Suicide Ideation and Depression: The Moderation Effects of Family Cohesion and Social Self-Concept

By Au, Apple C. Y.; Lau, Sing et al. | Adolescence, Winter 2009 | Go to article overview

Suicide Ideation and Depression: The Moderation Effects of Family Cohesion and Social Self-Concept


Au, Apple C. Y., Lau, Sing, Lee, Margaret T. Y., Adolescence


The suicide rate in Hong Kong has risen 35% from 1999 to 2003 (16.5% from 2002 to 2003). The figures for 1999, 2000, 2001, 2002, and 2003 are 882, 915, 988, 1025, and 1195, respectively (Hong Kong Coroners' Report 1999-2003). Among the 0-19 age group, the suicide rate has risen from 1.6 to 3.3 over these years. It is particularly alarming that the rate more than tripled in one year in the number of attempted suicides among students in 2001 (Hong Kong Coroners' Court 1999-2003; Chiang, 2001). Suicide has become the leading cause of death in Hong Kong for those aged 15-24 (Yip, Liu, Lam, Stewart, Chen, & Fan, 2004).

Psychiatric problems are common in youths who completed suicide. The vast majority had previous suicidal behaviors (Ho, Leung, Hung, Lee, & Tang, 2000), depressive disorders (e.g., Stewart, Lam, Betson, & Chung, 1999; Gould & Kramer, 2001; Lau, Chan, Lau, & Hui, 1997; Yip, Liu, Lam, Stewart, Chen, & Fan, 2004) and substance abuse (Ho, Leung, Hung, Lee, & Tang, 2000). Depression in particular has been reported to be a primary predictor of suicidal ideation (Chiles, Stroshahl, Ping, Michael, Jemelka, Senn, & Reto, 1989), as well as an important mediator in the relationship between many stressors and suicidal ideation (Stewart et al., 1999, Sun, Hui, & Watkins, 2006). Consistent with this line of thinking, local research (Lau, Chan, Lau & Hui, 1997; Yip, Ho, Hung, Laideler, & Leung, 1998; Yip, Liu, Sanita, & Chen, 2003) tends to show that depression is the major factor.

Studies on youth suicidal behaviors have revealed that psychosocial influences from both the family and peers correlated with suicide attempts and ideation. Harter and others (1992), for instance, showed that low social support from parents and peers were related to suicide ideation through inducing hopelessness and low self-worth. More recently, Prinstein and others (2000) similarly demonstrated that psychosocial risk factors related to peer and family functioning directly predicted suicide ideation and depressive symptoms in psychiatric patients. Given the significance of the family and peer relationships in children's and adolescents' social world, it is important to understand not only how interpersonal relationships in these two dimensions can place youths at risk of psychopathology, but whether and how familial and interpersonal functioning can buffer our new generation against self-destructive thoughts and behaviors.

Low family cohesion and support (e.g. Dubow, Kausch, Blum, Reed, & Bush, 1989; Friedrich, Reams, & Jacobs, 1982; Harris & Molock, 2000; McKeown, Garrison, Cuffe, Addy, & Waller, 1997; Morano, Cisler & Lemerond, 1993) as well as familial conflict and dysfunction (e.g. Sheeber, Hops, Alpert, Davis, & Andrews, 1997; Spirito, Brown, Overholser, & Fritz, 1989; Tishler, McKenry, & Morgan, 1981; Gencoz & Or, 2006) are either potential causes of suicide behaviors or indirectly aggravate risks through depressive symptoms. Similarly the relationship between suicide ideation and peer functioning such as peer social support, social self-concept, social isolation, have been consistently found (e.g. Harter et al., 1992; Lewinsohn, Rohde, & Seely, 1993; Tishler et al., 1981). Despite the fact that most of these studies could imply only correlational but not causal relationships between suicidal behaviors and familial and peer functioning due to possible limitations in research designs (for review, see Wagner, 1997), they nonetheless consistently reveal that family and peers are indisputably crucial domains that could influence youths' psychological well-being. Understanding the mechanism through which variables in these two domains affect youths' emotions and suicidal ideation is thus essential in order to prevent youth suicidal behaviors.

Social support from peers and the family are important coping resources, the lack of which can predispose individuals to self-damaging cognitions and suicidal behavior during stressful life events (Nelson, 1987; Rich & Bonner, 1987). …

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