Peer knowledge of and reactions to adolescent suicide

Questionnaire data were obtained from 120 high school students on their (1) knowledge of risk factors that identify potential suicidal behavior in peers, (2) attitudes toward peers who attempt or commit suicide, and (3) ability to respond appropriately to suicidal messages from peers. Overall, relatively few adolescents possessed accurate information, and many had misinformation concerning various warning signs. Furthermore, respondents expressed negative attitudes toward peers who attempt or commit suicide, and generally were unable to respond sensitively and appropriately to suicidal communications. These results have implications for suicide education programs for adolescents.This study was based on a Masters Thesis conducted by the first author under the direction of the latter two authors. Preliminary results of this investigation were presented at the Midwestern Psychological Association, Chicago, 1988.Received M.A. in clinical psychology from Loyola University. Current research interests include bulimia and alcoholism.Received Ph.D. in clinical psychology from Vanderbilt University. Primary research interests involve community psychology, prevention programs, and child psychology.Received Ph.D. from University of Chicago. Research interests include issues in adolescence and eating disorders.     

Antecedents of Suicide among Youth Aged 11–15: A Multistate Mixed Methods Analysis

Suicide is the second leading cause of death for youth aged 11 to 15, taking over 5,500 lives from 2003 to 2014. Suicide among this age group is linked to risk factors such as mental health problems, family history of suicidal behavior, biological factors, family problems, and peer victimization and bullying. However, few studies have examined the frequency with which such problems occur among youth suicide decedents or the context in which decedents experience these risk factors and the complex interplay of risk that results in a decedent’s decision to take his/her own life. Data from a random sample of 482 youth (ages 11–15) suicide cases captured in the National Violent Death Reporting System from 2003 to 2014 were analyzed. The sample had fewer girls than boys (31 vs. 69?%) and comprised primarily White youth (79?%), but also African Americans (13?%), Asians (4?%), and youth of other races (4?%). Narrative data from coroner/medical examiner and law enforcement investigative reports were coded and analyzed to identify common behavioral patterns that preceded suicide. Emergent themes were quantified and examined using content and constant comparative analysis. Themes regarding antecedents across multiple levels of the social ecology emerged. Relationship problems, particularly with parents, were the most common suicide antecedent. Also, a pattern demonstrating a consistent progression toward suicidal behavior emerged from the data. Narratives indicated that youth were commonly exposed to one or more problems, often resulting in feelings of loneliness and burdensomeness, which progressed toward thoughts and sometimes plans for or attempts at suicide. Continued exposure to negative experiences and thoughts/plans about suicide, and/or self-injurious acts resulted in an acquired capacity to self-harm, eventually leading to suicide. These findings provide support for theories of suicidal behavior and highlight the importance of multi-level, comprehensive interventions that address individual cognitions and build social connectedness and support, as well as prevention strategies that increase awareness of the warning signs and symptoms of suicide, particularly among family members of at-risk youth.     

Restrictive Emotionality,Depressive Symptoms,and Suicidal Thoughts and Behaviors Among High School Students

Depression and suicidal thoughts and behaviors are prevalent among youth today. The current study sought to further our understanding of the correlates of depression and suicidality by assessing the relationship between restrictive emotionality (difficulty understanding and expressing emotions) and depressive symptoms and suicidal ideation and attempts among adolescents. A large group of high school students (n = 2189, 58.3% male; 13–18 years of age) completed a self-report survey as part of a 2-stage suicide screening project. Logistic regression analyses were used to assess the association between restrictive emotionality and depressive symptoms, suicidal ideation, and suicide attempts. Those reporting high restrictive emotionality were 11 times more likely to have elevated depressive symptom scores, 3 times more likely to report serious suicidal ideation (after controlling for depressive symptoms), and more than twice as likely to report a suicide attempt (after controlling for depressive symptoms) than those reporting low restrictive emotionality. Restrictive emotionality partially mediated the relationship between depressive symptoms and suicidal ideation and behavior. The pattern of association between restrictive emotionality and the outcome variables was similar for boys and girls. Restrictive emotionality is highly associated with elevated depressive symptoms and suicidal thoughts and behaviors among high school students, and may be a useful specific target in prevention and treatment efforts.     

Associations Between Suicidal High School Students’ Help-Seeking and Their Attitudes and Perceptions of Social Environment

Suicide is a leading cause of death among adolescents, many of whom fail to disclose suicide concerns to adults who might help. This study examined patterns and predictors of help-seeking behavior among adolescents who seriously considered suicide in the past year. 2,737 students (50.9?% female, 46.9?% male; racial distribution 79.5?% Caucasian, 11.9?% Hispanic/Latino, and 3.6?% Black/African-American) from 12 high schools in rural/underserviced communities were surveyed to assess serious suicide ideation (SI) in the past year, disclosure of SI to adults and peers, attempts to get help, attitudes about help-seeking, perceptions of school engagement, and coping support. Help-seeking was defined as both disclosing SI to an adult and perceiving oneself as seeking help. The relationship between adolescents' help-seeking disclosure and (1) help-seeking attitudes and (2) perceptions of social resources was examined among suicidal help-seeking youth, suicidal non-help-seeking youth, and non-suicidal youth. Of the 381 (14?%) students reporting SI, only 23?% told an adult, 29?% sought adult help, and 15?% did both. Suicidal help-seekers were similar to non-suicidal peers on all measures of help-seeking attitudes and social environment perceptions. Positive attitudes about help-seeking from adults at school, perceptions that adults would respond to suicide concerns, willingness to overcome peer secrecy requests, and greater coping support and engagement with the school were associated with students' increased disclosure of SI and help-seeking. This study supports prevention strategies that change student norms, attitudes and social environments to promote help-seeking among adolescents with SI. Promising intervention targets include increasing students' perceptions of the availability and capability of adults to help them, and strengthening students' understanding of how existing resources can help them cope.     

Suicidal Behavior Among Homeless and Runaway Adolescents

The present study considered risk factors associated with suicidal ideation and the likelihood of a suicide attempt in a sample of 297 homeless and runaway youth from four Midwestern states. It was hypothesized that sociodemographic characteristics, family factors, suicide exposure, street factors, externalizing behavior, and internalizing behavior would be related to suicidal ideation and to the likelihood of a suicide attempt. It was also hypothesized that suicidal ideation would mediate the relationship between the other predictor variables and the likelihood of a suicide attempt. Over half the sample (53.9%) endorsed some level of suicidal ideation, and over one quarter (26.3%) attempted suicide in the year prior to the interview. Univariate and multivariate results indicated that sexual abuse by a family member, knowing a friend who attempted suicide, drug abuse, and internalization were highly related to suicidal ideation. In the absence of suicidal ideation, sexual abuse, sexual victimization while on their own, and internalization were highly related to the likelihood of a suicide attempt. Finally, the hypothesized mediating effect was found for both sexual abuse and internalization.     

Psychosocial Factors Contributing to Adolescent Suicidal Ideation

This study aimed to investigate the family, school, peer and psychological factors that contribute to adolescent suicidal ideation. The participants were 1,358 (680 boys and 678 girls) Hong Kong Chinese adolescents who were divided into younger (12.3 years, n=694) and older (15.4 years, n=664) age groups. By using structural equation modeling, the results showed that family cohesion and sense of school belonging were the core predictors of self-esteem and depression, and that depression was a strong mediator of suicidal ideation. In the prediction of suicidal ideation, peer support was significant among girls and younger adolescents only, whereas peer conflict was significant among older adolescents only. Family conflict, teacher support and academic pressure did not show any significant contribution in the prediction. The implications for future research and positive youth development programs are discussed. Rachel C. F. Sun (BSocSc, PhD) is a Postdoctoral Fellow at the Department of Social Work, the Chinese University of Hong Kong. She is also the Project Administrator of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes), which is an indigenous and large−scaled positive youth development programme in Hong Kong Chinese cultural context. She received her Bachelor Degree in Social Sciences, with Psychology Major, at the University of Hong Kong. She also received her PhD at the Faculty of Education, the University of Hong Kong in 2005. Her PhD research, which titled “Developing and evaluating a model of suicidal ideation for Hong Kong Chinese adolescents” aimed to develop a model that delineated the simultaneous relationship of family, school, peers, self-esteem and depression to adolescent suicidal ideation, and to explore the support mechanisms of the family, school and peers for maintaining adolescent psychological health. Her research interests comprise adolescent psychological health, positive youth development and school guidance. Eadaoin K. P. Hui is an Associate Professor at the Faculty of Education, the University of Hong Kong. Her research interests encompass student guidance and counseling and personal-social education.     

Rural adolescents' perceived personal risks for suicide

Rural adolescents' suicidal cognitions were assessed while conducting a larger project on risk perception. This allowed for a more indirect (less reactive) method of assessment than is typical in related research. High school students (n=455) rated on a 7-point scale their personal risks for 24 lethal events, including suicide. Over half the adolescents (56%) reported some risk for suicide, of which 12% reported that their subjective risk was quite likely. The rates are consistent with prevalence rates for suicidal ideations obtained from studies using more direct methods of assessment. Public high school students were significantly more likely to report serious suicide risks than parochial high school students. This finding is discussed in the context of Durkheim's proposition that religions deter self destructive impulses.Received Ph.D. from Southern Illinois University at Carbondale. Research interest: adolescents' perceptions of risks.Received Ph.D. from the University of Missouri. Research interests: in the areas of identity, self, and personality.     

Adolescent Emotional Distress: The Role of Family Obligations and School Connectedness

The current study draws upon ecodevelopmental theory to identify protective and risk factors that may influence emotional distress during adolescence. Hierarchical regression analyses were used to examine the relationship among family obligations, school connectedness and emotional distress of 4,198 (51% female) middle and high school students who were primarily (59%) European American. The overall model explained 21.1% of the variance in student emotional distress. A significant interaction effect was found indicating that school connectedness moderated the relationship between family obligations and emotional distress. Specifically, for students with low to moderate levels of family obligations, a stronger sense of school connectedness was associated with lower emotional distress. The buffering effect of school connectedness was weakened as the level of family obligations increased and completely disappeared for students who experienced high levels of family obligations. The creation of a program that takes a holistic approach, in order to curtail the levels of highly emotionally distressed adolescents, must continue to address the ever changing demands that adolescents encounter and prepare youth to deal with functioning within multiple contexts and do so while maintaining emotional well-being.     

Emotion Regulation Difficulties, Youth–Adult Relationships, and Suicide Attempts Among High School Students in Underserved Communities

To develop and refine interventions to prevent youth suicide, knowledge is needed about specific processes that reduce risk at a population level. Using a cross-sectional design, the present study tested hypotheses regarding associations between self-reported suicide attempts, emotion regulation difficulties, and positive youth–adult relationships among 7,978 high-school students (48.6 % male, 49.9 % female) in 30 high schools from predominantly rural, low-income communities. 683 students (8.6 %) reported a past-year suicide attempt. Emotion regulation difficulties and a lack of trusted adults at home and school were associated with increased risk for making a past-year suicide attempt, above and beyond the effects of depressive symptoms and demographic factors. The association between emotion regulation difficulties and suicide attempts was modestly lower among students who perceived themselves as having higher levels of trusted adults in the family, consistent with a protective effect. Having a trusted adult in the community (outside of school and family) was associated with fewer suicide attempts in models that controlled only for demographic covariates, but not when taking symptoms of depression into account. These findings point to adolescent emotion regulation and relationships with trusted adults as complementary targets for suicide prevention that merit further intervention studies. Reaching these targets in a broad population of adolescents will require new delivery systems and “option rich” (OR) intervention designs.     

One-Year Follow-Up of Suicidal Adolescents: Parental History of Mental Health Problems and Time to Post-Hospitalization Attempt

This longitudinal study of recently hospitalized suicidal youth examined parental mental health history in addition to several indices of adolescent functioning as risk factors for time-to-suicide attempt over a 1-year period. Participants were 352 adolescents (253 girls, 99 boys; ages 13–17 years) who participated in self-report and interview assessments within 1 week of hospitalization and 6 weeks, 3, 6, and 12 months post-hospitalization. Multivariable proportional hazards regression modeled time-to-suicide attempt. Results indicate that adolescents were almost twice as likely to make a suicide attempt if they had at least one biological parent with mental health problems. Risk was also increased for adolescents with baseline histories of multiple previous suicide attempts, more severe suicidal ideation and more severe functional impairment. Findings suggest the need to consider the family system when intervening with suicidal youth.     

The Moderating Effects of Parenting Styles on African-American and Caucasian Children’s Suicidal Behaviors

Given that parenting practices have been linked to suicidal behavior in adolescence, examining the moderating effect of parenting styles on suicidal behavior early in development could offer potential insight into possible buffers as well as directions for suicide prevention and intervention later in adolescence. Hence, the moderating effects of parenting styles, including authoritarian, permissive, and features of authoritative parenting, on depressed and aggressive children’s suicidal behavior, including ideation and attempts, were evaluated with young children (N = 172; 72% male, 28% female) ranging from 6 to 12 years of age. African American (69%) and Caucasian (31%) children admitted for acute psychiatric inpatient care completed standardized measures of suicidal behavior, depressive symptoms, and proactive and reaction aggression. Their parents also completed standardized measures of parental distress and parenting style. Hierarchical regression analyses revealed that, while statistically controlling for age and gender, children who endorsed more depressive symptoms or reactive aggression reported more current and past suicidal behavior than children who endorsed fewer depressive or aggressive symptoms. The significant positive relationship observed between depressive symptoms and childhood suicidal behavior, however, was attenuated by parental use of authoritarian parenting practices for African-American and older children but not for younger and Caucasian children. The ethnic/racial difference observed for the buffering effect of authoritarian parenting practices offers potential theoretical and clinical implications for conceptualizing the moderating effects of parenting styles on African-American and Caucasian children’s suicidal behavior.     

Differences in Non-Suicidal Self-Injury and Suicide Attempts in Adolescents

As suicide attempts and self-injury remain predominant health risks among adolescents, it is increasingly important to be able to distinguish features of self-harming adolescents from those who are at risk for suicidal behaviors. The current study examined differences between groups of adolescents with varying levels of self-harmful behavior in a sample of 373 high school students with a mean age of 15.04 (SD = 1.05). The sample was 48% female and the distribution of ethnicity was as follows: 35% Caucasian, 37.2% African-American, 16% Multi-ethnic, 9.2% Hispanic, and 2.3% Asian. The sample was divided into three groups: no history of self-harm, non-suicidal self-injury (NSSI) only, and NSSI in addition to a suicide attempt. Differences in depressive symptoms, suicidal ideation, social support, self-esteem, body satisfaction, and disordered eating were explored. Results indicated significant differences between the three groups on all variables, with the no self-harm group reporting the lowest levels of risk factors and highest levels of protective factors. Further analyses were conducted to examine specific differences between the two self-harm groups. Adolescents in the NSSI group were found to have fewer depressive symptoms, lower suicidal ideation, and greater self-esteem and parental support than the group that also had attempted suicide. The clinical implications of assessing these specific psychosocial correlates for at-risk adolescents are discussed.     

Epidemiology of Suicide Attempts among Youth Transitioning to Adulthood

Suicide is the second leading cause of death for older adolescents and young adults. Although empirical literature has identified important risk factors of suicidal behavior, it is less understood if changes in risk factors correspond with changes in suicide risk. To address this knowledge gap, we assessed if there were different trajectories of suicidal behavior as youth transition into young adulthood and determined what time-varying risk factors predicted these trajectories. This study used four waves of data spanning approximately 13 years from the National Longitudinal Study of Adolescent Health. The sample included 9027 respondents who were 12–18 years old (M?=?15.26; SD?=?1.76) at Wave 1, 50% male, 17% Hispanic, and 58% White. The results indicated that 93.6% of the sample had a low likelihood for suicide attempts across time, 5.1% had an elevated likelihood of attempting suicide in adolescence but not young adulthood, and 1.3% had an elevated likelihood of attempting suicide during adolescence and adulthood. The likelihood of a suicide attempt corresponded with changes on depression, impulsivity, delinquency, alcohol problems, family and friend suicide history, and experience with partner violence. Determining how suicide risk changes as youth transition into young adulthood and what factors predict these changes can help prevent suicide. Interventions targeting these risk factors could lead to reductions in suicide attempts.     

Relationships Between Level and Change in Family,School, and Peer Factors During Two Periods of Adolescence and Problem Behavior at Age 19

While prior research has examined family, school, and peer factors as potential predictors of problem behavior, less attention has been given to studying when these factors are most predictive of problems and if and when changes in these factors signal risk. Using annual data on a community sample of 1,040 individuals (47% female; 81% White), this study models growth in risk and protective factors during two developmental periods (Grades 5–8 and Grades 9–12) in order to predict substance misuse and crime at age 19. For protective factors of positive relationships with family and positive bonds to school, both the levels of these factors at Grade 5 and change between Grade 5 and Grade 8 predicted substance misuse and crime in early adulthood. Higher likelihoods of both forms of problem behavior also were predicted by increases in the risk factor of exposure to negative peers between 5th and 8th grade. In the late adolescent period, levels at 9th grade of all risk and protective factors examined predicted both substance misuse and crime. Also, increases in exposure to negative peers in late adolescence predicted greater likelihoods of both forms of problem behavior, while greater risk of substance misuse was predicted by decreases in school bonding and academic achievement, and greater risk of crime was predicted by worsening relationships with family. The results add to prior research by indicating that in addition to the level, change in risk and protective factors during these two stages of development can be signals of risk and are promising targets for intervention.     

Unique and Interactive Effects of Empathy,Family, and School Factors on Early Adolescents’ Aggression

Although research indicates that empathy inhibits youth aggression, little is known about the prospective associations between different components of empathy and aggression, as well as whether family and school factors moderate the aforementioned associations in early adolescents. Based on prior research, the current study examined whether empathic concern and perspective taking would contribute to subsequent overt and relational aggression over a 1-year period in middle school. Guided by the social development model, we also examined if positive family relations and school connectedness would differentially moderate the associations between both components of empathy and aggression. Participants were 481 10- to 14-year old students (54 % female; 78 % European American) who completed the first wave of a survey in 6th and 7th grades. Hierarchical regression analyses indicated that only for girls did lower levels of empathic concern, not perspective taking, contribute to increases in subsequent overt, not relational, aggression. Although neither positive family relations nor school connectedness played protective roles for girls, results indicated that boys’ reports of positive family relations buffered the negative impact of low empathic concern on both forms of aggression 1 year later. Over and above the two components of empathy, school connectedness also contributed to a decline in boys’ subsequent overt aggression. Recommendations are made to foster family and school relationships among boys, as well as to more heavily consider the role of emotion processes in the study and prevention of early adolescents’ aggression.     

The role of the high school professional in identifying and managing adolescent suicidal behavior

The ongoing contact of adolescents with high school staff may provide an opportunity for the early identification and effective management of suicidal behavior. In this study, the knowledge, attitude, and experience of 80 high school professionals regarding adolescent suicide were assessed through semistructured personal interviews. Respondents identified more than 30 signs of potential vulnerability — manifestations of depression, verbal and written cues, isolation, and self-destructive behaviors. Among predisposing factors, those related to alienation within the family were most prominent. Other important risk factors were low self-esteem, difficulty in peer relationships, and economic or ethnic differences from other students. When suicidal behaviors occurred, respondents saw students and staff as attempting to be helpful; families were more often viewed as defensive.     

Suicidal Ideation and Distress Among Immigrant Adolescents: The Role of Acculturation, Life Stress, and Social Support

Acculturative stress and social support play important roles in suicide-related phenomena among adolescent immigrants. To examine their contributions, measures of acculturative and general life stress and a measure of multiple sources of social support were used to predict psychological distress and suicidal ideation among Korean-born high school students residing in the US. Korean students who were sojourning without both parents were compared to Korean students who immigrated with both parents, Korean students who remained in Korea, and American high school students in the US (total N = 227; 56.8% female). The sojourning group reported higher levels of life stress, distress, psychological symptoms, and suicidal ideation than the other groups. Within the two acculturating groups, levels of distress, symptoms, and suicidal ideation were associated with life stress, lack of parental support, and not living with both parents. The findings have important implications for suicide prevention among immigrant adolescents, and imply that parental support is particularly protective.     

Risk factors related to suicidal behavior among male and female adolescents

This study examined gender differences in self-reported suicidal behavior in relation to the risk factors of tobacco use, alcohol use, drug use, school misconduct, academic difficulties, home environment, sexual activity, and violence among seventh-through twelfth grade students (N=3461)in a northern Midwest school district. Data were gathered from the Survey Instrument of Attitude/Behavior administered in the school district during the spring of 1993. The dependent variables were suicidal activity and suicidal tendency. Stepwise forward regression ordered the independent factors in predicting suicidal activity and suicidal tendency for the male and female samples. The comparison of regression results revealed the following: (1) the independent factors accounted for more variance in male suicidal activity and tendency than in female suicidal activity and tendency; (2) as the level of suicidality increased, so did the frequency of violent behaviors among both genders; (3) leading predictors for suicidal activity were similar between gender; and (4) gender differences were displayed in predictors of suicidal tendency.Major interests include risk taking behaviors, youth suicide, and educator use of research.     

The Potential Role of Meaning in Life in the Relationship Between Bullying Victimization and Suicidal Ideation

Adolescent bullying is a common problem in schools across America. The consequences of bullying are significant, and can include severe psychological trauma and suicide. A better understanding of the mechanisms that link bullying and suicidal ideation is needed in order to develop effective prevention and intervention initiatives. Meaning in life is a potential mechanism that has not been studied in this context. It was hypothesized that meaning in life could serve as both a mediator and a moderator of the relationship between bullying victimization and suicidal ideation. As a mediator, meaning in life is considered to explain why bullying victimization leads to suicidal ideation. As a moderator, meaning in life is considered to buffer the ill effect of bullying victimization on suicidal ideation. Data collected from an ethnically diverse sample of 2,936 (50 % female), 6th–12th grade students from one urban school district in the Northeastern US were used to examine the hypotheses. The model for girls was consistent with mediation (i.e., meaning in life may explain how victimization leads to suicidal ideation). The model for boys was consistent with moderation (i.e., the ill effect of victimization on suicidal ideation was attenuated as meaning in life increased). Implications for prevention are discussed.     

Adolescents’ Suicidal Thinking and Reluctance to Consult General Medical Practitioners

Appropriate help-seeking is widely recognized as a protective factor, and vital for early treatment and prevention of mental health problems during adolescence. General medical practitioners (GPs), that is, family doctors, provide a vital role in the identification of adolescents with mental health problems and the provision of treatment as well as access to other specialists in mental health care services. The current study examined the association between suicidal ideation and intentions to seek help from a GP for suicidal thoughts, emotional problems and physical health problems, using a sample of 590 Australian high school students that was 56.7% female and aged 13–18 years (M = 15.56 years, SD = .66 years). Higher levels of suicidal ideation and general psychological distress were related to lower intentions to seek help from a GP for suicidal and physical problems. The results suggest that even at subclinical levels, increases in suicidal ideation or psychological distress may lead to help avoidance. School personnel and other gatekeepers need to be aware of this trend in order to be more assertive in encouraging and supporting appropriate help-seeking for mental health problems. School health promotion programs should consider including information to explicitly address the help-negation process.