Adolescents, Negative psychological attributes, Overall distress, Stressful events, Suicidal ideation, Thailand.

97Vol. 21 No. 2

Benjamaporn Rungsang et al.


Suicidal ideation is known to be an indicator of suicide1 which is the leading cause of death among adolescents throughout the world,1-4 and the fourth highest cause of death among Thai adolescents.2 Studies of the suicidal ideation among adolescents found that it was at a high prevalence rate.2-5 For instance, in the United States of America (USA), nearly 40% of ninth-grade Latino females have experienced suicidal ideation, whereas, 20% of non-Latino ninth-grade females experienced suicidal ideation in the past year.5 In Bangkok, Thailand, among students aged

Benjamaporn Rungsang, R.N., Ph.D. Candiddate, Faculty of Nursing, Burapha University and Lecturer, Faculty of Nursing, Pathum Thani University. 111/47 Mubanphukapan Soi 7,Nong Pak Long, Muang District, Nakhon Pathom, 73000, Thailand E-mail: Correspondence to: Nujjaree Chaimongkol*, R.N., Ph.D., Associate Professor Faculty of Nursing, Burapha University. 169 Longhard Bangsaen Road, Muang District, Chon Buri, 20131, Thailand E-mail: Wannee Deoisres, R.N., Ph.D., Associate Professor, Faculty of Nursing, Burapha University. 169 Longhard Bangsaen Road, Muang District, Chon Buri, 20131, Thailand E-mail: Pairatana Wongnam, Ed.D., Associate Professor Faculty of Education, Burapha University.169 Longhard Bangsaen Road, Muang District, Chon Buri, 20131, Thailand E-mail:

Benjamaporn Rungsang, Nujjaree Chaimongkol*, Wannee Deoisres, Pairatana Wongnam

Abstract: The purpose of this cross-sectional study was to test the Rungsang-Chaimongkol Model of Suicidal Ideation among Thai Adolescents. A multi-stage random sampling technique was used to recruit a sample of 437 adolescents attending secondary schools in a central province of Thailand. Research instruments were self-report questionnaires, including the Scale for Suicidal Ideation, the General Health Questionnaire, the Strengths and Difficulties Questionnaire, the Rosenberg Self-Esteem Scale, and the Negative Event Scale. Descriptive statistics and structural equation modeling were used to explore the magnitude of direct and indirect effects on the suicidal ideation of the sample. Results revealed that negative psychological attributes and stressful events had a direct positive effect on suicidal ideation. Overall distress mediated the link between negative psychological attributes and stressful events, and suicidal ideation. The Model accounted for 32% of the overall variance in prediction of suicidal ideation among Thai adolescents. These findings suggested that the intervention program to prevent suicidal ideation aiming at decrease negative psychological attributes, stressful events and overall distress would be beneficial. However, it requires further testing with other groups.

Pacific Rim Int J Nurs Res 2017; 21(2) 97-107

Keywords: Adolescents, Negative psychological attributes, Overall distress, Stressful events, Suicidal ideation, Thailand.

98 Pacific Rim Int J Nurs Res • April – June 2017

Suicidal Ideation among Thai Adolescents: An Empirical Test of a Causal Model

15 -19 years, there was a report of 11.2% suicidal ideation.3 A study in a high school in the north of Thailand found that the prevalence rate of suicidal ideation in the past 12 months among adolescents age 13-15 years was 8.8 %.4 These studies also found out the prevalence rate of suicidal attempts. Suicidal ideation is considered as a predictor of attempted suicide and completed suicide making1, 6 a critical mental health problem among adolescents. Interestingly, a study in one high school in the north of Thailand revealed that there were 4.6% of adolescents had attempted suicide during the past year. In addition, the researchers presented that 7.4% of girls and 5.7% of boys had attempted suicide.4 To try to decrease the incidence rate, it would be of high interest to identify the risk factors associated with suicidal ideation among adolescents which can, in turn, lead to the development of nursing interventions that prevent or reduce the risk for suicide among Thai adolescents.

Conceptual Framework and Review of


The conceptual framework of this study was based on the cognitive behavioral model7 and a review of related literature in order to explain the causal relationship among factors including, psychological attributes, self-esteem, stressful events, and overall distress contribute to suicidal ideation among adolescents.

Rudd’s cognitive behavioral model7 grounded and explained suicidal ideation in that the cognitive systems of suicide mode that characterized suicidal individuals and were associated with increased vulnerability to suicidal ideation.8 Based on this model, it is believed that some individuals are more likely to develop suicidal ideation because of having a predisposition to suicide, that consists of cognitive, biological and behavioral susceptibility. The predisposition to suicide is stimulated by the presence of aggravating factors and an individual’s

perception to negative feelings such as perceived loss and relationship difficulties or problems which increase vulnerability for suicidal ideation and could lead to suicidal attempts or completed suicide. 7- 8

The literature on relationships and factors influencing suicidal ideation shows that psychological attributes of positive and negative behaviors are related to suicidal ideation among adolescents.9-10 Evidence indicates an association between negative psychological attributes and suicidal ideation in adolescents.9-12 For instance, a study reported that adolescents who made suicide attempts and those who experienced suicidal ideation had significant emotional problems and hyperactivity.10 Similarly, adolescents with higher scores on emotional problems are more likely to have suicidal ideation than those with lower scores.11 Other negative attributes, such as conduct behavior, impulsivity, and aggression, have also been found to be related to suicidal ideation in adolescents.12

In regards to self-esteem, a wide range of research has clearly shown that adolescents who have feelings of low self-worth are more likely to have suicidal ideation and greater ideation when this is compounded by depression and anxiety.13, 15-17 Studies have reported that self-esteem is negatively associated with suicidal ideation and have found that a decrease in self-esteem was significantly related to an increase in suicidal ideation.13-14 Suicide attempters had significantly lower levels of self-esteem than non-suicidal attempters.15-17 Furthermore, adolescents’ increased likelihood of suicidal ideation was associated with lower self-esteem.13

A perception of loss or a belief that one is a burden to others is also related to adolescents’ suicidal ideation.7 Stressful events, including problems with friends, boyfriends or girlfriends, studying, teachers, other students, parents, money, relatives and health problems, academic limitations, and poor course interest are associated with suicide risk.18 Several studies indicate that problems with peers, including physical fighting and bullying, were significantly related to increased risk of suicide ideation.9,19-20 Poor family