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Source, recency, and degree of stress in adolescence and suicide ideation.
Cynthia O. Huff.
Adolescence, Spring 1999 v34 i133 p81(9)
Author's Abstract: COPYRIGHT 1999 Libra Publishers Inc.
This study sought to identify factors related to stress that predict suicide ideation among adolescents. The sample consisted of 425 students aged 14 to 18 years. Multiple regression analysis revealed that recency and degree of stress were significant in the prediction of degree and recency of suicide ideation. The implications of these and other findings for prevention and intervention (e.g., health education, parent workshops, and adolescent support groups) are discussed.
Full Text: COPYRIGHT 1999 Libra Publishers Inc.
From the 1950s to the 1990s, the suicide rate among American youth rose from 4.5 to 13.2 per 100,000 population (National Center for Health Statistics, 1993). It is presently one of the leading causes of death for this age group (Maris, 1985; Neiger & Hopkins, 1988; Holmstrom, 1989). Further, it is estimated that the rate of attempted suicide is ten times higher than that of completed suicide (Maris, 1985).
One factor that increases the risk of suicide is depression (Lester & Gatto, 1989; Pfeffer et al., 1994), which may develop from perceived failure or difficulty coping with loss. Thus, a mental health crisis may set the stage for suicide ideation. Family disruption is also a contributing factor (Elkind, 1984; Rubenstein et al., 1989; Lester, 1991). The unrealistically high expectations placed on today's youth is yet another (Peters, 1985; Parker, 1988; Adcock, Nagy, & Simpson, 1991).
Stressors, especially within the previous year, have been linked to suicide ideation (Cole, Protinsky, & Cross, 1991). For youth, these include poor grades, drug and alcohol abuse, and increased pressure (Dixon, Rumford, Heppner, & Lips, 1992; Felts, Chenier, & Barnes, 1992; DuBois, Felner, Brand, Adan, & Evans, 1992; Greening & Dollinger, 1993). In turn, suicide ideation puts students at increased risk for suicide (Harkavy et al., 1987; Thompson, Moody, & Eggert, 1994).
The purpose of the present research was to investigate the relationship of source, recency, and degree of stress to the suicide ideation of high school students.
METHOD
Sample
Probability sampling was utilized. Students in five Knoxville, Tennessee, schools were randomly selected for inclusion in the study. Participants were drawn from the ninth through twelfth grades to ensure equal representation of all age groups. Students in ninth-grade English classes (both basic and college-preparatory), tenth-grade health classes, eleventh-grade United States history classes, and twelfth-grade economics classes were surveyed.
Instrument
Two scales were modified to form one survey instrument: the Adolescent Life Change Event Scale (ALCES) developed by Yeaworth, York, Hussey, Ingle, and Goodwin (1980) and the Beck, Schuyler, and Herman (1974) Suicidal Intent Scale. The instrument assessed the source and degree of stress through the use of the ALCES, the degree of suicide ideation through the addition of items from the Beck Suicidal Intent Scale, and the recency of occurrence of both stressors and items measuring suicide ideation.
Two life events relating to suicide were deleted from the 44-item ALCES because of overlap with the Beck Suicidal Intent Scale. Selection of 14 questions from the Beck scale was based on a review of the literature on characteristics of suicidal youth.
The instrument was pilot tested. Cronbach's alpha coefficient was .95 for questions regarding how upsetting the events would be to students and .88 for questions regarding the recency of the events. The instrument was found to have content and criteria validity.
The survey instrument was administered to students in the designated classes. They were assured anonymity and informed that they could withdraw at any time without penalty. Students who did not wish to participate were asked to complete the demographic portion and submit the survey at the end of the thirty-minute time frame.
Data Analysis
A multiple regression analysis was used to examine the extent, direction, and strength of the relationship between the independent variables (recency and degree of stressors) and the dependent variable (degree of suicidal ideation), with statistical significance set at the .05 level. Demographic data were analyzed using Tukey's multiple comparison test to determine if there were significant differences between groups.
RESULTS
Sample Characteristics
The composition of the sample was 52% male and 48% female; 80% were Caucasian, 18% African-American, and 2% other. Approximately 10% of the students were 14 years of age (n = 34), 26% were 15 (n = 88), 27% were 16 (n = 89), 30% were 17 (n = 102), and 7% were 18 (n = 22). Characteristics of the students, including grade, church attendance, school program, and work, appear in Table 1.
Rankings of Stress
Overall recency of stress and percentage of students experiencing each stressor within the past month appear in Table 2. The most recently occurring stressors involved being tired, family conflict, parental expectations regarding school, and making new friends.
Ranking of events according to their potential degree of stress is presented in Table 3. The three highest ranked events centered around death: brother or sister dying, close friend dying, and death of a grandparent. In terms of recency, these stressors ranked fiftieth, forty-first, and thirty-third, respectively (out of 56).
Suicide Ideation
The items relating to suicide ideation were examined in regard to recency and ranked according to the percentage of students who had such experiences within the past month (Table 4). The three highest ranked items were "getting tired for no reason," "feeling that no one cares or understands you," and "having crying spells or feeling like it."
Multiple regression analysis was used to determine the extent, direction, and strength of the relationship between the independent variables (recency and degree of stressors) and the dependent variable (suicidal ideation). One regression equation revealed that recency and degree of stress (entered as a block into the equation) were significant in the prediction of recency of suicide ideation (F = 4.359, p [less than] .0001), accounting for 68% of the variance. Another regression equation indicated that recency and degree of stress (entered as a block) were also significant in the prediction of degree of suicide ideation (F = 8.150, p [less than] .0001), accounting for 80% of the variance. Tukey's multiple comparison test revealed significant differences between females and males in the degree of stress, degree of suicide ideation, and recency of suicide ideation. There was no significant difference between males and females regarding the recency of stress.
Interestingly, students with grades of
C and D reported experiencing significantly more stress in the
previous month than did students with higher or lower grades.
In addition, while the perceived degree of stress was found to
be higher for students who attended church on a regular basis,
their actual stress was lower. This finding suggests that church
attendance is a protective factor in terms of frequency of stress.
TABLE 1
Characteristics of the Sample
(N = 392)
Characteristic Categories Frequency %
Gender Male 203 51.8
Female 189 48.2
Ethnicity Caucasian 313 80.1
African-American 69 17.6
Other 9 2.3
Age in years 14 34 10.1
15 88 26.3
16 89 26.6
17 102 30.4
18 22 6.6
Grades are mainly A's 67 17.8
B's 155 41.2
C's 125 33.2
D's 22 5.9
F's 7 1.9
Sunday school or Never 55 14.1
church attendance Once a year 67 17.1
Once a month 69 17.6
Weekly 136 34.8
Greater than once 64 16.4
a week
School Program Resource 8 2.1
Standard 318 83.5
Advanced placement 55 14.4
Gifted 0 0.0
Work Yes 139 35.5
No 253 64.5
If work, Less than 10 hrs. 34 26.6
number of hours 10 - 20 hrs. 55 43.0
each week More than 20 hrs. 39 30.5
TABLE 2
Ranks, Means, and Standard Deviations for Overall Recency of Stress
and Percentage of Students Experiencing Stress in the Past Month
(N = 335)
Source of Stress Rank Mean SD %
Getting tired for no reason 1 2.28 1.80 45.0
Increased or worse arguments/fights 2 2.24 1.62 33.1
with parents
Not doing as well as your parents 3 2.15 1.58 32.8
expect in school
Trying to make new friends 4 2.02 1.55 27.1
Feeling that no one cares or 5 2.00 1.72 32.8
understands you
No longer enjoying things you used 6.5 1.96 1.68 29.1
to do
Increased or worse arguments/fights 6.5 1.96 1.73 32.2
with brothers or sisters
Problems with size 8 1.89 1.75 33.1
Having crying spells or feeling 9 1.84 1.76 31.5
like it
Getting grounded 10 1.82 1.55 22.6
Feeling like you're falling apart 11 1.80 1.76 30.4
and going to pieces
Change in physical appearance 12 1.79 1.47 21.9
Parent or relative in family 13 1.78 1.49 21.0
getting very sick
Feeling useless and not needed 14 1.77 1.71 27.8
Feeling that things are never 15 1.71 1.72 26.3
going to get better
Failing one or more subjects 16 1.57 1.77 21.6
in school
Trouble with teacher or principal 17 1.52 1.57 25.5
Getting badly hurt or sick 18.5 1.51 1.68 13.7
Getting into alcohol 18.5 1.51 1.43 23.5
Feeling there's no one you can turn 20 1.49 1.70 23.9
to when things seem at their worst
Breaking up with a close friend 21 1.47 1.72 14.4
Losing a favorite pet 22 1.33 1.45 7.0
Taking chances when driving a car 23 1.25 1.20 22.7
Getting into physical fights 24 1.20 1.41 12.2
Feeling that life is not worth 25 1.17 1.56 16.0
living
Feeling that others would be 26 1.07 1.51 13.4
better off if you were dead
Scale: 0 = never, 1 = over a year ago, 2 = past year,
3 = past 6 months, 4 = past month
TABLE 3
Ranks, Means, and Standard Deviations for Potential Degree of Stress
and Percentage of Students Responding "Extremely Upsetting"
(N = 335)
Source of Stress Rank Mean SD %
Brother or sister dying 1 4.62 1.01 84.4
Close friend dying 2 4.61 0.93 79.2
Death of grandparent 3 4.36 1.08 66.5
Finding out you are pregnant 4 4.28 1.25 79.5
Finding out you got someone 5 4.27 1.25 55.0
pregnant
Being arrested by police 6 4.13 1.21 55.2
Flunking a grade in school 7 4.09 1.24 56.0
Wrecking a car 8 4.07 1.16 48.5
Parent or relative getting 9 4.03 1.11 45.6
very sick
Thinking of ways to kill yourself 10 4.01 1.13 59.1
Feeling that others would be 11 4.00 1.42 52.9
better off if you were dead
Failing one or more subjects 12 3.94 1.37 40.1
in school
Feeling that life is not worth 13 3.92 1.32 45.6
living
Feeling there's no one you can turn 14 3.91 1.29 46.5
to when things seem at their worst
Feeling hopeless about the future 15 3.86 1.23 42.5
Feeling useless and not needed 16 3.85 1.22 40.4
Breaking up with a close friend 17 3.80 1.15 34.0
Feeling like you're falling apart 18.5 3.79 1.32 42.5
and going to pieces
Family member having trouble 18.5 3.79 1.30 41.2
with drinking
Parents getting divorced or 20 3.78 1.41 45.2
separated
Feeling that things are never 21 3.76 1.27 37.5
going to get better
Feeling that no one cares or 22 3.74 1.26 35.8
understands you
Parent losing a job 23 3.71 1.29 37.1
Thinking of quitting school 24 3.63 1.43 40.1
Increased or worse arguments/ 25 3.55 1.26 29.5
fights with parents
Getting into drugs 26 3.50 1.58 42.0
Scale: 1 = not at all upsetting, 2 = a little upsetting,
3 = somewhat upsetting, 4 = very upsetting, 5 = extremely upsetting
TABLE 4
Suicide Ideation:
Students' Experiences within
the Past Month
(N = 335)
Suicide Ideation Items Rank %
Getting tired for no reason 1 45.0
Feeling that no one cares or 2 32.8
understands you
Having crying spells or feeling like it 3 31.5
Feeling like you're falling apart and 4 30.4
going to pieces
Feeling hopeless about the future 5 29.4
Feeling useless and not needed 6 27.8
Feeling that things are never going to 7 26.3
get better
Feeling that there is no one you can turn 8 23.9
to when things seem to be at their worst
Feeling that life is not worth living 9 16.0
Feeling that others would be better off 10 13.4
if you were dead
Thinking of ways to kill yourself 11 11.9
DISCUSSION
In general, adolescents' responses were consistent with the developmental theory of Erikson (1963) and the sociological theory of Durkheim (1951). Interpersonal conflict and loss, whether actual or perceived, increased stress and suicide ideation. On a positive note, many of the adolescents' sources of stress are amenable to preventive education and intervention.
Adolescent stress and suicide ideation must be addressed through a comprehensive interdisciplinary approach. Partnerships need to be developed between parents and professionals, including school nurses, counselors, health educators, and teachers.
The health education curriculum should address developmental issues and teach skills for coping with stressors. Classrooms, sports programs, and church activities should provide a safe atmosphere in which to practice these skills.
Five of the ten highest ranked stressors involved conflict with parents and siblings. Thus, parent workshops should be implemented that focus on developmental issues of adolescence and how to reduce family problems.
Support groups for adolescents should be formed. Resources can include both school personnel and community members, who could help them to improve communication, decision-making, and conflict-resolution skills, as well as to resolve boyfriend/girlfriend problems and friction with parents and friends. Churches, schools, recreation centers, and other locations where adolescents congregate would be convenient meeting places.
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