Barry M. Wagner

Family risk factors for child and adolescent suicidal behavior

In this review, the author evaluates the empirical support for the claims that various aspects of family dysfunction are risk factors for completed suicide or suicidal symptoms in childhood or adolescence. There is consistent evidence that a history of physical or sexual abuse is a risk factor and some evidence for other risk factors, including poor family or parent-child communication, loss of caregiver to separation or death, and psychopathology in first-degree relatives. However, the researchers of the vast majority of studies did not attend to whether the putative risk factors preceded the development of suicidal symptoms; thus, most of the claims regarding family risk factors are not justified by their research designs and findings.

Adolescent sibling differences in suicidal symptoms: The role of parent-child relationships

This study examined concordance for symptoms of suicide among 178 pairs of adolescent siblings, and the association of youth and maternal reports of parenting with variation in suicide ideation both across families and between siblings. Crosstabulation analyses indicated a significant risk of suicide ideation among siblings of adolescents who had made suicide attempts, as well as a significant degree of concordance for suicide ideation among pairs of siblings. Regression analyses indicated that reported levels of maternal warmth and harsh discipline, especially youth reports, were associated with suicide ideation, and that sibling differences on these parenting indices were associated with differences in suicide ideation both across families as well as between siblings. However, sibling differences in reported parenting did not contribute to prediction of suicide ideation above the variance accounted for by the simple levels of parenting reported by adolescents.

An Investigation of Interpersonal-Psychological Variables in Air Force Suicides: A Controlled-Comparison Study

Joiners (2005) theory attributes suicide to an individuals acquired capability to enact self-harm, perceived burdensomeness, and thwarted belongingness. This study evaluated whether Joiners theory could differentiate United States (US) Air Force (AF) personnel (n = 60) who died by suicide from a living active duty AF personnel comparison sample (n = 122). Responses from AF personnel on several scales assessing Joiners constructs were compared to data from a random sample of postmortem investigatory files of AF personnel who died by suicide between 1996–2006. This research also introduced a newly designed measure, the Interpersonal-Psychological Survey (IPS), designed to assess the three components of Joiners theory in one, easy-to-administer instrument. Analyses of the psychometric properties of the IPS support initial validation efforts to establish this scale as a predictive measure for suicide. Findings support that ones score on the Acquired Capability to Commit Suicide subscale of the IPS and the IPS overall score reliably distinguished between the two groups. The implications of these findings in relation to suicide prevention efforts in the US military are discussed.

Negative caregiver strategies and psychopathology in urban, African-American young adults

OBJECTIVE There were three aims: (1). assess the prevalence of reported exposure to negative caregiver strategies in a community-based African-American population, (2). examine the sources of variation in caregiver parenting strategies, including demographic variables and child characteristics, (3). investigate whether mental disorders in young adulthood may differ based on reported degree of exposure to negative strategies. METHOD The participants were 1197 African-Americans involved in a 1999-2001 young adult follow-up (age M=19.6, SD=.6) of an evaluation of school-based interventions in the Baltimore, MD metropolitan area. Measures included teacher-report of child aggression in first grade, parent-report of demographic variables in first and sixth grade, and young adult self-report of symptomatology, suicidal behaviors, and childhood caregiver discipline strategies. RESULTS Fifty-four percent of the sample reported some use of physical discipline by caregivers. Lower family income and younger caregiver age, as well as teacher reports of child aggression, were related to reports of caregivers high use of negative strategies. In addition, young adults who reported a high rate of negative caregiver strategies had a significantly increased risk for psychopathology and were over twice as likely to have experienced a history of suicidal ideation than those reporting low exposure. CONCLUSIONS The results demonstrate the importance of examining variation in this population, with the poorest and the youngest using negative parenting strategies more frequently. In addition, the present study replicated previous findings of the link between negative caregiver discipline strategies and psychopathology. This association appears robust across diverse populations. The implications for preventive interventions are discussed.

The Relationship Between Battered Women’s Causal Attributions for Violence and Coping Efforts

This study investigates the relationship between battered women’s causal attributions for the violence they experience and their subsequent coping efforts. Causal attributions related to partner blame, excusing the violence, and the combination of partner blame and excusing the violence were regressed on six categories of coping strategies: placating, resistance, formal help source, informal help source, safety planning, and legal strategies. Of the 793 women approached outside of a battered women’s shelter and the district court, 406 women completed the baseline measure. It was found that women who hold their partners accountable for abuse are more likely than women who excuse the violence to utilize more overall coping strategies. Also, women who blame their partners for the abuse utilize both more active and more public coping efforts. After accounting for the effects of ethnicity, violence severity, and excusing the violence, the percentage of blame attributions endorsed predicted informal (R 2 = .077, p = .001) and safety planning (R 2 = .054, p = .014) strategies. After controlling for ethnicity, violence severity, and blaming, the percentage of excuse attributions predicted placating (R 2 = .103, p = .016) strategies.

Staff security and work pressure: Contrasting patterns of stability and change across five dialysis units

Differences among clinical care units in social dynamics and social organization are associated with differences in the clinical course of patients with a range of chronic illness. These differences are also associated with well-being of staff members. Recent attention has focused on understanding these differences among units with an eye towards correcting deficiencies and enhancing strengths of clinical care units. The current study sought to delineate the effect of social and organizational dynamics unique to each unit on staff perceptions of the security of their relationships with other staff and their perceived work pressure. The unit as a major source of differences among staff subjects was compared with the impact of ethnic identity, of work in the morning shift vs other shifts, and of professional role. Results confirmed that unit membership was, by far, the most important correlate of staff perceptions of the unit, particularly those concerning security of relationships with others and perceived work pressure. Moreover, the results suggested that unit differences in perceived security were due to differences among units in long standing turmoil within the unit or long standing problematic ties between the unit and the larger institution which controls it. However, perceived work pressure seems more transient and may reflect the challenge of shorter-term fluctuations in the demands of patient care.

Association of positive responses to suicide screening questions with hospital admission and repeated emergency department visits in children and adolescents

Objectives Although validated suicide screening tools exist for use among children and adolescents presenting to emergency departments (EDs), the associations between screening positive for suicide risk and immediate psychiatric hospital admission or subsequent ED use, stratified by age, have not been examined. Methods This is a retrospective cohort study of a consecutive case series of patients aged 8 to 18 years presenting with psychiatric chief complaints during a 9-month period to a single urban tertiary care pediatric ED. Eligible patients were administered a subset of questions from the Risk of Suicide Questionnaire. Outcomes included the odds of psychiatric hospitalization at the index visit and repeated ED visits for psychiatric complaints within the following year, stratified by age. Results Of the 568 patients presenting during the study period, responses to suicide screening questions were available for 442 patients (78%). A total of 159 (36%) of 442 were hospitalized and 130 (29%) of 442 had 1 or more ED visits within the following year. The proportion of patients providing positive responses to 1 or more suicide screening questions did not differ between patients aged 8 to 12 years and those aged 13 to 18 years (77/154 [50%] vs 137/288 [48%], P = 0.63). A positive response to 1 or more of the questions was significantly associated with increased odds of psychiatric hospitalization in the older age group [adjusted odds ratio, 3.82; 95% confidence interval, 2.24–6.54) and with repeated visits to the ED in the younger age group (adjusted odds ratio, 3.55 95% confidence interval, 1.68–7.50). Conclusions Positive responses to suicide screening questions were associated with acute psychiatric hospitalization and repeated ED visits. Suicide screening in a pediatric ED may identify children and adolescents with increased need of psychiatric resources.

Higher childhood peer reports of social preference mediates the impact of the good behavior game on suicide attempt

The Good Behavior Game (GBG) is a universal classroom-based preventive intervention directed at reducing early aggressive, disruptive behavior and improving children’s social adaptation into the classroom. The GBG is one of the few universal preventive interventions delivered in early elementary school that has been shown to reduce the risk for future suicide attempts. This paper addresses one potential mechanism by which the GBG lowers the risk of later suicide attempt. In this study, we tested whether the GBG, by facilitating social adaptation into the classroom early on, including the level of social preference by classmates, thereby lowers future risk of suicide attempts. The measure of social adaptation is based on first and second grade peer reports of social preference (“which children do you like best?”; “which children don’t you like?”). As part of the hypothesized meditational model, we examined the longitudinal association between childhood peer social preference and the risk of future suicide attempt, which has not previously been examined. Data were from an epidemiologically based randomized prevention trial, which tested the GBG among two consecutive cohorts of first grade children in 19 public schools and 41 classrooms. Results indicated that peer social preference partially mediated the relationship between the GBG and the associated reduction of risk for later suicide attempts by adulthood, specifically among children characterized by their first grade teacher as highly aggressive, disruptive. These results suggest that positive childhood peer relations may partially explain the GBG-associated reduction of risk for suicide attempts and may be an important and malleable protective factor for future suicide attempt.

Are There Linguistic Markers of Suicidal Writing That Can Predict the Course of Treatment? A Repeated Measures Longitudinal Analysis.

The purpose of this pilot study was to predict resolution of suicidal ideation and risk over the course of therapy among suicidal outpatients (N = 144) using a novel method for analyzing Self- verses Relationally oriented qualitative written responses to the Suicide Status Form (SSF). A content analysis software program was used to extract word counts and a repeated measures longitudinal design was implemented to assess improvement over time. Patients with primarily Relationally focused word counts were more likely to have a quicker suicide risk resolution than those with more Self-focused word counts (6–7 sessions versus 17–18 sessions). Implications of these data are discussed, including the potential for enhancing treatment outcomes using this method with individuals entering treatment.

How Parental Reactions Change in Response to Adolescent Suicide Attempt

This study examined parental reactions to adolescents’ suicide attempts and the association of reactions with future suicidal self-directed violence. Participants were 81 mothers and 49 fathers of 85 psychiatric inpatient adolescents. Maternal hostility and paternal anger and arguing predicted future suicide attempts. From pre- to post-attempt, mothers reported feeling increased sadness, caring, anxiety, guilt, fear, and being overwhelmed; fathers reported increased sadness, anxiety, and fear. Findings have clinical implications; improving parent-child relationships post-suicide attempt may serve as a protective factor for suicide.