Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA.
Center for Depression, Anxiety and Stress Research, McLean Hospital, Mailstop 331, de Marneffe building, room 239, 115 Mill Street, Belmont, MA, 02478-9106, USA.
J Abnorm Child Psychol. 2018 Apr;46(3):581-596. doi: 10.1007/s10802-017-0304-7.
Suicide is a leading cause of death among youth worldwide, and depressed adolescents are at a significantly elevated risk to report suicidal ideation, planning, and attempts. Peer victimization is a robust predictor of adolescent suicidal thoughts and behaviors (STBs), but little research has focused on why bullying leads to suicidal thoughts and behaviors. To address this empirical gap, we recruited 340 (246 female) depressed adolescents ages 13-19 (M = 15.59, SD = 1.41) within 48 h of admission for acute psychiatric treatment. At the initial assessment, participants were administered clinical interviews characterizing psychopathology, nonsuicidal self-injury, and STBs (ideation, plans, and attempts). Further, they completed questionnaires assessing 3 forms of victimization (overt, relational, and reputational), recent risky behavior engagement, and psychiatric symptom severity. Controlling for internalizing symptoms and age, overt and reputational bullying were associated with more frequent past month suicide attempts, but not suicide ideation. Past month risky behavior engagement, but not NSSI, mediated the relation between victimization and attempts. However, sex differences revealed that this effect only held for males whereas bullying was directly associated with suicide attempts among females. In contrast, overt and relational bullying were non-linearly associated with suicide plans, and these relations were not mediated by risky behaviors or NSSI. Results highlight the complex network of factors that lead victimized adolescents to engage in STBs and may inform targeted suicide prevention and intervention programs.
自杀是全球青少年死亡的主要原因之一，而抑郁青少年报告自杀意念、计划和尝试的风险显著升高。同伴侵害是青少年自杀想法和行为（STB）的强有力预测因素，但很少有研究关注欺凌行为为何会导致自杀想法和行为。为了解决这一实证差距，我们在急性精神科治疗入院后 48 小时内招募了 340 名（246 名女性）抑郁青少年（年龄 13-19 岁，M=15.59，SD=1.41）。在初始评估中，参与者接受了临床访谈，以描述精神病理学、非自杀性自我伤害和 STB（意念、计划和尝试）。此外，他们还完成了评估 3 种侵害形式（公开、关系和名誉）、最近的高风险行为参与和精神症状严重程度的问卷。控制内化症状和年龄后，公开和名誉欺凌与过去一个月更频繁的自杀尝试有关，但与自杀意念无关。过去一个月的高风险行为参与，但与 NSSI 无关，在侵害和尝试之间起中介作用。然而，性别差异表明，这种效应仅适用于男性，而欺凌行为与女性的自杀尝试直接相关。相比之下，公开和关系欺凌与自杀计划呈非线性相关，这些关系不受高风险行为或 NSSI 的中介。研究结果突出了导致受侵害青少年从事 STB 的复杂因素网络，并可能为有针对性的自杀预防和干预计划提供信息。
