Sexual Activity, Fighting and Other Behaviors in Adolescents Are Linked to Risk of Suicidal Thoughts and Attempts, Yale Researchers Find

Yale researchers and their collaborators have found that high-risk behaviors such as smoking, physical fighting, alcohol use and sexual activity are associated with increased risk of suicidal attempts among adolescents.

The findings have potentially important clinical and preventive significance. “These results have implications for early identification and intervention because these risk behaviors may be more readily apparent and more easily identified than suicidal ideation or behavior,” said first author, Robert King, M.D., professor of child psychiatry and psychiatry at the Yale Child Study Center.

Published in the July issue of Journal of the American Academy of Child and Adolescent Psychiatry, the study looked at the relationships between suicidal thoughts or attempts and family environment, subject characteristics (including psychiatric diagnoses) and various risk behaviors in 1,285 children and adolescents aged nine through 17 who were randomly selected in four ethnically diverse communities.

“The evidence for an association of suicidal thoughts and attempts with psychosocial risk factors and problem behaviors, independent of psychiatric diagnosis, enriches our understanding of suicidal behavior in children and adolescents,” said King.

King and the co-authors found that compared with their non-suicidal peers, children and adolescents with a history of suicidal thoughts or attempts were more likely to have experienced stressful life events; to have become sexually active; to have smoked, gotten drunk or used drugs; or to have been involved in physical fighting, even after controlling for gender, ethnicity and socioeconomic status. King said the presence of these behaviors was associated with increased risk of suicidal thoughts or attempts, even after further controlling for the presence of psychiatric disorders known to be associated with suicidality, such as depression, anxiety disorder or disruptive behavior.

The researchers also found that a lack of parental monitoring was associated with increased suicide risk. “Past studies have shown that potentially self-destructive and unhealthy behaviors, including suicide, may represent inadequate parental care and a lack of concern for the child’s physical well-being,” said co-author Mary Schwab-Stone, M.D., the Harris Associate Professor of Child Psychiatry in the Yale Child Study Center.

Of the 1,285 study participants, 3.3 percent had attempted suicide and 5.2 percent had expressed suicidal ideations or thoughts. The participants and their parents were interviewed between December 1991 and July 1992 as part of the National Institute of Mental Health (NIMH) Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study.

Schwab-Stone said the MECA study provided an opportunity to look at a community sample of adolescents who were free of the referral or school attendance biases that may distort studies of clinical or school population samples.

Other researchers on the multi-site study included David Shaffer, Madelyn S. Gould and other colleagues at Columbia College of Physicians and Surgeons; Alan J. Fisher, M.D., of South Africa’s University of Cape Town; Sherryl H. Goodman of Emory University; and Benjamin B. Lahey of the University of Chicago.

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