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Min J, Tam V, Fein JA, Vasan A, Griffis HM, Krass P, Doupnik SK. Psychosocial Risks and Adolescent Mental Health: The Moderating Role of Objective Neighborhood Characteristics. J Adolesc Health 2024; 75:442-450. [PMID: 39001747 DOI: 10.1016/j.jadohealth.2024.05.025] [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: 01/26/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Although previous studies have examined the association between youth psychosocial risks and their perceptions of their neighborhood, it is unclear how objective neighborhood characteristics are associated with psychosocial risks and mental health symptoms among adolescents. We investigated how neighborhood characteristics moderate the relationship between youth psychosocial characteristics and mental health symptoms. METHODS This cross-sectional study examined 13,837 emergency department visits by 14-18-year-olds who completed a standardized Behavioral Health Screening in a tertiary pediatric hospital in Philadelphia from 2013 to 2020. Psychosocial risk factors and mental health symptoms were assessed based on self-reported survey responses. We characterized neighborhoods as low-, moderate-, and high-stress based on gun violence incidence from 2013 to 2020 and the census tract-level Child Opportunity Index. Mixed effects logistic regression and Poisson models were used to examine moderation effects. RESULTS The 9,814 included patients were 64% female and 64% non-Hispanic Black. The following psychosocial risk factors were associated with two to eight times higher odds of depressive symptoms and suicide risk: exposure to trauma, bullying at school, at-risk substance use, fighting, and retaliation. Adolescents living in high-stress neighborhoods were twice as likely to report fighting and retaliation and reported more psychosocial risk factors than those in low-stress neighborhoods. Odds of mental health symptoms increased with the number of psychosocial risk factors, particularly in youth from low-stress neighborhoods. DISCUSSION Objective neighborhood characteristics had a significant interaction effect on the relationship between psychosocial risks and depression and suicide risk among adolescents seeking care in a pediatric emergency department.
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Affiliation(s)
- Jungwon Min
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Vicky Tam
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joel A Fein
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania; Center for Violence Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania; Center for Violence Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness and PolicyLab, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heather M Griffis
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Polina Krass
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Violence Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness and PolicyLab, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephanie K Doupnik
- Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness and PolicyLab, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Deng B, McLeod GFH, Boden J, Sabel CE, Campbell M, Eggleton P, Hobbs M. The impact of area-level socioeconomic status in childhood on mental health in adolescence and adulthood: A prospective birth cohort study in Aotearoa New Zealand. Health Place 2024; 88:103246. [PMID: 38796935 DOI: 10.1016/j.healthplace.2024.103246] [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: 12/26/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/29/2024]
Abstract
Mental health conditions pose a significant public health challenge, and low area-level socioeconomic status (SES) is a potentially important upstream determinant. Childhood exposure might have influences on later-life mental health. This study, utilises data from the Christchurch Health and Development Study birth cohort, examining the impact of area-level SES trajectories in childhood (from birth to age 16) on mental health at age 16 and from age 18-40 years. Findings revealed some associations between distinct SES trajectories and mental health. The study underscores the importance of using a spatial lifecourse epidemiology framework to understand long-term environmental impacts on later-life health.
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Affiliation(s)
- Bingyu Deng
- Faculty of Health, Te Kaupeka Oranga, University of Canterbury, Te Whare Wānanga o Waitaha, Christchurch, Otautahi, New Zealand; GeoHealth Laboratory, Te Taiwhenua o te Hauora, University of Canterbury, Te Whare Wānanga o Waitaha, Christchurch, Otautahi, New Zealand.
| | - Geraldine F H McLeod
- Christchurch Health and Development Study, University of Otago, Te Whare Wānanga o Otāgo ki Ōtautahi, Christchurch, Otautahi, New Zealand
| | - Joseph Boden
- Christchurch Health and Development Study, University of Otago, Te Whare Wānanga o Otāgo ki Ōtautahi, Christchurch, Otautahi, New Zealand
| | - Clive E Sabel
- Department of Public Health, Aarhus University, Aarhus, Denmark; BERTHA, Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark; School of Geography, Earth and Environmental Sciences, University of Plymouth, UK
| | - Malcolm Campbell
- GeoHealth Laboratory, Te Taiwhenua o te Hauora, University of Canterbury, Te Whare Wānanga o Waitaha, Christchurch, Otautahi, New Zealand; School of Earth and Environment, Te Kura Aronukurangi, University of Canterbury, Te Whare Wānanga o Waitaha, Christchurch, Otautahi, New Zealand
| | - Phoebe Eggleton
- GeoHealth Laboratory, Te Taiwhenua o te Hauora, University of Canterbury, Te Whare Wānanga o Waitaha, Christchurch, Otautahi, New Zealand; School of Earth and Environment, Te Kura Aronukurangi, University of Canterbury, Te Whare Wānanga o Waitaha, Christchurch, Otautahi, New Zealand
| | - Matthew Hobbs
- Faculty of Health, Te Kaupeka Oranga, University of Canterbury, Te Whare Wānanga o Waitaha, Christchurch, Otautahi, New Zealand; GeoHealth Laboratory, Te Taiwhenua o te Hauora, University of Canterbury, Te Whare Wānanga o Waitaha, Christchurch, Otautahi, New Zealand
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Cambron C, Jaggers JW. Examining area- and individual-level differences in suicide ideation severity and suicide attempt among youth. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024; 34:35-44. [PMID: 37873580 DOI: 10.1111/jora.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
Youth suicide is a pressing problem and suicide rates are not equally distributed across geographic areas or socioeconomic status (SES). Death by suicide is often preceded factors including hopelessness and suicide ideation, planning, and attempt. The current study examined area- and individual-level differences in suicide ideation severity and suicide attempt in a state-representative sample of youth from 2019 (N = 78,740) and 2021 (N = 61,396). Youth from higher SES and rural areas showed lower suicide ideation severity and odds of suicide attempt. After including individual-level covariates, SES differences in ideation severity and suicide attempt persisted for 2019 but not 2021. Rural differences for ideation severity persisted across years but not for suicide attempt. Further research on geographic variation in suicide risk is needed.
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Berny LM, Mojekwu F, Nichols LM, Tanner-Smith EE. Investigating the Interplay Between Mental Health Conditions and Social Connectedness on Suicide Risk: Findings from a Clinical Sample of Adolescents. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01659-x. [PMID: 38308712 DOI: 10.1007/s10578-023-01659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 02/05/2024]
Abstract
This study examined whether school and community connectedness buffer the relationships between mental health conditions and suicide risk in a clinical sample of adolescents with histories of substance use disorders. Data from 294 adolescents were examined, with approximately 58% reporting lifetime suicidal ideation and/or prior attempts. Multinomial logistic regression was used to examine main and interaction effects on a three-category measure of suicide risk. Depression severity and panic disorder were associated with elevated suicidal ideation risk, whereas disordered eating was associated with elevated risk of attempts. Higher school-based positive peer interactions, school safety, and neighborhood social connection levels were associated with reduced suicide attempt risk. Moderation analyses revealed that high neighborhood social connection levels may partially mitigate the elevated likelihood of attempting suicide associated with disordered eating. Findings suggest clinical populations of adolescents may benefit from approaches aiming to promote social connectedness, further supporting a comprehensive approach to suicide prevention.
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Affiliation(s)
- Lauren M Berny
- Department of Counseling Psychology and Human Services, University of Oregon, 5251 University of Oregon, Eugene, OR, 97403, USA.
| | - Frank Mojekwu
- Department of Counseling Psychology and Human Services, University of Oregon, 5251 University of Oregon, Eugene, OR, 97403, USA
| | - Lindsey M Nichols
- Department of Counseling Psychology and Human Services, University of Oregon, 5251 University of Oregon, Eugene, OR, 97403, USA
| | - Emily E Tanner-Smith
- Department of Counseling Psychology and Human Services, University of Oregon, 5251 University of Oregon, Eugene, OR, 97403, USA
- Prevention Science Institute, University of Oregon, Eugene, USA
- HEDCO Institute for Evidence-Based Educational Practice, University of Oregon, Eugene, USA
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Berny LM, Tanner-Smith EE. Interpersonal violence and suicide risk: Examining buffering effects of school and community connectedness. CHILDREN AND YOUTH SERVICES REVIEW 2024; 157:107405. [PMID: 38371909 PMCID: PMC10871710 DOI: 10.1016/j.childyouth.2023.107405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Exposure to interpersonal violence is associated with elevated suicide risk. Preventing suicide among high-risk adolescents is most often discussed from a clinical treatment perspective, resulting in a gap in research examining whether school and community connectedness can buffer the relationships between forms of interpersonal violence and suicide risk in clinical samples of adolescents. Methods Baseline data from 294 adolescents who received substance use treatment were analyzed to help fill this gap in research. Adolescents in this sample were at greater risk for suicidal thoughts and behaviors given their histories of substance use disorders and high rates of interpersonal violence, with 57% reporting experiencing at least one form of abuse/violence. Independent variables included lifetime exposure to physical abuse, sexual abuse, and weapon violence; moderators included various measures of school and community connectedness. Multinomial logistic regression models were estimated to examine the main and interaction effects predicting a three-category measure of suicide risk: non-suicidal, suicidal ideation only, and prior suicide attempts. Results Sexual abuse survivors had the highest predicted probability of a prior suicide attempt when reporting lower levels of teacher support, school-based positive peer interactions, or neighborhood social connection, but at higher levels of these protective factors, their predicted probability was similar to those not exposed to sexual abuse. The same protective pattern was observed for physical abuse survivors with high neighborhood social connection. Conclusion The buffering effects observed in this study identified dimensions of school and community social connectedness as protective factors for youth exposed to abuse. Although promoting social connectedness is often cited as a universal suicide prevention approach, tailored efforts to enhance connectedness within this population may also be a promising secondary prevention strategy. Thus, in addition to clinical treatment, more emphasis should be placed on systems-level approaches to reducing risk among youth most vulnerable to suicide.
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Affiliation(s)
- Lauren M. Berny
- University of Oregon, Department of Counseling Psychology and Human Services, USA
- University of Oregon, Prevention Science Institute, USA
| | - Emily E. Tanner-Smith
- University of Oregon, Department of Counseling Psychology and Human Services, USA
- University of Oregon, Prevention Science Institute, USA
- University of Oregon, HEDCO Institute for Evidence-Based Educational Practice, USA
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Powell D. Growth in Suicide Rates Among Children During the Illicit Opioid Crisis. Demography 2023; 60:1843-1875. [PMID: 38009202 DOI: 10.1215/00703370-11077660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
This article documents child suicide rates from 1980 to 2020 in the United States using the National Vital Statistics System Multiple Cause of Death database. After generally declining for decades, suicide rates among children aged 10-17 accelerated from 2011 to 2018 in an unprecedented rise in both duration and magnitude. I consider the role of the illicit opioid crisis in driving this mental health crisis. In August 2010, an abuse-deterrent version of OxyContin was introduced and the original formulation was removed from the market, leading to a shift to illicit opioids and stimulating growth in illicit opioid markets. Areas more exposed to reformulation-as measured by pre-reformulation rates of OxyContin misuse in the National Survey on Drug Use and Health-were more affected by the transition to illicit opioids and experienced sharper growth in child suicide rates. The evidence suggests that children's illicit opioid use did not increase, implying that the illicit opioid crisis engendered higher suicide propensities by increasing suicidal risk factors for children, such as increasing rates of child neglect and altering household living arrangements. In complementary analyses, I document how living conditions declined for children during this time period.
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Dykxhoorn J, Hayes J, Ashok K, Sörberg Wallin A, Dalman C. Objective and subjective neighbourhood characteristics and suicidality: a multilevel analysis. Psychol Med 2023; 53:1166-1175. [PMID: 34231453 PMCID: PMC7614302 DOI: 10.1017/s0033291721002579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Characteristics of the neighbourhood environment, including population density, social fragmentation, and trust, have been linked to mental health outcomes. Using a longitudinal population-based cohort, we explored the relationship between objective and subjective neighbourhood characteristics and the odds of suicidal thoughts and attempts. METHODS We conducted a longitudinal study of 20764 participants living in Stockholm County who participated in the Stockholm Public Health Survey. We used multilevel modelling to examine if suicidal thoughts and attempts were associated with neighbourhood characteristics, independent of individual associations. We included objective and subjective measures to explore if there was a different relationship between these measures of the neighbourhood environment and suicidality. RESULTS Associations between neighbourhood factors and suicidality were predominantly explained by individual characteristics, with the exception of neighbourhood-level deprivation and average residential trust. Each unit increase of deprivation was linked to increased odds of suicidal thoughts [Odds ratio (OR) 1.04, 95% confidence interval (CI) 1.00-1.07] and attempts (OR 1.11, 95% CI 1.06-1.17). Decreasing residential trust was associated with increased odds of suicide attempts (OR 1.09, 95% CI 1.02-1.17). There was no evidence that neighbourhood-level fragmentation or average trust in public and political institutions had an independent effect on suicidality once individual and sociodemographic factors were accounted for. CONCLUSIONS This study showed that much of the neighbourhood-level variation in suicidal thoughts and attempts could be explained by compositional factors, including sociodemographic clustering within neighbourhoods. The independent effect of neighbourhood-level deprivation and average residential trust provide evidence that the neighbourhood context may exert an independent effect on suicidality beyond the impact of individual characteristics.
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Affiliation(s)
- Jennifer Dykxhoorn
- Division of Psychiatry, UCL, London, UK
- Department of Primary Care and Population Health, UCL, London, UK
| | | | | | | | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
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Jakobsen AL, Lund RL. Neighborhood social context and suicide mortality: A multilevel register-based 5-year follow-up study of 2.7 million individuals. Soc Sci Med 2022; 311:115320. [PMID: 36081301 DOI: 10.1016/j.socscimed.2022.115320] [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: 03/05/2022] [Revised: 06/10/2022] [Accepted: 08/25/2022] [Indexed: 11/20/2022]
Abstract
Previous studies have linked neighborhood social characteristics to suicide mortality. However, the effects of the operational definition of neighborhoods and the general importance of neighborhood context on suicide mortality have received little attention, with most studies using various administrative areas as neighborhood delineations. In this study, neighborhoods were delineated by micro-areas generated with an automated redistricting algorithm and divided by physical barriers, such as large roads. The geographic data were linked to register data on the Danish adult population in the age range of 20-59 years in December 2013 (N = 2,672,799 individuals nested into 7943 neighborhoods). This cohort was followed for five years to evaluate the association between suicide mortality and neighborhood socioeconomic deprivation, social fragmentation, and population density. We used the median hazard ratio (MHR) to quantify the general contextual effect (GCE) of neighborhoods on suicide mortality and hazard ratios to quantify the specific contextual effects (SCEs) using multilevel survival models stratified by age group. The results showed a larger GCE and larger SCEs of neighborhoods on suicide mortality for individuals aged 20-39 years compared with those aged 40-59 years. After controlling for individual characteristics, higher suicide mortality was observed for individuals living in the least densely populated neighborhoods and the most socially fragmented neighborhoods for both age groups. We found cross-level interactions between neighborhood population density and gender and ethnicity for those aged 40-59 years, as well as between neighborhood social fragmentation and ethnicity for those aged 20-39 years. The results indicate that beyond individual characteristics, the neighborhood social context may affect the risk of suicide, especially for people aged 20-39 years.
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Affiliation(s)
| | - Rolf Lyneborg Lund
- Department of Sociology and Social Work, Aalborg University, Fibigerstræde 13, 9220, Aalborg, Denmark
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Lambert SF, Boyd RC, Ialongo NS. Protective factors for suicidal ideation among Black adolescents indirectly exposed to community violence. Suicide Life Threat Behav 2022; 52:478-489. [PMID: 35150017 DOI: 10.1111/sltb.12839] [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: 07/01/2021] [Revised: 10/25/2021] [Accepted: 11/12/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Community violence exposure has been identified as a risk factor for Black youth suicide ideation. However, little is known about factors that protect community violence exposed youth against suicide ideation. The current study examined associations between knowledge of family member and peers' community violence exposure and Black youth's subsequent suicidal ideation, and investigated self-worth and social support as protective factors. METHOD Participants were a community sample of Black youth (N = 447, 47.4% female; Mage = 11.77, SD = 0.35) who reported about community violence exposure, self-worth, social support, and suicide ideation in grades 6 and 7. RESULTS Regression analyses revealed that grade 6 knowledge of family member and peers' community violence exposure was associated with increases in suicide ideation assessed in grade 7. Self-worth attenuated the association between knowledge of others' community violence exposure and suicide ideation for male adolescents. For female adolescents, social support attenuated the association between knowledge of others' community violence and suicide ideation. CONCLUSIONS Findings highlight the consequential impact of knowledge about community violence for Black youth's suicidal ideation. Enhancing protective factors for Black youth is an important target for intervening with exposure to violence and reducing suicide ideation.
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Affiliation(s)
- Sharon F Lambert
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia, USA
| | - Rhonda C Boyd
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nicholas S Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Chen PJ, Mackes N, Sacchi C, Lawrence AJ, Ma X, Pollard R, Matter M, Morgan C, Harding S, Schumann G, Pariante C, Mehta MA, Montana G, Nosarti C, Dazzan P. Parental education and youth suicidal behaviours: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2022; 31:e19. [PMID: 35352676 PMCID: PMC8967699 DOI: 10.1017/s204579602200004x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
AIMS Lower parental education has been linked to adverse youth mental health outcomes. However, the relationship between parental education and youth suicidal behaviours remains unclear. We explored the association between parental education and youth suicidal ideation and attempts, and examined whether sociocultural contexts moderate such associations. METHODS We conducted a systematic review and meta-analysis with a systematic literature search in PubMed, PsycINFO, Medline and Embase from 1900 to December 2020 for studies with participants aged 0-18, and provided quantitative data on the association between parental education and youth suicidal ideation and attempts (death included). Only articles published in English in peer-reviewed journals were considered. Two authors independently assessed eligibility of the articles. One author extracted data [e.g. number of cases and non-cases in each parental education level, effect sizes in forms of odds ratios (ORs) or beta coefficients]. We then calculated pooled ORs using a random-effects model and used moderator analysis to investigate heterogeneity. RESULTS We included a total of 59 articles (63 study samples, totalling 2 738 374 subjects) in the meta-analysis. Lower parental education was associated with youth suicidal attempts [OR = 1.12, 95% Confidence Interval (CI) = 1.04-1.21] but not with suicidal ideation (OR = 1.05, 95% CI = 0.98-1.12). Geographical region and country income level moderated the associations. Lower parental education was associated with an increased risk of youth suicidal attempts in Northern America (OR = 1.26, 95% CI = 1.10-1.45), but with a decreased risk in Eastern and South-Eastern Asia (OR = 0.72, 95% CI = 0.54-0.96). An association of lower parental education and increased risk of youth suicidal ideation was present in high- income countries (HICs) (OR = 1.14, 95% CI = 1.05-1.25), and absent in low- and middle-income countries (LMICs) (OR = 0.91, 95% CI = 0.77-1.08). CONCLUSIONS The association between youth suicidal behaviours and parental education seems to differ across geographical and economical contexts, suggesting that cultural, psychosocial or biological factors may play a role in explaining this association. Although there was high heterogeneity in the studies reviewed, this evidence suggests that the role of familial sociodemographic characteristics in youth suicidality may not be universal. This highlights the need to consider cultural, as well as familial factors in the clinical assessment and management of youth's suicidal behaviours in our increasingly multicultural societies, as well as in developing prevention and intervention strategies for youth suicide.
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Affiliation(s)
- P. J. Chen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Department of Psychiatry, Chang Gung Memorial Hospital at Taoyuan and Chang Gung University, Taoyuan, Taiwan
| | - N. Mackes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - C. Sacchi
- Department of Developmental Psychology and Socialisation, University of Padova, Padua, Italy
| | - A. J. Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - X. Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - R. Pollard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - M. Matter
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - C. Morgan
- Health Service & Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - S. Harding
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - G. Schumann
- Biological Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C. Pariante
- Biological Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M. A. Mehta
- Department of Neuroimaging & Psychopharmacology, Centre of Neuroimaging Sciences, King's College London, London, UK
| | - G. Montana
- Department of Data Science, University of Warwick, Coventry, UK
| | - C. Nosarti
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Centre for the Developing Brain, Department of Perinatal Imaging & Health, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - P. Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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Berny LM, Tanner-Smith EE. Differential Predictors of Suicidal Ideation and Suicide Attempts: Internalizing Disorders and Substance Use in a Clinical Sample of Adolescents. J Dual Diagn 2022; 18:59-69. [PMID: 34982653 PMCID: PMC8960344 DOI: 10.1080/15504263.2021.2016343] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: Dually diagnosed adolescents are a high-risk population for experiencing suicidal thoughts and behavior. Given that research suggests risk factors for suicidal ideation and suicide attempts may be different, this study examined whether internalizing disorder severity, frequency of substance use, and the interaction between them differentiated adolescents who attempted suicide from those who ideated. Methods: Baseline data from 287 adolescents who received formal substance use disorder (SUD) treatment were used in this analysis. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) severity as well as past-3 month use of alcohol, cannabis, and other illicit drugs were considered. The outcome of interest was a three-category measure of suicide risk: no reported suicidal ideation or attempts, suicidal ideation only, and suicide attempts. Results: Over half of the sample disclosed prior suicidal ideation (30.0%) or attempts (27.9%). Multinomial logistic regression models indicated more severe MDD and GAD symptomology differentiated ideators from non-suicidal adolescents, but internalizing disorder severity did not differ between ideators and attempters. Substance use frequency did not differ between suicide risk groups. MDD severity and frequency of alcohol use interacted to increase the risk of attempts, yet the effects were minimal. Instead, prior weapon violence victimization and sexual abuse were the largest differentiators between attempters and ideators. Conclusions: Findings suggest that internalizing disorder severity and prior traumatic experiences put adolescents with SUD histories at higher risk of suicidal thoughts and behaviors. Thus, integrating evidence-based suicide prevention and intervention efforts into SUD treatment is critical, particularly for dually diagnosed adolescents who meet these risk profiles. Psychotherapy and medication may help curtail the development of ideation by reducing symptoms of MDD and GAD, whereas adolescents with prior traumatic experiences may benefit from additional treatments shown to lower risk of suicide attempts.
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Affiliation(s)
- Lauren M Berny
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, USA
| | - Emily E Tanner-Smith
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, USA.,Prevention Science Institute, University of Oregon, Eugene, OR, USA
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Lee JH. Relationships between neighborhood collective efficacy and adolescent suicidal ideation. J Adolesc 2021; 93:10-19. [PMID: 34626886 DOI: 10.1016/j.adolescence.2021.09.009] [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: 02/07/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Until now, South Korean adolescent suicidal ideation literature has focused mainly on individual-level characteristics. Little is known about the contextual effects of social integration and social regulation on an individual's suicide behavior in South Korea as identified through the use of Durkheim's sociological insights. This study drew on Durkheim's suicide and collective efficacy theories and analyzed the effects of the structural characteristics and collective efficacy of neighborhoods on adolescents' suicidal ideation. METHODS The data analyzed was from three sources: the 2013 Korean National Survey of the Present Status of Children (n = 1,915; 50.41% girls; mean age = 13.04 years), government census data from the Korea Statistical Information System, and administrative data from the Korea Ministry of Health and Welfare. The Hierarchical Generalized Linear Model was used to investigate the effects of neighborhood structural characteristics and collective efficacy on adolescent suicidal ideation. RESULTS There were no significant associations between neighborhood characteristics such as concentrated poverty, divorce rate, and residential instability; however, adoles cents' perceptions of collective efficacy in neighborhoods was associated with lower suicidal ideation after accounting for individual adolescent differences. CONCLUSION The findings provide significant implications for the prevention of suicide in adolescents and suggest that enhancing the collective efficacy of neighborhoods through community-based intervention may be an important target of future suicide prevention strategies in South Korea.
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Affiliation(s)
- Ji Hyeon Lee
- Department of Christianity and Culture-Social Welfare, Presbyterian University and Theological Seminary, Gwangjang-ro(st) 5-gil(rd), Gwangjin-gu, Seoul, 04965, South Korea.
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Sakai-Bizmark R, Kumamaru H, Estevez D, Marr EH, Haghnazarian E, Bedel LEM, Mena LA, Kaplan MS. Health-Care Utilization Due to Suicide Attempts Among Homeless Youth in New York State. Am J Epidemiol 2021; 190:1582-1591. [PMID: 33576370 PMCID: PMC8484771 DOI: 10.1093/aje/kwab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022] Open
Abstract
Suicide remains the leading cause of death among homeless youth. We assessed differences in health-care utilization between homeless and nonhomeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009-2014) were used to identify homeless and nonhomeless youth aged 10-17 who utilized health-care services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models adjusted for individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with health-care utilization rates of 347.2 (95% confidence interval (CI): 317.5, 377.0) and 67.3 (95% CI: 66.3, 68.3) per 100,000 person-years for homeless and nonhomeless youth, respectively. Length of stay for homeless youth was statistically longer than that for nonhomeless youth (incidence rate ratio = 1.53, 95% CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with nonhomeless youth. Interventions tailored to homeless youth should be developed.
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Affiliation(s)
- Rie Sakai-Bizmark
- Correspondence to Dr. Rie Sakai-Bizmark, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Torrance Street, Torrance, CA 90502 (e-mail: )
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14
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Martin-Storey A, Bizier-Lacroix R, Temcheff C, Déry M. Understanding Youth Perceptions of Neighborhood Disorder: The Role of Conduct Problems. J Youth Adolesc 2021; 50:952-964. [PMID: 33745075 DOI: 10.1007/s10964-021-01418-y] [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: 12/22/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
While research addresses neighborhood disorder as leading to conduct problems, the role of individual-level differences in shaping adolescent perceptions of neighborhood has been overlooked. Data on youth, over-selected for childhood conduct problems (N = 744, 58% childhood conduct problems, 47% girls), were used to examine the link between conduct problems (time 1: Mean age = 12.23) and perceived neighborhood disorder (time 3: M = 14.30). The mediating role of delinquent friends, peer victimization, depressive symptoms, and observer-rated neighborhood disorder (time 2: M = 13.23) were also tested. Conduct problems were associated with higher levels of perceived neighborhood disorder, via delinquent peers and peer victimization. These findings offer new insight into the consequences of perceived neighborhood disorder for health and wellbeing.
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Affiliation(s)
- Alexa Martin-Storey
- Département de Psychoéducation, Université de Sherbrooke, 150 Place Charles LeMoyne, Longueuil, QC, J4K0A8, Canada.
| | - Roxanne Bizier-Lacroix
- Département de Psychoéducation, Université de Sherbrooke, 2500 Boul. de L'Université, Sherbrooke, QC, J1K 2R1, Canada
| | - Caroline Temcheff
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Montreal, QC, H3A 1Y2, Canada
| | - Michèle Déry
- Département de Psychoéducation, Université de Sherbrooke, 2500 Boul. de L'Université, Sherbrooke, QC, J1K 2R1, Canada
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Drescher CF, Griffin JA, Casanova T, Kassing F, Wood E, Brands S, Stepleman LM. Associations of physical and sexual violence victimisation, homelessness, and perceptions of safety with suicidality in a community sample of transgender individuals. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2019.1690032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - James A. Griffin
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, USA
| | - Tracy Casanova
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, USA
| | - Francesca Kassing
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, USA
| | - Elizabeth Wood
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, USA
| | - Susan Brands
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, USA
| | - Lara M. Stepleman
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, USA
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Song J, Park S, Lee K, Hong HJ. Influence of Area-Level Characteristics on the Suicide Rate in Korean Adolescents. Psychiatry Investig 2019; 16:800-807. [PMID: 31693841 PMCID: PMC6877454 DOI: 10.30773/pi.2019.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to investigate the influence of area-level factors on adolescent suicide and to determine which variables differ according to age and sex. METHODS We selected variables that were available for collection through an online database from 2005 to 2015 in the Korean Statistical Information Service and the Korea Labor Institute. We used administrative districts of Korea in 2017 for geographical classification. We examined the relationships between regional suicide rates and area-level variables in male and female subjects aged 10-14 years and 15-19 years. In addition, we analyzed area-level variables in adolescents aged 15-19 years according to sex. RESULTS Our findings indicated that several area-level variables affected adolescent suicide rates, varying according to age and sex. Economic problems were shown to be more associated with suicide in male adolescents than in female adolescents. On the other hand, social fragmentation and health services were shown to be more associated with suicide in females. CONCLUSION Suicide in adolescents was attributable to area-level factors such as economic status, social fragmentation, and community health services. By identifying area-level variables affecting adolescent suicide rates, we will be able to contribute to implement mental health policies related to adolescent suicide.
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Affiliation(s)
- Jungeun Song
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Seongjun Park
- Department of Social Welfare, University of Seoul, Seoul, Republic of Korea
| | - Kangwoo Lee
- Suicide and School Mental Health Institute, Anyang, Republic of Korea
| | - Hyun Ju Hong
- Suicide and School Mental Health Institute, Anyang, Republic of Korea.,Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
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Goldman-Mellor S, Kwan K, Boyajian J, Gruenewald P, Brown P, Wiebe D, Cerdá M. Predictors of self-harm emergency department visits in adolescents: A statewide longitudinal study. Gen Hosp Psychiatry 2019; 56:28-35. [PMID: 30553125 PMCID: PMC6353680 DOI: 10.1016/j.genhosppsych.2018.12.004] [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] [Received: 09/19/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study investigated patient- and area-level characteristics associated with adolescent emergency department (ED) patients' risk of subsequent ED visits for self-harm. METHOD Retrospective analysis of adolescent patients presenting to a California ED in 2010 (n = 480,706) was conducted using statewide, all-payer, individually linkable administrative data. We examined associations between multiple predictors of interest (patient sociodemographic factors, prior ED utilization, and residential mobility; and area-level characteristics) and odds of a self-harm ED visit in 2010. Patients with any self-harm in 2010 were followed up over several years to assess predictors of recurrent self-harm. RESULTS Self-harm patients (n = 5539) were significantly more likely than control patients (n = 16,617) to have prior histories of ED utilization, particularly for mental health problems, substance abuse, and injuries. Residential mobility also increased risk of self-harm, but racial/ethnic minority status and residence in a disadvantaged zipcode decreased risk. Five-year cumulative incidence of recurrent self-harm was 19.3%. Admission as an inpatient at index visit, Medicaid insurance, and prior ED utilization for psychiatric problems or injury all increased recurrent self-harm risk. CONCLUSIONS A range of patient- and area-level characteristics observable in ED settings are associated with risk for subsequent self-harm among adolescents, suggesting new targets for intervention in this clinical context.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Kevin Kwan
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Jonathan Boyajian
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA 94612, USA.
| | - Paul Brown
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Deborah Wiebe
- Department of Psychology, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Magdalena Cerdá
- Violence Prevention Research Program, University of California, Davis, Sacramento, CA 95817, USA.
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Yildiz M, Demirhan E, Gurbuz S. Contextual Socioeconomic Disadvantage and Adolescent Suicide Attempts: A Multilevel Investigation. J Youth Adolesc 2018; 48:802-814. [PMID: 30499039 DOI: 10.1007/s10964-018-0961-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/10/2018] [Indexed: 11/26/2022]
Abstract
Multilevel research on whether and how contextual socioeconomic disadvantage affects adolescent suicidal behaviors is scarce. Using data from the first two waves (1994/95 and 1996) of the National Longitudinal Study of Adolescent to Adult Health (N = 13,335; 49.63% girls; Mage = 15.02 years), this study examined (1) the association between area-level socioeconomic disadvantage and adolescent suicide attempts over and above individual-level socioeconomic factors, (2) the moderating role of gender, and (3) the mediating roles of contextually relevant stressors and available psychosocial resources. The results revealed that area-level socioeconomic disadvantage increased the risk of attempting suicide even after adjusting for individual-level socioeconomic status, especially for boys. Consistent with the stress process perspective, reports of exposure to violence and lack of safety explain this contextual effect. National suicidal behavior prevention strategies across the U.S. should recognize the strong association with the socioeconomic context, along with individual-level risk factors.
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Affiliation(s)
- Muhammed Yildiz
- Department of Sociology, Louisiana State University, 126 Stubbs Hall, Baton Rouge, LA, 70803, USA.
| | - Emirhan Demirhan
- Department of Sociology, University of North Texas, 288 Sycamore Hall, Denton, TX, 76203, USA
| | - Suheyl Gurbuz
- Department of Sociology, Midwestern State University, 3410 Taft Blvd., Wichita Falls, TX, 76308, USA
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