Adolescent suicide attempts in three diverse island nations: patterns, contextual differences and demographic associations

Abstract Objective Most epidemiological studies on suicidal behavior have been focused on high-income country settings. This study examine factors associated with suicidal behaviors among school-attending adolescents in three island nations. In this secondary analysis of the publicly available 2015 nationally representative GSHS data, we tested demographic, social, and behavioral attributes using multivariable logistic regression to association with suicide attempts. Results Within the recall period, 13.6% of participants reported having attempted suicide one or more times in the Cook Islands, 10.8% in Curaçao, and 9.8% in East Timor. In the Cook Islands, suicide ideation (AOR = 19.42, 95% CI = 9.11–41.41), anxiety (AOR = 2.51, 95% CI = 1.08–5.82), physical bullying (AOR = 3.3, 95% CI = 1.10–9.91), and cigarette smoking (AOR = 3.82, 95% CI = 1.38–10.54) were associated with suicide attempts. For Curaçaoo, suicide ideation (AOR = 7.88, 95% CI = 5.20–11.95) and suicide planning (AOR = 7.01, 95% CI = 4.24–11.60) were statistically significant. While for East Timor, suicide ideation (AOR = 4.59, 95% CI = 2.14–9.88), suicide planning (AOR = 3.36, 95% CI = 1.76–6.29), bullying victimization (AOR = 2.69, 95% CI = 1.02–7.12), and serious injuries (AOR = 2.22, 95% CI = 1.31–3.74) were statistically significant. Suicide attempt is relatively common in each of the three island nations. The socioeconomic context of adolescents might play a significant role in moderating suicidal behavior. Therefore, prevention efforts should be grounded in view of geographic, demographic, and socioeconomic contexts of the populations at risk.

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Suicidal Behavior in German Adolescents

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000331 ◽

2015 ◽

Vol 43 (1) ◽

pp. 39-45 ◽

Cited By ~ 4

Author(s):

Joana Straub ◽

Ferdinand Keller ◽

Nina Sproeber ◽

Michael G. Koelch ◽

Paul L. Plener

Keyword(s):

Suicidal Behavior ◽

Suicide Attempts ◽

Depression Scale ◽

Epidemiological Studies ◽

Present Sample ◽

Manic Symptoms ◽

Symptoms Of Depression ◽

Adolescent Sample ◽

History Of ◽

Sum Scores

Objective: Research in adults has identified an association between bipolar disorder and suicidal behavior. This relationship, however, has been insufficiently investigated in adolescents to date. Methods: 1,117 adolescents from 13 German schools (mean age = 14.83, SD = .63; 52.7% females) completed an extended German version of the Center for Epidemiological Studies Depression Scale (CES-D), which assesses depressive and manic symptoms during the last week, as well as the Self-Harm Behavior Questionnaire (SHBQ) for the assessment of lifetime suicidal behavior. Results: In the present sample 39.4% of the girls and 23.1% of the boys reported lifetime suicidal thoughts and 7.1% of the girls as well as 3.9% of the boys a lifetime history of suicide attempts. 18.7% of the adolescent sample revealed elevated symptoms of depression and 9% elevated levels of mania symptoms. Elevated sum scores of depression and mania were associated with a higher number of suicidal ideations and suicide attempts. A block-wise regression analysis revealed that sum scores of depression and mania predicted suicidal ideations best. Concerning suicide attempts, the best predictors were age as well as depression and mania sum scores. Conclusions: Suicidal behavior was reported more often when adolescents demonstrate symptoms of mania as well as symptoms of depression than when they demonstrate only depressive symptoms. The presence of bipolar symptoms in adolescents should alert clinicians to the heightened possibility of suicidal behavior.

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The Role of Past Suicidal Behavior on Current Suicidality: A Retrospective Study in the Israeli Military

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020649 ◽

2021 ◽

Vol 18 (2) ◽

pp. 649

Author(s):

Leah Shelef ◽

Jessica M Rabbany ◽

Peter M Gutierrez ◽

Ron Kedem ◽

Ariel Ben Yehuda ◽

...

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Military Service ◽

Suicide Ideation ◽

Rating Scale ◽

Suicide Attempts ◽

Significant Risk ◽

Significant Risk Factor ◽

Severity Rating ◽

Significant Difference

Past suicide attempts are a significant risk factor for future suicidality. Therefore, the present military-based study examined the past suicidal behavior of soldiers who recently made a severe suicide attempt. Our sample consisted of 65 active-duty soldiers (61.5% males), between the ages of 18 and 28 years old (M = 20.4, SD ± 1.3). The inclusion criterion was a recent severe suicide attempt, requiring at least a 24 h hospitalization. This sample was divided into two groups, according to previous suicidal behavior, namely whether their first suicide attempt was before or after enlistment (n = 25; 38.5% and n = 40; 61.5%, respectively). We then examined the lethality and intent of the recent event in regard to this division. Four measures were used to assess the subjects’ suicidal characteristics: the Columbia Suicide Severity Rating Scale, the Self-Harm Behavior Questionnaire, the Suicidal Behaviors Questionnaire-Revised, and the Beck Scale for Suicide Ideation. No significant difference in the severity of the suicide attempts (either actual or potential severity) were found between those who had suicide attempts before enlistment and those who had their first attempt in the service. As a matter of fact, most of the suicide attempts that occurred for the first time during military service had used a violent method (58.3%, n = 21). Finally, using multivariate analyses, we found that current thoughts and behavior, rather than past suicidality, was the strongest predictor for the lethality of suicide attempts.

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Interoceptive deficits, non-suicidal self-injury, and suicide risk: a multi-sample study of indirect effects

Psychological Medicine ◽

10.1017/s0033291718003872 ◽

2019 ◽

Vol 49 (16) ◽

pp. 2789-2800 ◽

Cited By ~ 1

Author(s):

Christopher R. Hagan ◽

Megan L. Rogers ◽

Amy M. Brausch ◽

Jennifer J. Muehlenkamp ◽

Thomas E. Joiner

Keyword(s):

Suicidal Ideation ◽

Suicidal Behavior ◽

Indirect Effect ◽

Indirect Effects ◽

Suicide Ideation ◽

Suicide Attempts ◽

Pain Tolerance ◽

Self Report ◽

Self Injury ◽

Two Samples

AbstractBackgroundInteroceptive deficits (ID) have been associated with non-suicidal self-injury (NSSI) and suicidal behavior in multiple studies. Many of these studies are limited in scope, and have not fully examined possible mechanisms explaining how ID affect suicidal behavior.MethodsThis study assesses how self-reported ID relate to suicide ideation and attempts in six distinct and geographically diverse samples of adults (n = 2706) and one sample of adolescents (n = 436). Participants responded to a variety of self-report questionnaires and interviews.ResultsContrary to our hypothesis, self-reported ID were only associated with suicidal ideation in two samples, one of which was the adolescent sample. Largely consistent with our predictions, self-reported ID exhibited an indirect effect on suicide attempts through versatility of NSSI in four of the five adult samples tested. Finally, the indirect effects of self-reported ID on suicide attempts through NSSI versatility did not act indirectly through behaviorally assessed pain tolerance.ConclusionsWe found that, in adults, self-reported ID are not associated with suicidal ideation, but are connected with a history of suicide attempts, through an indirect effect via NSSI. Our findings also indicate that the mechanism of action leading from self-reported ID to suicidal behavior may differ between adolescents and adults, and relate to suicidal behavior independent of pain tolerance. Clinical implications and future directions are discussed.

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Repetitive negative thinking about suicide: Associations with lifetime suicide attempts

Clinical Psychology in Europe ◽

10.32872/cpe.5579 ◽

2021 ◽

Vol 3 (3) ◽

Author(s):

Tobias Teismann ◽

Thomas Forkmann ◽

Johannes Michalak ◽

Julia Brailovskaia

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Suicide Ideation ◽

Suicide Attempts ◽

Clinical Sample ◽

Cross Sectional Study ◽

Repetitive Negative Thinking ◽

Cross Sectional ◽

Suicide Attempters ◽

Negative Thinking

Background Repetitive negative thinking has been identified as an important predictor of suicide ideation and suicidal behavior. Yet, only few studies have investigated the effect of suicide-specific rumination, i.e., repetitive thinking about death and/or suicide on suicide attempt history. On this background, the present study investigated, whether suicide-specific rumination differentiates between suicide attempters and suicide ideators, is predictive of suicide attempt history and mediates the association between suicide ideation and suicide attempts. Method A total of 257 participants with a history of suicide ideation (55.6% female; Age M = 30.56, Age SD = 11.23, range: 18–73 years) completed online measures on suicidality, general and suicide-specific rumination. Results Suicide-specific rumination differentiated suicide attempters from suicide ideators, predicted suicide attempt status (above age, gender, suicide ideation, general rumination) and fully mediated the association between suicide ideation and lifetime suicide attempts. Conclusion Overall, though limited by the use of a non-clinical sample and a cross-sectional study design, the present results suggest that suicide-specific rumination might be a factor of central relevance in understanding transitions to suicidal behavior.

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Trends in Suicidal Behaviors Among US Adults 2015–2018

Crisis ◽

10.1027/0227-5910/a000732 ◽

2020 ◽

pp. 1-9

Author(s):

R. Andrew Yockey ◽

Keith King ◽

Rebecca Vidourek

Keyword(s):

Drug Use ◽

Suicide Ideation ◽

Suicide Attempts ◽

Public Health Problem ◽

The United States ◽

National Sample ◽

Self Report ◽

Major Public Health Problem ◽

Suicidal Behaviors ◽

Suicide Planning

Abstract. Background: Suicide remains a major public health problem in the United States. The purpose of this study was to examine trends in suicide ideation, planning, and attempts among a national sample of US adults. Method: We used aggregated 2015–2018 data from the National Survey Drug Use and Health Survey. We utilized demographic and substance use questions with each suicide behavior. We assessed weighted absolute and relative changes in a national sample of 7,654 adults. Results: Results revealed that from 2015 to 2018, there was a 16.0% increase in suicide ideation, 18.6% increase in suicide planning, and 11.6% increase in suicide attempts. Significant increases in each behavior were found in African Americans, younger adults, sexual minorities, and individuals who reported past-year drug use. Limitations: Limitations include self-report of suicidal behaviors and desirability of answers. Conclusion: We believe our findings can inform harm reduction efforts and health messages surrounding suicide prevention.

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Suicide in probation: Towards the ideation-to-action model

Probation Journal ◽

10.1177/02645505211041581 ◽

2021 ◽

pp. 026455052110415

Author(s):

Charlie Brooker ◽

Karen Tocque ◽

Georgia West ◽

Alice Norman-Taylor ◽

James Fowler

Keyword(s):

Suicide Ideation ◽

Suicide Attempts ◽

Psychological Treatment ◽

Secondary Analysis ◽

Control Group ◽

Significant Difference ◽

Action Model ◽

History Of ◽

Clinically Significant ◽

A Prospective Study

Suicide in probation services is far higher than the general population. This paper presents secondary analysis of data previously used to evaluate the outcome of delivering psychological treatment to probationers in London. A sample of probation service users who screened positive for clinically significant symptoms of distress and were subsequently assessed and offered treatment ( n = 274) were allocated retrospectively to one of three groups: those with a history of suicidal ideations but no suicide attempts (ideation group), those with a history of a suicidal act (attempt group) or a control group where suicide was not evident (no history group). Results indicate no significant difference between the ideation and the attempt groups, but significant differences between these and the no history group. The findings are discussed within the context of the suicide ideation-to-action models that have been debated in other offender settings. We conclude that a more nuanced understanding of suicidal acts and suicide attempts is required in probation services including a prospective study that tests the ideation-to-action model.

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Suicidal Behavior of Adolescents with Behavior Disorders and Their Peers without Disabilities

Behavioral Disorders ◽

10.1177/019874299402000108 ◽

1994 ◽

Vol 20 (1) ◽

pp. 61-68 ◽

Cited By ~ 3

Author(s):

Darcy Miller

Keyword(s):

Emotional Disorders ◽

Suicidal Behavior ◽

Social Service ◽

Behavior Disorders ◽

Suicide Ideation ◽

Suicide Attempts ◽

Health Science ◽

Female Adolescents ◽

High Frequencies ◽

Gender Specific

Despite the fact that suicide is a major cause of death among adolescents (Centers for Disease Control, 1986; National Center for Health Science, 1989), the suicidal behavior of adolescents with behavioral/emotional disorders has not been extensively studied. A survey instrument was used to obtain information from adolescents with behavioral/emotional disorders and their peers without disabilities about the frequency of and the rationale behind their suicide ideation and suicide attempts. Significant differences were found between the adolescents with behavioral/emotional disorders and their nondisabled peers, as well as differences between the males and the females in each group in the frequency of suicide ideation and suicide attempts. The female adolescents with behavioral/emotional disorders reported high frequencies in both suicide ideation and suicide attempts. No group or gender differences were found in the rationales offered by the adolescents for suicidal behavior. Implications for teachers, parents, and social service personnel are discussed, including the need for gender-specific suicide prevention and intervention for adolescents with and without behavioral/emotional disorders.

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Can Postdischarge Follow-Up Contacts Prevent Suicide and Suicidal Behavior?

Crisis ◽

10.1027/0227-5910/a000158 ◽

2013 ◽

Vol 34 (1) ◽

pp. 32-41 ◽

Cited By ~ 97

Author(s):

David D. Luxton ◽

Jennifer D. June ◽

Katherine Anne Comtois

Keyword(s):

Suicidal Behavior ◽

Suicide Attempts ◽

Empirical Studies ◽

Secondary Analysis ◽

Inpatient Psychiatry ◽

Time Period ◽

Prevention Interventions ◽

Specific Factors ◽

E Mail

Background: The time period following discharge from inpatient psychiatry and emergency department (ED) treatment is one of heightened risk for repeat suicide attempts for patients. Evidence reported in the literature shows that follow-up contacts might reduce suicide risk, although there has not been a comprehensive and critical review of the evidence to date. Aims: To evaluate evidence for the effectiveness of suicide prevention interventions that involve follow-up contacts with patients. Methods: Published empirical studies of follow-up interventions with suicidal behaviors (suicide, attempts, and ideation) as outcomes were searched. Study populations were inpatient psychiatric or ED patients being discharged to home. Contact modalities included phone, postal letter, postcards, in-person, and technology-based methods (e-mail and texting). Results: Eight original studies, two follow-up studies, and one secondary analysis study met inclusion criteria. Five studies showed a statistically significant reduction in suicidal behavior. Four studies showed mixed results with trends toward a preventative effect and two studies did not show a preventative effect. Conclusions: Repeated follow-up contacts appear to reduce suicidal behavior. More research is needed, however, especially randomized controlled trials, to determine what specific factors might make follow-up contact modalities or methods more effective than others.

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Dissociation and Acquired Capability as Facilitators of Suicide Ideation Among Soldiers

Crisis ◽

10.1027/0227-5910/a000278 ◽

2014 ◽

Vol 35 (6) ◽

pp. 388-397 ◽

Cited By ~ 14

Author(s):

Lea Shelef ◽

Yossi Levi-Belz ◽

Eyal Fruchter

Keyword(s):

Suicidal Ideation ◽

Suicidal Behavior ◽

Mental Health Treatment ◽

Military Service ◽

Suicide Ideation ◽

Suicide Attempts ◽

Significant Proportion ◽

Control Group ◽

Dramatic Rise ◽

The Military

Background: The phenomenon of suicide and suicidal behaviors during military service is universal, with a recent dramatic rise in some armies. Aims: The aim of this study was to shed light on the role of dissociation and habituation as facilitators of suicidal behavior, beyond other well-established risk factors of stress, such as depression and hopelessness. Method: The study group included 167 soldiers, aged 18–21 years divided into three research groups: soldiers who made suicide attempts, soldiers who were psychologically treated, and a control group of soldiers having no history of mental health treatment. All subjects completed a suicide ideation scale and instruments measuring stress, mental pain, bodily dissociation, and habituation. Results: Suicide attempters had higher levels of subjective stress as well as depression and hopelessness compared with the psychologically treated and control groups. Using regression analysis, suicide facilitators of dissociation and habituation explained a significant proportion of the suicidal ideation variance, above and beyond the contribution of stress, depression, and hopelessness. A combined effect of stress and facilitating factors amplifies the level of suicidal ideation among soldiers. Conclusion: Identifying psychological facilitators of suicide-like dissociation and habituation may contribute to understanding suicidal behavior in soldiers and assist in developing effective suicide-prevention initiatives in the military setting.

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Tobacco Use and Parental Monitoring—Observations from Three Diverse Island Nations—Cook Islands, Curaçao, and East Timor

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207360 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7360

Author(s):

Masood Ali Shaikh ◽

Zahra Zare ◽

Kwok W. Ng ◽

Karen L. Celedonia ◽

Michael Lowery Wilson

Keyword(s):

Tobacco Use ◽

Parental Monitoring ◽

Economic Status ◽

East Timor ◽

Public Health Importance ◽

Cook Islands ◽

Adolescent Tobacco Use ◽

Monitoring Activities ◽

Nationally Representative

Tobacco use among adolescents is a global problem of public health importance. This study examined the profile of differences and similarities in adolescent tobacco use, and the role of parental monitoring activities among adolescents in three island nations of varying economic status: Cook Islands, Curaçao, and East Timor. Using nationally representative data we conducted regression modeling to determine the effect of four types of parental monitoring activities on tobacco use. Within a recall period of 30 days prior to being surveyed, 29.7% of students in East Timor, 21.6% in Cook Islands, and 13.1% in Curaçao reported having smoked cigarettes and/or used tobacco in other forms during 1 or more days during the preceding 30 days. Lower rates of parental monitoring as measured by four variables (parental understanding of problems and worries; knowing about how free time was being spent; going over things without approval; and checking to see if homework was done) were associated with higher percentages of adolescent tobacco use. Taken together the results underscore the need for increased parental involvement in programs which are designed to reduce tobacco use among adolescents.

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