Suicidal behavior in patients with adjustment disorders

This retrospective study characterizes the suicidal behavior in 119 patients with Axis I adjustment disorders as assessed by psychiatrists at the University of Virginia Hospital. Results indicated that 72 patients (60.5%) had documented suicide attempts in the past, 96% had been suicidal during their admission to the hospital, and 50% had attempted suicide before their hospitalization. The most commonly used method of suicide attempts was overdosing. Of the sample group with suicide attempts in the past, 67% had Axis II diagnoses of borderline personality disorder and antisocial personality disorder. Adjustment disorder diagnosis in patients with the suicide attempts was associated with a high level of suicidality at admission, involuntary hospitalization and substance-abuse disorders. Axis II diagnoses in patients with adjustment disorders constituted risk factors for further suicidal behavior. Additional future prospective studies with reliability checks on diagnosis of adjustment disorders and suicidal behavior are needed.     

Self-disclosure, depression, anxiety, and suicidal behavior in adolescent psychiatric inpatients

The objectives of this paper were to examine the personality variable of self-disclosure, or the tendency to share feelings with others, and its relationship to depression, anxiety, and suicidal behavior in adolescent psychiatric inpatients. Of the 87 adolescents who were assessed, 53 had made a suicide attempt and 34 had never shown any suicidal behavior during their lifetime. There was a significant relationship between suicidality and low levels of self-disclosure, which appears to be mediated by anxiety and depression. This sharing difficulty was most significantly marked between the adolescent and his/her family and seemed to be mediated by feelings of depression and anxiety.     

Outcome of suicidal ideation and behavior in a young, help-seeking population over a 2-year period

Suicidal behavior is associated with negative outcomes, including completed suicide. This study examined the prevalence of suicidal behavior in a sample of referrals to a youth psychiatric service and investigated the stability of suicidality over 2 years. Of the 140 people (mean age 17.8) who were referred to a youth psychiatric service, 82 who were accepted for treatment (RA group) and 58 who were not accepted (RNA group) were assessed; 57% reported considering suicide and 39% reported attempting suicide in the 12 months prior to referral. Participants who reported suicidal ideation were significantly more likely than nonsuicidal participants to have multiple Axis I diagnoses and lower levels of functioning. At the 2-year follow-up there was a significant reduction in suicidality in the RA group, but not in the RNA group. In conclusion, suicidality is prevalent among young people referred to psychiatric services. Even brief contact with services results in a reduction in suicidality over 2 years.     

The Link Between Child Abuse and Neglect and Delinquency: Examining the Mediating Role of Social Bonds

This article draws on previous research and social bonding theory to examine the child maltreatment–delinquency relationship. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), results show that child physical and sexual abuse and neglect are predictors of weakened social bonds and increased delinquency during later adolescence. For both females and males, strong social bonds significantly decrease delinquency. Among females, social bonds, especially the maternal bond and school attachment, mediate the effects of child sexual abuse and neglect on delinquency. The effects of abuse and neglect on delinquency among males remain robust and significant even when controlling for social bonds. Implications of the findings for theory and policy are discussed.     

Gender and cultural patterns of suicidal behavior: young Hindustani immigrant women in the Netherlands

Patterns of suicidal behavior vary among cultures and along gender. Young Hindustani immigrant women attempt suicide four times more often than young Dutch women. This article explores multi-disciplinary explanations for suicidal behavior in this group. The interconnection of Durkheimian concepts of social integration and regulation with ecological insights into family relations and psychological and psychiatric theories on individual distress are relevant. It is suggested that young Hindustani women who display suicidal behavior possess certain personality and cognitive constellations that are interlocked with specific parenting styles in stressful family environments. These families are embedded in a context of moral transformations resulting from migration to a Western culture and may be facing difficulties accompanying the transitional processes encountered in the West, particularly those regarding gender roles. Durkheimian fatalistic and anomic suicides elucidate this. The Hindustani women who appear most at risk are those facing contradictory norms and overregulation, which prevent them from developing autonomy.     

Familial study of suicidal behavior among adolescents in Slovenia

The number of adolescents who attempt or complete suicide is increasing. Risk factors range from mental disorders, to problems at school, family problems, or difficulties in establishing relationships. A further important, and too often underestimated, risk factor for adolescent suicide is the presence of suicidal behavior in the adolescent's family. We investigated 184 high school adolescents in a region in Slovenia with a high suicide rate (30/100,000/year). They were questioned by means of an anonymous questionnaire about the presence of suicidal behavior in their relatives and about the presence of suicidal thoughts, plans, and acts in themselves. The results revealed that 13% of the adolescents studied had a relative who had attempted suicide and a further 9% of the adolescents had lost a relative due to suicide. About half of all females and almost a third of males had had suicidal thoughts (differences between sexes were statistically significant: chi2 = 6.13; p < .01). Attempted suicide among relatives was positively correlated with the presence of suicidal plans among adolescents (phi = 0.15; p < .05). This correlation proved to be even stronger and statistically more significant in men when we split the sample by gender. All variables (suicidal thoughts, suicidal plans, and suicide attempts) in the adolescent males positively correlated with attempted suicide among their relatives ((phi = 0.28, p < .01; phi) = 0.26, p < .05; phi = 0.34, p < .01; respectively). Our results speak in favor of a higher risk of suicidal behavior among adolescents with suicidal behavior in their families.     

Suicidal intent in single-car accident drivers: Review and new preliminary findings

This study addressed the issue of a possible link between single-car accident drivers and suicidal intent. In the international literature this topic has generated both positive and negative results. Some authors have stressed unconscious suicidal motivations in various single accidents. Nevertheless, refutation of such theory was demonstrated through experimental studies. We selected 30 single-car accident drivers who had been admitted to emergency departments and then hospitalized for an average period of 10 days. We administered the Reason for Living Inventory (RFL) and investigated their attitudes toward suicide. We also matched these patients with a control group of drivers who had never had a car accident. Results showed that single-car accident drivers were not exposed to a higher overall suicidal risk, though they reported a higher risk on the RFL Survival and Coping Beliefs subscale and often expressed tiredness of being alive. These patients had experienced more life events than controls. We conclude that, although suicide risk was low in our patients, they were engaged in looking for a solution to their problems in which the accident played a role in such a process. This behavior has some characteristics of the logic of suicidal individuals.     

Descriptive Study of Precursors to Sex Offending among 813 Boys and Girls: Antecedent Life Experiences

In order to understand the precursors to sexual offending among youth and the associated gender differences, the records of 813 sexually abusive children (659 boys and 154 girls) referred for an evaluation of their sexually inappropriate and coercive behavior were reviewed and coded. These children ranged in age from 3 to 18 when they committed their first hands-on offenses. All were under the care of the Massachusetts Department of Social Services either prior to or as a result of their behavior. Principle findings included: (1) a high proportion of girls (19 percent) in a sample of children flagged as sexually abusive to other children, (2) an exceptionally high base rate of severe maltreatment and associated clinical and psychiatric sequelae, and (3) girls were significantly more likely to be sexually abused, and when sexually abused the abuse lasted longer, was more severe, and involved more perpetrators. In addition, the girls were significantly more likely to witness domestic violence and to witness sexual deviance within the home. For all other types of abuse, there were no group differences, and (4) all of the children were subjected to a very high level of caregiver instability.     

Incarcerated adolescents' distress and suicidality in relation to parental bonding styles

This study examines the relationships between the bonding style of an incarcerated adolescent with parents and his/her current feelings of self-esteem, hopelessness, and suicidal thoughts and attempts. It also investigates differences between bonding to mother and bonding to father. Some 296 incarcerated adolescents were interviewed using the Parental Bonding Instrument. Significant relationships were found between youths' self-esteem, hoplessness, and suicidal behavior and their bonding style. Youths whose parent(s) had a parental bonding style of affectionless control reported the greatest distress, and youths whose parent(s) had an optimal bonding style reported the least distress. Differences were found between bonding styles with the mother and with the father. Attachment theory may be useful in targeting incarcerated youths who have affectionless control bonding with parent(s) for special interventions since these youths are most at risk for psychosocial problems.     

Child and adolescent survivors of suicide

Suicide in a family is distressing for each and every member. Children and adolescents bereaved by suicide are known to be more at risk of suffering from a variety of psychiatric problems, especially affective disorders. A group of children and adolescents who experienced a suicidal death in the family were assessed for psychiatric problems as well as for social adjustment. The findings suggest that the bereaved children and adolescents are at elevated risk for major depressive disorder, posttraumatic stress disorder, and impaired social adjustment.     

Risk of suicide ideation associated with problem-solving ability and attitudes toward suicidal behavior in university students

The present paper investigates the risk of lifetime suicide ideation associated with problem-solving ability and attitudes toward suicidal behavior in a sample of 328 university students (41% male, 59% female). The response rate was 77% based on the total number of students registered for the relevant courses. A series of questions assessed lifetime suicide ideation, while problem solving and attitudes toward suicide were measured using the Self-Rating Problem Solving scale and four subscales of the Suicide Opinion Questionnaire, respectively (McLeavey, 1986; Domino et al., 1989). Almost one-third of the students surveyed had lifetime suicide ideation. Both genders were similar in terms of their suicide ideation history, problem solving, and attitudes toward suicidal behavior with the exception that male students were more in agreement with the attitude that suicidal behavior lacks real intent. Compared with 2% of nonideators and ideators, one in four planners reported that they would more than likely attempt suicide at some point in their life. Greater agreement with the attitude that suicidal behavior is normal was associated with significantly increased risk of being an ideator, as was poor problem solving and less agreement with the attitude that suicidal behavior is associated with mental illness.     

Adverse Childhood Experiences and Subsequent Substance Abuse in a Sample of Sexual Offenders: Implications for Treatment and Prevention

The purpose of this study was to explore the prevalence of substance abuse indicators in a sample of male sexual offenders (N = 679) and to examine the influence of adverse childhood experiences (ACE) on the likelihood of substance abuse outcomes. Half of these sex offenders reported a history of drug or alcohol abuse, and nearly one in five reported a substance-related arrest. Higher ACE scores were associated with endorsement of a greater number of substance-abuse-related problems, suggesting that accumulation of early trauma may increase the likelihood for substance misuse. By enhancing our understanding of the frequency and antecedents of dynamic risk factors such as substance abuse, we can better devise clinical interventions that respond to the comprehensive needs of sexually abusive individuals and reduce risk for sexual reoffense. As well, early interventions for at-risk families and maltreated youth may interrupt their trajectory toward adulthood substance abuse and criminal behavior, including sex offending.     

Body mass and suicide risk

Body mass has been neglected as a possible predictor of suicidal behavior. The present investigation explores the association between body mass index and completed suicide. Data are from the National Mortality Followback Survey and refer to 373 suicides, and 518 deaths from motor vehicle accidents as controls. The results of a logistic regression analysis indicated that, for females, the greater the BMI the greater the suicide risk. However, this relationship did not hold up under controls for race and other covariates of BMI. For males, the BMI was not significantly related to suicide risk either at the bivariate or multivariate levels of analysis. The best predictors of suicide were living alone for females, and alcohol abuse for males.     

Suicidal ideation and suicide attempts among Australian adults

Too little is known about suicidal thoughts and behaviors at a population level to recommend appropriate preventive strategies. Using data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), this study examined rates of, and risk factors for, suicidal ideation and suicide attempts. For 10,641 respondents, the 12-month and lifetime cumulative incidence rates of suicidal ideation were 3.4% and 16.0%, respectively; the 12-month and lifetime cumulative incidence rates of suicide attempts were 0.4% and 3.6%, respectively. 12-month ideation was associated with anxiety disorders (relative risk ratio [RRR] = 3.51; population attributable risk percent [PAR%] = 19.6%), affective disorders (RRR = 11.94; PAR% = 38.8%) and substance abuse disorders (RRR = 1.85; PAR% = 6.1%). Attempts in the past 12 months were also associated with anxiety disorders (RRR = 7.06; PAR% = 37.0%), affective disorders (RRR = 12.24; PAR% = 39.5%), and substance abuse disorders (RRR = 2.09; PAR% = 7.7%). Age, marital status, and disability were associated with ideation; marital status and employment status with attempts. Approximately 12% of ideators in the sample progressed to making an attempt; employment status was the only significant predictor. Reducing suicidal ideation and attempts requires a multi-faceted approach that targets those with mental illness but also adopts population-based strategies that address other factors, such as unemployment.     

Suicidal behavior by burns among adolescents in Kurdistan, Iran: a social tragedy

The aim of this study was to identify the epidemiologic features and current etiological factors of suicidal behavior by burns among adolescents in Kurdistan, Iran. A prospective population-based study was carried out on patients with suicidal behaviors by burns requiring hospitalization among adolescents during 2000-2001 in Kurdistan, Iran. Sociodemographic and etiological factors were obtained through interviews with each patient or with family, relatives, or friends of the patient. Of 54 hospitalized burn patients aged 13-19 years, 40 (74.1%) patients were hospitalized because of suicidal behaviors by burns (6 males and 34 females). The incidence rate of these behaviors was 18.1 per 100,000 person-years (P-Y) and varied by gender (the incidence rates for females and males were 31.6 and 5.3 per 100,000 P-Y, respectively, p(2) = .000004). Most of the patients (60%) were single, 70% were homemakers, and 60% were either illiterate or had a low level of education. The most common precipitating factors for suicidal behaviors by burns were a quarrel with a family member or relative (47.5%) and marital conflict (17.5%). Most of the patients who were able to communicate regretted their suicidal behaviors (85.7%). Adolescents in Kurdistan are at higher risk of suicidal behaviors by burns compared to adolescents in other areas of Iran. Factors likely to be associated with suicidal behaviors by burns include lower socioeconomic status and family problems. These factors should be investigated further to better elucidate the etiology of these events. It also is necessary to implement prevention programs and strategies known to be effective to reduce the incidence of suicide in this region.     

Dimensions of Child Abuse and Neglect Among Native and Immigrant Caribbean Families

Abstract

This study attempted to replicate a study that examined severity of physical child abuse among Barbados families with a sample of Caribbean families known to the New York City public child welfare agency. Study findings did not support the hypothesis that child abuse in the Caribbean community is linked to cultural child-rearing norms sanctioning the use of physical punishment of children, but were consistent with the largest body of research indicating that child abuse and neglect are driven by the complex interaction of interpersonal, economic, social and environmental factors.     

Suicidal behavior in patients diagnosed with cancer of the cervix

There is a paucity of literature on suicide and cancer, especially cancer of the cervix. This study reports on suicidal behavior in these patients. The sample consisted of adult, black, Zulu-speaking women from palliative and radical oncology treatment groups who volunteered for the study. There were more patients in the palliative group who were younger, and had a more significant delay between cancer symptom presentation and seeking oncology treatment. Patients experienced: significant depression, anxiety, stress, hopelessness/helplessness, anxious preoccupation about their disease, poor current or delayed social support, feelings of being a burden to their significant others, beliefs that they would be better off dead, perceptions that they were stigmatized by society or that their communities suspected them of being HIV-AIDS positive, and suppressed anger. More patients in the palliative, compared to the radical treatment, group were inclined toward suicidal ideation with serious intent. Overall, most patients coped inadequately with their disease and its management. These patients are a high risk group for suicidal behavior and should be identified in time for appropriate psychological intervention.     

The role of perfectionism and autobiographical memory in a sample of parasuicide patients: an exploratory study

The main objective of this study was to investigate the relationship between social perfectionism, overgeneral autobiographical memory recall, and psychological distress (hopelessness, depression/anxiety, and suicidal ideation) in a sample of parasuicide patients. Forty patients who had been admitted to a Scottish hospital following an episode of deliberate self-harm participated in the study. The participants completed the autobiographical memory task and a battery of self-report measures (multidimensional perfectionism, hopelessness, depression/anxiety, and suicidal ideation). The results showed that repetitive self-harmers were more overgeneral in their recall of positive autobiographical memories than were first-time self-harmers. Hierarchical regression analyses showed that socially prescribed perfectionism interacted with overgeneral recall of both positive and negative memories to predict suicidal ideation/depression. The findings are discussed in relation to previous research.     

Risk factors for and protective factors against adolescent suicidal behavior in Turkey

This study investigated the possible role of depression, self-esteem, problem solving, assertiveness, social support, and some socioeconomic factors on adolescent suicidal behavior in youth in a small city located in the southwestern part of Turkey. Participants in the study were 805 (367 girls) first-year high school students between the ages of 13-18 years. Some 23% of participants reported having thought of killing themselves during the past 12 months or their lifetime. The percentage of students who said that they had attempted to kill themselves was 2.5. Suicidal ideation during one's lifetime or during the past 12 months was more frequent among girls than among boys but suicidal attempts were equally common in girls and boys. Girls scored significantly higher on depression and the Suicide Probability Scale (SPS) but also on assertiveness and perceived social support from friends than boys. Boys tended to score higher on self-esteem than girls. Depression and low self-esteem were the most consistent and independent predictors of suicidal thoughts, attempts, and SPS scores in both girls and boys. The results are discussed in terms of relevant literature with special reference to developmental and sociocultural issues. The implications of findings for the assessment and treatment of suicidal youths are highlighted.     

Self-reported suicidal behavior in juvenile offenders in custody: prevalence and associated factors

Suicide rates in prisons in England and Wales are high, including those in juvenile detention centers. Previous deliberate self-harm (DSH) is the strongest predictor of suicide in the general population. There is limited information on how many juvenile offenders (15 to 18 year-olds) have a history of DSH at the time of entering custody, or on factors associated with previous DSH. We aimed to determine the prevalence of previous DSH and suicidal ideation in a population of juvenile offenders in custody and to identify factors associated with DSH and suicidal ideation. Seven out of 45 subjects (15.6%) reported an act of DSH in the past. Twelve (26.6%) reported past suicidal ideation. Peer relationship difficulties and sexual abuse were significantly associated with DSH (p < 0.05). Other factors showed a trend toward being more common among those with DSH, but the premature ending of the project by the juvenile detention center prevented full investigation of the extent of DSH and associated factors. Nevertheless, the results indicated a much higher rate of DSH in this population than in young males in the community. A larger joint project with juvenile detention centers is required to confirm the extent of previous DSH at the time young offenders are admitted, and the associated risk factors, in order to assist prevention and intervention strategies.