Factors associated with suicidal phenomena in adolescents: A systematic review of population-based studies

Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
Clinical Psychology Review (Impact Factor: 7.18). 01/2005; 24(8):957-79. DOI: 10.1016/j.cpr.2004.04.005
Source: PubMed


Suicidal phenomena (suicide attempts, deliberate self-harm, and suicidal plans, threats and thoughts) are common in adolescents. Identification of factors associated with these phenomena could play an important role in the development of school or community-based prevention and intervention programs. In this article, we report the results of a systematic review of the international literature on population-based studies of factors associated with suicidal phenomena in adolescents. These factors encompass psychiatric, psychological, physical, personal, familial and social domains. The quantity of evidence in support of associations between suicidal phenomena and specific factors is compared with the quantity of evidence against such associations. We conclude with a summary of the findings, including identification of new or neglected areas, which require further investigation. Methodological considerations are highlighted and implications of the findings for clinicians and other professionals concerned with prevention of suicidal behavior by adolescents are discussed.

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Available from: Keith Hawton, Apr 02, 2015
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    • "Social contexts including peer group, family, school, and community [10] have also been linked with DSH [9] [14] [16]. Evans et al. [9], for example, showed that family conflict is linked with DSH, particularly for females. "
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    ABSTRACT: Purpose: There have been few longitudinal studies of deliberate self-harm (DSH) in adolescents. This cross-national longitudinal study outlines risk and protective factors for DSH incidence and persistence. Methods: Seventh and ninth grade students (average ages 13 and 15 years) were recruited as state-representative cohorts, surveyed, and then followed up 12 months later (N = 3,876), using the same methods in Washington State and Victoria, Australia. The retention rate was 99% in both states at follow-up. A range of risk and protective factors for DSH were examined using multivariate analyses. Results: The prevalence of DSH in the past year was 1.53% in Grade 7 and .91% in Grade 9 for males and 4.12% and 1.34% for Grade 7 and Grade 9 females, respectively, with similar rates across states. In multivariate analyses, incident DSH was lower in Washington State (odds ratio [OR] = .67; 95% confidence interval [CI] = .45-1.00) relative to Victoria 12 months later. Risk factors for incident DSH included being female (OR = 1.93; CI = 1.35-2.76), high depressive symptoms (OR = 3.52; CI = 2.37-5.21), antisocial behavior (OR = 2.42; CI = 1.46-4.00), and lifetime (OR = 1.85; CI = 1.11-3.08) and past month (OR = 2.70; CI = 1.57-4.64) alcohol use relative to never using alcohol. Conclusions: Much self-harm in adolescents resolves over the course of 12 months. Young people who self-harm have high rates of other health risk behaviors associated with family and peer risks that may all be targets for preventive intervention.
    Journal of Adolescent Health 10/2015; 57(5):537-544. DOI:10.1016/j.jadohealth.2015.07.017 · 3.61 Impact Factor
    • "Self-harming behavior may be seen as an expression of a wide variety of problems (Evans et al., 2004) and although it may represent a transient period of distress without further risk, it can also be an important indicator of significant mental health problems and future completed suicide (Reulbach & Bleich, 2008; Zahl & Hawton, 2004). Major depressive disorder, alcohol misuse, and internalising behavior are strongly associated with self-cutting in young people (Shaffer et al., 1996). "
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    ABSTRACT: Adolescents comprise a unique and often challenging group of patients with diverse presentations to the Mental Health Services; suicidal behavior being one of them. The main aim of this naturalistic project was to investigate demographic and clinical correlates of adolescent suicidal and self-harm events, which may be of value to decision-making in clinical practice. All adolescents (n = 149) registered and actively managed by a specialist community mental health service in South London were included in the study. Clinical information from their files was used to determine suicidality/self-harm events. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) was utilised for classification purposes. Logistic regression was used to explore the effects of age, sex, diagnosis, medication, substance use (alcohol and/or cannabis) and ethnicity on suicidality/self-harming behaviors. Age, sex and use of psychotropic medication were identified to play a significant role in determining the risk of engaging in self-harming behavior. The risk was higher with increasing age and female sex. Medication seemed to have a protective effect. Reporting a 20% prevalence of non-suicidal self-injury (NSSI) in our population, we highlight the importance of NSSI as a distinct diagnostic category. Our findings have implications for risk assessment and appropriate decision-making in clinical settings. Results are translatable and relevant to other metropolitan areas.
    Journal of Mental Health 07/2015; 24(4):1-5. DOI:10.3109/09638237.2015.1022249 · 1.01 Impact Factor
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    • "Lesbian, gay and bisexual youth have higher rates of SI and SA compared to their heterosexual peers (Coker, Austin, & Schuster, 2010; Evans et al., 2004); because of the stigmatization of sexual minorities it would be expected that these youth might have higher levels of TB. School performance has been associated with suicide outcomes (Evans et al., 2004), and this finding might be explained by the protective role of competence for PB. Youth with chronic illness might perceive themselves as being a burden to their family, and there is evidence that these youth are at greater risk for suicidality (Barnes, Eisenberg, & Resnick, 2010; Bridge et al., 2006; Evans et al., 2004). "
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    ABSTRACT: Adolescence, when suicidal ideation and behaviors often begin, might offer an important window to understand the causes and prevent the progression of suicide phenomena. The need for frameworks to organize the fragmented field has been noted, but few studies are theoretically driven. An important recent contribution to understanding suicidality is Joiner's (200530. Joiner, T. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.View all references) Interpersonal-Psychological Theory of Suicide (IPTS). This article reviews the evidence for the applicability of the IPTS in adolescence. Seventeen studies of adolescents that specifically tested or interpreted findings in the light of Joiner's theory or the IPTS were located. In addition, several recent reviews of the literature on suicidality in adolescence covered information relevant to the IPTS. There is some support for the theory in adolescence, particularly with regard to its most novel component, the association between acquired capability and suicide attempt. In summary, we find this theory to be a promising heuristic to organize the disparate studies in suicide research. Future challenges and directions for researchers seeking to test and elaborate the applicability of the IPTS in adolescence include: adaptations of instruments to the developmental stage, capturing of imminent risk, and consideration of whether the current model is underspecified. Age might moderate adult findings that give impulsivity an indirect role in suicide attempts.
    Journal of Clinical Child & Adolescent Psychology 04/2015; DOI:10.1080/15374416.2015.1020542 · 1.92 Impact Factor
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