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.     

Sexual Minority-Related Victimization as a Mediator of Mental Health Disparities in Sexual Minority Youth: A Longitudinal Analysis

Sexual minority youth (youth who are attracted to the same sex or endorse a gay/lesbian/bisexual identity) report significantly higher rates of depression and suicidality than heterosexual youth. The minority stress hypothesis contends that the stigma and discrimination experienced by sexual minority youth create a hostile social environment that can lead to chronic stress and mental health problems. The present study used longitudinal mediation models to directly test sexual minority-specific victimization as a potential explanatory mechanism of the mental health disparities of sexual minority youth. One hundred ninety-seven adolescents (14–19 years old; 70 % female; 29 % sexual minority) completed measures of sexual minority-specific victimization, depressive symptoms, and suicidality at two time points 6 months apart. Compared to heterosexual youth, sexual minority youth reported higher levels of sexual minority-specific victimization, depressive symptoms, and suicidality. Sexual minority-specific victimization significantly mediated the effect of sexual minority status on depressive symptoms and suicidality. The results support the minority stress hypothesis that targeted harassment and victimization are partly responsible for the higher levels of depressive symptoms and suicidality found in sexual minority youth. This research lends support to public policy initiatives that reduce bullying and hate crimes because reducing victimization can have a significant impact on the health and well-being of sexual minority youth.     

Characteristics and Co-occurrence of Adolescent Non-Suicidal Self-Injury and Suicidal Behaviours in Pediatric Emergency Crisis Services

During the potentially tumultuous adolescent period, non-suicidal self-injury (NSSI) and suicide attempts are relatively common, particularly amongst youth who present to mental health services. These phenomena frequently co-occur but their relationship is unclear. This study evaluated clinical data from 468 youth between the ages of 12 and 17 years (63.5% female) to determine the incidence of NSSI 24 h prior to presentation at emergency crisis services, evaluated the overlap between NSSI and suicide attempt, and examined the characteristics of different types of self-harm. Half of the adolescents presenting to emergency crisis services had self-harmed within the previous 24 h, with most of these (91%) classified as NSSI only. The percentage of youth with a suicide attempt was 5% and the co-occurrence of these two behaviours was 4%. Group differences in depressive symptoms, suicidal ideation and impulsivity were identified, with the co-occurring NSSI and suicide attempt group presenting with the highest level of psychopathology. This study underscores the necessity of assessing suicidal ideation and NSSI in all youth presenting to mental health services.     

The relationship between physical activity and mental health among adolescents in six middle-income countries: A cross-sectional study

Physical inactivity and poor mental health are emerging worldwide youth problems. Using the Global School-based Health Survey, this secondary data analysis study examined the link between physical activity and adolescent mental health among 23,372 adolescents between 11 and 17 years of age in six middle-income countries. The authors assessed physical activity by participation in (a) exercise for 60 min and (b) walking/biking in any day of a week in the past 7 days. The authors assessed mental health by the presence of (a) loneliness, (b) anxiety, (c) depression, (d) suicidal ideation, and (e) suicide attempts in the past 12 months. There was a low prevalence of physical activity among the participants. In general, there was a low prevalence of 12-month mental health problems among adolescents. Further research may incorporate physical activity to promote positive youth mental health for possible cost-effective interventions.     

Suicidal ideation in adolescence: Depression,substance use,and other risk factors

The interrelationships of depression and suicide with adolescent drug use, delinquency, eating disorders, and the risk factors for these different problems were investigated among 597 9th and 11th graders in an urban high school. There is a strong association of drug use with suicidal ideation among girls, and a stronger relationship with attempts among girls and boys. Suicidal youths are ill-adjusted and display a lack of attachment and commitment to family and school. Causal models indicate that poor interpersonal interactions with parents, absence of peer interactions, and life events lead to depression, which in turn leads to suicidal ideation. Depressive symptoms are the strongest predictors of suicidal ideation. Among females, depression predicts drug involvement, and in turn, drug use increases suicidal ideation. Drug use is only one class of problem behaviors that constitutes a risk factor for suicidal behavior in adolescence. Delinquency and eating disorders also have direct effects on suicidal ideation beyond those of depressive affect. As for drug involvement, these problem behaviors are more predictive of suicidal behavior among girls than boys. Similarity and specificity of the predictors for problem behaviors within and between the sexes are discussed. Although young women use drugs to handle feelings of depression, drug use appears ineffective in the long run in relieving these depressive feelings. Understanding the dynamics of suicidal ideation in adolescence has important public health implications, since ideation is a strong predictor of attempts, especially among females.Revised version of a presentation at the Workshop on Adolescent Depression, Princeton, NJ, June 3, 1987.Work on this research has been partially supported by Research Grants DA00064, DA01097, DA03196, and DA02867, and by Research Scientist Award DA00081 from the National Institute on Drug Abuse; and awards from the John D. and Catherine MacArthur Foundation and the Research Foundation for Mental Hygiene, New York State Psychiatric Institute. Partial support for computer costs was provided by Mental Health Clinical Research Center Grant MH30906-07 from NIMH to the New York State Psychiatric Institute.Received Ph.D. in Sociology from Columbia University. Research interests include adolescent psychosocial development, epidemiology and risk factors for drug use, and interpersonal networks.Work on this research was carried out while a Research Associate at the School of Public Health, Columbia University. Received Ph.D. in Sociology from Columbia University. Research interests include personal networks and social support systems in chronic illness, societal factors in mental health, psychosocial consequences of drug use and abuse, panel mortality, and survey methodology.Received M.P.H. from Columbia University. Research interests include reliability and child psychiatry.     

The Association Between Family Factors and Depressive Disorders in Adolescents

The main aim of this study was to examine the familial factors (parental psychopathology and attachment to parents) in depressed adolescents. Another aim was to compare level of psychosocial impairment, use of mental health services, suicidal ideation and attempt, and the clinical features of depression (e.g., severity and age of onset) among depressed adolescents with depressed parent(s) with those whose parent(s) do not have any depression. Result showed that the adolescent depression was significantly associated with an elevated rate of having a depressed mother. Perceived level of attachment to parents, as measured using the Inventory of Parent and Peer Attachment, was significantly lower among depressed adolescents than among adolescents without any psychiatric disorders. Depressed adolescents with depressed parents reported significantly higher suicidal ideation and had more recurrent depressive episodes than depressed adolescents with nondepressed parent(s). Our results imply the importance of shifting our focus from universal programs to family-based prevention and intervention programs for depression.     

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.     

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.     

Understanding the Influence of Mental Health Diagnosis and Gender on Placement Decisions for Justice-Involved Youth

Justice-involved youth have high rates of psychiatric diagnoses, and these youth are often placed out-of-home, although evidence identifies several negative implications of juvenile confinement, especially for youth with psychopathology. Furthermore, youth in the justice system may be processed differently based on gender. As males and females tend to manifest symptoms differently, the psychopathology of youth may act to moderate the relationship between gender and placement in the juvenile justice system. The present study used a large, diverse sample (n?=?9?851, 19.8?% female) to examine whether youth placed in various types of out-of-home facilities differed in terms of externalizing, internalizing, substance use, or comorbid disorders, and to determine the predictive value of mental health diagnoses in placement decisions. The moderation effect of psychopathology and substance use on the relationship between gender and placement also was explored. The results indicated that each type of disorder differed across placements, with internalizing being most prevalent in non-secure, and externalizing, comorbid, and substance use being most prevalent in secure settings. Mental health diagnoses improved the prediction of placement in each out-of-home placement beyond legal and demographic factors such that externalizing and substance use disorders decreased the likelihood of placement in non-secure settings, and internalizing, externalizing, and substance use disorders increased the likelihood of placement in secure and state-secure facilities. The relationship between internalizing pathology and placement in more secure facilities was moderated by externalizing pathology. The relationship between gender and placement was significantly moderated by mental health such that females with mental health diagnoses receive less secure placements. Implications for policymakers and practitioners are discussed, as well as implications for reforming juvenile justice within a developmental approach.     

The Mediating Roles of Stress and Maladaptive Behaviors on Self-Harm and Suicide Attempts Among Runaway and Homeless Youth

Runaway and homeless youth often have a constellation of background behavioral, emotional, and familial problems that contribute to stress and maladaptive behaviors, which, in turn, can lead to self-harming and suicidal behaviors. The current study examined the roles of stress and maladaptive behaviors as mediators between demographic and psychosocial background characteristics and self-injurious outcomes through the lens of the stress process paradigm. The model was tested in a sample of runaway and homeless youth from Los Angeles County (N = 474, age 12–24, 41 % female, 17 % White, 32.5 % African American, 21.5 % Hispanic/Latino). Background variables (gender, age, sexual minority status, parental drug use history, and emotional distress) predicted hypothesized mediators of maladaptive behaviors and recent stress. In turn, it was hypothesized that the mediators would predict self-harming behaviors and suicide attempts in the last 3 months. Females and LGBT (lesbian, gay, bisexual, transgender) youth were more likely to have self-harmed and attempted suicide; younger participants reported more self-harming. The mediating constructs were associated more highly with self-harming than suicide attempts bivariately, although differences were modest. Maladaptive behaviors and recent stress were significant predictors of self-harm, whereas only recent stress was a significant predictor of suicide attempts. All background factors were significant predictors of recent stress. Older age, a history of parental drug use, and greater emotional distress predicted problem drug use. Males, younger participants, and participants with emotional distress reported more delinquent behaviors. Significant indirect effects on self-harming behaviors were mediated through stress and maladaptive behaviors. The hypothesized paradigm was useful in explaining the associations among background factors and self-injurious outcomes and the influence of mediating factors on these associations.     

Mental Health and Educational Experiences Among Black Youth: A Latent Class Analysis

Disproportionately lower educational achievement, coupled with higher grade retention, suspensions, expulsions, and lower school bonding make educational success among Black adolescents a major public health concern. Mental health is a key developmental factor related to educational outcomes among adolescents; however, traditional models of mental health focus on absence of dysfunction as a way to conceptualize mental health. The dual-factor model of mental health incorporates indicators of both subjective wellbeing and psychopathology, supporting more recent research that both are needed to comprehensively assess mental health. This study applied the dual-factor model to measure mental health using the National Survey of American Life—Adolescent Supplement (NSAL-A), a representative cross-sectional survey. The sample included 1170 Black adolescents (52% female; mean age 15). Latent class analysis was conducted with positive indicators of subjective wellbeing (emotional, psychological, and social) as well as measures of psychopathology. Four mental health groups were identified, based on having high or low subjective wellbeing and high or low psychopathology. Accordingly, associations between mental health groups and educational outcomes were investigated. Significant associations were observed in school bonding, suspensions, and grade retention, with the positive mental health group (high subjective wellbeing, low psychopathology) experiencing more beneficial outcomes. The results support a strong association between school bonding and better mental health and have implications for a more comprehensive view of mental health in interventions targeting improved educational experiences and mental health among Black adolescents.     

Acculturation,Gender, Depression,and Cigarette Smoking Among U.S. Hispanic Youth: The Mediating Role of Perceived Discrimination

Hispanic youth are at risk for experiencing depressive symptoms and smoking cigarettes, and risk for depressive symptoms and cigarette use increase as Hispanic youth acculturate to U.S. culture. The mechanism by which acculturation leads to symptoms of depression and cigarette smoking is not well understood. The present study examined whether perceived discrimination explained the associations of acculturation with depressive symptoms and cigarette smoking among 1,124 Hispanic youth (54% female). Youth in Southern California completed surveys in 9th–11th grade. Separate analyses by gender showed that perceived discrimination explained the relationship between acculturation and depressive symptoms for girls only. There was also evidence that discrimination explained the relationship between acculturation and cigarette smoking among girls, but the effect was only marginally significant. Acculturation was associated with depressive symptoms and smoking among girls only. Perceived discrimination predicted depressive symptoms in both genders, and discrimination was positively associated with cigarette smoking for girls but not boys. These results support the notion that, although Hispanic boys and girls experience acculturation and discrimination, their mental health and smoking behaviors are differentially affected by these experiences. Moreover, the results indicate that acculturation, gender, and discrimination are important factors to consider when addressing Hispanic youth’s mental health and substance use behaviors.     

Adolescent Health Risk Profiles: The Co-Occurrence of Health Risks among Females and Males

This analysis examines the complexity of adolescent health risk behaviors using data from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative study of students. The current sample includes 12,955 students (6,626 females and 6,329 males) in grades 9 through 12. Cluster analysis was conducted separately by gender to examine the interrelationships among eight health risk behaviors: sexual activity, general alcohol use, binge drinking, cigarette use, marijuana use, other illicit drug use, fighting, and suicide. Four distinct clusters for females and males were identified based on their profiles of risk-taking behavior. Females and males both report low- and high-risk profiles, and a risk profile with high alcohol use and sexual activity. Females have two distinct risk profiles, one that is highest on every measure of risk compared to others and one that has high levels of fighting and suicide with little participation in substance use or sexual activity. Males have a distinct risk profile with particularly high rates of marijuana use and suicidal behaviors. Few distinctions exist between profiles based on sociodemographic characteristics.     

Posttraumatic Stress as a Mediator of the Relationship Between Trauma and Mental Health Problems Among Juvenile Delinquents

This study investigated the interrelationships among trauma exposure, PTSD, and mental health problems in a sample of 289 adolescents (199 male, 90 female) detained in a juvenile correctional facility. Mean differences were found in that females scored higher than males on measures of interpersonal trauma exposure and symptoms of both simple and complex PTSD. Females also endorsed more mental health problems in the areas of depression/anxiety, somatic complaints, and suicidal ideation. For all youth, trauma exposure, PTSD, and mental health problems were correlated. Results of structural equation modeling were consistent with the hypothesis that PTSD mediates the relationship between interpersonal trauma and mental health problems for all youth, although the results were stronger for females.

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.     

Do Anti-Bullying Laws Reduce In-School Victimization,Fear-based Absenteeism,and Suicidality for Lesbian,Gay, Bisexual,and Questioning Youth?

Lesbian, gay, and bisexual youth are at heightened risk for bullying and other forms of in-school victimization. Anti-bullying laws are a potential policy mechanism for addressing this issue, yet there has been little investigation of the impact of such policies for this population using generalizable samples or quasi-experimental designs. The current study explores whether the presence of state anti-bullying laws predicts lower likelihood of bullying victimization, fear-based absenteeism, in-school threats or injury with a weapon, and suicidality for lesbian, gay, bisexual, and questioning high school students in the United States. Based on Youth Risk Behavior Survey data across 22 states from 2005–2015, coupled with data about the presence of general and enumerated anti-bullying laws that include sexual orientation as a protected class, this study analyzes this topic using a quasi-experimental design (linear difference-in-difference models). The results indicate that lesbian, gay, bisexual, and questioning youth (particularly boys aged 15 or younger) experienced less bullying victimization in states with general or enumerated anti-bullying laws. There was modest evidence of a reduction in fear-based absenteeism among boys in states with such laws. However, there was little evidence of a relationship between such policies and in-school threats or injuries or suicidality. Further, lesbian, bisexual, and questioning girls’ likelihood of victimization, absenteeism, or suicidality was generally not related to the presence of anti-bullying laws. The results suggest that general and enumerated anti-bullying laws may help reduce bullying victimization for gay, bisexual, and questioning boys.     

Trajectories of Depressive Symptoms and Suicidality Among Heterosexual and Sexual Minority Youth

Sexual minority youth report higher rates of depression and suicidality than do heterosexual youth. Little is known, however, about whether these disparities continue as youth transition into young adulthood. The primary goals of this study were to describe and compare trajectories of adolescent depressive symptoms and suicidality among sexual minority and heterosexual youth, examine differences in depressive symptoms and suicidality trajectories across sexual orientation subgroups, and determine whether there are gender differences in these longitudinal disparities. Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed using latent curve modeling (N = 12,379; 53 % female). Results showed that the rates of depressive symptoms and suicidality in early adolescence were higher among sexual minority youth than among heterosexual youth, and that these disparities persisted over time as participants transitioned into young adulthood. Consistent with previous cross-sectional studies, the observed longitudinal disparities were largest for females and for bisexually-identified youth. Sexual minority youth may benefit from childhood and early adolescent prevention and intervention programs.     

Sexual Attraction and Trajectories of Mental Health and Substance Use During the Transition from Adolescence to Adulthood

Previous research suggests that sexual minority youth have poorer health-related outcomes than their heterosexual peers. The purpose of this study is to determine whether sexual orientation disparities in mental health and substance use increase, decrease, or remain the same during the transition from adolescence to adulthood. Data are from Waves 1–4 of the National Longitudinal Study of Adolescent Health (n = 8,322; 55% female). Respondents were in grades 7–12 at Wave 1 and aged 24–32 at Wave 4. Latent growth curve modeling is used to compare the mental health and substance use trajectories of youth who consistently report heterosexual attraction versus those who consistently report lesbian, gay, or bisexual (LGB) attraction, those who report a transition to LGB attraction, and those who report a transition to heterosexual attraction. Among women and men, sexual orientation disparities in depressive symptoms and suicidal thoughts persist, but do not increase, during the transition from adolescence to adulthood. The same pattern is observed for disparities in smoking, heavy drinking, and marijuana use among women. Among men, disparities in substance use are only observed between those who report consistent heterosexual attraction and those who transition to heterosexual attraction. Disparities between these groups persist over time for heavy drinking and marijuana use but decrease over time for smoking. While this study finds evidence of numerous disparities in mental health and substance use outcomes during adolescence and young adulthood, particularly among young women, there is no indication that these disparities get larger over time.     

Youth Homelessness and Social Stigma

Building upon previous exploratory qualitative research (Kidd SA (2003) Child Adol Social Work J 20(4):235–261), this paper examines the mental health implications of social stigma as it is experienced by homeless youth. Surveys conducted with 208 youths on the streets and in agencies in New York City and Toronto revealed significant associations between perceived stigma due to homeless status and sexual orientation, pan handling and sex trade involvement, and amount of time homeless. Higher perceived stigma was also related to low self esteem, loneliness, feeling trapped, and suicidal ideation, with guilt/self-blame due to homeless status having the strongest impact on mental health variables. Sean Kidd is an assistant professor with the McMaster Department of Psychiary and Behavioural Neurociences. He received his Ph.D. in clinical psychology from the University of Windsor, Ontario, in 2003. His primary research areas are suicide and resiliency among homeless youth and the application of qualitative methodologies in psychological research.     

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.