Family and School Contexts as Predictors of Suicidal Behavior among Adolescents: The Role of Depression and Anxiety

How do adolescents consider life and death? A cognition-to-action framework for suicide prevention

Rising rates of suicide fatality, attempts, and ideations among adolescents aged 10-19 over the past two decades represent a national public health priority. Theories that seek to understand suicidal ideation overwhelmingly focus on the transition from ideation to attempt and on a sole cognition: active suicidal ideation - the serious consideration of killing one's self, with less attention to non-suicidal cognitions that emerge during adolescence that may have implications for suicidal behavior. A large body of research exists that characterizes adolescence not only as a period of heightened onset and prevalence of active suicidal ideation and the desire to no longer be alive (i.e., passive suicidal ideation), but also for non-suicidal cognitions about life and death. Our review synthesizes extant literature in the content, timing and mental imagery of thoughts adolescents have about their (1) life; and (2) mortality that may co-occur with active and passive suicidal ideation that have received limited attention in adolescent suicidology. Our "cognition-to-action framework for adolescent suicide prevention" builds on existing ideation-to-action theories to identify life and non-suicidal mortality cognitions during adolescence that represent potential leverage points for the prevention of attempted suicide and premature death during this period and across the life span.

Adolescent suicide: a major mental health issue in pediatric care

Adolescent suicide is a major public health problem, as suicide is one of the leading causes of death for adolescents. Predicting and preventing suicide represent very difficult challenges for clinicians. Youth suicide might be prevented by identifying risk factors for adolescent suicidal behavior. Diagnostic assessment involves identification of multiple factors including gender differences, psychopathology, comorbidity, interpersonal problems, family discord, family psychopathology, accessibility of lethal suicide methods, exposure to suicide, previous attempt, social support, life stressors, and protective factors. The literature clearly indicates a need for suicide awareness and prevention programs and for early identification of adolescents at risk for suicidal behaviors. However, many health care professionals who have frequent contact with adolescents are not sufficiently trained in suicide evaluation techniques and approaches to adolescents with suicidal behavior. Pediatricians and other health professionals involved in adolescents' care need more in-depth information about the characteristics and the warning signs for suicide.

Ambivalent attitudes toward life and death and suicide ideation among adolescents-The mediating role of depression

BACKGROUND

Ambivalence in attitudes towards life and death are associated with suicide ideation (SI) among adolescents. However, previous research was mainly cross-sectional and did not examine through which psychopathological mechanisms (such as depression) attitudes towards life and death are associated with SI.

OBJECTIVE

The current longitudinal study examined the mediating role of depression at follow-up in the association between attitudes towards life and death at baseline and SI at follow-up among at-risk adolescents referred to an outpatient psychiatric clinic.

METHODS

129 adolescents aged 10-18 years (75.2% females) with a history of suicidal thoughts and behaviors were assessed at clinic intake and 1 month follow-up (80% retention rate at follow-up). All participants completed a questionnaire assessing attitudes towards life and death and SI severity at clinic intake, and depression and SI severity at 1 month follow-up.

RESULTS

While controlling for SI severity at intake, attraction towards life at baseline, rather than attraction and repulsion towards death at baseline, led to higher SI severity at follow-up, while depression at follow-up fully mediated this association.

CONCLUSIONS

Attitudes towards life, as well as depression play critical roles in the development of SI among adolescents. Interventions targeting reasons for living and promoting meaning of life may be beneficial in preventing depression and SI.

Assessment of children suicide attempts frequency in the peripandemic period

Objectives

Our study aimed to evaluate patients after suicide attempts treated at the Department of Trauma Surgery for Children in the peripandemic period, assessment of potential risk factors, and the school's participation as the unit responsible for the prevention of suicidal behavior.

Materials and methods

Retrospective review of the medical database at equal time intervals of 24 months to identify patients treated before and after the COVID-19 was done. Thorough analysis including injury mechanism, medical procedures, history of previous mental disorders or suicidal behavior was performed. Furthermore, results were compared with the Polish police suicide statistics.

Results

Based on our retrospective review we found 4 patients treated in our department before the pandemic and 10 patients treated after COVID-19 outbreak. The group before SARS-Cov-2 era consisted of three girls and one boy with a mean age of 14.97 (12.7-17.6). The group treated in the pandemic crisis consisted of 8 boys and 2 girls, the mean age was 15.49 (10.8-17.2). In the pre-COVID-19 group, 2 out of 4 patients had received psychiatric treatment before, but none had attempted suicide before. In the COVID-19 group, 6 out of 10 patients had previously received psychiatric treatment, moreover 3 of them attempted suicide before. Based on our analysis, the number of individuals who displayed suicidal attempts has raised. Between 2018 and 2021 the largest number of suicides concerned the 13-18 y.o. group, both for the Silesian Voivodeship (H = 9.374; p = 0.0092) and for the whole country (H = 10.203; p = 0.0061).

Conclusion

(1) Results of our study indicate that the pandemic may have caused a wide range of negative mental health consequences for young individuals; (2) Suicide attempts in children are often related with high energy trauma; (3) Teachers and school psychologists, as well as medical health providers, should be aware of rising suicide rates among adolescents.

Prevalence and Associations of Depression among Saudi College Nursing Students: A Cross-Sectional Study

Depression affects approximately 350 million individuals globally and is the leading cause of disability. Depression among nursing students is an ongoing issue, yet little is known about the relationship between depression and its risk factors among nursing students in Saudi Arabia. The purpose of this study was to determine the prevalence of depression among a cohort of Saudi nursing students and to explore the risk factors associated with depression in this group. A cross-sectional design was employed for this study, which was conducted by the nursing faculty at King Saud University in Riyadh, Saudi Arabia. The researcher sampled 330 nursing students, with 252 students (a 76.3% response rate) randomly selected by the academic advising unit in the nursing college between January and February 2023. The participants completed an online survey based on the Arabic version of the Center for Epidemiologic Studies Depression Scale. The data were analyzed using univariate analysis and backward multi-variable logistic regression. The findings revealed that 65.1% of the participants scored 16 or above on the depression scale, indicating high levels of depressive symptoms. Univariate analysis identified several significant risk factors for depression, including sex (OR, 0.29; 95% CI, 0.16-0.51; p < 0.001), academic pressure (OR, 5.87; 95% CI, 2.04-16.84; p < 0.001), interpersonal relationships (evaluated by balance and harmony in thoughts, emotions, behavior, and interactions with others; categorized as good/fair or poor), and the relationship with the father, which were strongly associated with the presence of depression symptoms. Backward multi-variable logistic regression analysis further revealed that being male, experiencing reduced academic pressure, having stronger father-son relationships, and maintaining positive interpersonal relationships were significantly associated with decreased levels of depression (ORs ranged from 0.25 to 3.94). These findings highlight the need for family and school-based prevention interventions to help nursing students in college avoid depression.

The Global Prevalence of Non-suicidal Self-injury, Suicide Behaviors, and Associated Risk Factors Among Runaway and Homeless Youth: A Meta-analysis

A meta-analysis was performed to determine pooled prevalence of non-suicidal self-injury (NSSI), suicide behaviors (including ideation, attempts), and associated risk factors among runaway and homeless youth (RHY). The databases PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant studies published from January 1995 to May 2023. Initially, 8465 papers were screened, resulting in 69 included studies. The results showed that among RHY, lifetime prevalence rates were 42% for NSSI, 38% for suicidal ideation, and 27% for suicide attempts. Lifetime prevalence of NSSI and suicide behaviors was higher among adolescent minors (aged 12-17 years) compared to young adults (aged 18-24 years). Also, NSSI and suicide behaviors were associated with having a childhood history of physical and sexual abuse. Developing an impactful community-based suicide prevention campaign tailored for RHY appears warranted. Peer groups and mentorship programs would provide invaluable support for young individuals, as supportive friendships protect against NSSI.

The association between family adaptability and adolescent depression: the chain mediating role of social support and self-efficacy

Objective

Previous research has shown a correlation between family adaptability and adolescent depression. However, there is a lack of studies that have investigated the underlying mechanism between family adaptability and adolescent depression. Based on the Ecological Systems Theory, this study aims to investigate the link between family adaptability and depression in adolescents, mediated by the sequential roles of social support and self-efficacy.

Methods

The sample consisted of 1086 students randomly selected from seven public middle schools in Shandong Province, Eastern China. All the participants filled in the structured self-report questionnaires on family adaptability, social support, self-efficacy, and depression. The data were analyzed using SPSS 25.0 and Structural Equation Modeling (SEM) in AMOS 24.0.

Results

The findings of this study are as follows: (1) Family adaptability is negatively associated with adolescent depression; (2) Social support plays a mediating role between family adaptability and adolescent depression; (3) Self-efficacy plays a mediating role between family adaptability and adolescent depression; (4) Social support and self-efficacy play a chain mediation role between family adaptability and adolescent depression.

Conclusion

It is suggested that early interventions and support should be provided to facilitate adolescents' family adaptability, social support, and self-efficacy, thus reducing their depression and improving mental health of adolescents.

Suicide spectrum among young people during the COVID-19 pandemic: A systematic review and meta-analysis

Background

There are concerns that suicidal behaviors are arising among adolescents. The COVID-19 pandemic could have worsened the picture, however, studies on this topic reported contrasting results. This work aimed to summarise findings from the worldwide emerging literature on the rates of suicidality among young people during the COVID-19 pandemic.

Methods

A systematic review and meta-analysis were performed, searching five electronic databases for studies published from January 1, 2020 until July 27, 2022. Studies reporting rates for each of the three considered outcomes (suicide, suicidal behaviors, and suicidal ideation) among young people under 19 years old during the COVID-19 pandemic were included. Random-effects meta-analyses were conducted, and the intra-study risk of bias was assessed. When pre-COVID-19 data were available, incidence rate ratio (IRR) and prevalence ratio (PR) estimates were calculated between the two periods. All the analyses were performed according to the setting explored: general population, emergency department (ED), and psychiatric services. The review protocol was registered on PROSPERO (CRD42022308014).

Findings

Forty-seven observational studies were selected for more than 65 million subjects. The results of the meta-analysis showed a pooled annual incidence rate of suicides of 4.9 cases/100,000 during 2020, accounting for a non-statistically significant increase of 10% compared to 2019 (IRR 1.10, 95% CI: 0.94-1.29). The suicidal behaviors pooled prevalence during the COVID-19 pandemic was higher in the psychiatric setting (25%; 95% CI: 17-36%) than in the general population (3%; 1-13%) and ED (1%; 0-9%). The pooled rate of suicidal ideation was 17% in the general population (11-25%), 36% in psychiatric setting (20-56%) and 2% in ED (0-12%). The heterogeneity level was over 97% for both outcomes in all settings considered. The comparison between before and during COVID-19 periods highlighted a non-statistically significant upward trend in suicidal behaviors among the general population and in ED setting. The only significant increase was found for suicidal ideation in psychiatric setting among studies conducted in 2021 (PR 1.15; 95% CI: 1.04-1.27), not observed exploring 2020 alone.

Interpretation

During the pandemic, suicide spectrum issues seemed to follow the known pattern described in previous studies, with higher rates of suicidal ideation than of suicidal behaviors and suicide events. Governments and other stakeholders should be mindful that youth may have unique risks at the outset of large disasters like the COVID-19 pandemic and proactive steps are necessary to address the needs of youth to mitigate those risks.

Funding

The present study was funded by the University of Torino (CHAL_RILO_21_01).

[Effect of Family Function on Suicide-Related Behaviors of Junior Middle School Students: The Mediating Effect of Depression]

Objective

To examine the prevalence of suicide-related behaviors among junior middle school students, and to explore the mediating role of depression in the relationship between suicide-related behaviors and family function.

Methods

A total of 2572 junior middle school students from three middle schools in Chengdu were interviewed face-to-face by using suicide-related items from Youth Risk Behavior Surveillance System (YRBSS), Chinese Family Assessment Instrument (C-FAI), and Center for Epidemiologic Studies Depression Scale for Children (CES-DC). The mediating role of depression was analyzed with structural equation model.

Results

The prevalence of suicide-related behaviors was 26.01% among the respondents. The prevalence of suicide ideation, suicide plan and suicide attempt were 24.38%, 13.49% and 10.77%, respectively. Depression played a partial mediating role in how family function impacted on suicide-related behaviors, presenting a direct effect value of 0.170 (95% CI: 0.117-0.218, P<0.001) and an indirect effect value of 0.205 (95% CI: 0.176-0.234, P<0.001), with the mediating effect accounting for 54.67% of the total effect.

Conclusion

Poor family function may increase the risk of suicide-related behaviors, and this effect is produced mostly through the impact on children's mental health. Improving family function will not only improve children's psychological status, but also reduce suicide-related behaviors.

Suicide prevention in Japan: Government and community measures, and high-risk interventions

Suicide is one of the most critical issues worldwide. In Japan, more than 30 000 people died by suicide every year between 1998 and 2011, and the Japanese government, local governments, and various other agencies have been working on suicide prevention programs to reduce the suicide rate. While the number of suicides is still high (more than 20 000 per year), many specialists are striving to further reduce the number of suicides in Japan. The Japanese government has played a central role in suicide prevention through the enactment of several laws, and in recent years, suicide prevention has shifted from government to community-specific measures. This review discusses the suicide prevention measures that have been taken so far: (1) policy strategies for suicide prevention by the Japanese government, (2) community suicide prevention, and (3) strategic studies for suicide prevention. Finally, as shown in the ACTION-J study, we conclude that cooperation among related organizations in the community, not just one institution, is important for future suicide prevention, especially youth suicide prevention.

Effect of Violence and School Victimization on Suicidal Ideation in Mexican Adolescents

This study tests a model to predict suicidal ideation in adolescents, considering violence and school victimization, family and academic self-concept, and depressive symptoms as antecedents. 792 Mexican high school adolescents participated (49.4% women, 50.6% men) between 11 and 16 years old (M = 13.3, D.T. = 1.0), selected with a non-probabilistic sampling for convenience. The Suicidal Ideation, Violent Behavior at School, Victimization at School, Self-Concept Form-5 and CES-D scales were administered. From Structural Equation Models, the results showed that the model that best fits indicates a double relationship between school victimization and suicidal ideation: a direct and positive effect on suicidal thoughts, and, on the other hand, an indirect and negative effect through family support, and positive with depressive symptoms. Family self-concept was an important protection factor.

Do suicide rates in children and adolescents change during school closure in Japan? The acute effect of the first wave of COVID-19 pandemic on child and adolescent mental health

BACKGROUND

The coronavirus disease 2019 (COVID-19) has severely impacted the lives of children and adolescents. School closure, one of the critical changes during the first COVID-19 wave, caused decreases in social contacts and increases in family time for children and adolescents. This can have both positive and negative influences on suicide, which is one of the robust mental health outcomes. However, the impact of the COVID-19 crisis on children and adolescents in terms of suicide is unknown.

OBJECTIVE

This study investigates the acute effect of the first wave of the COVID-19 pandemic on suicide among children and adolescents during school closure in Japan.

DATA

Total number of suicides per month among children and adolescents under 20 years old between January 2018 and May 2020.

METHODS

Poisson regression was used to examine whether suicide increased or decreased during school closure, which spanned from March to May 2020, compared with the same period in 2018 and 2019. Robustness check was conducted using all data from January 2018 to May 2020. Negative binomial regression, a model with overdispersion, was also performed.

RESULTS

We found no significant change in suicide rates during the school closure (incidence rate ratio (IRR) = 1.15, 95% confidence interval (CI): 0.81 to 1.64). We found the main effect of month, that is, suicides significantly increased suicides in May (IRR: 1.34, 95% CI: 1.01 to 1.78) compared to March, but the interaction terms of month and school closure were not significant (p > 0.1).

CONCLUSIONS

As preliminary findings, this study suggests that the first wave of the COVID-19 pandemic has not significantly affected suicide rates among children and adolescents during the school closure in Japan.