Comparison of suicidal ideation,suicide attempt and suicide in children and young people in care and non-care populations: Systematic review and meta-analysis of prevalence

Suicide in children and young people is a major public health concern. However, it is unknown whether individuals who have been in the care of the child welfare system are at an elevated risk. Care is presently defined as statutory provision of in-home care (e.g. child living with birth family but in receipt of legal order involving supervision by social workers) or out-of-home care (e.g. foster care, residential care and kinship care). This paper presents a systematic review and meta-analysis comparing the prevalence of suicidal ideation, suicide attempt and suicide in children and young people placed in care with non-care populations. A systematic search was conducted of 14 electronic bibliographic databases and 32 websites. Of 2811 unique articles identified, five studies published between 2001 and 2011 met the inclusion criteria. Studies reported on 2448 incidents of suicidal ideation, 3456 attempted suicides and 250 suicides. The estimated prevalence of suicidal ideation was 24.7% in children and young people in care compared to 11.4% in non-care populations. The prevalence of suicide attempt was 3.6% compared to 0.8%. Two studies reported on suicide. Suicide risk in children and young people in care was lower in one study (0% vs 0.9%) and higher in the second (0.27% vs 0.06%). The results of the systematic review and meta-analysis confirm that suicide attempts are more than three times as likely in children and young people placed in care compared to non-care populations. Targeted interventions to prevent or reduce suicide attempt in this population may be required. Further comparative studies are needed to establish if children and young people in care are at an elevated risk of suicidal ideation and suicide.     

Positive Social Support,Negative Social Exchanges,and Suicidal Behavior in College Students

Abstract

Objective: Risk for suicide is often higher among college students, compared to same-age noncollegiate peers, and may be exacerbated by quality of social support and interactions. The authors examined the independent contributions of positive social support and negative social exchanges to suicide ideation and attempts in college students. Participants: Participants were 439 volunteer undergraduate students, who were primarily female (71%). Methods: Cross-sectional, survey design. Participants completed measures assessing positive social support, including emotional, informational, and tangible support; negative social exchanges; and suicidal behavior, including ideation and attempts. Results: Positive social support, particularly tangible support, and negative social exchanges were significantly predictive of greater suicidal behavior. Conclusions: Practical manifestations of support may buffer against suicide risk for college students, whereas conflict-based interactions may contribute to increased risk. At the institutional, parental, and peer levels, promotion of supportive relationships may be an important suicide prevention strategy.     

Suicidal behavior and associated factors in sexually abused adolescents

Objectives

The aim of the present study is to determine the rate of suicidal ideation and suicide attempts in sexually abused adolescents and to determine the factors associated with suicidal behavior.

Method

106 adolescents between the ages of 12–18 (94 girls, 12 boys) who were exposed to sexual abuse and referred for the preparation of forensic reports were included in the study. The investigators retrospectively examined the case files, forensic reports and social worker reports.

Results

It has been found that in cases exposed to sexual abuse, suicidal ideation developed in 63.2% (n = 67) of the individuals and 24.5% (n = 26) of them attempted suicide. The rate of suicidal ideation and suicide attempts was higher in cases who live separately from one or both parents, those who have ASD or PTSD after sexual abuse, cases in which abuse involved penetration, cases who were abused by someone known or someone from the family, cases where sexual abuse was accompanied by coercion and physical violence, and those who were exposed to abuse continuously. Among girls, in cases who have suicide history before sexual abuse and those who were abused by more than one abuser, the rate of suicidal ideation was higher.

Conclusion

It has been shown in many studies that sexual abuse in childhood increases the risk of suicidal behavior. Consideration of the factors associated with suicidal behavior in victims of sexual abuse will be helpful to clinicians in preventing suicide attempts.     

Sleep disturbances and suicide—New battles for veterans of U.S. wars in Afghanistan and Iraq: A retrospective review

In this article, we systematically reviewed 116 veterans’ medical records to explore the mitigating factors in sleep disturbance, polytrauma clinical triad (PCT), and suicide. We discovered that a particular nonaction (i.e., no standardized completion of sleep-disturbance screenings) had strong implications for resulting suicides among veterans with reported sleep disturbances, PCT, and suicidal ideations. This study provides strong propositions for the further study of this veteran cohort—Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND)—with regard to the impact of sleep disturbance on PCT and its relationship with suicide symptoms, ideation, and completion. The purpose of this study was to examine the outcomes of sleep disturbances on complex relationships among the three primary diagnoses—posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and chronic pain—that establish the PCT cluster. We identified that those diagnosed with sleep disturbances had increased suicidal ideations and rates of completed suicides. We analyzed these factors in veterans returning from the current wars in Afghanistan and Iraq. We hypothesized that (a) clinicians were not completing sleep-disturbance screenings as a standard practice for the OEF/OIF/OND veterans diagnosed with PCT who reported sleep disturbance concerns within the U.S. Department of Veterans Affairs; (b) if no sleep-disturbance screening instruments were used by clinicians, veterans would be at a greater risk of suicide completion.     

A Noncausal Relation Between Casual Sex in Adolescence and Early Adult Depression and Suicidal Ideation: A Longitudinal Discordant Twin Study

Research on relations between casual sex and mental health is inconclusive; while some studies indicate casual sex may lead to more negative mental health (e.g., depression), other studies report no such relationship. Using a genetically informed approach, this study examined whether earlier casual sex (i.e., ever engaging in casual sex and number of casual sex partners) in adolescence has a causal influence on later mental health in young adulthood (i.e., depressive symptoms and suicidal ideation), as well as the reverse relationship (adolescent negative mental health on young adult casual sex) by exploiting the quasi-experimental nature of discordant-twin models. Multilevel models that measured within-twin and between-twin pair effects of adolescent casual sex were estimated, using 714 twins (357 twin pairs) from the sibling subsample of the National Longitudinal Study of Adolescent Health (Add Health). Results indicated that there was no causal relationship between casual sex in adolescence and higher levels of depressive symptoms or suicidal ideation in young adulthood, and these effects did not differ by gender. There were also no causal relations between adolescent depressive symptoms or suicidal ideation and casual sexual experience in young adulthood. Implications for ways to increase scientific rigor by using different methods (e.g., genetically informed analyses) are discussed.     

Meaningful Youth Engagement as a Protective Factor for Youth Suicidal Ideation

Youth suicide is a leading cause of mortality. Greater still is the prevalence of suicidal behavior and ideation. In this study with 813 secondary school students, we explored youth engagement in structured extracurricular activities as a possible protective factor for suicidal ideation. Personally meaningful youth engagement significantly moderated the relationships between depressive symptoms, risk behaviors, self‐esteem, and social support in the prediction of suicidal ideation. Specifically, the more meaning found in engagement, the less likely youth were to report suicidal thoughts in spite of risk factors. Acknowledging limitations, a focus on engaging youth in well‐selected activities of interest might represent a nonstigmatizing approach to universal prevention. Further research into the mechanisms of such an approach is warranted.     

Army Soldiers and Suicidal Thoughts: The Impact of Negative Relationship Dynamics Moderated by the Dissolution of Romantic Relationships

Suicide among United States active‐duty Army soldiers rapidly increased over the past two decades. Using a sample of 322 soldiers from the Army STARRS study, the researchers examined if romantic relationship factors (i.e., hostile disagreements and relationship distress) were linked with suicidal thoughts in Army soldiers, and if these associations were moderated by a recent separation or divorce. Hostile disagreements and relational distress were both significantly associated with higher rates of suicidal ideation. These associations were significantly amplified in magnitude when in the context of a recent separation or divorce. Implications include novel assessment, prevention, and treatment efforts focused on romantic relationships that may reduce the likelihood of soldiers experiencing thoughts of suicide.     

Suicide clusters: introducing a novel type of categorization

A suicide cluster within a given community may be defined as a group of suicides or suicide attempts, or both, that happen closer together in time and space than would generally be expected. However, since the perception of clustering may itself be a risk factor for suicide, suicide clusters differ almost from all other event clusters. The aim of this article, therefore, is to discuss the unique pattern of suicide cluster and introduce a novel type of categorization taking into account varieties of studies, which investigate suicide clusters within diverse settings. This article concludes with challenging areas in suicide cluster studies and emphasizing that each community must deal rapidly and appropriately with any perceived suicide clusters.     

Young Adult Suicide and Sexual Orientation

ABSTRACT

The current project focused on the suicidal ideation and risk potential of young adults (N = 312) and explored scores on self-report measures of suicidal ideation inclusive of various sexual orientations. Results suggest that the Lesbian, Gay, and Bisexual (LGB) youth surveyed (N = 73) differ in their display of suicide risk with significantly higher Beck Hopelessness Scale (BHS) and Suicide Probability Scale (SPS) scores. Social support served as a mitigating factor relating significantly to lower levels of hopelessness and suicidal ideation, especially among those LGB participants. The SPS held a significant relationship to suicide attempt in the past year, while the BHS held a significant relationship to suicide attempt in the past six months. Implications for counselors serving young adults are addressed, including specific suggestions to enhance counselor education and supervision related to suicide assessment and LGB counselor competency.     

Suicidality among homeless people: Testing the mediating effects of self-efficacy and depression

ABSTRACT

This cross-sectional study examined the mediating effect of PTSD on suicide ideation and suicide attempt through two mediators, self-efficacy and depression, among homeless adults. We recruited a non-random, purposive sample of 156 homeless adults from seven homeless people shelters in Kansas. SEM results suggest that self-efficacy and depression were significant mediators between PTSD and suicide ideation, but not between PTSD and suicide attempt. This study’s findings can be used to identify risk factors associated with suicidal behaviors that can be used to design service programs aimed at preventing suicidal ideation and attempt among people who are homeless.     

“We Have Closed Our Eyes and Sealed Our Lips”: Black Women’s Accounts of Discussing Suicide within the Black Community

Conversing about suicide with an at-risk individual can be enough to save a life. Given the rise of suicidal behavior among African American subgroups (i.e., youth and male), advocates are urging blacks to have candid conversations about the issue. The current study highlights black women’s experiences discussing suicide. Findings suggest that widespread beliefs that suicide is an insignificant issue among blacks make conversing about suicide especially challenging. These findings reveal problematic implications for African Americans contemplating suicide in their communities. Suicide may be a phenomenon for which communal support is less prevalent.     

Predictors of suicidal ideation among college students: A prospective cohort study

ABSTRACT

This prospective cohort study investigated longitudinal predictors of suicidal ideation among college students. A non-clinical cohort of college students (N = 171) completed baseline and 3-month follow-up surveys. Depressive symptoms, worst-point suicidal ideation, and suicide attempt history significantly predicted follow-up suicidal ideation severity after adjusting covariates. Similarly, depressive symptoms and worst-point suicidal ideation (but not attempt history) were significant predictors of follow-up suicidal ideation intensity in an adjusted model. The results suggest that current depressive symptoms and lifetime worst-point suicidal ideation are independently valuable constructs that may provide relatively short-term predictive information when screening for suicidal ideation among college students.     

The effects of familial acculturative stress and hopelessness on suicidal ideation by immigration status among college students

Objectives: Based on acculturative family distancing theory, we examined whether familial acculturative stress interacted with hopelessness to predict suicidal ideation differentially among emerging adult immigrant versus nonimmigrant college students. Participants: We recruited 152 generationally and racially/ethnically diverse college students (42 immigrants) from 2012 to 2013. Methods: Participants completed measures of hopelessness, depressive symptoms, ethnic identity, familial acculturative stress, and suicidal ideation. Results: Immigrant status interacted with hopelessness and familial acculturative stress. Hopelessness was associated with less suicidal ideation among immigrants than among nonimmigrants at a familial acculturative stress score below the 11th percentile, but greater suicidal ideation among immigrants than among nonimmigrants at a familial acculturative stress score above the 72nd percentile. Conclusions: Familial acculturative stress may exacerbate the effect of hopelessness on suicidal ideation among immigrant college students, and should be monitored during suicide risk assessment and treatment.     

Risk for Preadolescent Suicidal Behavior: An Ecological Model

The relationship between preadolescent suicidality (ideation, threats, attempts) and subsequent adolescent suicidal behavior is well documented. We tested a six domain, ecological suicide risk model in a sample of 69 preadolescent outpatients (ages 5 to 12 years). We correlated items from each domain with Suicidality as measured by the Pfeffer Spectrum of Suicide Potential Scale. Three domains (Child Risk Factors, Childhood Traumas, Family Stressors) had a total of 19 items that were significantly correlated with Suicidality (alpha < .05 level); one item in the fourth dimension, Social Supports, was included (alpha = .06). We show that children who demonstrate anxiety/depression, aggressive and antisocial behavior in a climate of parental hostility are at risk for suicidal behavior.     

Spiritual Well-Being and Suicidal Ideation Among College Students

Objective: This study explored whether specific dimensions of spiritual well-being (religious well-being and existential well-being) relate to reduced suicidal ideation, and whether associations persisted after controlling for religiosity and psychosocial variables associated with suicide. Participants: Participants were 457 college students who completed measures that assessed spiritual well-being, religiosity, hopelessness, depression, social support, and suicidal ideation. Methods: The authors used linear regression modeling to assess religious and spiritual correlates of suicidal ideation. Results: After controlling for demographic variables and psychosocial factors, neither involvement in organized religion nor religious well-being significantly contributed to suicidal ideation. However, even after controlling for significant correlates, existential well-being remained a significant predictor of suicidal ideation. Conclusions: This investigation highlighted existential well-being as an important factor associated with lower levels of suicidal ideation among college students. Findings from this study focusing on the association between spiritual well-being and suicidality may prove especially beneficial to suicide prevention efforts.     

Living with suicidal feelings: Japanese non-profit organizations for suicide prevention amid the COVID-19 pandemic

The number of suicides in Japan increased for the first time in 11 years during the COVID-19 pandemic. This trend is particularly high among employed women and students. The Japanese government expanded its budget for providing telephone and social network service (SNS) counseling by prefectures and non-profit organizations (NPOs). On the basis of interviews with the chairman as well as counselors of an NPO in Osaka (Japan) that has provided telephone counseling services on suicide for over 40 years, this study examines suicide and suicide prevention amid the COVID-19 pandemic with a particular focus on how suicidal feelings are accepted. The results clarify that people do not wish to die just because of financial troubles or health problems; rather, they have lost the meaning in their life in the conflicts between social conditions and their personal life histories. Additionally, as volunteer counselors often experience the suicide of close relatives, their empathy for a caller may be based on their experiences of being overwhelmed by the realization of the otherness of others. They do not regard the acceptance of suicidal feelings as a “job,” but act as “friends.” Although modern society conceals death and suicide cases, the key to achieving a society where no one is driven into committing suicide is to place human life and human rights first as well as to talk about suicide and suicidal feelings without making the subject taboo or an aberration.     

Reconsidering Durkheim's Assessment of Tarde: Formalizing a Tardian Theory of Imitation,Contagion, and Suicide Suggestion

Emile Durkheim summarily rejected Gabriel Tarde's imitation thesis, arguing that sociology need only concern itself with social suicide rates. Over a century later, a burgeoning body of suicide research has challenged Durkheim's claim to a general theory of suicide as 4 decades worth of evidence has firmly established that (1) there is a positive association between the publicization of celebrity suicides and a spike in the aggregate suicide rate, (2) some social environments are conducive to epidemic‐like outbreaks of suicides, and (3) suicidal ideas or behavior spreads to some individuals exposed to a personal role model's suicidal behavior—for example, a friend or family member. Revisiting Tarde, the article examines why Tarde's theory deserves renewed attention, elucidates what he meant by imitation, and then formalizes his “laws” into testable theses, while suggesting future research questions that would advance the study of suicide, as well as other pathologies. Each “law” is elaborated by considering advances in contemporary social psychology as well as in light of its ability to supplement Durkheim's theory in explaining the “outlier” cases.     

Testing a path model of relationships between gender,age, and bullying victimization and violent behavior,substance abuse,depression, suicidal ideation,and suicide attempts in adolescents

The goal of this study was to test a path model for the relationships between age, gender, traditional bullying and cyberbullying victimization, and violent behavior, substance abuse, depression, suicidal ideation and suicide attempts in adolescents. A hypothesized path model was fit to data from the 2011 Youth Risk Behavior Surveillance System (YRBSS) on a nationally representative sample of 15,425 high-school students from across the United States. Results suggested that the effects of traditional and cyberbullying victimization on suicidal thinking, suicide planning, and suicide attempts were mediated by violent behavior, substance abuse, and depression. Results also suggested reciprocal paths between substance abuse and violent behavior. There were statistically significant indirect paths from both traditional and cyberbullying victimization to suicide attempts without the involvement of depression, suicidal thinking, or suicide planning, findings suggesting a model for spontaneous, unplanned adolescent suicides. Results suggested that female adolescents who reported cyberbullying victimization also reported higher rates of depression and suicidal behaviors compared to their male counterparts, and that as adolescents got older, depression and substance abuse tended to increase, while violent behavior and suicidal thinking tended to decrease. The implications of these findings for social workers, school counselors, and others who work with adolescents are considered.     

Links between past abuse,suicide ideation,and sexual orientation among San Diego college students

The authors explored relationships among childhood abuse, suicidal ideation, and sexual orientation of 18- to 30-year-old students enrolled in 2 San Diego area colleges, using responses from anonymous questionnaires. Sixty percent of the 138 eligible respondents were women, and 22% were self-identified gay/bisexual individuals. Women were more likely than men to report at least 1 form of emotional abuse (odds ratio [OR] = 2.3; p =.02) and unwanted sexual touching (OR = 4.3; p = .0004). Lesbian/bisexual women were significantly more likely to report past suicidal ideation than were heterosexual women (OR = 3.7, p = .03). Gay/bisexual men were more likely to report unwanted sexual touching than were heterosexual men (OR = 5.1, p = .04), but the men did not report significantly higher rates of past suicide ideation or suicide attempts. Sexual orientation and a past history of child sexual, physical, and emotional abuse could be compounding risk factors for suicidal ideation among college students.     

Treatment For Suicidal Thoughts and Behavior: A Review of Family‐Based Interventions

The purpose of this article is to review the scientific evidence on the effects of family based interventions for suicidal ideation and behavior. We conducted an extensive search of electronic databases using a comprehensive search strategy. This search resulted in 16 studies that tested 13 interventions for treating suicidal ideation and behavior using family based interventions. Of the interventions identified, three yielded an overall improvement in suicidal ideation and behavior while an additional three interventions produced partial improvement in mental health symptoms. These studies targeted suicidal ideation and behavior in youth or adolescents while no studies examined family interventions for adults with suicidal ideation and behavior. The limitations of these studies and the need for additional research are examined.