The Mental Health of the Peers of Suicide Completers and Attempters

Abstract

This study examined the prevalence and risk of psychiatric disturbances and suicidal behaviours among the peers of suicide attempters and completers. The subjects were selected from high schools with and without history of student suicides in the past 3 years. The psychiatric disturbances (as measured by the YSR and CBCL), suicidal behaviours, drug use, and a wide range of potential risk factors were measured. About a quarter of the peers of suicide completers and attempters were probable psychiatric cases and 15-21% of them reported suicidal acts. The increased risk of psychiatric disturbances and suicidal behaviours were still evident after controlling for age, sex, and potential risk factors. The presence of psychiatric disturbances could not wholly account for the increased odds of suicidal behaviours. Peers of suicide attempters carried a higher risk than peers of suicide completers. The close friends of suicide completers were particularly at risk of internalising problems, whereas the close friends of suicide attempters were at high risk of externalising problems. The peers of suicide completers and attempters represent a high-risk group for psychiatric disturbances and suicidal behaviours. The specific association of different types of psychiatric disturbances in the peers of suicide completers and attempters suggested that different risk mechanisms might be in operation within these peer groups.

Effect of Exposure to Suicidal Behavior on Suicide Attempt in a High-Risk Sample of Offspring of Depressed Parents

“…Our findings are consistent with studies observing an association between exposure status and increased likelihood of suicidal behavior 6,[10][11][12][13][14][15][16][17][18][19][21][22][23][24] , but do not support a casual pathway for exposure via imitation where the exposure must necessarily precede the imitative attempt. Despite finding that any lifetime exposure increased the likelihood of being a suicide attempter, when we examined only exposures that occurred before the age of first suicide attempt in attempters and before the same age in matched controls we found that exposure was not associated suicide attempter status.…”

“…We found no other studies that adequately addressed the temporal sequence of exposure and suicidal behavior in the exposed. Most did not describe temporal sequence at all 6,10,11,13,[16][17][18][19]22,24,25,29 , or only that there were limited exposures and/or attempts within 12 months prior to assessment, excluding possible earlier exposures and attempts 4,5,12,14 . In a prospective study, Lewinsohn et al assessed baseline exposure and suicidal behavior at a subsequent timepoint, but did not address the relationship of baseline exposure to prior suicide attempt, thus preventing any clear establishment of temporality necessary to infer causality 23 .…”

“…Most 5,6,[10][11][12][13][14][15][16][17][18][19] , but not all 4,20 , community or school based studies report associations between exposure to suicidal behavior and suicidal behavior in exposed individuals. Likewise in clinical and smaller scale cohort studies, both in adolescents and adults, some observe associations [21][22][23][24] , while others do not [25][26][27][28] .…”

“…Moreover, studies of suicide exposure differ considerably in the extent to which analyses control for common risk factors for suicidal behavior such as depression, life stress, and substance use. Some control for multiple related risk factors, and find a persistent association between suicide exposure and suicidal behavior 11,13,15,16,18 , others report associations in univariate comparisons that become non-significant after adjusting for other risk factors 20,21 , while yet others report associations but do not control for psychiatric symptoms or other risk factors 6,12,24,29 .…”

“…A modeling or imitation model requires a clear temporal order where the exposure precedes the suicidal act in the exposed individual. However, the majority of studies of suicide exposure are cross-sectional and do not specify the temporal order between exposure events and suicidal behavior 6,10,11,13,[16][17][18][19]22,24,25,29 . Others examine the occurrence of exposure and attempt in the 12 months prior to interview in order to establish a closer temporal proximity, however they do not examine the temporal order of exposures and suicidal acts within that 12 months, and/or do not assess attempts or exposures that may have occurred prior to that 12 months 4,5,12,14 .…”