Toward Understanding Suicide Among Youths: Results From the White Mountain Apache Tribally Mandated Suicide Surveillance System, 2001-2006
20 Aug 2009-American Journal of Public Health (American Public Health Association)-Vol. 99, Iss: 10, pp 1840-1848
TL;DR: An innovative tribal surveillance system identified high suicide and attempt rates and unique patterns and risk factors of suicidal behavior among Apache youths, which are guiding targeted suicide prevention programs.
Abstract: Objectives. We examined suicide and suicide attempt rates, patterns, and risk factors among White Mountain Apache youths (aged < 25 years) from 2001 to 2006 as the first phase of a community-based participatory research process to design and evaluate suicide prevention interventions.Methods. Apache paraprofessionals gathered data as part of a tribally mandated suicide surveillance system. We compared findings to other North American populations.Results. Between 2001 and 2006, 61% of Apache suicides occurred among youths younger than 25 years. Annual rates among those aged 15 to 24 years were highest: 128.5 per 100 000, 13 times the US all-races rate and 7 times the American Indian and Alaska Native rate. The annual suicide attempt incidence rate in this age group was 3.5%. The male-to-female ratio was 5:1 for suicide and approximately 1:1 for suicide attempts. Hanging was the most common suicide method, and third most common attempt method. The most frequently cited attempt precipitants were family or int...
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TL;DR: There is much work to be done to better understand suicidal thoughts and behaviors among youth, and future research is strongly encouraged to improve the scientific approach, knowledge base, and ultimately prevention of suicidal thought and behaviors in youth.
Abstract: Background
Suicide is a leading cause of death and a complex clinical outcome. Here, we summarize the current state of research pertaining to suicidal thoughts and behaviors in youth. We review their definitions/measurement and phenomenology, epidemiology, potential etiological mechanisms, and psychological treatment and prevention efforts.
Results
We identify key patterns and gaps in knowledge that should guide future work. Regarding epidemiology, the prevalence of suicidal thoughts and behaviors among youth varies across countries and sociodemographic populations. Despite this, studies are rarely conducted cross-nationally and do not uniformly account for high-risk populations. Regarding etiology, the majority of risk factors have been identified within the realm of environmental and psychological factors (notably negative affect-related processes), and most frequently using self-report measures. Little research has spanned across additional units of analyses including behavior, physiology, molecules, cells, and genes. Finally, there has been growing evidence in support of select psychotherapeutic treatment and prevention strategies, and preliminary evidence for technology-based interventions.
Conclusions
There is much work to be done to better understand suicidal thoughts and behaviors among youth. We strongly encourage future research to: (1) continue improving the conceptualization and operationalization of suicidal thoughts and behaviors; (2) improve etiological understanding by focusing on individual (preferably malleable) mechanisms; (3) improve etiological understanding also by integrating findings across multiple units of analyses and developing short-term prediction models; (4) demonstrate greater developmental sensitivity overall; and (5) account for diverse high-risk populations via sampling and reporting of sample characteristics. These serve as initial steps to improve the scientific approach, knowledge base, and ultimately prevention of suicidal thoughts and behaviors among youth.
306 citations
Cites background from "Toward Understanding Suicide Among ..."
...This pattern has been observed throughout distinct parts of the world ranging from American Indian, Alaska Native, and Aboriginal youth in the United States and Canada (CDC, 2017; Mullany et al., 2009), to indigenous youth in Australia and New Zealand (Beautrais, 2001; Cantor & Neulinger, 2000), to Guaran ı Kaiow a and ~ Nandeva communities in Brazil (Coloma, Hoffman, & Crosby, 2006)....
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...This pattern has been observed throughout distinct parts of the world ranging from American Indian, Alaska Native, and Aboriginal youth in the United States and Canada (CDC, 2017; Mullany et al., 2009), to indigenous youth in Australia and New Zealand (Beautrais, 2001; Cantor & Neulinger, 2000), to Guaran ı Kaiow a and ~Nandeva communities in Brazil (Coloma, Hoffman, & Crosby, 2006)....
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...…throughout distinct parts of the world ranging from American Indian, Alaska Native, and Aboriginal youth in the United States and Canada (CDC, 2017; Mullany et al., 2009), to indigenous youth in Australia and New Zealand (Beautrais, 2001; Cantor & Neulinger, 2000), to Guaran ı Kaiow a and ~Nandeva…...
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TL;DR: In this article, the results of collaborations with juvenile justice agencies nationwide were examined to provide generalizable estimates of psychiatric disorder and suicidality among justice system youth. Diagnostic assessments were aggregated from 57 sites (N = 9,819) from an automated computer-assisted self-interview (Voice Diagnostic Interview Schedule for Children).
Abstract: Results of collaborations with juvenile justice agencies nationwide were examined to provide generalizable estimates of psychiatric disorder and suicidality among justice system youth. Diagnostic assessments were aggregated from 57 sites (N = 9,819) from an automated computer-assisted self-interview (Voice Diagnostic Interview Schedule for Children). Disorder was predicted from setting type (system intake, detention, corrections), adjusting for demographic and offense characteristics, and for cross-site variability within settings. Race by comorbid disorder interactions were examined in predicting substance use disorder (SUD). White youth, repeat offenders, and those with further justice system penetration reported higher rates of most disorders; girls reported higher rates of internalizing conditions only. Although presence of another disorder increased SUD for most groups, SUD was high in American Indians regardless of either affective disorder or recent suicide attempt. Findings highlight (a) varying mental health needs across settings, (b) prior justice contact relating strongly to need, (c) girls’ elevated rates of internalizing disorder, and (d) racial/ethnic differences in diagnostic profiles.
203 citations
Cites background from "Toward Understanding Suicide Among ..."
...Compared to Whites, African Americans were approximately half as likely to meet criteria for either DBD (OR = 0.57, CI = 0.46, 0.70) or SUD (OR = 0.50, CI = 0.41, 0.61)....
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...Compared to African Americans, Whites reported significantly more disorder clusters (b = –.12, p < .0001)....
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...Although as noted African Americans of either gender were less likely to report SUD than were Whites, African American females were particularly less likely to meet criteria for SUD compared to White counterparts or to males of either race (OR = 0.31, CI = 0.22, 0.44, p < .001)....
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...Adolescent American Indian and Alaska Native males have a completed suicide rate 50% higher than Whites and almost double that of African Americans (Centers for Disease Control and Prevention, 2009; Mullany et al., 2009)....
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...There might be similar concerns in aggregating data across subgroups of Latinos or African Americans, where, once again, this level of detail was not available....
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TL;DR: There is preliminary cross-sectional evidence that dissociative disorders and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA.
Abstract: We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutti...
114 citations
TL;DR: A multidisciplinary group of AI/AN suicide research experts convened to outline pressing issues related to this subfield of suicidology and proposed directions to advance the field of suicide research in Indigenous communities and beyond.
Abstract: As part of the National Action Alliance for Suicide Prevention’s American Indian and Alaska Native (AI/AN) Task Force, a multidisciplinary group of AI/AN suicide research experts convened to outline pressing issues related to this subfield of suicidology. Suicide disproportionately affects Indigenous peoples, and remote Indigenous communities can offer vital and unique insights with relevance to other rural and marginalized groups. Outcomes from this meeting include identifying the central challenges impeding progress in this subfield and a description of promising research directions to yield practical results. These proposed directions expand the alliance’s prioritized research agenda and offer pathways to advance the field of suicide research in Indigenous communities and beyond.
105 citations
TL;DR: Results have revealed that unplanned suicide attempters experience suicidal ideation and precipitants prior to their attempt, and attempts were associated with affective and alcohol use disorders.
95 citations
References
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TL;DR: Substantial morbidity and social problems among youth also result from unintended pregnancies and sexually transmitted diseases, including human immunodeficiency virus infection.
Abstract: In the United States, 71% of all deaths among persons aged 10-24 years result from 4 causes: motorvehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2005 national Youth Risk Behavior Survey (YRBS) indicated that during the 30 days preceding the survey, many high school students engaged in behaviors that increased their likelihood of death from these 4 causes: 9.9% had driven a car or other vehicle when they had been drinking alcohol, 18.5% had carried a weapon, 43.3% had drunk alcohol, and 20.2% had used marijuana. In addition, during the 12 months preceding the survey, 35.9% of high school students had been in a physical fight and 8.4% had attempted suicide. Substantial morbidity and social problems among youth also result from unintended pregnancies and sexually transmitted diseases, including human immunodeficiency virus infection. During 2005, a total of 46.8% of high school students had ever had sexual intercourse, 37.2% of sexually active high school students had not used a condom at last sexual intercourse, and 2.1% had ever injected an illegal drug. Among adults aged > or =25 years, 61% of all deaths result from 2 causes: cardiovascular disease and cancer. Results from the 2005 national YRBS indicated that risk behaviors associated with these 2 causes of death were initiated during adolescence. During 2005, a total of 23.0% of high school students had smoked cigarettes during the 30 days preceding the survey, 79.9% had not eaten > or =5 times/day of fruits and vegetables during the 7 days preceding the survey, 67.0% did not attend physical education classes daily, and 13.1% were overweight.
1,193 citations
TL;DR: In these national samples of black, Hispanic, and white youth, unique and cross-cutting factors derived from a resiliency framework predicted or protected against attempting suicide.
Abstract: Objective. In 1997, suicide was the third leading cause of death among 10- to 19-year-olds in the United States, with the greatest increases in suicide rates in the previous decade experienced by black and other minority youth. The purpose of this study was to identify risk and protective factors for suicide attempts among black, Hispanic, and white male and female adolescents. Methods. We used data from the National Longitudinal Study of Adolescent Health, conducted in 1995 and 1996. A nationally representative sample of 13 110 students in grades 7 through 12 completed 2 in-home interviews, an average of 11 months apart. We examined Time 1 factors at the individual, family, and community level that predicted or protected against Time 2 suicide attempts. Results. Perceived parent and family connectedness was protective against suicide attempts for black, Hispanic, and white girls and boys, with odds ratios ranging from 0.06 to 0.32. For girls, emotional well-being was also protective for all of the racial/ethnic groups studied, while a high grade point average was an additional protective factor for all of the boys. Cross-cutting risk factors included previous suicide attempt, violence victimization, violence perpetration, alcohol use, marijuana use, and school problems. Additionally, somatic symptoms, friend suicide attempt or completion, other illicit drug use, and a history of mental health treatment predicted suicide attempts among black, Hispanic, and white females. Weapon-carrying at school and same-sex romantic attraction were predictive for all groups of boys. Calculating the estimated probabilities of attempting suicide for adolescents with increasing numbers of risk and protective factors revealed that the presence of 3 protective factors reduced the risk of a suicide attempt by 70% to 85% for each of the gender and racial/ethnic groups, including those with and without identified risk factors. Conclusions. In these national samples of black, Hispanic, and white youth, unique and cross-cutting factors derived from a resiliency framework predicted or protected against attempting suicide. In addition to risk reduction, promotion of protective factors may offer an effective approach to primary as well as secondary prevention of adolescent suicidal behavior.
756 citations
09 Jun 2000
TL;DR: Results from the 1999 national Youth Risk Behavior Survey demonstrate that numerous high school students engage in behaviors that increase their likelihood of death from these four causes, including motor-vehicle crashes, other unintentional injuries, homicide, and suicide.
689 citations
TL;DR: The data add to growing evidence that Mexican American youths are at increased risk of depression, and that community intervention efforts should specifically target this high-risk group.
Abstract: Data from an ethnically diverse sample of middle school (Grades 6–8) students (n = 5,423) are analyzed for ethnic differences in major depression. The point prevalence of major depression was 8.4% without and 4.3% with impairment. Data were sufficient to calculate prevalences for nine ethnic groups. Prevalences adjusted for impairment ranged from 1.9% for youths of Chinese descent to 6.6% for those of Mexican decent. African and Mexican American youths had significantly higher crude rates of depression without impairment, but only the latter had significantly higher rates of depression with impairment. Multivariate (logistic regression) analyses, adjusting for the effects of age, gender, and socioeconomic status (SES), yielded significant odds ratios for only one group. Mexican American youths were at elevated risk for both depression without (OR = 1.74, p < .05) and depression with impairment (OR = 1.71, p < .05). There was no significant interaction of ethnicity and SES in relation to depression. Females had higher prevalences of depression with and without impairment, as did youths who reported that their SES was somewhat or much worse off than their peers. The data add to growing evidence that Mexican American youths are at increased risk of depression, and that community intervention efforts should specifically target this high-risk group.
397 citations
TL;DR: The results suggest that suicidal behaviors are not infrequent occurrences among adolescents and that they often coexist with other high-risk behaviors.
Abstract: OBJECTIVES. We sought to analyze the frequency and correlates of suicidal behaviors in a community sample of adolescents. METHODS. Information concerning suicidal thoughts and acts, aggressive behaviors, substance use and physical recklessness were collected with the 70-item self-report Youth Risk Behavior Survey from a statewide sample of 3764 South Carolina public high school students. RESULTS. Seventy-five percent of students reported no suicidal behaviors, 11% reported serious suicidal thoughts, 6.4% reported specific suicidal plans, 5.9% reported attempts not requiring medical care, and 1.6% reported attempts requiring medical care. All types of suicidal behaviors occurred more frequently in females than males. Odds ratios for aggressive behaviors and cigarette use were elevated across all categories of suicide behaviors, increasing in magnitude with severity of reported suicidal behavior. Substance use was associated with some but not all categories of suicidal behaviors. The relationships were most pronounced with the use of potentially more dangerous drugs. CONCLUSIONS. The results suggest that suicidal behaviors are not infrequent occurrences among adolescents and that they often coexist with other high-risk behaviors. Interventions designed to reduce suicidal behaviors should simultaneously address coexisting high-risk behaviors. Language: en
365 citations
Additional excerpts
...3%.(15,21,22) Studies among AIAN populations consistently reported higher attempt rates than among other groups, regardless of methodology....
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