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Psychosocial determinants of adolescent suicide: A national survey

Published:April 13, 2022DOI:https://doi.org/10.1016/j.apnu.2022.04.004

      Highlights

      • This study explored the prevalence and psychosocial determinants of adolescent suicidal ideation in Jordan.
      • The prevalence of suicidal ideation among Jordanian school adolescents was 11 %.
      • Suicidal ideations were higher among adolescents who were boys, enrolled in public schools, and had a family history of suicide.
      • Suicidal ideations were significantly correlated with lower self-esteem and higher depressive symptoms scores.
      • School adolescents tend to hold negative and stigmatizing attitudes towards suicidal individuals.

      Abstract

      Background

      Suicide is a global health problem with considerable variability across countries in its prevalence and correlates. The aims of this study were to: (a) explore the prevalence and psychosocial determinants of adolescent suicidal ideation, and (b) explore the perceived stigma of suicide among adolescents.

      Method

      A nationally representative electronic survey was utilized to collect data from school adolescents. The Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data was used to design the survey. The study collected data on adolescents' suicidal ideation, depression, self-esteem, stigma of suicide, family functioning, educational stress, and anxiety levels. A representative sample of 647 Jordanian school adolescents was included.

      Results

      The prevalence of suicidal ideation among school adolescents was 11%. Suicidal ideation was significantly higher among respondents who were boys and enrolled in public schools, had a mental health problem, a family history of suicidal attempt, a lower self-esteem, and higher depressive symptoms. The majority of school adolescents agreed with the descriptions of people who take their own lives as being “lost” (70%), “coward” (53%), “stupid” (51%), and “lonely” (49%).

      Conclusion

      There is no typical suicide victim, and there are no specific characteristics that can point out those who are suicidal. Suicide remains a complex phenomenon that is embedded in its sociocultural context. Collaborative efforts from Jordanian policy makers, healthcare providers, researchers, and educators are needed to develop culturally appropriate screening and prevention approaches to address suicide among adolescents. Nurses have a significant role in helping adolescents experiencing suicidal ideation and their families restore, maintain, and/or promote their mental health and wellbeing.

      Keywords

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      References

        • American Psychiatric Nurses Association
        Competency based training for suicide prevention- psychiatric nurse generalist role.
        (Retrieved from)
        • American Nurse Association
        The nursing process.
        (Retrieved from)
        • Bahk Y.-C.
        • Jang S.-K.
        • Choi K.-H.
        • Lee S.-H.
        The relationship between childhood trauma and suicidal ideation: Role of maltreatment and potential mediators.
        Psychiatry Investigation. 2017; 14: 37
        • Batterham P.J.
        • Calear A.L.
        • Christensen H.
        Correlates of suicide stigma and suicide literacy in the community.
        Suicide and Life-threatening Behaviour. 2013; 43: 406-417
        • Batterham P.J.
        • Calear A.L.
        • Christensen H.
        The stigma of suicide scale: Psychometric properties and correlates of the stigma of suicide.
        Research Trends. 2013; 34: 13-21
        • Berlim M.T.
        • Perizzolo J.
        • Lejderman F.
        • Fleck M.P.
        • Joiner T.E.
        Does a brief training on suicide prevention among general hospital personnel impact their baseline attitudes towards suicidal behavior?.
        Journal of Affective Disorders. 2007; 100: 233-239
        • Bilsen J.
        Suicide and youth: Risk factors. Frontiers in Psychiatry. 2018: 9
        • Bolster C.
        • Holliday C.
        • Oneal G.
        • Shaw M.
        Suicide assessment and nurses: What does the evidence show?.
        Online Journal of Issues in Nursing. 2015; 20
        • Borgers G.
        • Benjet C.
        • Medina-Mora M.E.
        • Orozco R.
        • Nock M.
        Suicide ideation, plan, and attempt in the Mexican adolescent mental health survey.
        Journal of the American Academy of Child & Adolescent Psychiatry. 2008; 47: 41-52
        • Boukouvalas E.
        • El-Den S.
        • Murphy A.L.
        • Salvador-Carulla L.
        • O’Reilly C.L.
        Exploring health care professionals’ knowledge of, attitudes towards and confidence in caring for people at risk of suicide: a systematic review.
        Archives of Suicide Research. 2019; 1–32https://doi.org/10.1080/13811118.2019.1586608
        • Bridge J.A.
        • Goldstein T.R.
        • Brent D.A.
        Adolescent suicide and suicidal behavior.
        Journal of Child Psychology and Psychiatry. 2006; 47: 372-394
        • Canetto S.S.
        • Sakinofsky I.
        The gender paradox in suicide.
        Suicide & Life-Threatening Behavior. 1998; 28: 1-23
        • Cash S.J.
        • Bridge J.A.
        Epidemiology of youth suicide and suicidal behavior.
        Current Opinion in Pediatrics. 2009; 21: 613-619
        • Centers for Disease Control and Prevention
        Preventing suicide.
        (Retrieved from: https://www.cdc.gov/violenceprevention/suicide/fastfact.html#:~:text=Suicide%20is%20death%20caused%20by)
        • Centers for Disease Control and Prevention
        Suicide, family history, and genomics.
        (Retrieved from:)
        • Centers for Disease Control and Prevention
        Suicide rising across the US.
        (Retrieved from:)
        • Centers for Disease Control and Prevention
        Violence prevention.
        (Retrieved from:)
        • Chan S.W.
        • Chien W.
        • Tso S.
        Evaluating nurses’ knowledge, attitude and competency after an education programme on suicide prevention.
        Nurse Education Today. 2009; 29: 763-769
        • Chung D.
        • Hadzi-Pavlovic D.
        • Wang M.
        • Swaraj S.
        • Olfson M.
        • Large M.
        Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation.
        BMJ Open. 2019; 9e023883https://doi.org/10.1136/bmjopen-2018-023883
        • Coon H.
        • Darlington T.M.
        • DiBlasi E.
        • Callor W.B.
        • Ferris E.
        • Fraser A.
        • Gray D.
        Genome-wide significant regions in 43 Utah high-risk families implicate multiple genes involved in risk for completed suicide.
        Molecular Psychiatry. 2018; https://doi.org/10.1038/s41380-018-0282-3
        • Dardas L.A.
        Family functioning moderates the impact of depression treatment on adolescents’ suicidal ideations.
        Child and Adolescent Mental Health. 2019; 24: 251-258
        • Dardas L.
        • Silva S.
        • Smoski M.
        • Nanoon D.
        • Simmons L.
        The prevalence of depressive symptoms among Arab adolescents: Findings from Jordan.
        Public Health Nursing. 2018; 35: 100-108
        • Dardas L.A.
        • Simmons L.A.
        The stigma of mental illness in Arab families: A concept analysis.
        Journal of Psychiatric and Mental Health Nursing. 2015; 22: 668-679
        • Dardas L.A.
        • Silva S.
        • Vance A.
        • Sullivan B.
        • Smoski M.
        • Noonan D.
        • Simmons L.
        Psychosocial correlates of Jordanian adolescents’ help-seeking intentions for depression: a nationally representative school survey.
        Journal of School Nursing. 2017; 35: 117-127
        • Dardas L.A.
        • Price M.M.
        • Arscott J.
        • Shahrour G.
        • Convoy S.
        Voicing Jordanian adolescents' suicide.
        Nursing Research. 2020; 70: 1-10https://doi.org/10.1097/NNR.0000000000000476
        • Dardas L.A.
        • Khalaf I.
        • Nabolsi M.
        • Nassar O.
        • Halasa S.
        Developing an understanding of adolescents’ knowledge, attitudes, and practices toward COVID-19.
        The Journal of School Nursing. 2020; 36: 430-441https://doi.org/10.1177/1059840520957069
        • Eaton D.K.
        • Kann L.
        • Kinchen S.
        • Shanklin S.
        • Flint K.H.
        • Hawkins J.
        • Harris W.A.
        • Lowry R.
        • McManus T.
        • Chyen D.
        • Whittle L.
        • Lim C.
        • Wechsler H.
        Centers for Disease Control and Prevention (CDC). Youth risk behavior surveillance - United States, 2011.
        MMWR Surveillance Summaries. 2012; 61: 1-162
        • Epstein N.B.
        • Baldwin L.M.
        • Bishop D.S.
        The McMaster family assessment device.
        Journal of Marital and Family Therapy. 1983; 9: 171-180
        • Frey L.M.
        • Hans J.D.
        Attitudes toward assisted suicide: Does family context matter?.
        Archives of Suicide Research. 2015; 20: 250-264
        • Hagen J.
        • Knizek B.L.
        • Hjelmeland H.
        Mental health nurses’ experiences of caring for suicidal patients in psychiatric wards: An emotional endeavor.
        Archives of Psychiatric Nursing. 2017; 31: 31-37
        • Hanschmidt F.
        • Lehnig F.
        • Riedel-Heller S.G.
        • Kersting A.
        The stigma of suicide survivorship and related consequences—A systematic review.
        PLoS ONE. 2016; 11e0162688
        • Hansen B.
        • Lang M.
        Back to school blues: Seasonality of youth suicide and the academic calendar.
        Economics of Education Review. 2011; 30: 850-861
        • Im Y.
        • Oh W.-O.
        • Suk M.
        Risk factors for suicide ideation among adolescents: Five-year national data analysis.
        Archives of Psychiatric Nursing. 2017; 31: 282-286
        • Jones R.
        The development of nurse-led suicide prevention training for multidisciplinary staff in a North Wales NHS Trust.
        Journal of Psychiatric and Mental Health Nursing. 2010; 17: 178-183
        • Jordan Department of Statistics
        (Retrieved from)
        • Jordanian Ministry of Education (JMOE)
        Schools annual report.
        (Retrieved from)
        • Karam E.G.
        • Hajjar R.V.
        • Salamoun M.M.
        Suicidality in the Arab World Part I: Community studies.
        The Arab Journal of Psychiatry. 2007; 18: 99-107
        • Kazarian S.S.
        Arabic contingencies of Self- worth: Arabic translation and validation of the contingencies ofself-worth scale in Lebanese youth.
        The Arab Journal of Psychiatry. 2009; 20: 123-134
        • Keane E.M.
        • Dick R.W.
        • Bechtold D.W.
        • Manson S.
        Predictive and concurrent validity of the Suicidal Ideation Questionnaire among American Indian adolescents.
        Journal of Abnormal Child Psychology. 1996; 24: 735-747
        • Kennedy A.J.
        • Brumby S.A.
        • Versace V.L.
        • Brumby-Rendell T.
        Online assessment of suicide stigma, literacy and effect in Australia’s rural farming community.
        BMC Public Health. 2018; 18: 1-12
        • Kokkevi A.
        • Rotsika V.
        • Arapaki A.
        • Richardson C.
        Adolescents’ self- reported suicide attempt, self- harm thoughts and their correlates across 17 European countries.
        J Child Psychol Psychiatry. 2012; 53: 381-389
        • Lew B.
        • Huen J.
        • Yu P.
        • Yuan L.
        • Wang D.-F.
        • Ping F.
        • Jia C.-X.
        Associations between depression, anxiety, stress, hopelessness, subjective well-being, coping styles and suicide in Chinese university students.
        PLOS ONE. 2019; 14e0217372
        • Little R.J.
        A test of missing completely at random for multivariate data with missing values.
        Journal of the American Statistical Association. 1988; 83: 1198-1202
        • Malakouti S.K.
        • Davoudi F.
        • Khalid S.
        • Ahmadzad A.M.
        • Moosa Khan M.
        • Alirezaei N.
        • DeLeo D.
        The epidemiology of suicide behaviors among the countries of the Eastern Mediterranean region of WHO: A systematic review.
        Acta Medica Iranica. 2015; 53: 257-265
        • Matsubayashi T.
        • Ueda M.
        • Yoshikawa K.
        School and seasonality in youth suicide: Evidence from Japan.
        Journal of Epidemiology and Community Health. 2016; 70: 1122-1127
        • Morante A.
        • Djenidi V.
        • Clark H.
        • West S.
        Gender differences in online participation: Examining a history and a mathematics open foundation online course.
        Australian Journal of Adult Learning. 2017; 57: 266-293
        • Müller-Staub M.
        • Lavin M.A.
        • Needham I.
        • van Achterberg T.
        Nursing diagnoses, interventions and outcomes? application and impact on nursing practice: systematic review.
        Journal of Advanced Nursing. 2007; 56: 514-531
        • Mitchell A.M.
        • Terhorst L.
        PTSD symptoms in survivors bereaved by the suicide of a significant other.
        Journal of the American Psychiatric Nurses Association. 2017; 23: 61-65
        • Mueller A.S.
        • Abrutyn S.
        • Pescosolido B.
        • Diefendorf S.
        The social roots of suicide: Theorizing how the external social world matters to suicide and suicide prevention.
        Frontiers in Psychology. 2021; 12621569https://doi.org/10.3389/fpsyg.2021.621569
        • Munn Z.
        • Moola S.
        • Riitano D.
        • Lisy K.
        The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence.
        International Journal of Health Policy and Management. 2014; 3: 123-128
        • Nock M.K.
        • Borges G.
        • Bromet E.J.
        • Cha C.B.
        • Kessler R.C.
        • Lee S.
        Suicide and suicidal behavior.
        Epidemiologic Reviews. 2008; 30: 133-154
        • O’Beaglaoich C.
        • McCutcheon J.
        • Conway P.F.
        • Hanafin J.
        • Morrison T.G.
        Adolescent suicide ideation, depression and self-esteem: Relationships to a new measure of gender role conflict.
        Frontiers in Psychology. 2020; 11: 111
        • Peter T.
        • Roberts L.W.
        “Bad” Boys and “Sad” Girls? Examining internalizing and externalizing effects on parasuicides among youth.
        Journal of Youth and Adolescence. 2009; 39: 495-503
        • Plichta S.B.
        • Kelvin E.A.
        Munro’s statistical methods for health care research. 6th ed. Lippincott Williams & Wilkins, 2012: 95
        • Reynolds W.M.
        • Mazza J.J.
        Assessment of Suicidal Ideation in Inner-City Children and Young Adolescents: Reliability and Validity of the Suicidal Ideation Questionnaire-JR.
        School Psychology Review. 1999; 28: 17-30
        • Reynolds W.M.
        The Reynolds Adolescent Depression Scale-Second Edition (RADS-2).
        Comprehensive handbook of psychological assessment. 2004; 2: 224-236
        • Rosenberg M.
        Society and the adolescent self-image.
        Princeton University Press, Princeton, NJ1965
        • Saatchi B.
        • Taghavi Larijani T.
        Risk for suicide nursing diagnosis and its related risk factors, in psychiatric settings: A descriptive study.
        Nursing Open. 2019; https://doi.org/10.1002/nop2.342
        • Shahrour G.
        • Dardas L.A.
        • Al-Khayat A.
        • Al-Qasem A.
        Prevalence, correlates, and experiences of school bullying among adolescents: A national study in Jordan.
        School Psychology International. 2020; 41: 430-453
        • Shea S.C.
        The interpersonal art of suicide assessment: Interviewing techniques for uncovering suicidal intent, ideation, and actions.
        in: Simon R.I. Hales R.E. The American Psychiatric Publishing textbook of suicide assessment and management. 2nd ed. American Psychiatric Publishing, Washington, DC2012: 29-56
        • Smith G.
        Does gender influence online survey participation?: A record-linkage analysis of university faculty online survey response behavior.
        in: ERIC document reproduction service no. ED 501717. 2008 (Geneva)
        • Soto-Sanz V.
        • Piqueras J.A.
        • Perez-Vazquez M.T.
        • Rodriguez-Jimenez T.
        • Castellví P.
        • Miranda-Mendizabal A.
        • Alonso J.
        Self-esteem and suicidal behaviour in youth: A meta-analysis of longitudinal studies.
        Psicothema. 2019; 31: 246-254
        • Spence S.H.
        Structure of anxiety symptoms among children: A confirmatory factor-analytic study.
        Journal of Abnormal Psychology. 1997; 106: 280-297
        • Spence S.H.
        A measure of anxiety symptoms among children.
        Behaviour Research and Therapy. 1998; 36: 545-566
        • Spillane A.
        • Larkin C.
        • Corcoran P.
        • Matvienko-Sikar K.
        • Arensman E.
        What are the physical and psychological health effects of suicide bereavement on family members? Protocol for an observational and interview mixed-methods study in Ireland.
        BMJ Open. 2017; 7e014707
        • Stahlschmidt L.
        • Chorpita B.F.
        • Wager J.
        Validating the German version of the revised children’s anxiety and depression scale in a sample of pediatric chronic pain patients.
        Journal of Psychosomatic Research. 2019; 124109786https://doi.org/10.1016/j.jpsychores.2019.109
        • Sun J.
        • Dunne M.P.
        • Hou X.
        • Xu A.
        Educational stress scale for adolescents.
        Journal of Psychoeducational Assessment. 2011; 29: 534-546
        • Tal I.
        • Mauro C.
        • Reynolds C.F.
        • Shear M.K.
        • Simon N.
        • Lebowitz B.
        • Zisook S.
        Complicated grief after suicide bereavement and other causes of death.
        Death Studies. 2016; 41: 267-275
        • The Jordan Times
        Report: 605 people committed suicide in Jordan during last 5 years.
        (Retrieved from)
        • Thompson A.H.
        The suicidal process and self-esteem.
        Crisis: The Journal of Crisis Intervention and Suicide Prevention. 2010; 31: 311-316
        • Townsend M.C.
        Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice.
        6th ed. F.A. Davis Co, Philadelphia2014
        • Tripković I.
        • Roje R.
        • Krnić S.
        • Nazor M.
        • Karin Ž.
        • Čapkun V.
        Depression and self-esteem in early adolescence.
        Central European Journal of Public Health. 2015; 23: 166-169
        • Tsai W.-P.
        • Lin L.-Y.
        • Chang H.-C.
        • Yu L.-S.
        • Chou M.-C.
        The effects of the gatekeeper suicide-awareness program for nursing personnel.
        Perspectives in Psychiatric Care. 2010; 47: 117-125
        • Unicef
        Jordan country report on out-of-school children.
        (Retrieved from)
        • Valente S.
        Nurses’ psychosocial barriers to suicide risk management.
        Nursing Research and Practice. 2011; 1–4https://doi.org/10.1155/2011/650765
        • Varnik A.
        • Kolves K.
        • van der Feltz-Cornelis C.M.
        • Marusic A.
        • Oskarsson H.
        • Palmer A.
        • Hegerl U.
        Suicide methods in Europe: A gender-specific analysis of countries participating in the “European Alliance Against Depression”.
        Journal of Epidemiology & Community Health. 2008; 62: 545-551
        • World Health Organization
        Adolescent mental health.
        (Retrieved from)
        • World Health Organization
        Adolescent suicidal behaviours in 32 low- and middle-income countries.
        (Retrieved from)
        • World Health Organization
        Preventing suicide, a global imperative.
        2014 (Geneva)
        • Xu J.
        • Murphy S.L.
        • Kochanek K.D.
        • Bastian B.A.
        Deaths: Final data for 2013.
        in: From national vital statistics reports. 2. 2016
        • Zaidi U.
        • Awad S.
        • Mortada E.
        • Qasem H.
        • Kayal G.
        Psychometric evaluation of Arabic version of selfesteem, psychological well-being and Impact of weight on Quality-of-Life Questionnaire (IWQOL-LITE) in Female Student Sample of PNU.
        European Medical, Health and Pharmaceutical Journal. 2015; 8 (ISSN 1804–5804)