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      Suicidal behaviour among youths associated with psychopathology in both parents and youths attending outpatient psychiatric clinic in Kenya

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          Abstract

          Background

          Suicide is a major cause of death among youths particularly with psychiatric, alcohol abuse and substance abuse disorders. There are relatively few studies on the relationship between psychiatric and substance abuse disorders with suicidal behaviour from low-income countries. This study examines the relationship between suicidal behaviour and co-existing psychiatric or substance disorders among youths and depressive and alcohol use disorders in their parents.

          Method

          The study sample had 678 respondents: 250 youths and 226 and 202 biological mothers and fathers, respectively.

          Results

          This study found a significant statistical association between depressive ( p < 0.001), alcohol abuse ( p <0.001) and substance abuse ( p < 0.001) disorders and suicidal behaviour in youths. There was a significant relationship between maternal depressive disorder ( p < 0.001) and perceived maternal rejecting parenting behaviour ( p < 0.001) with suicidal behaviour in youths. There was a greater odds of a youth with two to three (odds ratio (OR) = 3.63; p = 0.009) and four or more (OR = 8.23; p < 0.001) co-existing psychiatric disorders to have suicidal behaviour than a youth with only one psychiatric disorder. The results also indicate that a higher proportion of youths between ages 16–18 years had suicidal behaviour than youths below 16 years or above 18 years of age ( p = 0.004).

          Conclusion

          These findings suggest that youths with psychiatric and substance abuse disorders have mothers living with a depressive disorder. Also, perceived maternal rejecting parenting behaviour contributes significantly to the development of suicidal behaviour later in adolescent years.

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          Most cited references28

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          Children of depressed parents: an integrative review.

          This article reviews the various literatures on the adjustment of children of depressed parents, difficulties in parenting and parent-child interaction in these families, and contextual factors that may play a role in child adjustment and parent depression. First, issues arising from the recurrent, episodic, heterogeneous nature of depression are discussed. Second, studies on the adjustment of children with a depressed parent are summarized. Early studies that used depressed parents as controls for schizophrenic parents found equivalent risk for child disturbance. Subsequent studies using better-defined samples of depressed parents found that these children were at risk for a full range of adjustment problems and at specific risk for clinical depression. Third, the parenting difficulties of depressed parents are described and explanatory models of child adjustment problems are outlined. Contextual factors, particularly marital distress, remain viable alternative explanations for both child and parenting problems. Fourth, important gaps in the literature are identified, and a consistent, if unintentional, "mother-bashing" quality in the existing literature is noted. Given the limitations in knowledge, large-scale, long-term, longitudinal studies would be premature at this time.
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            Adolescent suicide and suicidal behavior.

            This review examines the descriptive epidemiology, and risk and protective factors for youth suicide and suicidal behavior. A model of youth suicidal behavior is articulated, whereby suicidal behavior ensues as a result of an interaction of socio-cultural, developmental, psychiatric, psychological, and family-environmental factors. On the basis of this review, clinical and public health approaches to the reduction in youth suicide and recommendations for further research will be discussed.
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              Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey.

              General population survey data are presented on the lifetime prevalence of suicide attempts as well as transition probabilities to onset of ideation, plans among ideators, and attempts among ideators either with or without a plan. Risk factors for these transitions are also studied. Data are from part II of the National Comorbidity Survey, a nationally representative survey carried out from 1990 to 1992 in a sample of 5877 respondents aged 15 to 54 years to study prevalences and correlates of DSM-III-R disorders. Transitions are estimated using life-table analysis. Risk factors are examined using survival analysis. Of the respondents, 13.5% reported lifetime ideation, 3.9% a plan, and 4.6% an attempt. Cumulative probabilities were 34% for the transition from ideation to a plan, 72% from a plan to an attempt, and 26% from ideation to an unplanned attempt. About 90% of unplanned and 60% of planned first attempts occurred within 1 year of the onset of ideation. All significant risk factors (female, previously married, age less than 25 years, in a recent cohort, poorly educated, and having 1 or more of the DSM-III-R disorders assessed in the survey) were more strongly related to ideation than to progression from ideation to a plan or an attempt. Prevention efforts should focus on planned attempts because of the rapid onset and unpredictability of unplanned attempts. More research is needed on the determinants of unplanned attempts.
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                Author and article information

                Journal
                Ann Gen Psychiatry
                Ann Gen Psychiatry
                Annals of General Psychiatry
                BioMed Central
                1744-859X
                2013
                27 April 2013
                : 12
                : 13
                Affiliations
                [1 ]Department of Psychiatry, University of Nairobi, P.O. Box 30197, Nairobi, Kenya
                [2 ]Africa Mental Health Foundation (AMHF), P.O. Box 59176 00200, Nairobi, Kenya
                Article
                1744-859X-12-13
                10.1186/1744-859X-12-13
                3644274
                23622559
                b853a10d-7af9-4df8-aad4-3c86898932ba
                Copyright ©2013 Khasakhala et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 October 2012
                : 16 April 2013
                Categories
                Primary Research

                Clinical Psychology & Psychiatry
                suicidal behaviour,psychiatric disorders,youth,parents,outpatient,kenya

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