Lecture 12a suicide and related problems in adolescence 

Suicide in the Netherlands 

• 1% of all deaths 

• Males commit suicide 2 times more than females 

• Cause of death of young people in NL 

• 10-25 years 

• Traffic accidents 

• Suicide 

• 25-40 years 

• Suicide 

• 40-60 years 

• Health related causes 

• Suicide 

• Methods of suicide 

• men: violent method: 50% hanging, 1 in 9 jump in front of train (more often among youth) 

• Women: less violent: 33% hanging, 25% medication overdose, 1 in 9 jump in front of train (more often in youth) 

Leading cause of death US youth 

• Second cause of death 

• Also a high homicide rate 

• Across various ages: 

• Suiciding is the leading cause of death among individuals between 1 and 65 years of age 

• Suicide methods US: children and others 

• Availability of guns > firearms is the leading methods, then suffocation/hanging, ingestion, CO poisoning, jumping from a height, cutting, other causes 

Suicide rates by race/ethnicity 

• Males are more likely to attempt suicide 

• Rural areas 

Frequency of suicidal ideation and attempts 

• Thinking of suicide > ideation > attempt > suicide 

• Once one attempts suicide, they are more likely to do it again (15-fold) 

• Most common diagnoses in teen suicides: 

• Depression 

• Antisocial 

• Substance abuse 

• Anxiety 

• Despite the high rates of depression, among those who commit suicide, 24% who have completed suicide, were prescribed antidepressants, but zero found at autopsy: lack of using antidepressants > increases changes of suicide 

• Why do males complete more suicides than females, even though females are more likely to attempt suicide? 

• Gender paradox of suicidal behavior: 

• Areas with lower prescription rates (antidepressants), the rates of suicide are higher 

• If males are not going into doctors to get treatment, then this could be a potential explanation for why we see more suicides completions among males 

Factors that predispose to suicide 

• Personal characteristics 

• Psychopathology 

• History of prior suicide attempt 

• Cognitive and personality (hopelessness & poor interpersonal problem-solving) 

• Homosexuality 

• Biological factors 

• Family characteristics 

• Family history of suicidal behavior 

• Higher rates of parental psychopathology 

• Non-intact families 

• Impaired parent-child relationships 

• Adverse life circumstances 

• Stressful life events 

• Childhood physical abuse 

• Sexual abuse 

• Contextual factors 

• Educational/vocational problems 

• Impact of media supporting the notion of suicide contagion 

Factors that protect against suicide 

• Family cohesion 

• Religiosity 

• Resilience, self-esteem, direction, mission, determination, perseverance, optimism and empathy 

• Coping and problem solving skills, insight and intellectual competence 

• Social support and close relationships 

• Availability of a caring adult 

• Participation and bond with school 

Other risks and warnings 

• Approximately one in three adolescents who die by suicide is alcohol intoxicated at the time of death, and a further number are under the influence of drugs 

• The percentage change in alcohol consumption has the single highest correlation with changes in suicide rates 

• Alcohol and substance misuse are significant factors in youth suicide which affect thinking and reasoning ability, and may have a disinhibiting effect thus precipitating a suicidal act 

The interpersonal theory of suicide 

• Thwarted belongingness and perceived burdensomeness cause suicidal desire 

• Thwarted belongingness: 

• Loneliness 

• Reciprocal care 

• Perceived burdensomeness 

• Liability 

• Self-hate 

• Acquired capability 

• Lowered fear of death 

• Elevated physical pain tolerance 

• Individuals with high amounts of suicidal desire only become capable of engaging in suicidal behavior through habituation to physically painful and anxiety provoking nature of self-harming behaviors 

Study Barzilay (cross-sectional) 

• Regression predicting suicide ideation 

• Gender (female), depression, anxiety 

• Parent belongingness x burden 

• Burdensomeness x belongingness interaction: high level of burdensomeness and high level of parent thwarted belongingness > suicidal ideation 

• Predicting lifetime suicide attempt 

• Gender (female), ethnicity (Arab), depression 

• Next step: suicide ideation, health risk behaviors, self-harm  

• Significant predictors of having a suicidal attempt 

• Conclusion 

• Two separate pathways to suicide 

• Affective disorders 

• Self-harm 

• Limited support for ITS 

• Schematic of two pathway model 

Study 2 Barzilay (longitudinal) 

• Aims... 

• Interventions... 

• Which model was the best predictor of repeating suicide attempts compared to having no suicide attempts at all? 

• Two pathway model: two individual pathways to attempting suicide 

• Thwarted belonginess, burdensomeness, flowing in with depression > suicide ideation > change in suicide attempts 

• Self-injurious behavior (through self-harm or risky behaviors) 

• Interpersonal theory of suicide model 

• Interpersonal issues that are flowing into suicide ideation and general psychopathology (depression, anxiety, externalizing symptoms) > suicide ideation > repeated suicide attempts 

• Interventions 

• all 3 interventions reduced the combined effect of suicide ideation and self-injury on repeated suicide attempts 

• Yam reduced the effect or risk behaviors on suicide behavior 

• Conclusions 

• The interpersonal theory of suicide is a potential model that is useful for understanding adolescent suicide behavior 

• Underscores the important role NSSI plays in the transition from suicide ideation to suicide attempts 

• The intervention results support the effectiveness of school-based interventions in diminishing the accentuation effects of suicide ideation and self-harm on increasing the risk of suicide attempts