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The Suicidal Process and Self-Esteem


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It has not been made clear whether self-esteem is associated with the severity of suicidal behavior. To test the association between responses to a self-esteem inventory and levels of suicidal behavior as conceptualized in the notion of the suicide process. Questions on the severity of suicidal behavior over the lifespan (death wishes, ideation, plans, and attempts), as well as a self-esteem inventory, were administered to 227 university undergraduates. A negative relationship was found between the level of suicidality and self-esteem. As hypothesized, there were fewer cases in each succeeding level of seriousness of suicidal behavior. However, nearly all cases from any particular level were contained in the cohort of individuals who had displayed suicidal behavior at a less serious level. This suggests a possible progression through each of the stages of suicidal behavior, with very few cases showing a level of suicidal behavior that was not associated with a previous, less serious, form. It was hypothesized that early entry into the suicidal process may be indicated by low self-esteem, thus, allowing for a more timely preventive intervention.
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A.H. Thompson:Self-Esteem and SuicideCrisis2010;Vol. 31(6):311–316© 2010HogrefePublishing
Research Trends
The Suicidal Process and Self-Esteem
Angus H. Thompson
Institute of Health Economics, Edmonton, Alberta, Canada
Abstract. Background: It has not been made clear whether self-esteem is associated with the severity of suicidal behavior. Aims: To test
the association between responses to a self-esteem inventory and levels of suicidal behavior as conceptualized in the notion of the suicide
process. Methods: Questions on the severity of suicidal behavior over the lifespan (death wishes, ideation, plans, and attempts), as well
as a self-esteem inventory, were administered to 227 university undergraduates. Results: A negative relationship was found between the
level of suicidality and self-esteem. As hypothesized, there were fewer cases in each succeeding level of seriousness of suicidal behavior.
However, nearly all cases from any particular level were contained in the cohort of individuals who had displayed suicidal behavior at a
less serious level. Conclusions: This suggests a possible progression through each of the stages of suicidal behavior, with very few cases
showing a level of suicidal behavior that was not associated with a previous, less serious, form. It was hypothesized that early entry into
the suicidal process may be indicated by low self-esteem, thus, allowing for a more timely preventive intervention.
Keywords: suicide, ideation, attempts, self-esteem, suicide process
Self-esteem has been one of the most widely studied con-
cepts in the mental health field and has been linked to a
wide variety of mental health conditions and behaviors.
Many studies have demonstrated strong connections be-
tween self-esteem and both suicidal ideation and suicide
attempts (Bhar, Ghahramanlou-Holloway, Brown, & Beck,
2008; Marciano & Kazdin, 1994; Overholser, Adams, Leh-
nert, & Brinkman, 1995; Roberts, Roberts, & Chen 1998;
Wild, Flisher, & Lombard, 2004). Other investigations into
this relationship have focused on more specific aspects of
suicidal behavior such as death wishes, suicidal ideation
and making a suicide plan, as well as on suicide attempts.
These particular behaviors are commonly viewed as com-
prising an orderly progression. That is, suicidal ideation is
generally thought to precede a suicide attempt (Beck, Ko-
vacs, & Weissman, 1979) and movement from a death wish
through to a suicide attempt has been discussed under the
concept of “the suicide process” (Portzky, Audenaert, &
van Heeringen, 2005; Runeson, Beskow, & Waern, 1996;
van Heeringen, Hawton, & Williams, 2000) or interpreted
as a hierarchy of intent (Mo?cicki, 1989). However, few
studies have systematically examined the relationship be-
tween these levels of suicidal behavior and any measure of
mental health. Recently, however, it has been observed that
those with early-onset depression progressed to more seri-
ous levels of suicidality than those with later onset (Thomp-
son, 2008).
Self-esteem is generally regarded as a stable personality
characteristic that reflects a sense of personal worth (Ro-
senberg, 1965). The concept is not to be confused with self-
efficacy or self-confidence, which are related to a belief in
one’s ability to perform. Although self-esteem correlates
with depression and may, thus, be causally linked, these
conditions also need to be distinguished since the former
is a self-rating and the latter a description of mood. Indeed,
Thompson, Barnsley, and Battle (2004) have suggested that
low self-esteem may generally precede depression, indicat-
ing that the link may be functional but not necessarily con-
Not surprisingly, then, self-esteem is frequently noted as
a correlate, and often as a predictor, of one or another of
the components of the suicidal process (e.g., Hidaka et al.
2008; Martin, Richardson, Bergen, Roeger, & Allison,
2005; McAuliffe, et al. 2005; McGee & Williams, 2000;
McGee, Williams, & Nada-Raja, 2001; Park, Schepp, Jang,
& Koo, 2006; Reinherz, Tanner, Berger, Beardslee, & Fitz-
maurice, 2006). In spite of this, and even with the interest
in both self-esteem and the suicidal process, there have
been no studies that have arranged these suicidal behaviors
in order of seriousness and examined changes in self-es-
teem across the resulting dimension.
This study, then, was designed to examine the relation-
ship between self-esteem and suicidality, with the expecta-
tion that progressive decreases in self-esteem would be as-
sociated with increases in the seriousness of suicidal be-
It should be noted that there are still some definitional
issues pertaining to the suicidal process. Researchers in this
area (e.g., Portzky et al., 2005; Runeson et al., 1996; van
Heeringen et al., 2000) have described the progression
through the levels of the suicide process in terms of “sever-
ity,” “seriousness,” “lethality,” or “intent.” However, not
all individuals exhibiting suicidal behavior may actually
wish to die, including even some who have made a suicide
attempt (Kreitman, Phillip, Greer, & Bagley, 1969). There-
fore, terms like “lethality” or “intent,” could be misleading.
DOI: 10.1027/0227-5910/a000045
© 2010 Hogrefe Publishing Crisis 2010; Vol. 31(6):311–316
Van Heeringen (2001) has provided more on this defini-
tional issue. At present, it appears prudent to view the con-
cept of the suicide process as a working hypothesis that will
allow us to work toward further refinements. Until consen-
sus is reached on the most useful way to describe move-
ment through the suicide process, the commonly used
terms should be viewed with a certain allowance for impre-
In this study, the terms “seriousness” and “suicidality”
have been adopted to address variations in the level of sui-
cidal behavior to avoid debatable claims about severity
and/or lethality.
Participants were students in two nonintroductory under-
graduate psychology classes at a Canadian university . Par-
ticipation was voluntary, but it appeared that all, or nearly
all, of the students present completed the questionnaire.
There were a total of 227 participants; 80 (35%) were male.
Ages ranged from 17.8 to 46.3 years. The age distribution
showed a positive skew, with a mode of 19 years, median
of 21.4 years, and a mean of 23.4 years (SD = 5.70).
An information statement was placed at the beginning
of the questionnaire to explain that participation was vol-
untary and that a decision to participate or to not participate
would have no bearing on marks or any other aspect per-
taining to studies at the university. Students were asked to
supply their university identification number to allow link-
age with their course marks (not used in the present study).
It was made clear that all information would be kept con-
fidential and that the identification numbers would be de-
leted as soon as the linkage was made. This study was ap-
proved by the Ethics Committee of the Department of Psy-
chology at the University of Alberta.
The items used to assess the level of suicidality were adapt-
ed from the Diagnostic Interview Schedule (Robins, Hel-
zer, Croughan, Williams, & Spitzer, 1981), and are similar
in nature to items introduced in an epidemiologic study by
Paykel, Myers, Lindenthal, and Tanner (1974). The pur-
pose was to create a scale representing meaningful incre-
ments in suicidal intent. The four resultant questions, re-
spectively representing a death wish (without suicidal con-
tent), suicidal ideation (thoughts of taking one’s one life),
making a plan, and making an attempt, are as follows:
1. Has there ever been a period when you felt like you
wanted to die?
2. Have you felt so low you thought of committing suicide?
3. Have you ever made definite plans to commit suicide
(even though you did not actually make an attempt)?
4. Have you ever attempted suicide?
Self-esteem was measured with the Culture-Free Self-Es-
teem Inventory (CFSEI; Battle, 1981). An important con-
sideration in the selection of this instrument was the fact
that it was developed on a Canadian sample (Battle, 1981),
thus providing norms that were well suited to the partici-
pants in the present study. The adult form (AD) of this pa-
per and pencil test produces a total self-esteem score with
three component subscales; Social, Personal, and General
self-esteem, comprising, respectively, 8, 8, and 16 items.
Test-retest reliabilities are high (0.81). However, internal
consistency reliabilities were not as strong, showing Cron-
bach’s αvalues of 0.78, 0.72, and 0.57 for general, person-
al, and social self-esteem, respectively (Brooke, 1995);
with social self-esteem falling below the generally accept-
ed standard of 0.70. Concurrent validity was supported by
positive correlations (.71 to .80) between the child/adoles-
cent form of the CFSEI and Coopersmith’s (1967) Self-Es-
teem Inventory (Battle, 1981). No concurrent validity data
were shown for the CFSEI adult form. A number of studies
have shown positive associations between the CFSEI and
a variety of measures of depression, with correlations rang-
ing from 0.34 to 0.75 (Brooke, 1995).
In view of the fact that all of the subjects were students,
academic self-esteem was also of interest. Therefore, a 10-
item Academic Self-Esteem scale (not included in the adult
Form, AD) was adapted from the child/adolescent scale of
the same test (Form A), and added to the questionnaire used
in the present study. A similar approach to the inclusion of
the child/adolescent academic scale in the adult form was
successfully undertaken by Mendoza (1995). Since the
norms for the child/adolescent CFSEI academic subscale
are nonetheless not suitable for use in a study of adults, the
results for the academic subscale were calculated as if the
sample displayed the same mean and standard deviation as
the normative population. Given that this assumption may
be incorrect, main effect contrasts of subscale means could
be biased. However, comparison of subscale means is of
little interest here, and the analyses will, thus, focus on dif-
ferences in the level of suicidal behavior.
A total self-esteem score was calculated by summing the
scores of the four component scales. Raw scores were con-
verted to T-scores (mean = 50, SD = 10) for analysis and
presentation of results.
The results of an assessment of the internal consistency of
the four subscales of the CFSEI showed that three of the
scales produced Cronbach’s αcoefficients that surpassed
the 0.70 standard; Personal (0.77), General (0.81), and Ac-
ademic (0.73). The fourth, Social (0.60), was marginal,
312 A. H. Thompson: Self-Esteem and Suicide
Crisis 2010; Vol. 31(6):311–316 © 2010 Hogrefe Publishing
matching its relatively low performance on the normative
Of first importance, 52% of the students had, at some
time in their lives, engaged in some form of suicidal idea-
tion or behavior. As Table 1 indicates, nearly all of these
had, at some time, wished to be dead, fewer expressed
suicidal ideation, and the number making plans to take
their own lives was considerably lower than that. Al-
though a relatively small number had made a suicide at-
tempt, it still stands at a disturbing rate of 1 in 20 persons.
This rate lies within the range reported in reviews by
Angst, Degonda and Ernst in 1992, Weissman et al. in
1999, and Welch in 2001, but is higher that reported by
Bertolote et al. in 2005.
Also shown in Table 1 is the classification of the most
serious level of suicidal behavior attained by the respon-
dents. A one-way analysis of variance (ANOVA) showed
that total self-esteem varied significantly with changes in
the level of suicidal behavior, F(4, 191) = 7.61, p< .001.
Figure 1 clearly shows that as the level of suicidal behavior
increased, mean total self-esteem scores decreased. Post-
hoc polynomial analysis showed that the linear trend was
statistically significant, F(1, 191) = 20.28, p< .001, but the
departure from linearity was not, F(3, 191) = 0.60. The ab-
sence of a statistically significant nonlinear presence indi-
cates that there is no reason to question the conclusion that
the data can best be described as a linear gradient of de-
creasing self-esteem on increasing suicidality.
Since unequal cell sizes may affect the ANOVA as-
sumption of equal group variance, Levene’s test for ho-
mogeneity of variance was applied to the raw data. The
result was a statistically significant departure from equal-
ity, Levene’s Statistic (4/222) = 5.80, p< .001. However,
ANOVA is very robust when it comes to the assumption
of homogeneity. The variances of the five severity groups
ranged from a high of 93.5 down to 30.7, a ratio of 3.0,
which is within the acceptable range (below ) suggest-
ed by Moore (1995).
The trend analysis of the relationship between severity
of suicidal behavior and total self-esteem produced sim-
ilar results for each of the component subscales of the
CFSEI. This was tested posthoc by conducting a one-way
ANOVA on each of the four self-esteem subscales (a fac-
torial analysis was not used since the within-subject com-
parisons across self-esteem levels were not of interest).
The significance levels were adjusted upward to compen-
sate for the multiple comparisons involved when evalu-
ating the subscales in this way.
Table 1. Respondents distributed according to the level of
severity of suicidal behavior
None Death
Ideation Plan Attempt
Total* 108 (48%) 115 (51%) 80 (35%) 26 (12%) 12 (5%)
38 (17%) 52 (23%) 16 (7%) 12 (5%)
Note. *Many respondents reported more than one type of parasuicidal
behavior, thus the row total exceeds 100%. #Categories are mutually
exclusive. Assignment was determined by each person’s most serious
level of suicidal behavior.
Figure 1. Total self-esteem and suicid-
al behavior among university stu-
A. H. Thompson: Self-Esteem and Suicide 313
© 2010 Hogrefe Publishing Crisis 2010; Vol. 31(6):311–316
A significant linear trend was observed for all four sub-
scales with none showing a statistically significant departure
from linearity (for General, Social, Academic, and Personal
self-esteem, respectively, the FLinear values were 14.51, p<
.001; 6.48, p<.05;8.67,p< .05; and 10.53, p<.01).No
further analysis of the subscales was conducted since they
mirror the downward trend found for total self-esteem.
Of further interest is the probability that a particular level
of suicidal behavior was “preceded” by a less serious level.
The results of this analysis are shown in Table 2. Clearly,
nearly all of those who exhibited a particular level of suicidal
behavior had experienced what are hypothesized to be ante-
cedent suicidal behaviors. That is, 91% of attempts were pre-
ceded by plans; plans, in turn, were associated with ideation
in all cases; and ideation was associated with a death wish in
96% of cases.
Although these findings appear at first glance to be some-
what banal (i.e., it is difficult to imagine how someone could
make a suicide plan without thinking about it beforehand),
the results noted in the previous paragraphs make it clear that
each level of suicidality has a different meaning – at least in
terms of self-esteem. Furthermore, this kind of analysis begs
the question of whether the results suggest something differ-
ent when the levels are viewed in reverse order (their sup-
posed chronological sequence). It turns out thatthey do – the
associations were considerably lower in magnitude when
viewed in this way, but remained at meaningful levels. That
is, of those with a death wish, 67% exhibited suicidal idea-
tion; only 33% of ideators produced a plan, and just 38% of
those who made a plan also made an attempt. These data are
in line with the view that the five levels (an absence of sui-
cidal behavior being the first) represent a progression of in-
creasing seriousness, with the number of participants drop-
ping at each level. This inverse relationship between serious-
ness of behavior and the lifetime prevalence of suicidality is
in accord with the findings from a number of community
surveys (De Leo, Cerin, Spathonis, & Burgis, 2005; Kessler,
Borges, & Walters, 1999; Mo?cicki et al., 1988; Paykel et al.,
1974; Rancans, Lapins, Salander Renberg, & Jacobsson,
The results of this study demonstrate that self-esteem is
associated with the seriousness of suicidal behavior and
that the association is linear. The fact that self-esteem goes
down as the severity of suicidal behavior goes up does not,
however, prove causation. That is, we cannot say that sui-
cidal behavior is a consequence of lowered self-esteem.
Nor can we rule out the opposing hypothesis that current
self-esteem scores have been affected by previous suicidal
behavior. Our understanding of the sequence of events
would be enhanced by the inclusion of age data for both
variables in future studies of this nature. The primary im-
portance of this finding lies in the association. This extends
the previous findings on the self-esteem/suicidal behavior
relationship by indicating the existence of a gradient that
involves seriousness. That is, one way or the other, there is
a clear relationship indicating that increases in the serious-
ness of suicidal behavior are associated with decreases in
It should be noted that this finding was based on a stu-
dent sample and generalization to other groups has not yet
been demonstrated. Furthermore, there are two caveats that
need to be applied to the notion of self-esteem and to the
nature of the proposed suicidal process. First, self-esteem
is being used here to serve as an important indicator of
well-being, not to denote a behavior that can be modified
to produce a therapeutic outcome – this latter notion being
hotly disputed by many (Burr & Christensen, 1992; Selig-
man, 1991; Smelser, 1989). Second, a number of investi-
gators have indicated that it would be a mistake to consider
the suicidal process to be invariant. For example, Wyder
and De Leo (2007) have suggested that the process would
be better characterized as fluctuating, rather than smooth;
Bertolote et al. (2005) have noted that it varies according
to culture; and Fortune, Stewart, Yadav, and Hawton (2007)
have identified three types of suicidal processes – not one.
Nevertheless, the fact that each level of suicidal behav-
ior was almost always associated with the adjoining, less
serious, level of suicidal behavior supports the hypothesis
that end-point suicidality follows a suicidal process of in-
creasing intensity that begins with occasional thoughts of
death (Angst et al., 1992) and stops at some point along a
single continuum whose last possible position is completed
suicide. The reason, then, that prediction forward along this
scale is less than perfect appears to be because some indi-
viduals move to a certain level of severity and go no further
– not because the construct of the suicidal process is faulty
or because of measurement error. We are, nonetheless, left
with the difficulty of predicting a low probability event
(e.g., a suicide attempt) from an early behavior (e.g., a wish
to die) that is exhibited at some point by a large proportion
of the population. Thus, early suicidal behavior appears to
have very high sensitivity for completed suicide (it captures
most cases of more serious suicidal behavior), but very low
specificity (it also captures many false positives) – a tradi-
tional problem in research on risk factors (Leon, Friedman,
Sweeney, Brown, & Mann, 1990).
This paper shows a linear relationship between two im-
portant variables that lie along a developmental pathway.
This indicates that detection of early entry into the suicidal
Table 2. The proportion of individuals acknowledging a
particular level of suicidal behavior who also dis-
played relatively “lower” levels of severity
Lower level relative to index level
Index level % with a plan % with ideation % with a death wish
Attempt 91% 100% 100%
Plan 100% 100%
Ideation 96%
314 A. H. Thompson: Self-Esteem and Suicide
Crisis 2010; Vol. 31(6):311–316 © 2010 Hogrefe Publishing
process can allow the provision of preventive interventions
that can, in many cases, be applied well before the advent
of more serious suicidal actions. The importance of the re-
lationship with self-esteem lies in the fact that early suicidal
behavior (i.e., a death wish, a suicidal thought) is not easily
detected unless expressed in a public way. Low self-es-
teem, on the other hand, is usually manifest in observable
behaviors, and its formal (questionnaire) assessment is not
deemed to be as intrusive as questions about suicidal
thoughts or actions. Thus, among children, evidence of low
self-esteem should raise enough concern about future sui-
cidal behavior and other personal difficulties that further
investigation, at the least, should be deemed necessary.
Yan Jin provided valuable assistance in data collection and
the early literature search.
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About the author
Dr. Angus Thompson has served as Vice-President of the Cana-
dian Association for Suicide Prevention and has previously man-
aged Alberta’s Provincial Suicidology program. He has served as
a clinical psychologist, policy analyst, and senior manager. Re-
search involvement includes suicide, mental health, problem
gambling, and health services with a recent focus on work pro-
Angus H. Thompson
Institute of Health Economics
1200 – 10405 Jasper Avenue
Edmonton, Alberta T5 J 3N4
Tel. +1 780 448-4881
Fax +1 780 448-0018
316 A. H. Thompson: Self-Esteem and Suicide
Crisis 2010; Vol. 31(6):311–316 © 2010 Hogrefe Publishing
... Previous studies suggested strong connections between low self-esteem and Suicidal Ideation and suicidal attempts (Bhar et al., 2008;Thompson, 2010;Wild et al., 2004). More specifically, a deficit in selfesteem in relation to suicidal behaviour has remained a particular focus of attention among researchers. ...
... It is suggested that youth with low self-esteem develop Suicidal Ideation as a way to escape from the distressing emotions that are related to their negative self-evaluation. Particularly, negative self-evaluation has been identified as a significant factor in developing Suicidal Ideation among adolescents (Bhar et al., 2008;Fergusson et al., 2003;Rasmussen et al., 2018;Thompson, 2010). ...
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The main purpose of the study was to assess the relationship between self-esteem and suicidal ideation in undergraduate students (N= 600). A Structural Equation Modeling approach was used to analyse the data. All fit indices were examined on measurement level. Relationships between three latent variables: positive self-esteem, negative self-esteem, and suicidal ideation were assessed on structural level. Results revealed that students with negative self-esteem were more prone towards suicidal ideation. Moreover, those students who were having positive self-esteem were less likely indicating suicide ideation which suggested that positive self-esteem is a protective factor against suicidal ideation among students.
... The results of the analysis have indicated, in general, a very strong negative correlation between self-esteem and suicidal issues, which is consistent with (Thomson, 2010). In detail, the self-esteem of those, who possess suicidal ideation or attempt suicide would normally be extremely lower or negative. ...
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Self-esteem is the backbone for psychological resilience, and the psychological resilience of a person determines his or her overall resilience nature. Obviously, armed conflict-driven protracted displacements and associated tragic events often possess the potential to alter the self-esteem of individuals with ailing war-related experiences. As far as esteem needs are concerned, in the armed conflict-driven displacements in lower and lower-middle-income countries, the self-esteem needs of the victims of sexual and gender-based violence are not adequately addressed in some instances. To support the arguments, the psychosocial nature of the internally displaced Iraqi Yazidi females was considered, and a detailed narrative review of the documents related to Iraqi Yazidis' displacement, subsequent sexual violence, and Yazidis' psychosocial landscape in a post-conflict context was performed. The results of the review have identified the followings: (i) a negative correlation between sexual and gender-based violence and self-esteem; (ii) no correlation between social honour or social pride and the self-esteem of Yazidi females; (iii) negative correlation between self-esteem and psychiatric or psychopathological incidents as well as suicidal intentions among Yazidi females; (iv) fulfilling esteem needs of the Yazidi Internally Displaced Persons (IDPs) and returnees in Iraq should need further backing to improve the quality and quantity. The aim of this paper is to examine the importance of fulfilling the esteem needs of armed conflict-driven internally displaced populations, especially those, who experience sexual violence during armed conflicts from the context of Iraqi Yazidi female IDPs.
... 11 In adolescence, low self-esteem is a potential risk factor for depression and is associated with increased suicidality. 12,13 In Pakistan, so far, no such data exists on self-esteem among young acne vulgaris patients. The scarce data that is currently available cannot be applied to population of our setting and the consequences faced by the young patients with acne vulgaris. ...
... First, the association between suicidal tendencies and poor tooth brushing habits may not be associated with the experience of low self-esteem, which acts as an early entry into the suicidal process [47][48][49]. A prior study in India found an association between suicidal ideation/ attempt and poor oral hygiene status, but not with tooth brushing frequency or tooth brushing duration [50]. ...
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Background Oral health is a less-recognized correlate of overall and mental wellbeing. This study aimed to assess the relationship between suicidal behavior (ideation and attempt) and oral health practices and status, and to determine the effect of sex on these associations among Nigerian adolescents. Methods Household survey data were collected from 10 to 19-year-old adolescents in southwestern Nigeria. Dependent variables were daily tooth brushing, daily consumption of refined carbohydrates between meals, and oral hygiene status (measured by plaque index). The independent variable was lifetime suicidal ideation/attempt, dichotomized into ‘yes’ and ‘never’. ‘Daily tooth brushing’ and ‘daily consumption of refined carbohydrates between meals’ were included in two separate logistic regression models, and ‘oral hygiene status’ was included in a linear regression model. The models were adjusted for sex, age, and socioeconomic status. The linear regression model was also adjusted for frequency of daily tooth-brushing and of consumption of refined carbohydrates between meals. Interactions between sex and suicidal ideation/suicide attempt in association with dependent variables were assessed. Significance was set at 5%. Results We recruited 1,472 participants with mean age (standard deviation) of 14.6 (2.6) years. The mean plaque index was 0.84 (0.56), and 66 (4.5%) adolescents reported ever having suicidal ideation/attempt. Suicidal ideation/attempt was associated with significantly lower likelihood of tooth brushing (OR = 0.48, 95% CI: 0.26, 0.91), higher likelihood of consuming refined carbohydrates between meals (OR = 2.30, 95% CI: 1.29, 4.10), and having poor oral hygiene (B = 0.18, 95% CI: 0.05, 0.32). Among males, suicidal ideation/attempt was associated with less likelihood of eating refined carbohydrates between meals (OR = 0.96, 95% CI: 0.35, 2.61). Conversely, it was associated with a significantly higher likelihood of this outcome (OR = 4.85, 95% CI: 2.23, 10.55) among females. Conclusion The study findings suggest that poor tooth brushing habits and poor oral hygiene are indicators for risk of suicidal behavior for adolescents in Nigeria, while high sugar consumption may be an additional risk factor for adolescent females. These findings support the role of dental practitioners as members of healthcare teams responsible for screening, identifying and referring patients at risk for suicidal ideation/attempt.
... Moreover possible association of disturbances within DMN and SN and vulnerability to suicidal behavior was also mentioned inter alia by Van Heeringen et al. (2014). A noteworthy fact is that negative self-concept is associated with suicidal behaviors (Bhar et al., 2008;Santos et al., 2009;Thompson, 2010), whereas regions which are considered to be a part of the DMN Raichle et al., 2001) are known to be involved in self-referential processing (Northoff and Bermpohl, 2004;Northoff et al., 2006). ...
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Objective: The occurrence of death by suicide in patients diagnosed with bipolar disorder is as much as 60 times greater than in the general population. Even during the state of euthymia patients are characterized by suicide risk. The aim of the study is to investigate the baseline brain activity in euthymic bipolar disorder patients in regard to suicide risk. We hypothesized that patients compared to healthy control group will demonstrate altered functional connectivity among resting state networks which will be directly related to current suicide risk. Method: 41 subjects were enrolled in the study consisting control group (n = 21) and euthymic bipolar disorder patients group (n = 20). Functional magnetic resonance imaging was used to evaluate resting state brain activity and ROI-ROI functional connectivity analysis was performed. Suicidal risk was estimated using The Suicide Behaviors Questionnaire-Revised. Results: A two sample t-test revealed decreased functional connectivity between regions involved in the salience network in patients compared to the control group. This decrease was negatively correlated with current suicide risk. Conclusion: Obtained results suggest the association between risk of suicide and activity of regions responsible for functions such as learning from mistakes, prospective thinking, and sensory integration.
Introduction: People who are attracted to children may be at elevated risk for suicidal ideation and behavior compared to the general population. However, factors associated with suicidal ideation and behavior in this population represent a gap in the literature. Methods: The current study used multilinear regression to explore the impact of self-esteem and perceived social support on suicidal ideation and behavior in a sample of 154 adults attracted to children. Mediation analysis was conducted to investigate the role of lifetime major depressive disorder and hopelessness in these relationships. Results: Results showed high prevalence of past-year and lifetime suicidal ideation and behavior in the sample. Both self-esteem and perceived social support demonstrated significant, inverse relationships with suicidal ideation and behavior after adjustment for covariates. Mediation analyses provided support for the role of hopelessness, but not depression, in these relationships. Conclusion: Results demonstrate high rates of suicidal ideation and behavior among adults attracted to children and highlight important opportunities for prevention and intervention. Improving self-esteem, bolstering perceived social support, reducing hopelessness, and removing barriers to help-seeking may be targets for improving mental health and preventing suicidal ideation and behavior in this population.
Background Suicide is a global health problem with considerable variability across countries in its prevalence and correlates. The aims of this study were to: (a) explore the prevalence and psychosocial determinants of adolescent suicidal ideation, and (b) explore the perceived stigma of suicide among adolescents. Method A nationally representative electronic survey was utilized to collect data from school adolescents. The Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data was used to design the survey. The study collected data on adolescents' suicidal ideation, depression, self-esteem, stigma of suicide, family functioning, educational stress, and anxiety levels. A representative sample of 652 Jordanian school adolescents was included. Results The prevalence of suicidal ideation among school adolescents was 11%. Suicidal ideation was significantly higher among respondents who were boys and enrolled in public schools, had a mental health problem, a family history of suicidal attempt, a lower self-esteem, and higher depressive symptoms. The majority of school adolescents agreed with the descriptions of people who take their own lives as being “lost” (70%), “coward” (53%), “stupid” (51%), and “lonely” (49%). Conclusion There is no typical suicide victim, and there are no specific characteristics that can point out those who are suicidal. Suicide remains a complex phenomenon that is embedded in its sociocultural context. Collaborative efforts from Jordanian policy makers, healthcare providers, researchers, and educators are needed to develop culturally appropriate screening and prevention approaches to address suicide among adolescents. Nurses have a significant role in helping adolescents experiencing suicidal ideation and their families restore, maintain, and/or promote their mental health and wellbeing.
A relationship between rumination and suicidal ideation is well-evidenced. A role for thought suppression has also been suggested but under-explored. The present study assessed the relative contribution of rumination and a range of thought control strategies in the understanding of suicidal ideation, within the theoretical framework of the self-regulatory executive function (S-REF) model (Wells & Matthews, 2015). Twenty-four participants who had experienced suicidal ideation in the last two months completed trait-level measures of metacognitive beliefs and momentary sampling measures of thought control strategy use, rumination and suicidal ideation over six days. Maladaptive thought control strategy use (worry and punishment), alongside rumination, predicted suicidal ideation. Adaptive strategies (distraction, social control and reappraisal) emerged as negative predictors. Metacognitive beliefs about the need to control thoughts predicted the use of punishment- but not worry-based thought control strategies. Thought control strategy use is as important in the development of suicidal ideation as rumination. The S-REF model represents a promising new approach to understanding these processes in the development of suicidal ideation.
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Suicidal ideation and suicidal thinking are relevant phenomena to study given their high incidence among university students in higher education, even more so if during the academic period students are affected by a pandemic such as COVID-19. Consequently, this systematic review's objective was to determine the prevalence of suicidal ideation and suicidal thinking in university students during the COVID-19 pandemic and, as a secondary objective, to establish possible risk factors. The search was performed following the PRISMA model in the Web of Science, Scopus, PubMed, and Medline search engines between January 2020 and January 2021, and the Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of the studies. Regarding the results, at the end of the search, nine relevant studies were identified for analysis: four on suicidal thoughts, four on suicidal ideation, and one on suicide as a continuous variable. In conclusion, it was possible to stipulate that the average prevalence of suicidal ideation and suicidal thoughts were 17.8% for the university population. Likewise, the risk factors associated with the appearance of suicidal thoughts and ideation in university students during the COVID-19 pandemic were ethnographic, psychological, contextual and health factors.
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.
Background: General population survey data are presented on the lifetime prevalence of suicide attempts as well as transition probabilities to onset of ideation, plans among ideators, and attempts among ideators either with or without a plan. Risk factors for these transitions are also studied. Methods: Data are from part II of the National Comorbidity Survey, a nationally representative survey carried out from 1990 to 1992 in a sample of 5877 respondents aged 15 to 54 years to study prevalences and correlates of DSM-III-R disorders. Transitions are estimated using life-table analysis. Risk factors are examined using survival analysis. Results: Of the respondents, 13.5% reported lifetime ideation, 3.9% a plan, and 4.6% an attempt. Cumulative probabilities were 34% for the transition from ideation to a plan, 72% from a plan to an attempt, and 26% from ideation to an unplanned attempt. About 90% of unplanned and 60% of planned first attempts occurred within 1 year of the onset of ideation. All significant risk factors (female, previously married, age less than 25 years, in a recent cohort, poorly educated, and having 1 or more of the DSM-III-R disorders assessed in the survey) were more strongly related to ideation than to progression from ideation to a plan or an attempt. Conclusions: Prevention efforts should focus on planned attempts because of the rapid onset and unpredictability of unplanned attempts. More research is needed on the determinants of unplanned attempts.
Many family practitioners believe that enhancing self-esteem is a valuable educational and therapeutic strategy. If we look only at some of the short-term effects, this is probably true. However, if we pay attention to a broader range of effects, we would recognize that enhancing self-esteem also has a number of harmful side effects. These side effects are probably making some human problems worse, and they are creating new problems for the very people we are trying to help. The net effect is that in many situations we are doing more harm than good. This article explores these ideas, suggests an alternative, and discusses a number of implications these ideas have for family practitioners, theory, and research.
In Chicago and its many suburbs, the problem of technology transfer to field personnel is complicated by a large contingency of Spanish-speak ing workers. At present, few programs exist to meet their training needs. As a result, trees may be receiving less than optimal treatment, possibly leading to early mortality and unnecessary economic loss to the landscape, nursery and tree care companies that grow and maintain much of the private urban forest. A pilot study conducted by the author and sponsored by the University of Illinois, Department of Forestry found that the number of immigrant Hispanic workers in the Chicago area green industry was larger and more stable than previously believed. The study also found that most workers received either no training or in-house developed training in tree and plant care. Alienation, economics, education and self-esteem were also explored as factors affecting the training needs of this population.
Evaluated depression, hopelessness, and self-esteem in suicidal ideation and attempt among inpatient children (N = 123, ages 6 to 13 years). Suicidal ideators (n = 39), attempters (n = 42), and nonsuicidal patient control children (n = 42) participated. The major findings were that: (a) suicidal children reported significantly greater depression and hopelessness and lower self-esteem than did nonsuicidal children; (b) depression, as measured by the Children' Depression Inventory (CDI), was the single beast predictor of suicidal ideation and attempt; (c) hopelessness and self-esteem did not contribute further to the discrimination of suicidal children once CLPI depression entered; (d) when the CDZ was replaced by diagnosis of depression in the discriminant analysis, the Self-Esteem Inventory became the only measure to enter the equation; (e) suicidal girls were classified with greater accuracy than suicidal boys; and (f) the contribution of depression and self-esteem to discriminating between suicidal and nonsuicidal children varied as a function of the child's age. The results convey that depression and related cognitive domains discriminate suicidal and nonsuicidal children and vary in this regard as a function of child age and sex.