Literature Evaluation Paper 1

Running head: u07a1 Literature Evaluation Paper

u07a1: Literature Evaluation Paper

Anthony Rhodes

Psy5002

Orientation to Graduate Learning in Psychology

2911 Hamilton Blvd. 444

Sioux City, Iowa 51104

Telephone: 712-301-9258

Email: anthonyrhodes54@yahoo.com

Instructor: David Chapman, PsyD.

 Literature Evaluation Paper 2

Abstract

This paper reviews three peer-reviewed journal articles that examine the risk factors in
adolescent suicide attempters and completers. The articles document longitudinal research
studies and comparison studies of the effects of various risk factors that potentially lead to
adolescent suicide attempts and completions. In addition, common myths surrounding
suicidality are exposed and recommendations for treatment and prevention are suggested. This
author has chosen a primary research article and two other related articles for comparison to
verify or refute the research results so as to more clearly identify and confirm various risk factors
and their significance for suicide attempters.
 Literature Evaluation Paper 3

Few questions have drawn timeless and universal attention like the broad and diverse
philosophical question, What is life? Views on the meaning of life have been pondered and
articulated by scholars, philosophers, psychologists and many others throughout the ages. The
quest to live life to the fullest is commonly and earnestly embraced by nearly every individual of
every nation. But fewer individuals seem to reflect on the mysteries surrounding the subject of
death until confronted with its sudden and present reality.

Although one may accept the fact that death is simply the natural cessation of life, from a
mental health perspective the gripping reality of its causes and its effects can be impetuous,
painful and widespread. Suicide is one of the most painful and puzzling death realities we face
today. The escalating and alarming rates of suicide attempts (SA) and completions (SC) by
adolescents over the last three decades have led the mental health community to fervent study
of its causes and effects upon individuals, families and societies.

More recently, numerous research studies regarding factors that place adolescents at
potential risk for suicide have been conducted. The purpose of this paper is to summarize,
analyze and critically evaluate the research findings of studies that attempt to identify
psychosocial risk factors in adolescent suicide attempters and common myths associated with
this complex problem. The author has chosen a primary research article and two other related
articles for comparison to verify or refute the research results so as to more clearly identify and
confirm various risk factors and their significance for suicide attempters.

The primary article under review describes the sociodemographic and psychological
characteristics of adolescent suicide attempters (SA) in a longitudinal study done in Geneva,
Switzerland (Laederach, J., Fischer, W., Bowen, P., & Ladame, F., 1999). Because of the
known frequency correlation of SA to suicide completions, analysis of the causal elements or
risk factors of SA is critical to understanding how to successfully apply and critically review
therapeutic and preventative treatment models. The article documents research findings in
order to determine the impact of treatment models on adolescent suicide attempters who have
been subject to risk factors and compares the results to other risk factor studies chosen by the
research team.

The study included 148 adolescents from 15 to 19 years old who had been admitted to
the emergency unit of the Geneva University Hospital in Geneva, Switzerland after a confirmed
suicide attempts between October 1, 1992 and September 30, 1996 (Laederach, J., Fischer,
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W., Bowen, P., & Ladame, F., 1999). Both first time suicide attempters and repeaters were
included. The data for males and females was combined with the exception of data collection
from categories such as: inactivity for health reasons, suicide by an acquaintance and sexual
abuse, because no appreciable difference between male and females respondents was found in
other categories of risk (Laederach, J., Fischer, W., Bowen, P., & Ladame, F., 1999).

The research procedure included an initial interview done by experienced clinicians

while patients were undergoing treatment in the hospital. The research instruments consisted of
a structured questionnaire and an interview. The questionnaire was used to compile the
following data:

1. Sociodemographic data notably sex and age.

2. Psychosocial factors, as well as personal and family history, with regard to medical,
psychiatric and social issues. These include the subjective state of health of the subject,
absence from school or work, whether for health reasons or not, and sexual abuse.
3. Personal or family history of suicidality or self destructive behavior (Laederach, J.,
Fischer, W., Bowen, P., & Ladame, F., 1999).

Previous studies reviewed and noted by the researchers determined the following as
potential risk factors for SA and were used for comparative analysis with the risk factors that
emerged from their sample study:

1. Mental disorders: studies showed that comorbidity was critical in increasing the rate of
SA. The strongest association was depression coupled with a second disorder of
substance abuse, disruptive behavior or anxiety.
2. Previous suicide attempts: studies indicated that previous attempts were repeated.
3. Suicidal behavior among family and acquaintances: direct correlation with SA was
inconclusive in previous studies, but exposure to suicidal behavior among family and
friends did lead to affective disorders.
4. Poor health: studies showed an increase in somatic disorders among SA.
5. Poor social integration: the major finding here was most adolescents were unemployed
and experienced poor integration in their educational settings.
6. Past history of sexual abuse: Studies showed some evidence of SA among those who
had previous abuse during childhood and adolescence.
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The risk factor results of this study indicated there was a direct relationship between
psychopathology and SA. The majority of the respondents suffered from affective disorders
mainly depression (69.6%) and the majority had more than one disorder the most frequent
being mood disorder. Past suicidal attempts was significant (46.6%) as an indicator of a
repetitive pattern of suicidality but showed virtually no difference between males and females.
In terms of association with family and acquaintances that had attempted suicide, 34.5% had
such knowledge and relationship. Health concerns were also shown to have been a factor as
73.0% revealed that they considered their health condition to be poor. Social integration was
also a factor as absenteeism from school was representative of over half of the sample group.
Lastly, a small number of adolescents, mostly females, admitted to having had sexual violence
in their past (Laederach, J., Fischer, W., Bowen, P., & Ladame, F., 1999).

The comparative results to previous studies chosen by the researchers confirmed that
psychopathology did exist at the time of the suicide attempt. The study confirmed prior reports
that mood disorder was the predominant affective disorder among SA. The comorbid
psychopathology of the sample group was significant as over half suffered from more than one
disorder which also confirmed previous studies.

However, the comorbidity between substance abuse and mood disorder was not as
significant as reported in previous studies. Another difference this study had with previous
studies was there seemed to be a clear correlation between SA in adolescents and suicidal
behavior in family and friends. Although the relationship is not a simple matter of conventional
wisdom, the study showed that it did lead to depressive and anxiety disorders that increase the
probability of suicidal behavior.

The article was peer reviewed and the research procedures, methodologies and
instruments used to conduct the above study were professionally administered by trained
researchers, staff and clinicians. These elements suggest a scholarly research project was
conducted and communicated in a fashion that constitutes a professionally well-written and well-
documented scholarly work.

The researchers critical evaluation of their own research procedures, instruments and
subsequent conclusions are worth noting. The sample group seems to have significant
limitations in that a relatively small group of hospitalized adolescents cannot statistically be
construed as representative of the broader population of suicide attempters. Secondly, the low
 Literature Evaluation Paper 6

incidence of substance abuse in the sample group differs in comparison to other studies chosen
by the research team. It is possible that those adolescents that were diagnosed as substance
abusers were sent to substance abuse treatment facilities and still exhibited suicidal tendencies
but the attending physician diagnosed it as a secondary disorder.

For purposes of verification of the above study, the author has chosen a second article
of similar subject matter from a preventative perspective in regards to understanding suicidal
behavior among adolescents. This article identifies psychosocial risk factors of future suicide
attempts in adolescents (Lewinsohn, P., Rohde, P., & Seeley, J. 1994, April).

A broader sample selection existed in this study in comparison to the primary article
above. The sample group on this study consisted of 1508 randomly selected adolescents ages
14-18 years old from nine high schools representative of urban and rural areas in western
Oregon in the United States. The researchers administered instruments consisting of an
interview and questionnaire at two points in time approximately one year apart. The majority of
the participants were Caucasian and from two parent homes. A control group with similar
demographic characteristics was also recruited.

Some of the results were quite interesting in comparison to the primary article study.
This study indicated that a percentage of future attempters had younger mothers. Twenty-
seven percent of the attempters had a teenage mother compared with nine percent of the
nonattempters (Lewinsohn, P., Rohde, P., & Seeley, J., 1994). Parents with little formal
education were also seen as a risk factor for SA in adolescents. Furthermore, the rate of SA for
females was slightly lower than that of males.

Other factors not included in the primary articles study included: low self-esteem,
suicidal ideation, low perceived social support by family and friends and physical and functional
impairment. The study agreed with the primary article findings that the greatest contributor to a
future attempt was the risk factor of a prior suicide attempt.

However, the influence of suicide attempts by family members and friends was not
significant in this study in contrast to the primary article study. Conversely, poor integration in
the educational settings of the participants was found to be a byproduct of SA not a risk factor
for future SA. A similar finding existed for those who responded and admitted to poor health not
as a risk factor but a result of suicidal ideation or SA.
 Literature Evaluation Paper 7

The limitations of this study were based primarily on the fact that a smaller percentage
responded after the one year interval than initially anticipated. Secondly, an exclusive reliance
on adolescent self reporting diminished the accuracy of the data and opened the study to over
or underreporting bias (Lewinsohn, P., Rohde, P., & Seeley, J., 1994). However, one of the
positive aspects of the study in comparison to the primary article above was the size of the
sample group and its broad selection criteria which lends itself to more accurate results.

The peer reviewed article is a scholarly study that exhibits sound research instruments,
methods and statistical findings. The skillful writing in an organized, technical format
demonstrates the characteristics of a professional and scholarly approach to research and
reporting.

The final article chosen for comparison purposes to the primary article attempts to
expose the myths surrounding adolescent suicide attempts and completions while offering
recommendations for future suicide prevention programs (Moskos, M., Achilles, J., & Gray, D.,
2004). The article attempts to separate fact from fiction by compiling copious amounts of data
from various studies to expose misnomers and myths encountered by health professionals
when working with suicidal adolescents.

1. Myth #1: Suicide Attempters and Completers Are Similar. The authors state that roughly
84% of attempters are female (Moskos, M., Achilles, J., & Gray, D., 2004). But then they
admit that some of the data is speculative. The authors quote research sources that
indicate the suicide completion is a rare event in contrast to suicide attempts.
Furthermore, the authors document findings indicating that many completers have never
made a prior attempt at suicide.
2. Myth #2: Current Prevention Programs Work. Suicide hotlines and school education
programs according to the authors research have not significantly prevented suicide and
have not been scrutinized and evaluated statistically enough to verify their success.
Media reporting of suicides has not been rigorously controlled enough and at times has
lead to cluster suicides (Moskos, M., Achilles, J., & Gray, D., 2004).
3. Myth #3: Teenagers Have the Highest Suicide Rate. The authors state that elderly white
males are the highest risk for completed suicide. However, they also acknowledge that
adolescent and young adult suicide rates have more than tripled between the 1960s and
the 1990s.
 Literature Evaluation Paper 8

4. Myth #4: Suicide Is Caused by Family and Social Stress. The authors reference
research that these are not risk factors for SA and 90% of teenage suicide completers
have comorbid psychopathology. Conversely, they also cite research that indicates that
suicide completers had serious stress and family dysfunction.
5. Myth #5: Suicide Is Not Inherited. The authors reference a research study in Denmark
that confirmed adolescents are more likely to be SC if their parents have had a history of
mental illness.
6. Myth #6: Teen Suicide Represents Treatment Failure. The authors reference national
study research that indicates few SC were in treatment at the time of death. They also
make reference to studies indicating that the incidence of teen suicide has dropped in
recent years due to the use of medications.

In summary the authors conclude that the above myths expose the misconceptions that
exist in suicide prevention programs and in the general publics perception of suicide. They
suggest more research is needed to change those perceptions to accurately view suicide as a
mental illness (Moskos, M., Achilles, J., & Gray, D., 2004). More public awareness is needed to
champion the rights of individuals who struggle with mental illness in order to provide greater
access to health care.

The above article seems to be inconclusive and contradictory at times in regards to

formulating a convincing argument for each myth and subsequent treatment recommendations.
In several instances the authors attempt to state their position but admit the much of the
research regarding SA and suicide completion is incomplete and inconclusive. Although the
article does appear to be published in a peer reviewed scholarly journal, it does not seem to
have the same professional scholarly approach to research and writing as witnessed in the two
other articles this author has reviewed. Contradictory, selective and somewhat irrelevant
research findings are used to support the authors contention that such myths exist in American
society and the mental health industry. Moreover, one would need to spend significant time
verifying the research citations used to present the authors arguments. Overall, the article
appears scholarly but the lack of conclusive research and the overbearing writing style of using
frequent and broad research citations for supporting evidence significantly lessen its impact as a
key resource document in understanding the complex problem of suicide.

The three articles reviewed have apparent differences in their attempts to understand
suicide risk factors for adolescents. Two articles appeared to provide research to support the
 Literature Evaluation Paper 9

theory that family influences have a direct bearing on SA (Lewinsohn, P., Rohde, P., & Seeley,
J., 1994; Laederach, J., Fischer, W., Bowen, P., & Ladame, F., 1999). Conversely, another
article reviewed suggested that family and friends have little or no influence in determining risk
factors for SA, but suicide completers have confirmed family stress and dysfunction as a
secondary influence (Moskos, M., Achilles, J., & Gray, D., 2004). Two of the articles cite
confirmed research data that indicates suicide completers have a history of suicide attempts
(Lewinsohn, P., Rohde, P., & Seeley, J., 1994; Laederach, J., Fischer, W., Bowen, P., &
Ladame, F., 1999). However, the third article cites research that indicates that many
completers have never made a prior attempt at suicide (Moskos, M., Achilles, J., & Gray, D.,
2004). One article makes the case that adolescent suicide attempts and completions have
strong genetic influences (Moskos, M., Achilles, J., & Gray, D., 2004), while the other two
articles provide significant research that points to comorbidity and previous suicide attempts as
the strongest risk factors in adolescent SA (Lewinsohn, P., Rohde, P., & Seeley, J., 1994;
Laederach, J., Fischer, W., Bowen, P., & Ladame, F., 1999).

There are common threads of agreement that run through all three of the above
research articles. All three articles agree that psychopathological disorders are risk factors for
adolescent SA and SC and that comorbidity of depression and other mental disorders present
one of the greatest potential risk factor for SA and SC. Furthermore, there is agreement that
previous suicide attempts, biological, environmental and social risk factors do play a significant
role in developing mental disorders that lead to SA in adolescents. All three articles recognize
that research methodologies, instruments and samples can produce variable results and more
testing and research is needed to thoroughly understand the complexities of suicide in
adolescents.

In conclusion, the above articles seem representative of a cross section of ongoing

research being conducted by mental health professionals in an attempt to understand, diagnose
and prevent adolescent suicide attempts and completions. The apparent objective uncertainty
of testing results in two of the articles emphasizes the need for further research models that
target gaps and inaccuracies in research instruments and data collection. Although the authors
draw from numerous and diverse procedures, instruments and research methodologies, the
findings reveal some important consistencies in the quest to understanding risk factors in
adolescent suicide attempts and completions.
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Comorbidity and previous suicide attempts were two primary risk factors for adolescent
suicide attempts. Other risk factors seem to vary in influence depending on sample size and
selection, instruments, and methodologies used but all three articles agree that multiple risk
factors significantly increase the percentage of adolescent suicide attempts and completions.
As further research is conducted; relevant, research-based treatment models and suicide
prevention programs must be designed, implemented and evaluated appropriately (Moskos, M.,
Achilles, J., & Gray, D., 2004). Furthermore, greater attention is needed by mental health care
providers to recognize the risk factors for suicide in adolescents and seek appropriate action to
provide responsible, evidence-based and affordable health care to adequately address this
alarming trend among todays youth.
 Literature Evaluation Paper 11

References

Laederach, J., Fischer, W., Bowen, P., & Ladame, F. (1999). Common risk factors in adolescent
suicide attempters revisited. Crisis: The Journal of Crisis Intervention and Suicide Prevention,
20(1), 15-22

Lewinsohn, P., Rohde, P., & Seeley, J. (1994). Psychosocial risk factors for future adolescent
suicide attempts. Journal of Consulting and Clinical Psychology, 62(2), 297-305.

Moskos, M., Achilles, J., & Gray, D. (2004). Adolescent Suicide Myths in the United States. Crisis:
The Journal of Crisis Intervention and Suicide Prevention, 25(4), 176-182.