This book tackles an area of adolescent behavior that presents a significant challenge for parents, teachers and professionals the world over. Whilst much has been written on the topic of adolescent suicide we see continued high rates throughout industrialized nations. The overlap between suicidal behaviors and other forms of serious risk-taking is a relatively new avenue of research and gives insight into the motivations of some adolescents. The cognitive model developed and evaluated in this book provides further insight into the progression from early problems faced by young people to the serious outcomes of suicide and risk-taking. The model allows us to suggest points of intervention for young people and to demonstrate that whilst there are overlapping features, attempts to intervene would target different problem areas for suicidal adolescents than for risk-taking adolescents.

Preface

xv

Introduction

1

(10)

Adolescent Development

4

(1)

Adolescents and Suicide

5

(6)

1 Adolescent Suicide: An Overview of the Epidemiology

11

(6)

Epidemiology

11

(1)

Age and Gender

11

(6)

2 Risk and Predisposing Factors in Adolescent Suicide

17

(14)

Introduction

17

(1)

Environmental Variables

18

(5)

Stressful Life Events

18

(1)

Family Dysfunction

19

(1)

Interpersonal Interactions

20

(1)

Family Interactions

21

(2)

Intrinsic Factors

23

(3)

Gender

23

(1)

Sexuality

24

(2)

Family History of Psychiatric Illness

26

(1)

Experiences of Abuse as a Child

26

(1)

Genetic Predisposition

27

(4)

3 Emotional Problems and Adolescent Suicide

31

(12)

Depressive Disorder

32

(4)

Bipolar Disorder

36

(1)

Conduct Disorder, Substance Abuse, and the Issue of Comorbidity

36

(2)

The Role of Alcohol in Suicidal Behavior

38

(2)

Personality Disorder

40

(1)

Schizophrenia

41

(1)

Panic Disorder

41

(2)

4 Adolescent Suicide: Cognitive Variables

43

(16)

Hopelessness

43

(2)

Problem Solving

45

(2)

Hopelessness and Problem Solving

47

(2)

Coping Strategies

49

(2)

Protective Factors

51

(2)

Affect Dysregulation

53

(1)

Conclusions

54

(5)

ADOLESCENT RISK-TAKING

5 Adolescent Risk-Taking: An Overview

59

(12)

Differing Perspectives on Adolescent Risk-Taking

63

(8)

Sensation Seeking and Egocentrism

63

(1)

Problem Behavior Theory

64

(1)

Decision Making

65

(1)

Empirical Studies

66

(5)

6 Risk and Predisposing Factors in Adolescent Risk-Taking

71

(8)

Environmental Variables

71

(2)

Family Dysfunction

71

(1)

Peer Influence

72

(1)

Intrinsic Factors

73

(3)

Gender

73

(1)

Family History of Psychiatric Illness

74

(1)

Experiences of Abuse as a Child

74

(1)

Genetic Predisposition

74

(1)

Sexuality

75

(1)

Psychiatric Correlates of Adolescent Risk-Taking

76

(3)

Substance Abuse

76

(1)

Conduct Disorder

77

(2)

7 Adolescent Risk-Taking: Cognitive Variables

79

(12)

Problem Solving

79

(3)

Hopelessness

82

(1)

Protective Factors

83

(1)

The Effects of Alcohol and Stress on Problem Solving and Decision Making

83

(2)

A Pilot Study

84

(1)

An Overlap Between Suicidal and Risk-Taking Adolescents

85

(2)

Conclusions

87

(4)

A MODEL OF SUICIDE AND RISK-TAKING

8 An Integrated Model of Suicide and Risk-Taking

91

(18)

Introduction

91

(1)

An Earlier Model

92

(3)

The S/RT Model

95

(1)

A Rationale for the S/RT Model

96

(3)

Risk Factors for Suicide and Risk-Taking

96

(1)

Psychopathology, Suicide, and Risk-Taking

97

(1)

Mediating Variables, Suicide, and Risk-Taking

97

(2)

Problem-Solving and Decision-Making Deficits in Suicidal Behavior

99

(3)

Cognitive Capacity

99

(1)

Narrowing of Attentional Focus

100

(2)

Problem-Solving and Decision-Making Deficits in Risk-Taking

102

(3)

Narrowing of Attentional Focus

102

(1)

Regret Theory

103

(1)

Judgment and Confidence

104

(1)

Conclusions

105

(4)

AN EVALUATION OF THE S/RT MODEL

9 Depressed and Problem Behavior Adolescents

109

(16)

Data Collected

113

(2)

Method

115

(1)

Participants

115

(1)

Materials and Procedure

116

(1)

Results

116

(3)

Discussion

119

(6)

Problem Solving

119

(3)

Decision Making

122

(1)

Hopelessness

123

(2)

10 Suicide Attempters and Risk Takers

125

(16)

Method

125

(3)

Participants and Group Allocation

125

(1)

Suicide Attempter Group

126

(1)

Serious Risk-Taker Group

127

(1)

Suicide Attempters and Risk Takers Combined Group

128

(1)

Comparison Group

128

(1)

Materials and Procedures

128

(1)

Results

128

(4)

Discussion

132

(11)

Problem Solving

134

(2)

Decision Making

136

(1)

Protective Factors

137

(1)

Hopelessness

138

(3)

11 The Impact of Cognitive Variables as Mediators

141

(14)

The Paths to Suicidal Behavior

143

(2)

The Paths to Risk-Taking Behavior

145

(2)

The Paths to Risk-Taking and Suicidal Behaviors

147

(2)

Conclusions

149

(6)

IMPLICATIONS FOR TREATMENT

12 Clinical Implications: The Development of Problem Solving

155

(10)

The Development of Problem-Solving Skills

156

(10)

Symbolization

157

(1)

Memory

158

(2)

Moral Reasoning

160

(2)

Developmental Intelligence

162

(1)

Constancy of Emotions

163

(1)

Constancy of Behavior

164

(1)

13 Clinical Implications: Intervention and Resilience Building

165

(16)

Programs to Improve Problem-Solving Skills

166

(1)

Challenging Outdoor Programs

167

(1)

The School Culture

168

(3)

Improving Problem Solving in Symptomatic Adolescents

171

(4)

Depression

171

(1)

Suicide

171

(2)

Conduct Disorders and Serious Risk-Taking Adolescents

173

(1)

Serious Risk-Taking

174

(1)

Clinical Interventions

175

(3)

Conclusion

178

(3)

References

181

(22)

Index

203

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Out of Options: A Cognitive Model of Adolescent Suicide and Risk-Taking

9780521812382

0521812380

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