Academic journal article South African Journal of Psychiatry

Predicting Frequency of Suicide Attempts of Adolescent Outpatients at Weskoppies Hospital Using Clinical and Demographic Characteristics

Academic journal article South African Journal of Psychiatry

Predicting Frequency of Suicide Attempts of Adolescent Outpatients at Weskoppies Hospital Using Clinical and Demographic Characteristics

Article excerpt

Suicidal thinking and behaviour are of grave concern to the psychiatric community, with the prevalence of suicide attempts taking on alarming proportions in some countries. Several international studies have examined the lifetime prevalence of suicide attempts by adolescents between 13 and 18 years old, with figures of 2.7% in the USA, (1) 3% in Norway (2) and 6.5% in the USA and Germany, (3) and an increase from 7% to 13.4% in Greece, (4) being reported over the past few decades. The 12-month prevalence of suicide attempts by high-school students in a similar age range has been reported variously as 1.4% in the USA, 1.7% in Norway, 4.3% in a community sample in Australia and 12% in Nigeria. (1,2,5,6)

South African studies have also found high figures for the lifetime prevalence of attempted suicide in secondary school students. For example, Flisher et al. (2006) found that 18.6% of female high school students had attempted suicide, (7) and Cherian et al. (2000) that the frequency of attempted suicide was 11.3% among blacks, 13% among whites and 13.5% among Asians in a group of secondary school pupils aged 17-24 years. (8)

Research and practice illustrates that suicidality is largely determined by two sets of characteristics, clinical and demographic. While some features are present among both adults and adolescents, the profile of adolescent suicide attempters differs from that of adults in certain crucial aspects.

Clinically, a strong correlation exists between certain psychiatric disorders and suicide attempts, particularly among adolescents. Numerous studies show that anorexia nervosa and body image, (9-12) health risk behaviours including sexual intercourse, damaging property and substance abuse, (10-18) major depressive disorders, (11-20) anxiety disorders, particularly panic disorder and post-traumatic stress disorder, (11,12,16,20) impulse control disorders, (20) externalising behaviours (12,18) and other psychopathology, especially when linked with high environmental stress levels with a recent stressor including a recent romantic breakup, assault or arrest, contributed to the prediction of suicide attempts in multivariate analyses. (12,18)

In one survey of adolescents, 5% reported over one suicide attempt per year. (18) The factors leading to repeated attempts included depression (13 times increase), sexual assault (7 times increase), substance abuse disorder, violent behaviour in boys, and problems of increased weight in girls. (18) In a 2001 Centers for Disease Control and Prevention Youth Risk Behavioral Survey of 13 601 adolescents in school (grades 9-12), 53% of those who had attempted suicide did so only once per year. (18) One attempt increased the risk for further attempts 15-fold, however; 30% had two or three attempts per year, and 17% four or more attempts in a year. (18)

Physically and sexually abused children have high rates of suicidal behaviour. (19) Child abuse victims have a high incidence of suicidality, which may be directly attributable to the abuse or a consequence of the range of psychiatric problems associated with abuse. It is difficult for physically abused children to develop relationships, resulting in social isolation or conflictual relationships that predispose them to suicidal behaviour. Children with family members who completed suicide are at a higher risk of attempting suicide than children without such family members. (19)

Parental psychopathology is associated with adolescent suicidal behaviour. It remains unclear whether a family history of depression and substance abuse increases completed suicide risk. The purported association between dysfunctional families and adolescent suicide attempts is also unclear. (20)

Demographically, correlations have been found between adverse childhood experiences and suicide ideation and attempts. (21) Gender- and age-based patterns of differentiation in methods and prevalence of suicide attempts, as well as differences across types and levels of education and race/ethnicity, have been researched. …

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