Medicine:Suicidal ideation

From HandWiki
Short description: Thoughts, ideas, or ruminations about the possibility of ending one's life
Suicidal ideation
Other namesSuicidal thoughts, Suicidal ideas
Stückelberg Sappho 1897.jpg
Sappho, an 1897 portrait by Ernst Stückelberg
SpecialtyPsychiatry, psychology

Suicidal ideation, or suicidal thoughts, is the thought process of having ideas, or ruminations about the possibility of ending one's own life.[1] It is not a diagnosis but is a symptom of some mental disorders, use of certain psychoactive drugs, and can also occur in response to adverse life events without the presence of a mental disorder.[2]

On suicide risk scales, the range of suicidal ideation varies from fleeting thoughts to detailed planning. Passive suicidal ideation is thinking about not wanting to live or imagining being dead.[3][4] Active suicidal ideation involves preparation to commit suicide or forming a plan to do so.[3][4]

Most people who have suicidal thoughts do not go on to make suicide attempts, but suicidal thoughts are considered a risk factor.[5] During 2008–09, an estimated 8.3 million adults aged 18 and over in the United States, or 3.7% of the adult U.S. population, reported having suicidal thoughts in the previous year, while an estimated 2.2 million reported having made suicide plans in the previous year.[6] In 2019, 12 million U.S. adults seriously thought about suicide, 3.5 million planned a suicide attempt, 1.4 million attempted suicide, and more than 47,500 died by suicide.[7][8] Suicidal thoughts are also common among teenagers.[9]

Suicidal ideation is associated with depression and other mood disorders; however, many other mental disorders, life events and family events can increase the risk of suicidal ideation. Mental health researchers indicate that healthcare systems should provide treatment for individuals with suicidal ideation, regardless of diagnosis, because of the risk for suicidal acts and repeated problems associated with suicidal thoughts.[10][11] There are a number of treatment options for people who experience suicidal ideation.

Definitions

The ICD-11 describes suicidal ideation as "thoughts, ideas, or ruminations about the possibility of ending one's life, ranging from thinking that one would be better off dead to formulation of elaborate plans".[1]

The DSM-5 defines it as "thoughts about self-harm, with deliberate consideration or planning of possible techniques of causing one's own death".[12]

The U.S. Centers for Disease Control and Prevention defines suicidal ideation "as thinking about, considering, or planning suicide".[13]

Terminology

Another term for suicidal ideation is suicidal thoughts.[5]

When someone who has not shown a history of suicidal ideation experiences a sudden and pronounced thought of performing an act which would necessarily lead to their own death, psychologists call this an intrusive thought. A commonly experienced example of this is the high place phenomenon,[14] also referred to as the call of the void, the sudden urge to jump when in a high place.[15]

Euphemisms related to mortal contemplation include internal struggle,[16] voluntary death,[17] and eating one's gun.[18]

Risk factors

The risk factors for suicidal ideation can be divided into three categories: psychiatric disorders, life events, and family history.

Psychiatric disorders

Suicidal ideation is a symptom of many mental disorders and can occur in response to adverse life events without the presence of a mental disorder.[2]

There are several psychiatric disorders that appear to be comorbid with suicidal ideation or considerably increase the risk of suicidal ideation.[19] For example, many individuals with borderline personality disorder exhibit recurrent suicidal behavior and suicidal thoughts. One study found that 73% of patients with borderline personality disorder have attempted suicide, with the average patient having 3.4 attempts.[20] The following list includes the disorders that have been shown to be the strongest predictors of suicidal ideation. These are not the only disorders that can increase the risk of suicidal ideation. The disorders in which risk is increased the greatest include:[21]

Medication side effects

Antidepressant medications are commonly used to decrease the symptoms in patients with moderate to severe clinical depression, and some studies indicate a connection between suicidal thoughts and tendencies and taking antidepressants,[26] increasing the risk of suicidal thoughts in some patients.[27]

Some medications, such as selective serotonin reuptake inhibitors (SSRIs), can have suicidal ideation as a side effect. Moreover, these drugs' intended effects, can themselves have the unintended consequence of increased individual risk and collective rate of suicidal behavior: Among the set of persons taking the medication, a subset feel bad enough to want to attempt suicide (or to desire the perceived results of suicide) but are inhibited by depression-induced symptoms, such as lack of energy and motivation, from following through with an attempt. Among this subset, a "sub-subset" may find that the medication alleviates their physiological symptoms (such as lack of energy) and secondary psychological symptoms (e.g., lack of motivation) before or at lower doses than it alleviates their primary psychological symptom of depressed mood. Among this group of persons, the desire for suicide or its effects persists even as major obstacles to suicidal action are removed, with the effect that the incidences of suicide and suicide attempts increase.[28]

In 2003, the U.S. Food and Drug Administration (FDA) issued the agency's strictest warning for manufacturers of all antidepressants (including tricyclic antidepressants [TCAs] and monoamine oxidase inhibitors)[29] due to their association with suicidal thoughts and behaviors.[30] Further studies disagree with the warning, especially when prescribed for adults, claiming more recent studies are inconclusive in the connection between the drugs and suicidal ideation.[30]

Individuals with anxiety disorders who self-medicate with drugs or alcohol may also have an increased likelihood of suicidal ideation.[31]

Life events

Life events are strong predictors of increased risk for suicidal ideation. Furthermore, life events can also lead to or be comorbid with the previously listed psychiatric disorders and predict suicidal ideation through those means. Life events that adults and children face can be dissimilar and for this reason, the list of events that increase risk can vary in adults and children. The life events that have been shown to increase risk most significantly are:[32]

  • Alcohol use disorder
    • Studies have shown that individuals who binge drink, rather than drink socially, tend to have higher rates of suicidal ideation[33]
    • Certain studies associate those who experience suicidal ideation with higher alcohol consumption[34]
    • Not only do some studies show that solitary binge drinking can increase suicidal ideation, but there is a positive feedback relationship causing those who have more suicidal ideation to have more drinks per day in a solitary environment[33]
  • Minoritized gender expression and/or sexuality[35]
  • Unemployment[34]
  • Chronic illness or pain[36]
  • Death of family members or friends
  • End of a relationship or being rejected by a romantic interest
  • Major change in life standard (e.g. relocation abroad)
  • Other studies have found that tobacco use is correlated with depression and suicidal ideation[37]
  • Social isolation
  • Unplanned pregnancy
  • Bullying, including cyberbullying[38][39] and workplace bullying[40]
  • Previous suicide attempts
    • Having previously attempted suicide is one of the strongest indicators of future suicidal ideation or suicide attempts[33]
  • Military experience
    • Military personnel who show symptoms of PTSD, major depressive disorder, alcohol use disorder, and generalized anxiety disorder show higher levels of suicidal ideation[41]
  • Community violence[42]
  • Undesired changes in body weight[43]
    • Women: increased BMI increases chance of suicidal ideation
    • Men: severe decrease in BMI increases chance of suicidal ideation
      • In general, the obese population has increased odds of suicidal ideation in relation to individuals that are of average-weight
  • Exposure and attention to suicide related images or words[44]

Family history

  • Parents with a history of depression
    • Valenstein et al. studied 340 adults whose parents had experienced depression. They found that 7% of the offspring had suicidal ideation in the previous month alone[45]
  • Abuse[42]
    • Childhood: physical, emotional and sexual abuse[46]
    • Adolescence: physical, emotional and sexual abuse
  • Family violence
  • Childhood residential instability

Relationships with parents

According to a study conducted by Ruth X. Liu of San Diego State University, a significant connection was found between the parent–child relationships of adolescents in early, middle and late adolescence and their likelihood of suicidal ideation. The study consisted of measuring relationships between mothers and daughters, fathers and sons, mothers and sons, and fathers and daughters. The relationships between fathers and sons during early and middle adolescence show an inverse relationship to suicidal ideation. Closeness with the father in late adolescence is "significantly related to suicidal ideation".[47] Liu goes on to explain the relationship found between closeness with the opposite sex parent and the child's risk of suicidal thoughts. It was found that boys are better protected from suicidal ideation if they are close to their mothers through early and late adolescence; whereas girls are better protected by having a close relationship with their father during middle adolescence.

An article published in 2010 by Zappulla and Pace found that suicidal ideation in adolescent boys is exacerbated by detachment from the parents when depression is already present in the child. Lifetime prevalence estimates of suicidal ideation among nonclinical populations of adolescents generally range from 60% to 75% and in many cases its severity increases the risk of suicide.[48]

Prevention

Crisis hotlines, such as the National Suicide Prevention Lifeline, enable people to get immediate emergency telephone counselling.
As a suicide prevention initiative, these signs on the Golden Gate Bridge promote a special telephone that connects to a crisis hotline, as well as a 24/7 crisis text line.

Early detection and treatment are the best ways to prevent suicidal ideation and suicide attempts.[citation needed] If signs, symptoms, or risk factors are detected early then the individual might seek treatment and help before attempting to take their own life. In a study of individuals who did die by suicide, 91% of them likely had one or more mental illnesses. However, only 35% of those individuals were treated or being treated for a mental illness.[49] This emphasizes the importance of early detection; if a mental illness is detected, it can be treated and controlled to help prevent suicide attempts. Another study investigated strictly suicidal ideation in adolescents. This study found that depression symptoms in adolescents early as 9th grade is a predictor of suicidal ideation. Most people with long-term suicidal ideation do not seek professional help.[citation needed]

The previously mentioned studies point out the difficulty that mental health professionals have in motivating individuals to seek and continue treatment. Ways to increase the number of individuals who seek treatment may include:

  • Increasing the availability of therapy treatment in early stage
  • Increasing the public's knowledge of when psychiatric help may be beneficial to them
    • Those who have adverse life conditions seem to have just as much risk of suicide as those with mental illness[49]

A study conducted by researchers in Australia set out to determine a course of early detection for suicidal ideation in teens stating that "risks associated with suicidality require an immediate focus on diminishing self-harming cognitions so as to ensure safety before attending to the underlying etiology of the behavior". A Psychological Distress scale known as the K10 was administered monthly to a random sample of individuals. According to the results among the 9.9% of individuals who reported "psychological distress (all categories)" 5.1% of the same participants reported suicidal ideation. Participants who scored "very high" on the Psychological Distress scale "were 77 times more likely to report suicidal ideation than those in the low category".[50]

In a one-year study conducted in Finland, 41% of the patients who later died by suicide saw a healthcare professional, most seeing a psychiatrist. Of those, only 22% discussed suicidal intent on their last office visit. In most of the cases, the office visit took place within a week of the suicide, and most of the victims had a diagnosed depressive disorder.[51]

There are many centers where one can receive aid in the fight against suicidal ideation and suicide. Hemelrijk et al. (2012) found evidence that assisting people with suicidal ideation via the internet versus more direct forms such as phone conversations has a greater effect. In a 2021 research study, Nguyen et al. (2021) propose that maybe the premise that suicidal ideation is a kind of illness has been an obstacle to dealing with suicidal ideation.[52] They use a Bayesian statistical investigation, in conjunction with the mindsponge theory,[53] to explore the processes where mental disorders have played a very minor role and conclude that there are many cases where the suicidal ideation represents a type of cost-benefit analysis for a life/death consideration, and these people may not be called "patients".

Assessment

Assessment seeks to understand an individual by integrating information from multiple sources such as clinical interviews; medical exams and physiological measures; standardized psychometric tests and questionnaires; structured diagnostic interviews; review of records; and collateral interviews.[54]

Interviews

Psychologists, psychiatrists, and other mental health professionals conduct clinical interviews to ascertain the nature of a patient or client's difficulties, including any signs or symptoms of illness the person might exhibit. Clinical interviews are "unstructured" in the sense that each clinician develops a particular approach to asking questions, without necessarily following a predefined format. Structured (or semi-structured) interviews prescribe the questions, their order of presentation, "probes" (queries) if a patient's response is not clear or specific enough, and a method to rate the frequency and intensity of symptoms.[55]

Standardized psychometric measures

Treatment

Treatment of suicidal ideation can be problematic due to the fact that several medications have actually been linked to increasing or causing suicidal ideation in patients. Therefore, several alternative means of treating suicidal ideation are often used. The main treatments include: therapy, hospitalization, outpatient treatment, and medication or other modalities.[5]

Therapy

In psychotherapy a person explores the issues that make them feel suicidal and learns skills to help manage emotions more effectively.[5][57]

Psychotherapy has many types in which cognition behavioral therapy(CBT) and Dialectical behavior therapy (DBT) are most effective therapies for treatment of Suicidal ideation[58]

Hospitalization

Hospitalization allows the patient to be in a secure, supervised environment to prevent suicidal ideation from turning into suicide attempts. In most cases, individuals have the freedom to choose which treatment they see fit for themselves. However, there are several circumstances in which individuals can be hospitalized involuntarily. These circumstances are:

  • If an individual poses a danger to self or others
  • If an individual is unable to care for oneself

Hospitalization may also be a treatment option if an individual:

  • Has access to lethal means (e.g., a firearm or a stockpile of pills)
  • Does not have social support or people to supervise them
  • Has a suicide plan
  • Has symptoms of a psychiatric disorder (e.g., psychosis, mania, etc.)

Outpatient treatment

Outpatient treatment allows individuals to remain at their place of residence and receive treatment when needed or on a scheduled basis. Being at home may improve quality of life for some patients, because they will have access to their personal belongings, and be able to come and go freely. Before allowing patients the freedom that comes with outpatient treatment, physicians evaluate several factors of the patient. These factors include the patient's level of social support, impulse control and quality of judgment. After the patient passes the evaluation, they are often asked to consent to a "no-harm contract". This is a contract formulated by the physician and the family of the patient. Within the contract, the patient agrees not to harm themself, to continue their visits with the physician, and to contact the physician in times of need.[5] There is some debate as to whether "no-harm" contracts are effective. These patients are then checked on routinely to assure they are maintaining their contract and avoiding dangerous activities (drinking alcohol, driving fast and not wearing a seat belt, etc.).

Medication

Prescribing medication to treat suicidal ideation can be difficult. One reason for this is that many medications lift patients' energy levels before lifting their moods. This puts them at greater risk of following through with attempting suicide. Additionally, if a person has a comorbid psychiatric disorder, it may be difficult to find a medication that addresses both the psychiatric disorder and suicidal ideation.

Antidepressants may be effective.[5] Often, SSRIs are used instead of TCAs as the latter typically have greater harm in overdose.[5]

Antidepressants have been shown to be a very effective means of treating suicidal ideation. One correlational study compared mortality rates due to suicide to the use of SSRI antidepressants in certain counties. The counties which had higher SSRI use had a significantly lower number of deaths caused by suicide.[59] Additionally, an experimental study followed depressed patients for one year. During the first six months of that year, the patients were examined for suicidal behavior including suicidal ideation. The patients were then prescribed antidepressants for the six months following the first six observatory months. During the six months of treatment, experimenters found suicide ideation reduced from 47% of patients down to 14% of patients.[60] Thus, it appears from current research that antidepressants have a helpful effect on the reduction of suicidal ideation.

Although research is largely in favor of the use of antidepressants for the treatment of suicidal ideation, in some cases antidepressants are claimed to be the cause of suicidal ideation. Upon the start of using antidepressants, many clinicians will note that sometimes the sudden onset of suicidal ideation may accompany treatment. This has caused the Food and Drug Administration (FDA) to issue a warning stating that sometimes the use of antidepressants may actually increase suicidal ideation.[59] Medical studies have found antidepressants help treat cases of suicidal ideation and work especially well with psychological therapy.[61] Lithium reduces the risk of suicide in people with mood disorders.[62] Tentative evidence finds clozapine in people with schizophrenia reduces the risk of suicide.[63]

LGBT youth

Suicidal ideation rates among lesbian, gay, bisexual, transgender (LGBT) youth are significantly higher than among the general population.[64] Suicide ideation has a higher prevalence among gay teenagers compared to their heterosexual peers has been attributed to minority stress, bullying, and parental disapproval.[65][66]

South Korea

South Korea has the 10th highest rate of suicide in the world and the second in the OECD. Within these rates, suicide is the primary cause of death for South Korea n youth, ages 10–19.[67] While these rates are elevated, suicide ideation additionally increases with the introduction of LGBT identity.[68]

See also

References

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  2. ↑ 2.0 2.1 Barry, Lisa C. Passive Suicidal Ideation in Older Adults: Implications for Suicide Prevention, American Journal of Geriatric Psychiatry 27, no. 12 (December 2019): 1411 ("... growing evidence points toward a subgroup of individuals who endorse passive SI [suicidal ideation] in later life outside the context of clinical depression.")
  3. ↑ 3.0 3.1 Falcone, Tatiana; Timmons-Mitchell, Jane (2018-05-18). "Mood Disorders and Suicide" (in en). Suicide Prevention: A Practical Guide for the Practitioner. Springer. pp. 38. ISBN 978-3-319-74391-2. https://books.google.com/books?id=-j9bDwAAQBAJ. 
  4. ↑ 4.0 4.1 Kumar, Updesh (2017-10-26). "Suicidal Ideation in Adolescents–A Transcultural Analysis" (in en). Handbook of Suicidal Behaviour. Springer. pp. 269. ISBN 978-981-10-4816-6. https://books.google.com/books?id=qaI7DwAAQBAJ&q=%22passive+suicidal+ideation%22&pg=PA269. 
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Gliatto, MF; Rai, AK (March 1999). "Evaluation and Treatment of Patients with Suicidal Ideation". American Family Physician 59 (6): 1500–6. PMID 10193592. http://www.aafp.org/afp/990315ap/1500.html. Retrieved 2007-01-08.  open access
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  33. ↑ 33.0 33.1 33.2 Gonzalez, VM (2012). "Association of solitary binge drinking and suicidal behavior among emerging adult college students". Psychology of Addictive Behaviors 26 (3): 609–614. doi:10.1037/a0026916. PMID 22288976.  open access
  34. ↑ 34.0 34.1 34.2 Valenstein, H; Cronkite, RC; Moos, RH; Snipes, C; Timko, C (2012). "Suicidal ideation in adult offspring of depressed and matched control parents: Childhood and concurrent predictors". Journal of Mental Health 21 (5): 459–468. doi:10.3109/09638237.2012.694504. PMID 22978501. 
  35. ↑ McDermott, Elizabeth; Hughes, Elizabeth; Rawlings, Victoria (February 2018). "Norms and normalisation: understanding lesbian, gay, bisexual, transgender and queer youth, suicidality and help-seeking". Culture, Health & Sexuality 20 (2): 156–172. doi:10.1080/13691058.2017.1335435. ISSN 1369-1058. PMID 28641479. 
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  39. ↑ "The relationship between bullying, depression and suicidal thoughts/behaviour in Irish adolescents". Department of Health and Children. http://www.childrensdatabase.ie/database-project/document.asp?DocID=1222. 
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  42. ↑ 42.0 42.1 Thompson, R; Litrownik, AJ; Isbell, P; Everson, MD; English, DJ; Dubowitz, H et al. (2012). "Adverse experiences and suicidal ideation in adolescence: Exploring the link using the LONGSCAN samples". Psychology of Violence 2 (2): 211–225. doi:10.1037/a0027107. PMID 24349862.  open access
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  44. ↑ Cha, CB; Najmi, S; Park, JM; Finn, CT; Nock, MK (2010). "Attentional bias toward suicide-related stimuli predicts suicidal behavior". Journal of Abnormal Psychology 119 (3): 616–622. doi:10.1037/a0019710. PMID 20677851.  open access
  45. ↑ Valenstein, Helen (2012). "Suicidal ideation in adult offspring of depressed and matched control parents: Childhood and concurrent predictors". Journal of Mental Health 21 (5): 459–468. doi:10.3109/09638237.2012.694504. PMID 22978501. 
  46. ↑ Briere, John (1986). "Suicidal thoughts and behaviours in former sexual abuse victims". Canadian Journal of Behavioural Science 18 (4): 413–423. doi:10.1037/h0079962. 
  47. ↑ Liu, Ruth X. (December 2005). "Parent-Youth Closeness and Youth's Suicidal Ideation; The Moderating Effects of Gender, Stages of Adolescence, and Race or Ethnicity". Youth & Society 37 (2): 160–162. doi:10.1177/0044118X04272290. 
  48. ↑ Zappulla, Carla (2010). "Relations between suicidal ideation, depression, and emotional autonomy from parents in adolescence". Journal of Child and Family Studies (Springer Science + Business Media LLC) 19 (6): 747–756. doi:10.1007/s10826-010-9364-9. https://www.academia.edu/15733869. Retrieved 10 April 2012. [yes|permanent dead link|dead link}}]
  49. ↑ 49.0 49.1 Cavanagh, JO; Owens, DC; Johnstone, EC (1999). "Life events in suicide and undetermined death in south-east Scotland: a case-control study using the method of psychological autopsy". Social Psychiatry and Psychiatric Epidemiology 34 (12): 645–650. doi:10.1007/s001270050187. PMID 10703274. 
  50. ↑ Chamberlain, P; Goldney, R; Delfabbro, P; Gill, T; Dal Grande, L (2009). "Suicidal Ideation: The Clinical Utility of the K10". Crisis 30 (1): 39–42. doi:10.1027/0227-5910.30.1.39. PMID 19261567. 
  51. ↑ Halgin, Richard P.; Susan Whitbourne (2006). Abnormal psychology: clinical perspectives on psychological disorders. Boston: McGraw-Hill. pp. 267–272. ISBN 978-0-07-322872-3. 
  52. ↑ Nguyen, MH; Le, TT; Nguyen, HKT; Ho, MT; Nguyen, TTH; Vuong, QH (2021). "Alice in Suicideland: Exploring the Suicidal Ideation Mechanism through the Sense of Connectedness and Help-Seeking Behaviors". Int. J. Environ. Res. Public Health. 7 18 (7): 3681. doi:10.3390/ijerph18073681. PMID 33916123. 
  53. ↑ Vuong, QH; Napier, Nancy K. (2015). "Acculturation and global mindsponge: an emerging market perspective". International Journal of Intercultural Relations 49: 354–367. doi:10.1016/j.ijintrel.2015.06.003. 
  54. ↑ Coaley, Keith, "Introduction: Individual Differences and Psychometrics", chap. 1 in An Introduction to Psychological Assessment and Psychometrics, 2nd ed. (London: Sage, 2014), 1–34. ISBN:978-1-4462-6714-1
  55. ↑ Rogers, Richard. Handbook of Diagnostic and Structured Interviewing. New York: Guilford, 2001.
  56. ↑ Harris, K. M.; Syu, J. J.; Lello, O. D.; Chew, Y. L. E.; Willcox, C. H.; Ho, R. H. M. (2015). "The ABC's of suicide risk assessment: Applying a tripartite approach to individual evaluations". PLOS ONE 10 (6): 6. doi:10.1371/journal.pone.0127442. PMID 26030590. Bibcode: 2015PLoSO..1027442H. 
  57. ↑ "Suicide and suicidal thoughts - Diagnosis and treatment - Mayo Clinic". http://www.mayoclinic.org/diseases-conditions/suicide/basics/treatment/con-20033954. 
  58. ↑ shanzy, joseph (2023-12-08). "Suicide and suicidal ideation: treatment -" (in en-US). https://psychiatrymagazine.com/index.php/2023/12/08/suicide-and-suicidal-ideation-treatment/. 
  59. ↑ 59.0 59.1 Simon, GE (2006). "How can we know whether antidepressants increase suicide risk?". American Journal of Psychiatry 163 (11): 1861–1863. doi:10.1176/APPI.AJP.163.11.1861. PMID 17074930. 
  60. ↑ Mulder, RT; Joyce, P. R.; Frampton, C. M. A.; Luty, S. E. (2008). "Antidepressant treatment is associated with a reduction in suicidal ideation and suicide attempts". Acta Psychiatrica Scandinavica 118 (12): 116–122. doi:10.1111/j.1600-0447.2008.01179.x. PMID 18384467. 
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  62. ↑ "Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis". BMJ 346 (jun27 4): f3646. 27 June 2013. doi:10.1136/bmj.f3646. PMID 23814104. 
  63. ↑ Wagstaff, A; Perry, C (2003). "Clozapine: in prevention of suicide in patients with schizophrenia or schizoaffective disorder.". CNS Drugs 17 (4): 273–80; discussion 281–3. doi:10.2165/00023210-200317040-00004. PMID 12665398. 
  64. ↑ Haas, Ann P.; Eliason, Mickey; Mays, Vickie M.; Mathy, Robin M.; Cochran, Susan D.; D'Augelli, Anthony R.; Silverman, Morton M.; Fisher, Prudence W. et al. (30 December 2010). "Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations". Journal of Homosexuality 58 (1): 10–51. doi:10.1080/00918369.2011.534038. PMID 21213174. 
    Proctor, Curtis D.; Groze, Victor K. (1994). "Risk Factors for Suicide among Gay, Lesbian, and Bisexual Youths". Social Work 39 (5): 504–513. doi:10.1093/sw/39.5.504. PMID 7939864. 
    Remafedi, Gary; Farrow, James A.; Deisher, Robert W. (1991). "Risk Factors for Attempted Suicide in Gay and Bisexual Youth". Pediatrics 87 (6): 869–875. doi:10.1542/peds.87.6.869. PMID 2034492. 
    Russell, Stephen T.; Joyner, Kara (2001). "Adolescent Sexual Orientation and Suicide Risk: Evidence From a National Study". American Journal of Public Health 91 (8): 1276–1281. doi:10.2105/AJPH.91.8.1276. PMID 11499118. 
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    Johnson, R. B.; Oxendine, S.; Taub, D. J.; Robertson, J. (2013). "Suicide Prevention for LGBT Students". New Directions for Student Services 2013 (141): 55–69. doi:10.1002/ss.20040. http://libres.uncg.edu/ir/uncg/f/B_Johnson_Suicide_2013.pdf. 
  65. ↑ "New Research on LGBTQ Teen Suicide Rates". 27 February 2023. https://www.newportacademy.com/resources/mental-health/lgbt-suicide-rates/. 
  66. ↑ "Definition of Bisexual suicide risk". Medterms.com. 1999-10-27. http://www.medterms.com/script/main/art.asp?articlekey=10851. 
  67. ↑ Sohn, Min; Oh, Heymin; Lee, Sang-Kyu; Potenza, Marc N. (2017-10-09). "Suicidal Ideation and Related Factors Among Korean High School Students". The Journal of School Nursing 34 (4): 310–318. doi:10.1177/1059840517734290. ISSN 1059-8405. PMID 28992754. 
  68. ↑ Kim, SungYeon; Yang, Eunjoo (February 2015). "Suicidal Ideation in Gay Men and Lesbians in South Korea: A Test of the Interpersonal-Psychological Model". Suicide and Life-Threatening Behavior 45 (1): 98–110. doi:10.1111/sltb.12119. PMID 25220014. 

Further reading

  • Beck, AT; Steer, RA; Kovacs, M; Garrison, B (1985). "Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation". Am J Psychiatry 142 (5): 559–563. doi:10.1176/ajp.142.5.559. PMID 3985195. 
  • Uncapher, H (2000–2001). "Cognitive biases and suicidal ideation in elderly psychiatric inpatients". Omega 42 (1): 21–36. doi:10.2190/6uu8-hk8e-hl0v-q4cu. 
  • Uncapher, H; Gallagher-Thompson, D; Osgood, NJ (1998). "Hopelessness and suicidal ideation in older adults". The Gerontologist 38 (1): 62–70. doi:10.1093/geront/38.1.62. PMID 9499654. 

External links

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