Completed suicide and psychiatric diagnoses in young people: a critical examination of the evidence.

Department of Mental Health and Substance Dependence, World Health Organization, Geneva, Switzerland.
American Journal of Orthopsychiatry (Impact Factor: 1.5). 11/2005; 75(4):676-83. DOI: 10.1037/0002-9432.75.4.676
Source: PubMed

ABSTRACT Suicide rates of young people are increasing in many geographic areas. There is a need to recognize more precisely the role of specific mental disorders and their comparative importance for understanding suicide and its prevention. The authors reviewed the published English-language research, where psychiatric diagnoses that met diagnostic criteria were reported, to reexamine the presence and distribution of mental disorders in cases of completed suicide among young people worldwide. The number and geographical distribution of cases were limited (N = 894 cases). The majority of cases (88.6%) had a diagnosis of at least 1 mental disorder. Mood disorders were most frequent (42.1%), followed by substance-related disorders (40.8%) and disruptive behavior disorders (20.8%). Those strategies focusing exclusively on the prevention and treatment of depression in young people need to be reconsidered. A comprehensive suicide prevention strategy among young people should target mental disorders as a whole, not depression alone, and consider contextual factors.

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    ABSTRACT: Objective: To describe mental health services utilization for adolescents after attempted suicide, explore factors related to treatment compliance, and determine the relation between compliance and suicidality. Method: Eighty-five adolescents (ages 13-18) who had attempted suicide and their families were recruited from four psychiatric hospitals and were evaluated for symptoms of psychopathology. Subsequent assessments were conducted every 6 months for 2 years to determine treatment utilization, treatment compliance (nonadherence to medication regimens or nonattendance of psychosocial treatments against provider advice), attitudes toward treatments used, and further suicide attempts and ideation. Results: Adolescents with a disruptive behavior disorder diagnosis were less compliant with individual psychotherapy, as were those with a substance dependence other than alcohol or marijuana. Those with an affective/anxiety disorder diagnosis were less compliant with psychopharmacological interventions (6 months postattempt). Parental perception of treatment as helpful was predictive of greater compliance, whereas adolescents' attitudes toward treatment were not predictive of compliance. Finally, compliance with treatment was not generally predictive of future suicidality. Conclusions: Interventions focused on increasing compliance with mental health treatment for adolescent suicide attempters should focus on specific child psychopathology, as well as parental attitudes toward treatment.
    Journal of the American Academy of Child & Adolescent Psychiatry 08/2008; 47(8):948-957. DOI:10.1097/CHI.0b013e3181799e84 · 6.35 Impact Factor
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    ABSTRACT: Worldwide, suicide among young men is a major public health concern in most countries. In Norway, as well as abroad, in spite of great efforts invested, we still have scarce scientific evidence of effective prevention strategies, and suicide rates among young men remain high. The failure of effective prevention may be related to the fact that most studies of suicide are based on clinical populations, and the detection and treatment of mental disorder is the main focus in suicide prevention strategies. Yet, a large portion of suicides are not preceded by symptoms of mental disorder (i.e. non-clinical suicides). However, research on non-clinical suicide is almost totally lacking. To further improve our ability to prevent suicide, a broader research focus is needed to understand the complexities of suicides among young men outside the mental illness paradigm. The present study was undertaken to provide a deeper understanding of the role of age, gender and the underlying psychological mechanisms, such as self-esteem, that regulate the dynamics in suicide among young non-clinical men, and thereby to provide knowledge that may lead to new issues for prevention. The three studies included in this dissertation utilised a unique dataset, consisting of 120 in-depth interviews and 12 suicide notes relating to 20 suicides among individuals with no prior psychiatric treatment and no previous suicide attempts (Dieserud, 2006). A sub-sample, consisting of ten cases of young men, aged 18-30, was the focus of this study. The first aim was to provide a deeper understanding of the role of self-esteem in the suicidal process of young non-clinical men who took their lives in the transition period from late adolescence to young adulthood (paper 1). In paper 2, the aim was to explore developmental issues and experiences of the deceased which may have left them vulnerable to suicide when facing adult challenges and defeats. Finally, the aim in paper 3 was to identify any signs in the period immediately before the young men ended their life that might have indicated risk of suicide in near term. All studies are qualitative, phenomenological and hermeneutical, utilising the competence of those close to the deceased; i.e. how they themselves were trying to understand how “he” so suddenly and unexpectedly could end his own life. In-depth interviews with mothers, fathers, male friends, siblings and (ex-)-girl friends brought forward how each one of them experienced the deceased and his conduct in all its complexity. In total 61 interviews, as well as six suicide notes, were analysed guided by Interpretative Phenomenological Analysis (IPA). The findings show that for these young men, the transition to young adulthood, a period of major life challenges, seemed to be associated with deficiencies in the affective capacity to regulate personal defeats. A main finding was that the understanding of these suicides was linked to how a discrepancy between ideal and actual self-performances appeared unsolvable. The analyses pointed to a psychological logic of suicide as a way out of unbearable mental pain; pain that was related to a collapse in the regulation of self-esteem. Developmentally, these young men appeared to have compensated for their lack of self-worth by exaggerating the importance of success and being successful and thus developed a fragile adult achievement based self-esteem, which left them vulnerable in the face of rejections and perceptions of failures. The vulnerability in these young men seemed to be related to how their indispensable efforts to achieve in relation to neglectful or judgemental fathers/father figures left them trapped in anger, and how their dependency in the relationship with their mothers rendered them weak and shameful. Consequently, it may be assumed that the intolerable discrepancy between ideal and actual self, when reaching adulthood (paper 1), is associated in particular with experiences of shame; from being unable to meet significant others’ ideal standards (paper 2). Contrary to previous research, suggesting that mental illness, and in particular depression, in the period prior to death is an important risk factor for suicide, few of the informants mentioned depression or other mental illnesses in their narratives. Thus, the analysis of the role of self-esteem regulation in the suicidal process of young men who in spite of accomplishment and success, unexpectedly took their lives in young adulthood (papers 1 and 2) provides knowledge that may increase our understanding of non-clinical suicides, which is of importance for tailoring better prevention strategies. A major challenge in this respect is related to the fact that most young men who take their own lives are not in contact with, nor seek help from, any health professionals prior to their death. Despite a vast amount of research on clinical risk factors for suicide, research on warning signs is scarce. Thus, the last part of this study was conducted to identify possible warning signs of non-clinical suicides among young men. According to the informants, the young men did not disclose any plans of suicide or make any direct request for help prior to death. Four indirect signs, related to the psychological condition of the young men in the period prior to ending their life, were identified: 1) repeatedly pointing to the irreversibility of a mistaken decision; 2) the desperation they felt in this respect; 3) using their own death as a threat; and 4) and referring to death as a place to go (paper 3). In summary, because non-clinical suicides are not preceded by identifiable symptoms of mental disorder, and most young men who take their life do not seek help prior to death, the present findings underscore that talk or actions indicating suicidality, as well as worrisome indirect appeals for emotional support, should not be left unquestioned, but rather explored directly with the person. Such interpersonal inquiries may mediate some understanding that despair and threats, as well as withdrawal, may be appropriate responses at a personal level, without being effective for problem solving at a social level. Guidelines to increase responsibility for young men under conditions of despair and isolation may carry the potential to save lives.
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    ABSTRACT: To review the past decade of research on teenage suicide with a particular emphasis on epidemiologic trends by age, gender, and indigenous ethnicity. A review of research literature from 2003-2014 was conducted via a comprehensive search of relevant Psychological and Medical databases. Wide gaps in our knowledge base exist concerning the true extent of teenage suicide due to lack of data, particularly in developing countries, resulting in a Western bias. The gender paradox of elevated suicidality in females with higher completed suicide rates in males is observed in teenage populations worldwide, with the notable exceptions of China and India. Native and indigenous ethnic minority teens are at significantly increased risk of suicide in comparison to general population peers. Often those with the highest need for mental health care, (such as the suicidal adolescent), have least access to therapeutic support. Globally, suicide in teenagers remains a major public health concern. Further focused research concerning completed suicides of youth under the age of 18 is required across countries and cultures to understand more about risk as children progress through adolescence. Gender and ethnic variations in suicidality are embedded within cultural, historical, psychological, relational, and socio-economic domains. Worldwide, the absence of child/adolescent-specific mental health policies, may delay the development of care and suicide prevention. It is vital that clinicians adopt a holistic approach that incorporates an awareness of age and gender influences, and that cultural competency informs tailored and evaluated intervention programmes. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email:
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