Suicide Ideation and Depression among High-School Students in Mexico

Artículo de investigación. https://doi.org/10.16925/2382-3984.2020.01.05 1 Universidad de Guanajuato, Departamento de Psicología, Campus León ORCID: https://orcid.org/0000-0002-2563-403X Correo electrónico: josema_delaroca@yahoo.com.mx 2 Universidad de Guanajuato, Departamento de Psicología, Campus León ORCID: https://orcid.org/0000-0002-7933-282X 3 Universidad de Guanajuato, Departamento de Psicología, Campus León ORCID: https://orcid.org/0000-0002-6920-4672 4 Universidad de Guanajuato, Departamento de Psicología, Campus León ORCID: https://orcid.org/0000-0002-1792-0861 5 Universidad de Guanajuato, Departamento de Psicología, Campus León ORCID: https://orcid.org/0000-0001-9815-4777 6 Universidad Autónoma de Nayarit, Departamento de Psicología ORCID: https://orcid.org/0000-0003-1614-7587 Suicide Ideation and Depression among HighSchool Students in Mexico


Introduction
In the majority of cases, suicide is not an impulsive act and many actions are associated with suicidal behaviour. Suicidal ideation is the conscious desire to take one's own life, which includes planning how it will be carried out (Thompson, Dewa & Phare, 2012). The risk of actually making a suicide attempt increases when a person has made a concrete plan to end his or her life; therefore, it is important to identify early signs of suicidal behaviour. This point view, known as the suicide continuum, has been used in a wide range of studies and practical prevention programs. This is especially true when depression is a central variable in the studied persons (Sveticic & De Leo, 2012) because it allows us to order behaviours that are considered suicide risk factors. In general, the continuum includes the following stages: suicidal ideation, suicide plan, suicide attempt, and eventually, completed suicide.
Other suicide risk factors have been studied but they are not always are part of a theory and are not well understood, such as how they interact with other variables or in specific populations. Anxiety disorders, PTSD, drug use disorders, and sexual abuse history have all been investigated to differentiate suicide ideators from suicide attempters (May & Klonsky, 2016). Specifically, Mexican adolescents present with risk factors, englobed as psychosocial problems, such as: drug use (including alcohol and tobacco), depression symptoms, and previous suicide attempts (González-Forteza, Juárez-López, Jiménez, Montejo-León, Rodríguez-Santisbón & Wagner, 2017). Family factors including conflictive relationships with their father/mother, or parental conflicts have also been previously detected among Mexican students (González, Ramos, Caballero & Wagner, 2003). and high levels of stress in their daily activities also has been previously detected in Mexican students (González, Ramos, Caballero & Wagner, e-ISSN 2382-3984 / Vol. 16, n°. 1 / enero-junio 2020 / Medellín, Colombia Universidad Cooperativa de Colombia ideation without suicide attempt or behaviour during the year prior to the investigation (Borges et al., 2010). At the local level, a study conducted in 2004 among high-schoollevel students at the University of Guanajuato found that just over 8% of students had thought about committing suicide within the week preceding the investigation (Chávez, Pérez, Macías & Páramo, 2004).
Suicide in adolescents is not only a public health problem. Is also a complex phenomenon when transitions between developmental stages, psychological distress or even personal crisis and psychopathology co-occur , especially when we realize the phenomenon that occurs when there is suicidal ideation but that even the literature is not yet conclusive when affirming that it can be an antecedent of attempted suicide or of completed suicide .It is considered that the manner via which problems are resolved during this stage will directly influence their mental health as adults (De Hepcée, Reynaert, Jacques & Zdanowicz, 2015;Miranda & Shaffer, 2013). This is a period of vulnerability during which the adolescent struggles to fulfil the new demands of daily life and stressful events potentiate the risk of presenting suicidal behaviour (Leveton, 1987;De la Roca-Chiapas, 2008).

Methods
Our study was cross-sectional, observational, and comparative. Our main goal was to analyse the levels of depression and its influence on the presence of suicidal ideation in high school students in the city of Leon, Guanajuato.
Four high-schools participated in the study, among which we selected a representative and random sample from each grade. The sample included 447 students, who were assessed using the following tests: • The Beck Scale for Suicide Ideation (ssi); developed to identify the presence and quantify the severity of suicide ideation.
• The Beck Depression Inventory (bdi); designed to assess the severity (the intensity of symptoms) of depression in the preceding week.
• The Hamilton Rating Scale for Depression (hrsd); designed to provide a measure of the intensity or severity of depression during the preceding month.
Additionally, we developed and implemented a questionnaire based on a review of the literature on the risk factors associated with suicidal behaviours. The participants had to respond if they had lived through or were currently experiencing the situations described in each item. This questionnaire consisted of 24 items, including the questions "have you ever considered committing suicide?" and "have you ever tried to commit suicide?" The items included in this questionnaire and the answers given by students are shown in table 1. A scale to assess the level of risk presented by the participant was developed based on the responses to these two questions, in combination with the results of the ssi.  (20) Parental rejection perceived 3% (15) 4.2% (11/263) 2.2% (4/184) 9% (6) 24% (7) Source: Own elaboration.
Data were analysed using a description of variables, Pearson's correlation coefficient, and multiple regression to evaluate the associated factors. The confidence interval was set at 95% and p values < 0.05 were considered significant.

This study meets the standards established in the Declaration of Helsinki for
Human Scientific Research. The protocol was submitted and approved by the participating high-schools. All students provided informed consent prior to inclusion in the study, stating their voluntary participation and anonymity.

Descriptive Analysis
The age range of the students was 14-18 years (average, 16 years). Fifty-nine percent of the participants (263)  When asked whether they had considered committing suicide in the past, 23% (104 students) of the sample responded affirmatively. Among these individuals, 73 were female (27.8% of the total women included in the study) and 31 were male (16.8% of the male participants). When asked if they had tried to commit suicide, 6% (29 students) of the sample responded that they had made at least one suicide attempt in the past. Twenty-one of these individuals were women (7.9% of the female sample) and eight were men (4.3% of the male sample). The SSI showed that 14.8% of the participants (66 students) had suicide ideation at the time of the study; forty-five of them were female.

Correlations
We used Pearson's correlation coefficient to assess the presence of correlations between risk factors and the presence of suicidal ideation and suicide attempt. The correlations were considered significant at p<0.05 and are listed in table 2. The strongest correlations were found between the presence of suicidal ideation (ssi) and the lack of motivation, loss of interest, feeling depressed, suicidal thoughts, suicide attempt, perceived rejection by parents, and ratings on the two depression scales (these correlations showed p<0.001). Considering only those participants with suicidal ideation in the SSI (n = 66), there was a strong correlation between the BDI and HRSD, weight gain, feeling depressed, previous suicide attempt, and perceived support from parents (p < 0.001).

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The variables associated with the HRSD were the BDI, feeling depressed, suicidal thoughts, and perceived parental support (p < 0.001). Having considered committing suicide exhibited strongest correlation with suicide attempt and the HRSD (p < 0.001), whereas having a previous suicide attempt showed a strong correlation with the BDI, separation of the parents, and suicidal thoughts (p < 0.001). These results are shown in Table 3. The analysis of the data for the group of participants that reported having a previous suicide attempt (n = 29) revealed that the SSI was strongly correlated with the BDI (p = 0.002) and the divorce of the parents (p = 0.009). The BDI exhibited a strong correlation with the HRSD (p < 0.001) and the perceived parental support (p < 0.001) ( Table 4).

Multiple Regression
Because there were so many variables exhibiting significant correlations, we used multiple regression to determine whether there were correlations among these variables. In a first analysis, the SSI, the combination of the scales proposed in this study, and having a previous suicide attempt were significant risks for suicidal ideation (R 2 = .73, p < 0.001). After the elimination of the instruments that evaluate suicidal ideation, results indicated that the HRSD, the BDI, having a history of mental illness in the family, having a previous suicide attempt, and perceiving parental support were significant risks for suicidal ideation (R 2 = .29, p < 0.001) .The solution of the statistical package Statistics 8.0 revealed a correlation between suicidal ideation, the BDI, and having a previous suicide attempt (R 2 = .28, p < 0.001).
Regarding the presence of previous suicide attempts, multiple regression analysis of variables showed the presence of a correlation between this variable and a history of mental illness in the family, drug use, lack of motivation, feeling depressed,

Discussion and conclusions
The results obtained here are consistent with the findings of González-Forteza et al.
The specific relationship between depression and suicidal behaviour may be mediated by perceived burdensomeness (Kang, You, Huang, Ren, Lin & Xu 2018) and social cognitions and maladaptive interpersonal behaviours (Dueweke & Schwartz-Mette, 2017). In a similar way, neuroticism with its manifestations of anxiety and insecurity is highly correlated with suicidal ideation in young people (Huerta, De la Roca-Chiapas, Aguilar, Hernández & Barbosa, 2016). The interaction between depression and suicide potentiates the risk of presenting other risk behaviours. Major depressive disorder is the most common psychiatric diagnosis associated with suicide. According to the American Association of Suicidology (2002), 75% of people who commit suicide are depressed at the time of death. Similar data were obtained by Sánchez, Cáceres, and Gómez (2002) in a group of university students in Colombia, among whom most of the students with suicidal ideation were diagnosed as being in the depressive spectrum. The same study showed that the prevalence of suicidal ideation among these college students during the year prior to the investigation was 13% and that it was more common in women. The present investigation found similar data: a prevalence of suicidal ideation of 12.7%, which was more frequent in females. More recently, in Chile 26.3% of students in a study had attempted suicide at least once in their life, and 20% had suicidal thoughts (Barroilhet et al., 2012). It seems that the proportion of all types of suicidal behaviours is similar worldwide. Eskin et al. (2016) found that 29% of university students from 12 countries have suicidal ideation at least once in their lifetimes, and 7% reported at least one suicide attempt.
Having made a previous suicide attempt has become an important predictor of suicide risk and suicide ideation (Thompson et al., 2012;Peña, Casas, Padilla, Gómez & Gallardo, 2002 Most scales that evaluate suicide risk attribute special importance to the history of suicide attempts, to determine the severity of suicide risk at a given point (Ghasemi, Shaghaghi & Allahverdipour, 2015).
Another important factor that increases the risk of presenting suicidal behaviour is the use of drugs, as found by Schilling, Aseltine, Glanovsky, Jamesa, and Jacobs (2009), regarding the use of alcohol when feeling depressed; and by Zhang and Wu (2014), who demonstrated that cigarettes and alcohol use in adolescence increases.
A history of sexual abuse is also important, as shown by Pérez-González and Pereda (2015) and Joiner et al. (2007), who found a correlation between sexual abuse and the number of suicide attempts.
It has been demonstrated that family has an important influence on the development of suicidal behaviour in adolescents, regarding both the presence of a history of mental illness in the family (National Institute of Mental Health, 2018; King, Kerr, Passarelli, Foster & Merchant, 2010) and the relationships established between parents and children (Fotti, Katz, Afifi & Cox, 2006). The results obtained in the present investigation are consistent with the study by Fotti et al. (2006), who found that adolescents who perceived their parents as being distant or uncaring presented a higher risk of committing suicide Some studies suggest the existence of a sequence in suicidal behaviour, where suicidal ideation precedes behaviours such as suicidal threats or behaviours, suicide attempts, and, finally, suicide. However, most often, this behaviour goes unnoticed and it is not until a person makes a suicide attempt that he or she comes into contact with a health professional (Peña et al, 2002). For this reason, it is important to pay attention to the presence of risk factors, especially when it comes to adolescents. Given the characteristic vulnerability of this life stage, it is less likely that adolescents will seek help by their own means.

Limitations
The limitations of this study are the small sample size and possible bias in the answers, as the students knew from the informed consent letter that the results of the study may be shared with parents. There were a few cases in which parents did not give consent for the study, which may be due them not wanting to share information on risk conditions or family dynamic, or for fear of being stigmatised.