"I Don't Feel at Home in This World" Sexual and Gender Minority Emerging Adults' Self-Perceived Links Between Their Suicidal Thoughts and Sexual Orientation or Gender Identity.

OBJECTIVES: To examine whether sexual and gender minority (SGM) emerging adults perceived their SGM status was linked to suicidal ideation, and to explore if their responses fell within tenets of the minority stress framework. METHOD: Open text (survey) responses of Dutch and Flemish SGM emerging adults (n = 187) were thematically analysed using the constant comparative comparison method for qualitative analysis. RESULTS: We identified 8 themes in our qualitative analysis. Two themes fell within the scope of the minority stress framework that has received little attention: (1) concerns about relationships and family planning and (2) feeling different (internal stressor). Two additional themes emerged largely beyond the scope of existing minority stress framework studies on suicidality: (3) SGM-related questioning; (4) negativity in LGBT communities. Four established minority stress framework themes emerged: (5) gender identity stress; (6) victimization; (7) coming-out stress; (8) psychological difficulties linked to SGM status. CONCLUSION: Suicide prevention needs to focus on supporting SGM emerging adults who worry about feeling "different", or who have concerns over their romantic and family life, on reducing gender minority stress, as well as on caring for those who are victimized due to their sexual or gender identity.

Closing the gap between screening and depression prevention: a qualitative study on barriers and facilitators from the perspective of public health professionals in a school-based prevention approach.

BACKGROUND: The prevalence of depression has increased among adolescents in western countries. Prevention is needed to reduce the number of adolescents who experience depression and to avoid negative consequences, including suicide. Several preventive interventions are found to be promising, especially multi-modal approaches, for example combining screening and preventive intervention. However, an important bottleneck arises during the implementation of preventive intervention. Only a small percentage of adolescents who are eligible for participation actually participate in the intervention. To ensure that more adolescents can benefit from prevention, we need to close the gap between detection and preventive intervention. We investigated the barriers and facilitators from the perspective of public health professionals in screening for depressive and suicidal symptoms and depression prevention referral in a school-based setting. METHODS: We conducted 13 semi-structured interviews with public health professionals, who execute screening and depression prevention referral within the Strong Teens and Resilient Minds (STORM) approach. The interviews were recorded, transcribed verbatim, and coded in several cycles using ATLAS.ti Web. RESULTS: Three main themes of barriers and facilitators emerged from the interviews, namely "professional capabilities," "organization and collaboration," and "beliefs about depressive and suicidal symptoms and participation in prevention". The interviews revealed that professionals do not always feel sufficiently equipped in terms of knowledge, skills and supporting networks. Consequently, they do not always feel well able to execute the process of screening and prevention referral. In addition, a lack of knowledge and support in schools and other cooperating organizationorganizations was seen to hinder the process. Last, the beliefs of public health professionals, school staff, adolescents, and parents -especially stigma and taboo-were found to make the screening and prevention referral process more challenging. CONCLUSIONS: To further improve the process of screening and prevention referral in a school-based setting, enhancing professional competence and a holding work environment for professionals, a strong collaboration and a joint approach with schools and other cooperating organizations and society wide education about depressive and suicidal symptoms and preventive intervention are suggested. Future research should determine whether these recommendations actually lead to closing the gap between detection and prevention.

The self-perceived needs of adolescents with suicidal behaviour: a scoping review.

Suicidal behaviour in adolescents is a major public health problem. Much research on this issue has focused on epidemiology and risk factors for suicidal behaviour, paying less attention to the self-perceived needs of adolescents. However, to increase engagement in suicide prevention, it is important to include the views of adolescents. A scoping review was performed to identify the available empirical study findings, of any study design, related to the self-perceived needs of adolescents with suicidal behaviour. The literature databases Medline, Embase, Psycinfo, CINAHL, ERIC, Scopus, and Web of Science were searched. Twenty-nine studies from 14 predominantly Anglo countries were included in the scoping review. The review showed that girls were overrepresented and that studies predominantly used qualitative approaches. The identified needs of adolescents with suicidal behaviour can broadly be grouped into needs related to the following areas: the importance of connecting with other people; adolescents' self-help strategies and personal growth after self-harm; mental healthcare; school or study programs; and needs related to society in relation to taboo on suicidal behaviour. Prevention of suicidal behaviour in adolescents will need to focus on development and strengthening of interventions fitting the needs of adolescents in these areas.

Family Belongingness Attenuates Entrapment and Buffers Its Association with Suicidal Ideation in a Sample of Dutch Sexual Minority Emerging Adults.

Sexual minority emerging adults are more likely to engage in suicidal ideation than their heterosexual counterparts. Experiences of homophobic violence are associated with suicidal ideation. Yet, the specific mechanisms linking homophobic violence to suicidal ideation remain unclear. Entrapment and social belongingness were tested to determine their relevance for understanding the link between homophobic violence and suicidal ideation. A sample of sexual minority Dutch emerging adults (N = 675; ages 18-29, M = 21.93 years, SD = 3.20) were recruited through online platforms and flyers. Homophobic violence was expected to be positively associated with suicidal ideation and entrapment. The association between homophobic violence and suicidal ideation was expected to be indirectly linked through entrapment. We explored whether various sources of social belongingness moderated the path between entrapment and suicidal ideation and whether those sources of social belongingness moderated the indirect effect of homophobic violence on suicidal ideation through entrapment. Results showed that homophobic violence and entrapment were positively associated with suicidal ideation and that family belongingness was negatively associated with suicidal ideation. Homophobic violence and suicidal ideation were not indirectly linked through entrapment. The interaction effect between entrapment and family belongingness was significant, suggesting that, on average, the effect of entrapment on suicidal ideation decreased when family belongingness was high. These results suggest that family belongingness may reduce the association between entrapment and suicidal ideation while adjusting for homophonic violence. Reducing entrapment and improving family belongingness may be useful targets for programs aimed at preventing suicidal ideation among sexual minority emerging adults.

Additional Value of Peer Informants in Psychological Autopsy Studies of Youth Suicides.

In this study, we examined the feasibility and added value of including peer informants in a psychological autopsy study of youth suicides. Peer semi-structured interview data from 16 cases were analyzed qualitatively and compared to parent data. Results show that peers added information to parents' narratives in general and particularly on social relationships, bullying, school experiences, social media, and family relations. Peers also provided additional information on the presence of certain issues (such as social media contagion) as well as on the emotional impact from certain adverse events that seemed to have functioned as precipitating factors. We conclude that including peers in psychological autopsy studies of youth suicides is feasible and of added value but that more research is desirable. The results initially can be used in the design of psychological autopsies so that the maximum amount of information about each suicide will be learned.

Explaining Health Disparities between Heterosexual and LGB Adolescents by Integrating the Minority Stress and Psychological Mediation Frameworks: Findings from the TRAILS Study.

Lesbian, gay, and bisexual (LGB) adolescents experience elevated levels of internalizing problems and use more substances than heterosexual adolescents. The minority stress and psychological mediation framework are complementary theoretical frameworks that were developed to explain these disparities. However, limited empirical research has integrated both frameworks to study health disparities between heterosexual and LGB adolescents. This study attempts such an integration, using data from the first five waves (participant age 11-22) of the TRacking Adolescents' Individual Lives Survey (TRAILS), a cohort study of Dutch adolescents (N = 1738; 151 LGB; 54.8% girls). It was tested whether an LGB identity was linked to internalizing problems and substance use through a serial mediation process, in which sexual identity would be associated with peer victimization and negative relationships with parents (first set of mediators, in keeping with the minority stress framework), which in turn would be associated with fear of negative social evaluation and a lack of social support (second set of mediators, in keeping with the psychological mediation framework), and eventually increasing the risk for internalizing problems and elevated levels of substance use. Moreover, it was tested whether the link between minority stress and substance use was mediated by peers' substance use levels, as hypothesized by the psychological mediation framework. Compared to heterosexual participants, LGB participants reported more internalizing problems, smoked more cigarettes, and used more marijuana, but did not consume more alcohol. The relation between sexual identity and internalizing problems was mediated by peer victimization and parental rejection, which is in line with the minority stress framework. No statistically significant support was found for the psychological mediation framework. These findings provide a better understanding of the pathways through which sexual identity disparities in mental wellbeing and substance use come about.

Attempted suicide of ethnic minority girls with a Caribbean and Cape Verdean background: rates and risk factors.

BACKGROUND: WHO data shows that female immigrants in Europe attempt suicide at higher rates than 'native' women and 'native' and immigrant men. Empirical studies addressing attempted suicide of female immigrants of Caribbean (Antillean-Dutch and Creole-Surinamese-Dutch) as well as Cape Verdean descent in Europe are however scarce. We aim to increase knowledge about rates and risk factors of girls of Caribbean and Cape Verdean descent living in the Netherlands. METHODS: We conducted logistic regression on a dataset that consisted of self-reported health and well-being surveys filled out by 5611 female students, age 14-16, in Rotterdam, the Netherlands (Antillean Dutch N = 357, Creole-Surinamese-Dutch N = 130, and Cape Verdean-Dutch N = 402, and Dutch 'natives' N = 4691). We studied if girls of these minority groups had elevated risk for attempted suicide. Risk indicators that were suspected to play a role were investigated i.e. household composition, socio-economic class, externalizing problems, emotional problems and sexual abuse. RESULTS: We found that rates of attempted suicide among Antillean (14%), Creole-Surinamese young women (15.4%) were higher than of 'native' Dutch girls (9.1%), while rates of Cape-Verdean girls (8.3%) were rather similar to those of 'native' girls. Not living with two biological parents was a risk factor for 'native' girls, but not for girls of Caribbean and Cape Verdean descent. Emotional problems and sexual abuse seems to be a risk indicator for suicidality across all ethnicities. Aggressive behaviour was a risk factor for Antillean Dutch and 'native' girls. CONCLUSIONS: Our findings underscore the need for developing suicide prevention programs for minority girls in multicultural cities in western Europe, in particular those of Caribbean descent. Results suggest the importance of addressing socio-economic class and educational background for suicide prevention, which bear particular relevance for Caribbean populations. Referral in the case of sexual trauma and low psychological wellbeing seems critical for reducing suicidal behaviour in girls, regardless of ethnicity.

Nonresidential fatherhood and father-child relationships among Curaçaoan and Dutch adolescents and young adults.

Growing up with a nonresident biological father has been portrayed as problematic for different aspects of father-child relationships, but it is unclear whether experiencing nonresidential fatherhood is less problematic in countries where this family structure is more common and thus probably less stigmatized. Cross-country research into nonresidential fatherhood is scarce, especially including Caribbean countries where many children grow up without their biological father in the home. This study examined associations between nonresidential fatherhood and father-child relationship quality and fathers' parenting behaviors among Curaçaoan and Dutch adolescents and young adults. Curaçaoan (n = 450) and Dutch (n = 585) participants completed a digital questionnaire in class, using the same procedures on Curaçao and in the Netherlands. We estimated structural equation models of perceived avoidant and anxious father-child attachment and paternal emotional warmth, rejection, and monitoring for both groups separately because of measurement variance across countries. Nonresidential fatherhood was unrelated to perceptions of most aspects of father-child relationships among both Curaçaoan and Dutch participants. This study adds an important cross-country perspective to the current literature on nonresidential fatherhood and tentatively suggests that correlates of nonresidential fatherhood for father-child relationships might be less evident than previous studies suggest. Instead, young people's socioeconomic status (SES) and the frequency of contact between fathers and children seem to be more important for father-child attachment and paternal rearing behaviors. Further research across demographic characteristics and child outcomes is required to understand whether, when, and how nonresidence of the biological father might affect child well-being and development in different countries. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The forever decision: a qualitative study among survivors of a suicide attempt.

Background: Suicide attempts have a profound emotional impact on both individuals and society as a whole. This qualitative study delves into three key aspects: 1) the progression through the suicidal process, 2) the influential factors facilitating the transition from ideation to attempt using the volitional moderators within the integrated motivational-volitional (IMV) model, and 3) preventive strategies impeding this transition from ideation to attempt. Methods: Between October 1, 2022 and March 7, 2023 we interviewed 27 adults (23 women, four men, mean age 33 years) who attempted suicide within the past 12 months. Participants were recruited through social media and in collaboration with several mental health institutions in the Netherlands. The participants were initially screened and interviewed based on the Pathway to Suicidal Actions Interview. Analysis was performed employing the constant comparative method. Findings: Despite the heterogeneity of the suicidal process, suicidal thoughts predominately emerged during adolescence (Mdn = 15, M = 17.8). In most participants, planning and preparatory actions occurred long before the attempt, with a median of six years prior to the attempt for the selection of the method. All volitional moderators were observed, although pain sensitivity in particular varied among participants. Access to lethal means and planning emerged as important moderators in the suicidal process. Asking the survivors what could have helped to prevent their attempts, most participants mentioned that they felt their suicidality was not taken seriously enough. Interpretation: We discussed the significance of planning in the suicidal process, challenges in conceptualizing planning and impulsivity, and individual differences in pain sensitivity. Based on the findings, we underscore the critical need for restricting access to means, giving greater consideration to preparatory actions within the suicidal process, and fostering open dialogues about suicidality. Funding: This research was funded by ProRail, the Dutch rail infrastructure manager in line with their work on mental health.

Victimization and suicidality among Dutch lesbian, gay, and bisexual youths.

We examined Netherlands Institute for Social Research data, collected between May and August 2009, on 274 Dutch lesbian, gay, and bisexual youths. The data showed that victimization at school was associated with suicidal ideation and actual suicide attempts. Homophobic rejection by parents was also associated with actual suicide attempts. Suicidality in this population could be reduced by supporting coping strategies of lesbian, gay, and bisexual youths who are confronted with stigmatization by peers and parents, and by schools actively promoting acceptance of same-sex sexuality.

Social media use of adolescents who died by suicide: lessons from a psychological autopsy study.

BACKGROUND: while there are many benefits for young people to use social media, adverse effects such as cyberbullying, online challenges, social comparison and imitation may provoke and aggravate suicidal thoughts and behaviors. The influence of social media on mental health and suicidal thoughts and behaviours has been amply studied, but there is little empirical evidence for its potential role in adolescent suicides. The current study aimed to inform digital suicide prevention strategies by examining the meaning of social media in the lives of young suicide victims and elucidating the harmful and supportive effects of social media use on their wellbeing and distress. METHODS: data were analyzed from a psychological autopsy study of 35 adolescents who died by suicide in the Netherlands (43% of all adolescents who died by suicide in that year). These were 18 girls and 17 boys. All were under the age of twenty years, with an average of seventeen years. Interpretative Phenomenological Analysis was performed of 55 semi structured interviews with peers and parents of the decedents. RESULTS: young people benefitted from peer support and recovery stories. However, various themes were discussed relating to the harmful effects of social media, including dependency, triggers and imitation, challenges, cybervictimization and psychological entrapment. The themes of dependency and triggers and imitation were more salient in young females. A group of girls cultivated an online identity around their suicidal thoughts and behaviours. Next-of-kin, particularly parents, faced various challenges to talk to the adolescents about social media use, including technological illiteracy, online anonymity, and the youths' closedness. CONCLUSIONS: based on the findings, we recommend education to stimulate the digital literacy of parents, health workers and educators, supporting conscientious social media use in young people, and extending the prevention of cyberbullying. We encourage future research to examine how virtual social networks may sustain suicidal thoughts and behaviour, and to further investigate the effectiveness of digital interventions, like moderated peer support and the use of positive role models.

Minority Stress and Suicidal Ideation and Suicide Attempts Among LGBT Adolescents and Young Adults: A Meta-Analysis.

Purpose: This meta-analytic study examined associations between minority stressors and suicidal ideation and suicide attempts among LGBT adolescents and young adults (aged 12-25 years). Methods: Identified studies were screened using the inclusion and exclusion criteria. Studies had to include an association between a minority stressor and a suicidality outcome and were categorized into 10 meta-analyses. Overall effect sizes were calculated using three-level meta-analyses. In addition, moderation by sampling strategy was examined. Results: A total of 44 studies were included. Overall, LGBT bias-based victimization, general victimization, bullying, and negative family treatment were significantly associated with suicidal ideation and/or suicide attempts. Associations of discrimination and internalized homophobia and transphobia with suicidal ideation and/or suicide attempts were not significant. No moderation effects were found for sampling strategy. Conclusion: Although overall effect sizes were small, our meta-analytic study shows a clear link between various types of minority stressors and suicidal ideation and suicide attempts among LGBT adolescents and young adults.

Moderating role of coping in the association between minority stress and suicidal ideation and suicide attempts among sexual and gender minority young adults.

OBJECTIVE: This study examined associations of minority stressors (i.e., victimization, internalized homonegativity, and stigma consciousness), and coping styles (i.e., active, avoidant, and passive) with suicidal ideation and suicide attempts (suicidality) among sexual and gender minority (SGM) young adults, and whether coping style moderated these associations. METHODS: Logistic regression analyses examined these associations among 1432 SGM young adults (ages 18-29). RESULTS: Minority stressors and passive coping were associated with a higher likelihood of suicidality. Avoidant coping was associated with a lower likelihood of lifetime suicidal ideation and attempts among sexual minority participants, and active coping with a lower likelihood of past-year suicidal ideation among sexual minority participants. Moderation analyses among sexual minority participants showed that when avoidant coping was high, associations between low victimization (compared with no victimization) and lifetime suicide attempts, and stigma consciousness and lifetime suicide attempts became non-significant, and the association between internalized homonegativity and lifetime suicide attempts became significant. Among gender minority participants, when passive coping was high the association between low victimization and lifetime suicidal ideation became significant. CONCLUSION: This study underlines the importance of minority stress and coping for suicidality among SGM young adults and the need for more research regarding the role of coping.

Attempted suicide and suicide of young Turkish women in Europe and Turkey: A systematic literature review of characteristics and precipitating factors.

BACKGROUND: The increased risk of suicidal behaviour among Turkish women living in Europe and Turkey is a serious public health problem. This study compares and synthesises the empirical evidence of demographic, social, psychological and interpersonal characteristics and precipitating factors in the suicides and attempted suicides of Turkish women in Europe and Turkey. METHODS: We systematically searched eight databases (PsycINFO, PubMed, Med Line, Web of Science, Smart Cat, Safety Lit, BASE and Ulakbim), using search terms in English, Turkish, German and Dutch, as well as the reference lists of the retrieved papers. We extracted data on countries/regions, population characteristics, sample characteristics, recruitment, method of data collection, type of suicidal behaviour (suicide or attempted suicide) and precipitating factors and characteristics. The results were qualitatively synthesised. RESULTS: We retrieved nine studies on attempted suicide in Europe (from Germany, Switzerland and the Netherlands), 17 studies on attempted suicide in Turkey and 10 studies on suicide in Turkey (36 in total). Overall, we found similar precipitating factors and characteristics of attempted suicide and suicide in Turkey and Europe, including socio-demographic factors (young age and not being enrolled in the labour market), poverty and, to some extent, mental illness. Moreover, conflicts with family or spouses and violence against women, including so-called honour violence, were particularly common for women living in or originating from traditional areas in Turkey. CONCLUSION: The framework of intersectionality is relevant to understanding our results, because structural inequalities in gender roles, gender role expectations as well as power imbalances among socio-economic classes collectively impact the suicidal behaviour of Turkish women. Moreover, the importance of violence against women points to the cultural continuity of the patriarchal and oppressive structures of Europe and Turkey. Suicide prevention efforts should address cultural attitudes underlying violence against women and girls through community education programmes, cultural and gender-sensitive care provision and jurisdiction.

Parental Responses to Coming out by Lesbian, Gay, Bisexual, Queer, Pansexual, or Two-Spirited People across Three Age Cohorts.

OBJECTIVE: The study aimed to better understand the complexities of parental responses to coming out in the narratives from Lesbian, Gay, Bisexual, Queer, Pansexual, or Two-Spirited (LGBQ+) individuals, and to examine whether those from recent cohorts experience a different parental response than those in older cohorts. BACKGROUND: Sexual minorities come out at younger ages today than in past decades, and coming out to parents is a major part of the identification process. METHOD: Interview excerpts of 155 US lesbian, gay, bisexual, queer, pansexual, or two-spirited (LGBQ+) respondents were analyzed with a qualitative thematic analysis and with basic quantitative methods. The sample consisted of 61 interviewees in a young cohort (ages 18-25), 65 in a middle cohort (ages 35-42), and 29 in an older cohort (ages 52-59), in six ethnic/racial groups. RESULTS: Themes based on LGBQ+ people's accounts indicated that parental responses varied with the degree of their a priori knowledge of respondents' sexual identities (ranging from suspicion or certainty to surprise). Parental appraisal was either lacking, negative, mixed, or positive with accompanying silent, invalidating, ambivalent, and validating responses, respectively. Validating responses from parents were more often found in the youngest cohort, but invalidating responses were frequent across all cohorts. LGBQ+ people in the oldest cohort were more inclined to accept their parents being noncommunicative about sexuality in general and also about sexual diversity. CONCLUSION: It is too early to state that coming out to parents has become easier. Harmony in the parent-child relationship after coming out and open communication about sexual identities is regarded as desirable and yet it remains elusive for many LGBQ+ people.

Gender differences in suicide-related communication of young suicide victims.

OBJECTIVES: There is limited insight into gender differences in suicide-related communication (SRC) in youths. SRC is defined as "the act of conveying one's own suicide ideation, intent or behaviours to another person". Increasing our understanding of SRC in youths will enable us to recognize and specify needs of female versus male youths. The current study explores SRC in a sample of Dutch suicide victims aged under 20 and examines gender differences. METHODS: Interview data from a psychological autopsy study of 35 youths who died by suicide in the Netherlands in 2017 were analysed. Qualitative analyses were performed to examine explicit SRC throughout the youths' lives and implicit SRC during the last months prior to suicide. We employed the Constant Comparative Method to explore patterns in the debut, form, frequency, medium, content, type of recipient, and SRC in the last months prior to suicide death. RESULTS: We identified commonalities in the SRC of youths, including the content of suicide notes and an emphasis on suicide method and preparation in the last months. Girls, however, had an earlier debut of SRC, a higher frequency of explicit SRC, and more often directed SRC towards varied types of recipients compared to boys. Moreover, SRC of girls seemed focused on coping and achieving support from others more than SRC of boys. The SRC of boys in comparison to girls was often ambiguous or diluted by "humorous" connotations. CONCLUSION: Unique patterns in SRC of boys and girls posed corresponding challenges for next of kin to interpret communications and respond adequately to SRC. The early debut of girls' SRC highlights the importance of early screening and prevention efforts in girls, while the late debut and ambiguity in boys' SRC implores professionals and next of kin to encourage young males to be unequivocal about suicide ideation or intent.

Suicidal behavior and ethnicity of young females in Rotterdam, The Netherlands: rates and risk factors.

OBJECTIVE: Although Western Europe is becoming increasingly multicultural, ethnic minorities are scarcely included in studies of suicidology. We investigated the prevalence of non-fatal suicidal behavior and examined risk factors in non-western female immigrant adolescents compared to majority female adolescents in the city of Rotterdam, The Netherlands. DESIGN: We conducted logistic regression on a dataset that consisted of self-reported health and well-being questionnaires filled out by 4527 adolescents of Dutch, South Asian-Surinamese, Moroccan, and Turkish origin. We examined whether young females of specific ethnic groups had elevated risk for attempted suicide. Well-known risk factors in suicidology of social economic class, level of education, life events, abuse, and family context were investigated to verify whether these factors are beneficial to explaining ethnic differences in suicidal behavior. RESULTS; We found that rates of attempted suicide among Turkish and South Asian-Surinamese young women were higher than of Dutch females, while Moroccan females had lower rates than Dutch female adolescents. Physical and sexual abuse, and an impaired family environment, as well as parental psychopathology or parental substance abuse contributed to non-fatal suicidal behavior of females across ethnicities. However, these risk factors, as well as low social economic class and of level of education, did not fully explain the vulnerability of Turkish and South Asian-Surinamese females. CONCLUSION: Our findings underscored the need for developing suicide prevention for specific minority females in multicultural cities in Western Europe. Screening programs, which aim at preventing suicide attempts by young immigrant women should include risk factors in the family environment and relationship with the parents as well as physical and sexual abuse. However, the study also showed that the disproportionate risk of Turkish and South Asian-Surinamese females could not be understood by risk factors alone and transpired that the origins of ethnic disparities in suicidal behavior deserve further examination.

A multi-method psychological autopsy study on youth suicides in the Netherlands in 2017: Feasibility, main outcomes, and recommendations.

OBJECTIVES: In the Netherlands, there was a sharp increase in the number of suicides among 10- to 19-year-olds in 2017. A multi-method psychological autopsy study (PA) was conducted to assess feasibility, identify related factors, and study the interplay of these factors to inform suicide prevention strategies. METHODS: Coroners identified youth suicides in 2017 in their records and then general practitioners (GPs) contacted the parents of these youths. Over a period of 7 months, 66 qualitative interviews were held with the parents, peers, and teachers, providing information on precipitating factors and five topics involving 35 cases (17 boys and 18 girls, mean age 17 years). Furthermore, 43 parents and care professionals filled in questionnaires to examine risk and care-related factors. Qualitative and quantitative analyses were performed. RESULTS: Although registration problems faced by coroners and resistance to contacting bereaved families by GPs hampered the recruitment, most parents highly appreciated being interviewed. Several adverse childhood experiences played a role at an individual level, such as (cyber) bullying, parental divorce, sexual abuse, as well as complex mental disorders, and previous suicide attempts. Two specific patterns stood out: (1) girls characterized by insecurity and a perfectionist attitude, who developed psychopathology and dropped out of school, and (2) boys with a developmental disorder, such as autism, who were transferred to special needs education and therefore felt rejected. In addition, adolescents with complex problems had difficulty finding appropriate formal care. Regarding potential new trends, contagion effects of social media use in a clinical setting and internet use for searching lethal methods were found. CONCLUSION: This first national PA study showed that, as expected, a variety of mostly complex clusters of problems played a role in youth suicides. An infrastructure is needed to continuously monitor, evaluate, and support families after each youth suicide and thereby improve prevention strategies.

Peer specialists in suicide prevention: Possibilities and pitfalls.

The emergence of peer specialists with histories of suicidality in mental health care services is a recent but scarcely researched societal phenomenon. The current study aimed to explore how peer specialists who have experienced suicidality (either attempted suicide or suicidal ideation) use their experiences to contribute to suicide prevention in mental health care services. Qualitative interviews with 20 peer specialists who have personally dealt with suicidality in their past were conducted. Interviewees perceived their work to have unique value in terms of their approach to making contact with suicidal care consumers on an emotional level, which was perceived to lead to less reluctance on the part of suicidal care consumers to talk about suicidality, as well as affect feelings of being acknowledged and heard. However, the lack of professional distance was perceived to carry several risks, including burdening clients with the peer specialists' own suicidal experiences, perceived reluctance of coworkers to let peer specialists work with suicidal clients, and the burden of working with suicidal clients for the peer specialists. Specific conditions that were perceived to be needed in order to work with suicidal clients consisted of personal distance to own process of recovery and suicidality, establishing boundaries with the team or colleagues for the peer specialists' work concerning suicide risk assessment, safety, privacy, and sharing responsibility. Further discussion between mental health care clinicians and peer specialists regarding the role of the peer specialist in suicide prevention is needed to further clarify and optimize their role. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Gender and cultural patterns of suicidal behavior: young Hindustani immigrant women in the Netherlands.

Patterns of suicidal behavior vary among cultures and along gender. Young Hindustani immigrant women attempt suicide four times more often than young Dutch women. This article explores multi-disciplinary explanations for suicidal behavior in this group. The interconnection of Durkheimian concepts of social integration and regulation with ecological insights into family relations and psychological and psychiatric theories on individual distress are relevant. It is suggested that young Hindustani women who display suicidal behavior possess certain personality and cognitive constellations that are interlocked with specific parenting styles in stressful family environments. These families are embedded in a context of moral transformations resulting from migration to a Western culture and may be facing difficulties accompanying the transitional processes encountered in the West, particularly those regarding gender roles. Durkheimian fatalistic and anomic suicides elucidate this. The Hindustani women who appear most at risk are those facing contradictory norms and overregulation, which prevent them from developing autonomy.