Archives of Suicide Research最新文献

Objective: Previous research has identified loneliness as a risk factor for suicidal ideation and attempt but has lacked studies using representative samples of adolescents. We aimed to address this evidence gap by using a nationally representative sample of US adolescents to investigate whether loneliness is longitudinally associated with suicide-related outcomes.

Method: We analyzed data on 17,751 participants in the National Longitudinal Study of Adolescent to Adult Health (Add Health) aged 11-21 years at baseline. We used multivariable logistic regression to test the longitudinal association between baseline loneliness (1995; aged 11-21 years) and past-year suicidal ideation and suicide attempt measured six years later (2001-2002; aged 18-28 years) and 13 years later (2008-2009; aged 24-34 years) adjusted for socio-demographic and clinical characteristics.

Results: Adolescents with higher levels of loneliness aged 11-21 years were 1.97 times more likely to report suicidal ideation six years later (OR_adj1=1.97, 95% CI [1.45, 2.67], p < 0.001), but this association was no longer significant after adjustment (OR_adj2=1.10, 95% CI [0.75, 1.61], p = 0.62). They were also significantly more likely to report suicidal ideation at 13-year follow-up (OR_adj1=2.22, 95% CI [1.71, 2.89], p < 0.001), even after adjustment (OR_adj2=1.36, 95% CI [1.00, 1.86], p = 0.049). However, there was no association between loneliness and suicide attempt at either follow-up point.

Conclusions: Loneliness aged 11-21 years predicts suicidal ideation (but not suicide attempt) 13 years later, suggesting a need for interventions delivered at the start of adolescence to prevent the onset of distressing suicidal ideation later in adolescence and young adulthood.

Objective: Self-harm among children and adolescents is a global public health issue, with concerning trends of increased rates of hospital presenting self-harm in younger age groups (5-12 years). Few studies have investigated risk factors of emerging self-harm in preadolescent populations (<12 years). This study aimed to identify key factors associated with recent (past 12-months) self-harm in preadolescents (5-12 years) compared to adolescents (13-18 years).

Method: This cross-sectional case-control study recruited 305 parents/guardians who had a child (aged 5-18 years) that had (i) recently engaged in self-harm (case group) or (ii) never engaged in self-harm (control group). Participants completed an online parent-report questionnaire that assessed demographic characteristics and self-harm, childhood adversity, child-parent relationships, peer relationships, and problematic digital media use. Data were analyzed using univariate and multivariate logistic regression analyses.

Results: Poorer emotion regulation (OR = 1/0.76 = 1.32), lower parental age (OR = 1/0.83 = 1.20), lower household income (OR = 4.38), problematic peer relationships (OR = 1.38), and lifetime suicidal ideation (OR = 20.34) were associated with increased odds of self-harm among all youth ages. Higher parent education was associated with greater odds of self-harm among preadolescents (OR = 0.02). Lifetime mental health diagnosis (OR = 7.84) and lower levels of childhood adversity (OR = 0.60) were associated with greater odds of recent self-harm among adolescents.

Conclusions: Coordinated multi-agency efforts are essential for holistically addressing common, modifiable individual, social, and socioeconomic risk factors of youth self-harm that may help to prevent onset in young people.

Background: This study examined the implementation of structured suicide risk screening by a large state physician health monitoring program (PHP).

Methods: Physicians (n = 363; 87 women; 44.78 years-old, SD = 13.75) were screened for suicide risk with the Columbia Suicide Severity Rating Scale (C-SSRS) at PHP intake and at 2-weeks, 3-months, 1-year, 2-years, 3-years after initiating monitoring, and following any sentinel events. The PHP response was recorded at each timepoint.

Results: At intake, female physicians reported higher current (p = .025, Cramer's V = .178) and lifetime suicide risk (p = .010, Cramer's V = .163) compared to male physicians. Physicians monitored for substance use disorders (SUD) were more likely to deny any lifetime suicide risk than those monitored for co-occurring SUD and psychiatric disorders (p = .017, Cramer's V = .171), and had lower rates of "moderate" lifetime suicide risk than those monitored for psychiatric disorders only (p = .017, Cramer's V = .171). The PHP offered behavioral health referrals for physicians reporting "low" risk (n = 2) plus safety measures for those with "moderate" (n = 2) and "high" risk (n = 1). One physician reporting "low" risk and four physicians reporting "high" risk were already in-treatment. At 2-weeks and 3-months into monitoring, suicide risk remained "very low" (99.4% and 98.8%) or "low." At 1-year, risk was "very low" for 99.3% of physicians, with two at "moderate" risk. At 2 and 3 years, 100% reported "very low" suicide risk. No suicides occurred among monitored physicians.

Conclusion: PHPs offer support to mitigate suicide risk among physicians. The observed decrease in suicide risk across monitoring may reflect the recovery processes that monitoring is intended to support.

Introduction: Suicide is the leading cause of non-accidental death for Native American young people ages 15-24. Alarmingly, suicide rates have continued to rise over the past decade despite ongoing prevention efforts. This shortcoming has urged some scholars to (re)examine dominant theoretical models to better direct suicide prevention efforts in tribal communities.

Method: Using Indigenous Wholistic Theory, this study used an algorithmic approach to identify a broader set of factors associated with suicidal ideation among Native American high school students in California (n = 2,609). Data were drawn from the 2019-2020 California Healthy Kids Survey, a statewide school-based dataset. Lasso penalized regression was employed to select the most predictive variables for suicidal ideation from a set of 17 candidate factors.

Results: Ten predictors were retained in the final model: depressive symptoms; school-based victimization; sexual and gender minority status; lifetime use of alcohol, vapes, and cannabis; breakfast consumption; access to alcohol and other drugs; and parent education level.

Conclusion: A combination of factors spanning individual, emotional-social, mental-political, and physical-economic domains predicted individualized risk for experiencing suicidal ideation. These findings underscore the need to move beyond psycho-centric models and toward more comprehensive understandings of suicide-related behavior among Native American youth.

Objective: Suicidal communications (SCs)-also known as suicide threats or "gestures," whereby an individual verbally or behaviorally signals suicidal intent-present a serious challenge to clinicians and loved ones, who may struggle to determine the appropriate level of response. Yet, few studies have examined clinical correlates of SCs, partly due to inconsistent operationalization. It is critical to identify mechanisms that maintain SCs and clarify associated suicide risk, especially among individuals with borderline personality disorder (BPD), among whom SCs are relatively common.

Method: Adults (N = 108) with BPD receiving a 6-month course of dialectical behavior therapy (DBT) reported on SCs and other suicidal thoughts and behaviors (STBs) at intake, mid-treatment, and end-of-treatment. Participants also completed measures assessing BPD severity, emotion dysregulation, and DBT skills uptake.

Results: Participants who endorsed lifetime SCs (53%) reported higher BPD severity and worse emotion dysregulation at baseline. However, dosage of DBT-conceptualized as both skills uptake and length of time in treatment-reduced the incidence of SCs. There were no significant associations between lifetime SCs and engagement in other STBs, both at baseline and during treatment.

Conclusion: Current findings support a conceptualization of SCs as an expression of severe emotion dysregulation, which may be alleviated by DBT. Specifically, DBT may protect against SCs by teaching alternative, more adaptive coping strategies, even in the presence of heightened emotion dysregulation. Finally, though results indicate a lack of association between SCs and other STBs, further researcher is needed before clinical recommendations can be made.

Objective: Maternal suicide is a leading cause of death during pregnancy and after birth (perinatal period). Perinatal suicidality is associated with significant adverse consequences for mother and baby. It is vital that women experiencing suicidality are identified early and given access to appropriate care. Screening measures are one way to identify women requiring additional support. No self-report screening measures have been specifically designed to identify suicidality in perinatal women. This study sought to determine the content validity, acceptability, and potential clinical utility of 22 suicide-related items that have been adapted and/or developed for use with perinatal women.

Method: Two-round Delphi study. Thirty panelists with expertise and/or experience in perinatal mental health, suicidality and/or the development of measurement instruments took part. Items were rated against five dimensions, "relevance," "clarity," "acceptability," "effectiveness," and "feasibility." Consensus was determined as ≥70% panelists endorsing "quite" or "highly" for all dimensions. Response options were also rated on three dimensions, and qualitative feedback was explored.

Results: Ten items reached consensus ≥70% for all five dimensions in round-one and a further four reached consensus in round-two, totaling 14 items. Twenty-one response scales/items reached consensus ≥70% in both rounds. The top-ranking item for identifying suicidal ideation was "Have you had thoughts about ending your own life?" Qualitative findings highlighted key areas to be addressed. These included the implications of item content, the importance of asking perinatal women about suicidality, and the need for all pregnant and postnatal women to receive appropriate information about perinatal mental health and suicidality.

Conclusions: Specifically developed screening measures to identify perinatal suicidality are warranted. Findings from this study will help to inform the continuing development of suicidality items for measures to be used with pregnant and postnatal women in clinical and research settings.

Objective: Research gaps persist in understanding the underlying sociodemographic patterning of hospital-presenting self-injury (HPSI) in South Korea. Our research aims to understand the relationship between HPSI and gender over time in relation to its sociodemographic attributes.

Method: The study utilized the Korea National Hospital Discharge In-depth Injury Survey (KNHDIS) from 2004 to 2021. The change in the age-standardized rate per 100,000 Koreans over age groups and their gender distribution was examined. Logistic regression models were employed to understand the association between gender and HPSI.

Results: The study encompassed 497,882 injury patients, with 13,139 HPSI patients. The age-standardized rate per 100,000 was similar across years, and significantly higher in older age groups over 70. Also, the HPSI rate was higher in women (43.01, 95% CI: 40-46.08) than in men (36.65, 95% CI: 34.03-39.28). This gender pattern was consistent across years but showed an opposite trend over age 50, where men experience more HPSI. Gender gaps showed a decreasing trend over time, except for the 2019-2021 period in which HPSI rates rose disproportionately among adolescent girls and elderly men. Regression models confirmed these patterns, where the odds ratio of women on HPSI was 1.76 (95% CI: 1.46-2.16) in the fully adjusted model, it was 4.33 (95% CI: 3.64-5.14) in age group ≤20 and 0.39 (95% CI: 0.34-0.44) in age group >80.

Conclusions: The gender pattern of HPSI varies significantly by age group. Further research is imperative to delve into the root causes of these differences.

With its susceptibility in victimized populations and the potential for suicidality, non-suicidal self-injury (NSSI) is among the most severe health concerns in college students, indicating an urgency to explore its antecedents and interventions. The present study aims to examine the relationship between bullying victimization and NSSI and the mediating roles of internal shame, external shame, depressive symptoms, and PTSD symptoms based on the general strain theory, the vulnerability-stress theory, and the transactional stress theory. By adopting a three-time-point design with 6-month intervals, hypotheses were tested using data from 634 Chinese college students (374 female; Mage = 18.97). Through a structural equation modeling approach, the study found that bullying victimization was positively correlated with NSSI via internal shame and depressive symptoms. However, this study found no evidence for the mediating association of either external shame or PTSD symptoms in the examined relationship. Through a lens of emotion-driven mechanism, this study contributes to understanding the roles of internal shame and depressive symptoms in NSSI intervention strategies among victims of bullying. The results also illuminate the differentiation of the mechanisms of internal and external shame and the discrepancy between depressive symptoms and PTSD symptoms as two types of post-traumatic symptomatology.

Objective: Suicide is among the leading causes of death among adolescents. Many risk factors for suicide are well known, and self-harm ideation and behavior are among the strongest. Still, there is limited research on factors that distinguish those with self-harm ideation and those who self-harm. Our aim is to investigate nonpsychiatric risk factors that distinguish between adolescents with self-harm ideation, those who self-harm, and those who engage in repeated self-harm.

Method: This survey analysis was based on findings from a cross-sectional study (N = 7,943 adolescents). Multinomial logistic regression was employed to compare the effects of various exposures (including social relations, happiness, vulnerability, being bullied, self-worth, physical and sexual abuse) on self-harm ideation, self-harm, and repeated self-harm, using a reference group of adolescents without self-harming behavior.

Results: Adolescents exhibiting self-harming behavior showed significantly higher levels of exposure, with the highest exposure observed in the repeated self-harm group. Vulnerability and lack of self-worth emerged as the most significant risk factors. Additionally, we found a clear dose-response effect across all groups.

Conclusions: This study highlights the significant increase in the risk of self-harm with the accumulation of risk factors in adolescents' lives, emphasizing the importance of providing support and assistance to those exposed to multiple risk factors. Addressing these factors may help reduce the risk of suicidal behavior, as self-harm remains one of the strongest risk factors for suicide attempt and suicide. Furthermore, the findings point out the critical role of single risk factors, particularly vulnerability and lack of self-worth.

Objective: Self-directed violence with suicidal intent is one of the main causes of maternal mortality. We aimed to evaluate the impact of several predictors on suicidal ideation (SI) in postpartum women.

Methods: A cohort of 1,822 women, over 18 years old, was assessed in two Brazilian cities with contrasting sociodemographic profiles. Participants were followed from pregnancy (22nd-25th weeks) until postpartum (mean = 116.8 days, SD = 81.5 after delivery). The main outcome was SI assessed using item-10 of the Edinburgh Postpartum Depression Scale. Potential predictors of SI were allocated into seven different domains: sociodemographic characteristics, environmental stressors and social support during pregnancy, maternal mental health during pregnancy and postpartum, substance use during pregnancy, obstetric data, and newborn characteristics.

Results: SI prevalence was 3.1%. In the univariate analysis, having more children, lower family income, lower education, history of depression, stressors during pregnancy (perceived stress, hopelessness, anxiety, depression, alcohol use, smoking and history of violence, greater number of stressful events, lower social support, and racially discriminatory experience), newborn with low APGAR in the first minute, non-breastfeeding, and postpartum depression, were positively associated with SI. In the multiple predictors model (X² = 136,502; df = 6; p < 0.001), only racial discrimination during pregnancy (PR: 1.13; 95% CI 1.01-1.27) and postpartum depression (PR: 1.23; 95% CI 1.20-1.27) remained associated with SI.

Conclusions: Although racial discrimination was not assessed in the postpartum, such experiences during pregnancy seem to contribute to an increased risk of SI among depressed postpartum women. This underscores the importance of addressing racial disparities and fostering an inclusive and supportive environment to safeguard maternal mental health.