Psychosocial and Risk Behavior Correlates of Youth Suicide Attempts and Suicidal Ideation

doi:10.1097/00004583-200107000-00019

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 40, Issue 7, July 2001, Pages 837-846

https://doi.org/10.1097/00004583-200107000-00019 Get rights and content

ABSTRACT

Objective

To identify the independent psychosocial and risk behavior correlates of suicidal ideation and attempts.

Method

The relationships between suicidal ideation or attempts and family environment, subject characteristics, and various risk behaviors were examined among 1,285 randomly selected children and adolescents, aged 9 through 17 years, of whom 42 (3.3%) had attempted suicide and 67 (5.2%) had expressed suicidal ideation only. The youths and their parents were enumerated and interviewed between December 1991 and July 1992 as part of the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study.

Results

Compared with subjects with suicidal ideation only, attempters were significantly more likely to have experienced stressful life events, to have become sexually active, to have smoked more than one cigarette daily, and to have a history of ever having smoked marijuana. After adjusting for sociodemographic characteristics, a statistically significant association was found between suicidal ideation or attempt and stressful life events, poor family environment, parental psychiatric history, low parental monitoring, low instrumental and social competence, sexual activity, marijuana use, recent drunkenness, current smoking, and physical fighting. Even after further adjusting for the presence of a mood, anxiety, or disruptive disorder, a significant association persisted between suicidal ideation or attempts and poor family environment, low parental monitoring, low youth instrumental competence, sexual activity, recent drunkenness, current smoking, and physical fighting.

Conclusion

Low parental monitoring and risk behaviors (such as smoking, physical fighting, alcohol intoxication, and sexual activity) are independently associated with increased risk of suicidal ideation and attempts, even after adjusting for the presence of psychiatric disorder and sociodemographic variables.

Section snippets

METHOD

The methods of this study have been described in detail in the report of the MECA study (Lahey et al., 1996), and the diagnostic and demographic features of the subsample of suicidal youths have been described in Gould et al. (1998).

RESULTS

Of the total sample, 67 subjects (5.2%) reported suicidal ideation within the past 6 months but no lifetime history of suicide attempt; an additional 42 (3.3%) subjects reported a lifetime history of suicide attempt (Gould et al., 1998). The remaining 1,176 subjects denied having had either suicidal ideation in the past 6 months or any lifetime history of suicide attempt.

Subjects with a lifetime history of suicide attempts were compared on the principal variables with subjects reporting

DISCUSSION

Adverse family circumstances, such as caretaker's low satisfaction with the family environment, low parental monitoring, and parental history of psychiatric disorder, were significantly associated with suicidal ideation and behavior, even after we controlled for age, gender, and demographic factors. High levels of negative life events were also associated with increased risk of suicidal ideation or attempts. The effects of potential social risk factors found to be associated in other studies

REFERENCES (53)

DA Brent et al.
Psychiatric risk factors for adolescent suicide: a case control study
J Am Acad Child Adolesc Psychiatry
(1993)
DM Fergusson et al.
Suicide attempts and suicidal ideation in a birth cohort of 16-year-old New Zealanders
J Am Acad Child Adolesc Psychiatry
(1995)
AJ Flisher et al.
Risk behavior in a community sample of adolescents
J Am Acad Child Adolesc Psychiatry
(2000)
MS Gould et al.
Psychopathology associated with suicidal ideation and attempts among children and adolescents
J Acad Child Adolesc Psychiatry
(1998)
R Jessor
Risk behavior in adolescence: a psychosocial framework for understanding and action
J Adolesc Health
(1991)
BB Lahey et al.
The NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study: background and methodology
J Am Acad Child Adolesc Psychiatry
(1996)
JD Lish et al.
Family psychiatric screening instruments for epidemiologic studies: pilot testing and validation
Psychiatry Res
(1995)
AM Nezu
A problem-solving formulation of depression: a literature review and proposal of a pluralistic model
Clin Psychol Rev
(1987)
PK Orpinas et al.
The co-morbidity of violence-related behaviors with health-risk behaviors in a population of high school students
J Adolesc Health
(1995)
ME Schwab-Stone et al.
Criterion validity of the NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3)
J Am Acad Child Adolesc Psychiatry
(1996)

D Shaffer et al.

The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA study

J Am Acad Child Adolesc Psychiatry

(1996)

D Shaffer et al.

Preventing teenage suicide: a critical review

J Am Acad Child Adolesc Psychiatry

(1988)

DM Sosin et al.

Fighting as a marker for multiple problem behaviors in adolescents

J Adolesc Health

(1995)

HJ Walter et al.

Sexual, assaultive and suicidal behaviors among urban minority junior high school students

J Am Acad Child Adolesc Psychiatry

(1995)

Anthony J, Kellam S (1991), First-Stages of Methods Assessment of Early Maladaptive Behavioral Responses, Drug Use,...

M Beiser

Flower of Two Soils: Final Report

(1988)

M Beiser et al.

Measuring self-perceived role competence among First Nations and non-native children

Can J Psychiatry

(1993)

AH Brand et al.

Note on reliability of the Life Events Checklist

Psychol Rep

(1982)

JS Brook et al.

The psychosocial etiology of adolescent drug use: a family interactional approach

Genet Soc Gen Psychol Monogr

(1990)

DC Clark et al.

Physical recklessness in adolescence: trait or byproduct of depressive/suicidal states?

J Nerv Ment Dis

(1990)

P Cohen et al.

Family factors related to the persistence of psychopathology in childhood and adolescence

Psychiatry

(1987)

R Cohen-Sandler et al.

Life stress and symptomatology: determinants of suicidal behavior in children

J Am Acad Child Psychiatry

(1982)

TJ Dishion et al.

Family, school, and behavioral antecedents to early adolescent involvement with antisocial peers

Dev Psychol

(1991)

JG Dryfoos

Adolescents at Risk

(1990)

EF Dubow et al.

Correlates of suicidal ideation and attempts in a community sample of junior high and high school students

J Clin Child Psychol

(1989)

LM Dunn et al.

Peabody Picture Vocabulary Test-Revised

(1991)

Cited by (369)

A longitudinal investigation of the cross-dimensional mediating role of negative life events between neuroticism and depressive symptoms in adolescents
2024, Journal of Affective Disorders
Neuroticism has been identified as a significant predictor for depression within the adolescent population However, few longitudinal studies have investigated this association and explored the mediation effect of the negative life events. This study aimed to examine the longitudinal association between neuroticism, negative life events, and depression in a large sample of Chinese adolescents.
Data on Five Factor Inventory-Neuroticism Subscale (FFI-N) was collected from 1150 participants aged 14–19 years old at baseline, and data on Adolescent Life Event Questionnaire (ALEQ) and Center of Epidemiological Study-Depression (CES-D) were collected both at baseline and 6-month follow-up. Multilevel modelings were used to analyze the longitudinal associations among neuroticism, negative life events and depression.
Through a longitudinal study design, results from multilevel regression analyses indicated a direct correlation between increased levels of neuroticism and the aggregation of negative life events with the prediction of more severe depressive symptoms. Further, results of multilevel mediations suggested that the negative life events served to partially mediate the relationship between neuroticism and each dimension of depression.
The results cannot be used to make a clinical diagnosis.
The current findings suggest the negative life events as a cross-dimensional mediator in the relationship between neuroticism and each dimension of depression. Regulating neuroticism levels and implementing strategies to coping stress derived from daily life events could be integral approaches to reducing the prevalence of depression within the adolescent population.
Working together: The role of autistic students’ behavioral adjustment in promoting positive parent-teacher relationships
2024, Research in Autism Spectrum Disorders
Autistic children experience more externalizing and internalizing symptoms relative to non-autistic peers. Higher quality parent-teacher relationships (PTR) may support children’s adjustment. At the same time, higher levels of these mental health difficulties may create a strained relationship between parents and teachers. Therefore, the relation between PTR quality and externalizing or internalizing symptoms may be bidirectional. This study examined the longitudinal associations between PTR quality and externalizing or internalizing symptoms among 192 autistic children (91% boys, ages 4–8 years) across three assessments spanning two academic years.
Eight cross-lagged panel analyses were conducted to examine how parent-rated PTR quality and teacher-rated PTR quality relate to parent-rated or teacher-rated externalizing and internalizing symptoms.
Results showed that (1) parent-rated symptoms appeared to drive changes in PTR quality; this pattern was more consistently shown with parent-rated externalizing symptoms than with internalizing symptoms. (2) Teacher-rated symptoms did not drive changes in PTR quality. Finally, (3) there was no support for a relationship-driven or a reciprocal model; in other words, PTR quality did not contribute to changes in children’s externalizing or internalizing symptoms over time.
Higher parent-reported child symptoms appeared to predict reduced PTR quality across multiple teachers, school years, and classroom contexts. Addressing children’s elevated mental health problems may take a toll on parents’ and teacher’s ability to collaborate effectively over time. The results demonstrate the importance of interventions targeting child internalizing and externalizing symptoms at home, which may indirectly improve PTR quality.
A network analysis of depressive symptoms, psychosocial factors, and suicidal ideation in 8686 adolescents aged 12–20 years
2023, Psychiatry Research
Suicide has aroused global concern, and a better understanding of the complex interactions between suicide ideation and various psychopathological features is critical. We aimed to explore the complex interplays among adolescents. This study adopted a multistage stratified cluster sampling method and recruited adolescents aged 12 to 20 year-old from 8 middle and high schools between December 2020 and September 2021 in Guangzhou, China. We assessed loneliness, social support, bullying victimization, depressive symptoms, and suicidal ideation. We used network analysis to examine the network structure of the correlates of suicidal ideation and identify central symptoms and bridge symptoms. We used case-drop bootstrapping and correlation stability coefficients to examine the stability of the network. Among 8686 adolescents, 347 (4 %) adolescents reported suicidal ideation in the past two weeks. Network analyses identified ‘hopeless’, ‘psychomotor’, and ‘failure’ were the three strongest edges linked to suicidal ideation. The most central nodes were identified as ‘hopeless’ being the most central node, followed by loneliness and verbal bullying victimization, while sexual bullying victimization, sex, and relational bullying were the strongest bridging symptoms. The findings shed light on the complexity of associations of suicidal ideation and could provide insight into school-based suicide risk assessment and prevention for adolescents.
The range of suicidal ideation among people with care experience: Occurrences of suicidal thoughts in a cross-national sample from England and Germany
2023, Children and Youth Services Review
This paper investigates the range of suicidal ideation among people with care experience. People who grew up in care have an elevated risk of suicidal ideation, behavior and dying by suicide compared to people without care experience. However, a comprehensive and in-depth understanding of when suicidal ideation occurs and how care-experienced people experience suicidal thoughts, especially when leaving care in England and Germany, is currently not available but would help to inform suicide prevention tailored to care-experienced people across different ages. Aiming to address this gap, the current study applied a mixed-methods approach, combining an online survey and semi-structured interviews with young adults with care experience from England and Germany. The survey included 45 adults with care experience, age 18–40, and interviews were conducted with 13 care-experienced young adults from both countries. Descriptive statistical and significance tests were conducted to analyze the survey data with SPSS. Framework analysis was used to analyze the interviews. The findings show that many participants experienced suicidal thoughts from a young age and at different times up to adulthood. A range of suicidal thoughts and trajectories are identified with an increased risk of suicide for young people with care experience, especially during transitions such as when leaving care in early adulthood. The study underlines the need for a stronger recognition of suicide prevention in social work and the (leaving) care system across different countries.
Parental role and peer support in adolescent suicidal behavior in eight South-East Asian countries
2023, Journal of Affective Disorders
This study aimed to estimate the prevalence of suicidal behaviors, i.e. suicidal ideation (SI), suicidal plan (SP), and suicidal attempt (SA) among adolescents with a focus on parental and peer support in eight South-East Asian countries including Bangladesh, Bhutan, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand.
Data were drawn from Global School-based Student Health Survey (GSHS) covering 42,888 adolescents aged 11–17 years. Weighted prevalence of SI, SP, and SA along with country specific prevalence was computed and binary logistic regression was used to identify associated risk factors.
Among 42,888 adolescents 19,113 (44.9%) were males and 23,441 (55.1%) females. Overall prevalence of SI, SP and SA is 9.10%, 10.42% and 8.54%, respectively. Myanmar demonstrated the lowest SI (1.07%) and SP (0.18%) whereas lowest SA was found in Indonesia (3.79%). Maldives had the highest prevalence of SI, SP and SA which were 14.13%, 19.02% and 13.38% respectively. Overall suicidal behaviors were associated with being female [AOR: SI-1.26 (1.06,1.50), SP-1.34 (1.14,1.57)], high levels of sedentary behavior [AOR: SI-2.08 (1.62,2.66), SP-1.86 (1.49,2.32), SA-1.96 (1.45,2.64)], involvement in physical fighting [AOR: SI-1.30 (1.07,1.58), SP-1.37 (1.14,1.65), SA-1.50 (1.17,1.90)], being seriously injured [AOR: SI-1.40 (1.17,1.67), SP-1.44 (1.22,1.69), SA-1.74 (1.39,2.17)], being bullied [AOR: SI- 1.68 (1.39,2.02), SP-1.34 (1.12,1.60), SA-1.88 (1.50,2.36)], feeling lonely (most of time or always) [AOR: SI-3.41(2.60,4.46), SP-1.92 (1.48,2.47), SA-2.25 (1.62,3.13)], lack of parental support (never checking homework) [AOR: SI-1.59 (1.25,2.02), SP-1.52 (1.22,1.90)] and not having close friends [AOR: SI-2.19 (1.66,2.89), SP-2.26 (1.74,2.94), SA-4.23 (3.10,5.78)].
Though prevalence of suicidal behaviors varies, a range of cross-cutting risk factors exists that warrant further examination. We recommend focusing on strengthening parental and peer support, targeted programs addressing physical activity, bullying, loneliness and mental-health of adolescents.
Inter-relationships of depressive and anxiety symptoms with suicidality among adolescents: A network perspective
2023, Journal of Affective Disorders
Persons with suicidality including suicidal ideation (SI), suicide plans (SP) and/or suicide attempts (SA) are at higher risk for future suicide than those without suicidality. To reduce the risk of future suicide, it is important to understand symptoms of emotional distress that have the strongest links with SI, SP and SA. This network analysis examined item-level relations of depressive and anxiety symptoms with suicidality among adolescents during the COVID-19 pandemic.
Adolescents between 12 and 20 years of age were assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and individual binary reponse (no/yes) items assessing SI, SP, and SA during the pandemic. The structure of depressive symptoms, anxiety symptoms and suicidality was characterized using “Expected Influence” and “Bridge Expected Influence” as centrality indices in the symptom network. Network stability was tested using a case-dropping bootstrap procedure. Node-specific predictive betweenness was computed to examine short paths of anhedonia, other depressive symptoms and anxiety symptoms with suicidality. A Network Comparison Test (NCT) was conducted to examine whether network characteristics differed based on gender.
Prevalence rates of depressive symptoms, anxiety symptoms, and suicidality were 44.60 % (95% confidence interval (CI) = 41.53–47.67 %), 31.12 % (95%CI = 28.26–33.98 %), and 16.95 % (95%CI = 14.63–19.26 %), respectively, in the study sample. The network analysis identified GAD3 (“Worry too much”) as the most central symptom, followed by GAD6 (“Irritability”) and PHQ6 (“Guilt”) in the sample. Additionally, PHQ6 (“Guilt”), GAD6 (“Irritability”), and PHQ2 (“Sad mood”) were bridge nodes linking depressive and anxiety symptoms with suicidality. A flow network indicated that the connection between S (“Suicidality”) and PHQ6 (“Guilt”) reflected the strongest connection, followed by connections of S (“Suicidality”) with GAD2 (“Uncontrollable worrying”), and S (“Suicidality”) with PHQ2 (“Sad mood”). Finally, PHQ2 (“Sad mood”) was the main bridge node linking anhedonia with other depressive and anxiety symptoms and suicidality in the sample.
Findings highlight the potential importance of reducing specific depressive and anxiety symptoms as possible means of reducing suicidality among adolescents during the pandemic. Central symptoms and key bridge symptoms identified in this study should be targeted in suicide prevention for at-risk adolescents.

View all citing articles on Scopus

The MECA program is an epidemiological methodology study performed by four independent research teams in collaboration with staff of the Division of Clinical Research, which was reorganized in 1992 with components now in the Division of Epidemiology and Services Research and the Division of Clinical and Treatment Research, of the NIMH, Rockville, MD. The NIMH Principal Collaborators are Darrel A. Regier, M.D., M.P.H., Ben Z. Locke, M.S.P.H., Peter S. Jensen, M.D., William E. Narrow, M.D., M.P.H., Donald S. Rae, M.A., John E. Richters, Ph.D., Karen H. Bourdon, M.A., and Margaret T. Roper, M.S. The NIMH Project Officer was William J. Huber. The Principal Investigators and Coinvestigators from the four sites are as follows: Emory University, Atlanta, U01 MH46725: Mina K. Dulcan, M.D., Benjamin B. Lahey, Ph.D., Donna J. Brogan, Ph.D., Sherryl Goodman, Ph.D., and Elaine Flagg, Ph.D.; Research Foundation for Mental Hygiene at New York State Psychiatric Institute (Columbia University), New York, U01 MH46718: Hector Bird, M.D., David Shaffer, M.D., Myrna Weissman, Ph.D., Patricia Cohen, Ph.D., Denise Kandel, Ph.D., Christina Hoven, Dr.P.H., Mark Davies, M.P.H., Madelyn S. Gould, Ph.D., and Agnes Whitaker, M.D.; Yale University, New Haven, CT, U01 MH46717: Mary Schwab-Stone, M.D., Philip J. Leaf, Ph.D., Sarah Horwitz, Ph.D., and Judith H. Lichtman, M.P.H.; University of Puerto Rico, San Juan, U01 MH46732: Glorisa Canino, Ph.D., Martiza Rubio-Stipec, M.A., Milagros Bravo, Ph.D., Margarita Alegria, Ph.D., Julio Ribera, Ph.D., Sara Hertas, M.D., Michael Woodbury, M.D., and Jose Bauermesiter, Ph.D.

Reviewed under and accepted by Michael S. Jellinek, M.D., Associate Editor.

Support was provided by NIMH Child Research Grant 5P50MH43878-08.

View full text

ArticlesPsychosocial and Risk Behavior Correlates of Youth Suicide Attempts and Suicidal Ideation

ABSTRACT

Objective

Method

Results

Conclusion

Section snippets

METHOD

RESULTS

DISCUSSION

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Acad Child Adolesc Psychiatry

J Adolesc Health

J Am Acad Child Adolesc Psychiatry

Psychiatry Res

Clin Psychol Rev

J Adolesc Health

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Adolesc Health

J Am Acad Child Adolesc Psychiatry

Flower of Two Soils: Final Report

Measuring self-perceived role competence among First Nations and non-native children

Can J Psychiatry

Note on reliability of the Life Events Checklist

Psychol Rep

The psychosocial etiology of adolescent drug use: a family interactional approach

Genet Soc Gen Psychol Monogr

Physical recklessness in adolescence: trait or byproduct of depressive/suicidal states?

J Nerv Ment Dis

Family factors related to the persistence of psychopathology in childhood and adolescence

Psychiatry

Life stress and symptomatology: determinants of suicidal behavior in children

J Am Acad Child Psychiatry

Family, school, and behavioral antecedents to early adolescent involvement with antisocial peers

Dev Psychol

Adolescents at Risk

Correlates of suicidal ideation and attempts in a community sample of junior high and high school students

J Clin Child Psychol

Peabody Picture Vocabulary Test-Revised

Articles
Psychosocial and Risk Behavior Correlates of Youth Suicide Attempts and Suicidal Ideation