Life Stress and Suicide in Adolescents
- 181 Downloads
Stress exposure is central to theories of suicide. To advance understanding of the relation between stress and suicide, we examined whether specific, theoretically-pertinent life stressors were differentially related to suicidal thinking versus suicidal behaviors among hospitalized adolescents. Participants were 197 (144 female) adolescents aged 13 to 19 years old (M = 15.61, SD = 1.48) recruited from an acute residential psychiatric treatment program. Participants were categorized into mutually exclusive groups: psychiatric controls (n = 38) with no lifetime history of suicide ideation or suicide attempts, suicide ideators (n = 99) with current ideation and no lifetime attempts, and suicide attempters (n = 60) with a lifetime history of suicide ideation and at least one attempt in the past month. Adolescents completed the Stress and Adversity Inventory for Adolescents (Adolescent STRAIN), which assessed life events and chronic difficulties occurring in five social-psychological categories: Interpersonal Loss, Physical Danger, Humiliation, Entrapment, and Role Change/Disruption. Additionally, they completed a structured interview and symptom questionnaires to capture concurrent psychopathology. Controlling for demographic and clinical covariates, only Interpersonal Loss events distinguished attempters from psychiatric controls (OR = 2.27) and ideators (OR = 1.49); no events or difficulties differentiated ideators from controls. These effects persisted when analyses were restricted to single attempters and when events following the most recent attempt were excluded. The findings elucidate potential social-environmental triggers of suicide. Ultimately, this may improve the identification of ideators most likely to make an attempt, enabling the deployment of targeted early interventions.
KeywordsStress exposure Adolescents Suicide Ideation-to-action frameworks STRAIN
This research was supported by the National Institutes of Health (K08 MH103443 to GMS and K23 MH097786 to RPA), the Brain and Behavior Research Foundation (NARSAD Young Investigator Awards to JGS  and GMS ), the American Foundation for Suicide Prevention (PRG-1-140-15 to JGS), Harvard Medical School (Kaplen Fellowship on Depression and Livingston Award to JGS), the Society in Science Branco Weiss Fellowship (GMS), the Tommy Fuss Fund (RPA), and the Simches Fund (RPA).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Ethics approval for the study (Protocol #: 2012P000780) was obtained from the Partners Human Ethics Research Committee, the Institutional Review Board that oversees research at McLean Hospital and Harvard Medical School. All procedures were in line with the 1964 Helsinki declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
- Bernstein, D. P., & Fink, L. (1998). Childhood trauma questionnaire: A retrospective self- report: Manual. New York, NY: Harcourt Brace & Company.Google Scholar
- Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse and Neglect, 27, 169–190.CrossRefGoogle Scholar
- Cuneo, M. G., Schrepf, A., Slavich, G. M., Thaker, P. H., Goodheart, M., Bender, D., Cole, S. W., Sood, A. K., & Lutgendorf, S. K. (2017). Diurnal cortisol rhythms, fatigue and psychosocial factors in five-year survivors of ovarian cancer. Psychoneuroendocrinology, 84, 139–142.CrossRefGoogle Scholar
- Joiner, T. E. (2005). Why people die by suicide. Cambridge: Harvard University Press.Google Scholar
- Mars, B., Heron, J., Klonsky, E. D., Moran, P., O'Connor, R. C., Tilling, K., Wilkinson, P., & Gunnell, D. (2019). What distinguishes adolescents with suicidal thoughts from those who have attempted suicide? A population-based birth cohort study. Journal of Child Psychology and Psychiatry, 60, 91–99.CrossRefGoogle Scholar
- Massing-Schaffer, M., Helms, S. W., Rudolph, K. D., Slavich, G. M., Hastings, P. D., Giletta, M., Nock, M. K., & Prinstein, M. J. (2019). Preliminary associations among relational victimization, targeted rejection, and suicidality in adolescents: A prospective study. Journal of Clinical Child and Adolescent Psychology, 48, 288–295.Google Scholar
- Miller, A. B., Eisenlohr-Moul, T., Giletta, M., Hastings, P. D., Rudolph, K. D., Nock, M. K., & Prinstein, M. J. (2017). A within-person approach to risk for suicidal ideation and suicidal behavior: Examining the roles of depression, stress, and abuse exposure. Journal of Consulting and Clinical Psychology, 85, 712–722.CrossRefGoogle Scholar
- Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry, 70, 300–310.CrossRefGoogle Scholar
- O'Connor, R. C., Cleare, S., Eschle, S., Wetherall, K., & Kirtley, O. J. (2016). The integrated motivational-volitional model of suicidal behavior. In R. C. O’Connor & J. Pirkis (Eds.), The international handbook of suicide prevention – Second Edition (pp. 220–240). Malden, MA: Wiley Blackwell.Google Scholar
- Rudolph, K. D. (2009). The interpersonal context of adolescent depression. In S. Nolen-Hoeksema & L. M. Hild (Eds.), Handbook of depression in adolescents (pp. 377–418). New York, NY: Routledge.Google Scholar
- Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., Rogers, J. E., Milo, K. M., Stock, S. L., & Wilkinson, B. (2010). Reliability and validity of the Mini international neuropsychiatric interview for children and adolescents (MINI-KID). Journal of Clinical Psychiatry, 71, 313–326.CrossRefGoogle Scholar
- Shields, G. S., Moons, W. G., & Slavich, G. M. (2017b). Better executive function under stress mitigates the effects of recent life stress exposure on health in young adults. Stress, 20, 75–85.Google Scholar
- Slavich, G. M., Stewart, J. G., Esposito, E. C., Shields, G. S., & Auerbach, R. P. (2019). The Stress and Adversity Inventory for Adolescents (Adolescent STRAIN): Associations with mental and physical health, risky behaviors, and psychiatric diagnoses in youth seeking treatment. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.13038.
- Stein, D. J., Chiu, W. T., Hwang, I., Kessler, R. C., Sampson, N., Alonso, J., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., Florescu, S., Gureje, O., He, Y., Kovess-Masfety, V., Levinson, D., Matschinger, H., Mneimneh, Z., Nakamura, Y., Ormel, J., Posada-Villa, J., Sagar, R., Scott, K. M., Tomov, T., Viana, M. C., Williams, D. R., & Nock, M. K. (2010). Cross-national analysis of the associations between traumatic events and suicidal behavior: Findings from the WHO world mental health surveys. PLoS One, 5, e10574.CrossRefGoogle Scholar
- Stewart, S. M., Eaddy, M., Horton, S. E., Hughes, J., & Kennard, B. (2017a). The validity of the interpersonal theory of suicide in adolescence: A review. Journal of Clinical Child and Adolescent Psychology, 46, 437–449.Google Scholar
- Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Boston, MA: Pearson Education.Google Scholar