Risk factors for suicide in Taiwanese college students

Population-attributable risk of psychiatric disorders for suicide among adolescents and young adults in Taiwan

BACKGROUND

Youth suicide rates have increased markedly in some countries. This study aimed to estimate the population-attributable risk of psychiatric disorders associated with suicide among Taiwanese youth aged 10-24 years.

METHODS

Data were obtained from the National Death Registry and National Health Insurance (NHI) claims database between 2007 and 2019. Youth who died by suicide were included, and comparisons, 1:10 matched by age and sex, were randomly selected from the Registry for NHI beneficiaries. We used multivariable logistic regression to estimate suicide odds ratios for psychiatric disorders. The population-attributable fractions (PAF) were calculated for each psychiatric disorder.

RESULTS

A total of 2345 youth suicide and 23 450 comparisons were included. Overall, 44.8% of suicides had a psychiatric disorder, while only 7.9% of the comparisons had a psychiatric disorder. The combined PAF for all psychiatric disorders was 55.9%. The top three psychiatric conditions of the largest PAFs were major depressive disorder, dysthymia, and sleep disorder. In the analysis stratified by sex, the combined PAF was 45.5% for males and 69.2% for females. The PAF among young adults aged 20-24 years (57.0%) was higher than among adolescents aged 10-19 years (48.0%).

CONCLUSIONS

Our findings of high PAF from major depressive disorder, dysthymia, and sleep disorder to youth suicides suggest that youth suicide prevention that focuses on detecting and treating mental illness may usefully target these disorders.

Social Support Reduces the Risk of Unfavorable Parenting Styles for Suicidal Behaviors in Early Adolescents

OBJECTIVE

Depression and perceived stress are important risk factors for suicidal behaviors among adolescents. The current study examined the joint effects of parenting styles on suicidal ideation (SI) and attempt (SA) in early adolescents while considering relevant individual factors, and evaluated whether social support can offset the risk.

METHODS

The present study was part of a large cohort study aiming at tracing the mental health and risk behaviors in adolescents, and we utilized baseline data collected from 645 4th grade students with complete assessment of suicidal behaviors, social support, parental bonding, depression, and perceived stress. Participants' mean age was 9.97 years (SD = 0.38) with 53.02% boys. Logistic regression was performed to analyze the associations between independent variables and youth suicidal behaviors.

RESULTS

16.28% students reported to have SI and 4.96% had SA. Depression (SI: OR = 3.66-3.89; SA: OR = 3.98-4.50), father's low care and high authoritarian (LCHA) (SI: OR = 3.04; SA: OR = 2.43), and low acceptance and high authoritarian (LAHA) (SI: OR = 3.58; SA: OR = 4.77) parenting styles were strong risk factors, while overall social support (SI: OR = 0.98; SA: OR = 0.97) was a protective factor of SI and SA for early adolescents. Perceived stress (OR = 1.07-1.08) and mother's LCHA parenting style (OR = 2.03) were risk factors of SI. Overall, a family with LCHA parenting (OR = 2.82) or LAHA parenting (OR = 3.35-3.72) regardless parental gender had increased risk for SI and SA.

CONCLUSION

Family and social factors are important to consider in suicidal prevention and interventions among early adolescents, in addition to assessing individual risk factors. HighlightsSuicidal ideations (16.28%) and attempts (4.96%) were prevalent in early adolescents at elementary schools. Depression status remains a significant risk factor for both SI and SA in early adolescents.Unfavorable parenting styles (LCHA or LAHA) increased the risk of SI and SA, especially received from father.Overall social support had independent protective effect on suicidal behaviors, when taking aforementioned individual and family risk factors into account.

The risk and protective factors for suicidal burden among 251 763 school-based adolescents in 77 low- and middle-income to high-income countries: assessing global, regional and national variations

BACKGROUND

Adolescent suicide is a global public health concern and the second leading cause of adolescent death worldwide. This study aimed to estimate the burden of adolescent suicidal behaviours and its association with violence and unintentional injury, psychosocial, protective, lifestyle and food security-related factors amongst school-based adolescents across 77 countries in the six World Health Organization (WHO) regions.

METHODS

This study comprised a sample of 251 763 adolescents drawn from the latest Global School-based Student Health Survey of school-based adolescents, aged 11-17 years, across 77 countries. Logistic regression analyses were employed to estimate the adjusted effect of independent factors on adolescent suicidal behaviours.

RESULTS

The population-weighted 12-month prevalence of suicidal ideation (SI), suicidal planning (SP) and suicidal attempts (SA) amongst school-based adolescents was 18, 18 and 16%, respectively. Adolescent suicidal behaviours (i.e. SI, SP and SA) were respectively associated with being physically attacked, physical fighting, high levels of anxiety, feeling lonely, being bullied, lack of parental support, poor peer support, not having close friends and high levels of sedentary behaviours. Overall, these associations also extended to the context of food insecurity across regions and country income groups, where the magnitude of association slightly varied from odds ratios of 1.25 times to 3.13.

CONCLUSIONS

The burden of school-going adolescent suicidal thoughts, suicide planning and suicide attempts is of particular concern in low-resource countries. Comprehensive suicide prevention programmes for school-going adolescents in LMICs are needed that address socio-cultural inequities related to violence and unintentional injury, social support and psychological factors, protective, and lifestyle-related factors.

Parents parenting styles differences were associated with lifetime suicidal ideation: Evidences from the Chinese medical college students

This study aims to explore the association between parents parenting styles differences and lifetime suicidal ideation (LSI). The sample included 2598 Chinese medical students. Results showed that 10.5% of students reported LSI. Moreover, total differences in parenting styles (OR = 1.04, 95% CI = 1.02, 1.06), parental nurture rejects differences (OR = 1.11, 95% CI = 1.04, 1.18), parental emotional warmth differences (OR = 1.08, 95% CI = 1.03, 1.14), and parental overprotective differences (OR = 1.11, 95% CI = 1.06, 1.16), obtain a scholarship, physical disease and mental health were associated with LSI. The major finding reminds us of the importance of consistent parenting style for suicide prevention.

Factors Associated with Self-Esteem, Resilience, Mental Health, and Psychological Self-Care Among University Students in Northern Thailand

Background

The severity of mental health issues among university students in rural areas can affect the outcomes of their studies. The purpose of this study was to identify factors associated with self-esteem, resilience, mental health, and psychological self-care among university students.

Methods

We conducted a cross-sectional survey of 729 undergraduate students by a self-administered questionnaire. Using convenience sampling, the participants were chosen from four majoring in Public Health at University of Phayao in Northern Thailand.

Results

Approximately 82% of university students had mental health problem. Backward logistic regression analysis showed that 1) a good relationship with family had a significantly positive effect on self-esteem (p-value <0.05); 2) a good relationship with friends was significantly associated with high resilience (p-value <0.05); 3) having a disease/s and a relationship with family had a significant effect on mental health problem (p-value <0.05); 4) being female, perceived normal weight, and a good relationship with family were significantly related to high psychological self-care (p-value <0.05).

Conclusion

Gender, incurrent disease, perceived weight status, relationship with friends and family were associated with self-esteem, resilience, mental health, and psychological self-care among university students. Our findings can be incorporated in a support policy and integrated into the public health curriculum. University administrators and faculty have an opportunity to formulate an intervention program and provide services that could mitigate mental health problems and improve the well-being of students at their university.

Association between Perceived Parenting Style and Adolescents' Attitudes toward Suicide

Objectives

Adolescent suicide, a major cause of adolescent death, is affected by various factors, including attitudes toward suicide. This study investigated the association between parenting style and adolescents’ attitudes toward suicide and the mediating role of attitude toward suicide between parenting style and suicidal ideation.

Methods

We surveyed 1,071 adolescents from eight middle schools in Incheon, Korea. The survey included sociodemographic information, attitudes toward suicide, perception of parenting style, depression severity, and suicidality.

Results

Students in the authoritarian parenting group had a more permissive attitude toward suicide compared with the democratic and permissive parenting groups. These students considered that suicide is justified in certain situations and that choosing suicide is an individual’s right. They also had a negative attitude toward talking about suicide or intervening in others’ suicide. This association remained statistically significant after adjusting for the impact of confounding factors that could affect attitudes toward suicide, except for suicidal processes and preparedness to prevent suicide. In the mediation analysis, we observed that some factors of the attitudes toward suicide mediated between authoritarian parenting attitudes and suicidal ideation, namely, suicide as a right, preventability, suicide as normal/common, preparedness to prevent suicide, and resignation.

Conclusion

This study revealed the significant impact of parenting style on children’s attitudes toward suicide. Educating parents about the appropriate parenting attitudes–sympathetic and rational–can help prevent youth suicide.

Suicide and associated psychosocial correlates among university students in Taiwan: A mixed-methods study

BACKGROUND/PURPOSE

The trend of suicide rates among young adults has been increasing worldwide. The study aimed to identify the suicide risks and associated psychosocial factors in a large university in Taiwan.

METHODS

This is a mixed-methods study using both questionnaire survey and two open-ended questions for the exploration of qualitative data. An online survey was conducted between two periods of the same semester in 2018 to collect different sources of stress and other suicide correlates. The measurement scales included the 9-item Concise Mental Health Checklist, the University Stress Screening Tool in Taiwan and the Chinese Maudsley Personality Inventory. The participants were required to fulfill two open-ended questions about stress experience and depressive symptoms in the previous month in the end of the questionnaire, which was analyzed using thematic analysis.

RESULTS

A total of 857 university students were recruited (67.9% female participants). Over a quarter of participants were under poor mental health status and more than 60% experienced stressful events in the prior year. A higher suicide risk and neurotic trait was noticed compared to the general public. These results were consistent with the qualitative findings.

CONCLUSION

While identifying several risk factors that cumulatively conduced to higher suicide risks, neuroticism served as a key element in the increased suicide risk among the university students. Suicide prevention strategies for university students should highlight stress management for those with neurotic trait and early suicide risk identification.

Prevalence and correlates of suicidal ideation among college students: A mental health survey in Jilin Province, China

BACKGROUND

The prevention of suicidal ideation plays a key role in reducing suicide rates. This study aimed to determine the prevalence of suicidal ideation among college students in Jilin Province, China, and to analyse the risk factors associated with suicidal ideation.

METHODS

A total of 6284 valid data collection sheets were collected using the stratified cluster sampling method. The data collected were divided into four sections, namely, socio-demographic information, family and social interactions, daily habits, and mental health self-rating scales.

RESULTS

The prevalence of suicidal ideation in the past 12 months was 9.2%. A multivariate logistic regression analysis showed that being a senior (OR = 1.769, 95%CI:1.225-2.555), general family relationships (OR = 1.641, 95%CI:1.172-2.298), frequent parental quarrels (OR = 1.398, 95%CI:1.027-1.902)/parental separation (OR = 2.497, 95%CI:1.414-4.408), the level of satisfaction with motherly love (OR = 2.261, 95%CI:1.454-3.515), having only one or two friend(s) (OR = 1.530, 95%CI:1.038-2.254), frequent excursions to bars/ karaoke halls/ song and dance halls (OR = 1.673, 95%CI:1.257-2.229) or billiard halls with friends (OR = 1.865, 95%CI:1.270-2.740), smoking (OR = 2.175, 95%CI:1.603-2.951), moderate sleep quality (OR = 1.636, 95%CI:1.115-2.402), and depressive symptoms (OR = 2.078, 95%CI: 1.710-2.525) were risk factors for suicidal ideation. Family factors had the most influence on suicidal ideation, whereas depression symptoms were identified to be a mediating factor between family, social interactions, or daily habits and suicidal ideation, and it only exerted direct effects.

LIMITATIONS

This cross-sectional study cannot provide causal interpretations.

CONCLUSION

Our findings showed the prevalence of suicidal ideation among college students in Jilin province. Among all the risk factors associated with suicidal ideation, family factors should be the main concern in the prevention of suicidal ideation, and interventions that target depression symptoms are key to reducing suicidal ideation.

Perceived parental support in childhood and adolescence and suicidal ideation in young adults: a cross-sectional analysis of the i-Share study

BACKGROUND

Suicidal ideation and suicidal risk assessment are major concerns for health professionals. The perception of a low level of parental support is a risk factor for suicidal tendencies among adolescents, but little is known about its long-term impact on the vulnerability to suicidal behavior in young adults. We investigated whether the perceived level of parental support during childhood and adolescence was associated with current suicidal ideation in young adults.

METHODS

We retrieved data collected in the i-Share study from February 1st, 2013 through January 30, 2017. This cross-sectional study included 10,015 French students, aged 18-24 years that completed an on-line self-reported questionnaire about suicidal ideation in the last 12 months and their perceived parental support in childhood and adolescence. We performed multinomial logistic regressions and sensitivity analyses to assess associations between the degree of perceived parental support and the frequency suicidal thoughts, after adjusting for the main known risk factors of suicidal ideation. We employed multiple imputations to account for missing data.

RESULTS

The study sample included 7539 female (75.7%) and 2436 male (24.3%) students (mean [SD] age 20.0 [1.8] years). About one in five students reported occasional suicidal thoughts (n = 1775, 17.7%) and 368 students (3.7%) reported frequent suicidal thoughts. The adjusted multinomial logistic regression revealed a significant negative association between perceived parental support and suicidal thoughts. A lack of perceived parental support in childhood and adolescence was associated with > 4-fold elevated risk of occasional (adjusted OR, 4.55; 95% CI: 2.97-6.99) and nearly 9-fold elevated risk of frequent (adjusted OR, 8.58; 95% CI: 4.62-15.96) suicidal thoughts, compared to individuals that perceived extremely strong parental support. This association was strongest among students with no personal history of depression or suicide attempts.

CONCLUSIONS

Students that perceived low levels of past parental support had a higher risk of suicidal ideation. Past perceived parental support appeared to be a potent marker of suicidal risk in young adults. This marker should be routinely collected in studies on suicidal risk in young adults, and it could be considered an additional screening tool.

Diseño y validación de una escala para evaluar el Riesgo Suicida (ERS) en adolescentes colombianos

El objetivo del estudio fue construir y validar una escala para la evaluación del riesgo suicida en adolescentes. Los ítems iniciales se elaboraron con base en la revisión bibliográfica y se sometió a evaluación de expertos con el fin de analizar aspectos teóricos y lingüísticos. La muestra fue de 537 adolescentes entre 13 y 18 años, con una media de 15.2 (DE = 1.1), 268 hombres (49.9 %) y 269 (50.1 %) mujeres. La consistencia interna total del instrumento fue de 0.934; las escalas mostraron alfa de Cronbach entre 0.71 y 0.929; se aplicó el omega de Mcdonald con el uso del software R y los resultados fueron muy similares. Se realizó análisis factorial exploratorio método VARIMAX y análisis factorial confirmatorio con el uso del programa estadístico AMOS. Los análisis de ítems, correlación y efectos de suelo y techo mostraron correlaciones entre 0.411** y 0.784** con el puntaje global. Las correlaciones de los ítems con las dimensiones fluctuaron entre 0.71** y 0.908**. Una vez obtenida la agrupación de los ítems en cuatro factores, se hallaron correlaciones significativamente altas entre las subescalas con el puntaje global (0.749**a 0.868**). En conclusión, el instrumento constituye una medida válida y confiable para la evaluación del riesgo suicida en adolescentes colombianos.

Associations between health-related self-efficacy and suicidality

BACKGROUND

Few studies have focused on exploring the association of self-efficacy and suicidal behaviour. In this study, we aim to investigate the association between health-related self-efficacy and suicidality outcomes, including lifetime/recent suicidal ideation, suicidal attempts and future intent of suicide.

METHODS

A computer-assisted telephone interview (CATI) system was used to draw potential respondents aged over 15 in Taiwan via telephone numbers, which were selected by a stratified proportional randomization method according to the distribution of population size in different geographic areas of Taiwan. We obtained available information on suicide behaviours for the analysis of 2110 participants. Logistic regression was applied to investigate the independent effect of health-related self-efficacy on life-time suicidal thoughts and attempts.

RESULTS

Suicidality measured as suicide ideation and attempted suicide was reported as 12.6 and 2.7% respectively in the sample. Among those with suicide ideation, 9.8% had thoughts of future suicide intent. Female gender, low education, people living alone or separated, history of psychiatric disorders, substance abuse, poor self-rated mental health and physical health were associated with suicidality factors. Low health-related self-efficacy was associated with lifetime suicide ideation, prior suicide attempt and future suicidal intent. Among those with recent suicidal ideation, low health self-efficacy was independently associated with future suicide intent after adjustment of gender, age, education, marital status, substance abuse, psychological distress, poor mental and physical health.

CONCLUSION

Health-related self-efficacy was associated with suicide risks across different time points from prior ideation to future intention. Evaluation of the progress of self-efficacy in health may be long-term targets of intervention in suicide prevention strategies.

Self-efficacy as a mediator of the relationship between parental closeness and suicidal ideation among Malaysian adolescents

BACKGROUND

Suicide has become a serious worldwide mental health problem, including Asian countries. Suicidal ideation happens prior to the actual suicidal behaviour; thus, identifying the roots of suicidal ideation is vital. This study investigated the relationships between parental closeness, self-efficacy and suicidal ideation among adolescents in Malaysia. The mediation effect of self-efficacy on the relationship between parental closeness and suicidal ideation was also examined.

METHOD

A total of 684 school-going adolescents aged 14-17 years old were recruited via multistage cluster sampling. Bivariate analysis was conducted using Pearson's correlation analysis. The mediation model was tested using SPSS macro developed by Preacher and Hayes.

RESULTS

The results showed that mother closeness, father closeness and self-efficacy had significant negative correlation with suicidal ideation. Specifically, self-efficacy emerged as a partial mediator in the relation between mother closeness and suicidal ideation. Self-efficacy also fully mediated the relationship between father closeness and suicidal ideation.

CONCLUSIONS

The findings implied that mother closeness had stronger correlation with adolescents' suicidal ideation compared to father closeness, while self-efficacy plays an important role in the relationship between parental closeness and suicidal ideation. Prevention and intervention efforts by practitioners dealing with adolescents' mental health issues, specifically on suicidal ideation, should seriously consider providing them with skills to enhance mother-adolescent relationship and their self-efficacy.

Interpersonal-psychological theory and parental bonding predict suicidal ideation among soldiers in Taiwan

INTRODUCTION

Suicide is an important issue among military personnel, who have higher suicide rates compared with the general population. The interpersonal-psychological theory of suicide (IPTS) might provide an empirical explanation of this phenomenon, and parental bonding influences social adjustment and suicide. To investigate the relevance of IPTS and parental bonding for suicide among Taiwanese soldiers, a case-control study was conducted.

METHODS

Using a suicide-reporting system in a teaching general hospital in Southern Taiwan, 226 at-risk maladjusted soldiers and 229 well-adjusted controls were enrolled. We collected basic information, and participants answered four IPTS-based questions. Suicide risk was assessed using the Brief Symptom Rating Scale item 6. A four-factor model of the Parental Bonding Instrument assessed parental bonding. All participants were interviewed using the Mini International Neuropsychiatric Interview for primary screening and to recheck the accuracy of the Brief Symptom Rating Scale item 6 score.

RESULTS

A parsimonious model obtained by regression analysis of risk factors indicated that poor academic performance, conduct-related issues in childhood, and exposure to life-threatening situations are risk factors for suicide intention. Maladjusted suicidal soldiers showed a sense of thwarted belongingness (β = 0.145; P < 0.001), higher perceived burdensomeness (β = 0.311; P < 0.001), less fear of death (β = 0.124; P < 0.05), lower paternal autonomy (β = -0.122; P < 0.05), and higher maternal indifference (β = 0.162; P < 0.0001).

DISCUSSION

Interpersonal-psychological theory of suicide, accompanied by an assessment of parental bonding, could be used for assessing suicide risk and preventing suicide attempts.

Suicidal ideation, plans and attempts among medical college students in china: The effect of their parental characteristics

Medical college students are a high-risk population of suicidal ideation, plan and attempt. However, few studies discuss the effect of parental characteristics on suicidal ideation, plans and attempts among medical college students in China. A total of 2198 respondents answered the questionnaires referring social-demographic characteristics, psychological conditions, parental characteristics, suicidal ideation, plan and attempt. The prevalence of suicidal ideation, plan and attempt among the subjects were 17.9%, 5.2% and 4.3%, respectively. The results of multiple logistic regression showed that male, mother's education level, mother's parenting style, relationship in parents and psychological condition were associated with lifetime suicidal ideation. Male, mother's vocation, mother's parenting style, relationship in parents and psychological conditions were associated with suicide plan. Male, relationship in parents and psychological condition were associated with suicide attempt. Those imply that mother may play more roles on suicidal ideation and plan than father among medical college students in China. Psychological condition has a very strong association with suicidal ideation, plan and attempt.

Problem-Solving Skills and Suicidal Ideation Among Malaysian College Students: the Mediating Role of Hopelessness

OBJECTIVE

Recent evidence suggests that suicidal ideation has increased among Malaysian college students over the past two decades; therefore, it is essential to increase our knowledge concerning the etiology of suicidal ideation among Malaysian college students. This study was conducted to examine the relationships between problem-solving skills, hopelessness, and suicidal ideation among Malaysian college students.

METHODS

The participants included 500 undergraduate students from two Malaysian public universities who completed the self-report questionnaires.

RESULTS

Structural equation modeling estimated that college students with poor problem-solving confidence, external personal control of emotion, and avoiding style were more likely to report suicidal ideation. Hopelessness partially mediated the relationship between problem-solving skills and suicidal ideation.

CONCLUSION

These findings reinforce the importance of poor problem-solving skills and hopelessness as risk factors for suicidal ideation among college students.

Factors Associated with Post-Traumatic Symptoms in Mothers of Preterm Infants

OBJECTIVES

Symptoms of post-traumatic distress in mothers of preterm infants have been a subject of mental health research. The aim of this study was to assess the prevalence of and risk factors associated with such symptoms in mothers of preterm infants in Taiwan.

METHODS

This was a cross-sectional study performed between January 1, 2010 and June 30, 2011. One hundred and two mothers of preterm infants born at less than 37 weeks gestation and with a subsequent neonatal intensive care unit (NICU) stay between 2005 and 2009 were recruited. Participants completed a demographic questionnaire, the Impact of Event Scale-Revised (IES-R), the Center for Epidemiologic Studies Depression Scale (CES-D) and the neuroticism subscale of the Maudsley Personality Inventory (MPI). The preterm infants' data were taken from medical records.

RESULTS

The prevalence of symptoms of distress was 25.5% (26/102) in the participants. These symptoms were associated with previous miscarriages, preterm premature rupture of membranes, neurotic personality and depression.

CONCLUSIONS

The experience of preterm birth and NICU hospitalization can be traumatic to mothers. Early support for mothers during the preterm infants' NICU stay and transition to home care are recommended.

Parenting styles and emerging adult drug use in Cebu, the Philippines

Parenting style is a potent and malleable influence on emerging adult substance use. Most of the parenting-substance use literature has been conducted in Western populations and it is unknown whether findings are generalizable to other cultures and contexts. We extended the parenting-substance use literature to a cohort of emerging adults in the Philippines using the Cebu Longitudinal Health and Nutrition Survey. We assessed associations between mothers' and fathers' parenting styles (authoritative, permissive, authoritarian, and neglectful) reported by offspring at age 18 and odds of offspring-reported drug use three years later, adjusted for a range of offspring- and parent/household-level characteristics. Females were dropped from analyses due to low prevalence of drug users. We found that many emerging adults in Cebu reported having used drugs, particularly methamphetamine-a dangerous drug with high abuse potential. Authoritative (warm, firm) mothering was significantly associated with sons' reduced odds of drug use and neglectful fathering was related at a trend level with sons' increased odds of having tried drugs. Findings underscore the relation of parenting styles to emerging adults' drug use and add to the literature on cross-cultural variability in parenting styles.

Problem-solving skills appraisal mediates hardiness and suicidal ideation among malaysian undergraduate students

OBJECTIVES

Recent evidence suggests that suicidal ideation is increased among university students, it is essential to increase our knowledge concerning the etiology of suicidal ideation among university students. This study was conducted to examine the relationships between problem-solving skills appraisal, hardiness, and suicidal ideation among university students. In addition, this study was conducted to examine problem-solving skills appraisal (including the three components of problem-solving confidence, approach-avoidance style, and personal control of emotion) as a potential mediator between hardiness and suicidal ideation.

METHODS

The participants consisted of 500 undergraduate students from Malaysian public universities.

RESULTS

Structural Equation Modelling (SEM) estimated that undergraduate students with lower hardiness, poor problem-solving confidence, external personal control of emotion, and avoiding style was associated with higher suicidal ideation. Problem-solving skills appraisal (including the three components of problem-solving confidence, approach-avoidance style, and personal control of emotion) partially mediated the relationship between hardiness and suicidal ideation.

CONCLUSION

These findings underline the importance of studying mediating processes that explain how hardiness affects suicidal ideation.

Correlation between family environment and suicidal ideation in university students in China

Background: This study investigated the association between suicidal ideation and family environment. The sample included 5183 Chinese university students. A number of studies on suicidal ideation have focused on individuals rather than families. This paper reviews the general principles of suicidal ideation and the consequences resulting from the family environment. Methods: This study used six different colleges as the dataset, which included 2645 males and 2538 females. Students were questioned with respect to social demographics and suicidal ideation factors. The data were analyzed with factor and logistic analyses to determine the association between suicidal ideation and poor family environment. Results: The prevalence of suicidal ideation was 9.2% (476/5183). Most participants with suicidal ideation had significant similarities: they had poor family structures and relationships, their parents had unstable work, and their parents used improper parenting styles. Female students were more likely to have suicidal thoughts than male students. Conclusions: This study shows that suicidal ideation is a public health issue among Chinese university students and demonstrates the importance of considering the family environment when examining university students’ suicidal ideation. Understanding family-related suicidal ideation risk factors can help to predict and prevent suicides among university students.

Prevalence and factors associated with depressive symptoms in mothers with infants or toddlers

BACKGROUND

The objective of this study is to explore the prevalence of and factors associated with depressive symptoms in mothers with young children.

METHODS

This is a cross-sectional face-to-face study performed between January 1, 2010 and June 30, 2011. Mothers of premature infants with a gestational age of less than 37 weeks were recruited. Premature infants with any congenital anomaly or severe congenital heart disease were excluded. Controls were mothers of full-term infants with birth weight over 2500 g and without admission to a neonatal intensive care unit. Outcome measures included the Center for Epidemiologic Studies Depression Scale for maternal depressive symptoms, the Family Apgar Index for family support, and the Chinese Maudsley Personality Inventory for personality traits.

RESULTS

A total of 102 mothers of preterm infants and 111 mothers of full-term infants were recruited. The prevalence of depressive symptoms was 27.7% (59/213) in all mothers of this study, 29.4% (30/102) in mothers of preterm infants, and 26.1% (29/111) in mothers of full-term infants. Predictors of maternal depressive symptoms included the following: extended family structure, lack of postpartum confinement, low family support, and a personality characterized by neuroticism.

CONCLUSION

Depressive symptoms were common among mothers of young children. Family function and neurotic personality were highly correlated with depressive symptoms in mothers caring for young children. Pediatric health care providers are suggested to screen for maternal depressive symptoms and provide family-oriented support in Taiwan.

Prevalence of suicidal ideation in Chinese college students: a meta-analysis

Background

About 1 million people worldwide commit suicide each year, and college students with suicidal ideation are at high risk of suicide. The prevalence of suicidal ideation in college students has been estimated extensively, but quantitative syntheses of overall prevalence are scarce, especially in China. Accurate estimates of prevalence are important for making public policy. In this paper, we aimed to determine the prevalence of suicidal ideation in Chinese college students.

Objective and Methods

Databases including PubMed, Web of Knowledge, Chinese Web of Knowledge, Wangfang (Chinese database) and Weipu (Chinese database) were systematically reviewed to identify articles published between 2004 to July 2013, in either English or Chinese, reporting prevalence estimates of suicidal ideation among Chinese college students. The strategy also included a secondary search of reference lists of records retrieved from databases. Then the prevalence estimates were summarized using a random effects model. The effects of moderator variables on the prevalence estimates were assessed using a meta-regression model.

Results

A total of 41 studies involving 160339 college students were identified, and the prevalence ranged from 1.24% to 26.00%. The overall pooled prevalence of suicidal ideation among Chinese college students was 10.72% (95%CI: 8.41% to 13.28%). We noted substantial heterogeneity in prevalence estimates. Subgroup analyses showed that prevalence of suicidal ideation in females is higher than in males.

Conclusions

The prevalence of suicidal ideation in Chinese college students is relatively high, although the suicide rate is lower compared with the entire society, suggesting the need for local surveys to inform the development of health services for college students.

Intersection of suicidality and substance abuse among young Asian-American women: implications for developing interventions in young adulthood

PURPOSE

The purpose of this paper is to provide a review of the current literature uncovering specific factors associated with self-harm and suicidality among young Asian American women, as well as to present the Fractured Identity Model as a framework for understanding these factors. This paper offers concrete suggestions for the development of culturally competent interventions to target suicidality, substance abuse, and mental illness among young Asian American women.

DESIGN/METHODOLOGY/APPROACH

Empirical studies and theory-based papers featured in peer-reviewed journals between 1990 and 2014 were identified through scholarly databases, such as PubMed, MEDLINE, PsycINFO, JSTOR, and Google Scholar.

FINDINGS

We identified several factors associated with suicidality among young Asian American women: (1) family dynamics, or having lived in a household where parents practice "disempowering parenting styles," (2) substance use/abuse, and (3) untreated mental illness(es), which are exacerbated by the stigma and shame attached to seeking out mental health services. The Fractured Identity Model by Hahm et al. (2014) is presented as a possible pathway from disempowering parenting to suicidal and self-harm behaviors among this population, with substance abuse playing a significant mediating role. Research limitations/implications - Our review focused on Asian American women, substance use among Asian Americans, and mental health among Asian Americans. Literature that focused on Asians living in Asia or elsewhere outside of the USA was excluded from this review; the review was limited to research conducted in the USA and written in the English language.

PRACTICAL IMPLICATIONS

The complex interplay among Asian American culture, family dynamics, gender roles/expectations, and mental health justifies the development of a suicide and substance abuse intervention that is tailored to the culture- and gender-specific needs of Asian Pacific Islander young women. It is imperative for professionals in the fields of public health, mental health, medicine, and substance abuse to proactively combat the "model minority" myth and to design and implement interventions targeting family dynamics, coping with immigration/acculturative stresses, mental illnesses, suicidal behaviors, and substance abuse among Asian-American populations across the developmental lifespan.

ORIGINALITY/VALUE

This paper provides specific suggestions for interventions to adequately respond to the mental health needs of young Asian-American women. These include addressing the cultural stigma and shame of seeking help, underlying family origin issues, and excessive alcohol and drug use as unsafe coping, as well as incorporating empowerment-based and mind-body components to foster an intervention targeting suicidality among Asian-American women in early adulthood.

Development of suicidality within socioeconomic context: mediation effect of parental control and anomie

Despite some scientific research on suicide as one of the most serious social and mental health problems in Iran, there is still lack of research on the effective structural and socio-familial factors contributing to the issue in Iran. The purpose of this study is to investigate some of the effective variables conditioning suicidality while also establishing a synthetic model. Three hundred-fifty university students (165 males, 185 females) were randomly chosen from Shahid Chamran University, Ahvaz, Iran. The participants were asked to complete a package of self-report questionnaires including subjective socioeconomic status (SES), feeling of anomie, perceived parental control, and suicidality. The results show that all correlations among variables are significant. For testing the theoretical model, results of standardized regression coefficients suggest that SES has direct effect on suicidality and indirect effect via anomie and parental control. In addition, parental control has direct effects on suicidality and indirect effect via anomie as well. The findings confirm the expected paths hypothesized among variables which are consistent with the theories of Durkheim, Merton, Kohn, and Agnew. It implies that the development of suicidality takes place within socioeconomic context through the influence of parental control and feeling of anomie.

Prevalence and predictors of suicidal behavior among Mongolian high school students

The purpose of this study was to examine the prevalence and predictors of suicidal behavior among Mongolian high school students. Females were more likely to have suicidal behavior than males. No close friends, feelings of loneliness, insomnia, self perception of underweight or overweight, carrying a weapon were significant predictors of students' suicidal behavior. Missing school without permission, being bullied and going hungry were also important risk factors of suicidal ideation. Families and Schools are important environments to prevent high students' suicide. Improving students' psychological well being, quality of relationship with people, and support resources are critical to prevent suicidal behavior.

Fractured Identity: A Framework for Understanding Young Asian American Women's Self-harm and Suicidal Behaviors

Despite the high suicide rate among young Asian American women, the reasons for this phenomenon remain unclear. This qualitative study explored the family experiences of 16 young Asian American women who are children of immigrants and report a history of self-harm and/or suicidal behaviors. Our findings suggest that the participants experienced multiple types of "disempowering parenting styles" that are characterized as: abusive, burdening, culturally disjointed, disengaged, and gender-prescriptive parenting. Tied to these family dynamics is the double bind that participants suffer. Exposed to multiple types of negative parenting, the women felt paralyzed by opposing forces, caught between a deep desire to satisfy their parents' expectations as well as societal expectations and to simultaneously rebel against the image of "the perfect Asian woman." Torn by the double bind, these women developed a "fractured identity," which led to the use of "unsafe coping" strategies. Trapped in a "web of pain," the young women suffered alone and engaged in self-harm and suicidal behaviors.

Association between morningness-eveningness and the severity of compulsive Internet use: the moderating role of gender and parenting style

BACKGROUND

Eveningness and Internet addiction are major concerns in adolescence and young adulthood. We investigated the relationship between morningness-eveningness and compulsive Internet use in young adults and explored the moderating effects of perceived parenting styles and family support on such relationships.

METHODS

The participants consisted of 2731 incoming college students (men, 52.4%; mean age, 19.4±3.6years) from a National University in Taiwan. Each participant completed the questionnaires, which included the Morningness-Eveningness Scale (MES), the Yale-Brown Obsessive Compulsive Scale modified for Internet use (YBOCS-IU), the Parental Bonding Instrument for parenting style, the Family Adaptation, Partnership, Growth, Affection, and Resolve questionnaire (APGAR) for perceived family support, and the Adult Self-Report Inventory-4 (ASRI-4) for psychopathology. The morning (n=459), intermediate (n=1878), and evening (n=394) groups were operationally defined by the MES t scores.

RESULTS

The results showed that eveningness was associated with greater weekend sleep compensation, increased compulsive Internet use, more anxiety, poorer parenting styles, and less family support; additionally, the most associated variables for increased compulsive Internet use were the tendency of eveningness, male gender, more anxiety symptoms, less maternal affection/care, and a lower level of perceived family support. The negative association between the morning type and compulsive Internet use severity escalated with increased maternal affection/care and decreased with increased perceived family support. The positive association between the evening type and compulsive Internet use severity declined with increased maternal protection. However, the father's parenting style did not influence the relationship between morningness-eveningness and compulsive Internet use severity.

CONCLUSIONS

Our findings imply that sleep schedule and the parental and family process should be part of specific measures for prevention and intervention of compulsive Internet use.

Additive effects between prematurity and postnatal risk factors of suicidal behavior

BACKGROUND

Pre- and perinatal insults increase suicide risk. The main objective of the present study is to investigate if prematurity interacts in an additive fashion with postnatal risk factors of suicidal behavior.

METHOD

Sample and procedure: 857 adult suicide attempters consecutively hospitalized for a suicide attempt were included. Studied characteristics of suicide attempts included use of a violent mean, age at first suicide attempt, and number of suicide attempts. Risk factors of suicidal behavior included indexes of pre- and perinatal adversity, childhood maltreatment as measured with the Childhood Trauma Questionnaire, personality traits as measured with the Tridimensional Personality Questionnaire, and family history of suicidal behavior.

STATISTICAL ANALYSES

Comparisons between the different patterns of suicide attempts characteristics were made using logistic regression with crude and adjusted odds ratios and 95% confidence intervals.

RESULTS

The risk of violent suicide attempts increased significantly in patients born prematurely (OR [95%] = 2.38[1.12-5.08]). There were additive effects for very preterm birth and 1) emotional abuse (OR [95% CI] = 4.52 [1.75-11.60]), 2) novelty seeking (OR [95% CI] = 8.92[3.09-25.7]), and 3) harm avoidance (OR [95% CI] = 5.81 [2.43-13.90]) on the age at first suicide attempt, after adjustment for potential confounders.

CONCLUSIONS

Very preterm birth appears to be the first step in a cascade of stressors across lifetime, which affects the risk and the severity of suicidal behavior. Furthermore, very preterm birth, childhood maltreatment and personality traits have additive effects that influence the age at onset of suicide attempt. Our findings may have potential consequences for preventive policies.

Maternal parenting styles and mother-child relationship among adolescents with and without persistent attention-deficit/hyperactivity disorder

We investigated mothering and mother-child interactions in adolescents with and without persistent attention-deficit/hyperactivity disorder (ADHD) in a sample of 190 adolescents with persistent DSM-IV ADHD, 147 without persistent ADHD, and 223 without ADHD. Both participants and their mothers received psychiatric interviews for diagnosis of ADHD and other mental disorders; and reported on the Parental Bonding Instrument about mother's parenting style, the Social Adjustment Inventory for Children and Adolescents for interactions with mothers and home behavioral problems. The mothers also reported on their ADHD and neurotic/depressive symptoms. Our results based on both informants showed that both ADHD groups obtained less affection/care and more overprotection and control from the mothers, and perceived less family support than those without ADHD. Child's inattention and comorbidity, and maternal depression were significantly correlated with decreased maternal affection/care and increased maternal controls; child's hyperactivity-impulsivity and maternal neurotic trait were significantly correlated with maternal overprotection; and child's inattention and comorbidity, and maternal neurotic/depressive symptoms were significantly correlated with impaired mother-child interactions and less family support. Our findings suggested that, regardless of persistence, childhood ADHD diagnosis, particularly inattention symptoms and comorbidity, combining with maternal neurotic/depressive symptoms was associated with impaired maternal process.

The prevalence of and psychosocial risks for suicide attempts in male and female college students in Taiwan

The prevalence of and psychosocial risks for suicide attempts was investigated in college students in Taiwan by gender, after controlling for depressive symptoms. Self-reported data were collected from a nationally representative sample of 2,835 college students; 11.90% of females and 8.87% of males reported they had attempted suicide in the preceding 12 months. After controlling for depression, suicidal ideations were associated with suicide attempts in females, whereas there were fewer positive expectations toward the future associated with suicide attempts in males. Several explanations for the high prevalence of suicide attempts among college students in Taiwan were discussed. In the future, further verification of the findings is necessary.

Determinants of maternal satisfaction with diagnosis disclosure of autism

BACKGROUND/PURPOSE

Diagnosis disclosure is an important clinical issue in developmental disabilities, which may influence parents' ability to cope with their child's conditions. This paper presents the content and patterns of diagnosis-informed counseling for mothers of children with autism and investigates the determinants for maternal satisfaction with this counseling, in order to improve clinical practice.

METHODS

Mothers of 151 children, aged 3-12 years, with DSM-IV autistic disorder, confirmed by the Chinese version of the Autism Diagnostic Interview-Revised, were assessed. We collected information about the mothers' experience with diagnosis-informed counseling, their personality characteristics, and the extent to which they were satisfied with the counseling.

RESULTS

Satisfaction with diagnosis-informed counseling was related more to the context of the counseling, including the attitude of the counselors and the timing and duration of counseling, than to its content. Parents' social desirability, educational level, and employment status were negatively associated with their satisfaction with counseling. However, immediate emotion, neuroticism, and extroversion did not have a significant effect on the satisfaction with counseling. Approximately 60% of the mothers preferred to be informed of having an autistic child after the diagnosis had been confirmed.

CONCLUSION

Our findings suggest that more efforts are needed to improve the quality of diagnosis-informed counseling in autism, particularly in the context of breaking the news to mothers of children with autism. Future study could further examine the moderating effect of diagnostic subtype of autism spectrum disorders, treatment response, or social support on maternal satisfaction with diagnosis-informed counseling (ClinicalTrials.gov number, NCT00494754).

NCAM1, TACR1 and NOS genes and temperament: a study on suicide attempters and controls

Suicide, one of the leading causes of death among young adults, seems to be plausibly modulated by both genetic and personality factors. The aim of this study was to dissect the potential association between genetics and temperament in a sample of 111 suicide attempters and 289 healthy controls. We focused on 4 genes previously investigated in association with suicide on the same sample: the nitric oxide synthase 1 and 3 (NOS1 and NOS3), the neuronal cell adhesion molecule 1 (NCAM1), and the tachykinin receptor 1 (TACR1) genes. In particular, we investigated whether a set of genetic variants in these genes (NOS1: rs2682826, rs1353939, rs693534; NOS3: rs2070744, rs1799983, rs891512; NCAM1: rs2301228, rs1884, rs1245113, rs1369816, rs2196456, rs584427; TACR1: rs3771810, rs3771825, rs726506, rs1477157) were associated with temperamental traits at the Temperament and Character Inventory (TCI). No strong evidence was found for the association between TCI personality traits and the polymorphisms considered in the 4 genes, with the exception of an association between reward dependence trait and the rs2682826 SNP in NOS1 in the healthy sample. However, this result could be plausibly interpreted as a false-positive finding. In conclusion, our study did not support the thesis of a direct modulation of these genes on temperament; however, further studies on larger samples are clearly required in order to confirm our preliminary findings and to exclude any possible minor influence.

Association of the MAOA promoter uVNTR polymorphism with suicide attempts in patients with major depressive disorder

Background

The MAOA uVNTR polymorphism has been documented to affect the MAOA gene at the transcriptional level and is associated with aggressive impulsive behaviors, depression associated with suicide (depressed suicide), and major depressive disorder (MDD). We hypothesized that the uVNTR polymorphism confers vulnerability to MDD, suicide or both. The aim of this study was to explore the association between the MAOA uVNTR and depressed suicide, using multiple controls.

Methods

Four different groups were included: 432 community controls, 385 patients with MDD who had not attempted suicide, 96 community subjects without mental disorders who had attempted suicide, and 109 patients with MDD who had attempted suicide. The MAOA uVNTR polymorphism was genotyped by a PCR technique. The symptom profiles and personal characteristics in each group were also compared.

Results

The MAOA 4R allele was more frequent in males with MDD than in male community controls (χ² = 4.182, p = 0.041). Logistic regression analysis showed that, among the depressed subjects, those younger in age, more neurotic or who smoked had an increased risk of suicide (β = -0.04, p = 0.002; β = 0.15, p = 0.017; β = 0.79, p = 0.031, respectively). Moreover, among those who had attempted suicide, those younger in age, with more paternal overprotection, and more somatic symptoms were more likely to be in the MDD group than in the community group (β = -0.11, p < 0.001; β = 0.15, p = 0.026; β = 1.11, p < 0.001). Structural equation modeling (SEM) showed that nongenetic factors, such as age, paternal overprotection, and somatic symptoms, were associated with MDD, whereas depressed suicide were associated with severity of depression, personality traits, age, marital status, and inversely associated with anxiety symptoms. However, depression did not affect suicidal behavior in the community group.

Conclusion

The MAOA 4R allele is associated with enhanced vulnerability to suicide in depressed males, but not in community subjects. The MAOA 4R allele affects vulnerability to suicide through the mediating factor of depressive symptoms. Further large-scale studies are needed to verify the psychopathology of the relationships among MAOA uVNTR polymorphism, symptom profiles, and suicidal behavior.

Personality and psychopathology of university students

PURPOSE OF REVIEW

University students represent the national capital and investment for the future, with an implicit mission both for their families and for society as a whole. However, they face multiple stressors such as academic overload, constant pressure to succeed, competition with peers and in some countries financial burden and concerns about the future. As all this may lead to psychopathology, the health of university students has been the subject of increasing focus in recent years.

RECENT FINDINGS

Multiple protective and risk factors are involved in the psychological well being and distress of university students. Specific risk factors for the development of psychopathology are high test anxiety, lower self-efficacy, as well as certain personality traits. Moreover, some students arrive at college with already existing mental health problems. The most frequent mental disorders among students are substance abuse, depression, self-harm and suicide, eating and anxiety disorders.

SUMMARY

Acquiring and improving knowledge about the student population is a crucial factor in the development of mental health promotion programs in order to meet their needs and to help them cope with various problems. Better understanding and care of the personality profile of university students can be helpful in academic and career choice and prevention of future mental health problems.

The moderating effects of parenting styles on African-American and Caucasian children's suicidal behaviors

Given that parenting practices have been linked to suicidal behavior in adolescence, examining the moderating effect of parenting styles on suicidal behavior early in development could offer potential insight into possible buffers as well as directions for suicide prevention and intervention later in adolescence. Hence, the moderating effects of parenting styles, including authoritarian, permissive, and features of authoritative parenting, on depressed and aggressive children's suicidal behavior, including ideation and attempts, were evaluated with young children (N = 172; 72% male, 28% female) ranging from 6 to 12 years of age. African American (69%) and Caucasian (31%) children admitted for acute psychiatric inpatient care completed standardized measures of suicidal behavior, depressive symptoms, and proactive and reaction aggression. Their parents also completed standardized measures of parental distress and parenting style. Hierarchical regression analyses revealed that, while statistically controlling for age and gender, children who endorsed more depressive symptoms or reactive aggression reported more current and past suicidal behavior than children who endorsed fewer depressive or aggressive symptoms. The significant positive relationship observed between depressive symptoms and childhood suicidal behavior, however, was attenuated by parental use of authoritarian parenting practices for African-American and older children but not for younger and Caucasian children. The ethnic/racial difference observed for the buffering effect of authoritarian parenting practices offers potential theoretical and clinical implications for conceptualizing the moderating effects of parenting styles on African-American and Caucasian children's suicidal behavior.

Individual and family correlates for cigarette smoking among Taiwanese college students

OBJECTIVE

This college-based questionnaire survey aimed to explore the individual, family, and peer correlates for cigarette smoking among first-year college students.

METHOD

The sample included 2918 first-year college students (males, 45.5%) recruited from a national university in Taiwan (participation rate, 79.1%). The participants reported on questions about various substances, attitudes toward substances, personality characteristics, psychopathology, suicidal behaviors, parenting style, family function and use of substances, and peer substance use.

RESULTS

There were 263 (9.0%; males, 70.6%) current smokers. Compared to nonsmokers, college smokers were more extraverted and neurotic, and showed less harm avoidance, and more novelty seeking in their personality. They had more hostile, somatic, depressive, paranoid, and psychotic symptoms in terms of psychopathology. Smokers were more likely to use other substances, and to have suicidal ideations, wishes, plans, and attempts. Smokers perceived lower family cohesion, less care from their fathers, and less overprotection from their mothers. They were more likely to have peers and family members who also smoked or used other substances. The most associated correlates were male sex, older age, other substance use, novelty seeking, suicidal ideation and attempts, sibling and peer substance use, a prosubstance attitude, and less maternal overprotection.

CONCLUSIONS

Our findings support the association of cigarette use in Taiwanese young adults with several individual, family, and peer factors identified in Western studies. Intervention in cigarette use should be multifaceted, by taking its correlates and the concurrent psychopathology, use of substances, and suicidality into consideration.