Suicidal behavior among urban, African American young adults

Depression and Suicide Ideation: The Role of Self-Acceptance for Black Young Adults

Suicide is a leading cause of death for Black young adults. Though depression is commonly linked to increased risk for suicide, empirical literature examining the depression–suicide association and intrinsic buffers for this association remains limited among Black young adults. This study sought to address this gap in the literature by examining the relationship between depression and suicide ideation among Black young adults. Importantly, this study assessed the moderating role of self-acceptance, an index of how content one is with oneself. Study participants included 123 Black young adults (63.5% female, Mage = 20.91 years, SD = 2.45 years) who completed measures evaluating symptoms of depression, suicide ideation, and psychological well-being. Multivariate regression analyses revealed that self-acceptance moderated the association between depressive symptomatology and suicide ideation ( β = −0.05, p < .01, 95% CI [-1.01, −0.11]), such that the depression–suicide ideation association was not significant for individuals who reported high levels of self-acceptance. These findings suggest that self-acceptance may be an important treatment target for interventions aimed specifically at reducing suicide vulnerability among Black young adults.

Environmental Stressors May Drive Inflammation and Alter Neurocircuitry to Promote Suicidal Behavior

Suicide morbidity and mortality are serious public health problems, accounting for over 40,000 deaths annually and over $10 billion in combined medical and work loss costs. Suicidal behavior is the outcome of a complex causal web of distal and proximal risk processes that includes a range of interacting environmental and biological determinants. We review current understanding of risk and protective factors, including recent findings on inflammatory processes, discuss recent research on environmental risks for suicidal behaviors with a focus on economic stress, and examine potential mechanisms by which external factors and internal processes such as inflammation might contribute to pathways leading to suicidal behavior. We propose a model that links changes in the default network or resting state of brain activity with corresponding changes in brain structure and function, which in turn may be influenced by diverse inflammatory mediators, and suggest a potential framework that highlights multidisciplinary opportunities for further research.

Body Mass Index, Self-Esteem, and Suicide Risk in Clinically Depressed African American and White American Females

Self-esteem and depression, as well as depression and body mass index (BMI), have consistently been found to be significantly associated for African American and White American females. The results are dissimilar when BMI and self-esteem are studied. Historically, the relationship between BMI and self-esteem is weak or nonexistent for African American females; however, for White American females, the relationship is usually significant. The goal of this study was to determine whether clinically depressed, healthy-weight, overweight, and obese females would differ significantly on self-esteem and suicide risk measures. In a voluntary hospital-based inpatient psychiatric unit, 165 clinically depressed females completed the self-esteem rating scale and the suicide risk scale. Healthy-weight, overweight, and obese African American females did not differ significantly on measures of self-esteem and suicide risk. However, depressed, obese White American females had significantly lower self-esteem and increased suicide risk than depressed healthy-weight and overweight White American females. Implications of the current results are discussed.

Racist Incident–Based Trauma

Racist incidents are potentially traumatizing forms of victimization that may lead to increased psychiatric and psychophysiological symptoms in targets. The magnitude of the problem of racist incidents in the United States is difficult to estimate; however, data from several sources permit the inference that the prevalence of racist incidents, particularly among people of color, is high. This article (a) distinguishes traumatic stress from nontraumatic stress and (b) draws parallels between experiences of racist incidents and experiences that are acknowledged to be traumatic, such as rape or domestic violence. Conceptualizing the symptoms of some survivors of racist incidents as trauma responses may help inform treatment when these individuals are clients in psychotherapy.

Higher Childhood Peer Reports of Social Preference Mediates the Impact of the Good Behavior Game on Suicide Attempt

The Good Behavior Game (GBG) is a universal classroom-based preventive intervention directed at reducing early aggressive, disruptive behavior and improving children's social adaptation into the classroom. The GBG is one of the few universal preventive interventions delivered in early elementary school that has been shown to reduce the risk for future suicide attempts. This paper addresses one potential mechanism by which the GBG lowers the risk of later suicide attempt. In this study, we tested whether the GBG, by facilitating social adaptation into the classroom early on, including the level of social preference by classmates, thereby lowers future risk of suicide attempts. The measure of social adaptation is based on first and second grade peer reports of social preference ("which children do you like best?"; "which children don't you like?"). As part of the hypothesized meditational model, we examined the longitudinal association between childhood peer social preference and the risk of future suicide attempt, which has not previously been examined. Data were from an epidemiologically based randomized prevention trial, which tested the GBG among two consecutive cohorts of first grade children in 19 public schools and 41 classrooms. Results indicated that peer social preference partially mediated the relationship between the GBG and the associated reduction of risk for later suicide attempts by adulthood, specifically among children characterized by their first grade teacher as highly aggressive, disruptive. These results suggest that positive childhood peer relations may partially explain the GBG-associated reduction of risk for suicide attempts and may be an important and malleable protective factor for future suicide attempt.

Perceived racism and suicide ideation: mediating role of depression but moderating role of religiosity among African American adults

Suicide is a public health problem for African Americans who are young and of working age. The purpose of this study was to examine mediated and moderated effects of perceived racism on suicide ideation in a community sample of 236 African American men and women. Measures of suicide ideation, depression symptoms, intrinsic/extrinsic religiosity, and perceived racism were administered. Perceived racial discrimination was directly and indirectly associated with suicide ideation. For participants who reported low levels of extrinsic religiosity, the mediated effect of perceived racism (via depression symptoms) was significant. These findings provide some insight into suicide vulnerability for specific subgroups of African Americans.

Prevalence of suicide ideation and attempts among Black Americans in later life

This article provides the first national estimates of the prevalence and correlates of nonfatal suicidal behavior among older Black Americans. There is a lack of national data on suicide ideation and attempts across ethnic classifications of Blacks in a nationally representative sample. Data are a subsample from the National Survey of American Life (NSAL), a national U.S. adult household probability sample of 5,191 Black Americans. The WHO Composite International Diagnostic Interview (CIDI) was used to assess older Blacks for nonfatal suicidal behavior and 14 DSM-IV disorders. Bivariate and multivariate logistic regression analyses were employed to delineate patterns and correlates of nonfatal suicidal behavior. The estimated lifetime prevalence of suicidal ideation and attempts among older Blacks in the United States was 6.1% and 2.1%, respectively. On an average it took 2.5 and 5.7 years respectively to go from ideation to attempts or from planning to attempts. Surprisingly, among older Black adults, men reported attempting suicide and seriously consider taking their own lives more than women. Older Blacks at higher risk for suicide attempts were middle aged, had poorer health, were anxious, and had multiple DSM-IV disorders. The results also show that approximately 1 in 4 attempters and 2 in 5 ideators have never sought treatment for their emotional or psychological problems. Preventative care, particularly screening in primary care settings, should consider these findings when treating older Black Americans for psychiatric-related risk.

Suicide, negative interaction and emotional support among black Americans

OBJECTIVES

This study is the first to investigate the relationship between perceived emotional support and negative interaction with family members and suicide ideation and attempts among African American and Caribbean black adults.

METHOD

Cross-sectional epidemiologic data from the National Survey of American Life and multivariable logistic regression analyses were used to examine the association between perceived emotional support and negative interaction and suicide behaviors among 3,570 African Americans and 1,621 Caribbean blacks age 18 and older.

RESULTS

Multivariate analyses found that perceived emotional support was associated with lower odds of suicide ideation and attempts for African Americans and Caribbean blacks. Negative interaction with family was associated with greater odds of suicide ideation among African Americans and Caribbean blacks. Ethnicity moderated the impact of emotional support and negative interaction on suicide attempts; among Caribbean blacks, those who reported more frequent emotional support from their family had a significantly greater reduced risk for suicide attempts than African Americans. The effect of negative interaction on suicide attempts was also more pronounced for Caribbean blacks compared to African Americans.

DISCUSSION

Negative interaction was a risk factor for suicide ideation and emotional support was a protective factor for attempts and ideation. These associations were observed even after controlling for any mental disorder. The findings demonstrate the importance of social relationships as both risk and protective factors for suicide and ethnic differences in suicidal ideation and attempts among black Americans.

Mental health screening of African American adolescents and facilitated access to care

This study retrospectively reviews de-identified records from school-based mental health screening in a predominantly African American community. We compare participation rates, screening results, referrals to services and access to care of white and African American adolescents. Among those offered screening, 20.1% of white students (n = 297), and 28.8% of African American students (n = 499) were screened (χ(2) = 32.47, df = 1, P < .001). African American students (45.1%) were significantly more likely than white students (33.0%), (AOR = 1.59; P = .003) to be identified as being at risk. In both racial groups, most youth accessed the school-based services (89.02%, 95% CI 82.25-95.79) and community services (86.57%, 95% CI 78.41-94.73) to which they were referred. The groups did not differ in the odds of accessing community-based services (AOR = .58; P = .49). African American students were, however, more likely than white students to access school-based services (AOR = 10.08; P = .022). The findings support the effectiveness of screening in school settings in predominantly African American communities.

12-month and lifetime prevalence of suicide attempts among black adolescents in the National Survey of American Life

OBJECTIVE

Provide nationally representative data on the prevalence and psychiatric correlates of suicidal ideation and attempts among African American and Caribbean black adolescents in the United States.

METHOD

Data on nonfatal suicidal behavior among 1,170 African American and Caribbean black adolescents aged 13 to 17 years are from the National Survey of American Life-Adolescent, a nationally representative household survey of adults with an attached adolescent sample conducted between February 2001 and June 2003.

RESULTS

Nationwide black adolescents reported having a lifetime prevalence of 7.5% for suicidal ideation and 2.7% for attempts. The 12-month prevalence of suicidal ideation and attempt was 3.2% and 1.4%, respectively. Among all respondents, 4% of black American adolescents and 7% of female subjects were projected to attempt suicide by age 17 years. African American adolescents were approximately five times more likely than Caribbean black adolescents to attempt suicide. Almost half of the National Survey of American Life-Adolescent respondents who reported a suicide attempt had never met criteria for any of the DSM-IV disorders by the time of their attempts.

CONCLUSIONS

Clinicians should be trained to screen for suicidal behavior, even among those without DSM-IV disorders, when treating black adolescents, particularly female subjects. In addition, preventive efforts should consider ethnic differences in suicide risk and targeting nonclinical settings.

Socio-cultural features and sex profile of the individuals with serious suicide attempts in southeastern Turkey: a one-year survey

Our objective was to elucidate potential causes of higher rates of suicide attempts in females compared to males in southeastern Turkey through a 1-year survey. Gender-related differences observed in 96 subjects who attempted suicide by poisoning for the first time were as follows: in comparison to male, females were predominantly within the age interval of 15-24 years, experienced more stressful events in the previous week before suicide attempt, had lower education level, and had a lower rate of employment. One year after the suicide attempt, unfavorable attitude of family, lack of support, persisting unfavorable lifestyle comparable with that prior to the first attempt, and higher rates of domestic violence were more pronounced in females compared to males. These findings might be contributing factors to the higher suicide attempt rates observed in females compared to the males.

Suicide and suicidal behavior

Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.

The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts

OBJECTIVE

This paper reports the impact of two first- and second-grade classroom based universal preventive interventions on the risk of Suicide Ideation (SI) and Suicide Attempts (SA) by young adulthood. The Good Behavior Game (GBG) was directed at socializing children for the student role and reducing aggressive, disruptive behavior. Mastery Learning (ML) was aimed at improving academic achievement. Both were implemented by the teacher.

METHODS

The design was epidemiologically based, with randomization at the school and classroom levels and balancing of children across classrooms. The trial involved a cohort of first-grade children in 19 schools and 41 classrooms with intervention at first and second grades. A replication was implemented with the next cohort of first grade children with the same teachers but with little mentoring or monitoring.

RESULTS

In the first cohort, there was consistent and robust GBG-associated reduction of risk for suicide ideation by age 19-21 years compared to youths in standard setting (control) classrooms regardless of any type of covariate adjustment. A GBG-associated reduced risk for suicide attempt was found, though in some covariate-adjusted models the effect was not statistically robust. No statistically significant impact on these outcomes was found for ML. The impact of the GBG on suicide ideation and attempts was greatly reduced in the replication trial involving the second cohort.

CONCLUSIONS

A universal preventive intervention directed at socializing children and classroom behavior management to reduce aggressive, disruptive behavior may delay or prevent onset of suicide ideation and attempts. The GBG must be implemented with precision and continuing support of teachers.

The role of randomized trials in testing interventions for the prevention of youth suicide

Epidemiological considerations point to a small handful of prevention strategies that have the potential for dramatically reducing suicide rates. Nearly all of those prevention approaches involve population-based strategies to either find an increased number of individuals at high risk for suicide or to reduce the prevalence of risk factors in members of a population that, as a whole, has a relatively low rate of suicide. Few of these approaches have been evaluated in rigorous trials. We argue that there are rigorous randomized trial designs that are both feasible and ethical and can be used to test both programmes and implementation strategies for population-based suicide prevention. We review existing suicide prevention trials and introduce two new randomized trial designs that are likely to achieve sufficient statistical power. The 'dynamic wait-listed design' randomizes across different time periods and is now being used to test a gatekeeper training programme in 32 schools. It could also be used to examine suicide prevention programmes in rural areas. The multi-trial follow-up study builds on the large number of successful population-based preventive interventions aimed at reducing known risk factors for suicide in youths to see whether these also cause a reduction in rates of completed suicide.

Prevalence of and risk factors for lifetime suicide attempts among blacks in the United States

CONTEXT

Lack of data on the lifetime prevalence and age at onset of suicide ideation, plans, and attempts among blacks in the United States limits the creation and evaluation of interventions to reduce suicide among black Americans.

OBJECTIVE

To examine the prevalence and correlates of suicide ideation, planning, and attempts across 2 ethnic classifications of blacks in a nationally representative sample.

DESIGN, SETTING, AND PARTICIPANTS

Data are from the National Survey of American Life, a national household probability sample of 5181 black respondents aged 18 years and older, conducted between February 2001 and June 2003, using a slightly modified adaptation of the World Health Organization World Mental Health version of the Composite International Diagnostic Interview. Bivariate and survival analyses were used to delineate patterns and correlates of nonfatal suicidal behavior.

MAIN OUTCOME MEASURES

Self-reports of lifetime suicide ideation, planning, and attempts.

RESULTS

Survey respondents, categorized as African Americans and Caribbean Americans, reported lifetime prevalence of 11.7% for suicide ideation and 4.1% for attempts. Among the respondents who reported ideation, 34.6% transitioned to making a plan and only 21% made an unplanned attempt. Among 4 ethnic-sex groups, the 7.5% lifetime prevalence for attempts among Caribbean black men was the highest among black Americans. The greatest risk of progressing to suicide planning or attempt among ideators occurred within the first year after ideation onset. Blacks at higher risk for suicide attempts were in younger birth cohorts, less educated, Midwest residents, and had 1 or more Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders.

CONCLUSIONS

This study documents the burden of nonfatal suicidality among US blacks, notably Caribbean black men, and individuals making planned attempts. Advancing research on the transition from suicide planning to attempt is vital to the efficacy of health care professionals' ability to screen blacks at risk for suicide.

Explaining Changes in the Patterns of Black Suicide in the United States From 1981 to 2002: An Age, Cohort, and Period Analysis

To explore the different trends of suicide incidence among Blacks and possible contributing factors, the current study compared national epidemiologic data of suicide in the United States from 1981 to 2002. For the first time, period and birth-cohort effects on the incidence trends of Black suicide were evaluated using an age-period-cohort analysis. Cohort effects were found for males and females, suggesting that younger generations of Blacks are at higher risk. If younger cohorts carry their increased suicide risk into later life, then the recent decline in Black suicide rates will be reversed. The results of the current study are only interpretable in terms of group-level characteristics and population suicide rates and not individual-level characteristics. The possible explanation and the implications for prevention and future research are discussed.

Aggressive behaviors in early adolescence and subsequent suicidality among urban youths

PURPOSE

To examine the association of aggressive behaviors during early adolescence with subsequent suicidality among inner-city males and females.

METHODS

Seven hundred sixty nine African-American and Latino males and females were surveyed about their involvement in aggressive behaviors in 8th grade and again during 11th grade, when suicidality was assessed. Logistic regression was used to examine the influence of middle-school aggression on subsequent suicidality, controlling for demographic and social characteristics and 8th grade depressive symptoms and substance use. At 8th grade, 43% of males and 32% of females reported a recent fight, 33% of males and 19% of females carried a knife, 8% of males and 7% of females used a knife to cut or stab someone, and 15% of males and 4% of females carried a gun. At 11th grade, 24% of males and 29% of females scored high on suicidality, indicating suicidal thoughts, plans, or attempt.

RESULTS

Females scoring high on aggression were significantly more likely to report suicidality at 11th grade, controlling for demographic and social factors, early depressive symptoms, and substance use. For males, high depressive symptoms and substance use at 8th grade were related to suicidality, but not earlier aggressive behavior.

CONCLUSION

Urban girls who engage in physical aggression in middle school are at risk for subsequent inner-directed violence, including suicidal thoughts and behaviors. To address adolescents' mental health needs, attention must be paid to connections between externally and internally directed forms of violence over time, and whether warning signs of suicidality may differ by gender and require different intervention.

Suicidality in African American men: the roles of southern residence, religiosity, and social support

The rise in suicide by African Americans in the United States is directly attributable to the dramatic, nearly three-fold increase in suicide rates of African American males. Gibbs (1997) hypothesized high social support, religiosity, and southern residence are protective factors against suicidality for Black people. This hypothesis was tested among 5,125 participants from the National Comorbidity Survey; 299 were African American males. In this study we hypothesized that there would be significantly lower suicidality in the South, and social support and religiosity would mediate this relationship. Our results indicate that Southern region is indeed a significant predictor of suicidal symptoms in African American men, such that suicidal symptoms were lower in the South, but religiosity and social support did not account for this effect. Other potential mediators were also examined.

Protective factors against suicide attempt risk among African American women experiencing intimate partner violence

Protective factors (hope, spirituality, self-efficacy, coping, social support-family, social support-friends, and effectiveness of obtaining resources) against suicide attempts were examined in economically, educationally, and socially disadvantaged African American women (100 suicide attempters, 100 nonattempters) who had experienced recent intimate partner violence. Significant positive associations were found between all possible pairs of protective factors. Bivariate logistic regressions revealed that higher scores on each of the seven protective factors predicted nonattempter status; multivariate logistic regressions indicated that higher scores on measures of hope or social support-family showed unique predictive value for nonattempter status. Further, the multivariate model accurately predicted suicide attempt status 69.5% of the time. Partial support was found for a cumulative protective model hypothesizing a linear relationship between the number of protective factors endorsed and decreased risk for suicide attempts. Implications of these findings for community-based preventive intervention efforts and future research are discussed.

Psychopathology associated with suicide attempts among rural adolescents of China

This case control study examined the relationship between psychopathological profiles and self-reported suicide attempts among rural adolescents of China. Cases consisted of 142 adolescents who reported a suicide attempt in the past 6 months in a questionnaire survey (n=1365). An equal number of adolescents without reporting a suicide attempt, matched on age, gender, and school class, were selected from the same survey sample as controls. The Youth Self Report (YSR) was used to assess psychopathological profiles for suicide attempters and matched controls. Results indicated that 73% of suicide attempters had at least one behavioral/emotional syndrome, significantly higher than in controls (30%). Logistic regression analyses showed that anxiety/depression (OR = 3.68) and aggression (OR = 5.02) were each significantly associated with increased risk of suicide attempts after controlling for other behavioral problems. These findings demonstrated the independent contribution of anxiety/depression and aggression to suicide attempts in Chinese adolescents.

African American children's reports of depressed mood, hopelessness, and suicidal ideation and later suicide attempts

This study attempted to assess whether family demographic characteristics and child aggressive behavior are equal to or better than child self-reported depressive symptoms in predicting suicidal behavior. Participants were a community population of African Americans first recruited at age 6 and followed periodically through age 19-20. Measures included child self-reports of depressed mood, hopelessness, and suicidal ideation, teacher reported child aggression in grades 4-6, 6 th grade caregiver report of family demographic characteristics, and the participants' report at age 19-20 of suicide attempts. Depressed mood proved the most consistent predictor of adolescent/young adult attempts in our logistic regression analyses of the data from the population as a whole and among females. The relationship between depressed mood and suicide attempts in males was in the expected direction, but was not statistically significant. Teacher-reported youth aggressive behavior did prove to be a significant predictor of attempts in 4 th and 5 th grade for the population as a whole, but not in our analyses by gender. The relationships between family demographic characteristics and attempts failed to reach statistical significance, but were, generally, in the expected direction. The study revealed that African American children's self-reports of depressed mood as early as grade 4 may prove useful in predicting adolescent/young adult suicide attempts, particularly among females. Neither family demographics nor teacher-reported child aggressive behavior proved equal to child self-reported depressive symptoms in predicting later suicide attempts.

Social environment factors associated with suicide attempt among low-income African Americans: the protective role of family relationships and social support

BACKGROUND

Suicide and suicide attempts are important public health concerns, and recent decades have witnessed a rising rate of suicide among African Americans. A history of prior attempts is a leading risk factor for completed suicide. Further research is needed into the social environment risk factors for suicide attempt among African Americans. This study focused on two important dimensions of the social environment, family relationships and social support, as well as an important person-level risk factor--depressive symptoms.

METHOD

Data were obtained from a case-control study of 200 African American men and women aged 18-64 years, who sought services at a large, urban, public hospital. Odds ratios adjusted for significant sociodemographic differences between groups (aORs) were calculated for environment risk factors for suicide attempt among the cases and controls. The role of depressive symptoms was also studied.

RESULTS

Lower levels of family adaptability and family cohesion increased the relative rate of suicide attempt in the sample. The aOR associated with the lowest quartile of family adaptability was 3.90, and the aORs associated with the first and second quartiles of family cohesion were 8.91 and 5.51, respectively. Lower levels of social embeddedness and social support increased the relative rate of suicide attempt in our sample. The aOR associated with the first and second quartiles of social embeddedness were 5.67 and 4.93, respectively, and the aOR associated with the lowest quartile of social support was 6.29. A mediating role of depression was discovered when depressive symptoms were entered into the logistic regression models.

CONCLUSIONS

Our findings indicate that social environment factors including deficits in family functioning and social support are associated strongly with suicide attempts among low-income African American men and women seeking treatment in a large, urban hospital. Thus, better family functioning and social supports can be considered protective factors in this population. The presence of depressive symptoms, a well-known risk factor for suicide attempts and suicide, appears to mediate the association between social environment factors and suicide attempt.

Social predictors of suicidal behaviour in adolescents in Trinidad and Tobago

BACKGROUND

Previous research in Trinidad and Tobago has been limited in examining suicidal behaviours through psychological autopsy, secondary data and psychiatric populations. To date, there has been no community survey with an emphasis on causation and prevention.

METHODS

A total of 1,845 respondents aged 14-20 were selected in 24 schools across the country. Data were collected on socio-demographic variables and suicidal behaviour.

RESULTS

Gender differences existed for both suicidal ideation and attempts (p<0.001). Respondents from reconstituted families had higher suicidal ideation compared to other family structures (p<0.001), while intact families had the lowest rate for suicide attempts (p<0.01). Attendance to a religious institution lowered only suicidal ideation (p<0.05), while prayer with the family lowered both suicidal ideation (p<0.01) and suicide attempts (p<0.001). Individuals with alcohol abuse in the family had higher suicidal ideation (p<0.001) and attempts (p<0.001).

CONCLUSIONS

Significant social predictors of suicidal behaviour in Trinidad and Tobago are gender, attendance to a religious institution, prayer with the family, family structure and alcohol abuse in the family. It is essential to consider these predictors in planning public health policies.

The development of suicide ideation and attempts: an epidemiologic study of first graders followed into young adulthood

Studying community residing youths originally recruited for an intervention trial upon entry into first grade, this project sought to estimate risk of suicide ideation and attempts to young adulthood, with focus on those who used drugs before age 16, as compared to youths who used later in development or not at all. Standardized interview assessments in 1989-1994 were completed with 2311 youths age 8-15. Roughly 15 years after recruitment, our study team reassessed 1695, nearly 75% of the survivors (mean age = 21), finding 155 to have made suicide attempts (SA) and 218 with onset of depression-related suicide ideation (SI). We estimate relative risk (RR), from survival analysis and logistic regression models, to study early use of tobacco, alcohol, cannabis, and inhalants, with covariate adjustments for age, sex, race-ethnicity, and other pertinent covariates. Early-onset of cannabis use and inhalant use for females, but not for males, signaled modestly excess risk of suicide attempt (cannabis-associated RR = 1.9; p = 0.04; inhalant-associated RR = 2.2; p = 0.05). Early-onset of cannabis use by females (but not for males) signaled excess risk for suicide ideation (RR = 2.9; p = 0.006). Early-onset alcohol and tobacco use were not associated with later risk of SA or SI. In light of the relatively modest strength of association, the evidence may well reflect an underlying common diathesis or unmeasured prior confounding influences that link early-onset illegal drug use with later risk of these suicide-related events, rather than an influence of early-onset drug use per se.

Person Factors Associated With Suicidal Behavior Among African American Women and Men

This study compared person risk factors among the following groups of low-income, African American adults in an urban, public hospital: (a) suicide attempters and nonattempters, (b) male and female attempters, and (c) all 4 groups (50 female attempters, 50 female nonattempters, 50 male attempters, and 50 male nonattempters). Participants completed psychological distress, aggression, substance use, cognitive processes, religiosity/spirituality, and ethnic identity measures. Compared with nonattempters, attempters reported more psychological distress, aggression, substance use, and maladaptive coping strategies; less religiosity/spirituality; and lower levels of ethnic identity. Male attempters endorsed more substance use than female attempters. No person risk factors differentiated among the 4 groups. Assessment of person risk factors and implementation of commensurate culturally competent interventions are recommended.