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

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.

The relationship between childhood abuse and suicidal behaviours in a treatment-seeking sample of Canadian military, police, and Veterans

LAY SUMMARY Suicide and related behaviours (e.g., attempting suicide, planning suicide, and purposely harming oneself) can negatively impact individuals, families, and communities. Canadian military and police are generally more likely to engage in suicide-related behaviours than the general population. This study looked at how often suicide-related behaviours occur and whether experiences of childhood abuse increase the likelihood of such behaviours among actively serving and Veteran Canadian military and police personnel who are seeking mental health treatment. Data was drawn from the medical charts of 412 individuals at a clinic that specializes in serving members and Veterans of the Canadian military and police services with mental health needs. Approximately 41% of the sample had engaged in one or more suicide-related behaviour. By type of behaviour, 37% had thought about suicide, 11% had attempted suicide, 7% had a suicide plan, and 5% engaged in self-harm behaviours. Those with a history of childhood abuse and those who identified as Veterans were more likely to have attempted suicide. These findings may help inform efforts to reduce suicide and related behaviours in this unique group.

“In the Moment I Wanted to Kill Myself, and Then After I Didn’t”: A Qualitative Investigation of Suicide Planning, Method Choice, and Method Substitution Among Adolescents Hospitalized Following a Suicide Attempt

Research on planning, method choice, and method substitution in adolescents’ suicide attempts is limited. We conducted in-depth interviews with 20 adolescents following their suicide attempt to learn the extent to which the attempt was planned, why they used the method they did, and whether they would have substituted another method if the one they used had been unavailable. Applied Thematic Analysis was used to identify codes and develop themes. Attempts were largely unplanned, and planned attempts were often haphazard, as urgency to escape immediate pain was a main impetus for the attempt. Method choice was driven by easy access. Half of participants said they would not have attempted suicide if the method they used were inaccessible, but 7 of 20 said they would have, and 3 were unsure. Not all suicide attempts would be prevented by blocking access to methods that adolescent attempters would otherwise use. To understand whether restricting access to low-lethality methods could harm some attempters, future research should examine in-the-moment method substitution.

Marijuana use and suicidal behaviours among school-going adolescents in Africa: assessments of prevalence and risk factors from the Global School-Based Student Health Survey

BackgroundMarijuana use among adolescents, including high school students, has been consistently reported to be associated with a high incidence of suicidal behaviours. Little empirical research has been conducted on the propensity impact of marijuana use on suicidal behaviours in Africa.AimsTo assess factors associated with marijuana use and further quantify marijuana use as an associated factor of suicidal behaviours, including repeated attempted suicide, suicidal ideation and suicide planning, among high school students in Africa.MethodsA cross-sectional study was conducted among 32 802 school-going adolescents using the Global School-Based Student Health Survey data from 10 African countries grouped into West Africa, North Africa, South-East Africa, South Africa and East Africa subregions. Marijuana use and repeated attempted suicide were the main outcome variables. We employed double selection least absolute shrinkage and selection operator poisson regression model to assess risk factors associated with marijuana use and dominance analysis to establish ranked important and common risk factors. Inverse probability weighting poisson regression adjustment was applied to assess impact.ResultsThe prevalence of marijuana use and repeated attempted suicide were 3.7% (95% CI: 3.1 to 4.3) and 6.6% (95% CI: 5.9 to 7.4), respectively. The most important risk factor for marijuana use generally across the countries and specifically in three subregions was alcohol consumption, which constituted approximately 40% of the impact. The average treatment effect on the treated (ATT) indicated that marijuana use significantly increased the risk of suicidal ideation, suicide planning and repeated attempted suicide by 12% (ATT=0.12 (95% CI: 0.02 to 0.22)), 18% (ATT=0.18 (95% CI: 0.13 to 0.22)) and 31% (ATT=0.31 (95% CI: 0.20 to 0.41)), respectively.ConclusionsMarijuana use was significantly associated with suicidal behaviours (suicidal ideation, planning and repeated attempted suicide) among the students. To achieve Sustainable Development Goal 3.5 (to strengthen prevention and treatment of substance abuse), school-based psychosocial interventions should be streamlined to adequately assess and manage marijuana use. Targeting the most dominant risk factors in this population could translate into the reduction of suicidal behaviours in countries within Africa.

Gender and Age Differences in Comorbid Cannabis Use Disorders and Suicidality in a National Sample

Approximately 40 million adults use marijuana annually, making marijuana one of the most commonly used substances in the United States (SAMHSA, 2019). Men and emerging adults (ages 18-25) report higher prevalence of cannabis use disorders (CUDs) relative to women and older adults (CBHSQ, 2015; Khan et al., 2013). More frequent marijuana use is associated with greater likelihood of suicidal ideation (Ilgen et al., 2009), and past year use in emerging adults is associated with future suicide attempts (Pedersen, 2008). Similar to correlates of marijuana use, emerging adults and men have higher rates of suicidality (SAMHSA, 2019; Krug et al., 2002). Limited research has tested gender and age differences in comorbid CUDs and suicidality. The current study evaluated gender and age differences in CUDs only, suicidality only, or comorbid CUDs and suicidality in a national sample of adults. We hypothesized that men and emerging adults would be over-represented in comorbid CUDs and suicidality and CUDs only groups. Data were from four consecutive years (2015-2018) of the National Survey of Drug Use and Heath. Multinomial logistic regressions tested gender and age differences in adults with DSM-IV cannabis abuse or dependence (CUDs) only, suicidality only, and comorbid CUDs and suicidality, all compared to adults with neither CUDs or suicidality. Four separate regressions were conducted for passive suicidal ideation, active suicidal ideation, suicide planning, and suicide attempts. Gender was coded as male or female. Age groups were 18–25, 26–34, 35–49, and 50 years or older. Analyses controlled for survey year, race/ethnicity, sexual orientation, education, household income, past year major depressive episode, past year DSM-IV alcohol abuse or dependence, and past year illicit drug abuse or dependence other than CUDs. Men disproportionately reported CUDs only (ORs=1.73-2.19, p<.001) and comorbid CUDs and passive suicidal ideation, active suicidal ideation, and suicide planning (ORs=1.72-2.12, p<.01), but not attempts (OR=1.16, p=.45) relative to women. Men reported 22% higher odds of active suicidal ideation than women. Women reported 15% higher odds of suicide attempts than men. Gender differences in passive suicidal ideation and planning were not statistically significant. Compared to older age groups, emerging adults were significantly more likely to report CUDs only (ORs=1.74-10.49, p’s<.01) and showed 2.36 to 14.24 times greater odds of comorbid CUDs and all four forms of suicidality (p<.001). Emerging adults were at 18% to 66% higher odds of either passive or active suicidal ideation alone compared to all older age groups (p’s<.001). This study investigated the relations between CUDs, suicidality, gender, and age in a nationally representative sample of adults. Results indicated that men and emerging adults consistently reported the highest likelihood of negative outcomes. Next steps include determining the direction of the relationship between CUDs and increasing severity of suicidality. Further, development and investment in programs for emerging adults with CUDs and suicidality are vitally important given the striking risk profile compared to other age groups. Future research should include program development and evaluation as well as gathering more information on risk and protective factors for these populations.

Trends in Suicidal Behaviors Among US Adults 2015–2018

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.

Physical Fighting among School-Attending Adolescents in El Salvador: An Examination of the 2013 Global School-Based Health Survey

Background: Violence among school-attending adolescents is an important public health problem worldwide. The present study examined demographic correlates for physical fighting behavior among a nationally representative sample of school-attending adolescents in El Salvador. Methods: Initial cross-tabulations to screen for correlations was then followed by logistic regression to understand the direction and the strength of selected demographic variables for physical fighting behavior, which occurred within a 12 month period of recall. Results: Out of a sample of 1910 school-attending adolescents in El Salvador, 11.5% reported having been involved in two or more physical fights during the recall period. Regression analyses indicated that being male (OR = 3.55; 95% CI = 2.11–6.00); having experienced bullying (OR = 2.16; 95% CI = 1.44–3.24); physical activity (OR 0.61; 95% CI 0.46–0.80); a sedentary lifestyle (OR 1.54; 95% CI 1.05–2.27), suicide planning (OR 2.28; 95% CI 1.46–3.56), and having non-understanding parents (OR = 1.45; 95% CI 1.06–1.98) were significantly associated with physical fighting among the sampled adolescents. Conclusion: Within the limitations of cross-sectional surveys conducted in school settings, the results of the present study suggest that giving attention to preventing bullying behavior among males and involving parents should be components of a multi-pronged strategy to preventing physical fighting in schools in El Salvador.

An Assessment of Digital Media-related Admissions in Psychiatrically Hospitalized Adolescents

Background: Prevalent adolescent digital media use has brought clinical attention to its potential associated risks. While excessive digital media use has been connected to adolescent difficulties with mood and impulsivity, no study has examined digital media’s role in precipitating adolescent psychiatric admissions. Objective: Our study aims were to identify and characterize digital media-related admissions in a sample of psychiatrically hospitalized adolescents, and to recognize unique patterns of digital media use within this sample. We hypothesized that adolescents with digital mediarelated admissions would endorse higher amounts of digital media use and problematic online behaviors. Methods: We administered a cross-sectional survey of psychiatrically hospitalized adolescents between 2012 and 2016. Admissions were considered related to digital media use either by adolescent report or documentation in the medical record. Unadjusted comparisons were used to examine relationships between digital media-related psychiatric admissions, online behaviors and suicide-related risk factors. Results: 68 of 218 participants (31.2%) had digital media-related admissions. The most frequent cause of digital media-related admission was cyberbullying (31.9%). Teens with digital- media related admissions were significantly more likely to sext, use social media, and be cyberbullied; these adolescents were also at increased risk of suicide planning and hopelessness. Conclusion: Efforts should be made by mental health clinicians to identify and address online relational conflict, as well as to screen for cyberbullying and sexting. Clinicians should consider that adolescents with digital media-related presentations may be at elevated risk of self-harm, with higher rates of suicide planning and hopelessness compared to hospitalized peers with admissions unrelated to digital media.

Association of Bedtime with both Suicidal Ideation and Suicide Planning among Korean Adolescents

Study Objectives: In comparison to other countries, the South Korean population has a short average sleep duration, and studies have suggested that insufficient sleep is a risk factor for suicidal behavior. This study aimed to examine the association of bedtime with suicidal ideation and with suicide planning, respectively, among Korean adolescents. Methods: This study included 48,218 participants from the 2017 Korea Youth Risk Behavior Web-based Survey. Participants were divided into three categories: pre-23:00 bedtime, 23:00–01:30 bedtime, and post-01:30 bedtime. Suicidal ideation and suicide planning were the main dependent variables, and multiple logistic regression analysis was performed to examine the target association. Results: For both male and female respondents, compared to those who had a pre-23:00 bedtime, those whose bedtime was after 01:30 were more likely to have suicidal ideation (post-01:30 bedtime for men: OR = 1.29, 95% CI = 1.16–1.45; for women: OR = 1.32, 95% CI = 1.20–1.44). For suicide planning, the results were also significant for both genders (post-01:30 bedtime for men: OR = 1.41, 95% CI = 1.16–1.70; for women: OR = 1.21, 95% CI = 1.03–1.43). Odds of suicidal ideation were higher for those who had a post-01:30 bedtime on weekdays but not weekends. Conclusions: We found that, among adolescents, going to bed after 01:30 is significantly associated with suicidal ideation and suicide planning, after adjusting for demographic, socioeconomic, and health-related characteristics. Therefore, late bedtime should be the timepoint of a suicide intervention for adolescents, in order to prevent developing suicidal ideations and suicide planning.