Monthly Summaries of Nursing Research: January 2008

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Stress, Drug Use, and Poor Self-esteem Contribute to Suicide Risk Among Youths

Walsh E, Eggert LL. Suicide risk and protective factors among youth experiencing school difficulties. International Journal of Mental Health Nursing. 2007;16:349-359.

In the United States, suicide is the third leading cause of death among young persons aged 15-24 years. For high school youths, those with poor grades or those experiencing behavior problems are known to be at elevated suicide risk, but they may escape the attention of school teachers, administrators, and nurses due to irregular school attendance.

Researchers examined the suicide risk behaviors, as well as social and protective factors, of 730 high school students identified as having trouble in school, indicated by poor or declining grades, spotty attendance, or prior drop-out status. The average age of the students was 16 years, and 56% were male. The ethnic make-up of the sample was 40% white, 15% black, 13% Asian, 10% Hispanic, and 22% mixed or other. The students first completed a written questionnaire covering school issues, family, social support, coping, and mood. This questionnaire included a brief Suicide Risk Screen with items focused on depression, alcohol or drug use, and suicidal ideation or risk behaviors.

From this screening, 41% of the students were determined to be at suicide risk (SR) and 59% were not at suicide risk (NSR). The SR group was evenly divided between males and females. Each student was then interviewed to assess: (1) risk factors such as stress or emotional distress, drug history, and exposure to violence; (2) protective factors such as self-esteem, problem-solving, family involvement, and personal control; and (3) attitudes toward or exposure to suicide. Among all of the students, 19% reported suicidal ideation within the last 2 weeks, and 17% reported a previous suicide attempt. In the SR group, females had higher levels of suicide ideation, plans, and attempts than males. Compared with the NSR group, the SR group had higher levels of stress, social distress, illicit drug use, and drug control problems, along with lower levels of self-esteem, coping, and social or family support.

These findings indicate that among high school students with a history of poor school performance, SR is often accompanied by factors that can help serve as warning signs. School nurses and others who work with troubled teens may need to reach out to them, ask about suicidal behaviors, and help develop protective factors.

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