Factors Associated with Recovery in Aboriginal People in Canada Who Had Previously Been Suicidal.

To explore factors associated with recovery from suicidal ideation among Aboriginal peoples living off reserve in Canada. Recovery is defined as being free of serious suicidal thoughts for the past year. Data for this study came from the 2012 Aboriginal Peoples Survey, a nationally representative sample of Aboriginal peoples in Canada who are living off-reserve. The sample consisted of those who had seriously considered suicide at some point in their life (n = 2,680). Those who had been suicidal in the past year were compared to those who were no longer suicidal using Pearson chi-square and logistic regression analyses. Several factors were associated with recovery among Aboriginal peoples living off-reserve in Canada who had previously been suicidal. Recovery was higher among women, individuals who were older, and those who were food secure, spoke an Aboriginal language, had a high school degree, had a confidant, and had no previous diagnosis of mood disorders or learning disability. Several sociodemographic factors appear to influence recovery from suicidality among Aboriginal peoples. Intervention approaches to promote recovery from suicidal ideation would benefit from targeted outreach, a strength-based, culturally-specific approach using traditional practices, and encouraging involvement of various community members to foster resilience and formation of relationships.

Health risk behaviors and psychological problems among South Korean, North Korean, and other multicultural family adolescents (2011-2016).

This study was aimed to investigate the health risk behaviors and psychological problems among North Korean, other multicultural, and South Korean family adolescents. The data were collected from the Korea Youth Risk Behavior web-based survey (2011-2016) data set. A total of 17,195 adolescents (mean age 14.65 ±â€¯0.01 years) were analyzed to compare health risk behaviors and psychological problems among the three groups. Concerning risk behaviors, multicultural family adolescents showed a higher rate of alcohol use, smoking, drug use and sexual relations compared to South Korean family adolescents. Moreover, North Korean family adolescents were more likely to experience those risk behaviors than other multicultural family adolescents. Concerning psychological problems, multicultural family youth displayed more depressed mood, and more suicidal ideation, planning, and attempts when compared with South Korean family youth. Among multicultural families, North Korean family adolescents were more depressed and showed higher suicidality. School-based education and preventive interventions are necessary to manage risk behaviors and psychological difficulties of adolescents in North Korean and other multicultural families.

Risk factors for multiple suicide attempts among Roma in Hungary.

In recent years, suicide rates in Hungary have been among the highest in the European Union. Attempted suicide rates in the Roma population are 2-3 times higher than in the non-Roma population. Since individuals making multiple attempts have a higher pro-bability of eventual death by suicide, and there are limited data on suicidal behaviour of the Roma population, the aim of this study was to explore the sociodemographic and psychological background factors of multiple suicide attempts in the Hungarian Roma population. Semistructured interviews were conducted with 150 individuals admitted to hospital toxicology departments, who made suicide attempts by deliberate self-poisoning, 65 of whom were multiple attempters. Detailed information regarding the current attempt and previous suicidal acts was recorded. Patients also completed the Shortened Beck Depression, the Beck Hopelessness Questionnaire, and the Social Support Questionnaire. Independent samples t-tests were used to evaluate differences in psychological variables between the Roma ( N = 90) and non-Roma ( N = 60) groups. Stepwise linear regression and odds ratios analyses were performed to identify potential background factors of multiple suicide attempts. There was a significantly higher level of previous suicidal events among the Roma in the sample population (3.53 vs. 0.84, p < .001). Roma ethnicity was found to be a strong predictor of multiple suicide attempts. Current major depression, hopelessness, and diagnosed mood disorder were identified as significant risk factors of repeated attempts. Smoking (OR = 5.4), family history of suicide (OR = 4.9), and long-term unemployment (OR = 4.6) were additional risk factors among Roma patients. A thorough understanding of the ethnicity-specific risk factors for multiple suicide attempts could facilitate the development of effective intervention and postvention programmes.

Childhood Stress and Adversity is Associated with Late-Life Dementia in Aboriginal Australians.

OBJECTIVES: High rates of dementia have been observed in Aboriginal Australians. This study aimed to describe childhood stress in older Aboriginal Australians and to examine associations with late-life health and dementia. DESIGN: A cross-sectional study with a representative sample of community-dwelling older Aboriginal Australians. SETTING: Urban and regional communities in New South Wales, Australia. PARTICIPANTS: 336 Aboriginal and/or Torres Strait Islander Australians aged 60-92 years, of whom 296 were included in the current analyses. MEASUREMENTS: Participants completed a life course survey of health, well-being, cognition, and social history including the Childhood Trauma Questionnaire (CTQ), with consensus diagnosis of dementia and Alzheimer disease. RESULTS: CTQ scores ranged from 25-117 (median: 29) and were associated with several adverse childhood indicators including separation from family, poor childhood health, frequent relocation, and growing up in a major city. Controlling for age, higher CTQ scores were associated with depression, anxiety, suicide attempt, dementia diagnosis, and, specifically, Alzheimer disease. The association between CTQ scores and dementia remained significant after controlling for depression and anxiety variables (OR: 1.61, 95% CI: 1.05-2.45). In contrast, there were no significant associations between CTQ scores and smoking, alcohol abuse, diabetes, or cardiovascular risk factors. CONCLUSIONS: Childhood stress appears to have a significant impact on emotional health and dementia for older Aboriginal Australians. The ongoing effects of childhood stress need to be recognized as people grow older, particularly in terms of dementia prevention and care, as well as in populations with greater exposure to childhood adversity, such as Aboriginal Australians.

Health Risk Behaviors by Length of Time in the United States Among High School Students in Five Sites.

One in five public school students is from an immigrant-headed household. We used Youth Risk Behavior Survey data from one state and four large urban school districts to examine whether length of time living in the US was associated with health risk behaviors. Logistic regression models, using weighted data, controlled for sex, race/ethnicity, and grade. Compared to US natives, not having always lived in the US was correlated with lower risk for some behaviors (e.g., current marijuana use and alcohol use) among high school students, but higher risk for other behaviors (e.g., attempted suicide, physical inactivity). Many findings were inconsistent across the study sites. Interventions that specifically target recently-arrived school-aged youth to prevent behaviors that put health and safety at risk, may result in the best outcomes for immigrant youth. Care should be taken to understand the specific health risks present in different immigrant communities.

A comparison of risk factors associated with suicide ideation/attempts in American Indian and White youth in Montana.

We examined racial/ethnic and gender-specific associations between suicide ideation/attempts and risky behaviors, sadness/hopelessness, and victimization in Montana American Indian and White youth using 1999-2011 Youth Risk Behavior Survey data. Logistic regression was used to calculate odds ratios and 95% confidence intervals in stratified racial/ethnic-gender groups. The primary results of this study show that although the American Indian youth had more statistically significant suicidal thoughts and attempts than the White youth, they had fewer statistically significant predictors compared to the White youth. Sadness/hopelessness was the strongest, and the only statistically significant, predictor of suicide ideation/attempts common across all four groups. The unhealthy weight control cluster was a significant predictor for the White youth and the American Indian/Alaska Native girls; the alcohol/tobacco/marijuana cluster was a significant predictor for the American Indian boys only. Results show important differences across the groups and indicate directions for future research targeting prevention and intervention.

Asthma and suicidal ideation and behavior among Puerto Rican older children and adolescents.

There is growing evidence of a positive association between asthma and suicidal ideation and behavior in the general community, although information on this potential association is scarce among older children and adolescents and Puerto Ricans, groups at risk for both conditions. Data came from wave 3 of the Boricua Youth Study, a longitudinal study of youth in the Bronx and San Juan conducted from 2000 to 2004. Logistic regressions for correlated data (Generalized Estimating Equation) were conducted, with asthma predicting suicidal ideation and behavior among participants 11 years or older. After adjustment for survey design; age; sex; poverty; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, mental disorders; cigarette smoking; and stressful life events, asthma was positively associated with suicidal ideation and behavior among the Puerto Rican older children and adolescents. Public health interventions targeting Puerto Rican older children and adolescents with asthma and future studies investigating potential biological and psychological mechanisms of association are warranted.

[Factors related to suicide attempts in a Tunisian sample of patients with schizophrenia]. / Les facteurs liés aux tentatives de suicide dans une population tunisienne de patients atteints de schizophrénie.

INTRODUCTION: The mortality rate in schizophrenia is 4.5 times higher than in the general population. Suicide is one of the main causes of premature death in this affection. Life time prevalence of this behavior ranges from 10 to 15%, which represents a risk 20 to 50 times higher than in the general population. In addition, 40 to 93% of patients who committed suicide had attempted suicide previously. Thus, assessment of correlated variables with suicide attempts is a fundamental issue for developing preventive and therapeutic strategies in suicidal behavior. To the best of our knowledge, no systematic study has yet investigated suicide attempts in an Arabic Muslim population with schizophrenia, although many authors have demonstrated cultural differences in socio-demographic and clinical variables related to suicide attempts within many geographic areas around the world. OBJECTIVES: The objectives of this study were to assess the frequency and characteristics of lifetime suicide attempts in Tunisian schizophrenic outpatients and to determine the correlated socio-demographic, clinical and therapeutic variables. METHODS: A total of 134 patients with a DSM-IV diagnosis of schizophrenia who attended the outpatient department of the university psychiatric hospital of Tunis were included. The main demographic and lifetime clinical variables considered were: gender, marital status, family history of psychiatric disorders and suicide attempts, age at time of recruitment, age at onset of illness, duration of untreated psychosis defined as the interval between the onset of the illness and the first antipsychotic treatment, the type and dose of current treatment, dose of antipsychotic drugs converted to chlorpromazine equivalents, extrapyramidal side effects assessed with the Simpson Angus rating scale, number of hospitalizations, comorbid substance abuse, cigarette smoking, severity of psychopathology measured with the Positive And Negative Syndrome Scale (PANSS), and history of at least one suicide attempt. A suicide attempt was defined as a self-destructive act carried out with at least some intent to end one's life. We also assessed the number, the used methods and the causes of suicide attempts. We subdivided the sample into two sub samples according to the presence or absence of suicidal attempts. We analyzed and compared the demographic, clinical and therapeutic variables. RESULTS: Out of the 134 patients, 45 (32%) had attempted suicide at least once. Half of them (49%) had attempted suicide more than once. The number of suicide attempts varied from one to five with an average of 1.8. The most used methods were medication overdose (n=18, 23.4%), followed by organophosphate poisoning (n=11, 14.3%), defenestration (n=9, 11.7%) and hanging or using sharp objects (n=7, 9.1% for each of them). The main reported reasons of suicide attempts were depressive symptoms (n=46, 60%) including depressed mood and hopelessness, stressful life events (bereavement, divorce, separation) (n=35, 46%) and presence of delusions and/or auditory hallucinations (n=25, 32.5%). No differences were found between the two groups regarding the different socio-demographic variables. Significant differences were found with respect to a duration of untreated psychosis equal to or more than one year (P<0.001), smoking in men (P=0.03), positive symptoms score on the PANSS (P<0.001), scores of Simpson-Angus scale (P=0.029) and poor medication compliance (P=0.02). CONCLUSION: Demographic variables as suggested by other studies are less valuable predictors of suicide attempts in patients with schizophrenia. Interventions for reducing such behavior should focus on clinical variables and integrate an early diagnosis of the disease, reduce positive psychotic symptoms and tobacco consumption, correct extrapyramidal signs and improve medication compliance.

Suicidality and its associated factors in cancer patients: results of a multi-center study in Korea.

OBJECTIVE: The current study examined the prevalence and associated factors of suicidality among Korean cancer patients. Moreover, the association of multiple psychological morbidities with suicidality was investigated among cancer patients. METHODS: A cross-sectional, multi-center survey of 400 cancer patients was administered in five cancer-treatment hospitals throughout South Korea. Study variables were assessed using standardized measures including the Mini International Neuropsychiatric Interview suicidality module, the Hospital Anxiety and Depression Scale, and the Impact of Event Scale-Revised. RESULTS: 20.1% (80/399) of patients were positive cases of suicidality. Having no religion (p = .010), poor performance status (p = .000), and psychological comorbidity (p = .021) were significantly associated with the experience of suicidality in the multivariate analysis. Compared to "fully active" patients, patients who were capable of self-care but unable to perform any work activities had about a six times higher risk of suicidality (p = .000). Compared to patients with no psychological morbidity, the risk of suicidality was significantly higher among patients with comorbid anxiety and depression (p = .024), those experiencing comorbid depression and post-traumatic stress disorder (PTSD) (p = 0.051), and those experiencing comorbid anxiety, depression and PTSD (p = .001). CONCLUSIONS: This study found that having no religion, impaired levels of overall functioning, and "multiple psychological morbidities" were associated with suicidality in Korean cancer patients. These findings suggest a need for careful monitoring of these factors and enhanced comprehensive care addressing both the physical and psychosocial functioning of patients with cancer in suicide prevention efforts.

Race disparities in firearm injuries and outcomes among Tennessee children.

PURPOSE: The aim of this study was to identify race and socioeconomic factors associated with worse outcomes among Tennessee children who sustain firearm injuries. METHODS: We queried our institutional pediatric trauma registry and the Davidson County Regional Medical Examiner database for children ages 15 years and younger who sustained firearm injuries between July 1998 and July 2010. Descriptive statistics and logistic regression modeling were used to analyze demographic data, circumstance of injury (unintentional or intentional), odds of death, and characteristics of zip codes (total population, race distribution, and median income) where injuries occurred. RESULTS: One hundred eighty-eight children (median age, 13.2 years; range, 1.1-15.8 years) sustained a firearm injury and were either admitted to our institution or were referred directly to the medical examiner. More whites (n = 109, or 58%) sustained a firearm injury than blacks (n = 79, or 42%), but blacks were overrepresented 2.5-fold more compared with the general Tennessee population. Fifty-four children (29%) died, of whom 35 (65%) were black and 19 (35%) were white (P < .001). Ninety-three children sustained unintentional firearm injuries, and 84 were intentional (n = 67, assault; n = 17, suicide). When data were stratified by intent, 67% of blacks and 12% of whites were assaulted (P < .001). After controlling for age and intent, black children were 4 times more likely to die of firearm injuries than whites (P = .008; 95% confidence interval, 1.4-11.3). CONCLUSION: In a sample of firearm-injured Tennessee children, blacks were notably overrepresented and far more likely to die than whites. Using zip code data will help to establish firearm injury prevention programs specific to disparate populations and to reduce both violent and accidental childhood firearm injuries.

Factors associated with postpartum depression in Chilean women.

The purpose of this study was to assess the prevalence of postpartum depression in a regular clinical setting among Chilean women. The Postpartum Depression Screening Scale, Spanish Version was used to assess symptoms of depression. Chilean women (45%) reported depressive symptoms including suicidal thoughts, sleeping/eating disturbances, and emotional stability. Factors that predicted the probability of PPD included attitudes concerning pregnancy, social support, and tobacco use. Routine screening for PPD could make a difference in prevention, prompt diagnosis, and management of postpartum depression in developing countries.

Associations between risk behaviors and suicidal ideation and suicide attempts: do racial/ethnic variations in associations account for increased risk of suicidal behaviors among Hispanic/Latina 9th- to 12th-grade female students?

The objective of this study was to identify factors that may account for the disproportionately high prevalence of suicidal behaviors among Hispanic/Latina youth by examining whether associations of health risk behaviors with suicidal ideation and suicide attempts vary by race/ethnicity among female students. Data from the school-based 2007 national Youth Risk Behavior Survey were analyzed. Analyses were conducted among female students in grades 9 through 12 and included 21 risk behaviors related to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus; physical activity; obesity and weight control; and perceived health status. With the exception of physical activity behaviors and obesity, all risk behaviors examined were associated with suicidal ideation and suicide attempts. Associations of risk behaviors with suicidal ideation varied by race/ethnicity for 5 of 21 behaviors, and for 0 of 21 behaviors for suicide attempts. Stratified analyses provided little insight into factors that may account for the higher prevalence of suicidal behaviors among Hispanic/Latina female students. These results suggest that the increased risk of suicidal behaviors among Hispanic/Latina female students cannot be accounted for by differential associations with these selected risk behaviors. Other factors, such as family characteristics, acculturation, and the socio-cultural environment, should be examined in future research.

Family factors associated with suicide attempts among Chinese adolescent students: a national cross-sectional survey.

PURPOSE: To determine the prevalence and associated family factors of suicide attempts among junior and/or senior high school students, so as to provide bases for preventive measures of suicide in China. METHODS: A total of 13,512 students from 32 junior and/or senior high schools in grades 7 to 11 in eight cities of China participated in a self-administered anonymous survey to report their frequency of suicide attempts during the past year. Sociodemographic characteristics, tobacco, and alcohol use in the past 30 days were asked. Stressful family life events were used to evaluate the subjects' family characteristics. RESULTS: Overall, 2.7% (338/12,470) in-school adolescents reported a suicide attempt during the past year, girls significantly more often than boys. Considered independently, all stressful family life events were strongly associated with increased risk for self-reported suicide attempts. When taking sociodemographic characteristics, life style, and all the five family factors selected from factor analysis into consideration, there was a significant independent impact of three family factors on increasing suicide attempts risk among adolescents. The most notable risks were derived from improper parental rearing behavior, separation from parents, and social problems of the family members. However, neither poor material conditions of family life nor family member's adversity contribute significantly to the risk. CONCLUSIONS: This study not only indicates that suicide attempt is a significant public health issue among in-school adolescents in China, but also confirms that adolescents with family problems commonly manifest suicide attempts, which highlights the importance of considering family environmental factors when assessing suicide risk.

Repetition of suicide-related behavior: a study of the characteristics, psychopathology, suicidality and negative life events in Iran.

OBJECTIVE: Repetition of suicide-related behavior (SRB) is a risk factor for further suicidal behavior and death. The purpose of this study was to compare characteristics of patients with and without repeated episodes of SRB to determine whether characteristics of suicide attempt, psychopathology, and psychiatric comorbidity differ between groups, and if specific aspects of core suicidality may help guide screening of individuals at risk of further suicidal behaviors. METHODS: Thirty-five patient with repeated episodes of SRB and 49 with a single episode who came to the emergency room of two Qazvin referral hospitals after an episode of SRB were compared on demographic and background characteristics, the circumstances of the suicide attempts, levels of suicidality (i.e., ideation), and psychological characteristics. RESULTS: Patients with repeated episodes were more depressed, hopeless, and impulsive, had higher scores on factors associated with expected outcome and planning activities of the Suicide Intent Scale. They displayed greater suicidality, psychiatric comorbidity, and reported more negative life events, dissatisfaction with life, and poorer perceive social support. CONCLUSIONS: Some of the characteristics of patients with repeated suicide-related behavior propose major clinical challenges that should be addressed in an endeavor to reduce suicide risk.

Development of a Chinese version of the Suicide Intent Scale.

This study established the psychometric properties of the Chinese version of the Suicide Intent Scale (SIS) in a clinic- and community-based sample of 36 patients and 592 respondents, respectively. Results showed that the Chinese SIS demonstrated good inter-rater and test-retest reliability. Factor analysis generated three factors (Precautions, Planning, and Seriousness) explaining 92.9% of the total variance with high internal consistency. It was moderately correlated with depressive symptoms. Results suggest that the Chinese SIS is a reliable and valid instrument for use in assessing the extent of suicidal intention among subjects with deliberate self-harm in ethnic Chinese populations.

Impulsive but fatal self-poisoning with pesticides among South Asians in Nickerie, Suriname.

BACKGROUND: Intentional self-poisoning with pesticides is a serious problem in many developing countries. It is a commonly used method among South Asians all over the world. AIMS: To describe the circumstances and characteristics of suicides in Nickerie, e, in order to gain insight into why South Asians commonly use self-poisoning. METHODS: An exploratory psychological autopsy study was conducted among 19 survivors of 13 suicides in the Nickerie district in Suriname. RESULTS: Impulsivity plays an important role in self-poisonings, as well as aggression and easy accessibility of pesticides. CONCLUSIONS: Possible answers to the question why South Asians often use self-poisoning as a method for suicide may be found in culture, upbringing, styles of communication and genetics. However, more research is needed to further explore these hypotheses.

Differences in characteristics of Asian American and white problem gamblers calling a gambling helpline.

INTRODUCTION: The characteristics of Asian American and white problem gamblers using a gambling helpline were examined to identify race-related differences. METHODS: Logistic regression analyses were conducted on data obtained from callers to a gambling helpline serving southern New England in 2000-2003, inclusive. RESULTS: Of the 144 phone calls used in the analyses, 72 were from Asian American callers and 72 were from white callers who were matched on gender, education, income, marital/cohabitation status, and age. Race-related differences were observed in forms of gambling problems, psychiatric problems secondary to gambling, substance use problems, and family history. Asian American gamblers were more likely to report suicide attempts related to gambling and problems with non-strategic gambling. White gamblers were more likely to report both casino and non-casino gambling problems and personal and familial alcohol use problems. High proportions of both groups reported problems with strategic gambling, gambling-related anxiety, family and financial problems secondary to gambling, financial debt, daily tobacco use, and a family history of problem gambling. CONCLUSION: Race-related differences should be considered in optimizing prevention and treatment strategies related to problem gambling.

12-month and lifetime prevalence of suicide attempts among black adolescents in the National Survey of American Life.

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. METHOD: Data on nonfatal suicidal behavior among 1,170 African American and Caribbean black adolescents aged 13 to 17 years are from the National Survey of American Life-Adolescent, a nationally representative household survey of adults with an attached adolescent sample conducted between February 2001 and June 2003. RESULTS: Nationwide black adolescents reported having a lifetime prevalence of 7.5% for suicidal ideation and 2.7% for attempts. The 12-month prevalence of suicidal ideation and attempt was 3.2% and 1.4%, respectively. Among all respondents, 4% of black American adolescents and 7% of female subjects were projected to attempt suicide by age 17 years. African American adolescents were approximately five times more likely than Caribbean black adolescents to attempt suicide. Almost half of the National Survey of American Life-Adolescent respondents who reported a suicide attempt had never met criteria for any of the DSM-IV disorders by the time of their attempts. CONCLUSIONS: Clinicians should be trained to screen for suicidal behavior, even among those without DSM-IV disorders, when treating black adolescents, particularly female subjects. In addition, preventive efforts should consider ethnic differences in suicide risk and targeting nonclinical settings.

Suicidal ideation and associated factors among school-going adolescents in rural Uganda.

BACKGROUND: Mental health is a neglected area of health research and practice in most of sub-Saharan African countries where the largest burden of morbidity is from infectious diseases. This even occurs despite the fact that some mental health problems may arise from infectious diseases. METHODS: We conducted secondary analysis of the Uganda Global School-Based Health Survey-2003 to obtain the prevalence of, and assess factors that may be associated with suicidal ideation among school-going adolescents in rural Uganda. Assessment of association was conducted through both bi-variate and multivariate logistic regression analysis. RESULTS: Altogether 21.6% of the study participants, 21.3% males and 23.5% females had seriously considered committing suicide within the past 12 months. Loneliness, worry were positively associated with suicide ideation after adjusting for age, gender, smoking, drinking, and experience of having been bullied (OR = 1.59; 95% CI [1.12, 2.26] and OR = 1.19; 95% CI [1.12, 2.25]) respectively. Males were less likely to seriously consider committing suicide than females (OR = 0.70; 95% CI [0.50, 0.98]). CONCLUSION: Adolescent suicidal ideation is a major public health issue in rural Uganda. Measures aimed to prevent adolescent suicides in Uganda should incorporate our understanding of factors that are associated with suicide in rural Uganda such the gender disparity and the association observed with substance use.