THE ASSOCIATION OF THE INTENSITY OF SUICIDAL
BEHAVIOUR WITH SOCIAL PROBLEM BEHAVIOUR, SELFESTEEM, AND EARLY ONSET OF DEPRESSION
Angus H Thompson, Ph.D.
Department of Public Health, Flinders University, South Australia
angus.thompson@flinders.edu.au
http://www.socialproblemindex.com
INTRODUCTION
Background The progression from early signs of parasuicidal behaviour onward has not
been well studied. There is one school of thought, however, that has suggested that
movement often takes place through a series of hierarchical steps that range from the
absence of suicidal behaviour, through thoughts of death, suicidal ideation, suicide plans
and attempts. An important question that emerges from this conceptualization is whether
these apparent increases in suicidal intensity are associated with changes in other factors
thought to be associated with completed suicide.
Objective To examine the association between suicidal intensity and (1) social problem
behaviour, (2) self-esteem, & (3) the age of first-episode depression.
Methods Data from three different data sets were used to examine the relationship
between suicidal intensity and the three above-noted factors. The data sets were drawn,
respectively, from:
1.
ECA The Epidemiologic Catchment Area studies
(USA: N = 19,491)
2.
SE
Study on university student self-esteem
(Canada: N = 227)
3.
NCS The American National Co-morbidity Study
(USA: N = 9,282)
CHILDHOOD PROBLEMS AS A FUNCTION OF THE INTENSITY
OF LIFETIME PARASUICIDAL BEHAVIOUR
ANTISOCIAL PROBLEMS AS A FUNCTION OF LIFETIME
INTENSITY OF SUICIDAL BEHAVIOUR
60%
50%
40%
Hit Spouse
Prevalence
Intensity in the ECA and SE studies was
defined as an increases in the level of
seriousness of suicidal behaviour ranging
from a death wish, through ideation, a
suicide plan (SE only) , and finally an
attempt. In the case of the NCS, the levels
of intensity differed somewhat, beginning
with serious thoughts of suicide, a plan, an
attempt, with those exhibiting all three
suicidal behaviours comprising the final
group.
Violence
Convicted
30%
Lying
Fired 2+
Child Abuse
20%
10%
0%
None
Death Thought
Suicidal Thought
Attempt
SUICIDAL INTENSITY
Source: ECA
45%
40%
35%
30%
Fighting
Poor Grades
25%
Drunk
Stealing
20%
Lying
Arrested
15%
10%
5%
0%
None
Death Thought
Suicidal Thought
SUICIDAL INTENSITY
Source: ECA
Attempt
SOCIAL PROBLEM BEHAVIOUR
A body of research has indicated that social
problems (substance abuse, interpersonal
problems, crime, injuries, & suicide) cluster
in communities and in individuals. The two
figures on this page show that, furthermore,
antisocial behaviour and retrospectively
determined childhood problems show a
“dose-response” association with suicidal
intensity. That is, increases in suicidal
intensity are associated with a greater
likelihood of problem behaviour.
SELF-ESTEEM AND PSYCHOLOGICAL DIFFICULTIES
The figure below shows that self-esteem and suicidal intensity are clearly associated in a
linear fashion, with self-esteem dropping as intensity increases among young adults
(university students). The second figure shows the same trend for psychological problems
in a representative adult sample. The very steep slope for hopelessness is notable
because of its strong relationship with completed suicide.
ADULT PSYCHOLOGICAL PROBLEMS AS A FUNCTION OF LIFETIME
INTENSITY OF SUICIDAL BEHAVIOUR
INTENSITY OF SUICIDAL
BEHAVIOUR AND SELF-ESTEEM
90%
60
80%
55
70%
60%
Prevalence
T Score
50
45
50%
Hopelessness
Nervous
Rx Drug/Emot
40%
40
30%
35
20%
30
10%
None
Death Wish
Ideation
Plan
Attempt
0%
LEVEL OF SUICIDAL BEHAVIOUR
None
Suicidal Thought
Attempt
Source: ECA
ONSET OF DEPRESSION
This figure shows the age of the first
depressive episode among those who met
the DSM-IV criteria for major depression
(lifetime). Age at interview was examined as
well because of the potential biasing effect of
this variable on remembered age of onset. As
it turned out, irrespective of the age at
interview, the age of onset showed
progressively lower values as the intensity of
suicidal behaviour increased. Notably,
however, there was an independent age-atinterview cohort effect, indicating that
younger respondent age was associated with
earlier onset of depression.
AGE OF ONSET OF FIRST DEPRESSIVE EPISODE BY LEVEL
OF SUICIDAL INTENSITY AND AGE OF RESPONDENT
30
28
26
Age of First Depressive Episode
Source: SE
Death Thought
24
22
45 Yrs+
30-44 Yrs
<30 Yrs
20
18
16
14
12
Thought Only
Thought + Plan
Thought + Attempt
All
INTENSITY OF SUICIDAL BEHAVIOR
Source: NCS
CONCLUSIONS
The findings were simple and consistent. In all cases, increases in suicidal intensity were
associated with orderly increases among measures that signified both child and adult
social or mental difficulties. This may mean that suicidal behaviour, social problems, and
mental difficulties “grow” together. This is in contrast to the view that different levels of
suicidal behaviour are characteristic of different populations.
The earlier age of onset for depression for younger cohorts is suggestive of a general
time-trend for earlier onset. This may indicate growing severity, a notion in accord with
several studies that have found that major depression has increased dramatically over the
last few decades in many countries. This is certainly an area for future research. From a
practical view, the findings suggest that it might be wise to intensify early detection and
intervention efforts for emotional and behavioural problems in childhood.
Presented at the 11th International congress of the International Federation
of Psychiatric Epidemiology, Göteborg, Sweden, May 3-6, 2007.