The Connection Between Temperament and Suicidality
[seriesbox]A Parent’s Guide to Self-Harm and Suicide Risk in Teens
The Association Between Teen Suicidal Ideation and Childhood Depression and Irritability
Insomnia and Sleep Disturbances in Teens Linked to Higher Risk of Suicide
Bullying and Cyberbullying Associated with Higher Risk of Suicide in Teens
Risk of Escalation from Self-Harm to Suicide Attempts in Adolescents
Teen Suicide Contagion: Is Suicide Contagious?[/seriesbox]There’s a reason you see an increasing number of news stories online and on TV about the suicide rate among people in the U.S. From children to adults, it’s increasing across all demographics. The suicide rate among seniors is the highest, as it has been for years. But the suicide rates that get the most attention in the media are those for young adults and adolescents.
Here are the three data points that create the greatest concern (National Youth Risk Behavior Survey 2019):
- Suicide is the second leading cause of death for adolescents and young adults
- 8% reported seriously considering suicide in the past 12 months
- An average of 3,703 adolescents in grades 9-12 attempt suicide every day
Experts in adolescent mental health brought these figures to our attention over five years ago. Research into the increase over the past twenty years – with the most significant increase occurring between 2012 and 2019 – shows the various forces driving the change.
While many experts cite the rise of social media, the exponential expansion of screentime for children and adolescents, and the near-universal ownership of smartphones and internet access for children and adolescents as proximate causes of these increases, there is no conclusive, causal data that links these factors and the large jumps in suicidality among teens. This includes suicidal ideation, self-harming behavior, and suicide attempts.
What experts identify in their research on teen suicide risk, suicidal teens, adolescent self-harm risks, and risk factors for teen suicide – and recognize as a primary risk factor driving these decades-long increases – is the parallel increase in rates of the following mental health disorders and their association with teen suicidality:
For an in-depth discussion on suicide risk in teens, please read this article we published recently:
Screening for Suicide Risk in Adolescents
The presence of a mental health disorder increases suicide risk. That’s a well-known fact, supported by decades of research. In the wake of the coronavirus pandemic, understanding this fact is critical. Data shows that rates of mental health disorders among adolescents jumped during 2020. The rates of suicidal ideation and suicide attempts increased, also.
Teen Suicide Risk: The Effect of Temperament on Suicidal Ideation
This article discusses a paper published in 2018 that addresses factors associated with suicidal ideation – not suicide risk per se – that addresses the relationship of various personality traits and/or psychological habits that may contribute to suicidal ideation. The thing that distinguishes this study from others is that researchers consider these personality traits – temperamental tendencies, as it were – outside of the context of a mental health disorder that reaches a clinical threshold, and independent of the common risk factors and warning signs associated with teen suicidality.
Here’s the goal of the study in the words of the researchers themselves:
“Although suicide remains a leading cause of death for adolescents, risk factors beyond diagnoses and suicide attempt history remain unclear. We examined whether cognitive style and temperament impact risk for an early, yet still clinically relevant and distressing, form of suicidality: active suicidal ideation.”
We know the events leading to a suicide attempt typically follow a pattern. In the preliminary stages this pattern often – but not always – includes suicidal ideation. We also know that 80 percent of adolescents who attempt suicide show clear warning signs ahead of time. In addition, we know some form of suicidal ideation precedes 88 percent of suicide attempts. Knowing the risk factors and warning signs can help prevent teen suicide, mitigate adolescent self-harm risk, and decrease the likelihood a suicidal teen will attempt suicide.
We Need to Know More About Precursors to Suicidal Ideation
What we don’t know – or don’t know as much about – are the factors associated with suicidal ideation not included in the typical host of risk factors and warning signs associated with teen suicide. We’ll say that another way. We want to know more about the factors – the subclinical, pre-crisis, less-than-obvious ones – that can lead to suicidal ideation.
Why?
Everything we know about mental health teaches us that the earlier we catch a potential problem, the better we can help a teen that displays the early symptom/risk factors/warning signs related to that problem. Therefore, identifying the factors associated with suicidal ideation – factors independent of clinical diagnoses or well-known risk factors – can help us identify teens at risk of suicidal ideation earlier than before.
It follows, logically, that if we can identify these factors early enough, we can then intervene earlier and prevent a teen at-risk of suicidal ideation from engaging in suicidal ideation. This early intervention, in turn, can help prevent suicide attempts, self-harming behavior, and death by suicide, behaviors which are all associated with suicidal ideation.
Now let’s take a look at the study.
What the Study Measured: The Relationship Between Brooding, Inattention, Impulsivity, and Suicidal Ideation
First, let’s define the terms, and how the study authors measured them.
Brooding
Most of us know what brooding is. It’s when we mull over a situation with what a typical dictionary calls a “moody, sullen, or serious way.” But brooding also has a definition in psychology, as a subcategory of rumination: “the passive comparison of one’s own situation to some unachieved standard.” Research shows that brooding predicts suicidal ideation in adults, but to date, no research connects brooding and suicidal ideation among teens. To measure brooding in teens, researchers used a modified depression assessment tool, with a focus on questions related to the brooding aspect of rumination.
Inattention/Impulsivity
Inattention is another word for the inability to focus. The American Psychological Association (APA) Dictionary of Psychology defines inattention as “a state in which there is a lack of concentrated or focused attention or in which attention drifts back and forth.” Most of us associate inattention with attention-deficit hyperactivity disorder (ADHD). Research shows that adolescents with ADHD are 3.6 times more likely to attempt suicide than their peers without ADHD. However, no research – before this study – connects inattention in the absence of ADHD with an increased risk of suicidal ideation. To measure inattention in teens without ADHD, researchers used standard ADHD screening tools.
Suicidal Ideation
Suicidal ideation means “thinking or talking about suicide.” Suicidal ideation can be passive – meaning the person engaging in suicidal ideation does not have a suicide plan – and active – meaning the person engaging in suicidal ideation has a suicide plan. To learn more about the difference between active and passive suicidal ideation, please read our article “Treatment for a Suicidal Teenager: Understanding the Line between Passive Suicidal Thoughts and Active Intentions.” In this study, researchers measured suicidal ideation in adolescents using an assessment called the Diagnostic Interview Schedule for Children.
What the Study Says: The Impact of Temperament on Suicidality
One interesting thing about this study was its use of 134 pairs of twins. Of the total sample set, 46 twin pairs reported engaging in suicidal ideation, while the rest did not. This enabled researchers to investigate factors associated with suicidal ideation in the twin pairs that engaged in suicidal ideation, compare those to one another, and then compare those results to the twin pairs that did not engage in suicidal ideation, who functioned as the control group.
Here’s what they found:
Brooding
Adolescents who self-reported brooding had an increased likelihood of suicidal ideation. The presence of a clinical diagnosis of depression exacerbated this risk. For adolescents who engage in brooding:
- Risk of suicidal ideation increased by a factor of 2.08
For adolescents who engage in brooding and have a diagnosis of clinical depression:
- Risk of suicidal ideation increased by a factor 13.7
Inattention
Adolescents with high inattention scores had an increased likelihood of suicidal ideation. The presence of a clinical diagnosis of depression exacerbated this risk. For adolescents with high inattention scores:
- Risk of suicidal ideation increased by a factor of 2.98
For adolescents with high inattention scores and a clinical diagnosis of depression:
- Risk of suicidal ideation increased by a factor of 12.2
Impulsivity
Adolescents with high impulsivity scores had an increased likelihood of suicidal ideation. The presence of a clinical diagnosis of depression exacerbated this risk. For adolescents with high impulsivity scores:
- Risk of suicidal ideation increased by a factor of 2.47
For adolescents with high inattention scores and a clinical diagnosis of depression:
- Risk of suicidal ideation increased by a factor of 16.3
Let’s clarify the takeaways from this data. Adolescents who engage in/have the mental, emotional, or psychological habits we call brooding, inattention, and impulsivity are at increased risk of subsequently engaging in suicidal ideation, i.e. thinking or talking about suicide.
Note: If your teen talks about suicide and you think they’re at imminent danger of harming themselves, call 911 or take them to the emergency room. Do not wait. Do not ignore any talk of suicide.
When combined with a diagnosis of clinical depression, brooding, inattention, and impulsivity increase the likelihood of engaging in suicidal ideation by a factor of 6.9 for brooding, 4.1 for inattention, and 6.7 for impulsivity. Those are significant increases in risk. And they’re important for both parents of teens and clinicians who work with teens to understand.
How This Information Helps
This new study informs how we can assess suicide risk among teens in the future. We can use this information to expand screening criteria to include information on personality characteristics and idiosyncratic cognitive patterns. In addition to the traditional metrics that include risk factors and warning signs for suicide itself, we can add more. We now know brooding, inattention, and impulsivity are risk factors for suicidal ideation. If we identify and address those risk factors early, we can do two things. First, we can prevent escalation to suicidal ideation. Second, we can prepare at-risk teen with practical coping mechanisms to process thoughts related to suicidal ideation in a safe and productive manner.
We’ll allow the study authors the next to the last word:
“Our findings demonstrate that temperament traits and cognitive style can, independently of depression diagnoses, significantly impact risk for suicidal ideation during adolescence…These results underscore the potential importance of incorporating aspects of adolescents’ functioning that go beyond traditional symptom assessment when conceptualizing risk for suicidal ideation.”
This is critical information in maintaining and safeguarding the mental health of our teens. We need this now – in the wake of the coronavirus pandemic – more than ever. If we follow the advice offered and include screening for brooding, inattention, and impulsivity in our early assessments of adolescent mental health, we can support at-risk adolescents with the evidence-based treatment sooner, rather than later. This is crucial. Our experience – and decades of data – shows the sooner a teen who needs mental health support gets the support they need, the better the outcome.