ARTICLE IN PRESS Narrative of Young-person xxx (2010) 1–8 Contents lists profitable at ScienceDirect Narrative of Young-person narrative homepage: www. elsevier. com/locate/jado Factors accounting for early-person suicide endeavor in Hong Kong: A design fabric Gloria W. Y. Wan a, Patrick W. L. Leung b, * a b Clinical Psychology Service, Hong Kong Sheng Kung Hui Welfare Council, 5/F, Holy Trinity Bradury Center, 139 Ma Tau Chung Road, Kowloon, Hong Kong, China 3/F, Sino Building, Clinical and Health Psychology Centre, Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China b s t r a c t Keywords: Suicide ideation/endeavor Parentage Psychopathology Duration equablets/stressors Chinese early-persons This consider aimed at proposing and experienceing a conceptual design of early-person suicide endeavor. We designed a design that began delay parentage constituents such as a truth of natural affront and parental divorce/separation. Parentage connection, closeness of psychopathology, duration stressors, and suicide ideation were assumed as mediators, qualitative to early-person suicide endeavor. The plodwise register of the imperil constituents to a logistic reshape design de? ned their vicinity as allied to suicide endeavor.
Path partition prefer re? ned our designed design of early-person suicide endeavor. Our originally designed design was amply con? rmed. The main qualification was damage parental divorce/separation as a imperil constituent in the design due to behind a opportunitydrawal of signi? gibberish subscription when examined close delay other imperil constituents. This design was cross-validated by gender. This consider moved discovery on early-person suicide from identi? cation of idiosyncratic imperil constituents to design fabric, integrating disunited ? ndings of the late studies. O 2009 The Denomination for Professionals in Services for Adolescents.
Published by Elsevier Ltd. All rights silent. Introduction Young-person suicide, import one of the three qualitative causes of demise in infantine inhabitants, has been a convergence of discovery. Multiconceive idiosyncratic imperil constituents enjoy been identi? ed (Gould, Greenberg, Velting, & Shaffer, 2003). Opposing this luck, not until of-late are thither endeavors to expand involved theory-based designs that pull simultaneously all those identi? ed imperil constituents and paint their interstate (Bridge, Goldstein, & Brent, 2006; Mann, Waternaux, Haas, & Malone, 1999). Correspondingly, tentative studies in this area are few (e. g. Foley, Goldston, Costello, & Angold, 2006; Fortune, Stewart, Yadav, & Hawton, 2007; Prinstein et al. , 2008; Reinherz, Tanner, Berger, Beardslee, & Fitzmaurice, 2006). Hence, we move hither a design of early-person suicide endeavor and experience it in a case of Chinese violent teach students. We aim at articulating and experienceing provided roadways between parentage constituents, psychopathology, duration stressors, and suicidal comportment. Our design begins delay remuneration of parentage imperil constituents, including a truth of natural affront delayin the parentage, faulty parentage connection, and parental divorce/separation (Johnson et al. 2002; Gould, Fisher, Parides, Flory, & Shaffer, 1996; Gould, Shaffer, Prudence, & Robin, 1998; Liu, Sun, & Yang, 2008; Salzinger, Rosario, Feldman, & Ng-Mak, 2007). However, the dying’s denomination delay early-person suicidal comportment is no longer signi? gibberish or narrowless behind inferior for parent-child or parentage connection (Groholt, Ekeberg, Wichstrom, & Haldorsen, 2000). Parentage adversities are as-courteous notorious precursors of early-person psychopathology (Fergusson, Woodward, & Horwood, 2000). The dying in shape is base to be a imperil constituent of suicidal comportment * Similar cause. Tel. : ? 852 2609 6502; fax: ? 852 2603 5019.
E-mail address: [email protected] edu. hk (P. W. L. Leung). 0140-1971/$ – see front import O 2009 The Denomination for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights silent. doi:10. 1016/j. early-person. 2009. 12. 007 Please adduce this time in exexcrowd as: Wan, G. W. Y. , Leung, P. W. L. , Factors accounting for early-person suicide endeavor in Hong Kong: A design fabric, Narrative of Young-person (2010), doi:10. 1016/j. early-person. 2009. 12. 007 ARTICLE IN PRESS 2 G. W. Y. Wan, P. W. L. Leung / Narrative of Young-person xxx (2010) 1–8 (Brent, Baugher, Bridge, Chen, & Chiappetta, 1999; Osvath, Voros, & Fekete, 2004).
A remote rank of psychopathology has been answerable, including innerizing/externalizing disorders, and import use disorders (Brent et al. , 2004; Foley et al. , 2006; Gould et al. , 2003; Lee et al. , 2009; Shaffer et al. , 1996; Stewart et al. , 2006). Furthermore, the imperil of suicidal comportment increases delay the calculate of comorbid disorders and delay the fraternity of temper, disruptive and import affront disorders (Brent et al. , 1999; Shaffer et al. , 1996). Suicide ideation is unformed the best predictors of suicide endeavor (Prinstein et al. , 2008; Wong et al. , 2008).
Studies as-courteous propose that the affair of duration stressors may apt suicide ideators into acting on their ideation, ending up in endeavored suicide (Borges et al. , 2008; Liu & Tein, 2005). Based upon the overhead retrospect, our design on early-person suicide endeavor starts delay parentage imperil constituents such as a truth of natural affront and parental divorce/separation. We assume that faulty parentage connection, psychopathology, duration stressors, and suicide ideation act as mediators, qualitative to suicide endeavor. Speci? cally, we hypothesize that a truth of natural affront and parental divorce/separation are associated delay faulty parentage connection.
The dying is in shape allied to the affair of psychopathology in early-persons. Comorbid innerizing and externalizing disorders then state a piercing role as imperil constituents to modern duration stressors and suicide ideation. Finally, the dying two are imperil constituents undeviatingly linked to suicide endeavor. Arrangement Participants and progress A sum of 2754 grade 7–11 Chinese violent teach students were recruited to share freely in the consider. They were casually cased from 15 mainstream violent teachs of diversi? ed academic rankings from contrariant regions of Hong Kong.
The participating teachs represented a ease case, late they were teachs served by the Teach Counselling Service of Hong Kong Sheng Kung Hui Welfare Council, at which the ? rst cause of this consider worked. However, the participating teachs mellow a unmeasured rank of academic rankings and a remote geographic scatter opposing Hong Kong, and no speci? c prejudgment in their sampling was renowned. Thus, they were considered to be delegated-to-others of topical mainstream teachs. Special teachs of multiconceive kinds were exclusive. Ethics praise was ? rst obtained from the divert institutional causeity.
School visits were then made to expound the objectives of the consider. A sum of 15 teachs were contacted and all of them (100%) agreed to share in the consider. Informed written consents were obtained from parents of the casually cased students. The reply rate was 94. 4%. The participants fulld the self-description questionnaires during teach hours. The repeevish questionnaires were screened for keen psychopathology and suicidal comportment. For incorporeal reasons, the similar teach counselors would be alerted for such cases in enjoin to follow divert actions.
Measures Psychopathology The 1991 account of Young-person Self-Report (YSR) was re-validated delay enlivening experience–reexperience reliability and proof validity for use delay Hong Kong Chinese early-persons (Leung et al. , 2006). It evaluated the affair of psychopathology in the late 6 months. Late two items in YSR referred to suicidal/self injury comportment and they thus rotten the connection inferior search between psychopathology and suicidal comportment, the two items were removed in this consider from the compose of innerizing problems as assessed by YSR.
Youth suicide ideation/endeavor Self-description estimates of suicide ideation/endeavor had been base to be reliable pristine basis sources (Joiner, Rudd, & Rajab, 1999; Miranda et al. , 2008). Two estimates were used to assess suicide ideation/endeavor in this consider. First, YSR had two items that referred to suicide ideation and endeavor, regardively. However, a single-item estimate for a mutable was considered worthless.
Hence, two infull self-description questionnaires for suicide ideation and endeavor were extracted regardively from an corporeal, longer questionnaire used in a prior topical consider which asked the affairs and details of suicide ideation, despatch, cunning, and endeavor (Ho, Leung, Hung, Lee, & Tang, 2000). This questionnaire was base helpful in assessing the suicidal comportment of peers of suicide fullrs and endeavorers. Depending on whether a early-person had suitably involved suicide ideation and/or endeavor twain in the helpful questionnaires and delay the similar item in YSR, he/she would be considered ategorically in this consider as a suicide ideator and/or endeavorer, or not. Modern duration stressors The Social Readjustment Rating Scale (SRRS; Holmes & Rahe, 1967) asked 30 stressful duration equablets which jurisdiction happen to the infantine inhabitants and their families in the foregoing 12 months. In this consider, items in the SRRS allied to parental con? ict and divorce/separation were exclusive, late these parentage equablets were disunitedly examined elsewhither as parentage imperil constituents in our design. Items irdivert to topical infantine adolescents were as-courteous exclusive (e. g. social at a propaganda of your valuable). Parentage connection In this consider, the Parentage Connection Index (FRI), a composite of three subscales (i. e. , cohesion, expressiveness, and con? ict) of the Parentage Environment Scale (FES; Moos & Moos, 1986), was used as a estimate of parentage connection. The FRI had Please adduce this time in exexcrowd as: Wan, G. W. Y. , Leung, P. W. L. , Factors accounting for early-person suicide endeavor in Hong Kong: A design fabric, Narrative of Young-person (2010), doi:10. 1016/j. early-person. 2009. 12. 007 ARTICLE IN PRESS G. W. Y. Wan, P. W. L.
Leung / Narrative of Young-person xxx (2010) 1–8 3 been base to correlate courteous delay other estimates of parentage dysfunction (Hoge, Andrews, Faulkner, & Robinson, 1989) and was remotely used in discovery delay Chinese early-persons (Locke & Prinz, 2002). Parents’ matrimonial foundation The social matrimonial foundation of the participants’ parents was enquired delay intimation to divorce/separation. Truth of natural affront Participants were asked to description if they had accustomed any natural affront in the parentage late childhood. Three items were helpful from Childhood Trauma Questionnaire (CTQ) (Bernstein et al. 1994) and two concomitant ones that were divert to the topical Chinese matter were speci? cally written for this consider, e. g. , ‘‘People in my parentage had applied material pain to me’’ and ‘‘After I was import naturally punished, I had to go to see a master or could not go to teach’’. Basis partition First, a course of logistic reshape partition would be conducted to investigate the signi? cance of each idiosyncratic imperil constituent disunitedly in predicting suicide ideation and endeavor. Save for parental divorce/separation, other imperil constituents were estimated in this consider in dimensional scales. They were shapeed into ategorical basis in this logistic reshape partition using distributional cutoffs to de? ne not-absolute deviance (see Table 1 for the proper de? nitions of cutoffs). Second, we experienceed our designed design of early-person suicide endeavor, using clerical reshape ? rst. The course of predictors would be entered in plods according to their positions in relative to suicide endeavor in our designed design. The imperil constituents of a truth of natural affront and parental divorce/separation would ? rst be unfeeling into the reshape equation, behind persuasive for property of the enhancement mutables (including age, gender, and parentage proceeds).
Family connection would then be entered into the equation in the promote plod. The third batch of predictors would be innerizing and externalizing problems. They were followed in shape by suicide ideation and duration stressors. We hypothesized a peculiar or full mediational design in which the property of constituents entered ? rst would be narrowless or superseded by those of the following constituents in predicting early-person suicide endeavor. Lastly, road partition would be conducted to undeviatingly experience our designed design of early-person suicide endeavor, using Lisrel 8. 71.
Path partition has its strengths in examining the chains of in? uences between fractions mutables, and in postulating the likely cause-and-effect relatives unformed mutables for prefer search. An commonplace case covariance matrix for road partition would not be divert to negotiate delay the dichotomous basis of suicidal comportment and parental divorce/separation, as courteous as the kurtosis and skewness delayin the other dimensional basis. Instead, an asymptotic covariance matrix should be used, partition of which would exact the use of an estimator that undisputed for non-normality.
The weighted lowest squares (WLS) arrangement, instead of the zenith likelihood estimator, had produce for such non-normality and was thus the divert estimator to be used in this consider. Results The balance age of the 2754 participants was 13. 9 years (SD ? 1. 3, rank ? 11–18). Unformed the participants, 55. 7% was virile. Thither were privation basis on suicidal comportment from 39 participants. Unformed the cherishing 2715 participants, 252 participants (9. 2%) descriptioned suicide ideation in the late 6 months. Unformed the 91 (3. 3%) descriptioning suicide endeavor in the selfsame time, solely six (6. %) did not description suicide ideation. By gender, unformed the 1219 fevirile participants, 167 (13. 7%) descriptioned suicide ideation, opportunity solely two (3. 0%) of 66 (5. 4%) fevirile suicide endeavorers did not description suicide ideation. The similar ? gures for virile participants (1535) were 85 (5. 5%), four (16. 0%), and 25 (1. 6%). Table 1 Percentages of suicide ideators, endeavorers, and non-suicidal regulates, denomination delay multiconceive imperil constituents, and odds ratios (ORs) for predicting suicide ideation and endeavor. Variables Cronbach’s Alpha Ideators (n ? 52) n Parents divorced/separated Truth of natural affronta Faulty parentage connectionb Internalizing problemsc Externalizing problemsc Numerous modern duration stressorsd – 0. 83 0. 83 0. 89 0. 88 – 41 73 142 76 99 102 % 16. 3 29. 0 56. 3 30. 2 39. 3 40. 5 Attempters (n ? 91) n 19 29 51 32 45 44 % 20. 9 31. 9 56. 0 35. 2 49. 5 48. 4 Non-suicidal regulates (n ? 2457) n 239 169 602 103 153 364 % 9. 7 6. 9 24. 5 4. 2 6. 2 14. 8 Ideators vs regulates OR 1. 8** 5. 8*** 3. 8*** 13. 9*** 9. 8*** 3. 6*** (95% CI) (1. 2–2. 6) (4. 2–8. 1) (2. 9–5. 1) (9. 6–20. 1) (7. 1–13. 4) (2. 7–4. 8) Attempters vs regulates OR 2. 3** 5. *** 3. 7*** 10. 7*** 11. 1*** 5. 2*** (95% CI) (1. 3–4. 0) (3. 3–8. 6) (2. 4–5. 7) (6. 6–17. 5) (7. 1–17. 5) (3. 4–8. 1) **p < 0. 01; ***p < 0. 001. a Cutoff at sum account > ? 6 (80th percentile). b Cutoff at sum account > ? 15 (80th percentile). c Cutoff at T-account > ? 64 (at clinical rank, 92nd percentile). d Cutoff at calculate of modern duration stressors > ? 4 (80th percentile). Please adduce this time in exexcrowd as: Wan, G. W. Y. , Leung, P. W. L. , Factors accounting for early-person suicide endeavor in Hong Kong: A design fabric, Narrative of Young-person (2010), doi:10. 1016/j. early-person. 2009. 12. 07 ARTICLE IN PRESS 4 G. W. Y. Wan, P. W. L. Leung / Narrative of Young-person xxx (2010) 1–8 Table 1 presents the inner proportion coef? cients of the estimates populated in this consider. They were suitably enlivening, ranging from 0. 83 to 0. 89. Table 1 as-courteous lists the results of disunited logistic reshape partition of each imperil constituent, including the percentages of suicide ideators, endeavorers, and non-suicidal participants (i. e. , those descriptioning neither suicide ideation nor endeavor) having multiconceive imperils, as courteous as the odds ratios (ORs) of these imperil constituents in predicting suicide ideation and endeavor.
Despite multiple experienceing of the bunch differences, such experienceing was all theory-driven (see the literary-works retrospect overhead) and was not casual so that statistical regulate of the property of multiple experienceing was not exactd. All three parentage imperil constituents (i. e. , parental divorce/separation, truth of natural affront, and faulty parentage connection) were further social unformed suicide ideators and endeavorers, and had signi? gibberish ORs. Unformed these imperil constituents, a truth of natural affront was the best predictor of suicide ideation (OR ? 5. 8, 95% CI ? 4. 2–8. 1) and endeavor (OR ? 5. 3, 95% CI ? 3. 3–8. 6).
Nearly one third of ideators (29. 0%) and endeavorers (31. 9%), in opposition to 6. 9% of non-suicidal participants, had a truth of import naturally affrontd. Delay regard to the other two parentage imperil constituents, 16. 3% of ideators (OR ? 1. 8, 95% CI ? 1. 2–2. 6) and 20. 9% of endeavorors (OR ? 2. 3, 95% CI ? 1. 3–4. 0), compared to 9. 7% of non-suicidal participants, descriptioned parental divorce/separation, opportunity 56. 3% of ideators (OR ? 3. 8, 95% CI ? 2. 9–5. 1) and 56. 0% of endeavorors (OR ? 3. 7, 95% CI ? 2. 4–5. 7), compared to 24. 5% of nonsuicidal participants, descriptioned faulty parentage connection.
Compared to parentage constituents, innerizing and externalizing problems were equable further associated delay violenter imperils of suicidal comportments. The ORs of innerizing problems for suicide ideation and endeavor were regardively 13. 9 (95% CI ? 9. 6– 20. 1) and 10. 7 (95% CI ? 6. 6–17. 5), opportunity the ORs of externalizing problems were 9. 8 (95% CI ? 7. 1–13. 4) and 11. 1 (95% CI ? 7. 1–17. 5). Nearly one third of ideators (30. 2%) and endeavorers (35. 2%), in opposition to 4. 2% of non-suicidal participants, had innerizing problems. The similar ? gures for externalizing problems were 39. 3% and 49. 5% vs 6. %. Duration stressors in the late year as-courteous violent the imperil of suicide ideation (OR ? 3. 6, 95% CI ? 2. 7–4. 8) and endeavor (OR ? 5. 2, 95% CI ? 3. 4–8. 1). About 40. 5% of suicide ideators and 48. 4% of endeavorers were descriptioning further numerous duration stressors, compared to 14. 8% of non-suicidal participants. Table 2 shows the results of logistic reshape partition delay unfeeling register of subsets of imperil constituents in plods, behind persuasive for enhancement mutables (i. e. , age, gender, and parentage proceeds). Delay each luckive register of each subset of imperil constituents, the superiority of the prior ones became insigni? ant so that in the ? nal reshape design, solely modern duration stressors (OR ? 1. 01, p < 0. 01) and suicide ideation (OR ? 95. 7, p < 0. 001) signi? gibberishly accounted for early-person suicide endeavor. In other articulation, opposing their judicious statistical signi? cance when ? rst entered into the reshape design, those imperil constituents such as a truth of natural affront, faulty parentage connection, and innerizing and externalizing disorders no longer signi? gibberishly accounted for early-person suicide endeavor, behind duration stressors and suicide ideation were following entered into the design.
This design of results involved a mediational design amply congenial to our designed design of early-person suicide endeavor. It should be renowned that parental divorce/separation as a predictor was not signi? gibberish equable when ? rst entered into the reshape partition close delay a truth of natural affront. This imperil constituent was thus dropped in the following road partition. Our designed design of early-person suicide endeavor, in a conceive of a mediational design, was undeviatingly experienceed by road partition. It achieved a very good-natured-natured ? t: c2 (6, N ? 2754) ? 39. 5, p < 0. 0001; GFI ? 0. 99; AGFI ? 0. 97; RMSEA ? 0. 045; NFI ? 0. 96; CFI ? . 97; RMR ? 0. 57 (Fig. 1). Weighted lowest squares standardized estimators of the design and their signi? cance according to the two-tailed z compute are presented in Fig. 1. All roads shown were signi? gibberish at p < 0. 01. As shown in Fig. 1, a truth of natural affront, as a parentage imperil constituent, was linked undeviatingly to suicide ideation, as courteous as to the ? rst tier of mediators in the design, namely, faulty parentage connection, and externalizing and innerizing problems. They were in shape linked to suicide ideation. The externalizing and innerizing problems were concomitantly linked to modern duration stressors.
Finally, suicidal ideation and duration stressors were twain associated delay suicide endeavor, delay duration stressors as-courteous linking to the suicide ideation as courteous. This mediational design delay sundry tiers of mediators expounded 48% and 87% of the variances in early-person suicide ideation and endeavor, regardively. Table 2 Logistic reshape of imperil constituents in predicting early-person suicide endeavor, inferior for demographic mutables. Blocks entered to the designa Deviance between fills (c2)b 18. 37*** 1. 02*** n. s. 55. 59*** 72. 71*** 1. 02** n. s. 1. 17*** 1. 01* n. s. 1. 07** 1. 07*** 1. 09*** 168. 80*** 10. 5*** 1. 02* n. s. n. s. n. s. n. s. n. s. n. s. 95. 67*** 1. 01** ORs 1 2 3 4 5 1. Parentage constituents Truth of natural affront Parental divorce/separation 2. Faulty parentage connection 3. Psychopathology Internalizing problems Externalizing problems 4. Suicide ideation 5. Duration stressors n. s. n. s. 103. 72*** n. s. : non-signi? gibberish. *p < 0. 05; **p < 0. 01; ***p < 0. 001. a The posteriority of fills entered into the logistic reshape design; all constituents entered were uniform mutables save parental divorce/separation and suicide ideation. b Chi-square deviance of each fill entered.
Please adduce this time in exexcrowd as: Wan, G. W. Y. , Leung, P. W. L. , Factors accounting for early-person suicide endeavor in Hong Kong: A design fabric, Narrative of Young-person (2010), doi:10. 1016/j. early-person. 2009. 12. 007 ARTICLE IN PRESS G. W. Y. Wan, P. W. L. Leung / Narrative of Young-person xxx (2010) 1–8 5 0. 85*** 0. 52*** 0. 13*** 1. 00*** Truth of natural affront 0. 39*** Faulty parentage connection 0. 19*** 0. 13*** Suicide ideation 0. 20*** 0. 15*** 0. 88*** Suicide endeavor 0. 21*** 0. 17*** 0. 44*** 0. 79*** 0. 13*** 0. 33*** Externalizing problems 0. 42*** 0. 29*** Modern stressors 0. 82*** *p