Suicidal Thoughts among Adolescents: An Intercultural Approach
Choquet, Marie, Kovess, Viviane, Poutignat, Nathalie, Adolescence
Most studies concerning the "suicide phenomenon" of young people aged 15-19 have analyzed mortality and to a lesser extent morbidity. In France, the suicide rate in 1987 was 14.7 for boys and 4.7 for girls (per 100,000). Concerning attempted suicide, Davidson and Philippe (1986) estimated the rate to be 212 for boys and 456 for girls (per 100,000). In Quebec, the suicide rate is clearly higher for boys, having reached 24.1 in 1981, but similar for girls (5.0) (Kovess & Choquet, 1989). As for attempted suicide, a study conducted in Ontario estimated the rate at 500 for boys and 1,000 for girls (Jarvis et al., 1976). While these studies have measured the prevalence of suicidal behavior and noted the associated risk factors, they have not elucidated the emergence of suicidal ideation or its ensuing chronicity.
Suicidal ideation has been infrequently studied for two main reasons. First, it is not as easy to measure objectively as is suicidal behavior, and information is therefore considered to be less reliable. Ideation may be transient, questions may not be pertinent, and answers are liable to be biased (Jeanneret, 1989). This view is corroborated by the disparity in survey results. Concerning adults, rates range from 9% (Paykel et al., 1974) to 14% (Sorenson & Goldning, 1988). For adolescents, they range from 8% (Wright, 1985) to 62% (Friedman et al., 1987). Further, there is the problem of the wording of the questionnaire (suicidal ideation, precise suicidal plans), as well as that of the proposed answers (binary, multiple choice), and the time span taken into account (lifetime, one year, one week).
Second, the study of suicidal ideation requires large populations, which are generally difficult to obtain (cohorts, cost), particularly concerning such a delicate matter. Those in charge of planning these surveys are often reluctant to carry them out because they fear their inductive capacity, and those who actually conduct the survey may find it difficult to approach the subject. To these considerations may be added the problem of ensuring confidentiality. A related ethical issue is that if a suicidal individual is identified, he or she should be referred for appropriate counseling.
Although difficult, it is necessary to understand the factors that may lead to self-destructive acting out in order to plan primary prevention measures. The present comparative study was undertaken to investigate suicidal ideation in French and Canadian (Quebec) adolescents.
The two surveys were set up concurrently but independently of one another. Therefore, the results came from secondary analyses. In addition, variations in the wording of questions on similar subjects may account for some of the differences between samples. On the other hand, there are many advantages to using such data for cross-cultural comparisons. One is that the high cost of setting up similar protocols in different countries is reduced.
The factors investigated were the same for both surveys. They included the consumption of licit and illicit drugs, health, family, social integration, self-perception, and suicidal ideas.
In France the survey was conducted under the heading of adolescent health (Choquet et al., 1988). The Quebec survey pertained to the general population of youth aged 15 and over. From within this group, a cohort of 15- to 19-year-olds was chosen from the region of Rimouski, an area similar to the one studied in France (Kovess & Choquet, 1989). The characteristics of the survey as well as the instruments and population studied are summarized in Table 1.
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Comparing France and Quebec had advantages. The language spoken is the same, whereas sociocultural backgrounds differ, allowing comparisons.
The wording of the question on suicidal ideation was, for France, "J'ai pense au suicide," which could be translated as "I have had suicidal thoughts" or "I have thought about suicide. …