Research reportSuicidal thoughts and attempts among adolescents: a longitudinal 8-year follow-up study
Introduction
The frequency of suicide attempts increases sharply during the adolescent years (McClure, 1984, Aro et al., 1993). The rise in suicidality with age in adolescence may be due to developmental stresses, physical and psychological changes, increased social pressures, increasing drive for individuation, weakening of support systems and increase of major psychiatric disorders during adolescence. Suicidal behaviours in adolescence represent a continuum, ranging from thoughts to plans to attempts to completions (Kosky et al., 1990, Reynolds and Mazza, 1994, Pfeffer, 1997). In addition to the number of suicidal deaths, many persons make non-fatal attempts to harm themselves, often seriously enough to require medical care and not infrequently resulting in irreversible disability. A history of suicidal behaviour substantially increases the risk of psychopathology and psychosocial dysfunction among adolescents (Garrison et al., 1991, Brent et al., 1993, Lewinsohn et al., 1993, Reynolds and Mazza, 1994, Pfeffer, 1997, Roberts et al., 1998).
Both suicide attempts and verbal expressions of suicidality in adolescence indicate a heightened risk for suicide completion (Otto, 1972, Motto, 1984). Most adolescent suicides are an endpoint of long-term difficulties, and all suicidal tendencies among adolescents should be taken seriously (Marttunen et al., 1992).
It is important to study the factors associated with suicidal thoughts or attempts in order to plan effective preventive programmes for adolescents. The first aim of the present study is to report the prevalence of suicidal thoughts and behaviour among 16-year-olds drawn from a community sample. The second aim is to identify child, family and help-seeking factors at age 8 and at age 16, which are associated with suicidal features at age 16.
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Study sample and study design
This investigation was part of an 8-year follow-up study included in the Epidemiological Multicenter Child Psychiatric Study in Finland. The research plan was approved by the Joint Commission on Ethics of Turku University and the Turku University Central Hospital. The first assessment was conducted in October and November 1989 and the second assessment 8 years later, between May and September 1997. The original study sample was drawn from the total population of Finnish children born during
Suicidal thoughts and attempts
Table 1 shows the prevalence of suicidal attempts and suicidal ideations, according to parent and self-reports. There were altogether 62 adolescents (10.5% of the sample) who, according to self-report or parental report, had had suicidal behaviours or ideations. Of girls, 14% (45/324) and of boys, 7% (17/256) had shown suicidal features. Of adolescents with suicidal features, 52% (32/62) were within the clinical range on the CBCL Total Problem Scale, and 60% (37/62) within the clinical range on
Discussion
In the present study, 14% of girls and 7% of boys reported suicidal thoughts or preoccupations. Girls were about two-fold more likely to manifest a variety of suicidal features than boys. The result that girls are more likely to express a wish to be dead as well as to attempt to do themselves harm is consistent with previous studies (Shaffer and Hicks, 1994, Roberts et al., 1998). Almost three times more adolescents reported suicidal features than their parents had observed. The differences
Clinical implications
The present study stresses the importance of the development of mental health perspectives in preventing self-destructive behaviours in adolescence. Suicidal behaviours and thoughts were strongly associated with other signs of psychopathology and low social competence in adolescence. Many of the suicidal adolescents had a wide range of behavioural symptoms already at age 8. Better recognition by professionals working in child health services, and early intervention for children with depressive
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