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Effects of perceived stress and resilience on suicidal behaviors in early adolescents

  • Yun-Ling Chen
  • Po-Hsiu KuoEmail author
Original Contribution
  • 73 Downloads

Abstract

Suicidal behaviors are significant public health issues. The aim of the current study is to examine the effects of perceived stress and resilience on suicidal ideation (SI), plan (SP), and attempt (SA) among early adolescents. A longitudinal study was conducted with data collected from 1035 junior high-school students at baseline and 1-year follow-up. Participants were assessed for suicidal behaviors, resilience, and perceived stress. Logistic regression was performed to analyze for the associations between independent variables and suicidal behaviors. 210 (20.3%) of the participants reported to have SI, 59 (5.7%) had SP, and 49 (4.7%) had SA at baseline. Perceived stress was a strong risk factor (p < 0.001) for SI (OR 1.16–1.18), SP (OR 1.20–1.21), and SA (OR 1.12–1.16) while accounting for different dimensions of resilience. Students with persistent high stress during the 1-year follow-up period had significantly increased risk of SI (OR 7.14–9.64), SP (OR 3.92–6.37), and SA (OR 3.76–3.84) than the persistent low-stress group (p < 0.01). Increased perceived stress scale (PSS) (OR 2.89–3.15) and decreased PSS (OR 2.47) also had a higher risk for SI than persistent low PSS group. Moreover, students with high perceived stress who reported to have higher hope and optimism were less likely to show SI (OR 0.90, p = 0.001) and SP (OR 0.87, p = 0.002) at baseline, and the problem-solving and cognitive maturity mature dimension of resilience showed a significant protective effect on SP longitudinally (OR 0.25, p = 0.003). Perceived stress substantially increased the risk for suicidal behaviors, and moderates the protective effect of resilience on suicide. Considering both risk and protective factors of suicidal behaviors is essential in designing future suicide prevention and intervention programs.

Keywords

Adolescent Suicide Stress Resilience 

Notes

Acknowledgements

This work was supported by Ministry of Science of Technology grant (NSC101-2314-B-002–184-MY3; MOST 105–2628-B-002–028-MY3). We thank for all the participants in the study and Mei-Hsin Su, Pei-Chen Chu, Jen-Hsiu Shen, and Wen-Hsuan Chiu who assisted for data collection.

Funding

The funding has beeb received from Ministry of Science and Technology, Taiwan (TW) with Grant No. NSC101- 2314-B-002-184- MY3; Ministry of Science and Technology, Taiwan (TW) with Grant No. MST 105-2628-B-002-028-MY3.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was taken from all the students and their parents.

Ethics

This study was approved by the ethical committee of National Taiwan University Hospital (No. 201202053RIC).

References

  1. 1.
    World Health Organization (2018) Fact sheet of suicide. https://www.who.int/mediacentre/factsheets/fs398/en/. Accessed 19 June 2018
  2. 2.
    Department of Statistics in Ministry of Health and Welfare (2017) The analysis of statistical results of major cause of death in 2016. https://dep.mohw.gov.tw/DOS/lp-3352-113.html. Accessed 13 October 2017 (Chinese)
  3. 3.
    Klonsky ED, May AM, Saffer BY (2016) Suicide, suicide attempts, and suicidal ideation. Annu Rev Clin Psychol 12:307–330.  https://doi.org/10.1146/annurev-clinpsy-021815-093204 CrossRefGoogle Scholar
  4. 4.
    Silverman MM, Berman AL, Sanddal ND, O'Carroll PW, Joiner TE (2007) Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors: Part 2: Suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav 37:264–277.  https://doi.org/10.1521/suli.2007.37.3.264 CrossRefGoogle Scholar
  5. 5.
    McKinnon B, Gariépy G, Sentenac M, Elgar FJ (2016) Adolescent suicidal behaviours in 32 low- and middle-income countries. Bull World Health Organ 94:340–350F.  https://doi.org/10.2471/BLT.15.163295 CrossRefGoogle Scholar
  6. 6.
    Turecki G, Brent DA (2016) Suicide and suicidal behaviour. Lancet 387:1227–1239.  https://doi.org/10.1016/S0140-6736(15)00234-2 CrossRefGoogle Scholar
  7. 7.
    Tandon R, Nathani MK (2018) Increasing Suicide rates across asia—a public health crisis. Asian J Psychiatr 36:A2–a4.  https://doi.org/10.1016/j.ajp.2018.09.006 CrossRefGoogle Scholar
  8. 8.
    Snowdon J (2018) Differences between patterns of suicide in East Asia and the West: The importance of sociocultural factors. Asian J Psychiatr 37:106–111.  https://doi.org/10.1016/j.ajp.2018.08.019 CrossRefGoogle Scholar
  9. 9.
    Chang SS, Gunnell D, Sterne JA, Lu TH, Cheng AT (2009) Was the economic crisis 1997–1998 responsible for rising suicide rates in East/southeast Asia? A time-trend analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand. Soc Sci Med 68:1322–1331.  https://doi.org/10.1016/j.socscimed.2009.01.010 CrossRefGoogle Scholar
  10. 10.
    Chan WS, Law CK, Liu KY, Wong PW, Law YW, Yip PS (2009) Suicidality in Chinese adolescents in Hong Kong: the role of family and cultural influences. Soc Psychiatry Psychiatr Epidemiol 44:278–284.  https://doi.org/10.1007/s00127-008-0434-x CrossRefGoogle Scholar
  11. 11.
    Chen CH, Chen YH, Chen CY, CShiu SS, Shao WC, Wang TN, Chen H, Tan HKL (2008) Factors associated with suicide ideations and attempts in adolescents. Taiwanese Journal of Psychiatry 22:57–66. https://doi.org/10.29478/TJP.200803.0007
  12. 12.
    Kang EH, Hyun MK, Choi SM, Kim JM, Kim GM, Woo JM (2015) Twelve-month prevalence and predictors of self-reported suicidal ideation and suicide attempt among Korean adolescents in a web-based nationwide survey. Aust N Z J Psychiatry 49:47–53.  https://doi.org/10.1177/0004867414540752 CrossRefGoogle Scholar
  13. 13.
    Kim HH-s (2016) The associations between parental involvement, peer network, and youth suicidality in China: evidence from the Global school-based student health survey (2003). Soc Sci J 53:77–87.  https://doi.org/10.1016/j.soscij.2015.10.004 CrossRefGoogle Scholar
  14. 14.
    Lee CY, Lin MF, Tseng HF, Wang WL (2008) The prevalence of suicide risk behavior among high school students in southern Taiwan, and factors related thereto. J Evidence Based Nursing 4:71–81 (Chinese).  https://doi.org/10.6225/jebn.4.1.71 Google Scholar
  15. 15.
    Pan X, Zhang C, Shi Z (2011) Soft drink and sweet food consumption and suicidal behaviours among Chinese adolescents. Acta Paediatr 100:e215–e222.  https://doi.org/10.1111/j.1651-2227.2011.02369.x CrossRefGoogle Scholar
  16. 16.
    Shek DTL, Yu L (2012) Self-harm and suicidal behaviors in Hong Kong adolescents: prevalence and psychosocial correlates. Sci World J.  https://doi.org/10.1100/2012/932540 Google Scholar
  17. 17.
    Abdollahi A, Talib MA, Yaacob SN, Ismail Z (2015) The role of hardiness in decreasing stress and suicidal ideation in a sample of undergraduate students. J Humanist Psychol 55:202–222.  https://doi.org/10.1177/0022167814543952 CrossRefGoogle Scholar
  18. 18.
    Yeh ZT (2001) Negative mood regulation, anxiety, social support, life events and suicide ideations in adolescence: Chinese Annual report of guidance and counseling. https://doi.org/10.7082/CARGC.200109.0151
  19. 19.
    Wu CY, Yen CF, Yu LF (2007) A meta-analysis on risk factors in adolescent suicide. Taiwanese Journal of Psychiatry 21:271–281 (Chinese). https://doi.org/10.29478/TJP.200712.0005
  20. 20.
    Tu HT, Cheng JCC, Huang TM, Lin SR, See LC (2013) The epidemiology of suicide among adolescents and young adults in northern Taiwan. Cheng Ching Medical Journal 9:37–49 (Chinese).Google Scholar
  21. 21.
    Tan L, Xia T, Reece C (2018) Social and individual risk factors for suicide ideation among Chinese children and adolescents: a multilevel analysis. Int J Psychol 53:117–125.  https://doi.org/10.1002/ijop.12273 CrossRefGoogle Scholar
  22. 22.
    Collishaw S (2015) Annual research review: Secular trends in child and adolescent mental health. J Child Psychol Psychiatry 56:370–393.  https://doi.org/10.1111/jcpp.12372 CrossRefGoogle Scholar
  23. 23.
    Bor W, Dean AJ, Najman J, Hayatbakhsh R (2014) Are child and adolescent mental health problems increasing in the 21st century? A systematic review. Aust N Z J Psychiatry 48:606–616.  https://doi.org/10.1177/0004867414533834 CrossRefGoogle Scholar
  24. 24.
    Wasserman D, Hoven CW, Wasserman C, Wall M, Eisenberg R, Hadlaczky G, Kelleher I, Sarchiapone M, Apter A, Balazs J, Bobes J, Brunner R, Corcoran P, Cosman D, Guillemin F, Haring C, Iosue M, Kaess M, Kahn J-P, Keeley H, Musa GJ, Nemes B, Postuvan V, Saiz P, Reiter-Theil S, Varnik A, Varnik P, Carli V (2015) School-based suicide prevention programmes: The SEYLE cluster-randomised, controlled trial. Lancet 385:1536–1544.  https://doi.org/10.1016/S0140-6736(14)61213-7 CrossRefGoogle Scholar
  25. 25.
    Hu T, Zhang D, Wang J (2015) A meta-analysis of the trait resilience and mental health. Pers Individ Dif 76:18–27.  https://doi.org/10.1016/j.paid.2014.11.039 CrossRefGoogle Scholar
  26. 26.
    Chang HY, Song LY (2007) Adolescent resilience: The concept and related research analysis. Soochow J Soc Work 17:171–192.  https://doi.org/10.29734/SJSW.200712.0006 (Chinese) Google Scholar
  27. 27.
    Chan YC, Yeh YC, Peng YY, Yeh BL (2009) The development of the "Inventory of adolescent resilience". Psychological Testing 56:491–518.  https://doi.org/10.7108/PT.200912.0491 Google Scholar
  28. 28.
    Luthar SS, Cicchetti D, Becker B (2000) The construct of resilience: a critical evaluation and guidelines for future work. Child Dev 71:543–562.  https://doi.org/10.1111/1467-8624.00164 CrossRefGoogle Scholar
  29. 29.
    Breton JJ, Labelle R, Berthiaume C, Royer C, St-Georges M, Ricard D, Abadie P, Gérardin P, Cohen D, Guilé JM (2015) Protective factors against depression and suicidal behaviour in adolescence. Can J Psychiatry 60:S5–S15Google Scholar
  30. 30.
    Wu PY, Tan TW, Tung YY (2012) The relationships among experiences of family violence, resilience and adolescent self-injurious. Journal of Research in Delinquency and Prevention 4:69–107. https://doi.org/10.29751/JRDP.201212.0003
  31. 31.
    Johnson J, Gooding PA, Wood AM, Tarrier N (2010) Resilience as positive coping appraisals: testing the schematic appraisals model of suicide (SAMS). Behav Res Ther 48:179–186.  https://doi.org/10.1016/j.brat.2009.10.007 CrossRefGoogle Scholar
  32. 32.
    Nagra GS, Lin A, Upthegrove R (2016) What bridges the gap between self-harm and suicidality? The role of forgiveness, resilience and attachment. Psychiatry Res 241:78–82.  https://doi.org/10.1016/j.psychres.2016.04.103 CrossRefGoogle Scholar
  33. 33.
    Stratta P, Capanna C, Carmassi C, Patriarca S, Di Emidio G, Riccardi I, Collazzoni A, Dell'Osso L, Rossi A (2014) The adolescent emotional coping after an earthquake: a risk factor for suicidal ideation. J Adolesc 37:605–611.  https://doi.org/10.1016/j.adolescence.2014.03.015 CrossRefGoogle Scholar
  34. 34.
    Burke TA, Connolly SL, Hamilton JL, Stange JP, Abramson LY, Alloy LB (2016) Cognitive risk and protective factors for suicidal ideation: a two year longitudinal study in adolescence. J Abnorm Child Psychol 44:1145–1160.  https://doi.org/10.1007/s10802-015-0104-x CrossRefGoogle Scholar
  35. 35.
    Siegmann P, Teismann T, Fritsch N, Forkmann T, Glaesmer H, Zhang XC, Brailovskaia J, Margraf J (2018) Resilience to suicide ideation: a cross-cultural test of the buffering hypothesis. Clin Psychol Psychother 25:e1–e9.  https://doi.org/10.1002/cpp.2118 CrossRefGoogle Scholar
  36. 36.
    Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, Carli V, Höschl C, Barzilay R, Balazs J, Purebl G, Kahn JP, Sáiz PA, Lipsicas CB, Bobes J, Cozman D, Hegerl U, Zohar J (2016) Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry 3:646–659.  https://doi.org/10.1016/S2215-0366(16)30030-X CrossRefGoogle Scholar
  37. 37.
    Chiu WH, Yang HJ, Kuo PH (2017) Chronotype preference matters for depression in youth. Chronobiol Int 34:933–941.  https://doi.org/10.1080/07420528.2017.1327441 CrossRefGoogle Scholar
  38. 38.
    Fu YZ, Zhang YH, Du SH, Liao PS (2014) Taiwan social change survey, round 4 of phase 6. Institute of Sociology Academia Sinica, TaipeiGoogle Scholar
  39. 39.
    Cohen S, Williamson GM (1988) Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S (eds) The social psychology of health: The claremont symposium on applied social psychology. Sage Publications, Thousand Oaks, CA, pp 31–67Google Scholar
  40. 40.
    Lu W, Bian Q, Wang W, Wu X, Wang Z, Zhao M (2017) Chinese version of the perceived stress scale-10: a psychometric study in Chinese university students. PLoS ONE 12:e0189543.  https://doi.org/10.1371/journal.pone.0189543 CrossRefGoogle Scholar
  41. 41.
    Tsai YT, Li WL (2016) The study of the effect of team building for university students' resilience-a case in National Quemony University. J Phys Educ Fu Jen Catholic Univerity 15:41–55 (Chinese) Google Scholar
  42. 42.
    Goldman-Mellor S, Gregory AM, Caspi A, Harrington H, Parsons M, Poulton R, Moffitt TE (2014) Mental health antecedents of early midlife insomnia: Evidence from a four-decade longitudinal study. Sleep 37:1767–1775.  https://doi.org/10.5665/sleep.4168 CrossRefGoogle Scholar
  43. 43.
    Kaneita Y, Yokoyama E, Harano S, Tamaki T, Suzuki H, Munezawa T, Nakajima H, Asai T, Ohida T (2009) Associations between sleep disturbance and mental health status: a longitudinal study of Japanese junior high school students. Sleep Med 10:780–786.  https://doi.org/10.1016/j.sleep.2008.06.014 CrossRefGoogle Scholar
  44. 44.
    Fraser SL, Geoffroy D, Chachamovich E, Kirmayer LJ (2015) Changing rates of suicide ideation and attempts among Inuit youth: a gender-based analysis of risk and protective factors. Suicide Life Threat Behav 45:141–156.  https://doi.org/10.1111/sltb.12122 CrossRefGoogle Scholar
  45. 45.
    Liu DWY, Fairweather-Schmidt AK, Roberts RM, Burns R, Anstey KJ (2014) Does resilience predict suicidality? A lifespan analysis. Arch Suicide Res 18:453–464.  https://doi.org/10.1080/13811118.2013.833881 CrossRefGoogle Scholar
  46. 46.
    Horwitz AG, Berona J, Czyz EK, Yeguez CE, King CA (2017) Positive and negative expectations of hopelessness as longitudinal predictors of depression, suicidal ideation, and suicidal behavior in high-risk adolescents. Suicide Life Threat Behav 47:168–176.  https://doi.org/10.1111/sltb.12273 CrossRefGoogle Scholar
  47. 47.
    Alavi A, Sharifi B, Ghanizadeh A, Dehbozorgi G (2013) Effectiveness of cognitive-behavioral therapy in decreasing suicidal ideation and hopelessness of the adolescents with previous suicidal attempts. Iran J Pediatr 23:467–472.  https://doi.org/10.1016/j.neurenf.2012.04.266 Google Scholar
  48. 48.
    McAuliffe C, Corcoran P, Keeley HS, Arensman E, Bille-Brahe U, De Leo D, Fekete S, Hawton K, Hjelmeland H, Kelleher M, Kerkhof AJ, Lonnqvist J, Michel K, Salander-Renberg E, Schmidtke A, Van Heeringen K, Wasserman D (2006) Problem-solving ability and repetition of deliberate self-harm: a multicentre study. Psychol Med 36:45–55.  https://doi.org/10.1017/s0033291705005945 CrossRefGoogle Scholar
  49. 49.
    Tyrer P, Thompson S, Schmidt U, Jones V, Knapp M, Davidson K, Catalan J, Airlie J, Baxter S, Byford S, Byrne G, Cameron S, Caplan R, Cooper S, Ferguson B, Freeman C, Frost S, Godley J, Greenshields J, Henderson J, Holden N, Keech P, Kim L, Logan K, Manley C, MacLeod A, Murphy R, Patience L, Ramsay L, De Munroz S, Scott J, Seivewright H, Sivakumar K, Tata P, Thornton S, Ukoumunne OC, Wessely S (2003) Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: The POPMACT study. Psychol Med 33:969–976.  https://doi.org/10.1017/S0033291703008171 CrossRefGoogle Scholar
  50. 50.
    Hetrick SE, Yuen HP, Bailey E, Cox GR, Templer K, Rice SM, Bendall S, Robinson J (2017) Internet-based cognitive behavioural therapy for young people with suicide-related behaviour (Reframe-IT): a randomised controlled trial. Evid Based Ment Health 20:76–82.  https://doi.org/10.1136/eb-2017-102719 CrossRefGoogle Scholar
  51. 51.
    Tang TC, Jou SH, Ko CH, Huang SY, Yen CF (2009) Randomized study of school-based intensive interpersonal psychotherapy for depressed adolescents with suicidal risk and parasuicide behaviors. Psychiatry Clin Neurosci 63:463–470.  https://doi.org/10.1111/j.1440-1819.2009.01991.x CrossRefGoogle Scholar
  52. 52.
    Joshi SV, Hartley SN, Kessler M, Barstead M (2015) School-based suicide prevention: Content, process, and the role of trusted adults and peers. Child Adolesc Psychiatr Clin N Am 24:353–370.  https://doi.org/10.1016/j.chc.2014.12.003 CrossRefGoogle Scholar
  53. 53.
    Katz C, Bolton S-L, Katz LY, Isaak C, Tilston-Jones T, Sareen J (2013) A systematic review of school-based suicide prevention programs. Depress Anxiety 30:1030–1045.  https://doi.org/10.1002/da.22114 Google Scholar

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Authors and Affiliations

  1. 1.Department of Public Health and Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan UniversityTaipei CityTaiwan

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