Feelings of worthlessness Perceptions of low self-worth and feelings of worthlessness have been connected to suicidal behavior (Wakefield & Schmitz, 2016). These feelings may arise as a function of recent difficulties in occupational or social realms. These feelings are often perceived rather than truthful, as even people deemed successful by others die by suicide. Hopelessness Hopelessness, or the belief that one’s situation will not change, is also a robust predictor of ideation, attempts, and death by suicide (Baryshnikov et al., 2020; Wolfe, Nakonezny, Owen, Rial, Moorehead, et al., 2019). Hopelessness is considered the most pervasive cognitive state in suicidal individuals (Klonsky et al., 2018); however, in adolescents, it can be difficult to parse the A history of dysfunction in the family of origin is another distal potentiating factor. Family histories of violence, abuse (physical and sexual), neglect, and parental separations are associated with increased suicide risk, as well as a variety of self-harming behaviors (Clements-Nolle, Lensch, Yang, Martin, Peek, & Yang, 2020). Additionally, it appears that suicide tends to run in families, and it has been estimated that social environment and genetic factors play about an equal role in determining who engages in suicidal behaviors (Lin & Tsai, 2016). Other family dysfunction factors linked to suicidal behavior include parental separation or divorce, presence of psychiatric diagnoses in other family members, domestic violence, and displacement (e.g., temporary living situations vs. stable ones) (Clements-Nolle et al., 2020; Marshall, Semovski, & Stewart, 2020; Miranda- Mendizzbal et al., 2019). Bullying Interpersonal risk factors Family dysfunction Bullying is a topic of considerable concern for youth suicidal behavior (Gunn & Goldstein, 2017), especially as it relates to LGBTQIA youth (Mueller et al., 2015). Bullying can affect any child or adolescent and is a challenging problem for both parents and educators. Even more problematic, cyberbullying has become a larger issue in recent years with the explosion in social networking applications and changes in adolescent behavior in virtual settings (Kim, Kimber, Boyle, & Georgiades, 2019). Whenever assessing youth for suicidal behavior, bullying The stigma of mental illness and suicide, as well as negative social norms, can contribute to higher suicide rates because they inhibit individuals from seeking the lifesaving help they need. It has been well-established in the literature by a number of researchers that persons with suicidal thoughts were less likely to seek psychological help compared to those who have psychological problems but no suicidal thoughts, especially among men (Calear, Banfield, Batterham, Morse, Forbes, et al., 2017). Those who do not seek psychological help tend to have negative attitudes and are more likely to have a stigma against help-seeking behaviors (Reynders, Kerkhof, Molenbergh & Van Audenhove, 2015). Socioeconomic risk factors Social stigma Indeed, most people who seek and receive psychological help tend to experience shame and feel stigmatized after receiving the help (Reynders et al., 2015). Stigma is defined as behaviors that are often perceived by the general public to be disgraceful or shameful (Dunford & Granger, 2017; Reynders et al., 2015). The stigma perceived from having suicidal thoughts is distinguished from that perceived after receiving help for the management of suicidal ideation and suicidal behaviors. Perceived stigma purports the idea that people are convinced that they will be discriminated against for seeking help with psychological problems. These people then tend to apply the attitude of stigmatizing onto themselves, resulting in low self-esteem and low self-efficacy. Therefore, they erroneously deduce that in order to prevent being stigmatized they should
contribution of hopelessness to suicidality when depression is also prevalent. Hopelessness has been reported to be more severe among multiple suicide attempters rather than those making a single attempt (Klonsky et al., 2018). Sleep disturbance In the last decade, a growing body of research has emerged to highlight the role of sleep problems in the onset of suicidal behavior (Liu et al., 2018). Sleep disturbance can include initial insomnia (difficulty falling asleep), middle insomnia (waking up for long periods in the middle of the night), and terminal insomnia (waking up earlier than preferred). Other sleep problems associated with suicidal behavior include poor overall sleep quality and nightmares. is an important factor to inquire about, and ideally resolve when possible. Romantic relationships and divorce Difficulties in romantic relationships can be a contributing or even a potentiating factor for suicidal behavior. Dating violence in young women (Miranda-Mendizzbal et al., 2019), for example, has been connected to suicide risk. Non-married and especially divorced status are predictive of suicide among men and, to a lesser degree, women (Kyung-Sook, SangSoo, Sangjin, & Young-Jeon, 2018). As will be seen in subsequent discussion of theoretical models of suicide, romantic relationships represent one of the most important interpersonal relationships an individual can have, and problems in this area can substantially weaken interpersonal connections that buffer against suicide risk. Domestic violence Women experiencing turbulent relationships are also at increased risk for suicide, especially when the relationship is characterized by domestic violence and in cases where the partner is exhibiting addiction, coercion, physical assault, jealousy, infidelity, or threatening divorce (Rahmani, Salmasi, Rahmani, Bird, Asghari, et al., 2019). Patients indicating the presence of domestic violence in their home should be carefully screened for suicide risk in addition to addressing personal safety concerns. not disclose psychological problems and should not seek help (Reynders et al., 2015). Economic factors Economic uncertainty has been linked to an immediate increase in suicide risk for those affected (Vandoros, Avendano, & Kawachi, 2019), although economic factors alone are unlikely to be the sole cause of suicidal behavior. Findings include acute adverse financial market conditions as a risk for proximal increases in suicidal behavior (Agrrawal, Waggle, & Sandweiss, 2017). Individuals reporting chronic income and full-time employment problems have also been found to have higher risk (Griffith, 2017). Rates across various socioeconomic statuses tend to fluctuate over time, but suicide rates are generally higher in more economically deprived communities (Iemmi, Bantjes, Coast, Channer, Leone, et al., 2016). Health disparities Health disparities are preventable differences in the incidence, prevalence, mortality and disease burden that are closely linked with social, economic, and environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their race or ethnicity; religion; socioeconomic status; sexual orientation; gender, gender expression, or gender identity; age; mental health; cognitive, sensory or physical disability; geographic location; or other characteristics historically linked to discrimination or exclusion (Barnett, Gonzalez, Miranda, Chavira, & Lau, 2018; Oberg, Colianni, & King-Schult, 2016). Young
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