Suicidality among Norwegian youth: review of research on risk factors and interventions

Identification of Risk Factors for Suicide and Insights for Developing Suicide Prevention Technologies: A Systematic Review and Meta-Analysis

Suicide is a termite that engulfs close to seven hundred thousand people worldwide each year. Existing work on risk factors that predict suicide lacks statistical associations, does not consider most countries, and has a wide range of risk factor domains. The goal of this systematic review and meta-analysis is to enhance our current understanding of suicidality by identifying risk factors that are most strongly associated with suicide and their impact on developing technological interventions for suicide prevention. A search strategy was carried out on four databases: (1) PsycINFO, (2) IEEE Xplore, (3) the ACM Digital Library, and (4) PubMed, and twenty-five studies were included based on the inclusion criteria. Factors statistically associated with suicide are any diagnosed mental disorder, adverse life events, past suicide attempts, low education level, loneliness or high levels of isolation, bipolar disorder, depression, multiple chronic health conditions, family history of suicide, sexual trauma, and being female. Domain-wise, comorbid disorders, and behavior-related risk factors are most strongly associated with suicide. We present a new hierarchical model of risk factors for suicide that advances our understanding of suicide and its causes. Finally, we present open research directions and considerations for developing suicide prevention technologies.

Associations between insecure attachment styles to parents and suicidal ideation in adolescents with depression

Objective

Suicidal ideation and depressive symptoms are often interrelated in clinical settings. Insecure attachment may be a risk factor for suicidal ideation in depressed adolescents. To our knowledge, this study is the first to examine the association between self-reported insecure attachment styles to both parents and suicidal ideation in a clinical sample of adolescents with depression.

Methods

Fifty clinically depressed adolescents (13-17 years, 84% girls) completed self-reported measures of suicidal ideation, depressive symptoms, and attachment style to parents.

Results

There was a statistically significant bivariate association between higher levels of attachment anxiety in relation to mothers and fathers and higher levels of suicidal ideation. When attachments to both parents were included in the same multivariate model, only attachment anxiety to the mother was significantly associated with the level of suicidal ideation. Self-reported depressive symptoms remained significantly associated with the level of suicidal ideation in all analyses. Younger adolescents with attachment anxiety reported higher levels of suicidal ideation than older adolescents.

Conclusion

Conclusions about directionality and causality of associations between insecure attachment and suicidal ideation are limited due to the cross-sectional design. Our findings suggest that attachment anxiety in relation to the mother and father is associated with increased levels of suicidal ideation. Implication of these findings for treatment selection is discussed.

Childhood adversity predicts persistence of suicidal thoughts differently in females and males at clinical high-risk patients of psychosis. Results of the EPOS project

AIM

Depression and suicidal ideation (SUI) and behaviour are more prevalent in females than males, and common in clinical high-risk (CHR) patients. Childhood adversities and trauma (CAT) are associated with adult depression and SUI. The role of gender as a moderator and depression as a mediator for the effect of CAT on SUI has not been explored in CHR patients.

METHODS

In all, 245 young help-seeking CHR patients were assessed for SUI (thoughts of killing themselves) with the Beck Depression Inventory at baseline, 9-month and 18-month follow-ups. At baseline, clinical depression was assessed by the Structured Clinical Interview for DSM-IV (SCID-I), and CAT by the Trauma and Distress Scale (TADS) which includes the five domains of emotional, physical and sexual abuse, emotional and physical neglect.

RESULTS

CAT total and all domains except physical neglect predicted SUI over the study period. The effect of CAT on SUI was mediated via clinical depression and concurrent depression symptoms differently for females and males. In females, the effect of emotional abuse and neglect on SUI was mediated via baseline depression. In males, emotional and physical abuse had a direct effect on SUI, and the effect of sexual abuse and emotional neglect was partly mediated via concurrent depression symptoms.

CONCLUSIONS

For CHR females, the effect of CAT on adult SUI is mediated via depression, while for males, CAT and its domains have mainly direct effects in maintaining SUI. These gender differences should be taken into account when treating CHR patients with SUI.

Presence of minor and major mental health impairment in adolescence and death from suicide and unintentional injuries/accidents in men: a national longitudinal cohort study

OBJECTIVE

To examine the association between minor and major mental health impairment in late adolescence and death from suicide and unintentional injuries/accidents in men.

METHODS

In Norway, all men attend a compulsory military medical and psychological examination. We included 558 949 men aged 17-19 years at the time of military examination in 1980-1999 and followed them up for death from suicide and unintentional injuries/accidents until the end of 2013. We used Cox proportional hazard models to examine the association between the presence of minor and major mental health impairments at examination and death from suicide and unintentional injuries/accidents.

RESULTS

Compared to men with no mental health impairment, those with minor mental health impairment was associated with an increased risk of death from suicide (adjusted HR (HR_adj)=1.63, 95% CI 1.39 to 1.92), transport accidents (HR_adj=1.33, 95% CI 1.09 to 1.63), accidental poisoning (HR_adj=2.27, 95% CI 1.79 to 2.88) and other unintentional injuries/accidents (HR_adj=1.54, 95% CI 1.17 to 2.02). In men with major mental health impairment, the risk of death from suicide and accidental poisoning was elevated two times (HR_adj=2.29, 95% CI 1.85 to 2.85) and three times (HR_adj=3.53, 95% CI 2.61 to 4.79), respectively.

CONCLUSIONS

We found an increased risk of death from suicide and unintentional injuries/accidents in men who had minor and major mental health impairment at age 17-19 years.

Suicides among military conscripts between 1991-2007 in Finland--a descriptive replication study

BACKGROUND

Suicide mortality in Finland particularly among young people remains high, compared with other European countries. Suicide is one of the leading causes of death among military conscripts in Finland.

AIMS

In this record-based study, we investigated characteristics of all 48 suicides among Finnish conscripts during the period 1991-2007.

METHODS

We collected and analyzed healthcare records during military service and medicolegal investigations (medicolegal autopsy) of suicide victims.

RESULTS

Of the 48 suicides, 36 (75%) were completed during leave days. Shooting, hanging and jumping were the most common methods used; a service gun was used in four (14%) of the 29 shooting cases. One-third of the victims had been in contact with military healthcare during the week preceding their suicide, and two-thirds during the preceding month.

CONCLUSIONS

When conscripts use healthcare services, suicidal thoughts should be actively asked of those conscripts with history of any risk factors for suicidal behavior.

Life-time and current suicide-ideation in Australian secondary school students: Socio-demographic, health and psychological predictors

BACKGROUND

This study involved a multi-level analysis of factors related to self-reported suicidality (both current and life-time) in adolescents

METHODS

A sample of 2552 students aged 14-16 years answered questions relating to demographics, social and familial functioning, psychological well-being and suicidality.

RESULTS

Suicidality, defined as being at least some element of reported suicide ideation, Behaviourally, suicidality was also more likely if students smoked, drank alcohol without adult supervision or if they took illicit drugs was more likely in girls, and in those with poorer social, family and psychological functioning. Behaviourally, suicidality was also more likely if students smoked, drank alcohol or took illicit drugs. Multi-level modelling showed that negative affect, substance use and the presence of romantic relationships were most strongly associated with suicidality. Both current and life-time measures of suicidality showed similar results. Both models suggested that the presence of substance use in teenagers is a potentially useful indicator of elevated suicide risk and that many of the social problems commonly associated with suicidality are likely to be mediated by negative affective states.

LIMITATIONS

The study had several limitations. First, it was cross-sectional so it was not possible to examine how variables measured at one time predicted subsequent suicidality. Second, the present analyses were based on a single measure of suicidality that did not differentiate between ideation and attempts. Thus, the analyses did not indicate the severity of the suicidality: whether it involved ideation or actual attempts.

CONCLUSIONS

Adolescent girls and adolescents with poor social and family functioning and those who engage in substance use are at risk of suicidal ideation (a known precursor of suicide attempts). School counsellors and teachers need to be aware of the risks.

The association between school class composition and suicidal ideation in late adolescence: Findings from the Young-HUNT 3 study

BACKGROUND

Few studies have explored the association between social context and suicidal ideation using multilevel models. This study examines how suicidal ideation in adolescence is related to school class composition.

METHODS

Data were obtained from the Young-HUNT 3 study (2006-2008), a population study of adolescents attending secondary school in the Norwegian county of Nord-Trøndelag. The final sample included 2923 adolescents distributed among 379 school classes in 13 schools. Multilevel logistic regression was used to estimate the contribution of various factors at the individual and school class levels.

RESULTS

The results indicate that 5.3 percent of the variation in suicidal ideation can be attributed to differences between school classes. However, a substantial part of this variation can be explained by an unequal distribution of students at risk as a result of individual factors. After controlling for individual-level variables, the results show a higher probability of suicidal ideation in school classes having higher proportions of girls as well as in those following a vocational education programme.

CONCLUSION

Targeting classes that either follow a vocational education programme or have a high proportion of girls can be an effective approach to intervention because such classes may include a greater number of students at risk for having suicidal thoughts compared to classes with a high proportion of boys or classes following a general education programme.

[Factors on the suicidal attempt by gender of middle and high school student]

PURPOSE

The suicide rate of adolescents in Korea is increasing annually. Therefore, this research was done to identify the suicide attempt rate of middle and high school students and to identify factors that influence suicidal attempts.

METHODS

The Korea Youth Health Risk Behavior Web-based Survey (2007) was used as data. Discriminant analysis and logistic regression were performed to analyze the data depending on gender to consider the gender difference in assessing the influence of each independent variable on suicidal attempts.

RESULTS

Discriminant analysis according on gender showed that 13 factors correlated with suicidal attempts for boys, and 20 factors for girls. The most highly correlated factors were smoking, depression and inhalation experience. For inhalation experience, boys had 2.7 times higher possibility of suicide attempts (95% CI 1.8-3.0) and girls, a 2.4 times higher possibility (95% CI 1.7-3.5).

CONCLUSION

The results of the study indicate a need to classify adolescents for expectation of suicide risk and high danger for suicidal attempts through, and introduce suicide prevention programs for these adolescents. In particular, it is necessary to start intervention with students who smoke, have sexual and inhalation experiences and high levels of depression.