Saturday, December 26, 2015

To What Extent Can Adolescent Suicide Attempts Be Attributed to Violence Exposure? A Population-Based Study from Western Canada

Suicide is the second leading cause of death among adolescents in Canada and globally. The purpose of our study was to calculate what proportion of adolescent suicide attempts could be prevented in the absence of verbal, physical and sexual violence. Using the province-wide 2008 British Columbia Adolescent Health Survey (N=29,315) we calculated population-attributable fractions for each type of violence, as well as exposure to any violence, separately by gender, among adolescents age 12–19. We found violence victimization is implicated in the majority of suicide attempts. Focusing on violence prevention may be an important strategy for reducing suicide among young people.

This study of adolescent students in British Columbia shows that violence exposure is not only linked to suicide attempt, it is strongly implicated among the majority of adolescents in school who attempt suicide. For both boys and girls, whether that violence is verbal harassment and taunting, physical assaults and abuse, or sexual assaults, we can partially attribute to violence exposure between one-third to two-thirds of those youth who attempt suicide. We also considered the exposure to any form of violence as compared to no violence at all, and that comparison offers an even more sobering finding: the majority of the prevalence of suicide attempts could be attributed, in part, to experiencing some form of violence.

Our results are similar to rates found by one large-scale study of suicide attempts and various childhood adverse events among adults (), but much higher than those reported in the other adult studies. However, since the attributable fraction is a function of the prevalence of various types of violence, as well as the strength of the relationship between the violence exposure and suicide attempt, it is possible that underreporting of both violence exposure and prior suicide attempts due to recall bias among older adults, or the limited types of violence included (usually limited to more severe forms of violence exposure) may help explain differences between our results and those among adults in other countries. The high prevalence of any violence victimization in our study was similar to that found in a study of peer-to-peer violence in one school district in the same region (), and is much higher than the rates of violence retrospectively reported by adults in other countries, when the questions did not also include exposure to bullying in school or sexual harassment. At the same time, several studies have documented the link between bullying at school and suicidal ideation and attempts, so it is clear these forms of violence should be included in considering global exposures to violence as a contributor to suicide among adolescents.

Exposure to violence victimization, whether in school, at home, or in the community, is an important social determinant of health for adolescents, even in a country like Canada, which is not experiencing armed conflicts at home, and where firearms and similar weapons are not easily accessible to the general population. This suggests that violence prevention initiatives may have further value as a strategy for suicide prevention for adolescents, especially as primary prevention. This perspective, however, does not appear to be widely considered by public health policy makers and others involved in suicide prevention initiatives. International reviews of suicide prevention strategies suggest most strategies are focused on secondary or tertiary prevention, i.e., improving screening to identify those at higher risk for suicide, means restriction for who are actively suicidal, reducing stigma and promoting help-seeking behaviours among those who are depressed, or pharmacological and therapeutic treatments for those who have already experienced a suicide attempt (; ; ). While these may be important strategies for suicide prevention when they are effective, they are downstream approaches, and many are not population-based strategies. At the same time, many population-based suicide prevention strategies have focused on social media campaigns or psycho-educational approaches designed to raise awareness of signs of depression and suicidality, sources of help for those at risk, and occasionally problem coping skills; such strategies have been targeted to the general population (Mann et al.,), or to students in schools (Buus Florentine & Crane; ). Unfortunately, these population-based prevention strategies offer limited to no evidence of effective prevention of suicidal behaviour, primarily documenting changes in awareness, attitudes, and knowledge of sources for referral and help-seeking (Buus Florentine & Crane; Miller, et al.), or offering some promising results but weak evaluation methods. None of them focus on preventing upstream risk factors for suicide.

Full article at:

By:   Elizabeth M. Saewyc, PhD, RN, FSAHM and Weihong Chen, PhD
University of British Columbia School of Nursing, Vancouver, British Columbia
Author Contact: Dr. Elizabeth M. Saewyc, UBC School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Tel: 604-822-7505, Fax: 604-822-7466, Email: ac.cbu.gnisrun@cyweas.htebazile

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