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When Hope Fades: Considering Self-Esteem, Depression, Social Support, Loneliness in The Context of Suicide Prevention

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Abstract

Individuals engaging in suicidal ideation or making suicide attempts are a substantial demographic group to investigate preventive mental health due to inherent high risks associated with potential outcomes of suicidal behaviors for public health. Factors increasing the likelihood of suicide might include self-esteem, depression, social support, loneliness, or certain demographic profiles, and the purpose of this study is to synthesize these variables to advocate for effective strategies to intervene in cases of suicide. Specifically, this commentary aims to identify suicidal coping mechanisms and psychological resilience factors among suicidal individuals through the enhancement of self-esteem, intervention of depressive symptoms, and promotion of connectedness. Through discussing the determinants that might play a role in the onset of suicidal thoughts and suicide attempts, this paper has important implications for suicide prevention strategies and the identification of psychological resilience factors that can predict suicidal thoughts and suicide attempts in individuals.

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The present research study focuses on the relationship between self-esteem and suicidal ideation among the students of senior secondary level. It was hypothesized that there will be no relation between Self-esteem and suicidal ideation. The sample for the study consisted of 120 students of different boards of Senior Secondary examination. Theage of the students ranged between 16 and 18 years. Suicidal Ideation Questionnaire developed by Reynolds (1988) and Self-esteem Scale developed by Rosenberg (1965) were used to measure the level of Suicidal Ideation and Self Esteem respectively. Results revealed that there was negative correlation between Self Esteem and Suicidal Ideation among students. Regression analysis indicated that Low self esteem leads to higher levels of suicidal ideation.
Article
Current theories of loneliness posit that biases in social information processing play a key role in the development and maintenance of loneliness. However, this assumption has rarely been tested in longitudinal research in adolescence. The current study concentrated on two constructs associated with such biases, that is, fear of negative evaluation and self-esteem. More specifically, we examined whether changes in loneliness were associated with simultaneous changes in fear of negative evaluation and self-esteem. A sample of Dutch adolescents (N ¼ 1,174; 50% female) in Grades 7 to 10 completed well-established measures of loneliness, fear of negative evaluation, and self-esteem on four measurement occasions with yearly intervals. Correlations among both initial levels and rates of change for these three variables were examined using a Parallel Process Model (PPM). Adolescents scoring high on loneliness scored high on fear of negative evaluation, but low on self-esteem. Changes in loneliness were accompanied by changes in the same direction for fear of negative evaluation and in the opposite direction for self-esteem. These findings indicate that fear of negative evaluation and low self-esteem could indeed play a role in the development and maintenance of loneliness. Future research will need to clarify how exactly these variables can hamper re-affiliation efforts and lead to sustained loneliness over time.
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Objective: To evaluate the substances used, outcomes, temporal and demographics associated with suicide attempts by self-poisoning in children and young adults aged 10–25 years old from 2000 to 2018. Methods: This is a retrospective review of suspected-suicide self-poisoning cases reported to the National Poison Data System (NPDS) from US Poison Centers from 2000 to 2018 for patients 10–25 years old. For comparison of annual rates, we obtained population data by year of age from the US Census Bureau. We evaluated changes in: monthly and annual incidence/rate per 100,000 population, substances used and outcome by patient age and demographics. Results: There were 1,677,435 cases of suicide attempt by self-poisoning among individuals 10–25 years old reported to US PCCs from 2000 to 2018. There were 410,940 self-poisoning cases (24.5%) with a serious medical outcome, and the proportion of exposures that resulted in a serious medical outcome increased with increasing age group. For the age groups of 10–12, 13–15 and 16–18 years of age, there was a significant increase after 2011, which was influenced primarily by females. The substance groups with the greatest number of serious medical outcomes were OTC analgesics, antidepressants, antihistamines and antipsychotics. ADHD medications were common in the younger age groups of 10–15 years, while the sedative/hypnotics occurred more commonly in the older age groups. The groups with the greatest increase in serious medical outcomes after 2011 were antidepressants, OTC analgesics, antihistamines and ADHD medications. Opiates were less commonly involved (7.4%) in cases with serious medical outcomes and decreased significantly in the 19–25 year-old age groups after 2012. States with a lower population per square mile had a greater number of reported cases with serious medical outcomes. There was a significant decrease in the number of cases in the age groups of 10–18 years during the traditional non-school months of June–August compared with September–May. This seasonal trend occurred among cases with all outcomes and among cases with serious medical outcomes. This decrease did not occur in the age group of 19–21 years, and there was an increase during summer months in the age group 22–25 years. Conclusions: The substances used during self-poisoning varies by age group but appears to include substances available to that age group, with a significant increase after 2011, increased rates in more rural states, and a seasonal variation of increased rates during school months among adolescents but not among young adults. Two of the top substances, OTC analgesics and antihistamines, in all age groups, comprising more than a third of all substances used, are widely available over-the-counter with no restrictions regarding access. Of additional concern, ADHD medications had the highest risk of a serious medical outcome.
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Objective To assess internalizing and externalizing symptoms as risk factors for suicidal behavior and suicide among adolescents and young adults. Method We conducted a systematic review of articles published until January 2017. We identified 26883 potential papers; 1701 full text articles were assessed for eligibility, of which 1479 were excluded due to methodological reasons. Diverse meta‐analyses were performed for each group of symptoms. Odds ratios (ORs) and 95% confidence intervals (95% CI) or beta coefficients for categorical variables, and effect size (ES) were calculated for continuous variables. Results Finally, 41 studies were included, involving participants aged 12–26 years for a systematic review, and 24 articles were included for meta‐analysis. The meta‐analysis showed that youths with any internalizing (ES = 0.93) or externalizing symptoms (ES = 0.76 and OR = 2.59) were more likely to attempt suicide in future. This effect was also seen in depression symptoms (OR = 6.58 and ES = 1.00), legal problems (OR = 3.36), and anxiety (ES = 0.65). Conclusion Reported internalizing and externalizing symptoms are predictors of suicide behavior in young people; therefore, the detection and management of these symptoms in young populations could be a crucial strategy for preventing suicidality in this group. This article is protected by copyright. All rights reserved.
Article
The suggestion that self-esteem is both a protective and a risk factor for depression is well documented. However, this association is not consistently observed by empirical research. The current study investigated the main and interactive effects of low self-esteem and stressful life events on depressive mood in a sample of university students (N = 862; female = 72%; black = 67%; mean age = 21.70, SD = 13.51). The students completed the Hopkins Symptom Checklist, the Rosenberg Self-Esteem Scale, and the Perceived Stress Scale. Data were analysed using structural equation modelling (SEM); with stressful life events scores as a mediator, and gender as a moderator, of the relation between low self-esteem and depression. Results indicate that low self-esteem significantly predicted depression, and that stressful life events partially mediated that relationship. Support emerged for the vulnerability effects of low self-esteem on depression and they held across gender groups. Low self-esteem may be a significant indicator of individuals who are at risk for developing depressive mood.
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Background: Suicide is the second leading cause of death for young people. Objective: To assess mental disorders as risk factors for suicidal behaviour among adolescents and young adults including population-based longitudinal studies. Method: We conducted a systematic literature review. Bibliographic searches undertaken in five international databases and grey literature sources until January 2017 yielded a total of 26,883 potential papers. 1701 full-text articles were assessed for eligibility of which 1677 were excluded because they did not meet our eligibility criteria. Separate meta-analyses were conducted for each outcome (suicide death and suicide attempts). Odds ratio (OR) and 95% confidence intervals (95%CI) and beta coefficients and standard errors were calculated. Results: 24 studies were finally included involving 25,354 participants (12–26 years). The presence of any mental disorder was associated with higher risk of suicide death (OR = 10.83, 95%CI = 4.69–25.00) and suicide attempt (OR = 3.56; 95%CI 2.24–5.67). When considering suicidal attempt as the outcome, only affective disorders (OR = 1.54; 95%CI = 1.21–1.96) were significant. Finally, the results revealed that psychiatric comorbidity was a primary risk factor for suicide attempts. Limitations: Data were obtained from studies with heterogeneous diagnostic assessments of mental disorders. Nine case-control studies were included and some data were collected in students, not in general population. Conclusions: Mental disorders and comorbidity are strong predictors of suicide behaviour in young people. Detection and management of the affective disorders as well as their psychiatric comorbidity could be a crucial strategy to prevent suicidality in this age group.
Article
There is a long tradition in suicide research, accompanied by recent developments in nonsuicidal self-injury (NSSI) research, of examining cognitive processes as potential precursors of risk. But these cognitive processes are often studied separately, and are rarely integrated or directly compared with each other. In an effort to synthesize this literature, this systematic review (n=109 longitudinal studies conducted over the past 10 years) demonstrates how specific cognitive processes predict self-injurious thoughts and behaviors (SITBs), and examines whether intervening on features of cognition may help mitigate SITB risk. Our review reveals that cognitive processes, measured using self-report and behavioral measures, are most often linked to recurrent suicidal ideation. Overall, several patterns emerged. First, SITB-themed cognitions were robust risk factors and proximally associated with SITB outcomes. Second, negatively-valenced cognitive risk factors were the most commonly studied risk factors, relatively robust, and modestly related to SITB outcomes. Third, cognitive deficits (i.e., basic cognitive processes not characterized by thematic content or negative valence) produced mixed findings that suggest a more distal relationship to SITB outcomes. Moreover, our review of treatment articles revealed that while many interventions are informed by the cognitive literature, potential cognitive mechanisms of treatment change are rarely studied. We conclude by outlining key ways that future research can generate more comprehensive cognitive profiles of self-injurious and suicidal individuals.
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Objective: The purpose of this study was to examine whether suicidal ideation in a community population of adolescents represents normative adolescent angst or is predictive of psychopathology, suicidal and problem behaviors, and compromised functioning 15 years after onset. Method: Participants were 346 largely Caucasian individuals who were part of a single-age cohort from a working class community and whose development had been traced prospectively from ages 5 to 30. Those with suicidal ideation at age 15 were compared to those without suicidal ideation at age 15 on measures of psychopathology, suicidal ideation and behavior, problem behaviors, and adult functioning at age 30. Gender differences were assessed across all domains. Results: At age 30, there were marked differences between adolescents with suicidal ideation and adolescents without suicidal ideation of both genders in most domains examined. Subjects with suicidal ideation were twice as likely to have an axis I disorder, nearly 12 times more likely to have attempted suicide by age 30, and 15 times more likely to have expressed suicidal thoughts in the past 4 years. Subjects with suicidal ideation had more problem behaviors and poorer overall functioning as assessed by multiple informants. Their self-perceptions of coping ability, self-esteem, and interpersonal relations were also lower. Although subjects with suicidal ideation among both genders had higher levels of psychopathology, suicidal ideation and behavior, and problem behaviors at age 30, male subjects with suicidal ideation had lower salaries and socioeconomic status and were less likely to have achieved residential independence. Conclusions: Findings underscore the importance of considering suicidal ideation in adolescence as a marker of severe distress and a predictor of compromised functioning, indicating the need for early identification and continued intervention.
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Objective This study was designed to explore the decision‐making processes for disclosing suicidal ideation and behavior. Background Suicide attempt survivors are an invaluable resource that can provide essential information about suicidal behavior and related communication to family and friends. Because of the stigma associated with suicide and seeking help, many individuals choose to conceal their suicidal ideation or behavior or to disclose only to a few family and friends. Method Semistructured, audio‐only interviews were conducted with a convenience sample of 40 suicide‐attempt survivors to develop a grounded theory of factors that influence the decision to disclose current and past suicidal behavior to family members and other individuals within one's social network. Results Several motivations for disclosing (e.g., seeking help, sharing personal information, informing others) were identified, and a majority of the sample conducted an informal cost–benefit analysis before disclosing. The findings also elucidate the process of choosing a person with whom disclosure occurs, and the importance of having that family or friend with whom attempt survivors feel safe disclosing ideation as it occurs as well as subsequently processing the experience and seeking treatment. Conclusion Decision‐making processes for suicide‐related disclosure include identifying motivations to disclose, an informal cost–benefit analysis, and the selection of a recipient to whom one will disclose. Implications This emergent model identifies five tangible intervention strategies for increasing the likelihood of suicide disclosure. Future research should examine the internal resources that motivate individuals to engage in subsequent disclosure to individuals from whom they have previously experienced stigma.
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Background Many studies have documented robust relationships between depression and hopelessness and subsequent suicidal thoughts and behaviours; however, much weaker and non-significant effects have also been reported. These inconsistencies raise questions about whether and to what degree these factors confer risk for suicidal thoughts and behaviours. Aims This study aimed to evaluate the magnitude and clinical utility of depression and hopelessness as risk factors for suicide ideation, attempts and death. Method We conducted a meta-analysis of published studies from 1971 to 31 December 2014 that included at least one longitudinal analysis predicting suicide ideation, attempt or death using any depression or hopelessness variable. Results Overall prediction was weaker than anticipated, with weighted mean odds ratios of 1.96 (1.81–2.13) for ideation, 1.63 (1.55–1.72) for attempt and 1.33 (1.18–1.49) for death. Adjusting for publication bias further reduced estimates. Effects generally persisted regardless of sample severity, sample age or follow-up length. Conclusions Several methodological constraints were prominent across studies; addressing these issues would likely be fruitful moving forward. Declaration of interest None.
Article
The learned helplessness hypothesis is criticized and reformulated. The old hypothesis, when applied to learned helplessness in humans, has two major problems: (a) It does not distinguish between cases in which outcomes are uncontrollable for all people and cases in which they are uncontrollable only for some people (univervsal vs. personal helplessness), and (b) it does not explain when helplessness is general and when specific, or when chronic and when acute. A reformulation based on a revision of attribution theory is proposed to resolve these inadequacies. According to the reformulation, once people perceive noncontingency, they attribute their helplessness to a cause. This cause can be stable or unstable, global or specific, and internal or external. The attribution chosen influences whether expectation of future helplessness will be chronic or acute, broad or narrow, and whether helplessness will lower self-esteem or not. The implications of this reformulation of human helplessness for the learned helplessness model of depression are outlined.
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Background: Loneliness has been linked to an increased risk of engaging in suicidal behavior. To date, however, there has been comparatively little research on this in the general adult population, or on the role of common mental disorders (CMDs) in this association. The current study examined these associations using nationally representative data from England. Methods: Data came from the Adult Psychiatric Morbidity Survey 2007. Information was obtained from 7403 household residents aged ≥16 years on perceived loneliness and lifetime and past 12-month suicide ideation and attempts. The Clinical Interview Schedule Revised (CIS-R) was used to assess six forms of CMD. Logistic regression analysis was used to examine these associations. Results: Loneliness was associated with suicidal behavior. Although adjusting for CMDs attenuated associations, higher levels of loneliness were still significantly associated with suicidal ideation and suicide attempts with odds ratios (OR) for those in the most severe loneliness category ranging from 3.45 (lifetime suicide attempt) to 17.37 (past 12-month suicide attempt). Further analyses showed that ORs for suicidal behavior were similar for individuals who were lonely without CMDs, and for those respondents with CMDs who were not lonely. Lonely individuals with CMDs had especially elevated odds for suicidal ideation. Limitations: This study used cross-sectional data and a single-item measure to obtain information on loneliness. Conclusion: Loneliness is associated with suicidal behavior in the general adult population. This highlights the importance of efforts to reduce loneliness in order to mitigate its harmful effects on health and well-being.
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Abstract Objective: Given depression is a significant risk factor for suicidal behaviour, it is possible that interventions for depression may also reduce the risk of suicide in adolescents. The purpose of this literature review is to determine whether psychological interventions aimed to prevent and/or treat depression in adolescents can also reduce suicidality. Methods: We conducted a systematic review of psychological interventions aimed to prevent and/or treat depression in adolescents in which outcomes for suicidality were reported, using five databases: PsycINFO, Embase, Medline, CINAHL and Scopus. Study quality was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Results: A total of 35 articles pertaining to 12 treatment trials, two selective prevention trials and two universal prevention trials met inclusion criteria. No studies were identified that used a no-treatment control. In both intervention and active control groups, suicidality decreased over time; however, most structured psychological depression treatment interventions did not outperform pharmaceutical or treatment as usual control groups. Depression prevention studies demonstrated small but statistically significant reductions in suicidality. Limitations: Analysis of study quality suggested that at least 10 of the 16 studies have a high risk of bias. Conclusive comparisons across studies are problematic due to differences in measures, interventions, population differences and control groups used. Conclusions: It is unclear whether psychological treatments are more effective than no treatment since no study has used a no-treatment control group. There is evidence to suggest that Cognitive Behavioural Therapy interventions produce pre–post reductions in suicidality with moderate effect sizes and are at least as efficacious as pharmacotherapy in reducing suicidality; however, it is unclear whether these effects are sustained. There are several trials showing promising evidence for family-based and interpersonal therapies, with large pre–post effect sizes, and further evaluation with improved methodology is required. Depression prevention interventions show promising short-term effects. Keywords Suicide, adolescents, depression, systematic review, treatment
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Suicide is a complex public health problem of global importance. Suicidal behaviour differs between sexes, age groups, geographic regions, and sociopolitical settings, and variably associates with different risk factors, suggesting aetiological heterogeneity. Although there is no effective algorithm to predict suicide in clinical practice, improved recognition and understanding of clinical, psychological, sociological, and biological factors might help the detection of high-risk individuals and assist in treatment selection. Psychotherapeutic, pharmacological, or neuromodulatory treatments of mental disorders can often prevent suicidal behaviour; additionally, regular follow-up of people who attempt suicide by mental health services is key to prevent future suicidal behaviour.
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Background: The purpose of this study is to investigate whether the type and number of stressful life events (SLEs) will be associated with suicidal behavior in a 3-year follow-up period in persons with major depressive disorder (MDD). Methods: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative longitudinal survey of mental health in non-institutionalized adults in the United States. The survey consisted of two waves: Wave 1 (2001-2002) and Wave 2 (2004-2005), n = 34,653. Twelve past-year SLEs were assessed at baseline. These SLEs were categorized into the following groups based on previous research: Loss or victimization; Relationship, friendship, or interpersonal stress; Financial stress; and Legal problems. Only respondents with MDD at Wave 1 were included (n = 6004). Results: Several SLEs were strongly associated with suicide attempts, among which, "serious problems with neighbor, friend or relative" [adjusted odds ratio (AOR) = 2.21; 95% confidence interval (95% CI): 1.41, 3.45] and "major financial crisis, bankruptcy or unable to pay bills" [AOR = 2.31; 95% CI: 1.45, 3.66] were the most robust predictors of suicide attempts even after adjusting for sociodemographic variables and any anxiety, substance use, or personality disorder. Conclusions: People with MDD who had been exposed to certain SLEs are at elevated risk for future suicide attempts, even after accounting for the demographic factors and psychiatric comorbidity.
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This study investigated the effect of loneliness on depression and further tested the mediating effect of social support. A total of 320 elderly persons completed the Emotional and Social Loneliness Scale, Multidimensional Scale of Perceived Social Support, and Self-Rating Depression Scale. Results revealed that loneliness and social support significantly correlated with depression. Structural Equation Modeling indicated that social support partially mediates loneliness and depression. The final model illustrated a significant path from loneliness to depression through social support. This study sheds light on the concurrent effects of loneliness and social support on depression, providing evidence on how to reduce depression among the elderly.
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Objectives: We present a study on the role of social support and positive events as protective factors in suicide. Methods: Participants (n = 379) were administered measures of social support, life events, depressive symptoms and suicide ideation. Results: Results indicated that (a) social support had a direct protective effect on suicide ideation (b) social support and positive events acted as individual buffers in the relationship between negative events and suicide ideation, and (c) social support and positive events synergistically buffered the relationship between negative events and suicide ideation. Conclusion: Our results provide evidence that positive events and social support act as protective factors against suicide individually and synergistically when they co-occur.