Friday, May 26, 2023

Social stress, problem-solving deficits contribute to suicide risk for teen girls


Adolescents who have trouble solving interpersonal problems and experience greater interpersonal stress may be at elevated risk for suicidal behavior, study suggests

Peer-Reviewed Publication

AMERICAN PSYCHOLOGICAL ASSOCIATION

Teen girls who have greater difficulty effectively solving interpersonal problems when they experience social stress, and who experience more interpersonal stress in their lives, are at greater risk of suicidal behavior, suggests research published by the American Psychological Association.

Suicide is the second-leading cause of death among teens, and rates of suicidal behavior are particularly high among girls. Previous research has found that interpersonal stressors – such as conflict with peers, friends and family – are related to suicidal behavior. Some theories of suicidal behavior suggest that poor social problem-solving skills may contribute to the link, possibly because teens with poorer social problem-solving skills are more likely to see suicide as a viable solution to their distress when they feel they’ve exhausted other options.

The current study aimed to test these associations by considering both experimentally simulated and real-world measures of social stress. The research was published in the Journal of Psychopathology and Clinical Science.

“The findings provide empirical support for cognitive and behavioral theories of suicide that suggest that deficits in abilities to effectively manage and solve interpersonal problems may be related to suicidal behavior,” said study lead author Olivia Pollak, MA, of The University of North Carolina at Chapel Hill. “Clinically, this is notable, as problem-solving features prominently in several treatments for suicidal or self-harming behaviors.”

Participants were 185 girls ages 12 to 17 who had experienced some mental health concerns in the past two years. At the beginning of the study, participants completed surveys or interviews about their mental health symptoms and suicidal behaviors. Participants also completed a task assessing their social problem-solving skills, which involved responding to scenarios involving interpersonal conflicts or challenges with other people, such as peers, friends, family members and romantic partners. The teens were then asked to perform a task that has been shown in previous studies to induce social stress – they had to prepare and deliver a three-minute speech before what they thought was an audience of peers watching via video link. Immediately after the stressful task, they again completed the social problem-solving task to see whether experiencing social stress led to declines in their problem-solving ability.

The researchers also followed the girls for nine months, checking in every three months, to ask them about the stressors they were experiencing in interpersonal domains, such as with peers, friends and family members, as well as about suicidal behaviors.

Overall, the researchers found that girls who showed greater declines in problem-solving effectiveness in the lab, and who also experienced higher levels of interpersonal stress over the nine-month follow-up period, were more likely to exhibit suicidal behavior over the nine-month follow-up period.

“Importantly, problem-solving deficits under distress may increase risk for future suicidal
behavior only in combination with greater cumulative interpersonal stress in real life,” Pollak said. “Risk for suicidal behavior was higher among adolescents who showed greater declines in
effectiveness and who experienced high levels of interpersonal stress over nine-month follow-up, consistent with robust evidence for links between interpersonal life stress and suicidal behavior.”

ARTICLE: “Social Problem-Solving and Suicidal Behavior in Adolescent Girls: A Prospective Examination of Proximal and Distal Social Stress-Related Risk Factors,” by Olivia Pollak, MA, and Mitchell J. Prinstein, PhD, The University of North Carolina Chapel Hill; Shayna M. Cheek, PhD, Duke University; Karen D. Rudolph, PhD, University of Illinois Urbana-Champaign; Paul D. Hastings, PhD, University of California Davis; and Matthew K. Nock, PhD, Harvard University. Journal of Psychopathology and Clinical Science, published online May 25, 2023.

CONTACT: Olivia Pollak can be reached at ohpollak@email.unc.edu.

Fewer suicides among boys in regions with more bipolar diagnoses

Peer-Reviewed Publication

KAROLINSKA INSTITUTE

Bipolar disorder underlies roughly five percent of all suicides among young people. Previous studies also show that there is often a long delay between the onset of bipolarism and its correct diagnosis and treatment. Researchers at Karolinska Institutet now show that fewer boys commit suicide in Swedish regions where bipolar diagnoses are more common. The study, which is published in JAMA Psychiatry, could contribute to more proactive care for reducing the number of suicides.

“Bipolar disorder is often more distressing for people who develop it early in life and is one of the psychiatric disorders most associated with suicide risk,” says the study’s first author Peter Andersson, doctoral student at the Department of Clinical Neuroscience, Karolinska Institutet.

The disease usually manifests between the ages of 12 and 25 and is characterised by recurring episodes of mania and depression. Previous studies have shown that it can take up to six years for bipolar disorder to be diagnosed and treated, and comparisons with data from previous large-scale prevalence studies, indicate that under-diagnosis in Sweden is high among individuals aged 15-19.

Large regional differences

Using registry data from all of Sweden's 21 regions between 2008 and 2021, researchers from Karolinska Institutet examined regional differences in the number of people aged 15 to 19 diagnosed with bipolar disorder and the correlation between population size-adjusted diagnoses and confirmed suicides for males and females.

The results, which included 585 confirmed suicides in this age group, showed large regional differences in the percentage of young people diagnosed with bipolar disorder.

The study also found an association between a higher number of population-adjusted bipolar diagnoses and lower suicide rates among boys.

“Our results show that the suicide rate among boys is almost five per cent lower in the regions that make most bipolar diagnoses than in those that make the fewest,” says corresponding author Adrian E. Desai Boström, resident in child and adolescent psychiatry in Stockholm and postdoc researcher at the Department of Clinical Neuroscience, Karolinska Institutet. “This suggests that suicide among teenage boys in Sweden could be reduced with improvements to the diagnosis of bipolarism and its treatment.”

Sometimes wrongly diagnosed

The study's complementary analyses showed that the relationship between the number of bipolar diagnoses and lower suicide rates among boys was independent of the number of care episodes and diagnoses of depression or schizophrenia.

Although the number of prescriptions for the mood stabilizer lithium paradoxically decreased when more bipolar diagnoses were established, increases were observed in the number of boys who received lithium at least once. The researchers hypothesised that this could be interpreted as indicating that boys with bipolar disorder often begin lithium therapy but then switch to other mood-stabilising drugs for various reasons.

The researchers also see a possible risk that misguided treatment could lead to a higher suicide rate rather than no treatment at all.

"For example, some young people might be passed on by the psychiatric services to the social services under the provisions of laws relating to the care of the young and people with functional impairments," says Andersson. "We also know that bipolar patients are sometimes wrongly diagnosed with 'normal' depression."

In a recently published study in Nature Communications the researchers found large regional differences in the use of advanced psychiatric treatments in child and adolescent psychiatry in Sweden. They now plan to further investigate the effects of advanced psychiatric treatments on young people with bipolar disorder and other serious psychiatric conditions.

The study was a collaboration among researchers at Karolinska Institutet, Uppsala University, Umeå University, Lund University, Region Halland, and Region Stockholm in Sweden and was financed by the Swedish Research Council. Co-author Jussi Jokinen has been part of an advisory committee for the pharmaceutical company Janssen on the use of esketamine in the treatment of depression. No other conflicts of interest have been reported.

Publication: ”Association of Bipolar Disorder Diagnosis With Suicide Mortality Rates in Adolescents in Sweden”. Peter Andersson, Jussi Jokinen, Håkan Jarbin, Johan Lundberg, Adrian E. Desai Boström. JAMA Psychiatry, online 24 May 2023, doi: 10.1001/jamapsychiatry.2023.1390.

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