Risk Factors For Adolescent Suicide Research Articles

Suicidal behaviour in adolescents: Associations with parental marital status and perceived parent–adolescent relationship

Background Because equivocal findings exist with regard to the relationship between adolescents' suicidal behaviour and parental marital status, the aim of this study was to investigate this relationship and in particular the effect of the perceived parent–adolescent relationship on this association, taking into account the role of gender. Method For this purpose, self-report surveys were administered to a representative school-based sample of 2707 adolescents in Antwerp (Belgium). Results 1) Boys living in a single parent family reported more suicidal ideations and self-harming behaviour than boys living in an intact family or in a remarried family; 2) Girls living in a remarried family reported more suicidal ideations and self-harming behaviour than girls living in an intact or in a single parent family; 3) Even after controlling for the levels of perceived parent–adolescent relationship, these associations remained significant. Limitations The cross-sectional design, the retrospective assessment of suicidality and changes in family structure, the lack of external information and the assessment of the parent–adolescent relationship for both parents together, may have influenced the findings. Conclusions When assessing risk factors for adolescent suicidality, marital status of the parents may bear clinical importance. In contrast to other studies, the perceived parent–adolescent relationship did not alter this association, a finding that needs further study.

What Role Does Race Play in Adolescent Suicidal Ideation?

ABSTRACT Epidemiological data indicate that suicide rates have been decreasing among 15–19-year-olds in the United States; however, rates have been increasing among some minority groups. Research has identified numerous risk factors for adolescent suicide and suicide-related behaviors, but models testing these risk factors within different racial or ethnic groups are scarce. The current study tested a model of adolescent suicide ideation in a sample of 258 high school students, comparing the model fit across two racial groups. The model significantly fit the data for both groups indicating that the relationship between suicide exposure and current suicidal ideation is mediated by reasons for living and level of depressive symptoms. Ways in which the results improve our understanding of risk factors in diverse adolescents are discussed.

Adolescent Suicide in Quebec and Prior Utilization of Medical Services

Psychopathology is the main risk factor for adolescent suicide but several studies have shown that only a small proportion of suicide victims receive mental health care during the months preceding their suicide. The goal of this study is to describe the utilization of medical services by Quebec adolescent suicide victims during the year preceding their suicide. All suicides of persons aged 19 or less that occurred during a five-year period were retrieved from the Quebec Coroner's database. Corresponding medical services utilization data were retrieved from the Quebec physician payment database (RAMQ) and the Quebec hospitalization database (MED-ECHO). Data were analyzed in terms of types and intensity of medical services (physical or psychiatric), types of providers (general practitioners, psychiatrists, and other medical specialists), and timing of interventions relative to the date of suicide. 78% of all Quebec adolescent suicide victims utilized medical services during the year before their suicide. However, only 12% of all victims received medical attention for psychiatric problems, and only 9.9% met with a psychiatrist during that same period of time. General practitioners and non-psychiatric medical specialists provided medical attention for psychiatric problems to only 5.6% and 0.7% of those future suicide victims with whom they met in outpatient settings, and the intensity of their interventions was low. These results suggest that the level of recognition and treatment of psychopathology in Quebec adolescents who later commit suicide is low, despite the fact that a large proportion of them meet with physicians during the year preceding their suicide. This suggests that information and training programs pertaining to adolescent suicide and psychopathology should be implemented for GPs and non-psychiatric medical specialists as well.

Familial study of suicidal behavior among adolescents in Slovenia.

The number of adolescents who attempt or complete suicide is increasing. Risk factors range from mental disorders, to problems at school, family problems, or difficulties in establishing relationships. A further important, and too often underestimated, risk factor for adolescent suicide is the presence of suicidal behavior in the adolescent's family. We investigated 184 high school adolescents in a region in Slovenia with a high suicide rate (30/100,000/year). They were questioned by means of an anonymous questionnaire about the presence of suicidal behavior in their relatives and about the presence of suicidal thoughts, plans, and acts in themselves. The results revealed that 13% of the adolescents studied had a relative who had attempted suicide and a further 9% of the adolescents had lost a relative due to suicide. About half of all females and almost a third of males had had suicidal thoughts (differences between sexes were statistically significant: chi2 = 6.13; p < .01). Attempted suicide among relatives was positively correlated with the presence of suicidal plans among adolescents (phi = 0.15; p < .05). This correlation proved to be even stronger and statistically more significant in men when we split the sample by gender. All variables (suicidal thoughts, suicidal plans, and suicide attempts) in the adolescent males positively correlated with attempted suicide among their relatives ((phi = 0.28, p < .01; phi) = 0.26, p < .05; phi = 0.34, p < .01; respectively). Our results speak in favor of a higher risk of suicidal behavior among adolescents with suicidal behavior in their families.

Adolescent suicide and household access to firearms in Colorado: results of a case-control study

Purpose: To determine whether, compared with age- and sex-matched controls who did not commit suicide, adolescents who committed suicide by firearms were more likely to have had household access to firearms (after adjusting for significant risk factors for adolescent suicide). Methods: A case-control study design was used; case subjects were Colorado adolescents who committed suicide between 1991 and 1993; controls were sex- and age-matched adolescents who were randomly selected from the same school the subjects had attended. Interviews were conducted with the parent or guardian of cases and controls. Results: Of the 36 case subjects in this study, 67% committed suicide using a gun obtained from their home. Adolescent suicide victims who committed suicide by firearms were significantly more likely to have a firearm in their home (72%) than age- and sex-matched community controls (50%), after adjusting for significant risk factors. Conduct disorder and previous mental health treatment were also found to be independent risk factors for adolescent firearm suicide. Conclusions: Two types of public health interventions to prevent adolescent firearm suicides are likely to be successful: (a) limiting household access to firearms, and (b) identifying adolescents at high risk of firearm suicide.

Age- and Sex-Related Risk Factors for Adolescent Suicide

To examine the impact of age and sex on adolescent suicide risk. A standard psychological autopsy protocol was used to compare 140 suicide victims with 131 community controls. The risk factors for older (> or = 16 years) and younger, and for male and female suicide were compared. Mood disorders, parental psychopathology, lifetime history of abuse, availability of a gun, and past suicide attempt conveyed significant risk for suicide across all 4 demographic groups. Psychopathology, particularly substance abuse (alone and comorbid with mood disorder), was more common and conveyed a much higher risk for suicide in the older versus younger adolescents. Younger suicide victims showed lower suicidal intent. Males chose more irreversible methods, and conduct disorder was both more prevalent and a more significant risk factor in males. The increased rate of suicide in older versus younger adolescents is due in part to greater prevalence of psychopathology, namely substance abuse, and greater suicidal intent in the older population. The increased rate in males is less easily explained, but it may stem from method choice and the greater prevalence of and risk conveyed by conduct disorder in males.

Adolescent Physical Abuse and Suicide Attempts

The rate of suicide attempts and the exposure to risk factors for suicide in an unselected sample of confirmed cases of physically abused adolescents recruited directly from the New York State Central Register for Nassau and Suffolk Counties was compared with those of a community sample of nonabused adolescents. Semistructured and structured diagnostic interviews were used in the assessment of psychopathology of adolescents and their parents The proportion of adolescents attempting suicide did not differ for the two groups. However, the abused adolescents showed significantly greater exposure to risk factors for adolescent suicide, including family disintegration, and diagnoses of depression, disruptive behavior disorders, and substance abuse and dependence. Comparisons of the 8 physically abused adolescents who attempted suicide with the 91 who did not attempt suicide showed that the following factors were associated with significantly greater risk for suicide attempts: adolescents' perceptions of their families as lacking cohesiveness and maternal support, higher adolescent "hostility" ideation scores, adolescent diagnoses of disruptive disorders and conduct disorders, adolescent substance abuse/dependence, and exposure to a suicide attempt by a family member or a friend. A transactional model of abuse, family and personal stressors, and the development of adolescent vulnerability leading to psychopathology is offered to explain the results.

Hospitalizing the Suicidal Adolescent: Decision-Making Criteria of Psychiatric Residents

The primary purpose of this research is to investigate the criteria used by general psychiatric residents in determining the appropriateness of hospitalization. A questionnaire containing 64 vignettes describing adolescent suicide attempts was completed by a sample of 33 residents from a general psychiatry training program. Six variables known to relate to lethality of attempt were systematically varied within the vignettes: gender, depression, conduct disorder/substance abuse, previous attempts, suicidal relative, and family supports. Respondents were asked to judge the appropriateness of hospitalization for each vignette. Hospitalization preference was significantly predicted by all risk factors except for gender, with the presence of depression emerging as the most important predictor of hospitalization. Residents recommended hospitalization more frequently than did experienced child and adolescent clinicians. In comparison with experienced clinicians, residents placed more importance on depression, and less importance on conduct disorder/substance abuse, in making decisions to hospitalize. Although psychiatric residents use known risk factors for adolescent suicide in assessing need for hospitalization, there was clear support for further training initiatives for psychiatric residents concerning the assessment of suicidal adolescents.

Risk Factors for Adolescent Suicide and Suicidal Behavior: Mental and Substance Abuse Disorders, Family Environmental Factors, and Life Stress

This review focuses on psychopathologic risk factors for adolescent suicide and suicidal behavior, namely, affective, disruptive, substance abuse, psychotic, and personality disorders. The interaction of psychopathology with age and gender is discussed. The role of family environmental risk factors and stress events in suicide and suicidal behavior, both alone, and in interaction with psychopathology are reviewed. Research reviewed will include psychological; autopsy studies, longitudinal studies examining predictors of suicide, and epidemiologic studies of suicide attempts.

Hospitalizing the Suicidal Adolescent: An Empirical Investigation of Decision-Making Criteria

The primary purpose of this research is to investigate the criteria used by child and adolescent clinicians in determining the appropriateness of hospitalization for suicidal adolescents. A questionnaire containing 64 vignettes describing adolescent suicide attempters was completed by a sample of 36 child and adolescent clinicians. Six variables known to relate to lethality of attempt were systematically varied within the vignettes: gender, depression, conduct disorder/substance abuse, previous attempts, suicidal relative, and family supports. Respondents were asked to judge the appropriateness of hospitalization for each vignette. Hospitalization preference was found to be inversely related to professional experience and was significantly predicted by all risk factors except gender. Configural cue utilization added substantially to the efficacy of a linear model in predicting preference to hospitalize. Experienced clinicians use known risk factors for adolescent suicide in making recommendations to hospitalize, but results also suggest ongoing needs for education and training in adolescent suicidality.

Confusing conclusions and the clinician: An approach to evaluating case-control studies

Between the news in the popular press that hamburgers in Seattle caused hemolytic-uremic syndrome and that diphtheria-tetanus-pertussis vaccine can cause neurologic damage, and the advice from the American Academy of Pediatrics that this vaccine probably does not cause neurologic damage 1 American Academy of Pediatrics Committee on Infectious Diseases The relationship between pertussis vaccine and brain damage: a reassessment. Pediatrics. 1991; 88: 397-400 PubMed Google Scholar and that prone sleeping is recommended for infants, 2 American Academy of Pediatrics Task Force on Infant Positioning and SIDS Positioning and SIDS. Pediatrics. 1992; 89: 1120-1126 PubMed Google Scholar pediatricians are bombarded by statements based on case-control studies. Recently published case-control studies have addressed the relationships between neonatal vitamin K deficiency and maternal anticonvulsants, 3 Cornelissen M Steegers-Theunissen R Kollee L et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol. 1993; 168: 923-928 Abstract Full Text PDF PubMed Scopus (60) Google Scholar risk factors for adolescent suicide, 4 Grossmen DC Soderberg R Rivara FP. Prior injury and motor vehicle crash as risks factors for youth suicide. Epidemiology. 1993; 4: 155-159 Google Scholar the protective effects of breast- feeding, 5 Pisacane A Graziano L Mazzarella G Scarpellino B Zona G Breast-feeding and urinary tract infection. J PEDIATR. 1992; 120: 87-89 Abstract Full Text PDF PubMed Scopus (148) Google Scholar and whether passive smoking is associated with SIDS. 6 Mitchell EA Ford RP Stewart AW et al. Smoking and the sudden infant death syndrome. Pediatrics. 1993; 91: 893-896 PubMed Google Scholar Interpretation of studies such as these is generally the domain of the clinician, who in turn must be able to analyze critically and expediently the data on which these claims are based. CorrectionThe Journal of PediatricsVol. 125Issue 3Preview Full-Text PDF

Familial risk factors for adolescent suicide: a case‐control study

Sixty-seven adolescent suicide victims and 67 demographically matched living controls were compared as to family constellation, familial stressors and familial loading for psychopathology. Suicide victims were less likely to have lived with both biological parents, were more likely to be exposed to stressors such as parent-child discord, physical abuse and residential instability and showed greater familial loading for depression and substance abuse. Multivariate analyses showed that family history of both depression and substance abuse and lifetime history of parent-child discord were most closely associated with adolescent suicide. Children who are the offspring of parents with depression or substance abuse should be psychiatrically screened. Family interventions to decrease discord may also be helpful in decreasing the risk of adolescent suicide.

Cluster suicide in rural western Canada.

This paper focuses on a series of adolescent suicides which occurred in a small rural community in Western Canada between December 1989 and June 1990. Risk factors for adolescent suicide and recent epidemiological data on cluster suicide are reviewed and discussed. The circumstances of the five adolescent suicides are then discussed, and the question of whether or not this was a cluster suicide is considered. This article supports the view that suicide is an abnormal response to stress or loss and emphasizes the role of genetic psychophysiological predisposition.

Psychiatric Risk Factors for Adolescent Suicide: A Case-Control Study

Objective The objective of this study was to determine the psychiatric risk factors for adolescent suicide. Method Sixty-seven adolescent suicide victims were compared with 67 demographically matched community controls. Psychiatric disorder was assessed in suicide victims using a psychological autopsy protocol and in controls using similar semistructured psychiatric interviews. Risk factors were quantified by use of the odds ratio (OR), that is, the relative frequency of the occurrence of a given condition in the suicides compared with the controls. Results The most significant psychiatric risk factors associated with adolescent suicide were major depression (OR = 27.0), bipolar mixed state (OR = 9.0), substance abuse (OR = 8.5), and conduct disorder (OR = 6.0). Substance abuse was a more significant risk factor when comorbid with affective illness than when alone (OR = 17.0 versus 3.3). The majority of depressed suicide victims had a primary affective disorder (82%). A significant minority (31%) of depressed suicide victims had been depressed less than 3 months. Previous suicide attempts, suicidal ideation, and homicidal ideation also were associated with adolescent suicide. Conclusions The development of effective treatments for youth who fit the above-noted risk profiles should be given high priority. J. Am. Acad. Child Adolesc. Psychiatry, 1993, 32, 3:521–529.

Pediatricians ignore suicidal behavior

PHILADELPHIA -- Physicians caring for adolescents often fail to recognize or record histories of previous suicidal behavior and as a result, potentially suicidal teens aren9t receiving the care they need, according to a recent study. This report was published in the June issue of the Journal of Adolescent Health. According to researchers, the single most important risk factor for adolescent suicide is a previous attempt.

Firearm Access and Suicide-Reply

In Reply. —Dr Blackman raises concerns about the size of the study as limiting the ability to draw firm conclusions. However, this study is a replication of a previously published comparison of 27 suicides and 56 suicidal adolescents. 1 The fact both studies yielded the same results strengthens the ability to draw the conclusion the availability of firearms is a risk factor for adolescent suicide. Blackman raises an interesting hypothesis, that household gun ownership is positively associated with mental health in teenagers. I am not sure if Blackman is suggesting there are salutary properties associated with firearm ownership, or whether those families with psychiatrically ill adolescents are less likely to have a gun available in the home. Both the suicide victims and suicide attempters were psychiatrically ill, but the rate of firearm ownership was higher in families of suicide victims, suggesting there is no relationship between

Adolescent suicide attempters: Do physicians recognize them?

The single most important risk factor for adolescent suicide is a previous attempt. It is unclear if physicians can identify adolescents who have attempted suicide. Our objectives were to determine the prevalence of previous attempts in an adolescent clinic population, if physicians identify attempters, and if attempters demonstrate persistent distress. Of 332 patients aged 12–19 years attending a medical clinic, 48 (14.5%) reported a previous attempt. The physician's visit note documented that only 8 (16.7%) of the 48 attempters were asked about suicidal behavior. Attempters were more likely than nonattempters ( p < 0.05) to be female; to come to clinic without a guardian; to give a chief complaint pertaining to sexually transmitted disease, obstetrics-gynecology, or mental health; and to report previous mental health care. Attempters had poorer mean scores ( p < 0.05) on validated subscales for family relationships, social competence, depression, unpopularity, somatic complaints, thought disorders, delinquency, aggression, and identity. We conclude that suicide attempts are common among adolescent clinic patients, that physicians may not recognize attempters, and that attempters remain distressed and in need of care. Physicians who see adolescents for routine medical problems must consider the potential for self-destructive behavior, regardless of the presenting complaint.