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.

Download full-text


Available from: Keith Hawton, Apr 02, 2015
    • "Moreover, selfharm , defined as intentional self-poisoning or self-injury, irrespective of type of motive or the extent of suicidal intent, is a grave public health problem among young people (Hawton, Saunders, & O'Connor, 2012). Thoughts about self-harm are also a risk factor for suicide and are strongly associated with mental illnesses, especially Major Depressive Disorder (MDD) (Evans, Hawton, & Rodham, 2004; Kessler, Berglund, Borges, Nock, & Wang, 2005; Pfaff & Almeida, 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examines depression-related chatter on Twitter to glean insight into social networking about mental health. We assessed themes of a random sample (n=2,000) of depression-related tweets (sent 4-11 to 5-4-14). Tweets were coded for expression of DSM-5 symptoms for Major Depressive Disorder (MDD). Supportive or helpful tweets about depression was the most common theme (n=787, 40%), closely followed by disclosing feelings of depression (n=625; 32%). Two-thirds of tweets revealed one or more symptoms for the diagnosis of MDD and/or communicated thoughts or ideas that were consistent with struggles with depression after accounting for tweets that mentioned depression trivially. Health professionals can use our findings to tailor and target prevention and awareness messages to those Twitter users in need.
    No preview · Article · Jan 2016 · Computers in Human Behavior
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Oct 2015 · Journal of Adolescent Health
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jul 2015 · Journal of Mental Health
Show more