Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.

/pdf/suicide-and-suicidal-behavior-41x9ufvkfm.pdf

Suicide and Suicidal Behavior

BACKGROUND: Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were: (a) What is the size and direction of any association between stigma and help-seeking? (b) To what extent is stigma identified as a barrier to help-seeking? (c) What processes underlie the relationship between stigma and help-seeking? (d) Are there population groups for which stigma disproportionately deters help-seeking? METHOD: Five electronic databases were searched from 1980 to 2011 and references of reviews checked. A meta-synthesis of quantitative and qualitative studies, comprising three parallel narrative syntheses and subgroup analyses, was conducted. RESULTS: The review identified 144 studies with 90,189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d = - 0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier. A detailed conceptual model was derived that describes the processes contributing to, and counteracting, the deterrent effect of stigma on help-seeking. Ethnic minorities, youth, men and those in military and health professions were disproportionately deterred by stigma. CONCLUSIONS: Stigma has a small- to moderate-sized negative effect on help-seeking. Review findings can be used to help inform the design of interventions to increase help-seeking.

/pdf/what-is-the-impact-of-mental-health-related-stigma-on-help-4umw0hpq34.pdf

What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies.

Empirical studies and some high-profile anecdotal cases have demonstrated a link between suicidal ideation and experiences with bullying victimization or offending. The current study examines the extent to which a nontraditional form of peer aggression--cyberbullying--is also related to suicidal ideation among adolescents. In 2007, a random sample of 1,963 middle-schoolers from one of the largest school districts in the United States completed a survey of Internet use and experiences. Youth who experienced traditional bullying or cyberbullying, as either an offender or a victim, had more suicidal thoughts and were more likely to attempt suicide than those who had not experienced such forms of peer aggression. Also, victimization was more strongly related to suicidal thoughts and behaviors than offending. The findings provide further evidence that adolescent peer aggression must be taken seriously both at school and at home, and suggest that a suicide prevention and intervention component is essential within comprehensive bullying response programs implemented in schools.

/pdf/bullying-cyberbullying-and-suicide-37o16bzpxw.pdf

Bullying, cyberbullying, and suicide

eMedicine创建于1996年，由近万名临床医师作为作者或编辑参与此临床医学知识库的建设，其中编辑均是来自美国哈佛、耶鲁、斯坦福、芝加哥、德克萨斯、加州大学等各分校医学院的教授或副教授。

eMedicine

Context Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts). Objectives To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors. Design Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement. Setting Face-to-face household interviews with adolescents and questionnaires for parents. Participants A total of 6483 adolescents 13 to 18 years of age and their parents. Main Outcome Measures Lifetime suicide ideation, plans, and attempts. Results The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring. Conclusions Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.

/pdf/prevalence-correlates-and-treatment-of-lifetime-suicidal-4117px4iuq.pdf

Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents: Results From the National Comorbidity Survey Replication Adolescent Supplement

Suicide accounts for 1.5% OF the global burden of disease, which represents 20 million years of healthy life lost due to premature death or disability.1 Among all Americans, suicide is the 11th leading cause of death and the rates range across specific demographic subgroups (eg, it is the 8th leading cause of death among Native Americans, Asian/Pacific Islanders, and men).2 Across race and sex, the elderly, particularly white men aged 85 years and older have the highest suicide rate (51.6/year per 100 000 population). 3 The risk of dying from suicide in 2003 was more than double for whites (13.0/100 000) than for blacks (5.3/100 000).4 In recent years, suicide and nonfatal suicidal behavior have emerged as crucial health issues for blacks, particularly among older adolescents and young adults.5–7 According to a recent Centers for Disease Control and Prevention report, the prevalences of attempted suicide for white and black high school students (7.3% and 7.6%, respectively) were roughly equal.8 Although suicide has traditionally been viewed as a problem that affects more whites, the rates of suicide among blacks have increased significantly since the mid 1980s.9 A precipitous increase in the rate of suicide10,11 and nonfatal suicidal behavior12 among younger blacks has reduced US racial disparities in suicidal behaviors. The difference in suicide rates between whites and blacks aged 15 to 24 years narrowed from a ratio of 1.7 in 1980 to 1.4 in 2003.3

Despite increasing recognition of the public health significance of these trends, more comprehensive data on the occurrence of suicidal ideation and attempts are needed to further the understanding of whether the prevention and treatment of antecedents to suicide are effective in reducing risk among this population. Given that the US black population is projected to double by 2050,13 and that suicidal thoughts and behaviors are among the strongest predictors of suicide,14 obtaining national estimates of nonfatal suicidal behavior among this population is an important public health objective. Generating more reliable and more extensive scientific data on nonfatal suicidal behaviors is a critical first step in developing and testing preventive interventions aimed at reducing both suicide morbidity and mortality.

Reports from the Institute of Medicine and US surgeon general have highlighted the need for nationally representative epidemiological data on the occurrence of suicidal thoughts and attempts. 5,7,15 There is no single primary data source for nationally representative information on nonfatal suicidal behavior. 5 Reliable population estimates of such behaviors are hampered by the absence of centralized data registries and consistent definitions of suicide across regions.16–18 Current estimates of nonfatal suicidal behavior in the United States are derived from either ongoing surveillance systems or epidemiological surveys reporting population-based prevalence estimates for suicidal thoughts and attempts.19,20 These systems provide valuable information, but they are limited because they provide little to no race-specific information.5 The most recent epidemiologic studies, the National Comorbidity Survey and the National Comorbidity Survey Replication,19,20 provide national prevalence estimates of suicide ideation, planning, and attempts, but not by race or ethnicity. The most recent data on black adult nonfatal suicidal behaviors are from the National Institute of Mental Health’s Epidemiologic Catchment Area study for 1980–1984, which found a 2.3% lifetime estimate of attempted suicide among US blacks.21 These studies lack information on the onset of suicide ideation, prevalence of suicide planning, and data on the correlates of suicide-related behaviors among blacks. National estimates of the lifetime prevalence and correlates of suicide ideation, planning, and attempts among blacks of African American and Caribbean ethnicity in the United States are reported herein for the first time using the recently collected National Survey of American Life (NSAL).

https://jamanetwork.com/journals/jama/articlepdf/203885/joc60149_2112_2123.pdf

Prevalence of and risk factors for lifetime suicide attempts among blacks in the United States.

OBJECTIVES: To determine if racial and ethnic subgroups of adolescents are at high risk for engagement in suicidal behaviors. METHODS: Using the nationally representative school-based Youth Risk Behavior Survey from the years 1991 to 2017, we conducted logistic regression analyses to examine trends by different racial and ethnic groups, with each suicide indicator serving as a dichotomous outcome. Participants included 198 540 high school students. RESULTS: Across all sex and race and ethnic groups, there were significant linear decreases in self-reported suicidal ideation and suicide plans from 1991 to 2017. Female adolescents (odds ratio [OR], 0.98; P CONCLUSIONS: The results suggest that, over time, black youth have experienced an increase in suicide attempts, which is troubling because attempts are the most prominent risk factor associated with suicide death. For black boys, a significant increase in injury by attempt occurred, which suggests that black boys may be engaging in increasingly lethal means when attempting suicide. Examining trends of suicidal thoughts and behaviors over time by sex and race and ethnicity allow us to determine where to focus prevention and intervention efforts. Future research should examine the underlying reasons for these changes observed in US high school students.

/pdf/trends-of-suicidal-behaviors-among-high-school-students-in-1hp6n0otnj.pdf

Trends of Suicidal Behaviors Among High School Students in the United States: 1991-2017.

African American adolescent boys underutilize mental health service due to stigma associated with depression. Gaining an increased understanding of how depressed, African American adolescent boys perceive their mental health needs and engage in help-seeking behaviors might play an essential role in efforts to improve their symptoms and access to care. Using a mixed-methods design, this study examined the influence of mental health stigma and social support on depressive symptoms among African American adolescent boys. Findings indicated the protective effects of social support in decreasing depressive symptoms, especially when participants experienced mental health stigma. Results also revealed the pivotal role of family social support over both professional and peer support for participants who struggled with depressive symptoms. The primacy of family support among the sample, combined with the frequent distrust of professionals and peer networks, would indicate that working with families may improve initial identification of depression among African American adolescent boys and decrease their barriers to care.

/pdf/family-matters-the-role-of-mental-health-stigma-and-social-2ejw3albba.pdf

Family Matters: The Role of Mental Health Stigma and Social Support on Depressive Symptoms and Subsequent Help Seeking among African American Boys.

Objective
Provide nationally representative data on the prevalence and psychiatric correlates of suicidal ideation and attempts among African American and Caribbean black adolescents in the United States.

12-Month and Lifetime Prevalence of Suicide Attempts Among Black Adolescents in the National Survey of American Life

The purpose of this study was to examine African Americans' lay beliefs and attributions toward suicide. The Attitudes Toward Suicide Scale, Life Ownership Orientation Questionnaire, Stigma Questionnaire, and Suicide Ideation Questionnaire were administered to 251 undergraduate college students. Beliefs about stigma associated with suicide were comparable across ethnic groups. However, African American college students were significantly less likely than European American college students were to attribute suicide to interpersonal problems and to report that the individual or government is responsible for life. African American students were significantly more likely to report that God is responsible for life. These findings have important implications for suicide risk and also for developing culturally appropriate interventions.

/pdf/lay-theories-of-suicide-an-examination-of-culturally-1lqaehxpcj.pdf

Sean Joe

Papers

Prevalence of and risk factors for lifetime suicide attempts among blacks in the United States.

Trends of Suicidal Behaviors Among High School Students in the United States: 1991-2017.

Family Matters: The Role of Mental Health Stigma and Social Support on Depressive Symptoms and Subsequent Help Seeking among African American Boys.

12-Month and Lifetime Prevalence of Suicide Attempts Among Black Adolescents in the National Survey of American Life

Lay Theories of Suicide: An Examination of Culturally Relevant Suicide Beliefs and Attributions Among African Americans and European Americans.