Teen Suicide Risk, Protective Factors Differ Between Sexes

Deborah Brauser

March 05, 2015

Sex may influence the impact of several key factors on both depression and suicidal behavior in teens, new research suggests.

A cross-sectional study of more than 400 adolescents showed that hopelessness and nonproductive coping were significant risk factors for depression for the girls. On the other hand, positive thinking was a protective factor for girls, whereas self-discovery was protective for boys.

Significant risk factors for suicidal behavior for the entire group included depression, hopelessness, or coping problems. For boys, specifically, keeping to themselves was also a significant risk factor, whereas peer support and acceptance were protective.

"Developing protection appears important in the presence of chronic conditions, such as depressive disorders, to reduce the likelihood of further episodes," write the investigators, led by Jean-Jacques Breton, MD, from the Centre de Recherche de l'institut universitaire en santé mentale de Montréal, Hôpotal Rivière-des-Prairies, Canada.

"The influence of sex on protection and risk factors makes it all the more relevant to target different factors for girls and boys in prevention and intervention programs," they add.

The study was one of six included in a special supplement in the February issue of the Canadian Journal of Psychiatry dedicated to assessing protective factors of suicidal behavior in this young age group.

International Collaboration

All of the supplement's studies are from a child psychiatry network known as a "Franco-Quebec academic cooperation," the authors write.

The first article reported results from the Protection for Adolescent Depression Study. It included 119 patients between the ages of 13 and 17 years (65.5% girls) from a Montreal mood disorder clinic (clinical group) and 283 adolescents between the ages of 14 and 17 years (57.5% boys) from several secondary schools in Montreal (community group).

Measures for potential protective factors included the Adolescent Coping Scale, the Reasons for Living Inventory for Adolescents (RFL-A), and the Spirituality Scale. Potential risk factors were measured using the Life Events Questionnaire, the Beck Depression Inventory, and the Beck Hopelessness Scale.

A total of 60% of the participants from the clinical group had severe depression, and all but one reported experiencing a stressful life event (SLE). Only 25% of the community group had depression, which was classified as "light to severe," but 84.5% reported having had at least one SLE.

In addition, 50% of the clinical group reported suicidal ideation, 39% reported suicidal intent, and only 11% reported no suicidal behavior of any type. On the other hand, 23% of the community group reported suicidal ideation, and none reported suicidal intent.

Results showed that "protective factors predicted lower levels of depression and absence of suicidal behavior, as expected under the vulnerability-resilience stress model," write the investigators. And the opposite was found for risk factors.

In other words, the model notes that protective factors lead to a resilience to stress, which can stave off health problems ― and risk factors increase stress vulnerability, increasing future health problems.


The strongest risk factors for depression among all the girls was hopelessness. In fact, multivariate analyses showed that girls in the community group who felt hopeless were eight times more likely than those who felt hopeful to have light to severe depression (P < .001).

Nonproductive coping total score was also a key risk factor for light to severe depression in the community group (odds ratio [OR], 4.7; P < .001) and for severe depression in the clinical group (OR, 5.2; P = .002).

RFL-A total scores predicted lower levels of depression in all participants.

In the community group, self-discovery on the Spirituality Scale was a significant protective factor for depression (OR, 2.5; P < .001), as was "focusing on the positive" for the girls (OR, 2.6; P < .001) Self-discovery was also significantly protective for the boys in the clinical group (OR, 4.0; P = .001).

Univariate analyses for suicidal behavior showed that predictors of suicidal ideation in the community group and suicidal intent in the mood disorders group included depression (OR, 3.4 and 3.7, respectively; both P < .001), hopelessness (OR, 1.8 and 2.2, respectively; both P < .001), and nonproductive coping strategies (OR, 2.4; P < .001, and OR, 1.9; P = .002; respectively).

"Boys who keep to themselves were 6 times as likely of showing suicidal intent in the clinical population as those who did not," write the researchers.

Protective factors included productive coping strategies for the community group and physical recreation for the group's boys (but not girls). For the clinical group, peer acceptance and support were more protective for the boys (OR, 4) than the girls (OR, 1.4), as was self-discovery (OR, 5.2 and 1.5, respectively).

In multivariate analyses, depression was the only significant risk factor for suicidal behavior in the overall community group (OR, 3.4). Depression (OR, 4.0) and keeping to oneself (OR, 4.3) were risk factors for boys in the clinical group, whereas respect for others and for the environment were protective factors (OR, 1.7).

"Focusing on the positive represents an interesting path to pursue to increase positive thoughts and decrease dysfunctional cognitions among adolescent who are depressed and suicidal," write the investigators.

The authors have reported no relevant financial relationships.

Can J Psychiatry. 2015;60(2Suppl1):1-64. Full supplement


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