Title: Suicidal Ideation Among Adolescents in Relation to Recalled Exposure to

Violence.
Authors: Cohen, Elizabeth M.
Source: Current Psychology; Spring2000, Vol. 19 Issue 1, p46, 11p
Document Type: Article
Subject Terms: *ADOLESCENCE
*ATTITUDE (Psychology)
*HEALTH
*TEENAGERS
*TEENAGERS -- Suicidal behavior
*VIOLENCE
Psychological aspects
Abstract: The relationship between exposure to violence and vulnerability to suicide among
adolescents was examined. The topic was initiated by the rapid increase in
adolescent's exposure to violence and the sparse (escaso) systematic research
available on its relationship to attitudes about life and death. The study's main
hypothesis is that high levels of exposure to violence are associated with high
suicide risk according to two conceptual paradigms--Fear of Death and Attraction
and Repulsion to Life. Eighty-five adolescents were administered three self report
questionnaires. The questionnaires assessed levels of exposure to violence, fear of
death, and attitudes towards life and death. Those who had been exposed to a high
level of violence reported attitudes synonymous with the profile of an individual at
risk for suicide (low fear of death, low repulsion to death, and low attraction to life;
high repulsion to life and high attraction to death). [ABSTRACT FROM
AUTHOR]
Copyright of Current Psychology is the property of Transaction Publishers and its content may not be
copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written
permission. However, users may print, download, or email articles for individual use. This abstract may
be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original
published version of the material for the full abstract. (Copyright applies to all Abstracts)
Full Text Word 5299
Count:
ISSN: 0737-8262
Accession Number: 3212076
 
Persistent link to this http://search.ebscohost.com/login.aspx?
record: direct=true&db=aph&AN=3212076&site=ehost-live
 
<A href="http://search.ebscohost.com/login.aspx?
Cut and Paste: direct=true&db=aph&AN=3212076&site=ehost-live">Suicidal Ideation Among
Adolescents in Relation to Recalled Exposure to Violence.</A>
 
Database: Academic Search Premier

SUICIDAL IDEATION AMONG ADOLESCENTS IN RELATION TO RECALLED EXPOSURE TO

VIOLENCE

Dateline: Tufts University

The relationship between exposure to violence and vulnerability to suicide among adolescents was
examined. The topic was initiated by the rapid increase in adolescent's exposure to violence and the
sparse systematic research available on its relationship to attitudes about life and death. The study's main
hypothesis is that high levels of exposure to violence are associated with high suicide risk according to
two conceptual paradigms--Fear of Death and Attraction and Repulsion to Life. Eighty-five adolescents
were administered three self report questionnaires. The questionnaires assessed levels of exposure to
violence, fear of death, and attitudes towards life and death. Those who had been exposed to a high level
of violence reported attitudes synonymous with the profile of an individual at risk for suicide (low fear of
death, low repulsion to death, and low attraction to life; high repulsion to life and high attraction to
death).

Relatively large numbers of children are exposed to violence on a regular basis. A recent National Crime
Survey reported violent victimization rates for young persons, twelve to nineteen years of age, to be twice
those of adults (Bureau of Statistics, 1991). While child victims of violence elicit considerable concern,
and rightfully so, many more children witness extreme acts of violence, often perpetrated against family
and friends. Exposure occurs in such a manner that it and its pernicious effects are often subtle (sutil) and
underestimated. Direct observation of the violent assault of another person, referred to as "co-
victimization" by Shakoor and Chalmers (1991), is frequently accompanied by immersion in a violent
milieu in which the child is in constant danger even if, in fact, never actually victimized. A recent study
of exposure to violence among a sample of 165 children between the ages of eight and fourteen in one
Washington D.C. community reported a large number of children witnessed community violence two to
four times more than they were victimized (Bell and Jenkins, 1991). The evidence to date on the actual
extent of children's witnessing of violence is considerable. For example, in Los Angeles county in 1982,
10 to 20 percent of the 2,000 homicides were witnessed by a youth (Pynoos, 1985).

Clinical and non-clinical studies have explored stress-related circumstances and their effects on the
mental health of children and adolescents (Copmas, 1987; Garmezy, 1986; Monroe et al., 1983; American
Psychiatric Association, 1994). These and other studies demonstrate that acute life events and chronic
stressors produce adverse mental health outcomes for youth (Compas et al., 1985). However, most studies
report on the prevelance and severity of post traumatic stress symptomatology in children who have been
exposed to high levels of violence. (Singer et al., 1995; Burton et al., 1994; Martinez, 1993; Fitzpatrick,
1993; Compas, 1987; Monroe, 1982; Pynoos, 1985).

Little systematic research has explored the link between youth's exposure to violence and self reported
suicidal symptomatology. Durant et al. (1995) examined the relationships between exposure to violence
and depression, hopelessness, and purpose in life. Higher current depression and hopelessness and lower
purpose in life were associated with frequency of lifetime exposure to violence. In addition, Bell and
Jenkins' (1991) research suggests that adolescents' attitudes towards life and death may be a function of
their exposure to violence. Those exposed to violence described a sense of futurelesness accompanied by
a belief that they will not reach adulthood. A detailed and more systematic examination of the relationship
between exposure and vulnerability to suicide is needed.

CONCEPTUAL PARADIGMS TO ASSESS (evaluar) SUICIDE RISK

A number of techniques can be utilized to assess and record an individual's vulnerability to suicide. The
two batteries implemented in this study are based on two conceptual models of suicide.

Fear of Death

Attitudes toward death and fear of death have been found to play an important role in suicidal behavior. It
has been demonstrated (Orbach, 1988; Pfeffer et al., 1979) that suicidal adolescents fear death to a lesser
degree than non-suicidal adolescents. The suicidal adolescent tends to perceive death as an attractive
state, and a continuation of life under improved conditions in which long-standing wishes may come true.
Similar findings regarding distortions in the perception of death were reported in respect to suicidal adults
(Neuringer, 1970). Orbach and Glaubman (1979) suggested that such distorted and idiosyncratic
perceptions of death serve as a defense mechanism against the fear of death that arises in face of suicidal
urges. This defensive maneuver of reducing the fear of death may facilitate the suicidal act itself.
Lester (1967) found that suicidal individuals fear death less than non-suicidal ones. They reported less
anxiety over loss of self-fulfillment, which is typically associated with suicidal individuals' tendency to
show more self-indifference and lack of selfappreciation. A similar study with a normal population also
revealed a negative correlation between suicidal ideation and fear of death (Minton and Brush, 1980).
According to these findings, fear of death is associated with the vulnerability to suicidal ideation and/or
attempts. This way of conceptualizing and assessing suicidality gave rise to the fear of death assessment
scale (Florian et al., 1983). Investigating and assessing an individual's level of fear of death can be helpful
in concluding whether he/she is more vulnerable to suicidal ideation or attempts.

Attraction and Repulsion of Life and Death: A New Way of Understanding Suicidal Behavior

Orbach (1988) presents a phenomenological approach to understanding the act and motives of suicide
based on the subjective experiences of the sufferer and his pain. One of the most striking aspects of
suicidal adolescents is their ambivalence towards life and death. With these youths, suffering is mixed
with pleasure, helplessness with initiative, and feelings of worthlessness with manifestations of talent and
achievement. Their ambivalence is most pronounced in reference to death. At one moment, an adolescent
may distort the meaning of death so grossly that she does not seem to understand what death is. She may
relate to death as a longed-for goal, somehow better than life. Yet sometimes, only moments later or when
circumstances change, the same child may reveal even greater insight and anxiety about death than
normal children.

According to Orbach, adolescent suicide revolves around a basic conflict of attitudes towards life and
death. It is more than the conflict between the wish to live and the wish to die. Rather, each aspect of the
conflict represents a separate continuum: the wish to live with its high and low polarities and the wish to
die with its high and low polarities. Moreover, each of the two forces in the conflict can be divided into
further dimensions. One can speak of four types of conflicting attitudes of repulsion and attraction toward
life and repulsion and attraction to death.

Attraction to life arises from feelings of gratification and happiness brought about by one's positive
experiences with others. Repulsion by life involves the experiences of pain and suffering that arise from
sources of anxiety, frustration, and stress. Throughout life the balance between these attitudes is in
constant flux. According to Orbach, it is the unique and specific balance between them that is a
determining factor in the move to suicide.

The basic assumptions underlying this paradigm are partially supported by a number of studies. One
study found that adults hospitalized after attempting suicide expressed both a wish to live and a wish to
die (Kovacs and Beck, 1977). Moreover, changes in these motives correlated with the severity of the
suicide attempt. If attitudes toward life and death can be determined, acts of suicide might become more
understandable and predictable. The four attitudes can be described concisely as follows.

 Attraction to life is influenced by the individual's feeling of security in interpersonal relations, the
fulfillment of his basic needs, feelings of selflove and self-esteem, and positive feedback from the
environment. It is this attraction to life that prevents self-destruction.
 Repulsion towards life reflects the pain and suffering the individual experiences. The entire range
of experiences alluded to in suicide reflect these painful feelings: the death of a loved one,
physical and emotional abuse, rejection, isolation, and alienation.

Attitudes towards death are not simply the antithesis of attitudes towards life but are independent mental
forces derived from the inevitable confrontation with death. Interest in death, among both adults and
adolescents, is not only a product of suffering, but an integral part of existence.

 Attraction to death embodies the belief that death is a mode of physical or emotional existence
that is superior to, and therefore preferable to, life. Such fantasies facilitate suicidal behavior as
they increase attraction to death and become a motivating force behind self-destruction.
  Repulsion by death is salient even among people with strong tendencies toward self-destruction.
This attitude stems from the realistic, frightening perception of death as an irreversible
annihilation, but it is also colored by the individual's inner world.

Approaching the phenomenon of suicide from the perspective of opposing attitudes enables one to
formulate a relatively simple hypothesis regarding the different strengths of these attitudes in people with
and without suicidal tendencies. It may be assumed that most people are strongly attracted to life and
strongly repulsed by death while evincing little attraction to death and little repulsion by life. In contrast,
suicidal individuals might be expected to evince strong repulsion toward life, little repulsion toward
death, a strong attraction to death, and little attraction to life.

This model was evaluated by studies that compared the relative strengths of the four key attitudes among
adolescents showing suicidal tendencies (Orbach et al., 1983, 1984). In Orbach's 1993 study, smcidal
individuals showed more repulsion to life, less attraction to life, more attraction to death, and less
repulsion by it than normal subjects. A study investigating adolescents' attitudes about death in relation to
suicidality found that when suicidal ideation was examined, greater ideation correlated with weaker
attraction to life, stronger attraction to death, and a stronger repulsion by life (Gutierrez et al., 1996).

Osman and his colleagues (1993) found that attraction to life, repulsion to life, and attraction to death
significantly correlated with other scales of suicidal ideation threats and likelihood of suicidal behavior
after controlling for general psychopathology. In another study Osman and his colleagues investigated the
fear of death levels in normal, psychiatric inpatient and suicidal inpatient adolescents (1994). The four
attitudinal factors were replicated once more. One factor, repulsion towards life, significantly correlated
with other valid measures of suicidal ideation, attempts, likelihood of suicide, and suicide risk.

This report attempts to address the question of whether adolescents who are exposed to violence and
witness its destructiveness frequently are prone to express attitudes similar to the profile of an individual
at risk for suicide. To support this hypothesis, a number of conditions must be obtained. Exposure to
violence must be related to the four attitudes described by Orbach et al., (1991) and to Florian et al.'s
(1983) conception of fear of death. The amount of exposure an individual has encountered will increase
the adolescent's attraction to death, decrease his attraction to life, decrease his repulsion to death, increase
his repulsion to life and decrease his fear of death.

METHOD Subjects

Adolescent men and women, ages thirteen to eighteen years (mean age of fifteen), participated in the
study. The subjects were recruited from two separate high schools in Massachusetts. Classes were chosen
by the schools' guidance counselors. Data were collected from a total of eighty-five adolescents. In
following with federal regulations, knowing, informed, and voluntary parental consent and subject assent
were obtained prior to participation. All those included in the study were able to read above the 6th grade
level, as measured by the school's guidance counselors.

Materials

Exposure to Violence Scales: The study employed a self report survey to record a subject's level of
exposure to violence. The survey was created by Mark Singer and colleagues (1995). The questionnaire
delineated two types of exposure to violence based on the time of exposure. The first twenty-two
questions referred to recent exposure to violence and the final ten questions referred to past exposure to
violence. The questionnaire was designed to be understood at the 5th grade reading level and was pre-
tested by Singer et al. (1995) on a socioeconomic diverse sample of adolescents. All scales achieved
acceptable reliability, based on Cronbach's alpha values.

Recent Exposure to Physical Violence Scale: Recent exposure to violence was measured by a 22-item
scale. This scale measured five specific acts of violence: threats, slapping/hitting/punching, beatings,
knife attacks, and shootings. For the first three types, separate items were designed to capture the site
where the violence occurred: at home, at school, or in the neighborhood. Reports on knife attacks and
shootings were not site specific. Adolescents were asked to report separately on violence they had
experienced directly and personally witnessed over the past year. A sixpoint Likert scale ranging from
"never" (a score of 0) to "almost every day" (a score of 5) was used to assess the frequency of exposure to
each type of violence. The variables recording the recent exposure to violence in the neighborhood had
a .87 Cronbach's alpha value. The variables recording recent exposure from victimization or witnessing at
home obtained a .75 Cronbach alpha value. The variables recording recent exposure of violence from
witnessing events at school received a Cronbach alpha value of .80. Variables that recorded recent
exposure to either a shooting or knife attack obtained a .70 Cronbach's alpha value. Variables recording
recent victimization at school or the neighborhood received a .68 Cronbach alpha value. The three
variables used to record past exposure to violence were distinguished by whether the violence was
witnessed (Cronbach alpha of .80), an act of victimization (Cronbach alpha of .71), or the result of a
shooting or knife attack (Cronbach alpha of .66).

Past Exposure to Physical Violence Scale: A ten-item scale was used to measure past exposure to
violence. Adolescents were asked to report specific acts of violence they had experienced directly or
personally witnessed while growing up, not including the past year. The same violence categories
described earlier were employed; however, the sites (home, school, and neighborhood) were excluded
because of the time elapsed between the event and requested memory recall. A four-point Likert scale
ranging from "never" (a score of 0) to "very often" (a score of 3) was used to assess the frequency of each
type of violence.

Fear of Death Scale: The Fear of Personal Death Scale (Florian and Kravetz, 1983) is a self-report
questionnaire that consists of thirty items answered on a 7-point Likert scale. The maximum score (7)
indicates very high fear, and the minimum score (1) indicates no fear. The questionnaire presented a
statement one could adopt towards his or her own death. Subjects were asked to record their agreement
with a number of statements. A subject could choose a response between completely agree (1) and
completely disagree (7). The validity and reliability of this scale were established through several
principal component factor analyses (Unger, Florian, and ZernitskyShurka, 1989-1990). Florian and
Kravetz reported a test-retest reliability of .91 (1983).

Multi-Attitude Suicide Tendency Scale (MASTS, not to be confused with the Michigan Alcohol
Screening Test): The MASTS is a self-report survey constructed by Orbach et al. (1991). Orbach and his
colleagues attempted to construct an alternative, comprehensive, and multifaceted suicidal tendency scale
on the basis of a phenomenological model of suicidal behavior (Orbach, 1988). The model is grounded on
the premise that suicidal behavior evolves around a basic conflict among attitudes towards life and death.
Subjects were presented with statements with which they were asked if they agreed or disagreed. The
attraction to life factor (AL) included seven items (e.g., I enjoy many things in my life; I am very
hopeful). The repulsion to life factor (RL) included seven items (e.g., I feel that I am not important to my
family; Life seems to be one long and difficult struggle.) The attraction to death factor (AD) included
seven items (e.g., I believe that death can bring a great relief from suffering; Many problems can be
solved by death only). The fourth factor, repulsion to death (RD) included nine items (e.g., Thinking
about death gives me the shivers; I fear death because all my plans will come to an end). The items were
arranged on a 5-point Likert scale, ranging from 1 (strongly agree) to 5 (strongly disagree). The score for
each attitude was calculated by summing the scores for each item and then dividing it by the number of
items that defined each attitude. The internal consistency for each factor was computed. The alpha values
for each factor were as follows: AL=.83, RL=.76, AD=.76, RD=.83. Each item is scored on a range of 1
to 5, and the score of each factor is based on the mean of the items in each factor. The questionnaire also
has concurrent and discriminant validity (Orbach et al., 1991).

Design
This study implemented bivariate analyses using the Pearson product-moment correlation coefficient. A
number of bivariate correlations were performed. The eleven variables of exposure to violence (total
recent exposure, total past exposure, total exposure, recent witnessing in the neighborhood, recent
victimization or witnessing at home, recent witnessing at school, recent exposure to a shooting or knife
attack, recent victimization at school or in neighborhood, past witnessing, past shooting or knife attack,
past victimization) were correlated with overall fear of death, attraction to life, repulsion to life, repulsion
to death, and attraction to death.

Procedure

The study protocol was approved by the Tufts University Institutional Review Board. The three surveys
were administered in the subject's classrooms. Students were told that if they felt uncomfortable at any
point in the experiment they could terminate their involvement. However, no subjects did so. Also, if they
did not want to answer a question, or felt they could not accurately produce a response they were not
required to do so. Since topics that could be anxiety provoking and potentially dangerous were asked in
the questionnaires fifteen-minute debriefing sessions (which also had Institutional Review Board
approval) were conducted with all subjects. School guidance counselors followed up with the children
four and twelve weeks after the procedure. They were equipped to refer students to the appropriate
facilities for treatment. It was explained to the students that they would be accorded reatment for as long
as they were needed. At the four and twelve week follow-ups no one reported any adverse effects of the
study or continuing problems. In addition, the counselors reported that none of the participants had
approached them for guidance regarding issues related to the procedure.

RESULTS

Data were analyzed from eighty-five subjects. To test the original hypothesis each of the eleven modes of
recording exposure to violence--total recent exposure, total past exposure, total exposure, recent
witnessing in the neighborhood, recent victimization or witnessing at home, recent witnessing at school,
recent exposure to a shooting or knife attack, recent victimization at school or in the neighborhood, past
witnessing, past shooting or knife attack, past victimization--were correlated with the two measures of
suicide potential: Fear of Death scale and the Multi-Attitude Suicide Tendency scale. A number of
significant correlations were found.

The hypotheses that exposure to violence would be associated with less attraction to life, high attraction
to death, and high repulsion to life were supported by the data analysis. Attraction to life was negatively
correlated with recent exposure to violence at home, (r = -.26, p < .01) and past victimization (r = -.21, p
< .05). Those who have experienced a high level of recent exposure to violence at home or have
experienced high levels of violent victimization in the past record less attraction to life.

Attraction to death is positively correlated with past exposure to violence of all types (r = -.21, p < .05)
and past witnessing of all types of violence (r = -.25, p < .05). Those who have been exposed to a lot of
violence in the past record having a high attraction to death. In addition, those who report having
witnessed a high amount of violence in the past record a high attraction to death.

Repulsion to life was positively correlated with the amount of violence witnessed recently in one's home
(r = .35, p < .001). There was a strong association found between the amount of recent exposure to
violence at home by means of direct witnessing and repulsion to life. Those who had witnessed a high
amount of violence at home recently recorded a high level of repulsion towards life. Repulsion to life also
correlated with a high level of past victimization (r = .21, p < .05). Those that have experienced a high
amount of victimization report a high repulsion to life.

Total exposure to violence did not significantly correlate with fear of death (r = .09, p = .41). However,
there was a negative association found between past exposure to a shooting or knife attack and fear of
death (r = .28, p < .01).
DISCUSSION

The more violence an individual was exposed to, the more he/she exhibited a vulnerability to suicide.
Exposure to violence affects variables used to decipher an individuals potential suicide risk--low
attraction to life, high attraction to death, and high repulsion to life. Although in this study some of the
relationships were stronger than others, the general trends reveal an association. Adolescents in this study
reported similar feelings as subjects who were at great risk for suicidal thoughts.

Those who have either a great deal of past exposure to violence of all types or have witnessed a lot of
violence report a higher level of repulsion towards life than adolescents who have not. Those who have
witnessed high levels of exposure to violence feel more dissatisfaction with life. These individuals see the
world as a difficult, abusive place to live. If given the choice, they would opt to leave their suffering lives
more than those who had not been exposed to as much violence. The high association found between
exposure and repulsion to life is noteworthy since it was to be the factor most strongly associated with
suicidal attempts, likelihood of suicide, and suicide risk (Osman, 1994). In addition, those who have
recently witnessed a great deal of violence at home reported lower attraction to life. We can conclude
from this that victims of exposure to violence do not find many rewards in their lives.

In relationship to fear of death, exposure to violence was only a predictor of a low fear of death if a
person had been exposed to a knifing or a shooting in the past. The other measures of exposure to
violence did not seem to predict a high or low level of fear of death. One reason for this may be the
difficulty of some of the concepts presented in the questionnaire. A number of the students noted after the
study that the survey asked questions about things that were hard to answer. A survey using vignettes
might be more helpful in accurately assessing an adolescent's fear of death. Overall, the general profile
for an individual at risk for suicide was related to a high level of exposure to violence.

Limitations

This study's main limitation was the subject group investigated. The group was small and heterogeneous
consisting mainly of middle-class Caucasian adolescents. There is a need to extend the subject pool in
order to generalize these important findings to others. Variables such as age, race, socioeconomic status,
and family cohesion should be examined when investigating the affects of exposure to violence. These
variables could affect an individual's vulnerability to suicide and should be recorded. Moreover, the
different attitudes recorded in this study between groups may have surfaced due to differences in the
demographic variables mentioned earlier rather than from exposure. The relationship between exposure to
violence and vulnerability to suicide needs to be reassessed, taking into account these important
differences via the technique of multiple regression analysis. The best way to examine these questions
would be to collect data from a randomized epidemiologic sample of adolescents.

A common weakness in self-report studies on exposure to violence is that adolescents often over-estimate
or under-exaggerate the amount of violence they have witnessed. A validation of their claims should be
obtained by their parents, teachers, and police officers (when applicable). Obtaining consensus on an
adolescent's report adds validity and assurance that the differences recorded are accurate and related to
their outcomes.

Conclusions

The disturbing findings of this research argue strongly for implementing and evaluating preventive
interventions. The intervention can occur at the individual, family, classroom, group, or community level,
with intervention at each level addressing a particular goal. A key to successful treatment is intervention
soon after the trauma occurs. However, when dealing with an individual's exposure to violence it is
difficult to flag these occurrences. Often, those who witness a brutal murder, shooting or fight are
ignored. They are the silent victims, who are not rushed to the hospital but rather pushed to the side to
watch alone.
At issue in the treatment of adolescents exposed to violence is the identification of these silent victims.
Witnesses of family and community violence receive little attention. In most instances, these crimes are
handled by law enforcement professionals whose concern is the event and the actual victims, with the
presence of others being of interest only if they have a bearing on the case. When violence occurs in a
public place, professionals may not even be aware of the number of witnesses. That a violent event is
witnessed by so many contributes to the perception that the trauma is shared and thus has less impact on
the individual than if that person alone had been present when the incident occurred. Regardless of how
these youthful co-victims are identified, steps must be taken to make sure that appropriate and adequate
services are available for them.

Future Research

While this study has provided some encouraging progress regarding the impact of adolescents' witnessing
of violence on their attitudes towards life, there is much more to be learned about and done for these
silent victims.

Clearly, all adolescents exposed to violence do not sustain psychological damage. Who are the exceptions
and what buffers them against the deleterious effects of violence and victimization? The study of the
stress-resistant child is an important focus for experimental interest. Attributes that mark such children
may be revealing factors of temperament, cognition, affects, and social skills. A systematic investigation
into the operation of these and other protective factors is required.

This study examined the effect direct witnessing of violence has on adolescents' attitudes towards life and
death. When asked to record the amount of exposure subjects were asked not to include violence they had
been exposed to via different media modalities: movies, television, radio, and video games. However, the
question of whether exposure to violence "second hand," through media, is associated with the same
characteristics as direct exposure should be addressed. Do adolescents who watch a lot of violent
television and play violent video games present an increased vulnerability to suicide? These questions
must be answered through systematic research whose findings could impact both legislation in the
government arid daily life in every household.

There is much work to be done regarding research on children who have been exposed to violence. This
research study has begun by addressing a very small part of a huge national dilemma which expands far
beyond the inner city streets. That the investigation of this phenomenon must continue seems evident
based both on what is currently known and what one might potentially learn about a critical risk factor for
the psychological adjustment, and indeed physical survival of adolescents.

NOTE

Address correspondence to: Elizabeth M. Cohen, Boston Univ., Ctr. for Anxiety and Related Disorders,
648 Beacon St., 6th floor, Boston, MA 02215. ecohen@bu.edu

REFERENCES

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.)
Washington D.C.: Author.

Bell, C.C. and Jenkins, E.J. (1991). Traumatic stress and children. Journal of Health Care for the Poor and
Underserved, 2, 175-185.

Bureau of Justices Statistics (1991). Teenage victims: A national crime survey report. Washington D.C.:
Department of Justice.
Burton, D., Foy, D., Bwanausi, C., Johnson, J., and Moore, L. (1994). The relationship between traumatic
exposure, family dysfunction and post-traumatic stress symptoms in male juvenile offenders. Journal of
Traumatic Stress, 7, 83-93.

Compas, B.E. (1987). Stress and life events during childhood and adolescence. Clinical Psychology
Review, 7, 275-302.

Compas, B.E., Davis, G.E., and Foresythe, C.J. (1985). Characteristics of life events during adolescence.
American Journal of Community Psychology, 13, 677-691.

Durant, R.H., Getts, A., Cadenhead, C., Emans, S.J., and Woods, E.R. (1995). Exposure to violence and
victimization and depression, hopelessness, and purpose in life among adolescents living in an around
public housing. Developmental and Behavioral Pediatrics, 16, 233-237.

Fitzpatrick, K.M. (1993). Exposure to violence and presence of depression among low-income,
AfricanAmerican youth. Journal of Consulting and Clinical Psychology, 61, 528-531.

Florian, Kravetz, S. (1983). Fear of personal death's attribution, structure and relationship to religious
belief. Journal of Personality and Social Psychology, 20, 64-79.

Garmezy, N. (1986). Children under severe stress: Critique and commentary. American Academy of
Child Psychiatry, 25, 384-392.

Gutierrez, P., King, C.A., and Ghaziuddin, N. (1996). Adolescent attitudes about death in relation to
suicidality. Suicide and Life Threatening Behavior, 26, 8-18.

Kovacs, M. and Beck, A. (1977). The wish to die and the wish to live in attempted suicide. Journal of
Clinical Psychology, 33, 361-365.

Lester, D. (1967). Fear of death in suicidal persons. Psychological Reports, 20, 1077-1078.

Martinez, J. (1993). Psychological impact of violence. Journal of Traumatic Stress, 5, 67-75.

Minton, J.D. and Brush, L.R. (1980-1981). The correlation of attitudes towards suicide with death
anxiety, religiosity, and personal closeness to suicide. Omega, 11, 317-324.

Monroe, S.M. (1982). Major and minor life events as predictors of psychological distress: Further issues
and findings. Journal of Behavioral Medicine, 6, 189-205.

Monroe, S.M., Imhoff, D.F., Wise, B.D., and Harris, J.E. (1983). Prediction of psychological symptoms
under high-risk psychosocial circumstances: Life events, social support and symptom specificity. Journal
of Abnormal Psychology, 92, 338-350.

Neuringer, C. (1970). Changes in attitude towards life and death during a serious suicide attempt.
Omega ,1, 201-209.

Orbach, I. (1988) Children who don't want to live. New York: Brunner/Mazel.

Orbach, I. (1991). A multi-attitude suicide tendency scale for adolescents. Journal of Consulting and
Clinical Psychology, 3, 398-404.

Orbach, I., Feshbach, S., Carlson, G., and Ellensberger, I. (1984). Attitudes toward life and death on
suicidal, normal and chronically ill children. Journal of Consulting and Clinical Psychology, 52, 1020-
1027.
Orbach, I., Feshbach, S., Carlson, G., Glaubman, H., and Gross, Y. (1983). Attraction and repulsion by
life and death in suicidal and normal children. Journal of Consulting and Clinical Psychology, 51, 661-
670.

Orbach, I. and Glaubman, H. (1979). Children's perception of death as a defensive process. Journal of
Abnormal Psychology, 88, 671-674.

Osman, A., Barrios, F.X., Gitterman, L.E., and Osman, (1993). The multi-attitude suicide tendency scale:
Psychometric characteristics in an American sample. Journal of Clinical Psychology, 49, 701-708.

Osman, A., Barrios, F.X., Panak, W.F., Osman, J.R., Hoffman, H., and Hammer, R. (1994). Validation of
the multi-attitude suicide tendency Scale in American adolescent samples. Unpublished manuscript.

Pfeffer, R.C., Conte, H.R., Plutchik, R., and Jerrett, I. (1979). Suicidal behavior in latency age children:
An empirical study. Journal of the American Academy of child Psychiatry, 18, 679-692.

Pynoos, R. (1985). Developmental perspectives on psychic trauma on childhood. In R. Figley (Ed.),

Trauma and its wake (pp. 56-64). New York: Brunner/Mazel.

Shakoor, B. and Chalmers, D. (1991). Co-victimization of African-American children who witness

violence and the theoretical implications of its effect on their cognitive, emotional and behavioral
development. Journal of the National Medical Association, 83, 233-238.

Singer, M.I, Anglin, T.M., Song, L.I., and Lunghofer, L. (1995) Adolescents' exposure to violence and
associated symptoms of psychological trauma. Journal of the American Medical Association, 273, 477-
482.

~~~~~~~~

By Elizabeth M. Cohen

Copyright of Current Psychology is the property of Transaction Publishers and its content may not be
copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written
permission. However, users may print, download, or email articles for individual use.
The link information above provides a persistent link to the article you've requested.

Persistent link to this record: Following the link above will bring you to the start of the article or citation.

Cut and Paste: To place article links in an external web document, simply copy and paste the HTML
above, starting with "<A HREF"

If you have any problems or questions, contact Technical Support at

http://support.epnet.com/contact/askus.php or call 800-758-5995.

This e-mail was generated by a user of EBSCOhost who gained access via the UNIVERSIDAD DE
BUENOS AIRES account. Neither EBSCO nor UNIVERSIDAD DE BUENOS AIRES is responsible for
the content of this e-mail.