbursts under the rubrics of tantrums, anger, irritability, aggression, rage attacks, or emotional and behavioral dysregulation. Consistent methods for identifying and assessing impairing emotional outbursts across development or systems of care are lacking. METHOD The American Academy of Child and Adolescent Psychiatry Presidential Task Force (2019-2021) conducted a narrative review addressing impairing emotional outbursts within the limitations of the existing literature and independent of diagnosis. RESULTS Extrapolating from the existing literature, best estimates suggest that outbursts occur in 4%-10% of community children (preschoolers through adolescents). Impairing emotional outbursts may respond to successful treatment of the primary disorder, especially for some children with attention-deficit/hyperactivity disorder whose medications have been optimized. However, outbursts are generally multi-determined and often represent maladaptive or deficient coping strategies and responses. CONCLUSION Evidence-based strategies are necessary to address factors that trigger, reinforce, or excuse the behaviors and to enhance problem-solving skills. Currently available interventions yield only modest effect sizes for treatment effect. More specific definitions and measures are needed to track and quantify outbursts and to design and assess the effectiveness of interventions. Better treatments are clearly needed.
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Affiliation(s)
- Gabrielle A Carlson
- Renaissance School of Medicine at Stony Brook University, Putnam Hall, South Campus, Stony Brook, New York.
| | | | | | - Tami D Benton
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Jeff Q Bostic
- MedStar Georgetown University Hospital, Washington, DC
| | - Jaclyn Datar Chua
- Perelman School of Medicine, University of Pennsylvania, Philadelphia; University of Pennsylvania, Philadelphia
| | | | - Cathryn A Galanter
- SUNY Downstate, Brooklyn, New York; Kings County Hospital Center, Brooklyn, New York
| | | | - Michael T Sorter
- Cincinnati Children's Hospital and the University of Cincinnati, Ohio
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Cepuch G, Kruszecka-Krówka A, Liber P, Micek A. Association between Suicidal Behaviors in Adolescence and Negative Emotions, the Level of Stress, Stress Coping Strategies and the Quality of Sleep. Healthcare (Basel) 2023; 11:healthcare11030306. [PMID: 36766881 PMCID: PMC9914235 DOI: 10.3390/healthcare11030306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Suicidal behaviors in adolescents stem from complex processes deeply rooted in various spheres of life and functioning. The study was aimed at assessing the relationship between selected negative emotions, the quality of sleep, the level of perceived stress as well as stress coping strategies and suicidal ideation and attempts among high school students. The examined group consisted of adolescents aged 16-18 recruited by social-media groups in Poland. The study was based on a diagnostic survey with the application of CAWI method. The other research tools applied in the study included: Hospital Anxiety and Depression Scale-Modified, Perceived Stress Scale-10, How do you cope?-Questionnaire, Athens Insomnia Scale as well as the authors' own questionnaire on suicidal ideation and suicide attempts. Anxiety, depression, aggression and insomnia as well as a high level of stress were statistically more common in girls than in boys (p < 0.001). The high level of negative emotions and insomnia, in turn, increased the risk of suicidal ideation (OR = 3.59, 95% CI: 2.13-6.06 and OR = 2.35, 95% CI: 1.60-3.46), as well as suicide attempts (OR = 6.29, 95% CI: 2.93-14.80 and OR = 3.29, 95% CI: 2.07-5.35). Additionally, high level of stress was associated with more than twice larger odds of suicidal ideation (OR = 2.26, 95% CI: 1.13-4.63). Significantly higher prevalence of suicidal ideation (p = 0.017) and suicide attempts (p = 0.016) was observed in girls. A high level of negative emotions and stress accompanied by a low quality of sleep are factors predisposing people to suicidal ideation and attempted suicide.
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12
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Machetanz L, Lau S, Habermeyer E, Kirchebner J. Suicidal Offenders and Non-Offenders with Schizophrenia Spectrum Disorders: A Retrospective Evaluation of Distinguishing Factors Using Machine Learning. Brain Sci 2023; 13:brainsci13010097. [PMID: 36672077 PMCID: PMC9856902 DOI: 10.3390/brainsci13010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Patients with schizophrenia spectrum disorders (SSD) have an elevated risk of suicidality. The same has been found for people within the penitentiary system, suggesting a cumulative effect for offender patients suffering from SSD. While there appear to be overlapping characteristics, there is little research on factors distinguishing between offenders and non-offenders with SSD regarding suicidality. Our study therefore aimed at evaluating distinguishing such factors through the application of supervised machine learning (ML) algorithms on a dataset of 232 offenders and 167 non-offender patients with SSD and history of suicidality. With an AUC of 0.81, Naïve Bayes outperformed all other ML algorithms. The following factors emerged as most powerful in their interplay in distinguishing between offender and non-offender patients with a history of suicidality: Prior outpatient psychiatric treatment, regular intake of antipsychotic medication, global cognitive deficit, a prescription of antidepressants during the referenced hospitalisation and higher levels of anxiety and a lack of spontaneity and flow of conversation measured by an adapted positive and negative syndrome scale (PANSS). Interestingly, neither aggression nor overall psychopathology emerged as distinguishers between the two groups. The present findings contribute to a better understanding of suicidality in offender and non-offender patients with SSD and their differing characteristics.
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13
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Sun L, Liu Z, Zhang Y, Jing Y, Lei Y, Zhang Y. The cognitive neural mechanism of response inhibition and error processing to fearful expressions in adolescents with high reactive aggression. Front Psychol 2023; 13:984474. [PMID: 36687923 PMCID: PMC9849117 DOI: 10.3389/fpsyg.2022.984474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/30/2022] [Indexed: 01/05/2023] Open
Abstract
Reactive aggression in adolescents is characterized by high levels of impulsivity. This is associated with deficits in response inhibition and error processing and spontaneous emotion-driven responses to a perceived threat. However, the characteristics and cognitive neural mechanisms of response inhibition and error processing to indirect threat in adolescents with high levels of reactive aggression are unclear. This study explored the characteristics and cognitive neural mechanisms of response inhibition and error processing to fearful expressions in adolescents with high levels of reactive aggression using an emotional Go/No-Go paradigm combined with ERP recordings. Adolescents with high levels of reactive aggression (n = 31) and a control group (n = 30) took part in this study. Results showed that when presented with fearful expressions, adolescents with high levels of reactive aggression showed a smaller No-Go P3 effect and smaller ERN amplitudes following commission errors on the No-Go task than the control group. Results suggested that when presented with fearful expressions, adolescents with high levels of reactive aggression have impaired response inhibition in the later stage of actual inhibitory control of the motor system and impaired error processing in the early stage of fast and automatic initial error detection.
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Affiliation(s)
- Lijun Sun
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Ziqi Liu
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Yan Zhang
- School of Psychology, Central China Normal University, Wuhan, China
| | - Yaopeng Jing
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Yang Lei
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Yuanyuan Zhang
- School of Psychology, Xinxiang Medical University, Xinxiang, China
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14
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Peng C, Guo T, Cheng J, Wang M, Tan Y, Rong F, Kang C, Ding H, Wang Y, Yu Y. Association between childhood physical abuse and suicidal behaviors among Chinese adolescents: The mediation of aggression. J Affect Disord 2022; 318:338-346. [PMID: 36113686 DOI: 10.1016/j.jad.2022.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/30/2022] [Accepted: 09/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although previous studies have examined many predictors of suicidal behaviors. However, little is known for childhood physical abuse (CPA) and aggression, which are prevalent among adolescents. This study aimed to explore association between CPA and suicidal behaviors, and the potential mediating role of aggression. METHOD A total of 16,111 students graded 7 to 12 were recruited using a stratified cluster sampling across five representative provinces in China. Conflict Tactics Scale-Parents to Child (CTS-PC) and Buss and Warren's Aggression Questionnaire (BWAQ) were used to measure CPA and aggression, respectively. RESULTS During the last year, 16.0 % of adolescents reported suicidal behaviors. Specifically, 7.9 % were suicide ideators, 4.6 % were planners, and 3.5 % were attempters. The prevalence of CPA in mild, moderate, and severe was 15.7 %, 26.9 %, and 4.4 %, respectively. Multinomial logistic regression indicated that moderate and severe CPA and overall aggression were associated with suicide ideators, planners, and attempters. In five sub-types of aggression, only hostility was significantly associated with all three suicidal behaviors. Structural equation modelling showed that aggression partially mediate the relationship between CPA and suicidal behaviors. The mediation proportion of overall aggression, physical aggression, verbal aggression, anger, hostility, and indirect aggression were 27.2 %, 22.4 %, 5.2 %, 14.2 %, 23.5 %, and 12.1 %, respectively. LIMITATIONS Cross-sectional design, self-reported questionnaire, and no other forms of childhood maltreatment. CONCLUSIONS CPA is a critical risk factor of suicidal behaviors among Chinese adolescents and aggression is a mediator between CPA and suicidal behaviors. Targeted suicide prevention should focus on those adolescents who report CPA and aggression, especially for hostility.
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Affiliation(s)
- Chang Peng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tengyun Guo
- Department of Neurosurgery, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Junhan Cheng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mengni Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yafei Tan
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fajuan Rong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chun Kang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hongli Ding
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yizhen Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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15
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Yue L, Cui N, Golfenshtein N, Cui N, Hao Y, Lyu P. The protective role of mindful parenting against child maltreatment and aggressive behavior: an exploratory study among Chinese parent-adolescent dyads. Child Adolesc Psychiatry Ment Health 2022; 16:72. [PMID: 36042476 PMCID: PMC9429749 DOI: 10.1186/s13034-022-00507-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well-established that child maltreatment practiced by parents is associated with adolescent aggression. Emerging evidence has suggested that higher levels of mindful parenting are associated with fewer negative parenting practices. However, the relationships among mindful parenting, child maltreatment, and adolescent aggression remain unclear. AIM To examine the association between mindful parenting, child maltreatment, and adolescent aggressive behavior among Chinese parent-adolescent dyads. METHODS Survey data from 554 Chinese parent-adolescent dyads were used for the analysis. Parents reported mindful parenting, and adolescents reported three forms of child maltreatment (i.e., physical abuse, psychological aggression, and neglect) by their parents and aggressive behavior. Path models were used to analyze whether higher levels of mindful parenting were associated with decreased likelihood of parent-to-adolescent maltreatment that were further related to lower levels of adolescent aggression. RESULTS Mindful parenting and its two factors (i.e., interaction with full attention and compassion and acceptance) were associated with lower likelihood of physical abuse and psychological aggression, which were related to decreased levels of adolescent aggressive behavior. Stratified analyses by parent gender showed that the path from interaction with full attention to adolescent aggression through psychological aggression was also significant or marginally significant in both mother-adolescent and father-adolescent dyads. Stratified analyses by adolescent gender demonstrated that the paths from interaction with full attention to physical abuse and psychological aggression were significant, which were also significantly correlated with adolescent aggression among male adolescents, whereas the mindful parenting-child maltreatment-adolescent aggression paths were not significant among female adolescents. CONCLUSIONS The findings contributed to the existing literature by assessing mindful parenting as a multifaceted construct and exploring the gender differences in the relationships. Gender-tailored interventions to improve mindful parenting, specifically focusing on the parents' ability of interacting with adolescents providing full attention, compassion, and acceptance may work towards preventing child maltreatment and promoting adolescent behavioral health.
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Affiliation(s)
- Lei Yue
- grid.27255.370000 0004 1761 1174School of Nursing and Rehabilitation, Shandong University, No. 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Naixue Cui
- School of Nursing and Rehabilitation, Shandong University, No. 44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
| | - Nadya Golfenshtein
- grid.18098.380000 0004 1937 0562Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Naisong Cui
- Rizhao Agricultural College, Rizhao, Shandong China
| | - Yinjun Hao
- grid.27255.370000 0004 1761 1174School of Nursing and Rehabilitation, Shandong University, No. 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Pingping Lyu
- grid.27255.370000 0004 1761 1174School of Nursing and Rehabilitation, Shandong University, No. 44 Wenhuaxi Road, Jinan, 250012 Shandong China
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16
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Xiong Y, Wei Y, Wang Y, Zhang H, Yang L, Ren P. Self-harm and Aggression in Chinese Early Adolescents: Their Co-occurrence and the Role of Bullying Victimization. J Youth Adolesc 2022; 51:2008-2017. [PMID: 35503194 DOI: 10.1007/s10964-022-01620-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
Self-harm and aggression increase markedly during early adolescence. However, few studies considered these harmful behaviors simultaneously. This study employed a person-centered approach to identify profiles of adolescents who differed in their patterns of self-harm, reactive aggression, and proactive aggression, examined the stability of these patterns, and explored the effect of bullying victimization on latent profile membership and transition. A total of 2463 early adolescents (48.8% girls, Mage = 13.93 ± 0.59) participated in two waves of the study over six months. The results indicated that low symptoms profile (80.4%), moderate aggression profile (14.2%), high aggression profile (3.0%), and high self-harm profile (2.4%) were identified at time 1, and low symptoms profile (82.1%), dual-harm profile (7.6%), high aggression profile (7.7%), and high self-harm profile (2.6%) were identified at time 2. Adolescents assigned to at-risk profiles showed moderate to high transition, suggesting the developmental heterogeneity of self-harm and aggression. Moreover, adolescents high in bullying victimization were more likely to belong or transition to at-risk profiles. The findings revealed the co-occurring and transitional nature of self-harm and aggression and the transdiagnostic role of bullying victimization, which can be used to guide prevention and intervention strategies.
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Affiliation(s)
- Yuke Xiong
- Collaborative Innovation Center of Assessment toward Basic Education Quality, Beijing Normal University, No. 19 Xinjiekouwai Street, Beijing, 100875, China
| | - Yi Wei
- China National Children's Center, 43 Pinganlixi Street, Beijing, 100035, China
| | - Yue Wang
- Collaborative Innovation Center of Assessment toward Basic Education Quality, Beijing Normal University, No. 19 Xinjiekouwai Street, Beijing, 100875, China
| | - Hang Zhang
- Collaborative Innovation Center of Assessment toward Basic Education Quality, Beijing Normal University, No. 19 Xinjiekouwai Street, Beijing, 100875, China
| | - Liu Yang
- Collaborative Innovation Center of Assessment toward Basic Education Quality, Beijing Normal University, No. 19 Xinjiekouwai Street, Beijing, 100875, China
| | - Ping Ren
- Collaborative Innovation Center of Assessment toward Basic Education Quality, Beijing Normal University, No. 19 Xinjiekouwai Street, Beijing, 100875, China.
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17
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Yue L, Cui N, Liu Z, Jia C, Liu X. Patterns of sleep problems and internalizing and externalizing problems among Chinese adolescents: A latent class analysis. Sleep Med 2022; 95:47-54. [DOI: 10.1016/j.sleep.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 04/10/2022] [Accepted: 04/17/2022] [Indexed: 10/18/2022]
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18
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Kurtz BP, Levins BH. Youth Suicide. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:191-196. [PMID: 37153133 PMCID: PMC10153499 DOI: 10.1176/appi.focus.20220039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
In the setting of the current youth mental health crisis and increasing rates of suicide, detecting suicide risk and intervening to prevent it is crucial. Factors that confer an elevated risk of suicide attempts and death by suicide include past suicide attempts, nonsuicidal self-injurious behavior, psychiatric disorders, gender and sexual minority identity, family history, history of trauma and loss, bullying, a lack of connectedness, and access to lethal means. Proper screening, assessment, and crisis planning may help save lives and reverse the trend of increasing youth suicide rates.
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Affiliation(s)
- Brian P Kurtz
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center (Kurtz, Levins), and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati (Kurtz)
| | - Brian H Levins
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center (Kurtz, Levins), and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati (Kurtz)
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19
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Fernández-Sevillano J, González-Ortega I, MacDowell K, Zorrilla I, López MP, Courtet P, Gabilondo A, Martínez-Cengotitabengoa M, Leza JC, Sáiz P, González-Pinto A. Inflammation biomarkers in suicide attempts and their relation to abuse, global functioning and cognition. World J Biol Psychiatry 2022; 23:307-317. [PMID: 34730074 DOI: 10.1080/15622975.2021.1988703] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To explore the link between cytokines and suicide attempts and their relationship with the psychological aspects of this complex multifactorial phenomenon. METHODS 96 participants, including 20 patients with a recent suicide attempt and diagnosis of Major Depression Disorder (MDD), 33 MDD patients with a lifetime history of suicide attempt, 23 non-attempter MDD patients, and 20 healthy controls underwent an assessment on depressive symptoms, global functioning, aggressive behaviour, presence of abuse and attention performance. Additionally, all participants had a blood extraction for IL-2, IL2-R, IL-4, IL-6, and TNF-α plasma levels analysis. RESULTS IL-6 levels were significantly different across groups (F(3,89)=3.690; p = 0.015), with higher concentrations in both recent (p = 0.04) and distant (p = 0.015) attempt in comparison to MDD non-attempters. IL-6 was associated with adult physical abuse (B = 2.591; p = 0.021), lower global functioning score (B = -0.512; p = 0.011), and poorer performance on attention (B = -0.897; p = 0.011). CONCLUSIONS Recent and distant suicidal behaviour is associated with elevated IL-6 levels, which may be influenced by stressful and traumatic experiences. Elevated concentrations of IL-6 could have a negative impact on attention, increasing suicide risk. More research is needed to clarify the role of cytokines in suicide-related features to explore novel treatments and more effective preventive interventions.
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Affiliation(s)
- Jessica Fernández-Sevillano
- Department of Neuroscience, University of the Basque Country UPV/EHU, Leioa, Spain.,Bioaraba Research Institute, Severe Mental Disorder Research Group, Vitoria-Gasteiz, Spain.,Department of Psychiatry, Araba University Hospital, OSIARABA, Osakidetza, Vitoria-Gasteiz, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Itxaso González-Ortega
- Bioaraba Research Institute, Severe Mental Disorder Research Group, Vitoria-Gasteiz, Spain.,Department of Psychiatry, Araba University Hospital, OSIARABA, Osakidetza, Vitoria-Gasteiz, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Karina MacDowell
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain.,Department of Pharmacology & Toxicology, Faculty of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Instituto de Investigación Hospital 12 de Octubre (i + 12), IUIN-UCM, Madrid, Spain
| | - Iñaki Zorrilla
- Department of Neuroscience, University of the Basque Country UPV/EHU, Leioa, Spain.,Bioaraba Research Institute, Severe Mental Disorder Research Group, Vitoria-Gasteiz, Spain.,Department of Psychiatry, Araba University Hospital, OSIARABA, Osakidetza, Vitoria-Gasteiz, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - María Purificación López
- Department of Neuroscience, University of the Basque Country UPV/EHU, Leioa, Spain.,Bioaraba Research Institute, Severe Mental Disorder Research Group, Vitoria-Gasteiz, Spain.,Department of Psychiatry, Araba University Hospital, OSIARABA, Osakidetza, Vitoria-Gasteiz, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, University of Montpellier, Montpellier, France
| | - Andrea Gabilondo
- Mental Health and Psychiatric Care Research Unit, BioDonostia Health Research Institute, Donostia-San Sebastián, Spain.,Outpatient Mental Health Network, Osakidetza, Donostia-San Sebastián, Spain
| | - Mónica Martínez-Cengotitabengoa
- Department of Neuroscience, University of the Basque Country UPV/EHU, Leioa, Spain.,Psychology Clinic of East Anglia, Norwich, United Kingdom
| | - Juan Carlos Leza
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain.,Department of Pharmacology & Toxicology, Faculty of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Instituto de Investigación Hospital 12 de Octubre (i + 12), IUIN-UCM, Madrid, Spain
| | - Pilar Sáiz
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain.,Department of Psychiatry, Universidad de Oviedo. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Ana González-Pinto
- Department of Neuroscience, University of the Basque Country UPV/EHU, Leioa, Spain.,Bioaraba Research Institute, Severe Mental Disorder Research Group, Vitoria-Gasteiz, Spain.,Department of Psychiatry, Araba University Hospital, OSIARABA, Osakidetza, Vitoria-Gasteiz, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
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20
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Hong JS, Zhang S, Burlaka V, Yoshihama M, Yan Y, Voisin DR. From Exposure to Violence between Mother and Her Intimate Partner to Suicidality Experienced by Urban Adolescents in Chicago's Southside. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157870. [PMID: 34360163 PMCID: PMC8345526 DOI: 10.3390/ijerph18157870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/11/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
Although the relationship between exposure to intimate partner violence and youths’ psychological and other wellbeing has been widely studied, there is limited research about how youths’ exposure to violence between mother and her intimate partner may be related to youth psychological wellbeing. The study used a sample of urban adolescents in Chicago Southbound to examine whether youths’ exposure to verbal conflict between mother and her intimate partner is related to their suicidality and whether youth depression and aggression may be in between such a linkage. Our findings indicated that one-third of the youth had suicidal thoughts or suicidal/self-hurting attempts. Youths’ exposure to verbal conflict between mother and her intimate partner was associated with their depressive and aggressive symptoms, and depressive symptoms subsequently were linked to suicidality. The findings also showed that youth depressive symptoms and aggressive symptoms were positively correlated, which may influence their associations with suicidality. We concluded that youth exposure to parental intimate partner violence, even comparatively mild forms such as a verbal conflict between mother and her intimate partner, may increase their risk of suicidality by worsening psychological wellbeing. The findings highlight the importance of tackling youth suicidality risks while accounting for their exposure to intimate partner violence including verbal conflicts between parents.
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Affiliation(s)
- Jun Sung Hong
- School of Social Work, Wayne State University, Detroit, MI 48202, USA;
- Correspondence: ; Tel.: +1-313-577-9367
| | - Saijun Zhang
- Department of Social Work, University of Mississippi, Oxford, MS 38677, USA;
| | - Viktor Burlaka
- School of Social Work, Wayne State University, Detroit, MI 48202, USA;
| | - Mieko Yoshihama
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Yueqi Yan
- Biostatistics and Data Support, University of California Merced, Merced, CA 95344, USA;
| | - Dexter R. Voisin
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada;
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21
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Fite PJ, Abel MR, Hesse DR, Griffith RL, Doyle RL. Links between proactive and reactive aggression and disciplinary actions among middle school‐age youth. PSYCHOLOGY IN THE SCHOOLS 2021. [DOI: 10.1002/pits.22536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Paula J. Fite
- Clinical Child Psychology Program University of Kansas Lawrence Kansas USA
| | - Madelaine R. Abel
- Clinical Child Psychology Program University of Kansas Lawrence Kansas USA
| | - Daryl R. Hesse
- Clinical Child Psychology Program University of Kansas Lawrence Kansas USA
| | | | - Rachel L. Doyle
- Clinical Child Psychology Program University of Kansas Lawrence Kansas USA
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22
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An Examination of Post-Traumatic Stress Symptoms and Aggression among Children with a History of Adverse Childhood Experiences. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-021-09884-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Szewczuk-Bogusławska M, Kaczmarek-Fojtar M, Adamska A, Frydecka D, Misiak B. Assessment of the association between non-suicidal self-injury disorder and suicidal behaviour disorder in females with conduct disorder. BMC Psychiatry 2021; 21:172. [PMID: 33771124 PMCID: PMC7995747 DOI: 10.1186/s12888-021-03168-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/15/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) and aggression have been demonstrated to serve as risk factors of suicidal behaviours (SB). Non-suicidal self-injury disorder (NSSID) and Suicidal Behaviour Disorder (SBD) are among new diagnostic categories for further studies in the DSM-5 classification. METHODS We recruited 196 girls (aged 15.5 ± 1.2 years) diagnosed with conduct disorder (CD). All of them were assessed with respect of non-suicidal self-injury acts, suicidal attempts, psychopathology, self-esteem and general functioning. RESULTS Age of NSSI onset was significantly lower compared to age of first suicidal attempt. SBD was present in 50.0% of patients with NSSID and the prevalence of NSSID in individuals with SBD was estimated at 52.2%. A diagnosis of NSSID, with at least 8 days of engagement in self-injuries during the preceding year, significantly predicted the risk of SBD. This effect appeared to be independent of depressive symptomatology. LIMITATIONS Our results cannot be generalized over the whole population of individuals diagnosed with CD because of a lack of male patients, as well as individuals with the most severe and mildest forms of CD. Causal inferences cannot be established due to a cross-sectional study design. CONCLUSIONS The NSSID with at least 8 days of engagement in self-injuries during the preceding year serves as a predictor of SBD independently of the effects of depressive symptoms. Longitudinal studies are required to confirm our findings.
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Affiliation(s)
- Monika Szewczuk-Bogusławska
- Department of Psychiatry, Wroclaw Medical University, Katedra i Klinika Psychiatrii UM, Wybrzeże L. Pasteura 10, 50-367, Wrocław, Poland.
| | | | - Agnieszka Adamska
- grid.4495.c0000 0001 1090 049XDepartment of Psychiatry, Wroclaw Medical University, Katedra i Klinika Psychiatrii UM, Wybrzeże L. Pasteura 10, 50-367 Wrocław, Poland
| | - Dorota Frydecka
- grid.4495.c0000 0001 1090 049XDepartment of Psychiatry, Wroclaw Medical University, Katedra i Klinika Psychiatrii UM, Wybrzeże L. Pasteura 10, 50-367 Wrocław, Poland
| | - Błażej Misiak
- grid.4495.c0000 0001 1090 049XDepartment of Psychiatry, Wroclaw Medical University, Katedra i Klinika Psychiatrii UM, Wybrzeże L. Pasteura 10, 50-367 Wrocław, Poland
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24
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Relationships between inflammatory markers and suicide risk status in major depression. J Psychiatr Res 2021; 134:192-199. [PMID: 33388702 PMCID: PMC8830592 DOI: 10.1016/j.jpsychires.2020.12.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/15/2020] [Accepted: 12/09/2020] [Indexed: 12/31/2022]
Abstract
Pro-inflammatory status has been implicated in depression and suicidal behaviors. Polyunsaturated fatty acids (PUFAs) and cytokines, two types of inflammatory biomarkers, have been associated with suicide, independent of depression severity. How these biomarkers relate to each other is less clear. We measured plasma phospholipid levels of arachidonic acid (AA%), docosahexaenoic acid (DHA%), and eicosapentaenoic acid (EPA%) as a percentage of total phospholipids, as well as serum interleukin-6 (IL-6), interleukin-1β (IL-1β) and tumor necrosis factor α (TNF-α), in 80 patients with major depressive disorder (MDD) and 24 healthy controls (HC). Individual PUFA and cytokine species were compared using ANOVA across four suicide risk-stratified groups: 1) highest-risk, recent (within 5 years) suicide attempters (n = 20); 2) high-risk, severe current suicidal ideators (having intent or plan) with no recent attempt history (n = 22); 3) low-risk, current non-ideators who were also lifetime non-attempters (n = 38); and 4) HC (n = 24). None of the participants were enrolled following an acute suicide attempt. Of biomarkers studied, only DHA% (p = 0.012) and IL-1β (p = 0.002) differed between groups. In post-hoc testing, DHA% was lower in attempters than ideators (p = 0.018) or MDD non-ideators (trend level, p = 0.073). IL-1β was lowest in attempters, differentiating them from ideators (p = 0.009) and HC (p = 0.004). Recent suicide attempt, one of the most powerful predictors of suicide risk, was also most closely tied to inflammatory indices in this study. Low DHA% as an indicator of suicide risk is consistent with previous reports; however, lower IL-1β was unexpected and may relate to acuity/chronicity of inflammation. There is a need for prospective studies of immune status with respect to suicidal behaviors.
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25
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Namuli JD, Nalugya JS, Bangirana P, Nakimuli-Mpungu E. Prevalence and Factors Associated With Suicidal Ideation Among Children and Adolescents Attending a Pediatric HIV Clinic in Uganda. FRONTIERS IN SOCIOLOGY 2021; 6:656739. [PMID: 34212027 PMCID: PMC8239397 DOI: 10.3389/fsoc.2021.656739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/25/2021] [Indexed: 05/15/2023]
Abstract
Background: Suicidal behavior and HIV/AIDS are vital public health challenges especially in low and middle-income countries. As suicide in adults is perturbing for those closest to them, this sentiment is much more intense and generalized in the case of a child or adolescent. Knowledge of factors associated with suicidal ideation in HIV infected children and adolescents may inform suicide prevention strategies needed to improve their quality of life. This study aimed to assess the prevalence and factors associated with suicidal ideation among HIV infected children and adolescents attending a pediatric HIV clinic in Uganda. Methods: Data from a sample of 271 children and adolescents aged 6-18 years living with HIV/AIDS attending a pediatric HIV clinic was analyzed. Child characteristics and clinical variables were assessed using a socio-demographic questionnaire and medical records respectively. Suicidal ideation and depression were assessed using the Child Depression Inventory. The types of behavioral problems and the parent-child relationship were assessed using Child Behavioral Check List (6-18 years) and the Parent Child Relationship Scale respectively. Child exposure to different stressful life events was assessed with a series of standardized questions. Logistic regression models were used to explore factors independently associated with suicidal ideation. Results: The prevalence of suicidal ideation was 17%. In the multivariate analysis; Child exposure to family or friend's death (prevalence rate ratio (PRR = 2.02; 95% CI, 1.01-4.03), p = 0.046), HIV wasting syndrome (PRR = 0.39; 95% CI, 0.21-0.75, p = 0.04), Depression (PRR = 1.08; 95% CI, 1.03-1.12, p = 0.001), Anxiety symptoms (PRR = 1.10; 95% CI, 1.01-1.20, p = 0.024) and Rule breaking behavior (PRR = 1.06; 95% CI, 0.99-1.13, p = 0.051) were independently associated with suicidal ideations. Conclusion: The prevalence of suicidal ideation among children and adolescents living with HIV/AIDS is substantial. Children and adolescents with exposure to family or friend's death, those with higher depression scores, anxiety symptoms and rule breaking behavior are more likely to report suicidal ideation. Those with HIV wasting syndrome were less likely to report suicidal ideation. There is urgent need for HIV care providers to screen for suicide and link to mental health services.
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Affiliation(s)
- Justine Diana Namuli
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
- *Correspondence: Justine Diana Namuli,
| | | | - Paul Bangirana
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
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26
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Jha MK, Minhajuddin A, Chin Fatt C, Kircanski K, Stringaris A, Leibenluft E, Trivedi MH. Association between irritability and suicidal ideation in three clinical trials of adults with major depressive disorder. Neuropsychopharmacology 2020; 45:2147-2154. [PMID: 32663842 PMCID: PMC7784964 DOI: 10.1038/s41386-020-0769-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/19/2020] [Accepted: 07/08/2020] [Indexed: 12/19/2022]
Abstract
Irritability in pediatric samples is associated with higher rates of subsequent suicide-related outcomes. No study, to date, has evaluated the longitudinal association between irritability and suicidal ideation (SI) in adults with major depressive disorder (MDD). This report evaluated whether irritability is associated with SI at the same visit (i.e., concurrently) and whether early changes in irritability with antidepressant treatment predict subsequent levels of SI. Participants of Combining Medications to Enhance Depression Outcomes (CO-MED, n = 665), Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC, n = 296), and Suicide Assessment Methodology Study (SAMS, n = 266) were included. Repeated-measures mixed model analyses evaluated concurrent association throughout the trial between irritability (five-item irritability domain of Concise Associated Symptom Tracking scale) and SI (three-item suicidal thoughts factor of Concise Health Risk Tracking scale) after controlling for overall depression (excluding suicidality-related item), and predicted subsequent levels of SI (repeated observations from week-2-to-week-8) based on early (baseline-to-week-2) changes in irritability after controlling for early changes in overall depression. Higher irritability was associated with higher SI concurrently; estimates (standard error) were 0.18 (0.02, p < 0.0001), 0.64 (0.02, p < 0.0001), and 0.26 (0.04, p < 0.0001) in CO-MED, EMBARC, and SAMS respectively. Greater baseline-to-week-2 reductions in irritability predicted lower levels of subsequent SI; estimates (standard errors) were -0.08 (0.03, p = 0.023), -0.50 (0.05, p < 0.0001), and -0.12 (0.05, p = 0.024) in CO-MED, EMBARC, and SAMS, respectively. Controlling for anxiety or insomnia produced similar results. In conclusion, irritability and SI were consistently linked in adults with MDD. These findings support careful assessment of irritability in suicide risk assessment.
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Affiliation(s)
- Manish K Jha
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
| | - Cherise Chin Fatt
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
| | | | - Argyris Stringaris
- National Institute of Mental Health, 10 Center Dr, Bethesda, MD, 20814, USA
| | - Ellen Leibenluft
- National Institute of Mental Health, 10 Center Dr, Bethesda, MD, 20814, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA.
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Influence of coping strategies on the efficacy of YAM (Youth Aware of Mental Health): a universal school-based suicide preventive program. Eur Child Adolesc Psychiatry 2020; 29:1671-1681. [PMID: 32025960 DOI: 10.1007/s00787-020-01476-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
The school-based mental health promotion and suicide prevention universal program Youth Aware of Mental Health (YAM) significantly reduces incident suicide attempts and severe suicidal ideation. This paper aims at elucidating psychological mechanisms underlying YAM's efficacy. Our hypothesis is that YAM operates through interactions with coping strategies (CS) on the reduction of suicidal ideation (SI). In the Saving and Empowering Young Lives in Europe (SEYLE) study, five coping strategies were assessed at baseline (T0) and 12-month follow-up (T12): "learning", "help-seeking", "arts", "sports" and "fight". We analyzed interactions between the YAM intervention, coping strategies and SI in the YAM group (N = 1693) and the minimal intervention group (N = 1909), after excluding prevalent cases with SI and previous suicide attempts from our total sample (N = 5654). General Linear Mixed Model regressions were performed. The present study confirms that coping strategies play an influential role on suicidal ideation. Our results showed that YAM acts whatever the prevailing coping strategies used. It is particularly efficient for pupils insufficiently using adaptive coping strategies such as LEARN and HELP-SEEKING or using maladaptive coping strategies, such as ARTS and FIGHT. The socialization induced by the YAM intervention seems to be a strong component of its efficiency.
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Hill SY, Jones BL, Haas GL. Suicidal ideation and aggression in childhood, genetic variation and young adult depression. J Affect Disord 2020; 276:954-962. [PMID: 32745832 PMCID: PMC7484359 DOI: 10.1016/j.jad.2020.07.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 06/01/2020] [Accepted: 07/05/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Suicidal thoughts and behaviors have been studied in association with a variety of risk factors. The aim of the present study was to determine if levels of child/adolescent aggression and/or variation in candidate genes previously associated with suicidal behaviors in adults would influence the presence of suicidal ideation in childhood/adolescence, and to determine if ideation was associated with young adult depression. METHODS A longitudinal study of children, adolescents and young adults who were at high or low risk for alcohol and other substance use disorders by familial background were assessed. The Child Behavior Checklist (CBCL) aggression scale scores with derived subtypes (physical and relational) and genetic variation (ANKK1, DRD2, COMT, SLC6A4, HTR2C) were used as predictors of the presence and onset of suicidal ideation in childhood using survival analysis. Structural equation models (SEM) were fit to determine the relative importance of the predictors controlling for background variables. RESULTS CBCL aggression was significantly associated with child/adolescent suicidal ideation. One SNP in the ANKK1 gene (rs1800497), one in the HTR2C gene (rs6318), and two haplotypes, AAAC in the ANKK1-DRD2 complex and the CCC haplotype of the HTR2C gene, were significantly associated with the presence and onset of child/adolescent suicidal ideation. Follow up in young adulthood showed a significant relationship between suicidal ideation in childhood/adolescence and young adult depression. CONCLUSIONS Genetic variation and presence of elevated aggression scores from the childhood CBCL are significant predictors of childhood suicidal ideation. Suicidal ideation in childhood and being female are predictors of young adult depression.
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Affiliation(s)
- Shirley Y. Hill
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 15213,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA 15213,Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA USA 15213
| | - Bobby L. Jones
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 15213
| | - Gretchen L. Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 15213,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA 15213,VA Pittsburgh Healthcare System, Pittsburgh, PA USA 15213
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Moore CC, Hubbard JA, Bookhout MK, Mlawer F. Relations between Reactive and Proactive Aggression and Daily Emotions in Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1495-1507. [PMID: 30929183 DOI: 10.1007/s10802-019-00533-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The current study examined whether individual differences in reactive and proactive aggression: 1) relate to level of daily emotion, including happiness, sadness, anger, and fear, 2) predict across-day variability in these emotions, and 3) moderate reactivity of these emotions to positive and negative events. Participants were a racially/ethnically diverse sample of 144 adolescents (80 girls, 64 boys; M age = 13.55 years; SD = 1.34). Adolescents self-reported on reactive and proactive aggression in a home visit prior to the collection of daily data. Using daily dairy procedures, adolescents then reported on their daily emotions and positive/negative events over 12 consecutive days. Higher reactive aggression was associated with greater levels of daily anger, more variability in anger across days, and heightened angry reactivity to negative events. Additionally, higher reactive aggression predicted lower levels of daily happiness but greater happy reactivity to positive events. Finally, higher reactive aggression was linked to increased variability in daily fear. In contrast, proactive aggression was largely unrelated to adolescents' daily emotions, with the exception that higher proactive aggression predicted less variability in happiness across days. Results indicate that reactive aggression is characterized by significant emotionality at the daily level, and proactive aggression is characterized by lack of emotionality.
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Affiliation(s)
- Christina C Moore
- University of Delaware, 105 The Green, Newark, Delaware, 19716, USA.
| | - Julie A Hubbard
- University of Delaware, 105 The Green, Newark, Delaware, 19716, USA
| | - Megan K Bookhout
- University of Delaware, 105 The Green, Newark, Delaware, 19716, USA
| | - Fanny Mlawer
- University of Delaware, 105 The Green, Newark, Delaware, 19716, USA
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30
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Sun L, Li J, Niu G, Zhang L, Chang H. Reactive Aggression Affects Response Inhibition to Angry Expressions in Adolescents: An Event-Related Potential Study Using the Emotional Go/No-Go Paradigm. Front Psychol 2020; 11:558461. [PMID: 33101129 PMCID: PMC7556161 DOI: 10.3389/fpsyg.2020.558461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022] Open
Abstract
Although it is well established that response inhibition to angry expressions is impaired among reactively aggressive adolescents, the cognitive processes underlying this effect remain unclear. The main goal of our study was to investigate the time course of response inhibition to angry expressions in reactively aggressive adolescents compared to controls. In total, 23 reactively aggressive adolescents and 23 control adolescents were recruited to participate in an event-related potential (ERP) study measuring response inhibition to angry expressions with an emotional Go/No-go paradigm. The results showed that when presented angry or happy expressions, reactively aggressive adolescents showed a smaller No-go P3 effect than the control group. These results indicate that response inhibition to angry expressions in reactively aggressive adolescents is impaired at the later stage of the actual inhibitory control. The characteristics of response inhibition to happy expressions in reactively aggressive adolescents are similar to those in response to angry expressions.
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Affiliation(s)
- Lijun Sun
- School of Psychology, Xinxiang Medical University, Xinxiang, China
- *Correspondence: Lijun Sun,
| | - Junyi Li
- School of Psychology, Sichuan Normal University, Chengdu, China
| | - Gengfeng Niu
- School of Psychology, Central China Normal University, Wuhan, China
| | - Lei Zhang
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Hongjuan Chang
- School of Nursing, Xinxiang Medical University, Xinxiang, China
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31
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Hsu HT, Fulginiti A, Petering R, Barman-Adhikari A, Maria DS, Shelton J, Bender K, Narendorf S, Ferguson K. Firearm Violence Exposure and Suicidal Ideation Among Young Adults Experiencing Homelessness. J Adolesc Health 2020; 67:286-289. [PMID: 32327274 PMCID: PMC7398823 DOI: 10.1016/j.jadohealth.2020.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/14/2020] [Accepted: 02/07/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aimed to explore the association between direct exposure, indirect exposure, and perpetration of gun violence and suicidal ideation among young adults experiencing homelessness (YAEH). METHODS YAEH (n = 1,426) in seven cities across the U.S. were surveyed. Logistic regression analyses were conducted to examine the association between lifetime gun violence exposure and suicidal ideation in the past 12 months. RESULTS Forty-five percent (n = 641) of YAEH had experienced direct or indirect gun violence, whereas 17% (n = 247) had engaged in gun violence perpetration. Gun violence perpetration is associated with elevated suicidal ideation risk (odds ratio = 1.46; 95% confidence interval = 1.02-2.01) among YAEH. CONCLUSIONS A high percentage of YAEH were exposed to firearm violence. Cross-sector, multiagency collaborations are warranted to reduce firearm violence exposure among this vulnerable population. Homeless service providers should screen for gun violence exposure and suicide risk and target prevention efforts on YAEH with a history of gun violence perpetration.
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Affiliation(s)
- Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, Missouri.
| | - Anthony Fulginiti
- Graduate School of Social Work, University of Denver, Denver, Colorado
| | | | | | - Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center, Houston, Texas
| | - Jama Shelton
- Silberman School of Social Work, Hunter College, City University of New York, New York City, New York
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, Colorado
| | - Sarah Narendorf
- Graduate College of Social Work, University of Houston, Houston, Texas
| | - Kristin Ferguson
- School of Social Work, Arizona State University, Phoenix, Arizona
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32
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Orri M, Geoffroy MC, Turecki G, Feng B, Brendgen M, Vitaro F, Dionne G, Paquin S, Galera C, Renaud J, Tremblay RE, Côté SM, Boivin M. Contribution of genes and environment to the longitudinal association between childhood impulsive-aggression and suicidality in adolescence. J Child Psychol Psychiatry 2020; 61:711-720. [PMID: 31782164 DOI: 10.1111/jcpp.13163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Population-based and family studies showed that impulsive-aggression predicts suicidality; however, the underlying etiological nature of this association is poorly understood. The objective was to determine the contribution of genes and environment to the association between childhood impulsive-aggression and serious suicidal ideation/attempt in young adulthood. METHODS N = 862 twins (435 families) from the Quebec Newborn Twin Study were followed up from birth to 20 years. Repeated measures of teacher-assessed impulsive-aggression were modeled using a genetically informed latent growth model including intercept and slope parameters reflecting individual differences in the baseline level (age 6 years) and in the change (increase/decrease) of impulsive-aggression during childhood (6 to 12 years), respectively. Lifetime suicidality (serious suicidal ideation/attempt) was self-reported at 20 years. Associations of impulsive-aggression intercept and slope with suicidality were decomposed into additive genetic (A) and unique environmental (E) components. RESULTS Additive genetic factors accounted for an important part of individual differences in impulsive-aggression intercept (A = 90%, E = 10%) and slope (A = 65%, E = 35%). Genetic (50%) and unique environmental (50%) factors equally contributed to suicidality. We found that 38% of the genetic factors accounting for suicidality were shared with those underlying impulsive-aggression slope, whereas 40% of the environmental factors accounting for suicidality were shared with those associated with impulsive-aggression intercept. The genetic correlation between impulsive-aggression slope and suicidality was 0.60, p = .027. CONCLUSIONS Genetic and unique environmental factors underlying suicidality significantly overlap with those underlying childhood impulsive-aggression. Future studies should identify putative genetic and environmental factors to inform prevention.
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Affiliation(s)
- Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, QC, Canada.,Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux, Bordeaux, France
| | - Marie-Claude Geoffroy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, QC, Canada.,Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Bei Feng
- School of Psychology, Université Laval, Québec City, QC, Canada
| | - Mara Brendgen
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Frank Vitaro
- School of Psychoéducation, University of Montréal, Montréal, QC, Canada
| | - Ginette Dionne
- School of Psychoéducation, University of Montréal, Montréal, QC, Canada
| | - Stephane Paquin
- School of Psychology, Université Laval, Québec City, QC, Canada.,Department of Sociology, University of Montréal, Montréal, Montréal, QC, Canada
| | - Cedric Galera
- Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux, Bordeaux, France
| | - Johanne Renaud
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, QC, Canada.,Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Montréal, QC, Canada
| | - Richard E Tremblay
- Department of Pediatrics and Psychology, University of Montréal, Montréal, QC, Canada.,School of Public Health, University College Dublin, Dublin, Ireland
| | - Sylvana M Côté
- Department of Social and Preventive Medicine, University of Montréal, Montréal, QC, Canada
| | - Michel Boivin
- School of Psychology, Université Laval, Québec City, QC, Canada
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33
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Koyama E, Zai CC, Bryushkova L, Kennedy JL, Beitchman JH. Predicting risk of suicidal ideation in youth using a multigene panel for impulsive aggression. Psychiatry Res 2020; 285:112726. [PMID: 31870620 DOI: 10.1016/j.psychres.2019.112726] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 01/01/2023]
Abstract
Childhood traumatic experiences and impulsive aggression are strong predictors of suicide ideation in youth. This study examines whether a gene panel previously associated with impulsive aggression, together with a measure of traumatic experience, will predict suicidal ideation in youth. The sample consisted of 158 youth (ages 9-17 years) of European ancestry that participated in a case-control study for childhood aggression. The Massachusetts Youth Screening Instrument (MAYSI-2) was used to examine suicide ideation and traumatic experiences. The impulsive aggression gene panel consists of 5 markers across 5 susceptibility genes (CRH, CRHR2, MC2R, OXTR, BDNF). A multi-gene risk score (MRS) for each individual was calculated by taking the total number of risk genotypes for that person. The covariates for the multiple regression model included sex, age, symptoms of anxiety/depression, MRS, traumatic experiences, and MRS x traumatic experience interaction. Results show the MRS x traumatic experience interaction term and the anxious/depressed symptoms to be significant predictors of suicide ideation in the full model. Importantly, genetic susceptibility to impulsive aggression and traumatic experiences remained a significant predictor for suicide ideation over and above the youth's level of anxiety and depression. This finding may have important implications for early intervention for youth suicide-related behaviors.
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Affiliation(s)
- Emiko Koyama
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way Room 5218, Toronto, Ontario M6J 1H4, Canada
| | - Clement C Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Lyubov Bryushkova
- Postgraduate Medical Education, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - James L Kennedy
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Joseph H Beitchman
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way Room 5218, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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34
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Abel MR, Poquiz JL, Fite PJ, Doyle RL. Reactive Aggression and Suicidal Behaviors in Children Receiving Outpatient Psychological Services: The Moderating Role of Hyperactivity and Inattention. Child Psychiatry Hum Dev 2020; 51:2-12. [PMID: 31222508 DOI: 10.1007/s10578-019-00905-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The current study examines associations between reactive and proactive aggression and suicidal thoughts and behaviors among youth (N = 115, 62% male), ranging from 6 to 12 years, seeking services in an outpatient psychological clinic. Symptoms of hyperactivity/impulsivity and inattention were evaluated as potential moderators of this link. Children and a caregiver completed self- and parent-report questionnaires on aggression, suicidal behaviors, depressive symptoms, and ADHD-related behaviors during intake. Reactive aggression was more strongly linked to suicidal thoughts and behaviors than proactive aggression. Further, hyperactivity/impulsivity, but not inattention, moderated the association between reactive aggression and suicidal thoughts and behaviors, such that reactive aggression was only associated with suicidal behaviors at high levels of hyperactivity/impulsivity. These findings were evident for reactive, not proactive, aggression and when accounting for the variance associated with depressive symptoms, age, and gender. Hyperactivity/impulsivity is discussed as a potentially important target among reactively aggressive youth for prevention of suicidal behaviors.
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Affiliation(s)
- Madelaine R Abel
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA.
| | - Jonathan L Poquiz
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Paula J Fite
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Rachel L Doyle
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
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35
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Pettit JW, Buitron V, Green KL. Assessment and Management of Suicide Risk in Children and Adolescents. COGNITIVE AND BEHAVIORAL PRACTICE 2019; 25:460-472. [PMID: 31787833 DOI: 10.1016/j.cbpra.2018.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article presents a pragmatic approach to assessing and managing suicide risk in children and adolescents. We first present general recommendations for conducting risk assessments with children and adolescents, followed by an algorithm for designating risk. Risk assessment and designation should be based on both distal (i.e., a prior history of self-harm behaviors) and proximal (i.e., suicide ideation, plans, intent, and preparations) predictors of suicide attempt. We then discuss safety planning as an easy-to-implement approach for intervening and managing suicide risk when working with children and adolescents. We end with a case example illustrating the implementation of risk assessment, risk designation, and safety planning with an adolescent client and her mother.
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Affiliation(s)
| | | | - Kelly L Green
- Perelman School of Medicine of the University of Pennsylvania
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36
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Magalotti SR, Neudecker M, Zaraa SG, McVoy MK. Understanding Chronic Aggression and Its Treatment in Children and Adolescents. Curr Psychiatry Rep 2019; 21:123. [PMID: 31741142 DOI: 10.1007/s11920-019-1105-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
PURPOSE OF REVIEW Youth aggression is common and has a significant burden on individuals, families, and society. However, its treatment is often a challenge for clinicians. Thus, this review will examine the current understanding of youth aggression, conceptualize aggression as a symptom rather than its own disorder, and provide an overview of treatment strategies. RECENT FINDINGS Youth aggression is associated with complex genetic, neurobiological, and environmental risks. Prevention strategies are of the utmost importance for at-risk families and youth. Psychosocial interventions are the first line treatment. But if not fully effective, then pharmacologic interventions-including psychostimulants, alpha-2 agonists, atomoxetine, and risperidone-have shown benefits. Other medications, such as SSRIs, can be useful in certain scenarios. It is important to conceptualize youth aggression as being a trans-diagnostic symptom in psychopathology. Determining the underlying cause of aggression will help to guide treatment.
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Affiliation(s)
- Selena R Magalotti
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mandy Neudecker
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Solomon G Zaraa
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Molly K McVoy
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. .,Case Western University School of Medicine, Cleveland, OH, USA. .,W. O. Walker Building, Division of Child and Adolescent Psychiatry, 10524 Euclid Ave, Suite 1155A, Cleveland, OH, USA.
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37
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Barzilay S, Apter A, Snir A, Carli V, Hoven CW, Sarchiapone M, Hadlaczky G, Balazs J, Kereszteny A, Brunner R, Kaess M, Bobes J, Saiz PA, Cosman D, Haring C, Banzer R, McMahon E, Keeley H, Kahn JP, Postuvan V, Podlogar T, Sisask M, Varnik A, Wasserman D. A longitudinal examination of the interpersonal theory of suicide and effects of school-based suicide prevention interventions in a multinational study of adolescents. J Child Psychol Psychiatry 2019; 60:1104-1111. [PMID: 31512239 DOI: 10.1111/jcpp.13119] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Predictions of two different models for suicide attempts (SA) over 12 months, as differentially impacted by specific school-based suicide prevention interventions, were compared. These were as follows: (a) interpersonal theory (IPTS) and (b) a two-pathway model, one path associated with externalizing symptoms and continuum of self-harm behaviors, and the other with internalizing symptoms. METHODS Self-report questionnaires were completed by 11,110 high school students from ten EU countries enrolled in the Saving and Empowering Young Lives in Europe (SEYLE) study. Baseline measures included perceived burdensomeness, thwarted belongingness from parents and peers, health risk behaviors, self-injury, suicide ideation (SI), and attempts (SA). SI and SA were reassessed at 12-month follow-up. Each model's predictions of SI and SA groups over time (i.e., repeated SA, remitted SA, SA onset, and no SA) were estimated in the no intervention/control group. The superior model was estimated across intervention groups. RESULTS Interpersonal theory showed better fit compared to the two-pathway model. In partial agreement with IPTS predictions, parental low belongingness but not peer belongingness or burdensomeness predicted greater likelihood of SI. The likelihood of repeated SA versus no SA was higher among adolescents who reported SI, self-injury, risk behaviors, and particularly both SI and self-injury. All three interventions attenuated the combined effect of SI and self-injury. Youth Aware of Mental Health Program (YAM) additionally decreased the effect of risk behaviors on the likelihood of repeated SA. CONCLUSIONS Interpersonal theory assumptions were partially supported. Perceived interpersonal difficulties with parents were primarily related with SI, and risk behaviors and self-injury were important predictors of SA. Suicide prevention interventions may be effective by mitigating the hazardous effect of varying self-harm behaviors and may be further advanced by increasing parental involvement.
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Affiliation(s)
- Shira Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Avigal Snir
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, Campobasso, Italy.,National Institute for Health, Migration and Poverty, Rome, Italy.,Kazakh National Medical University, Almaty, Kazakhstan
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary.,Bjørknes University College, Oslo, Norway
| | - Agnes Kereszteny
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - Romuald Brunner
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Pilar A Saiz
- Department of Psychiatry, School of Medicine, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain
| | - Doina Cosman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Haring
- Research Division for Mental Health, University for Medical Information Technology (UMIT), Hall in Tirol, Austria
| | | | | | - Helen Keeley
- National Suicide Research Foundation, Cork, Ireland
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France
| | - Vita Postuvan
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Tina Podlogar
- Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Airi Varnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.,School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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38
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Single nucleotide polymorphisms, variable number tandem repeats and allele influence on serotonergic enzyme modulators for aggressive and suicidal behaviors: A review. Pharmacol Biochem Behav 2019; 180:74-82. [PMID: 30928299 DOI: 10.1016/j.pbb.2019.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 11/22/2022]
Abstract
The serotonergic system plays key regulatory roles in cognition and emotion. Several lines of evidence suggest that genetic variation is associated with aggressive and suicidal behaviors. Genetic studies have largely focused on three types of variations: single nucleotide polymorphisms (SNPs), variable number tandem repeats (VNTRs), and alleles. 95 published papers (49 papers for aggression and 46 for suicide) were reviewed to summarize the impact of SNPs, VNTRs, and alleles of tryptophan hydroxylase (TPH, the rate-limiting enzyme in serotonin [5-HT] synthesis), 5-HT transporter (5-HTT), serotonergic receptors, monoamine oxidase (an enzyme that catalyzes 5-HT degradation) on aggression and suicidal behaviors. These study samples include healthy controls, psychiatric disease patients, and animal models. This article mainly reviews studies on the relationship between 5-HT transmissions and genetic variations involved in aggression (particularly impulsive aggression) or suicide in people with different ethnicities and psychiatric disorders. We found that most SNPs, VNTRs, and alleles exerted influences on aggression or suicide. Only A128C in TPH1, A138G in 5-HT2A, and L type in the VNTR of monoamine oxidase A (MAOA) affected both aggression and suicide. The associations between some genetic variations and aggression/suicide may be influenced by gender, age, ethnicity, psychiatric disease, and even parenting or prenatal stress. These findings may help clarify how genetic and environmental factors influence the development of aggressive and suicidal behaviors.
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Buitron V, Hartley CM, Pettit JW, Hatkevich C, Sharp C. Aggressive Behaviors and Suicide Ideation in Inpatient Adolescents: The Moderating Roles of Internalizing Symptoms and Stress. Suicide Life Threat Behav 2018; 48:580-588. [PMID: 28833393 PMCID: PMC6445376 DOI: 10.1111/sltb.12375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 05/15/2017] [Indexed: 11/27/2022]
Abstract
The present study examined a conceptual model in which the association between aggressive behaviors and suicide ideation is moderated by internalizing symptoms and ongoing stress. Participants were 304 psychiatric inpatient adolescents (65.8% girls) ranging in age from 12 to 17 years (Mean age = 14.69). The association between aggressive behaviors and suicide ideation was significantly moderated by internalizing symptoms and ongoing stress; the association was positive in adolescents low in internalizing symptoms or high in ongoing stress, but negative in adolescents high in internalizing symptoms or low in ongoing stress. The three-way interaction between aggressive behaviors, internalizing symptoms, and ongoing stress was not statistically significant. The current findings indicate that in adolescents who display high levels of aggressive behaviors, the presence of high ongoing stress provides a more useful indicator of levels of suicide ideation than the presence of high internalizing symptoms. Implications for case identification and prevention are discussed.
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