Suicidal ideation and attempts among chemically dependent adolescents

Childhood adversity and racial discrimination forecast suicidal and death ideation among emerging adult Black men: A longitudinal analysis

OBJECTIVES

Disproportionate exposure to childhood adversity and the effects of racial discrimination take a toll on Black American men's mental health. Despite increasing rates of suicidal behaviors and thoughts among young adult, Black American men, few longitudinal studies examine their risk for suicidal and death ideation (SDI). We tested a developmental model linking childhood adversity (experiences of deprivation and threatening experiences) and emerging adult exposure to racial discrimination to increases in SDI and examined a potential mechanism for these effects, negative relational schemas.

METHOD

A sample of 504 Black men (Mage = 20.7) from rural Georgia were recruited with respondent-driven sampling and completed a baseline survey. Men participated in two additional follow-up surveys (Mage = 21.9 and Mage = 23.5). Hypotheses were tested using structural equation modeling.

RESULTS

Analyses largely supported the proposed model. Childhood adversities were associated directly with reports of SDI. Childhood deprivation indirectly predicted SDI via negative schemas (β = 0.03, 95% CI [.014, .046]). Racial discrimination also indirectly predicted SDI via negative relational schemas (β = 0.01, 95% CI [.001, .018]).

CONCLUSION

Study results suggest that clinical and preventive interventions for suicidality should target the influence of racism and adverse experiences and the negative relational schemas they induce. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effect of Mindfulness on Death Escape Acceptance in Young People: Emotion Regulation as a Mediator

Few studies have examined young people's attitudes toward death escape acceptance and its relationship to mindfulness. This study addressed this issue and examined the mediating role of emotion regulation. In Study 1, 61 undergraduate students aged 19-22 years participated in a mindfulness intervention program, and the results showed that increasing young people's levels of mindfulness could improve their attitudes toward death escape acceptance. The Study 2, which recruited 440 young people aged 18-26 years to complete a cross-sectional survey, replicated the main effect and showed that young people's difficulty in emotion regulation fully mediated the coping effect of mindfulness. These findings suggest that individuals with high levels of mindfulness may have low levels of difficulty in emotion regulation and in turn promote healthy attitudes toward death escape acceptance.

Perceived Chronic Social Adversity and Suicidal Ideation Among Chinese College Students: The Moderating Role of Hope

This study aimed to investigate the relations among perceived chronic social adversity, hope and suicidal ideation among Chinese college students. 535 college students completed the Perceived Chronic Social Adversity Questionnaire (PCSAQ), the Suicidal Ideation Scale (SIS), and the Revised Adult Dispositional Hope Scale (RADHS). The results showed that perceived chronic social adversity was positively associated with suicidal ideation, and hope was negatively associated with suicidal ideation. The results also confirmed that hope negatively moderated the relationship between perceived chronic social adversity and suicidal ideation. Further study showed that there was a significant positive relation between perceived chronic social adversity and suicidal ideation under the low hope level, however, there was a non-significant relation between perceived chronic social adversity and suicidal ideation under the high hope level.

Abnormal attentional bias in individuals with suicidal ideation during an emotional Stroop task: an event-related potential study

Introduction

There is increasing evidence that suicidal individuals exhibit an attentional bias toward negative or suicide-related stimuli, but the underlying neural mechanism remains unclear. This study aimed to investigate the neural mechanism of attentional bias toward emotional stimuli using a modified emotional Stroop task (EST) and to further explore the influencing factor of abnormal attention processing by identifying whether mental disorders or suicidal ideation contributes to attention processing disruptions.

Methods

Fourteen students with suicidal ideation and mental disorders (SIMDs), sixteen students with suicidal ideation but no mental disorders (SINMDs), and fourteen sex- and age-matched healthy controls (HCs) were recruited. Moreover, 64-channel electroencephalography (EEG) data and behavioral responses were recorded simultaneously during the EST. Participants were instructed to respond to the ink color for various types of words (positive, neutral, negative, and suicide) while ignoring their meanings. Event-related potentials (ERPs) were analyzed to evaluate attention to the stimuli. Spearman correlations between clinical psychological assessment scales and ERP signatures were analyzed to determine the risk factors for suicide.

Results

The results showed that the SIMD group exhibited longer early posterior negativity (EPN) latency compared to the SINMD and HC groups, indicating that early attention processing was affected during the EST, and the automatic and rapid processing of emotional information decreased. Furthermore, P300 latency for positive words was positively correlated with current suicidal ideation in the SINMD group, suggesting that delayed responses or additional processing to positive information may lead individuals with suicidal ideation to an incorrect interpretation of external events.

Conclusions

Generally, our findings suggest that the neural characteristics of the SIMD group differed from those of the SINMD and HC groups. EPN latency and P300 latency during the EST may be suicide-related neurophysiological indicators. These results provide neurophysiological signatures of suicidal behavior.

Depression and Suicidal Ideation among Patients Receiving Opioid Maintenance Treatments Considering Cognitive Flexibility

Objective: Cognitive flexibility is associated with psychiatric disorders. Drug addicts experience more psychiatric disorders. This research aimed to examine depression and suicidal ideation among those receiving opioid maintenance treatment (OMT), taking into account the mediating role of cognitive flexibility. Method : This cross-sectional research was conducted on patients who were enrolled in the OMT program in Semnan in 2021 and abstained from opioid use for at least one year. 126 participants (115 males and 11 females) were randomly selected from among patients in three therapeutic groups (42 from each of the methadone, buprenorphine, and opium tincture groups). The main data collection tools were the Beck Scale for Suicide Ideation (BSSI), Cognitive Flexibility Inventory (CFI), and Beck Depression Scale (BDI-II). Data analysis was done through logistic regression models. Results: Correlation analysis between depression scores, suicidal ideation, and cognitive flexibility showed a significant correlation between each of them. Adjusting for the type of treatment, the increase in cognitive flexibility was associated with a decreasing chance of depression (odds ratio [OR] = 0.87; 95% CI [0.82, 0.92]), and the use of buprenorphine (OR = 15.1) and opium tincture (OR = 9.3), compared to methadone, were associated with a depression increase. Yet, multivariate analysis did not show an independent and significant association between cognitive flexibility and the risk of suicide. Conclusion: Based on the results, patients receiving maintenance treatments are in different conditions in terms of depression and suicide, and psychological flexibility is in correlation with depression and suicidal thinking and behavior in them. This suggests that these patients seem to benefit from cognitive training, at least in reducing their depression.

A cross-lagged study of the associations among problematic smartphone use, depressive symptoms, and suicidal ideation in chinese university students

The present study aimed to investigate the longitudinal and reciprocal relationships among problematic smartphone use (PSU), depressive symptoms (DS), and suicidal ideation (SI) in Chinese university students. Using a cross-lagged design, the Mobile Phone Addiction Inventory Scale, the Center for Epidemiologic Studies Depression Scale, and the Self-Rating Idea of Suicide Scale as research instruments, 194 university students completed a questionnaire four consecutive times. June of Year 1, December of Year 2, June of Year 2, and December of Year 3 of their college study. We refer to these as the Time 1 (T1), Time 2 (T2), Time 3 (T3), and Time 4 (T4) assessments, respectively. The levels of PSU and DS fluctuated significantly over time. DS at T1 was significantly predicted to influence SI at T2 (β = 0.17, p < .05); DS at T3 was significantly predicted by PSU and by SI at T2 (respectively, β = 0.30, p < .05; β = 0.21, p < .05); DS at T2 significantly predicted PSU at T3 (β = 0.14, p < .05); and DS at T3 significantly predicted SI at T4 (β = 0.14, p < .05) in the cross-lagged pathway. DS at T3 fully mediated the relationship between PSU at T2 and SI at T4 (indirect effect: β = 0.133, 95% CI = [0.063, 0.213]). The results suggest that there is a reciprocal relationship between PSU and DS and, furthermore, that DS plays an important mediating role between PSU and SI. Our results suggest the importance of early identification and treatment of SI. Timely reduction of PSU and improvement of DS among university students may help prevent SI.

Correlates of suicidality in young people with depressive disorders: A systematic review

OBJECTIVE

Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders.

METHOD

Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15-25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines.

RESULTS

We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible.

CONCLUSION

Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.

Passive and active suicidal ideation among left-behind children in rural China: An evaluation of intrapersonal and interpersonal vulnerability and resilience

OBJECTIVE

Although theoretical conceptualizations of suicide hold that passive and active suicidal ideation are etiologically distinct, existing research observing this distinction is modest, with most prior studies focusing exclusively on active ideation. Understanding processes associated with passive ideation is clinically important insofar as passive ideation may precede active ideation, and thus serve as an earlier intervention target prior to potential onset of suicidal behavior. We aimed to evaluate intrapersonal and interpersonal vulnerability and resilience factors for passive ideation and differentiating passive from active ideation.

METHOD

Left-behind adolescents in rural China (n = 371) were assessed for passive and active ideation, depressive symptoms, rumination, grit, peer support, and peer victimization.

RESULTS

Overall, 15.9% of the sample endorsed passive ideation without active ideation, and 17.8% endorsed active ideation. In multivariate analyses, rumination and grit differentiated left-behind children with passive ideation from those with no ideation. Depressive symptom severity predicted active ideation among adolescents with passive ideation.

CONCLUSIONS

The current findings suggest that rumination and grit may characterize passive ideation. Although passive and active ideation may differ modestly in vulnerability and resilience factors, depressive symptoms may be important to monitor among those with passive ideation and have not yet experience active ideation.

Differences in Behavioral Inhibitory Control in Response to Angry and Happy Emotions Among College Students With and Without Suicidal Ideation: An ERP Study

Suicidal ideation is one of the strongest predictors of suicide. A large number of studies have illustrated the important effect of impulsivity on suicidal ideation, and behavioral inhibitory control (BIC) is a specific manifestation of impulsivity. The goal of the present study is to evaluate the difference in BIC in response to happy and angry emotions between individuals with or without suicidal ideation to reveal the underlying mechanism of the effect of impulsivity on suicidal ideation when accounting for the effect of emotion. Combining the ERP technique and the two-choice oddball paradigm, a total of 70 college students were recruited to participate in this study. The Beck Scale for Suicidal Ideation–Chinese Version was used to identify whether the participants had suicidal ideation. There were 30 participants in the risky-suicidal ideation (SI) group and 19 participants in the non-suicidal ideation (NSI) group. The results showed that the reaction time of the SI group was longer than that of the NSI group for happy emotions. At the electrophysiological level, the P3 amplitude of the NSI group was larger than that of the SI group regardless of the electrode sites and valence, and the P3 component elicited by angry faces was larger than those elicited by happy faces in the SI group. These findings suggest that individuals without suicidal ideation have better BIC, and the SI group has more difficulty controlling their responses to happy emotions than their responses to angry emotions.

Association of Childhood Maltreatment With Suicide Behaviors Among Young People: A Systematic Review and Meta-analysis

Importance

Children and young people's reports of experiences of adverse childhood events have increased in recent years, and this trend has been associated with an elevated risk for suicide behaviors. However, a systematic review and meta-analysis is needed to confirm the significance of this association in young people.

Objective

To quantify the association between core types of childhood maltreatment, including sexual, physical, and emotional abuse and/or neglect and suicide behaviors in children and young adults.

Data Sources

Medline, PsychInfo, Embase, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health) databases were searched from January 1, 1980, until December 31, 2019. The reference lists of all the included studies were also checked.

Study Selection

Quantitative studies that focused on the association between core types of childhood abuse and/or neglect and suicide ideation, plans, and attempts.

Data Extraction and Synthesis

Data were extracted by 2 independent raters. Publication bias and risk of bias across studies were assessed. Meta-analyses using random-effect models were applied, and heterogeneity was quantified using the I2 statistic. Data were analyzed from January to May 2020 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines.

Main Outcomes and Measures

The association between core types of childhood maltreatment and suicide behaviors.

Results

Seventy-nine studies with 337 185 young individuals (mean [SD] age, 15.67 [2.11] years; 63.19% female) were included. The findings demonstrated that sexual abuse (odds ratio [OR], 3.41; 95% CI, 2.90-4.00), physical abuse (OR, 2.18; 95% CI, 1.75-2.71), emotional abuse (OR, 2.21; 95% CI, 1.37-3.57), emotional neglect (OR, 1.93; 95% CI, 1.36-2.74), physical neglect (OR, 1.79; 95% CI, 1.27-2.53), and combined abuse (OR, 3.38; 95% CI, 2.09-5.47) were significantly associated with higher rates of suicide attempts. Core types of childhood maltreatment were also associated with as much as 2.5-fold greater odds for suicide ideation, and sexual abuse with a 4.0-fold increase for suicide plans. Studies based on community samples (β [SE] = -1.68 [0.79]; P = .04) or with lower methodological quality (β [SE] = -2.86 [1.30]; P = .03) were associated more strongly with suicide attempts in those reporting experiences of sexual abuse, whereas young age was associated with both suicide attempts (β [SE] = -0.59 [0.27]; P = .03) and ideation (β [SE] = -0.41 [0.18]; P = .03).

Conclusions and Relevance

These findings suggest that policy actions should focus on raising public awareness and offering proactive suicide prevention therapies for children and young adults who have experienced abuse and/or neglect.

Emotion reactivity, nonsuicidal self-injury, and regulatory emotional self-efficacy: A moderated mediation model of suicide ideation

BACKGROUND

Adolescent suicide ideation (SI) has received increased attention in recent years, and emotion reactivity (ER) has been found to be a risk factor for SI. However, little is known about the mediating and moderating mechanisms underlying this relationship. The aim of this study is to test a moderated mediation model of SI.

METHOD

A total of 2,716 Chinese adolescents (53.2% males, mean age = 13.19 years, SD = 0.52) completed self-report questionnaires regarding SI, ER, nonsuicidal self-injury (NSSI), and regulatory emotional self-efficacy (RESE).

RESULTS

After controlling for gender, ER was significantly associated with SI, and this association was mediated by NSSI. RESE buffered the relation between ER and SI, as well as the relation between ER and NSSI.

LIMITATION

This study was cross-sectional in design and relied upon self-report measures only. Almost all participants were recruited from a single city of China.

CONCLUSION

Findings of this study demonstrate a relationship among ER, NSSI, and SI, and expand our understanding of the development of SI. Further, RESE may be a protective factor against SI and NSSI in adolescence, which suggests a potential role of promoting RESE in the prevention and intervention of SI and NSSI.

Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation

BACKGROUND

Compared to active ideation, passive ideation remains relatively understudied and its clinical importance poorly defined. The weight that should be accorded passive ideation in clinical risk assessment is therefore unclear.

METHODS

We conducted a systematic review and meta-analysis of the prevalence of passive ideation, its psychiatric comorbidity, associated sociodemographic characteristics, as well as psychological and environmental correlates. For reference, pooled effects were also calculated for direct comparisons of passive and active ideation with respect to potential correlates. Relevant articles published since inception to 9 September 2019 were identified through a systematic search of MEDLINE and PsycINFO.

RESULTS

A total of 86 studies were included in this review. The prevalence of passive ideation was high across sample types, ranging from 5.8% for 1-year prevalence to 10.6% for lifetime prevalence in the general population. Passive ideation was strongly associated with sexual minority status, psychiatric comorbidity, psychological characteristics implicated in risk, and suicide attempts. Preliminary evidence exists for a large association with suicide deaths. The effect sizes for individual correlates of passive and active ideation were largely equivalent and mostly non-significant in head-to-head comparisons.

CONCLUSIONS

Passive ideation is a prevalent clinical phenomenon associated with significant psychiatric comorbidity. Current evidence also suggests notable similarities exist between passive and active ideation in terms of psychiatric comorbidity and psychological and other characteristics traditionally associated with risk.

Effect of Same-Sex Marriage Referendums on the Suicidal Ideation Rate among Nonheterosexual People in Taiwan

: Taiwan held voter-initiated referendums to determine same-sex marriage legalization on 24 November 2018. This study aims to compare suicidal ideation rates in heterosexual and nonheterosexual participants of a first-wave survey (Wave 1, 23 months before the same-sex marriage referendums) and a second-wave survey (Wave 2, one week after the same-sex marriage referendums) in Taiwan and to examine the influence of gender, age, and sexual orientation on the change in suicidal ideation rates in nonheterosexual participants. In total, 3286 participants in Wave 1 and 1370 participants in Wave 2 were recruited through a Facebook advertisement. Each participant completed an online questionnaire assessing suicidal ideation. The proportions of heterosexual and nonheterosexual participants with suicidal ideation were compared between the Wave 1 and Wave 2 surveys. Suicidal ideation rates between participants in the Wave 1 and Wave 2 surveys were further compared by stratifying nonheterosexual participants according to gender, age, and sexual orientation. Nonheterosexual participants in the Wave 2 survey had a higher suicidal ideation rate than those in the Wave 1 survey, whereas no difference was observed in suicidal ideation rates between heterosexual participants in Wave 2 and Wave 1. Nonheterosexual participants who were female, younger, gay, lesbian, and bisexual in Wave 2 had a higher suicidal ideation rate than those in Wave 1. The suicidal ideation rate significantly increased in nonheterosexual participants experiencing the same-sex marriage referendums in Taiwan. Whether civil rights of sexual minority individuals can be determined through referendums should be evaluated.

Relationship between binge drinking experience and suicide attempts in Korean adolescents: based on the 2013 Korean Youth Risk Behavior Web-based Survey

OBJECTIVES

Suicide and drinking problems in adolescents are increasing every year, and it is known that suicide is related to drinking. This study aims to identify the relationship between binge drinking experience (BDE) and suicide attempts in Korean adolescents.

METHODS

The Ninth Korean Youth Risk Behavior Web-based Survey (KYRBS), conducted in 2013, was used for analysis. Multiple logistic regression analysis was used to identify the relationship between BDE and suicide attempts, and the relationship between BDE and suicide attempts in middle and high school students was stratified by age.

RESULTS

BDE and suicide attempts were highly related. The odds ratio (OR) of attempted suicide in BDE was 1.63 times (95% confidence interval [CI], 1.28 to 2.09) higher then non-drinking in males. And the OR of attempted suicide in females was 1.21 times (95% CI, 1.07 to 1.37) higher then non-drinking in non-BDE, 1.79 times (95% CI, 1.47 to 2.19) higher in BDE. BDE was associated with suicide attempts in males aged 12 or 13 years (OR, 3.97; 95% CI, 1.57 to 10.03) and in females aged 15 years (OR, 2.66; 95% CI, 1.79 to 3.96).

CONCLUSIONS

BDE is an important factor related to suicide attempts in adolescents. In order to reduce suicide attempts, it is necessary to educate the youth about the regulation of BDE and drinking prevention.

Evaluation of drug use and medication compliance in adolescents admitted to a psychiatric facility from the pediatric emergency department

OBJECTIVES

Knowledge of drug use and medication compliance during mental health evaluation can help guide evaluation and treatment. The objective was to evaluate drug use and medication compliance in a pediatric emergency department (PED) psychiatric population by comparing medical history, standard urine drug screen (EIA), and expanded urine drug screen (HPLC-MS/MS).

METHODS

A prospective cohort study of admitted psychiatric patients ≥13years and ≤18years in a tertiary-care children's hospital psychiatric ED from January 31, 2013 through April 16, 2014.

RESULTS

100 patients in our PED were enrolled. Marijuana was the most commonly admitted and detected substance; 43% had co-ingestions. HPLC-MS/MS revealed 36 additional substance exposures than identified by history. All substances detected by EIA were also detected by HPLC-MS/MS. Combination of history and HPLC-MS/MS revealed the most substances used. HPLC-MS/MS identified antidepressants in 76% of patients prescribed a detectable antidepressant.

CONCLUSION

Marijuana use was greater than nicotine use and was associated with concomitant polysubstance abuse. A combination of history and HPLC-MS/MS was the most thorough in obtaining history of drug use. Almost a quarter of patients did not have their prescribed antidepressant detected by HPLC-MS/MS. A rapid, affordable expanded drug screen should replace the more standard limited drug screen particularly for patients who are refractory to treatment.

A Longitudinal Study of Racial Discrimination and Risk for Death Ideation in African American Youth

Although multiple studies have found that African Americans commonly experience racial discrimination, available studies have yet to examine how perceived racism might be related to suicide vulnerability in African American youth. The purpose of this study was to examine a framework for how perceived racial discrimination contributes to symptoms of depression and anxiety as well as subsequent suicide ideation and morbid ideation. Data were obtained from 722 African American youth at mean age 10.56 years (SD = 0.64); a second wave of data was obtained 2 years later. Results revealed both a direct effect and mediated effects of perceived racism on later suicide and morbid ideation. For boys and girls, the effect of perceived racism was mediated by symptoms of depression. However, the association was mediated by anxiety for girls, but not for boys in the current sample. Implications for future research and interventions are discussed.

[Efficacy of repetitive transcranial magnetic stimulation for alleviating clinical symptoms and suicidal ideation in elderly depressive patients: a randomized controlled trial]

OBJECTIVE

To assess the efficacy of repetitive transcranial magnetic stimulation (rTMS) for alleviating the clinical symptoms and suicidal ideation in elderly patients with depression.

METHODS

A total of 178 elderly depressive patients with suicidal ideation were randomized into rTMS treatment group (n=80) and control group (n=98) and treated with rTMS or sham rTMS treatment for 4 weeks in addition to conventional therapy with medications. The 24-item Hamilton Depression Scales (HAMD) and Self-rating Idea of Suicide Scale (SIOSS) were used to assess the severity of depression and the risk of suicide at the baseline and after 2 and 4 weeks of treatment. The treatment response was defined as a 25% reduction in HAMD scores from baseline, and an early improvement as 20% reduction in HAMD scores after 2 weeks of treatment.

RESULTS

The two groups of patients were comparable for baseline socio-demographic characteristics and baseline SIOSS and HAMD scores (P>0.05). After 2 and 4 weeks of treatment, both SIOSS and HAMD scores were improved in the two groups, but the patients in rTMS group showed a significantly faster score reduction. A significantly higher rate of early improvement at 2 weeks (52.5% vs 28.6%; χ²=10.569, P<0.01) and a higher response rate at 4 weeks (77.5% vs 53.1%; χ²=15.470, P<0.05) were observed in rTMS group.

CONCLUSIONS

rTMS combined with medications can effectively improve sleep quality, cognitive impairment and somatization symptom and reduce suicidal ideation in elderly patients with depression.

Characteristics of 61 Mexican American Adolescents Who Attempted Suicide

A total of 61 Mexican American adolescents who were consecutively admitted to an inpatient psychiatric unit after a suicide attempt were studied. They were given structured interviews to study their demographic, personal, and family characteristics. The intent of the suicide attempts was measured with the Pierce Suicide Intent Scale. Compared to subjects in the low-intent group, those in the high-intent group showed a history of more frequent previous suicide attempts (p < .03), had lived with both biological parents for a longer time (p < .04), usually had at least one biological parent at home at the time of the suicide attempts (p < .001), and had lived in the United States for a shorter period of time (p < .04). Psychosocialfactors including the phenomenon of acculturation are reviewed in the discussion of these results.

Adolescent Depression and Suicide: A Review and Analysis of the Current Literature

Adolescent suicide is a major worldwide problem. Reported rates for suicide ideation, attempts, and completion are particularly high in developed countries. For Canada, the suicide rate for adolescents consistently has been among the highest of those rates reported. Despite significant gouvernment attempts at intervention and public atigst when confronted with specific tragic examples of adolescent suicide, the rate does not appear to be significantly decreasing. This article reviews the nature and extent of suicide among Canadian adolescents. It also provides a brief overview of current assessment and treatment perspectives. With this information, school teachers, counsellors, and psychologists may be better informed regarding the significant problem of adolescent suicide in Canada and hence better prepared to recognize adolescents at high risk of suicide and to appropriately intervene.

Firearm Violence, Disability Rights, and Rehabilitation

The demographics of disability in the United States are changing. A rapidly increasing minority within the larger disabled population consists of individuals who have become disabled as the direct result of firearm-related violence. This population of individuals differs markedly from those disabled from birth or as a result of accident or chronic illness, causes that have historically been familiar to our established medical and rehabilitation systems. Firearm victims tend to be younger and relatively poorly educated and are disproportionately drawn from ethnic and minority communities. Furthermore, many seem to have a host of previous problems : alcohol and drug dependency, HIV+ status, and prior histories of domestic and interpersonal violence. To date, we know little about this population, but what we do know indicates that attending to their needs will represent a substantial challenge to the current rehabilitation system and to the disability rights community.

Risk factors of repeated infectious disease incidence among substance-dependent girls and boys court-referred to treatment

BACKGROUND

A small portion of Americans account for a disproportionate amount of the incidences of sexually transmitted infection observed over a short period of time. Studies with adults have begun to characterize this population, yet there is very little data on adolescent sexually transmitted infection repeaters (STIR). This study explores characteristics associated with STIR among 102 girls and 93 boys (aged 14-18) court-referred for residential treatment.

METHODS

Background characteristics, substance use disorders, risky and interpersonal behaviors, and history of sexually transmitted infections were collected at intake using valid and reliable instruments. A negative binomial logistic regression was performed to determine the background, risky behaviors, and social patterns associated with adolescent STIR.

RESULTS

Approximately two out of three adolescents (62%) did not use contraception the last time they had sex, and 15% had at least one sexually transmitted infection recorded in their medical chart. Sexually transmitted infection repeaters entered treatment with higher rates of cocaine abuse (13%) than youth without multiple infections (3%, p < 0.05). History of sexual abuse, having sex with a person who said no, higher exhibitionism, and social estrangement increased the odds of adolescent STIR. Main effects of exhibitionism and social estrangement on increased odds of STIR were more pronounced for sexually abused adolescents.

CONCLUSIONS

The findings suggest a need for incorporating HIV education during residential treatment to improve health outcomes and intervention strategies that further connectedness for youth and victims of sexual abuse.

Daily Spiritual Experiences and Adolescent Treatment Response

The purpose of this study is to explore changes in belief orientation during treatment and the impact of increased daily spiritual experiences (DSE) on adolescent treatment response. One-hundred ninety-five adolescents court-referred to a 2-month residential treatment program were assessed at intake and discharge. Forty percent of youth who entered treatment as agnostic or atheist identified themselves as spiritual or religious at discharge. Increased DSE was associated with greater likelihood of abstinence, increased prosocial behaviors, and reduced narcissistic behaviors. Results indicate a shift in DSE that improves youth self-care and care for others that may inform intervention approaches for adolescents with addiction.

Differences in the quality of life of two groups of drug users

Objectives: The aim of this study was to compare aspects of the quality of life of drug users on a methadone maintenance programme to drug users on a harm minimisation programme.

Method: Thirty-six clients attending the harm minimisation programme in the National Drug Treatment Centre, Dublin, were matched for age and sex to 36 clients on the methadone maintenance programme. All were interviewed with the SF-36 Health Survey Questionnaire to measure health related quality of life and with the Hospital Anxiety and Depression Scale (HADs) to measure psychological morbidity.

Results: More clients from the harm minimisation programme had previous psychiatric problems than clients on the methadone maintenance programme, with an odds ratio of 4.3 CI(1.2,15.2). On the HADs, clients on the methadone maintenance programme had significantly lower depression scores than clients on the harm minimisation programme. In addition more clients on the harm minimisation programme were severely depressed than clients on the methadone maintenance programme. On the UK SF-36 Scale, clients on the harm minimisation programme perceived a significantly greater deterioration in ‘change in health’ over the previous year than clients on the methadone maintenance programme.

Conclusions: Although clients on a methadone maintenance programme had an improved perception of their quality of life in relation to psychological and overall health function from the previous year, compared to clients on a harm minimisation programme, there still existed varying degrees of psychopathology in both groups which need to be considered when providing future services for drug users.

Risk of psychiatric and neurological diseases in patients with workplace mobbing experience in Germany: a retrospective database analysis

Introduction: The number of mobbing experiences recorded has increased during recent years and it has now been established as global phenomenon among the working population. The goal of our study was to analyze the incidence of certain neurologic and psychiatric diseases as a consequence of mobbing as compared with a control group and to examine the possible influence of previous diseases that occurred within one year before the first mobbing documentation on the incidence of mobbing.

Material & methods: We used a large database (IMS^® Disease Analyzer, Germany) to collect data from general practitioners in Germany from 01/2003 until 12/2012. Based on age, gender, and health insurance, patients with experience of mobbing were matched with a control group of patients who had not reported workplace mobbing and who were being treated by the same physicians. At first, diseases that occurred within one year before the bullying experience took place (“index date”) were noted and compared to a control group of similar composition in terms of gender, age, and health insurance. Subsequently, the prevalence of depression, anxiety, somatoform disorders, and sleep disorders following experiences of mobbing were determined. After adjustment to take into account the odds of bullying, the ratios of these diseases were assessed using a logistic regression model.

Results: The study population consisted of n=2,625 patients and n=2,625 controls, of which 33% were men. The number of cases of bullying documented rose continuously from 2003 to 2011 and remained high in 2012. Those who would later become victims of mobbing demonstrated a considerably higher prevalence of diseases in general – these diseases were not confined to the neurologic-psychiatric spectrum. Following experiences of bullying, depression, anxiety, somatoform disorders, and sleep disorders were significantly more prevalent than in the control group (for all, p<0.05). Similarly, odds ratios (OR) representing the risk of suffering from diseases were higher in affected patients, with the highest value (4.28) for depression and the lowest value for sleep disorders (OR=2.4).

Conclusion: Those who will later become the victims of bullying are more prone to suffer from diseases in general, even before this experience of mobbing has occurred, which underlines the importance of supporting (chronically) ill patients to protect them against bullying. Sequelae of mobbing include, in particular, diseases from the neurologic-psychiatric spectrum.

The relation between child maltreatment and adolescent suicidal behavior: a systematic review and critical examination of the literature

A large body of research suggests that child maltreatment (CM) is associated with adolescent suicidal ideation and attempts. These studies, however, have not been critically examined and summarized in a manner that allows us to draw firm conclusions and make recommendations for future research and clinical work in this area. In this review, we evaluated all of the research literature to date examining the relationship between CM and adolescent suicidal ideation and attempts. Results generally suggest that childhood sexual abuse, physical abuse, emotional abuse, and neglect are associated with adolescent suicidal ideation and attempts across community, clinical, and high-risk samples, using cross-sectional and longitudinal research designs. In most studies, these associations remain significant when controlling for covariates such as youth demographics, mental health, family, and peer-related variables. When different forms of CM are examined in the same multivariate analysis, most research suggests that each form of CM maintains an independent association with adolescent suicidal ideation and suicide attempts. However, a subset of studies yielded evidence to suggest that sexual abuse and emotional abuse may be relatively more important in explaining suicidal behavior than physical abuse or neglect. Research also suggests an additive effect-each form of CM contributes unique variance to adolescent suicide attempts. We discuss the current limitations of this literature and offer recommendations for future research. We conclude with an overview of the clinical implications of this research, including careful, detailed screening of CM history, past suicidal behavior, and current suicidal ideation, as well as the need for integrated treatment approaches that effectively address both CM and adolescent suicidal ideation and suicide attempts.

The association between suicidality and Internet addiction and activities in Taiwanese adolescents

OBJECTIVE

The aims of this cross-sectional study were to examine the associations of suicidal ideation and attempt with Internet addiction and Internet activities in a large representative Taiwanese adolescent population.

METHODS

9510 adolescent students aged 12-18 years were selected using a stratified random sampling strategy in southern Taiwan and completed the questionnaires. The five questions from the Kiddie Schedule for Affective Disorders and Schizophrenia were used to inquire as to the participants' suicidal ideation and attempt in the past one month. The Chen Internet Addiction Scale was used to assess participants' Internet addiction. The kinds of Internet activities that the adolescents participated in were also recorded. The associations of suicidal ideation and attempt with Internet addiction and Internet activities were examined using logistic regression analysis to control for the effects of demographic characteristics, depression, family support and self-esteem.

RESULTS

After controlling for the effects of demographic characteristics, depression, family support and self-esteem, Internet addiction was significantly associated with suicidal ideation and suicidal attempt. Online gaming, MSN, online searching for information, and online studying were associated with an increased risk of suicidal ideation. While online gaming, chatting, watching movies, shopping, and gambling were associated with an increased risk of suicidal attempt, watching online news was associated with a reduced risk of suicidal attempt.

CONCLUSIONS

The results of this study indicated that adolescents with Internet addiction have higher risks of suicidal ideation and attempt than those without. Meanwhile, different kinds of Internet activities have various associations with the risks of suicidal ideation and attempt.

Risk Factors for Suicidal Ideation among College Students: 6-Month Follow-up

This study was a 6-month follow-up study examining risk factors for suicide among college students. The sample included 95 participants who also participated in the first data collection period. Online questionnaires were completed by participants from the first wave. Thirteen percent of the sample had clinically significant levels of suicidal ideation, 3.2% met the criteria for dysthymia, and 15.8% and 17.9% met the DSM-IV criteria for a diagnosis of Major Depressive Disorder and Generalized Anxiety Disorder, respectfully. About 9.5% met criteria for alcohol dependence and 16.8% met criteria for drug abuse. Overall, 23% of the variance was explained in suicidal ideation with depressive symptoms, presence of anxiety, and high relational victimization scores attributing to 15% of the variance. Results of the 6-month follow-up support prior research suggesting high correlation between Major Depressive Disorder and suicidal ideation. However, there was no correlation found between levels of suicidal ideation and Generalized Anxiety Disorders.

Cyber bullying and physical bullying in adolescent suicide: the role of violent behavior and substance use

The impact of bullying in all forms on the mental health and safety of adolescents is of particular interest, especially in the wake of new methods of bullying that victimize youths through technology. The current study examined the relationship between victimization from both physical and cyber bullying and adolescent suicidal behavior. Violent behavior, substance use, and unsafe sexual behavior were tested as mediators between two forms of bullying, cyber and physical, and suicidal behavior. Data were taken from a large risk-behavior screening study with a sample of 4,693 public high school students (mean age = 16.11, 47 % female). The study's findings showed that both physical bullying and cyber bullying associated with substance use, violent behavior, unsafe sexual behavior, and suicidal behavior. Substance use, violent behavior, and unsafe sexual behavior also all associated with suicidal behavior. Substance use and violent behavior partially mediated the relationship between both forms of bullying and suicidal behavior. The comparable amount of variance in suicidal behavior accounted for by both cyber bullying and physical bullying underscores the important of further cyber bullying research. The direct association of each risk behavior with suicidal behavior also underscores the importance of reducing risk behaviors. Moreover, the role of violence and substance use as mediating behaviors offers an explanation of how risk behaviors can increase an adolescent's likelihood of suicidal behavior through habituation to physical pain and psychological anxiety.

Substance abuse and suicide risk among adolescents

The aim of this paper was to review the literature concerning the relationship between suicide and substance abuse behaviours among adolescents, focusing on epidemiology, comorbidity and preventive programmes. We performed a Pubmed/Medline, Scopus, PsycLit and PsycInfo search to identify all papers and book chapters during the period between 1980 and 2011. Adolescents with substance abuse disorder who attempt or complete suicide can be characterized as having mood disorders, stressful life events, interpersonal problems, poor social support, lonely lives and feelings of hopelessness. The research supports the existence of a strong relationship between suicide and substance abuse. Preventive programmes should be based on the detection of risk factors associated with both suicide and substance abuse disorder. Management programmes should combine different therapeutic strategies such as peer-to-peer education, school-based programmes, psychotherapy and pharmacological treatment. Evidence suggests that targeted suicide prevention programmes can be delivered which reduce the burden associated with substance abuse and suicide in youths.

The relationship between dating violence and suicidal behaviors in a national sample of adolescents

Relationship violence is a common problem faced by adolescents in the United States. In general, adolescents are at higher risk for relationship victimization than adults (Silverman, Raj, Mucci, & Hathaway, 2001), and females between the ages of 16 and 24 years are at the highest risk of relationship victimization (Rennison, 2001). This study uses data from the 2007 Youth Risk Behavior Surveillance (YRBSS) System (or referred to as Youth Risk Behavior Survey [YRBS]; N = 11,781) of adolescents between the ages of 14 and 17 years to estimate two logistic regression models on the association between relationship violence and suicidal behaviors controlling for variables such as sexual assault and drug use. The findings indicated that victimized adolescents are at higher risk for planning and/or attempting suicide compared to nonvictimized adolescents. Implications for research and practice are explored.

Exposure to alcohol, drugs and tobacco and the risk of subsequent suicidality: findings from the Mexican Adolescent Mental Health Survey

AIMS

To examine whether the association between prevalence measures of suicidality and substance abuse/dependence among adolescents (1) is attenuated when temporal priority of exposure and outcome are taken into account, (2) extends to substance use (i.e. without disorder), (3) applies to tobacco use and dependence independent of illicit drugs and alcohol use/disorder, and (4) is confounded by comorbid mental illness.

DESIGN

Discrete-time survival models were applied to retrospectively reported age of onset of first suicidal ideation, plan and attempt and age of onset of first substance use and disorder.

PARTICIPANTS

3005 adolescents aged 12-17 residing in the Mexico City Metropolitan Area in 2005.

MEASUREMENTS

The World Mental Health computer-assisted adolescent version of the Composite International Diagnostic Interview was used to assess suicidal outcomes and psychiatric disorders including substance dependence/abuse.

FINDINGS

Use of and dependence on tobacco is as strong a predictor of subsequent suicidality as is use of and dependence with abuse of alcohol and drugs. The association between substance use and subsequent suicidality is not fully accounted for by comorbid mental illness.

CONCLUSION

Efforts to reduce the use as well as the abuse of alcohol, drugs and tobacco may help reduce the risk of subsequent suicidal behaviors among adolescents in Mexico.

A prospective investigation of suicide ideation, attempts, and use of mental health service among adolescents in substance abuse treatment

This study examined suicide ideation, attempts, and subsequent mental health service among a sample of 948 youth from substance abuse treatment facilities across the United States. Youth were surveyed at intake and every 3 months for a 1-year period. Thirty percent of youth reported ideating in at least one interview, and 12% reported attempting suicide; almost half of all youth reported receiving outpatient mental health treatment at least once, and close to one-third of all youth reported being on prescription drugs for an emotional or behavioral problem. Higher levels of conduct disorder symptoms were associated with both ideation and attempts, while higher levels of depressive symptoms and being female were associated with ideation only. Among all youth, older youth were less likely to receive outpatient and prescription drug treatment, and Black and Hispanic youth were less likely to receive prescription drug treatment than White youth. Among youth who reported ideating, those with conduct disorder were less likely to receive prescription drug treatment 3 months later. These findings emphasize a high prevalence of suicide risk behavior in substance abuse treatment programs and provide insight into the specialized treatment youth in substance abuse treatment at risk for suicide currently receive.

Ethnicity, socio-economic status and self-harm in Swedish youth: a national cohort study

BACKGROUND

Previous studies have shown an elevated risk for self-harm in adolescents from ethnic minorities. However, potential contributions to this risk from socio-economic factors have rarely been addressed. The main aim of this article was to investigate any such effects.

METHOD

A national cohort of 1009 157 children born during 1973-1982 was followed prospectively from 1991 to 2002 in Swedish national registers. Multivariate Cox analyses of proportional hazards were used to estimate the relative risk of hospital admission for self-harm. Parental country/region of birth was used as proxy for ethnicity.

RESULTS

Youth with two parents born outside Sweden (except those from Southern Europe) had higher age- and gender-adjusted hazard ratios (HRs) of self-harm than the majority population (HR 1.6-2.3). The HRs decreased for all immigrant groups when socio-economic factors were accounted for but remained significantly higher for immigrants from Finland and Western countries and for youth with one Swedish-born and one foreign-born parent.

CONCLUSIONS

Socio-economic factors explain much of the variation by parental country of birth of hospital admissions for self-harm in youth in Sweden.

Challenges and opportunities in the treatment of adolescents with substance use disorder and suicidal behavior

Many youth who present for substance abuse treatment report co-occurring suicidality. Therefore, it is important to learn about the characteristics of this population and effective treatment strategies. The purpose of this paper is to provide an overview of some of the key issues that arise when treating youth with substance abuse and co-occurring suicidality and to offer recommendations on how to approach these areas. Specifically, we discuss the potential utility of an integrated approach to treatment, and provide an overview of the characteristics of this treatment population, motivational and treatment engagement issues, the clinical management of suicidality in the context of treatment, and the effect of psychiatric comorbidity on treatment needs. We then discuss school, family, and peer issues that may arise as well as special considerations for the use of urine drug screens with this population. We conclude with recommendations for future treatment development research in this very important area.

Adolescent Suicidal Behavior and Substance Use: Developmental Mechanisms

Adolescent suicidal behaviors and substance use are disturbingly common. Research suggests overlap of some of the etiological mechanisms for both adolescent suicidal behavior and substance use, yet clear understanding of the complex relations between these behaviors and their causal underpinnings is lacking. A growing body of evidence and a diathesis model (Mann et al. 1999; Mann, 2003) highlight the importance of impulse control as a proximal risk factor for adolescent suicidal and substance use behaviors. This literature review extends current theory on the relationships between adolescent suicidal behavior and substance use by: (1) examining how, when, and to what extent adolescent development is affected by poor impulse control, stressful life events, substance use behavior, and biological factors; (2) presenting proposed causal mechanisms by which these risk factors interact to increase risk for suicidal behaviors and substance use; and (3) proposing specific new hypotheses to extend the diathesis model to adolescents at risk for suicide and substance use. More specifically, new hypotheses are presented that predict bidirectional relationships between stressful life events and genetic markers of 5-HT dysregulation; substance use behavior and impulsivity; and substance use behavior and suicide attempts. The importance of distinguishing between different developmental trajectories of suicidal and substance use behaviors, and the effects of specific risk and protective mechanisms are discussed. Use of new statistical approaches that provide for the comparison of latent growth curves and latent class models is recommended to identify differences in developmental trajectories of suicidal behavior and substance use. Knowledge gained from these prospective longitudinal methods should lead to greater understanding on the timing, duration, and extent to which specific risk and protective factors influence the outcomes of suicidal behavior and substance use. In turn, findings from these studies should inform researchers who conduct future treatment and prevention studies.

The relationship between lifetime abuse and suicidal ideation in a sample of injection drug users

This study examined the relationship between lifetime abuse and suicidal ideation in a sample of 245 injection drug users (IDUs) who attended the Baltimore Needle Exchange Program and received a referral for opiate agonist therapy. Data were obtained from baseline interviews and HIV antibody tests. The sample mean age was 42.2 (SD = 8.1 ); 77% were African American; 69% were male. Overall, 27% reported thoughts of suicide in the last six months, and lifetime emotional, physical and sexual abuse was reported by 17%, 12% and 10%, respectively. In bivariate analyses, recent suicidal ideation was associated with emotional (odds ratio [OR] = 3.2; p = 0.001), physical (OR = 2.5; p = 0.026), and sexual abuse (OR = 5.0; p < 0.001). In multiple logistic regression models controlling for HIV status and Center for Epidemiological Studies Depression (CES-D) score, individuals who experienced emotional abuse were more than twice as likely to report recent suicidal ideation (adjusted odds ratio [AOR] = 2.6; p = 0.011); those who experienced sexual abuse were four times more likely to report suicidal ideation (AOR = 4.0; p = 0.004). These findings suggest that emotional and sexual abuse might be risk factors for suicidality among IDUs and also might suggest that suicide prevention should be an integral part of drug treatment for treatment-seeking IDUs.

Preventing Suicide: A Neglected Social Work Research Agenda

Social workers encounter suicidal clients; however, little is known about social work's empirical knowledge base for suicide assessment and treatment. In the first comprehensive study of social work's contribution to the suicide literature, the authors conducted systematic electronic and manual searches for suicide research published in peer-reviewed journals by social work investigators for the period 1980-2006, with the purpose of ascertaining the state of clinical knowledge related to suicide risk factors and effective treatments. These findings reveal that despite recent increases to the study of suicide by social work researchers, they have contributed limited evidenced-based knowledge in the last twenty-six years on the treatment or prevention of suicide or suicide-related behaviours. The article outlines the risk factors for suicide and discusses the implications for clinical social work practice and research.

Adolescent Substance Use and Suicidal Behavior: A Review With Implications for Treatment Research

Adolescent substance use (alcohol and other drugs) and suicidal behavior, independently, pose serious public health problems. Youths who report co-occurring substance use and suicidality are a particularly high-risk group. In this review, we explore four areas that are pertinent to research with substance-abusing and suicidal adolescent populations. First, we review epidemiological research that is relevant to the association between substance use and suicidal behavior. Results suggest that substance use heightens statistical risk for suicidal behavior in adolescent clinical and community populations. Alcohol intoxication may serve as a proximal risk factor for suicidal behavior among distressed youths through its psychopharmacological effects on the brain. Substance use may also serve as a distal risk factor for suicidal behavior by increasing stress and exacerbating co-occurring psychopathology. Second, we propose different theoretical models that might explain the high rates of co-occurring substance use and suicidal behavior among adolescents. Substance use may stem from an underlying syndrome of problem behavior among impulsive suicide attempters with predominant externalizing symptoms. In contrast, nonimpulsive suicide attempters with predominant internalizing symptoms may use substances to cope with negative affective states. Third, we explore the status of treatment research with substance abusing and suicidal adolescent populations. Studies of substance abuse treatment and suicidal behavior have neither adequately assessed nor incorporated treatment of the other co-occurring problem. Finally, we conclude with proposed directions for future research, including the development of integrated interventions tailored to adolescents with these co-occurring problems.

Developmental differences in risk factors for suicide attempts between ninth and eleventh graders

In order to identify differences in risk factors for suicide attempts throughout adolescence, this study utilized a school-based survey of ninth (n = 1,192) and eleventh graders (N = 1,055). Suicide attempts were associated with cigarette and alcohol use, family violence, and depression for ninth graders and with illicit drug use, school violence, and sexual abuse for eleventh graders, while having friends was protective for both groups. Additionally, having more than one risk factor imparted an exponential risk for suicide attempts (ninth > eleventh graders). The differences detected are consistent with developmental changes of adolescence and represent important information for identification of at-risk youth.

Prognostic impact of psychoactive substances use during hospitalization for intentional drug overdose

OBJECTIVE

To assess whether current use of psychoactive substance(s) is a prognostic factor during hospitalization for intentional drug overdose (IDO).

METHOD

Current intoxication with psychoactive substance(s) [cannabis, opiate, buprenorphine, amphetamine/ecstasy, cocaine, lysergic acid diethylamide (LSD)] was identified using toxicological urinalysis in 671 patients with IDO. An IDO was a priori defined as serious if associated with one of the following events: death, hospitalization in intensive care unit longer than 48 h, respiratory support, use of vasopressive drugs, cardiac massage or dialysis.

RESULTS

Subjects positive for toxicological assays were twice as likely to present with serious IDO (OR = 1.9, 95% CI: 1.3-2.8, P = 0.001), independently from a large range of confounding factors. The risk of serious IDO was especially marked in subjects using LSD, buprenorphine or opiates.

CONCLUSION

Systematic investigation of substance use could be important to adapt medical management of subjects with IDO in general hospital, but also in primary care and psychiatric settings.

Suicidal ideation and correlates in Taiwanese adolescent methamphetamine users

The aim of this study was to evaluate the prevalence of suicidal ideation and its correlates in adolescent methamphetamine (MAMP) users. Using the Epidemiological Version of the Kiddie Schedule for Affective Disorders and Schizophrenia, 200 adolescent MAMP users were assessed for suicidal ideation and psychiatric disorders during the preceding year. Demographic variables, family and peer interaction, characteristics of MAMP use, and personality were also evaluated. Factors correlating to suicidal ideation in adolescent MAMP users were analyzed by logistic regression. In the preceding year, 16% of adolescent MAMP users had suicidal ideation, and multiple factors, including illicit drug use among family members, depressive disorder, adjustment disorder, and emotional instability, correlated with suicidal ideation. Multiple factors, including family, psychopathology, and personality correlate with suicidal ideation in adolescent MAMP users. Subjects showing these characteristics should be monitored for suicidal ideation.

Substance use and suicidal conduct: a study of adolescents hospitalized for suicide attempt and ideation

AIM

To study the prevalence of psychoactive substance use disorder (PSUD) among suicidal adolescents, psychoactive substance intoxication at the moment of the attempt, and the association between PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s).

METHODS

186 adolescents aged 16 to 21 y hospitalized for suicide attempt or overwhelming suicidal ideation were included (T0); 148 of them were traced again for evaluations after 6 mo (T1) and/or 18 mo (T2). DSM-IV diagnoses were assessed each time using the Mini International Neuropsychiatric Interview.

RESULTS

At T0, 39.2% of the subjects were found to have a PSUD. Among them, a significantly higher proportion was intoxicated at the time of the attempt than those without PSUD (44.3% vs 25.4%). Among the 148 adolescents who could be traced at either T1 or T2, two died from suicide and 30 repeated suicide attempts once or more times. A marginally significant association was found between death by suicide/repetition of suicide attempt and alcohol abuse/dependence at baseline (OR=3.3, 95% CI 0.7-15.0; OR=2.6, 95% CI 0.7-9.3). More than one suicide attempt before admission to hospital at T0 (OR=3.2, 95% CI 1.1-10.0) and age over 19 y at T0 (OR=3.2, 95% CI 1.1-9.2) were independently associated with the likelihood of death by suicide or repetition of suicide attempt.

CONCLUSION

Among adolescents hospitalized for suicide attempt or overwhelming suicidal ideation, the risk of death or repetition of attempt is high and is associated with previous suicide attempts--especially among older adolescents--and also marginally associated with PSUD; these adolescents should be carefully evaluated for such risks and followed up once discharged from the hospital.

Risk factors of suicidal ideations and attempts in talented, at-risk girls

The purpose of the present study was to investigate the relationships among suicidality, substance use, self-esteem, family structure, and eight personality characteristics (harm avoidance, impulsivity, aggression, social recognition, cognitive structure, succorance, abasement, and achievement) with 337 talented, at-risk, adolescent girls. Results indicated that girls with histories of suicidal ideations and/or attempts had significantly higher levels of substance use, impulsivity, aggression, and social recognition, and significantly lower levels of self-esteem and harm avoidance than girls without such histories. Girls without suicide histories were also more likely to come from single mother families. Consideration of these factors, by both researchers and clinicians, in assessing suicide risk is encouraged.

The suicidal process; prospective comparison between early and later stages

BACKGROUND

Mechanisms contributing to suicidal behaviour may differ according to how far individuals have progressed through the suicidal process.

METHODS

Lifetime and subsequent 12-month cumulative incidences were obtained of death ideation, death wishes, suicide contemplation and deliberate self-harm in a survey (n=5618) of Dutch adults. Mokken's scale analysis was used to examine whether these were compatible with underlying lifetime and 12-month severity dimensions of suicidality. Sociodemographic details and personality traits, 12-month occurrence of negative life events, hopelessness and CIDI-generated DSM-III-R diagnoses were obtained. Ordered logistic regression was used to examine whether the effects of these on the 12-month incidence of suicidality differed by individuals' prior lifetime history of suicidality.

RESULTS

Mental illness was more strongly associated with 12-months' suicidality in the presence (ordered logistic regression coefficient 0.80, 95% confidence interval 0.48-1.12) than the absence of previous suicidality (0.49 [0.25-0.74]). The reverse obtained for negative life events (0.18 [0.08-0.29] vs. 0.40 [0.33-0.48], respectively) and a number of sociodemographic risk factors. Female gender was a risk factor for 12-months' suicidality (0.47 [0.28-0.66]) only when it was first-onset.

LIMITATIONS

Completed suicides were not recorded. Self-report of lifetime suicidal behaviour may be biased.

CONCLUSION

Environmental influences on suicidal behaviour are most pronounced early in the suicidal process which, after it has progressed, becomes more autonomous and intricately linked with mental illness and depression in particular. Men progress through the suicidal process faster than women. Management of suicidal behaviour depends on the stage of the process the person is at.