Abstract
Child and adolescent suicide is a major public health issue in Chile. Although we have seen a decline in child and adolescent suicide statistics over the past few years, suicide is still the leading cause of death in adolescents between 15 and 19 years of age. Suicidal ideation is an important factor in the prevention and early intervention of suicide. However, this factor has great variability, dependent on territory, rurality, gender, and social status in Chilean adolescents. Owing to this distinct inequality, this chapter addresses important questions regarding the effect of social context on the mental health of adolescents and the mediating mechanisms that explain the relationship between a certain social context and suicidal behavior. To address these questions, the chapter describes risk and protection variables in a Chilean context, which are theoretically and empirically grounded, and which shed light on the relationship between context and extreme psychological distress. This chapter identifies findings regarding the relationship between suicidal behavior and sociodemographic variables like rurality, economic vulnerability and gender, among others. Furthermore, this chapter considers related studies that focus on the effects of psychosocial variables such as family functionality, alcohol consumption, drug use, with a clear focus on the construct of social defeat. Finally, this chapter identifies and describes clinical predictors of suicidal behavior. The results of a study completed on an adolescent Chilean population that identifies risk trajectories through the analysis of mediation are discussed in this chapter. These results demonstrate that risk trajectories begin with the contextual, pass through the psychosocial and clinical variables, and finally increase the probability of experiencing suicidal behavior.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
The IVE measures the percentage of vulnerable students in an educational establishment, and creates values between 0 and 100, where higher values reflect greater vulnerability. The index reflects the level of poverty and risk of school failure in an educational establishment. It is evaluated by the Ministry of Education via a direct census of all the families in a school, and the information is cross checked with other institutions (health, child protection system, and civil registry).
References
Anyan, F., & Hjemdal, O. (2018). Stress of home life and gender role socializations, family cohesion, and symptoms of anxiety and depression. Women & Health, 58(5), 548–564. https://doi.org/10.1080/03630242.2017.1316343
Araya, M. P. (2019). Programa Nacional de Prevención del Suicidio, Ministerio de Salud de Chile. [National Suicide Prevention Program, Chilean Ministry of Health]. https://todomejora.org/wp-content/uploads/2019/03/PPT_Plan-Nacional-Prevenci%C3%B3n-del-Suicidio_Ma.-Paz-Araya.pdf
Barroilhet, S., Fritsch, R., Guajardo, V., Martínez, V., Voehringer, P., Araya, R., & Rojas, G. (2012). Suicidal ideation, self-directed violence and depression among Chilean school adolescents. Revista Médica de Chile, 140(7), 873–881. https://doi.org/10.4067/s003498872012000700007
Bonanno, R., & Hymel, S. (2010). Beyond hurt feelings: Investigating why some victims of bullying are at greater risk for suicidal ideation. Merrill-Palmer Quarterly, 56(3), 420–440.
Borges, G., Benjet, C., Orozco, R., Medina-Mora, M. E., & Menendez, D. (2017). Alcohol, cannabis and other drugs and subsequent suicide ideation and attempt among young Mexicans. Journal of Psychiatric Research, 91, 74–82. https://doi.org/10.1016/j.jpsychires.2017.02.025
Bostwick, J. M., Pabbati, C., Geske, J. R., & McKean, A. J. (2016). Suicide attempt as a risk factor for completed suicide: Even more lethal than we knew. The American Journal of Psychiatry, 173(11), 1094–1100. https://doi.org/10.1176/appi.ajp.2016.15070854
Carvalho, A. F., Stubbs, B., Vancampfort, D., Kloiber, S., Maes, M., Firth, J., & Koyanagi, A. (2019). Cannabis use and suicide attempts among 86,254 adolescents aged 12–15 years from 21 low-and middle-income countries. European Psychiatry, 56(1), 8–13. https://doi.org/10.1016/j.eurpsy.2018.10.006
CEPAL. (2010). Perfil epidemiológico básico de la población mapuche residente en la Provincia de Arauco. [basic epidemiological profile of the Mapuche population residing in the Arauco Province] MINSAL, Chile. https://www.minsal.cl/sites/default/files/files/SERIE%20PUBLICACIONES%20SITUACION%20DE%20SALUD%20N%C2%B07%20ARAUCO.pdf
Damsgaard, M. T., Holstein, B. E., Koushede, V., Madsen, K. R., Meilstrup, C., Nelausen, M. K., & Rayce, S. B. (2014). Close relations to parents and emotional symptoms among adolescents: Beyond socio-economic impact? International Journal of Public Health, 59(5), 721–726. https://doi.org/10.1007/s00038-014-0600-8
Daniel, S. S., Walsh, A. K., Goldston, D. B., Arnold, E. M., Reboussin, B. A., & Wood, F. B. (2006). Suicidality, school dropout, and reading problems among adolescents. Journal of Learning Disabilities, 39(6), 507–514. https://doi.org/10.1177/00222194060390060301
DEIS. (2017). Mortalidad. https://www.deis.cl/series-y-graficos-de-mortalidad/
Duarte, D. (2007). El suicidio en chile. Un signo de exclusión. Editorial Universitaria.
Florenzano, R., Cáceres, E., Valdés, M., Calderón, S., Santander, S., Cassasus, M., & Aspillaga, C. (2010). Comparación de frecuencia de conductas de riesgo, problemas juveniles y estilos de crianza, en estudiantes adolescentes de tres ciudades chilenas. [Comparison of frequency of risk behaviors, youth problems and parenting styles in adolescent students in three Chilean cities]. Cuadernos Médico Sociales, 50(2), 115–123.
Fonseca-Pedrero, E., Inchausti, F., Pérez-Gutiérrez, L., Solana, R. A., Ortuño-Sierra, J., Lucas-Molina, B., & Urbiola-Merina, E. (2018). Suicidal ideation in a community-derived sample of Spanish adolescents. Revista de Psiquiatría y Salud Mental, 11(2), 76–85. https://doi.org/10.1016/j.rpsmen.2018.02.008
Fontanella, C. A., Hiance-Steelesmith, D. L., Phillips, G. S., Bridge, J. A., Lester, N., Sweeney, H. A., & Campo, J. V. (2015). Widening rural-urban disparities in youth suicides, United States, 1996–2010. JAMA Pediatrics, 169(5), 466–473. https://doi.org/10.1001/jamapediatrics.2014.3561
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 1–46. https://doi.org/10.1037/bul0000084
Gilbert, P., & Allan, S. (1998). The role of defeat and entrapment (arrested flight) in depression: An exploration of an evolutionary view. Psychological Medicine, 28(3), 585–598. https://doi.org/10.1017/S0033291798006710
Glenn, C. R., Franklin, J. C., & Nock, M. K. (2015). Evidence-based psychosocial treatments for self-injurious thoughts and behaviors in youth. Journal of Clinical Child & Adolescent Psychology, 44(1), 1–29. https://doi.org/10.1080/15374416.2014.945211
Handley, T. E., Inder, K. J., Kelly, B. J., Attia, J. R., & Kay-Lambkin, F. J. (2011). Urban–rural influences on suicidality: Gaps in the existing literature and recommendations for future research. Australian Journal of Rural Health, 19(6), 279–283. https://doi.org/10.1111/j.14401584.2011.01235.x
Haquin, C., Larraguibel, M., & Cabezas, J. (2004). Protective and risk factors in mental health in children and adolescents in the city of Calama. Revista Chilena de Pediatría, 75(5), 425–433. https://doi.org/10.4067/S0370-41062004000500003
Hernández, M., & Raczynski, D. (2015). School choice in Chile: From distinction and exclusion to the social segregation of the school system. Estudios Pedagógicos, 41(2), 127–141. https://doi.org/10.4067/S0718-07052015000200008
Hounkpatin, H. O., Wood, A. M., & Dunn, G. (2016). Does income relate to health due to psychosocial or material factors? Consistent support for the psychosocial hypothesis requires operationalization with income rank not the Yitzhaki index. Social Science & Medicine, 150, 76–84. https://doi.org/10.1016/j.socscimed.2015.12.008
Huang, Y., Edwards, J., & Laurel-Wilson, M. (2020). The shadow of context: Neighborhood and school socioeconomic disadvantage, perceived social integration, and the mental and behavioral health of adolescents. Health & Place, 66, 102425. https://doi.org/10.1016/j.healthplace.2020.102425
INJUV. (2015). Octava encuesta nacional de juventud 2015. [Eighth National Youth Survey 2015]. Instituto de la Juventud.
Jaya, E. S., & Lincoln, T. M. (2016). Social adversities and psychotic symptoms: A test of predictions derived from the social defeat hypothesis. Psychiatry Research, 245, 466–472. https://doi.org/10.1016/j.psychres.2016.09.002
Jeong, S. C., Kim, J. Y., Choi, M. H., Lee, J. S., Lee, J. H., Kim, C. W., & Kim, S. H. (2020). Identification of influencing factors for suicidal ideation and suicide attempts among adolescents: 11-year national data analysis for 788,411 participants. Psychiatry Research, 291, 113228. https://doi.org/10.1016/j.psychres.2020.113228
Kim, D. H. (2020). Applying the social-ecological framework on the pattern of longitudinal trajectory of truancy in south Korean adolescents. Children and Youth Services Review, 119, 105511. https://doi.org/10.1016/j.childyouth.2020.105511
Leadbeater, B. J., Ames, M. E., & Linden-Carmichael, A. N. (2019). Age-varying effects of cannabis use frequency and disorder on symptoms of psychosis, depression and anxiety in adolescents and adults. Addiction, 114(2), 278–293. https://doi.org/10.1111/add.14459
Lecic-Tosevski, D. (2019). Is urban living good for mental health? Current Opinion in Psychiatry, 32(3), 204–209. https://doi.org/10.1097/YCO.0000000000000489
Leiva, L., Pineda, M., & Encina, Y. (2013). Autoestima y apoyo social como predictores de la resiliencia en un grupo de adolescentes en vulnerabilidad social. Revista de Psicología, 22(2), 111–123. https://doi.org/10.5354/0719-0581.2013.30859
Li, D., Li, X., Wang, Y., & Bao, Z. (2016). Parenting and Chinese adolescent suicidal ideation and suicide attempts: The mediating role of hopelessness. Journal of Child and Family Studies, 25(5), 1397–1407. https://doi.org/10.1007/s10826-015-0334-0
Li, X., Ren, Y., Zhang, X., Zhou, J., Su, B., Liu, S., & You, J. (2020). Testing the integrated motivational-volitional model of suicidal behavior in Chinese adolescents. Archives of Suicide Research, 1–17. https://doi.org/10.1080/13811118.2019.1690607
Madero, I. (2011). Inclusion and exclusion of gender and class within the Chilean school in 4 communes of southern Chile. Estudios Pedagógicos, 37(2), 135–145. https://doi.org/10.4067/S0718-07052011000200008
Miller, A. B., Esposito-Smythers, C., & Leichtweis, R. N. (2015). Role of social support in adolescent suicidal ideation and suicide attempts. The Journal of Adolescent Health, 56(3), 286–292. https://doi.org/10.1016/j.jadohealth.2014.10.265
Moksnes, U. K., Løhre, A., Lillefjell, M., Byrne, D. G., & Haugan, G. (2016). The association between school stress, life satisfaction and depressive symptoms in adolescents: Life satisfaction as a potential mediator. Social Indicators Research, 125(1), 339–357. https://doi.org/10.1007/s11205-014-0842-0
Nrugham, L., Larsson, B., & Sund, A. M. (2008). Specific depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence. Journal of Affective Disorders, 111(1), 83–93. https://doi.org/10.1016/j.jad.2008.02.010
Núñez, D., Arias, V., Vogel, E., & Gómez, L. (2015). Internal structure of the community assessment of psychic experiences—Positive (CAPE-P15) scale: Evidence for a general factor. Schizophrenia Research, 165(2–3), 236–242. https://doi.org/10.1016/j.schres.2015.04.018
O’Connor, R. C. (2011). The integrated motivational-volitional model of suicidal behavior. Crisis, 32(6), 295–298. https://doi.org/10.1027/0227-5910/a000120
O’Connor, R. C., Smyth, R., Ferguson, E., Ryan, C., & Williams, J. M. G. (2013). Psychological processes and repeat suicidal behavior: A four-year prospective study. Journal of Consulting and Clinical Psychology, 81(6), 1137143. https://doi.org/10.1037/a0033751
OEA. (2019). Informe sobre el consumo de drogas en las Américas, 2019/Comisión Interamericana para el Control del Abuso de Drogas [Inter-American Observatory on Drugs (OID)]. http://www.cicad.oas.org
Oesterle, T. S., Hitschfeld, M. J., Lineberry, T. W., & Schneekloth, T. D. (2015). CRAFFT as a substance use screening instrument for adolescent psychiatry admissions. Journal of Psychiatric Practice, 21(4), 259–266. https://doi.org/10.1097/PRA.0000000000000083
Organization for Economic Co-Operation and Development (OECD). (2015). “Suicide,” in Health at a Glance 2015: OECD Indicators. OECD.
Padilla-Moledo, C., Ruiz, J. R., & Castro-Piñero, J. (2016). Parental educational level and psychological positive health and health complaints in Spanish children and adolescents. Child: Care, Health and Development, 42(4), 534–543. https://doi.org/10.1111/cch.12342
Patrick, M. E., Kloska, D. D., Terry-McElrath, Y. M., Lee, C. M., O’Malley, P. M., & Johnston, L. D. (2018). Patterns of simultaneous and concurrent alcohol and marijuana use among adolescents. The American Journal of Drug and Alcohol Abuse, 44(4), 441–451. https://doi.org/10.1080/00952990.2017.1402335
Pavez, P., Santander, N., Carranza, J., & Vera-Villarroel, P. (2009). Familial risk factors for suicide among adolescents with depression. Revista Médica de Chile, 137(2), 226–233. https://doi.org/10.4067/S0034-98872009000200006
Proctor, C. L., Linley, P. A., & Maltby, J. (2009). Youth life satisfaction: A review of the literature. Journal of Happiness Studies, 10(5), 583–630. https://doi.org/10.1007/s10902-008-9110-9
Pruessner, M., King, S., Vracotas, N., Abadi, S., Iyer, S., Malla, A. K., & Joober, R. (2019). Gender differences in childhood trauma in first episode psychosis: Association with symptom severity over two years. Schizophrenia Research, 205, 30–37. https://doi.org/10.1016/j.schres.2018.06.043
Quijada, Y., Villagrán, L., Vaccari, P., Reyes, C., & Gallardo, L. D. (2019). Social inequality and mental health in Chile, Ecuador, and Colombia. Latin American Perspectives, 46(6), 92–108. https://doi.org/10.1177/0094582X18803682
Quijada, Y. (2019). Modelo explicativo del intento de suicidio en adolescentes escolarizados, basado en variables contextuales, psicosociales y clínicas relevantes en Chile. Informe Final. [Explanatory model of the suicide attempt in adolescent students based on relevant contextual, psychosocial, and clinical variables in Chile. Final report]. Comisión Nacional de la Ciencia y la Tecnología.
Ribeiro, J. D., Huang, X., Fox, K. R., & Franklin, J. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts and death: Meta-analysis of longitudinal studies. The British Journal of Psychiatry, 212(5), 279–286. https://doi.org/10.1192/bjp.2018.27
Riecher-Rössler, A., Butler, S., & Kulkarni, J. (2018). Sex and gender differences in schizophrenic psychoses—A critical review. Archives of Women's Mental Health, 21(6), 627–648. https://doi.org/10.1007/s00737-018-0847-9
Salvo, L., & Castro, A. (2013). Association of loneliness, impulsivity and alcohol use with suicidal behavior in adolescents. Revista Médica de Chile, 141(4), 428–434. https://doi.org/10.4067/S0034-98872013000400002
Salvo, L., & Melipillán, R. (2008). Predictores de suicidalidad en adolescentes. [predictors of suicidality in adolescents]. Revista Chilena de Neuro-Psiquiatría, 46(2), 115–123. https://doi.org/10.4067/S0717-92272008000200005
Schofield, P., Das-Munshi, J., Bécares, L., Morgan, C., Bhavsar, V., Hotopf, M., & Hatch, S. L. (2016). Minority status and mental distress: A comparison of group density effects. Psychological Medicine, 46(14), 3051–3059. https://doi.org/10.1017/S0033291716001835
Senda. (2018). Décimo Segundo Estudio Nacional de Drogas en Población Escolar de Chile, 2017 8° Básico a 4° Medio. Ministerio del Interior y Seguridad Pública. https://www.senda.gob.cl/wp-content/uploads/2019/01/ENPE-2017.pdf
Shekhtmeyster, Z., Sharkey, J., & You, S. (2011). The influence of multiple ecological assets on substance use patterns of diverse adolescents. School Psychology Review, 40(3), 386–404. https://doi.org/10.1080/02796015.2011.12087705
Silva, D., Vicente, B., Saldivia, S., & Kohn, R. (2013). Suicidal behavior and psychiatric disorders in Chile. A population-based study. Revista Médica de Chile, 141(10), 1275–1282. https://doi.org/10.4067/S0034-98872013001000006
Silva, D., Valdivia, M., Vicente, B., Arévalo, E., Dapelo, R., & Soto, C. (2017). Intento de suicidio y factores de riesgo en una muestra de adolescentes escolarizados de Chile [Suicide attempt and risk factors in a sample of school adolescents in Chile]. Revista de Psicopatología y Psicología Clínica, 22(1), 33–42. https://doi.org/10.5944/rppc.vol.22.num.1.2017.16170
Spears, M., Montgomery, A. A., Gunnell, D., & Araya, R. (2014). Factors associated with the development of self-harm amongst a socio-economically deprived cohort of adolescents in Santiago, Chile. Social Psychiatry and Psychiatric Epidemiology, 49(4), 629–637. https://doi.org/10.1007/s00127-013-0767-y
Taylor, P. J., Gooding, P., Wood, A. M., & Tarrier, N. (2011). The role of defeat and entrapment in depression, anxiety, and suicide. Psychological Bulletin, 137(3), 391–420. https://doi.org/10.1037/a0022935
Troop, N. A., & Baker, A. H. (2008). The specificity of social rank in eating disorder versus depressive symptoms. Eating Disorders, 16, 331–341. https://doi.org/10.1080/10640260802115993
Turecki, G., & Brent, D. A. (2016). Suicide and suicidal behaviour. The Lancet, 387(10024), 1227–1239. https://doi.org/10.1016/S0140-6736(15)00234-2
Uddin, R., Burton, N. W., Maple, M., Khan, S. R., & Khan, A. (2019). Suicidal ideation, suicide planning, and suicide attempts among adolescents in 59 low-income and middle-income countries: A population-based study. The Lancet Child & Adolescent Health, 3(4), 223–233. https://doi.org/10.1016/S2352-4642(18)30403-6
Valdivia, M., Silva, D., Sanhueza, F., Cova, F., & Melipillán, R. (2015). Suicide attempts among Chilean adolescents. Revista Médica de Chile, 143(3), 320–328. https://doi.org/10.4067/S003498872015000300006
Valdivieso, P., Cavieres, H., & Antivilo, A. (2005). La exclusión social: un estudio psicosocial sobre las percepciones juveniles [Social exclusion: a psychosocial study on youth perceptions]. In Universidad Internacional SEK (Ed.), La Violencia en la Familia, Escuela y Sociedad. Facultad de Ciencias Sociales, Universidad Internacional SEK.
Varas, R. A., Betancourt, M. E., & Rodríguez, H. M. (2020). El movimiento estudiantil secundario en Chile abordado desde la complejidad [the secondary student movement in Chile approached from a complex perspective]. Sophia, Colección de Filosofía de la Educación, 29, 209–233. https://doi.org/10.17163/soph.n29.2020.07
Ventura-Juncá, R., Carvajal, C., Undurraga, S., Vicuña, P., Egaña, J., & Garib, M. J. (2010). Prevalence of suicidal ideations and suicidal attempts among adolescents living in metropolitan Santiago. Revista Médica de Chile, 138(3), 309–315. https://doi.org/10.4067/S0034-98872010000300008
Wetherall, K., Daly, M., Robb, K. A., Wood, A. M., & O’Connor, R. C. (2015). Explaining the income and suicidality relationship: Income rank is more strongly associated with suicidal thoughts and attempts than income. Social Psychiatry and Psychiatric Epidemiology, 50(6), 929–937. https://doi.org/10.1007/s00127-015-1050-1
Wood, A. M., Boyce, C. J., Moore, S. C., & Brown, G. D. (2012). An evolutionary based social rank explanation of why low income predicts mental distress: A 17 year cohort study of 30,000 people. Journal of Affective Disorders, 136(3), 882–888. https://doi.org/10.1016/j.jad.2011.09.014
World Health Organization. (2004). Prevention of mental disorders: Effective interventions and policy options. WHO. https://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf
World Health Organization. (2014). Preventing suicide: A global imperative. WHO. https://www.who.int/mental_health/suicide-prevention/exe_summary_english.pdf?ua=1
Yates, K., Lång, U., Cederlöf, M., Boland, F., Taylor, P., Cannon, M., … Kelleher, I. (2019). Association of psychotic experiences with subsequent risk of suicidal ideation, suicide attempts, and suicide deaths: A systematic review and meta-analysis of longitudinal population studies. JAMA Psychiatry, 76(2), 180–189. https://doi.org/10.1001/jamapsychiatry.2018.3514
Acknowledgments
This study is supported by the Agencia Nacional de Investigación y Desarrollo [National Research and Development Agency] of the Ministerio de la Ciencia, Tecnología, Conocimiento e innovación de Chile [Chilean Ministry of Science, Technology, Knowledge and Innovation] (FONDECYT ID: 11170308).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Quijada, Y. (2021). Understanding Social Risk Factors in Chilean Adolescent Suicides: An Analysis of Mediating Mechanisms. In: Barcelata Eguiarte, B.E., Suárez Brito, P. (eds) Child and Adolescent Development in Risky Adverse Contexts. Springer, Cham. https://doi.org/10.1007/978-3-030-83700-6_8
Download citation
DOI: https://doi.org/10.1007/978-3-030-83700-6_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-83699-3
Online ISBN: 978-3-030-83700-6
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)