Exposure to Suicide in High Schools: Impact on Serious Suicidal Ideation/Behavior, Depression, Maladaptive Coping Strategies, and Attitudes toward Help-Seeking

Network analysis of correlations between suicide exposure, depression, and anxiety symptoms in adolescents

BACKGROUND

Adolescents with a history of suicide exposure, defined as experiencing the suicide death of a family member, friend, or other acquaintances, are more likely to experience mental health issues such as depression or anxiety.

AIMS

This study aimed to explore prevalence rates and the network of adolescents' suicide exposure, depression, and anxiety symptoms, and to clarify the correlations between suicide exposure and symptoms of depression and anxiety.

METHOD

A total of 8,957 adolescents were included in this cross-sectional study. Data regarding general information, symptoms of depression and anxiety, and suicide exposure were collected from mid-September to early October 2021. Network analysis was employed to assess relationships between suicide exposure and individual symptoms of both depression and anxiety. Central symptoms were identified by strength; the flow network was visualized to identify symptoms directly related to suicide exposure.

RESULTS

The prevalence rates of suicide exposure, depression, and anxiety were 5.28%, 12.87%, and 10.48%. Results indicated that suicide exposure was associated with both depression and anxiety, and had the strongest positive association with suicidal ideation. Central symptoms of the network were sad mood, nervousness, fatigue, irritability, and uncontrollable worry. Bridge symptoms were suicidal ideation and irritability. Appetite changes, suicidal ideation, uncontrollable worry, sleep difficulties, and irritability were symptoms directly related to suicide exposure.

CONCLUSIONS

There were significant inter-symptom associations between suicide exposure, depression, and anxiety in adolescents. It is recommended that future studies explore whether targeted interventions and long-term monitoring concerning these inter-symptom associations can protect adolescents with suicide exposure.

Friendships and peer relationships and self-harm ideation and behaviour among young people: a systematic review and narrative synthesis

Friendships and peer relationships have an important role in the experience of self-harm ideation and behaviour in young people, yet they typically remain overlooked. This systematic review and narrative synthesis explores the extant literature on this topic to identify important relationships between these constructs. We did a keyword search of peer-reviewed empirical articles relating to friendships and peer relationships and self-harm ideation and behaviour in young people (aged 11-25 years). We identified 90 articles with evidence primarily from adolescents aged 11-18 years, including mixed genders and a majority of White individuals. Findings highlight substantive relationships between the key constructs, showing that: characteristics of friends and peers, including their self-harm ideation and behaviour, relate to and predict ego self-harm ideation and behaviour; friends and peers are important sources of support; and evidence on causal mechanisms is scarce but highlights potential peer selection and influence processes. Studies of the friends and peers of young people with self-harm ideation and behaviour highlight that: friends' attitudes to self-harm and suicide influence their responses to peers with self-harm ideation and behaviour; and friends who are bereaved and friend supporters experience negative outcomes such as symptoms of depression, anxiety, PTSD, and grief, alongside difficult emotions. Despite substantial heterogeneity across samples, study designs, and definition or measurement of the primary constructs, this work presents an initial step in organising a complex literature on a crucially important topic, which can help to inform future research and evidence-based interventions.

Do We Belong? Examining the Associations Between Adolescents' Perceptions of School Belonging, Teacher Discrimination, Peer Prejudice and Suicide

In the USA, suicide is a leading cause of death for adolescents ages 12 to 18 (National Institute of Mental Health (NIMH), 2019). Given the urgency of this public health crisis, this paper aims to explore the impact of a sense of school belonging and teacher-based discrimination and peer-based prejudice on suicidal ideation and attempts among Black youth. This secondary analysis used a sample of Black youth (N = 4229; Mage = 16) from the National Longitudinal Study of Adolescents to Adult Health data. Independent variables included a sense of school belonging, school-based teacher discrimination, and school-based peer prejudice; the dependent variable was suicidal thoughts and behaviors. The results of multinomial regression analyses revealed that as Black adolescents' sense of school belonging decreased, they were 35% more likely to be at risk for suicidal ideation and attempts. Findings from our study support the assertion that the school microsystem plays a substantial role in modifying the risk of suicidal behavior among Black youth.

After a Suicide Death in a High School: Exploring Students' Perspectives

By the time they leave high school, 17% of adolescents will have experienced the suicide death of a friend, peer, or classmate. While some will be unaffected or experience a brief period of distress following the death, for others the death will cause significant disruption and distress, even increasing their risk of suicidal thoughts and behaviors. It is essential for social workers to be able to support at-risk adolescents after this type of loss. To do this, it is critical to understand the ways that adolescents experience the death, grieve, and recover from the loss. This qualitative study explored adolescents' experiences with grief and loss following an adolescent suicide death in the United States. Thematic analysis of semi-structured interviews with young adults (N = 13) who had been exposed to the suicide death of a peer, classmate, or friend while in high school examined themes about their processing of the death, yielding four themes about sense-making and making meaning about the death. Implications for social workers, schools, and suicide postvention researchers are identified and discussed.

Pediatric Suspected Suicides and Nonfatal Suicide Attempts Reported to United States Poison Control Centers Before and During the COVID-19 Pandemic

INTRODUCTION

This study investigated the characteristics and compared the trends of pediatric suspected suicide and nonfatal suicide attempts reported to United States (US) poison control centers (PCCs) before and during the first year of the COVID-19 pandemic.

METHODS

An interrupted time series analysis using an ARIMA model was conducted to evaluate the trends of suspected suicides and nonfatal suicide attempts among children 6-19 years old reported to the National Poison Data System during March 2020 through February 2021 (pandemic period) compared with March 2017 through February 2020 (pre-pandemic period).

RESULTS

The annual number of cases of suspected suicides and nonfatal suicide attempts increased by 4.5% (6095/136,194) among children 6-19 years old during March 2020 through February 2021 compared with the average annual number during the previous three pre-pandemic years. There were 11,876 fewer cases than expected from March 2020 to February 2021, attributable to a decrease in cases during the initial three pandemic months. The average monthly and average daily number of suspected suicides and nonfatal suicide attempts among children 6-12 years old and 13-19 years old was higher during school months than non-school months and weekdays than weekends during both the pre-pandemic and pandemic periods.

CONCLUSIONS

There was a greater than expected decrease in the number of suspected suicides and nonfatal suicide attempts among children 6-19 years old reported to US PCCs during the early pandemic months, followed by an increase in cases. Recognizing these patterns can help guide an appropriate public health response to similar future crises.

Impact of the COVID-19 pandemic for youth with a history of exposure to self-directed violence

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic created a sudden shift in the social lives of youth with important negative impacts on mental health. The current article aims to understand how the pandemic may have differentially impacted the mental health of adolescents and young adults with recent (1 year or less) and past (> 1 year) exposure to self-directed violence (SDV).

METHOD

Data were collected online from 990 youth and young adults, aged 13-23 years between November 27, 2020 and December 11, 2020.

RESULTS

Participants who had recently been exposed to SDV reported being more impacted by the pandemic and had poorer mental health indicators. Participants with past SDV exposure who engaged in a high number of prosocial activities (e.g., talking with friends) were less likely to report depressive symptoms (β = -.13, p = .01) than similarly engaged nonexposed participants; the same was true for recently exposed participants (β = -.14, p = .02).

CONCLUSIONS

Findings highlight that the effects of the COVID-19 pandemic on the mental health of young people are compounded by exposure to mental health concerns of people in their network. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association between Suicidal Behaviors in Adolescence and Negative Emotions, the Level of Stress, Stress Coping Strategies and the Quality of Sleep

Suicidal behaviors in adolescents stem from complex processes deeply rooted in various spheres of life and functioning. The study was aimed at assessing the relationship between selected negative emotions, the quality of sleep, the level of perceived stress as well as stress coping strategies and suicidal ideation and attempts among high school students. The examined group consisted of adolescents aged 16-18 recruited by social-media groups in Poland. The study was based on a diagnostic survey with the application of CAWI method. The other research tools applied in the study included: Hospital Anxiety and Depression Scale-Modified, Perceived Stress Scale-10, How do you cope?-Questionnaire, Athens Insomnia Scale as well as the authors' own questionnaire on suicidal ideation and suicide attempts. Anxiety, depression, aggression and insomnia as well as a high level of stress were statistically more common in girls than in boys (p < 0.001). The high level of negative emotions and insomnia, in turn, increased the risk of suicidal ideation (OR = 3.59, 95% CI: 2.13-6.06 and OR = 2.35, 95% CI: 1.60-3.46), as well as suicide attempts (OR = 6.29, 95% CI: 2.93-14.80 and OR = 3.29, 95% CI: 2.07-5.35). Additionally, high level of stress was associated with more than twice larger odds of suicidal ideation (OR = 2.26, 95% CI: 1.13-4.63). Significantly higher prevalence of suicidal ideation (p = 0.017) and suicide attempts (p = 0.016) was observed in girls. A high level of negative emotions and stress accompanied by a low quality of sleep are factors predisposing people to suicidal ideation and attempted suicide.

Adolescents' Experiences With School-Based Postvention Services: Needs, Supports, and Recommendations

This exploratory qualitative study of youth (N = 13) exposed to a peer's suicide death examined responses to the death and needed school-based responses and supports. Youth reported emotions including anger, grief, and fear, described suicide as a profound and impactful experience, and shared beliefs about entitlement to grief. Participants wanted schools to provide support for grief, to feel cared about by adults at school, to receive education about grief and suicide at school, and to have school-based opportunities to commemorate the deceased. Recommendations for schools include strategies for facilitating healthy grieving, supporting students, educating the community, and memorializing the deceased, while remaining cognizant of the need to prevent suicide contagion in the community.

Youth Suicide

In the setting of the current youth mental health crisis and increasing rates of suicide, detecting suicide risk and intervening to prevent it is crucial. Factors that confer an elevated risk of suicide attempts and death by suicide include past suicide attempts, nonsuicidal self-injurious behavior, psychiatric disorders, gender and sexual minority identity, family history, history of trauma and loss, bullying, a lack of connectedness, and access to lethal means. Proper screening, assessment, and crisis planning may help save lives and reverse the trend of increasing youth suicide rates.

Association Between Exposure to Suicidal Behaviors and Suicide Attempts Among Adolescents: The Moderating Role of Prior Psychiatric Disorders

Theories suggest that adolescents exposed to suicide attempts and/or deaths are at higher risk of attempting suicide, themselves. However, research findings have been mixed, with most studies not accounting for psychiatric vulnerability. We examined past psychiatric diagnosis as a moderator of the association between lifetime exposure to suicide attempts and/or deaths and adolescents' suicide attempts. Adolescents (N = 518; 60% female; 45% White), ages 12-21, reported on prior suicide ideation and attempts, and mood, anxiety, and substance use disorders at baseline. Suicide attempts since baseline and exposure to suicidal behaviors were assessed 4-6 years later. Lifetime exposure to family suicide attempts and/or suicide deaths, but not to suicidal behaviors of peers/friends or others, was associated with a suicide attempt at follow-up among those with prior psychiatric disorders. Psychologically vulnerable adolescents may require additional support after exposure to suicidal behaviors of a family member to reduce their risk of attempting suicide.

Suicide Postvention in Schools: What Evidence Supports Our Current National Recommendations?

Suicide is a leading cause of death for school-aged preteens and adolescents and a growing risk for younger children. Schools are the ubiquitous institutional context serving this age group. These trends suggest a need for knowledge and guidance related to school postvention efforts, yet the available research is limited. Focusing on postvention, or the period after a peer suicide occurs, is critical to youth suicide prevention because this is a time of elevated suicide risk for youth. Targeted postvention interventions in schools can mitigate youth suicide risk and limit contagion within a school's student body. This article explores the scientific literature related to school-based suicide postvention, describing the strength and limits of research supporting common recommendations for suicide postvention in schools. It identifies widespread recommendations for school postvention that have only preliminary supportive evidence and notes several areas in need of additional research. With clearer postvention best practices to guide their suicide crisis preparedness plans and postvention procedures, schools can better support students, families, and the community as a whole in order to prevent further tragedies.

Positive Relationships with Adults and Resilience to Suicide Attempt among New Mexico Hispanic Adolescents

Suicide is a leading cause of adolescent death and has increased in recent years. The purpose of this study was to examine the effect that relationships with adults at home and in the community had on the probability of suicide attempts of Hispanic teenagers in New Mexico. Data from the 2019 New Mexico Youth Risk and Resiliency Survey were analyzed to identify the ways in which relationships with adults influenced suicide attempts among Hispanic adolescent students. The examined factors included: relationships with adults in the home and in the community and with same-age friends, and participation in hobbies or organizations outside of school. The resiliency factors were similar for male and female Hispanic students. As positive relationships with adults at home or in the community increased, the probability of suicide attempts decreased by 37–54%. Positive relationships with same-age friends were also associated with reduced suicide attempts. Community organization involvement and hobbies affected males and females differently. Adults at home and in the community can decrease the risk of suicide for Hispanic teenagers through supportive relationships. Hybrid programs focusing on adolescent health, positive communication, and academic support, which integrate adults from home and community environments, show promise in reducing suicidal thoughts and other risk behaviors.

Identifying a probable suicide cluster in an acute care psychiatric hospital in the Eastern Cape, South Africa

Background

Two young male patients who were diagnosed with drug-induced psychosis committed suicide in a psychiatric hospital in South Africa within a month of each other. The psychiatric nurses working in the hospital had never before had to deal with a similar trauma of suicide cluster.

Aim

To assess the psychiatric nurses' experiences of suicide cluster in an inpatient psychiatric setting.

Setting

A psychiatric hospital in the Eastern Cape, South Africa.

Method

A qualitative design was used. The research population consisted of psychiatric nurses who were purposively selected. Data were gathered using in-depth interviews where the participants narrated their experiences of the incidents. The interviews were transcribed verbatim and the data was coded using descriptive and explanatory codes. Trustworthiness was ensured. Ethical principles of justice, autonomy, beneficence and non-maleficence were ensured.

Results

An attempt was made to compare the suicides of two patients with the characteristics of cluster suicide to determine if clustering took place. Two young males committed suicide in an institutional setting within a month of each other. Other characteristics present included using the same method, in the same venue and in the same unit. They had similar educational and social backgrounds. The second victim knew the first victim and was aware of what happened.

Conclusion

When the two events are analysed together it would seem as if clustering did occur. The suicide victims knew each other and victim number 2 was aware of the facts of the first suicide. They were in their early 20's, were mentally ill and committed suicide in the same site, using the same method and were both institutionalised at the time. Members of the mental healthcare team should be made aware of the characteristics of clustering so that when a suicide attempt occurs in a place where mentally-ill individuals are cared for, measures can be put in place to prevent another patient from copying such an event.

Suicidal Ideation among Youths at Risk of School Dropout: Impact of Student Demographics, Stressors, and Academic Self-Concept

In the United States, suicidal ideation is an issue for high school-age youths. Research supports that youths who have learning difficulties and who are at risk of high school dropout are at greater risk for suicidal ideation. Although alternative high schools address both student academics and emotional health, they are underused, nonclinical settings for understanding and addressing suicidal ideation. This study aimed to examine the impact of student identity, external stressors, and academic self-concept on suicidal ideation among sexual and ethnic minority and underserved students enrolled in an alternative education public high school. The student sample (N = 103) completed a onetime survey comprised of the Suicidal Ideation Questionnaire-Junior, the Cultural Assessment of Risk of Suicide, the Coddington Life Events Scale for Adolescents, and the Piers Harris 2. Results of hierarchical linear regression indicated that identifying as nonheterosexual and experiencing discrimination were associated with greater student reporting of suicidal ideation. Identifying as Latino and other non-White was associated with lower reporting of suicidal ideation. Controlling for student demographics and external stressors, positive academic self-concept was associated with a lower reporting of suicidal ideation. Findings have future implications for health social work, suicide prevention and intervention, and education policy.

The Hospice as a Learning Environment: A Follow-Up Study with a Palliative Care Team

In Western society, the topic of death has been removed from everyday life and replaced with medical language. Such censorship does not reduce individuals’ fear of death, but rather limits their ability to elaborate their experiences of death, thus generating negative effects. The objective of this follow-up qualitative study was to detect how and if death education can help to improve individuals’ relationship with death and enhance care environments like hospices. Semi-structured interviews were conducted with palliative care professionals and teachers who had taken part in a death education initiative three years earlier. The results confirmed the initiative’s positive effect on both palliative care professionals and teachers. The participants reported that the education initiative helped them to positively modify their perspective on death, end-of-life care, and their own relationship to life, as well as their perception of community attitudes towards the hospice, which seemed to become less discriminatory. This study confirmed that school education initiatives can usefully create continuity between hospices and local communities. This project provided an educational space wherein it was possible for participants to elaborate their experiences in relation to death and to re-evaluate and appreciate hospices.

Social Media and Suicide: A Validation of Terms to Help Identify Suicide-related Social Media Posts

BACKGROUND

Communication plays an important role in the prevention of suicide, a leading cause of death in the United States. Prior research suggests people who die by suicide often communicate their intent to more than one member of their social network. The ubiquity of social media in modern society means an individual's social network may be larger than ever before, which has contributed to a proliferation of colloquial terms and phrases to describe suicide.

AIMS

The present study collected and validated suicide-related terms from the U.S. English language in 2018-2019. By validating clinical and lay terms with people on the front lines of suicide prevention, the study provides a necessary foundation for lexical analyses of suicide communication on social media.

METHOD

98 terms related to suicide were collected from online, academic, and other sources. Mental health professionals and members of the electronic mailing list of the American Association of Suicidology were asked to validate terms.

RESULTS

The survey validated common terms used to communicate about suicide.

LIMITATIONS

The lexicon did not capture international phrases. It also did not document less direct language, such as expressions of emotion.

Advancing Research in Child Suicide: A Call to Action

OBJECTIVE

To highlight the problem of child suicide, summarize what is known and not known about the problem in the empirical literature, and provide recommendations with ethical considerations for future research and practice.

METHOD

The development of this paper was informed by a meeting of national experts on the topic hosted by the National Institute of Mental Health, as well as by a review of the empirical literature.

RESULTS

We know something about demographic characteristics that are related to higher child suicide rates, but beyond that we know relatively little about risk factors, prevention, and intervention for suicide risk in children <12 years. It is important for child suicide researchers and practitioners to pay particular attention to ethical issues that may be likely to arise in doing this type of work.

CONCLUSION

Much more research is needed on child suicide in the areas of measurement, prevention, and intervention in order to advance the field and provide practitioners with the tools that they critically need.

Psychological factors of vulnerability to suicide ideation: Attachment styles, coping strategies, and dysfunctional attitudes

BACKGROUND

Suicide ideation is one of the common mental health problems among university students. This study aimed to explain suicide ideation susceptibility by examining the relationships between psychological factors.

METHODOLOGY

The population of the study included all female undergraduate students at the University of Isfahan in autumn 2018. A sample of 180 individuals were selected through multistage sampling from different faculties and majors. The scales used in this study included adults attachments inventory, Coping Inventory for Stressful Situation, Dysfunctional Attitudes Scale, and Suicide Ideation Scale. The statistical analyses included t-test, Pearson correlation, and path analysis.

RESULTS

Suicide ideation was reported in 25% of the participants. The t-test analysis indicated that the mean scores for dysfunctional attitudes (P < 0.01) and problem-focused coping (P < 0.01) were significantly different in with and without suicide ideation groups. Suicide ideation significantly correlated with problem-focused coping (r = -0.42, P < 0.01), emotion-focused coping (r = 0.25, P < 0.05), and dysfunctional attitudes (r = 0.23, P < 0.05). Path analysis showed that dysfunctional attitudes and emotion-focused coping significantly influenced suicide ideation. Moreover, the indirect effect of insecure (ambivalent and avoidant) attachment styles by mediating role of dysfunctional attitudes and emotion-focused coping was statistically significant (P < 0.01) and the indirect effect of dysfunctional attitudes by mediating role of emotion-focused coping as well (P < 0.05).

CONCLUSION

Insecure attachment styles and dysfunctional attitudes work as stress-diathesis model in predicting suicide ideation and increase suicide ideation susceptibility by affecting emotion-focused coping strategy. The hypothesized model in this study can help formulate, evaluate, and prevent suicide risk.

Clustering of suicides in children and adolescents

Suicide is one of the major causes of death in young people, in whom suicide can occur in clusters. In this Review, we have investigated definitions and epidemiology of such clusters, the factors associated with them, mechanisms by which they occur, and means of intervening and preventing them. Clustering of suicidal behaviour is more common in young people (<25 years) than adults. Suicide clusters can occur as a greater number of episodes than expected at a specific location, including in institutions (eg, schools, universities, psychiatric units, and youth offender units). They might also involve linked episodes spread out geographically. Locations exposed to clusters can be at risk for future clusters. Mechanisms involved in clusters include social transmission (particularly via person-to-person transmission and the media), perception that suicidal behaviour is widespread, susceptible young people being likely to socialise with others at risk of suicidal behaviour, and social cohesion contributing to the diffusion of ideas and attitudes. The internet and social media might have particularly important roles in spreading suicidal behaviour. The effect of suicide clusters on communities and institutions is usually profound. Experience of intervening in clusters has resulted in best practice guidance. This guidance includes preparation for occurrence of clusters in both community and institutional settings. Identification of clusters in the community requires real-time monitoring of suicidal behaviour. Effective intervention is more likely if a cluster response group is established than if no such group exists. The response should include bereavement support, provision of help for susceptible individuals, proactive engagement with media interest, and population-based approaches to support and prevention. Social media can provide a powerful means for disseminating information and reaching young people at risk.

Editorial: Suicide and self-harm: advancing from science to preventing deaths

Globally, suicide is the second leading cause of death among youth ages 15-29-years, and self-harm is one of the strongest known predictors of death by suicide. This editorial introduces the Special Issue on suicide and self-harm, emphasizing the research and policy implications of the included articles. By illustrating advances in our science, the Special Issue both celebrates our achievements and highlights the need to use our science to inform suicide prevention policy and practice to reduce the tragedy of suicide and premature deaths.

The personal experience of severe suicidal behaviour leads to negative attitudes towards self- and other's suicidal thoughts and behaviours: A study of temperaments, coping strategies, and attitudes towards suicide among medical students

The attitudes individuals have towards suicidal behaviour, be it their own or others', and their capacity for developing specific coping strategies are influenced by affective temperaments that play a significant role in emotional regulation. However, few studies have investigated these specific patterns with a view to stratify them according to the severity of suicidal behaviours in medical students. The Pearson χ2 test for the comparison of categorical variables, the t-test for independent samples of continuous variables and logistic regression analysis were used to compare the association among temperaments, coping strategies, and attitudes towards suicide in a sample of medical students who attend the School of Medicine, Genoa. Severe suicidal thoughts and behaviours relative to those who were not at risk for suicide were also revealed. The severe suicidal thought and behaviour group had significantly more anxious and cyclothymic temperaments together with a higher use of dis-adaptive, lower emotional focus coping strategies, and higher self-reproaching, criticizing, and judgemental attitudes towards suicidality compared to the no severe suicidal thought and behaviour group. The identified pattern suggests the need for clinicians to carefully consider the complex interplay of clinical features which characterize severely at risk for suicide young adults in order to develop effective and comprehensive prevention strategies.

Assisting the School in Responding to a Suicide Death: What Every Psychiatrist Should Know

When a child or adolescent dies by suicide, many individuals are affected, most of whom are attending school. Child and adolescent psychiatrists can be called on during the wake of such tragic events in order to help schools navigate the difficult tasks following a student suicide. Being familiar with suicide postvention guidelines is crucial for anyone involved in managing the events following a student suicide. By understanding the tenets of suicide postvention and resources that are available to schools and clinicians, the tragedy of suicide can also be an opportunity to improve school mental health and suicide prevention.