Mental health: A road map for suicide research and prevention

To develop and refine interventions to prevent youth suicide, knowledge is needed about specific processes that reduce risk at a population level. Using a cross-sectional design, the present study tested hypotheses regarding associations between self-reported suicide attempts, emotion regulation difficulties, and positive youth-adult relationships among 7,978 high-school students (48.6% male, 49.9% female) in 30 high schools from predominantly rural, low-income communities. 683 students (8.6%) reported a past-year suicide attempt. Emotion regulation difficulties and a lack of trusted adults at home and school were associated with increased risk for making a past-year suicide attempt, above and beyond the effects of depressive symptoms and demographic factors. The association between emotion regulation difficulties and suicide attempts was modestly lower among students who perceived themselves as having higher levels of trusted adults in the family, consistent with a protective effect. Having a trusted adult in the community (outside of school and family) was associated with fewer suicide attempts in models that controlled only for demographic covariates, but not when taking symptoms of depression into account. These findings point to adolescent emotion regulation and relationships with trusted adults as complementary targets for suicide prevention that merit further intervention studies. Reaching these targets in a broad population of adolescents will require new delivery systems and "option rich" (OR) intervention designs.

Evidence of an association between a vulnerability to suicidal behaviour and neurobiological abnormalities is accumulating. Post-mortem studies have demonstrated structural and biochemical changes in the brains of suicide victims. More recently, imaging techniques have become available to study changes in the brain in vivo. This systematic review of comparative imaging studies of suicidal brains shows that changes in the structure and functions of the brain in association with suicidal behaviour are mainly found in the orbitofrontal and dorsolateral parts of the prefrontal cortex. Correlational studies suggest that these changes relate to neuropsychological disturbances in decision-making, problem solving and fluency, respectively. As a consequence, the findings from these studies suggest that suicidal behaviour is associated with (1) a particular sensitivity to social disapproval (2) choosing options with high immediate reward and (3) a reduced ability to generate positive future events. Further study is needed to elaborate these findings and to investigate to what extent changes in the structure and function of suicidal brains are amenable to psychological and/or biological interventions. Copyright © 2010 Elsevier Ltd. All rights reserved.

Suicidal behavior is a prevalent problem among adolescents and young adults. Although most theoretical models of suicide suggest that this behavior results from the interaction of different risk factors, most prior studies have tested only bivariate associations between individual risk factors and suicidal behaviors. The current study was designed to address this limitation by testing the effect of an emotion-cognition interaction on suicide attempts among youth. Specifically, we hypothesized that the interaction of emotion reactivity and problem-solving skills would statistically predict the probability of a recent suicide attempt among 87 adolescents and young adults. Results revealed a significant interaction, such that emotion reactivity was strongly associated with the probability of a suicide attempt among those with poor problem-solving skills, moderately associated among those with average problem-solving skills, and not significantly associated among those with good problem-solving skills. The next generation of studies on suicidal behavior should continue to examine how risk factors interact to predict this dangerous outcome.