Madelyn S. Gould

Psychopathology Associated With Suicidal Ideation and Attempts Among Children and Adolescents

OBJECTIVE To identify the independent and differential diagnostic and symptom correlates of suicidal ideation and suicide attempts and determine whether there are gender- and age-specific diagnostic profiles. METHOD The relationships between suicidal ideation, suicide attempts, and psychiatric disorders were examined among 1,285 randomly selected children and adolescents, aged 9 to 17 years, of whom 42 had attempted suicide and 67 had expressed suicidal ideation only. Youths and their parents were interviewed as part of the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, using the Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3). RESULTS Logistic regression analyses indicated that mood, anxiety, and substance abuse/dependence disorders independently increased the risk of suicide attempts, after controlling for sociodemographic characteristics. There was no significant independent contribution of disruptive disorders to suicide attempts, although its association with suicidal ideation was significant. Substance abuse/dependence independently differentiated suicide attempters from ideators. Noncriterion symptoms that remained significant predictors of suicide risk, after adjusting for psychiatric disorder, included panic attacks and aggressiveness. Perfectionism did not significantly increase suicide risk after adjusting for psychiatric disorder. The association of specific disorders and noncriterion symptoms with suicidality varied as a function of gender and age. CONCLUSION A monolithic diagnostic risk profile for suicidality, ignoring gender- and age-specific risks, is inadequate. The contribution of substance abuse/dependence in the escalation from suicidal thoughts to suicide attempts is underscored.

Preventing Teenage Suicide: A Critical Review

Abstract This paper reviews the risk factors for suicide in teenagers to which prevention procedures could rationally be directed. A range of suicide preventive interventions, including hotline and crisis services, school based educational and screening procedures, effective treatment of suicide attempters, minimizing opportunities for suicide imitation, and controlling access to the methods most often used to commit suicide are described, and evidence for their efficacy is presented. Most suicides among teenagers occur in those with identifiable mental or character disorders, and increasing knowledge about risk factors may facilitate prediction in the future. The evidence for the efficacy of any existing intervention, however, is slender, and there is a clear need for more effective research into the management of high-risk groups.

The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: a critical review of the literature

This article critically reviewed the research addressing the epidemiology and phenomenology of non-suicidal self-injury (NSSI) among adolescents. Articles were identified through a search of Medline and Psychinfo. Findings indicate a lifetime prevalence of NSSI ranging from 13.0% to 23.2%. Reasons for engaging in NSSI include to regulate emotion and to elicit attention. Correlates of NSSI include a history of sexual abuse, depression, anxiety, alexithymia, hostility, smoking, dissociation, suicidal ideation, and suicidal behaviors. Suggested areas of future research include identifying the psychiatric diagnoses associated with NSSI among adolescents, determining the temporal link between NSSI and suicide attempts, learning more about the course of NSSI, understanding the biological underpinnings of NSSI, and identifying effective treatments for NSSI in adolescents.

Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation

OBJECTIVE To identify the independent psychosocial and risk behavior correlates of suicidal ideation and attempts. METHOD The relationships between suicidal ideation or attempts and family environment, subject characteristics, and various risk behaviors were examined among 1,285 randomly selected children and adolescents, aged 9 through 17 years, of whom 42 (3.3%) had attempted suicide and 67 (5.2%) had expressed suicidal ideation only. The youths and their parents were enumerated and interviewed between December 1991 and July 1992 as part of the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. RESULTS Compared with subjects with suicidal ideation only, attempters were significantly more likely to have experienced stressful life events, to have become sexually active, to have smoked more than one cigarette daily, and to have a history of ever having smoked marijuana. After adjusting for sociodemographic characteristics, a statistically significant association was found between suicidal ideation or attempt and stressful life events, poor family environment, parental psychiatric history, low parental monitoring, low instrumental and social competence, sexual activity, marijuana use, recent drunkenness, current smoking, and physical fighting. Even after further adjusting for the presence of a mood, anxiety, or disruptive disorder, a significant association persisted between suicidal ideation or attempts and poor family environment, low parental monitoring, low youth instrumental competence, sexual activity, recent drunkenness, current smoking, and physical fighting. CONCLUSION Low parental monitoring and risk behaviors (such as smoking, physical fighting, alcohol intoxication, and sexual activity) are independently associated with increased risk of suicidal ideation and attempts, even after adjusting for the presence of psychiatric disorder and sociodemographic variables.

Patterns of Diagnostic Comorbidity in a Community Sample of Children Aged 9 through 16 Years

Secondary analyses of the data from the Puerto Rico Child Psychiatry Epidemiologic Study were done to provide information on the comorbidity of four major diagnostic domains (attention deficit disorders, conduct/oppositional disorders, depression and anxiety disorders). A high level of comorbidity was found among these four domains of child and adolescent psychopathology. In general the patterns of comorbidity were not affected by whether the data was put together by a clinician or by means of a computer algorithm scoring a structured interview. The patterns were not affected in any major way by who the informants were in the diagnostic process. Minor differences were found in certain comorbidity patterns depending on the sex and age of the subjects. Comorbidity was associated with level of impairment and to service utilization.

Childhood Bullying Behaviors as a Risk for Suicide Attempts and Completed Suicides: A Population-Based Birth Cohort Study

OBJECTIVE There are no previous studies about the association of childhood bullying behavior with later suicide attempts and completed suicides among both sexes. The aim was to study associations between childhood bullying behaviors at age 8 years and suicide attempts and completed suicides up to age 25 years in a large representative population-based birth cohort. METHOD The sample includes 5,302 Finnish children born in 1981. Information about bullying was gathered at age 8 years from self-report, as well as parent and teacher reports. Information about suicide attempts requiring hospital admission and completed suicides was gathered from three different Finnish registries until the study participants were 25 years old. Regression analyses were conducted to determine whether children who experience childhood bullying behaviors are at risk for later suicide attempts and completed suicides after controlling for baseline conduct and depression symptoms. RESULTS The association between bullying behavior at age 8 years and later suicide attempts and completed suicides varies by sex. Among boys, frequent bullying and victimization are associated with later suicide attempts and completed suicides but not after controlling for conduct and depression symptoms; frequent victimization among girls is associated with later suicide attempts and completed suicides, even after controlling for conduct and depression symptoms. CONCLUSIONS When examining childhood bullying behavior as a risk factor for later suicide attempts and completed suicides, each sex has a different risk profile.

The impact of suicide in television movies. Evidence of imitation.

Increasing evidence suggest that imitative behavior may have a role in suicide among teenagers. We studied the variation in the numbers of suicides and attempted suicides by teenagers in the greater New York area two weeks before and two weeks after four fictional films were broadcast on television in the fall and winter of 1984-1985. The mean number of attempts in the two-week periods after the broadcasts (22) was significantly greater than the mean number of attempts before the broadcasts (14; P less than 0.05), and a significant excess in completed suicides, when compared with the number predicted, was found after three of the broadcasts (P less than 0.05). We conclude that the results are consistent with the hypothesis that some teenage suicides are imitative and that alternative explanations for the findings, such as increased referrals to hospitals or increased sensitivity to adolescent suicidal behavior on the part of medical examiners or hospital personnel, are unlikely to account for the increase in attempted and completed suicides.

Seeking help from the internet during adolescence.

OBJECTIVE To assess the prevalence and demographic and psychological correlates of Internet use as a help-seeking resource for emotional problems in a community sample of adolescents. METHOD A self-report survey was completed by 9th-through 12th-grade students ( = 519) enrolled in health courses in six New York State high schools in the fall/winter of 1999. The relationship between Internet help-seeking behavior and demographic characteristics, hopelessness, functional impairment, and use of various treatment services was examined. RESULTS Nearly one fifth (18.2%) of the adolescents sought help on the Internet for emotional problems in the previous year. The proportions of males and females seeking help on the Internet did not significantly differ (15.6% and 20.8%, respectively). Internet help-seekers were significantly more likely than non-help-seekers to score above the clinical threshold on the Columbia Impairment Scale (34% versus 20.6%; chi(2)(1) = 7.4, <.01) or Beck Depression Inventory (16.1% versus 9.1%; chi(2)(1) = 3.8, <.05). These at-risk youths tended to combine Internet help-seeking with other sources of help, rather than substituting it for other resources. More than 20% of Internet help-seekers were dissatisfied with the help they received, and only 14% thought it had helped them very much. CONCLUSIONS For the Internet to realize its potential as an effective resource for teenagers struggling with emotional problems, further development is needed.

Impairment in the Epidemiological Measurement of Childhood Psychopathology in the Community

The desirability of incorporating a measure of impairment to the categorization of childhood psychopathology in the community is examined. The use of the Childrens Global Assessment Scale (CGAS) for this purpose is recommended. The choice of 61 (definite case) and 71 (probable case) as cutpoints on the Childrens Global Assessment Scale is supported empirically by the data on service utilization, parental perceived need, and behavior problem scores obtained in the Puerto Rico Child Psychiatry Epidemiological Study.

Media Contagion and Suicide Among the Young

Research continues to demonstrate that vulnerable youth are susceptible to the influence of reports and portrayals of suicide in the mass media. The evidence is stronger for the influence of reports in the news media than in fictional formats. However, several studies have found dramatic effects of televised portrayals that have led to increased rates of suicide and suicide attempts using the same methods displayed in the shows. Recent content analyses of newspapers and films in the United States reveal substantial opportunity for exposure to suicide, especially among young victims. One approach to reducing the harmful effects of media portrayals is to educate journalists and media programmers about ways to present suicide so that imitation will be minimized and help-seeking encouraged. Recently released recommendations for journalists are attached as an appendix. Similar initiatives with the entertainment industry would be highly desirable.