Exploring risk factors and their differences on suicidal ideation and suicide attempts among depressed adolescents based on decision tree model

BACKGROUND

Suicide has been recognized as a major global public health issue. Depressed adolescents are more prone to experiencing it. We explore risk factors and their differences on suicidal ideation and suicide attempts to further enhance our understanding of suicidal behavior.

METHODS

2343 depressed adolescents aged 12-18 from 9 provinces/cities in China participated in this cross-sectional study. We utilized decision tree model, incorporating 32 factors encompassing participants' suicidal behavior. The feature importance of each factor was measured using Gini coefficients.

RESULTS

The decision tree model demonstrated a good fit with high accuracy (SI = 0.86, SA = 0.85 and F-Score (SI = 0.85, SA = 0.83). The predictive importance of each factor varied between groups with suicidal ideation and with suicide attempts. The most significant risk factor in both groups was depression (SI = 16.7 %, SA = 19.8 %). However, factors such as academic stress (SI = 7.2 %, SA = 1.6 %), hopelessness (SI = 9.1 %, SA = 5.0 %), and age (SI = 7.1 %, SA = 3.2 %) were more closely associated with suicidal ideation than suicide attempts. Factors related to the schooling status (SI = 3.5 %, SA = 10.1 %), total years of education (SI = 2.6 %, SA = 8.6 %), and loneliness (SI = 2.3 %, SA = 7.4 %) were relatively more important in the suicide attempt stage compared to suicidal ideation.

LIMITATIONS

The cross-sectional design limited the ability to capture changes in suicidal behavior among depressed adolescents over time. Possible bias may exist in the measurement of suicidal ideation.

CONCLUSION

The relative importance of each risk factor for suicidal ideation and attempted suicide varies. These findings provide further empirical evidence for understanding suicide behavior. Targeted treatment measures should be taken for different stages of suicide in clinical interventions.

Suicidal behaviour and ideation among adolescents during the COVID-19 pandemic

Adolescence is a period of elevated risk for suicide, and mental health professionals expressed concerns that suicidal behaviours and suicide rates may increase among this age group during the COVID-19 pandemic. Adolescent suicide rates, attempts, and ideation during the pandemic varied depending on the country, data collection methodology, and population (e.g., general population vs. emergency department). Many pre-pandemic risk factors for suicidal behaviour or ideation were identified as risk factors during the pandemic; however, there was also some evidence that certain groups were disproportionately at risk, such as girls, and adolescents identifying as Black, Asian, American Indian/Alaska Native, or Asian/Pacific Islander. Given the trend of increased adolescent suicide in many countries over the past two decades, there is an ongoing need to direct resources toward prevention programs, screening, and evidence-based interventions for suicide risk.

Parental role and peer support in adolescent suicidal behavior in eight South-East Asian countries

BACKGROUND

This study aimed to estimate the prevalence of suicidal behaviors, i.e. suicidal ideation (SI), suicidal plan (SP), and suicidal attempt (SA) among adolescents with a focus on parental and peer support in eight South-East Asian countries including Bangladesh, Bhutan, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand.

METHOD

Data were drawn from Global School-based Student Health Survey (GSHS) covering 42,888 adolescents aged 11-17 years. Weighted prevalence of SI, SP, and SA along with country specific prevalence was computed and binary logistic regression was used to identify associated risk factors.

RESULTS

Among 42,888 adolescents 19,113 (44.9 %) were males and 23,441 (55.1 %) females. Overall prevalence of SI, SP and SA is 9.10 %, 10.42 % and 8.54 %, respectively. Myanmar demonstrated the lowest SI (1.07 %) and SP (0.18 %) whereas lowest SA was found in Indonesia (3.79 %). Maldives had the highest prevalence of SI, SP and SA which were 14.13 %, 19.02 % and 13.38 % respectively. Overall suicidal behaviors were associated with being female [AOR:SI-1.26(1.06,1.50), SP-1.34(1.14,1.57),], high levels of sedentary behavior [AOR:SI-2.08(1.62,2.66), SP-1.86(1.49,2.32), SA-1.96(1.45,2.64)], involvement in physical fighting [AOR:SI-1.30(1.07,1.58), SP-1.37(1.14,1.65), SA-1.50(1.17,1.90)], being seriously injured [AOR:SI-1.40(1.17,1.67), SP-1.44(1.22,1.69), SA-1.74(1.39,2.17)], being bullied [AOR:SI- 1.68(1.39,2.02), SP-1.34(1.12,1.60), SA-1.88(1.50,2.36)], feeling lonely(most of time or always) [AOR:SI-3.41(2.60,4.46), SP-1.92(1.48,2.47), SA-2.25(1.62,3.13)], lack of parental support(never checking homework) [AOR:SI-1.59(1.25,2.02), SP-1.52(1.22,1.90)] and not having close friends [AOR:SI-2.19(1.66,2.89), SP-2.26(1.74,2.94), SA-4.23(3.10,5.78)].

CONCLUSION

Though prevalence of suicidal behaviors varies, a range of cross-cutting risk factors exists that warrant further examination. We recommend focusing on strengthening parental and peer support, targeted programs addressing physical activity, bullying, loneliness and mental-health of adolescents.

Prevalence and factors associated with loneliness among Indonesian female adolescents: a cross-sectional study

Background

Loneliness, or the perception of social disconnectedness, is a public health concern and is reported to be a frequent experience during adolescence (10–19 years). This study investigates the prevalence of loneliness and associated health-risk behaviors among Indonesian female adolescents.

Methods

This was a cross-sectional study, data for which were extracted from the WHO’s Global School-based Student Health Survey (GSHS), which uses a globally standardized cross-sectional methodology to provide accurate data on behaviors and protective factors among students. Data from 4993 female students aged 13–17 years old from 74 schools were extracted from the 2015 survey in Indonesia and analyzed. Loneliness was used as a single measure, as happens in other studies using GSHS data. Descriptive analysis was done for age, socioemotional issues, health-risk behaviors, and contextual factors. This was followed by multiple logistic regression analysis to identify loneliness-associated factors.

Results

Approximately 6.5% of Indonesian female adolescents experience loneliness most of the time or always. Adolescents experiencing loneliness had a higher rate of sleep disturbance (37.6%), suicide ideation (21%), suicide plan (20.8%), smoking behavior (15%), and alcohol use (15.7%) than the general population. Multiple regression analysis confirms that adolescents who have no close friends, have been bullied during the past month, experience sleep disturbance, have had suicide ideation and suicide plans, are always feeling hungry, are exposed to passive smoking, and are engaged in a sedentary lifestyle are at a higher likelihood of suffering from loneliness (p < 0.05). On the other hand, having kind and helpful classmates served as a useful protection against loneliness (p < 0.05).

Conclusions

The rate of loneliness in Indonesian female adolescents is relatively lower than previously reported elsewhere. Several health-risk behaviors and contextual factors are associated with loneliness. It is important to gain insight into the exact interplay between factors and loneliness since that could inform future intervention development and lead to better well-being among female adolescents.

Transition from Depression to Suicidal Attempt in Young Adults: The Mediation Effect of Self-Esteem and Interpersonal Needs

BACKGROUND

Depression increases the risk of suicide. Depression and suicide attempts are significantly impacted by low self-esteem and interpersonal needs (i.e., thwarted belongingness (TB) and perceived burdensomeness (PB)). More research is required to clarify how these factors affected the change from depression to suicidal attempts, which would dramatically lower the suicide fatality rate. We sought to examine the mediating roles of self-esteem, TB, and PB in Chinese young adults, since previous research shows that self-esteem has a strong relationship with TB, while TB and PB have strong relationships with suicide attempts.

METHODS

Measures on depression, interpersonal needs, and attempted suicide were completed by a sample of 247 Chinese social media users who had stated suicidal ideation online.

RESULTS

The findings showed that people who attempted suicide had significantly higher levels of TB and PB. Suicidal attempts were also impacted by depression via the mediational chains, which included self-esteem, TB, and PB.

CONCLUSIONS

Our findings might contribute to the expansion of the interpersonal theory of suicide and have an impact on effective suicide prevention.

Adolescent perspectives on depression as a disease of loneliness: a qualitative study with youth and other stakeholders in urban Nepal

BACKGROUND

There is a lack of research on the adolescent experience of depression in low- and middle-income countries. Criteria derived from research conducted primarily among adult Western populations inform current diagnostic standards for depression. These clinical categories are often used without exploration of their relevance to adolescent experience. Also, reliance on these categories may overlook other symptoms of depression that manifest in non-western settings. Cross-cultural qualitative work with adults in non-Western settings has suggested some differences with experience of depression and symptoms that are most relevant to service users. Research into adolescent experiences of depression is warranted to inform the development of effective interventions.

METHODS

Qualitative interviews were conducted in Nepal with adolescents with depressive symptoms (n = 9), healthy adolescents (n = 3), parents (n = 6), teachers (n = 10), social workers (n = 14), primary (n = 6) and mental (n = 6) healthcare providers, and policymakers (n = 6). Two focus groups were conducted with parents (n = 12) of depressed and non-depressed adolescents. Data were analyzed according to the framework approach methodology.

RESULTS

Loneliness was the hallmark experience that stood out for all adolescents. This was connected with 5 other clusters of symptoms: low mood and anhedonia; disturbances in sleep and appetite, accompanied by fatigue; irritability and anger; negative self-appraisals including hopelessness and self-doubt; and suicidality. Adolescents distinguished depression from other forms of stress, locally referred to as tension, and described depression to involve having "deep tension." Perceived causes of depression included (1) Family issues: neglectful or absent parents, relationship problems, and family discord; (2) Peer relationships: romantic problems, bullying, and friendship problems; and (3) Social media: social comparison, popularity metrics, cyberbullying, and leaking of personal information.

CONCLUSIONS

Consistent with other cross-cultural studies, loneliness was a core element of the adolescent experience of depression, despite its absence as a primary symptom in current psychiatric diagnostic classifications. It is important to note that among youth, symptoms were clustered together and interrelated (e.g., sleep and appetite changes were connected with fatigue). This calls for the need for more cross-cultural qualitative research on experience of depression among adolescents, and potential for modification of diagnostic criteria and prevention and treatments to focus on the experience of loneliness.

Hopelessness and shame in relation to suicide attempts by Cuban adolescents

Youth suicide rates in Cuba are very high compared with most other countries, despite considerable improvement in recent years. The purpose of our study was to determine whether hopelessness and shame distinguish adolescent suicide attempters from non-attempters, over and above the effects of depression and suicidal ideation. Participants were 844 Cuban adolescents from the province of Holguin in Eastern Cuba. The attempter groups included 38 participants being treated for suicide attempts in a day hospital and 82 participants in the community who self-reported a previous suicide attempt. The other participants were non-attempter controls. All participants were asked to complete measures of depression, hopelessness, shame and suicidal ideation. As expected, attempters scored higher than non-attempters on the control variables of depression and suicidal ideation. In addition, attempters self-reported greater shame, especially behavioral and characterological shame, than non-attempters. Contrary to our hypothesis, there was no significant difference in hopelessness between attempters and non-attempters. The results are inconsistent with the considerable narrative lore about hopelessness as a reason for suicide in Cuba and other socialist countries. However, some collective socialization practices may lead to shame.

Low Perceived Social Rank Increases the Impact of Mental Health Symptoms on Suicidal Ideation: Evidence among Young Adults from the Philippines

Studies on social factors that could influence the mental health-suicidal ideation link remain scarce, especially in non-Western contexts. This study examined the relationship between mental health symptoms (i.e., depression, anxiety, and stress) and suicidal ideation and whether one's perceived social rank moderates such a relationship. Data from 631 students from two universities in the Philippines collected between October to December 2018 was analyzed. Bivariate correlations show that greater symptoms of depression, anxiety, and stress are associated with increased suicidal ideation. Hierarchical linear regression models supported the direct relationship between mental health symptoms and suicidal ideation and demonstrated that perceived social rank significantly moderated such a relationship. Johnson-Neyman plots and simple slopes analyses further illustrate how mental health symptoms and perceived social rank interact to impact suicidal ideation. The results show that as one's perceived social rank lowers, the strength of the positive association between depression, anxiety, and stress symptoms to suicidal ideation strengthens. The results held while controlling for age, gender, college year level, and family income. The findings are discussed using the social rank theory and the Integrated Motivational-Volitional (IMV) model of suicide to view suicidal ideation from both an individual and a social perspective. We expound on the role of low perceived social rank on suicidal ideation among young adults.HIGHLIGHTSHigher depression, anxiety, and stress symptoms are associated with higher suicidal ideation.Perceived social rank moderates the link between mental health symptoms and suicidal ideation.One's perception of being inferior to others can exacerbate suicidal ideation.

Suicidal ideation and suicide attempt among Indonesian adolescent students

Suicide among young people is growing as a public health threat worldwide. With a paucity of studies on this issue in Indonesia, this study aimed to identify factors associated with suicidal behaviors (suicidal ideation and suicide attempt) among Indonesian adolescents. This was a cross-sectional study using secondary data analysis from the Global School-based Student Health Survey (GSHS) of Indonesia in 2015. The samples were 8634 school-going adolescents aged 13-18 years old. The data analysis consisted of univariate, bivariate and multivariate analysis. The chi-square (χ2) test was employed to identify proportion differences of suicidal behaviors by independent variables whereas multiple logistic regression was used to develop models for factors associated with suicidal ideation and suicide attempt. This study found that 4.75% and 2.46% reported for having suicidal ideation and suicide attempt in the last 12 months, respectively. The effects of intrapersonal factors (sex, age, loneliness, anxiety, current use of tobacco and alcohol) and interpersonal factors (physically attacked, bullying victimization, having no close friends, parental understanding and having sexual intercourse) varied by suicidal behavior and sex. Therefore, developing comprehensive approaches for prevention of mental health problems, including suicidal behaviors in the school setting is essential by asking for a collaboration of schools, parents, public health centers (PHCs), related stakeholders and non-governmental organizations (NGOs).

Suicidal ideation, suicidal behaviors, and attitudes towards suicide of adolescents enrolled in the Alternative Learning System in Manila, Philippines-a mixed methods study

BACKGROUND

Globally, suicide is a significant cause of death among adolescents. Previous studies conducted in high-income countries suggest that students in alternative schools are more likely to engage in suicidal behaviors than those in formal schools. This study aimed to document suicidal ideation and behaviors among adolescent learners enrolled in the Alternative Learning System (ALS) in Manila, Philippines.

METHODS

A mixed methods study was conducted in 24 ALS centers in the city of Manila. ALS centers were stratified according to congressional district and selected using probability proportionate sampling. A cross-sectional survey to determine attitudes towards suicide and prevalence of suicidal ideation and behaviors was administered to 171 learners aged 13 to 17 years old. In-depth interviews with 18 teachers and 12 learners were conducted to explore the school psychosocial environment's role on learners' suicidal ideation and behaviors. Exploratory factor analysis was used to extract attitude factors. Fisher's exact test and Student's t-test were used to identify differences in sociodemographic characteristics and attitudes towards suicide between learners with or without suicidal ideation or behaviors. Qualitative data were analyzed using thematic analysis.

RESULTS

Non-specific active thoughts were the most common type of lifetime suicidal ideation (40.9%) while passive ideation was the most common in the past month (13.5%). Aborted suicide attempt was the most frequent behavior in both lifetime (16.4%) and in the past month (4.7%). Non-fatal suicide attempt in the past month was 2.3%, reaching 12.9% for the entire lifetime. Age, sex, education, and attitudes towards suicide were significantly associated with suicidal ideation or behavior. Thematic analysis showed five themes: (1) fostering belongingness, (2) securing learners' safety, (3) teaching philosophy, (4) teacher and learner beliefs towards suicidal behavior, and (5) availability of school-offered and community-based services.

CONCLUSION

Suicidal ideation and behaviors are prevalent among adolescent ALS learners. This study also showed a significant difference in attitudes towards suicide and sociodemographic characteristics between learners with and without suicidal ideation behaviors. It also suggests that the school psychosocial environment, through social norms and learner-teacher interactions, can potentially prevent progression of suicidal ideation to behavior, influence help-seeking, and promote mental health among learners.

Impact of parent-adolescent bonding on school bullying and mental health in Vietnamese cultural setting: evidence from the global school-based health survey

Background

The mental well-being of adolescents is a crucial issue affecting lives of both adults and young people. Bullying and mental health problems are important factors that can have a negative impact on the mental well-being of adolescents. Public awareness of mental health problems among adolescents is rapidly growing in Vietnam. However, current approaches to identifying risk factors influencing mental health problems do not pay attention to potentially protective factors. This study was performed to examine the associations between parent–adolescent bonding and mental health outcomes as protective elements during the adolescent period.

Methods

Data collected from 3331 respondents in grade 8–12 as part of the Vietnam Global School-based Student Health Survey (GSHS) 2013 was used for the analysis. A three-stage cluster sample design was used to produce data representative of students. Multivariate logistic regression analysis was performed to examine the association of demographic characteristics and data regarding parent–adolescent bonding associations with status of mental health problems in adolescents.

Results

Parental understanding, parental monitoring were significantly associated with reduced likelihood of being bullied and mental health problems (P < 0.05). However, parental control was significantly associated with greater likelihoods of being physically attacked (adjusted odd ratio (aOR) = 1.36, 95%CI, 1.06, 1.75) and mental health problems, such as suicidal ideation, and loneliness (aOR = 1.96, 95%CI, 1.49, 2.57, aOR = 2.35, 95%CI, 1.75, 3.15, respectively), after adjusting for potential confounders.

Conclusions

The study indicated the significant associations between parental understanding, monitoring and control in a proxy of parent–adolescent bonding and mental well-being during the period of adolescent rebellion. Thus, parent–adolescent bonding in Southeast Asian cultural context may provide an effective means to promote the mental well-being of adolescents.

The Level of Hopelessness and Psychological Distress among Abused Women in A Women's Shelter in Turkey

Hopelessness prevents abused women from participating in social life and increases the risk of suicide. The aim of this study was to determine the level of hopelessness and psychological distress among abused women admitted to shelter in a conservative country. The sample included 40 abused women. A questionnaire, Beck Hopelessness Scale and the General Health Questionnaire were used to collect data. Chi-square, the Pearson correlation analysis test, and variance analysis were performed. Half of the women experienced moderate and severe hopelessness. Higher levels of hopelessness were found to be associated with higher psychological distress. Women had problems with decision-making, concentrating on a job, felt unhappiness, and depression. The results of the study would be useful in designing training programs for nurses, social workers and counselors as well as policy makers who assist women facing domestic violence to provide better physiological and psychological care for sheltered women in conservative countries.

Prevalence and predictors of alcohol and drug use among secondary school students in Botswana: a cross-sectional study

BACKGROUND

Alcohol and illicit drug use has been recognized as a growing problem among adolescents in Botswana. Little is known about factors affecting alcohol and drug use among Botswana's secondary school students. To aid the design and implementation of effective public health interventions, we sought to determine the prevalence of alcohol and drug use in secondary school students in urban and peri-urban areas of Botswana, and to evaluate risk and protective factors for substance use.

METHODS

We performed a 72-item cross-sectional survey of students in 17 public secondary schools in Gaborone, Lobatse, Molepolole and Mochudi, Botswana. The World Health Organization's (WHO) Alcohol Use Disorder Identification Test (AUDIT) was used to define hazardous drinking behavior. Using Jessor's Problem Behavior Theory (PBT) as our conceptual framework, we culturally-adapted items from previously validated tools to measure risk and protective factors for alcohol and drug use. Between-group differences of risk and protective factors were compared using univariate binomial and multinomial-ordinal logit analysis. Relative risks of alcohol and drug use by demographic, high risks and low protections were calculated. Multivariate ordinal-multinomial cumulative logit analysis, multivariate nominal-multinomial logit analysis, and binominal logit analysis were used to build models illustrating the relationship between risk and protective factors and student alcohol and illicit drug use. Clustered data was adjusted for in all analyses using Generalized Estimating Equations (GEE) methods.

RESULTS

Of the 1936 students surveyed, 816 (42.1%) reported alcohol use, and 434 (22.4%) met criteria for hazardous alcohol use. Illicit drug use was reported by 324 students (16.7%), with motokwane (marijuana) being the most commonly used drug. Risk factors more strongly associated with alcohol and drug use were reported alcohol availability, individual and social vulnerability factors, and poor peer modeling. Individual and social controls protections appear to mitigate risk of student alcohol and drug use.

CONCLUSIONS

Alcohol and illicit drug use is prevalent among secondary school students in Botswana. Our data suggest that interventions that reduce the availability of alcohol and drugs and that build greater support networks for adolescents may be most helpful in decreasing alcohol and drug use among secondary school students in Botswana.

The Association of Mastery With Loneliness

Abstract. The focus of this paper is on the association of sense of mastery with feelings of loneliness, reviewing research conducted during the period 2000–2017. The basic findings show that across different age groups and different situations, mastery is negatively correlated with loneliness. The presumed contributions of mastery to loneliness are summarized by several explanatory models: Mastery can be conceived as contributing to low loneliness through the initiation of active coping to change the situation, through behavior that changes loneliness, and through changes in perceptions. Future research should include intervention studies, longitudinal designs, and mediating variables to assess the processes by which a high sense of mastery can lower feelings of loneliness.

Searching for Psychological Predictors of Suicidal Ideation in University Students

ABSTRACT The present study aims to identify psychological predictors of suicidal ideation in university students. We collected a sample of 366 participants, representing a population of 7102 students from a university in northern Portugal (95% CI). Both in the whole sample and in the intra-gender analysis, students with suicidal ideation revealed higher levels of depressive symptoms, loneliness, social anxiety and fears of abandonment, and lower levels of comfort with intimacy and trust in others. Loneliness and depression are significant predictors of suicidal ideation, with an odds ratio of 1.095 and 1.108, respectively. The results were consistent with those found in the literature, and call for more research and implementation of intervention protocols in university populations.

Loneliness, Insomnia and Suicidal Behavior among School-Going Adolescents in Western Pacific Island Countries: Role of Violence and Injury

This study aimed to examine whether being bullied, fighting, and injury, regarded in terms of frequency and nature, were significantly associated with psychological distress and suicidal behavior, independent of substance abuse and parental support in adolescents. Secondary analysis of data from the Global School-based Student Health Survey from Kiribati, the Solomon Islands, and Vanuatu was conducted. Binomial logistic regression analysis was used to examine the association of being bullied, fighting and injury with psychological health outcomes (loneliness, insomnia, suicidal ideation and suicide attempt) at a 5% level of significance. A total of 4122 students were included; 45.5% were male, and 52.0% were 14 years of age or younger. Of the total, 9.3% felt lonely and 9.5% had insomnia most of the time over the last 12 months; 27.6% had suicidal ideation, and 30.9% reported at least one suicide attempt in the last 12 months. Multivariable logistic regression analysis showed that being bullied, fighting and injury were significantly associated with psychological health outcomes; adjusted odds ratios (AORs) of loneliness, insomnia, suicidal ideation and suicide attempt increased with increased exposure to bullying, fighting, and injury compared to non-exposed group. Among the types of bullying victimization, the highest AORs of insomnia and suicide attempt were among students who were left out of activities, compared to the non-bullied. Among the causes of injury, adolescents injured due to a physical attack were the most likely to report the highest AORs of loneliness, insomnia and suicidal ideation compared to those not injured. Preventing violence and injury among adolescents might contribute to better mental health and reduction of suicidal behavior.

A comparative analysis of suicide attempts in left-behind children and non-left-behind children in rural China

To estimate the prevalence of suicide attempts and explore the shared and unique factors influencing suicide risk in left-behind children (LBC) and non-left-behind children (NLBC) in rural China, this study collected data using a multi-stage cluster random sampling method from 13,952 children including 6,034 LBC and 7,918 NLBC. Sociodemographic characteristics, suicide attempts, neglect and physical abuse, negative life events, and loneliness were measured by self-reported questionnaires. Data were analyzed using logistic regression models. Gender and mother's education level were unique influential factors for NLBC while family structure type was a unique influential factor for LBC. The study provides two novel findings regarding NLBC specifically: 1. Children with optimal family socioeconomic status are more likely to report suicide attempts (odds ratio OR = 1)than are those in the general children population, OR 0.52 (95% CI: 0.39-0.70), and 2. Children with higher mother's education level are subject to higher suicide rates in high school, OR 1.67 (95% CI: 1.13-2.46), and post-secondary education, OR 2.14 (95% CI: 1.37-3.37). The unique characteristics of LBC and NLBC in China suggest that investigating risk factors and determining the factors that might be targeted in intervention programs are urgently needed currently.

The association between adolescent risk behaviours and feelings of sadness or hopelessness: a cross-sectional survey of South African secondary school learners

Poor mental health in adolescents has shown associations with engagement in other risk behaviours. However, evidence of this association in Sub-Saharan Africa, particularly South Africa, is lacking. This study examines the associations between pertinent risk behaviours and feelings of sadness or hopelessness amongst a nationally representative sample of South African school going adolescents. Data was analysed from the South African Youth Risk Behaviour Survey 2011 (n=10,997), a cross-sectional national survey among grades 8-11 school learners. Logistic regression examined the association of demographic, substance use, violent behaviour, sexual activity and suicidal plans and attempts with the primary outcome, feelings of sadness or hopelessness. Having feelings of sadness or hopelessness was significantly associated with more senior grades, being bullied (AOR:1.67, 95% CI: 1.42-1.96), being assaulted by a partner (1.33 [1.05-1.68]), forced sex (1.78 [1.37-2.32]); gang membership (1.32 [1.06-1.65]), binge drinking (1.37 [1.14-1.65]), ever having sex (1.23 [1.02-1.47]), having ≥1 partner/s in preceding three months (1.25 [1.02-1.53]), having made a plan to attempt suicide (2.50 [1.95-3.21]) and suicide attempt (1.49 [1.21-1.85]). Adolescents in South Africa are experiencing a multiple burden of risk. Health promotion strategies targeting adolescent mental health and risk behaviours need to be developed and implemented in a timely and comprehensive manner.

Development and psychometric properties of the Suicidality of Adolescent Screening Scale (SASS) using Multidimensional Item Response Theory

Suicide prevention in adolescents by early detection using screening tools to identify high suicidal risk is a priority. Our objective was to build a multidimensional scale namely "Suicidality of Adolescent Screening Scale (SASS)" to identify adolescents at risk of suicide. An initial pool of items was developed by using in-depth interview, focus groups and a literature review. Initially, 77 items were administered to 307 adolescents and analyzed using the exploratory Multidimensional Item Response Theory (MIRT) to remove unnecessary items. A subsequent exploratory factor analysis revealed 35 items that collected into 4 factors: Stressors, Pessimism, Suicidality and Depression. To confirm this structure, a new sample of 450 adolescents were collected and confirmatory MIRT factor analysis was performed. The resulting scale was shown to be both construct valid and able to discriminate well between adolescents that had, and hadn't previous attempted suicide.

Testing a Theory-Based Model of Suicidality in a Community Sample

The aim of the present study is to test a theory-based model of suicide in a low-risk nonclinical sample. A community sample of convenience of 200 adults, 102 men and 98 women, responded to the Depressive Experiences Questionnaire, the Center for the Epidemiologic Studies of Depression Scale, the Psychache Scale, the Interpersonal Needs Questionnaire, and the Suicide Behaviors Questionnaire Revised. The hypothesized structural equation model, including trait dimensions of self-criticism and neediness, and state dimensions of depression, psychache, perceived burdensomeness, and thwarted belongingness, fit the observed data well and significantly explained 49% of the variance of suicidality.

Attempted Suicide Triggers in Thai Adolescent Perspectives

The study goal was to describe attempted suicide triggers in Thai adolescents. A descriptive exploratory qualitative study approach was used utilizing in-depth interviews with twelve adolescents who had attempted suicide and six of their parents. Content analysis was conducted. Attempted suicide triggers were (1) severe verbal criticisms and expulsion to die by a significant family member, (2) disappointed and unwanted by boyfriend in first serious relationship, (3) unwanted pregnancy, and (4) mental illness leading to intense emotions and irresistible impulses. These attempted suicide triggers should be of concern and brought into suicide prevention management programs such as emotional management, effective communication for adolescents and family.

Neuroanatomical correlates of attitudes toward suicide in a large healthy sample: A voxel-based morphometric analysis

Previous studies have indicated that permissive attitudes toward suicide are positively associated with mental illness (e.g., depression and loneliness). Evidence suggests that there are abnormalities in the cognitive and brain functioning of suicidal patients. Nevertheless, there has been no evidence of the correlation between attitudes toward suicide and abnormal brain structure variations in healthy people. Therefore, in this study, we seek to investigate the neuroanatomical differences in healthy participants with regard to attitudes toward suicide. The results show that permissive attitudes toward suicide were significantly correlated with gray matter volume (GMV) in the left dorsolateral prefrontal cortex (DLPFC) and the left cerebellum in the large sample (n=405), which may be related to inefficient inhibitory control of negative emotion. Then, in a subset of healthy individuals with permissive attitudes (n=113), we also observed that stronger permissive attitudes toward suicide were positively related to the larger GMV in the left DLPFC and the left middle temporal gyrus (MTG), which may be associated with sensitivity of emotional feeling. Furthermore, loneliness had a mediating effect on the relation between the DLPFC volume and attitudes toward suicide. Taken together, neuroanatomical differences in healthy participants with permissive attitudes toward suicide may provide a better understanding of permissive attitudes toward suicide as a likely risk factor for suicidal behavior.

Pathways From Bullying Perpetration, Victimization, and Bully Victimization to Suicidality Among School-Aged Youth: A Review of the Potential Mediators and a Call for Further Investigation

In the wake of several highly publicized adolescent suicides attributed to bullying victimization, national attention has been brought to bear on the profound public health problem of bullying. This article reviews the extant literature on the associations between bullying perpetration, victimization, and thoughts of or attempts at suicide and proposes five potential mediators, namely depression, anxiety, low self-esteem, loneliness, and hopelessness, that may explain this relationship. Numerous studies have found empirical support for the interrelations between internalizing behaviors and both bullying perpetration and victimization and suicide. We find that further longitudinal research needs to be conducted to more conclusively determine the role and causal ordering these various psychosocial factors may play in bullying perpetration, victimization, and suicide. Although the research literature implies causal directions among all these potential mediators, untangling the unique influence of bullying perpetration, victimization, and bully victimization on suicide and its mechanisms of action has major research and practice implications.

Early Substance Use Initiation and Suicide Ideation and Attempts among School-Aged Adolescents in Four Pacific Island Countries in Oceania

This study aimed to investigate the correlations between early initiation (<12 years) of smoking cigarettes, alcohol use, and drug use (cannabis) with suicidal ideation and suicide attempts in school-aged adolescents in four Pacific Island countries in Oceania. The sample included 6540 adolescents (≤13 to ≥16 years old) from Kiribati, Samoa, Solomon Islands, and Vanuatu. Bivariate and multivariable analyses were conducted to assess the association between pre-adolescent substance use initiation and suicidal ideation and suicide attempts. Results indicate a prevalence of 25.8% suicidal ideation in the past 12 months (ranging from 17.2% in Vanuatu to 34.7% in Kiribati) and 34.9% suicide attempts in the past 12 months (ranging from 23.5% in Vanuatu to 62.0% in Samoa). The prevalence of early cigarette smoking initiation was 15.7%, early alcohol initiation 13.8%, and early drug use initiation was 12.9%. Students who reported pre-adolescent substance use initiation, compared with non-substance users, were more likely reporting suicidal ideation and suicide attempts. The concurrent initiation of cigarette smoking, alcohol, and drug use should be targeted in early prevention programmes in order to prevent possible subsequent suicidal behaviours.

Personality vulnerabilities in adolescent suicidality: The mediating role of psychological distress

The research literature consistently indicates that self-criticism is related to suicidality. Evidence for the role of dependency, however, is more controversial. This study examines the extent to which these personality vulnerabilities are mediated by psychological distress in the prediction of suicidality. As part of a study of adolescent psychopathology, a sample of 260 Portuguese adolescents (148 [56.9 %] female and 112 [43.1%] male), ranging in age from 15 to 18 years (M = 16.32, SD = 1.19) completed measures of personality, suicidal behavior, and current distress, in counterbalanced order. The measures were: self-criticism and dependency from the Depressive Experiences Questionnaire for Adolescents; two psychological distress scales, social withdrawal from the Youth Self Report and depression from the Center for Epidemiologic Studies of Depression Scale; and a measure of suicidality from the Suicide Behaviors Questionnaire Revised. Structural equation modeling indicated that self-criticism and dependency were both significantly associated with suicidality. Psychological distress, however, as measured by withdrawal and depression, fully mediated these relationships, but did not moderate them. The authors conclude that adolescents with higher levels of self-criticism and dependency are at greater risk for experiencing intense psychological distress-high levels of social withdrawal and depression-that account for their vulnerability to suicide risk.

Hopelessness in adolescents

BACKGROUND

The hopelessness scales devised by Beck and by Kazdin have been used in hundreds of studies of both non-clinical and clinical samples. The present study identified non-clinical adolescent samples to see if the mean scores differed by age, sex, year of publication of the study, and nation.

METHODS

Studies of school students administered the Beck Hopelessness Scale or the Kazdin Hopelessness Scale for Children were identified from a literature search using PsycINFO and the search term "hopelessness" anywhere in the text. Seventy-eight studies were found reporting mean scores, 44 for American students and 34 for students in other countries.

RESULTS

The scores of American students were significantly lower than those of students in other countries, and there was a tendency for boys to have higher scores than girls (in 18 of the 27 studies which reported differences by sex). There was no tendency for the hopelessness scores of American students to have increased in recent years.

CONCLUSIONS

American adolescents appear to be less hopeless than adolescent in other nations, and the scores of American adolescents do not seem to have changed significantly over the last 30 years.

Suicidal Ideation Among Malaysian Adolescents

Adolescence is the time of greatest risk for the first onset of suicidal behaviors. This study aimed to identify the risk and protective factors associated with suicidal ideation among Malaysian adolescents. Data from the 2012 Malaysia Global School-based Student Health Survey, a nationwide study using a 2-stage cluster sampling design, were analyzed. The survey used a self-administered validated bilingual questionnaire and the Depression Anxiety and Stress Scale. The prevalence of suicidal ideation was 7.9%. Analysis revealed that suicidal ideation was positively associated with depression, anxiety, stress, substance use, being bullied, and being abused at home, either physically or verbally. In addition, suicidal ideation was significantly higher among females and among the Indians and Chinese. Having close friends and married parents were strongly protective against suicidal ideation. Understanding the risk and protective factors is important in providing comprehensive management for suicidal ideation.

Suicidal behaviour and related risk factors among school-aged youth in the Republic of Benin

INTRODUCTION

Research on factors associated with suicidal ideation and suicide attempts has been conducted largely in developed countries. Research on West African countries in particular is lacking.

METHODS

Data were obtained from the Global School-based Health Survey conducted in Benin in 2009. This was a cross-sectional study of three grades, spanning Junior and Senior High, which sampled a total of 2,690 adolescents. Data on the occurrence of demographic, psycho-social and socio-environmental risk factors were tested using multinomial logistic regression for their association with suicidal ideation and suicide attempts.

RESULTS

The survey indicated that 23.2% had thought about suicide and 28.3% had made a suicide attempt in the previous year. Anxiety, loneliness, being bullied, alcohol misuse, illicit drug use, and lack of parental support were independently related to the ideation outcomes, suicidal ideation without planning and suicidal ideation with planning. Multinomial regression analysis, using one suicide attempt and multiple suicide attempts as outcomes, revealed that female sex, anxiety, loneliness, being physically attacked, and illicit drug use were associated these outcomes.

DISCUSSION

The prevalence of suicide attempts reported in the survey is relatively high. It is possible that there are cultural factors that could explain this finding. Our research indicates that many factors are related to the occurrence of suicidal ideation and suicide attempts among youth in Benin. Illicit drug use and violence in particular are associated with a high rate of suicide attempts in Benin. Measures to address these issues may reduce the risk of self-inflicted violence.

Suicide and related health risk behaviours among school learners in South Africa: results from the 2002 and 2008 national youth risk behaviour surveys

BACKGROUND

Attempted and completed suicide constitute a major public health problem among young people world-wide, including South Africa (SA). Suicide attempt and completed suicide increase during the adolescent period. One in 5 adolescents considers attempting suicide, but statistics are frequently unreliable.

METHODS

Data for this study were derived from the 2002 and 2008 South African Youth Risk Behaviour Surveys (YRBS). The study population comprised grades 8, 9, 10 and 11 students in governmental schools in the nine provinces of SA (N = 10,699 in 2002 and 10,270 in 2008). Key outcome measures were suicide ideation and suicide attempts.

RESULTS

Of the total sample, 18% of the students in 2002 and 19% in 2008 reported to have seriously considered and/or made a plan to commit suicide during the past six months (Suicide ideation), whereas 18.5% of students in 2002 and 21.8% in 2008 reported that they had attempted suicide at least 1 time during the past six months. On both suicide measures girls have higher prevalence scores than boys, and older school learners score higher than younger learners. In addition, 32% of the learners reported feelings of sadness or hopelessness. These feelings contributed significantly to the explanation of suicide ideation and suicide attempt next to being the victim or actor in violent acts and illegal substance use.

CONCLUSION

The prevalence of suicide ideation and suicide attempts among South African adolescents is high and seems to be influenced by a wide spectrum of factors at the demographic, psychological and behavioural level. Hence, more research is needed to determine the behavioural and psychological determinants of suicide among youngsters in order to develop comprehensive intervention strategies for suicide prevention and care.

Hopelessness and social comparison in Turkish adolescent with visual impairment

The purpose of this study was to determine visually impaired adolescents' level of hopelessness and how they perceive of themselves socially compared to other individuals. Another purpose of this study was to look for relationships between hopelessness and social comparison in adolescents with visual impairment. The research population was comprised of 130 students at a secondary school for the visually impaired in Istanbul, Turkey. Our study demonstrated a weak relationship between social comparison and hopelessness (r=-0.46, P < 0.000). The mean hopelessness score for the adolescents with visual impairment was 4.59 ± 3.12 (girls: 4.23 ± 3.10; boys: 4.83 ± 3.11) and social comparison score was 87.50 ± 11.19 (girls: 88.67 ± 11.62; boys: 86.60 ± 10.85). Hopelessness and social comparison were not affected by being blind from birth compared to later or from being a full-time boarding student compared to being a day student. The hopeless (Beck Hopelessness Scale score ≥ 9) adolescents' social comparison scores were found lower than hopeful ones' scores (P < 000). Factors affecting hopelessness and social comparison were feelings about their father, teacher and school.

Multi-country, cross-national comparison of youth suicide ideation: Findings from Global School-based Health Surveys

This study describes the prevalence of suicide ideation in 109 Global School-based Health Surveys (GSHS) conducted from 2003–2010 representing 49 different countries and 266,694 school-attending students aged 13–15 years primarily living in developing areas of the World. Prevalence of suicide ideation varied widely among and between countries, regions, and by gender, with an overall mean prevalence of suicide ideation of 15.3%. When grouped by region, Africa had the highest percentage of participants reporting suicide ideation (19.8%). The wide variability in the prevalence of suicide ideation found in this study confirms that school psychologists and counselors must be prepared to deal with the unique needs and characteristics of the specific populations of youth they serve, as the needs are likely to vary substantially from locality to locality, and country to country.

The importance of modeling method effects: resolving the (uni)dimensionality of the loneliness questionnaire

This study sought to resolve the dimensionality of the Loneliness Questionnaire (LQ; Asher, Hymel, & Renshaw, 1984) by applying recommended confirmatory factor analytic procedures that control for method effects (Brown, 2003). This study was needed given that inconsistent findings have been reported recently regarding the structure of this instrument (Bagner, Storch, & Roberti, 2004) and all models to date have not accounted for method effects due to the non-reversed-worded and reversed-worded items of this instrument. Using a large sample of youth in Grades 2 through 12 (N = 11,725), we compared the previously reported 1- and 2-factor models with a newly posited 1-factor model that incorporated correlated error terms to account for method effects. We found that the 1-factor model that included correlated error terms fit the data best, and that this factor structure evidenced measurement invariance across boys and girls in childhood, but not in adolescence. The meaning of the LQ indicators was also consistent for boys across development, but evidenced differences for girls in childhood versus adolescence. More generally, it was demonstrated that modeling method effects is vital to accurately understanding the dimensionality of loneliness when reversed-worded and non-reversed-worded items are used as indicators. The measurement and clinical implications of these findings are discussed.

Suicidal ideation and associated factors among school-going adolescents in Thailand

The aim of this study was to estimate the prevalence and identify associations between suicidal ideation and indicators of psychosocial distress and social-environmental factors in Thai adolescents. Using data from the Thailand Global School-Based Student Health Survey (GSHS) 2008, we assessed the prevalence of suicidal ideation and its associated factors among adolescents (N = 2,758). Overall the prevalence of suicidal ideation in the past 12 months was 8.8% (9.9% males and 7.7% females). Variables influenced the suicidal ideation in multivariable analysis were sadness (Odds Ratio = OR: 6.03; 95% Confidence Interval = CI (3.00-12.14), lack of parental attachment (OR = 2.26, CI = 1.09-4.67), current alcohol use (OR = 2.32, 1.21-4.44), and ever having had sexual intercourse (OR = 4.16, CI = 3.40-7.68). Psychosocial, health-risk behaviours and lack of protective factors appear to effect suicidal ideation in this youth population.

Peer relationships and suicide ideation and attempts among Chinese adolescents

BACKGROUND

Suicide is a global health concern. Therefore, studying suicide behaviour and identifying the early roots of suicide are critical. To address these issues, the present study examined (i) the association between peer relationships and suicide ideation and attempts among Chinese adolescents; and (ii) whether such associations were moderated or mediated by feeling of loneliness. We hypothesized that problems in peer relationships were positively associated with suicide ideation and attempts, and that feeling of loneliness would moderate and mediate such associations.

METHODS

The sample included 8778 Chinese adolescents from a large survey. Measures of peer relationships, suicide ideation and attempts, and feeling of loneliness were obtained through adolescents' self-reports.

RESULTS

Results from multivariate logistic regressions suggested that specific problems in peer relationships, such as lack of peer association and being victimized by bullying, were significantly related to suicide ideation and attempts. In addition, the moderating effects of feeling of loneliness on the association between peer relationships and suicide ideation and attempts were found. Finally, some gender effects were also found.

CONCLUSIONS

The present study provided strong evidence that suicide ideation and attempts were serious problems among adolescents in China, to which peer relationships played an important role. Further, feeling of loneliness acted as a moderator affecting the association between peer relationships and suicide ideation and attempts. Finally, there were some gender differences that have important implications.

Psychosocial Distress and Suicide Ideation in Chinese and Philippine Adolescents

Objective: The purpose of this study was to identify associations between suicide ideation and indicators of psychological distress and health behaviors in Chinese and Philippine adolescents. Method: Global School Health Surveys consisting of 9015 Chinese and 7338 Philippine students aged 11 to 17 years were analyzed using logistic regression to determine demographic, psychosocial, and health/risk behavioral determinants of suicide ideation. Results: In both samples, suicide ideation was associated with substance use, physical activity, feelings of loneliness, hopelessness/sadness, and worrying. Chinese girls were more likely to than boys to report suicide ideation and suicide planning, whereas Philippine girls were more likely to report suicide planning. Overweight status and sedentary behaviors were associated with increased risk of suicide ideation in Chinese adolescents, but the same influences were observed to be protective for Philippine adolescents. Conclusions: Psychosocial, demographic, and health/risk behaviors factors appear to impact suicide ideation and suicide planning in both of these youth populations.