Research report
Suicidal thoughts and attempts among adolescents: a longitudinal 8-year follow-up study

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Abstract

Background: To study the prevalence of and factors associated with suicidal behaviour among 580 adolescents. Methods: An 8-year longitudinal study included questions about suicidal attempts and thoughts at age 16. Children were evaluated with parent and teacher Rutter scales and self-reported Child Depression Inventory at age 8. At age 16, parents filled in the Child Behaviour Check List and adolescents the Youth Self Report. Results: 14% of girls and 7% of boys reported suicidal thoughts or preoccupations at age 16. Emotional and behavioural problems at age 8, especially antisocial symptoms, reported by parents and teachers and depressive symptoms reported by the child were correlated with suicidal thoughts and behaviour 8 years later. At age 16, internalizing and externalizing problems and low social competence were associated with suicidal features. Only about 20% of those who reported suicidal features had been referred to child mental health services. Conclusions: Many adolescents with suicidal thoughts and behaviour had a high rate of behavioural and emotional problems already at age 8. Clinical implications: The early school years represent an opportunity for interventions which may prevent self-destructive behaviours in adolescence.

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.

Section snippets

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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