Effects of perceived stress and resilience on suicidal behaviors in early adolescents


Suicidal behaviors are significant public health issues. The aim of the current study is to examine the effects of perceived stress and resilience on suicidal ideation (SI), plan (SP), and attempt (SA) among early adolescents. A longitudinal study was conducted with data collected from 1035 junior high-school students at baseline and 1-year follow-up. Participants were assessed for suicidal behaviors, resilience, and perceived stress. Logistic regression was performed to analyze for the associations between independent variables and suicidal behaviors. 210 (20.3%) of the participants reported to have SI, 59 (5.7%) had SP, and 49 (4.7%) had SA at baseline. Perceived stress was a strong risk factor (p < 0.001) for SI (OR 1.16–1.18), SP (OR 1.20–1.21), and SA (OR 1.12–1.16) while accounting for different dimensions of resilience. Students with persistent high stress during the 1-year follow-up period had significantly increased risk of SI (OR 7.14–9.64), SP (OR 3.92–6.37), and SA (OR 3.76–3.84) than the persistent low-stress group (p < 0.01). Increased perceived stress scale (PSS) (OR 2.89–3.15) and decreased PSS (OR 2.47) also had a higher risk for SI than persistent low PSS group. Moreover, students with high perceived stress who reported to have higher hope and optimism were less likely to show SI (OR 0.90, p = 0.001) and SP (OR 0.87, p = 0.002) at baseline, and the problem-solving and cognitive maturity mature dimension of resilience showed a significant protective effect on SP longitudinally (OR 0.25, p = 0.003). Perceived stress substantially increased the risk for suicidal behaviors, and moderates the protective effect of resilience on suicide. Considering both risk and protective factors of suicidal behaviors is essential in designing future suicide prevention and intervention programs.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Figure 3


  1. 1.

    World Health Organization (2018) Fact sheet of suicide. https://www.who.int/mediacentre/factsheets/fs398/en/. Accessed 19 June 2018

  2. 2.

    Department of Statistics in Ministry of Health and Welfare (2017) The analysis of statistical results of major cause of death in 2016. https://dep.mohw.gov.tw/DOS/lp-3352-113.html. Accessed 13 October 2017 (Chinese)

  3. 3.

    Klonsky ED, May AM, Saffer BY (2016) Suicide, suicide attempts, and suicidal ideation. Annu Rev Clin Psychol 12:307–330. https://doi.org/10.1146/annurev-clinpsy-021815-093204

    Article  PubMed  Google Scholar 

  4. 4.

    Silverman MM, Berman AL, Sanddal ND, O'Carroll PW, Joiner TE (2007) Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors: Part 2: Suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav 37:264–277. https://doi.org/10.1521/suli.2007.37.3.264

    Article  PubMed  Google Scholar 

  5. 5.

    McKinnon B, Gariépy G, Sentenac M, Elgar FJ (2016) Adolescent suicidal behaviours in 32 low- and middle-income countries. Bull World Health Organ 94:340–350F. https://doi.org/10.2471/BLT.15.163295

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Turecki G, Brent DA (2016) Suicide and suicidal behaviour. Lancet 387:1227–1239. https://doi.org/10.1016/S0140-6736(15)00234-2

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Tandon R, Nathani MK (2018) Increasing Suicide rates across asia—a public health crisis. Asian J Psychiatr 36:A2–a4. https://doi.org/10.1016/j.ajp.2018.09.006

    Article  PubMed  Google Scholar 

  8. 8.

    Snowdon J (2018) Differences between patterns of suicide in East Asia and the West: The importance of sociocultural factors. Asian J Psychiatr 37:106–111. https://doi.org/10.1016/j.ajp.2018.08.019

    Article  PubMed  Google Scholar 

  9. 9.

    Chang SS, Gunnell D, Sterne JA, Lu TH, Cheng AT (2009) Was the economic crisis 1997–1998 responsible for rising suicide rates in East/southeast Asia? A time-trend analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand. Soc Sci Med 68:1322–1331. https://doi.org/10.1016/j.socscimed.2009.01.010

    Article  PubMed  Google Scholar 

  10. 10.

    Chan WS, Law CK, Liu KY, Wong PW, Law YW, Yip PS (2009) Suicidality in Chinese adolescents in Hong Kong: the role of family and cultural influences. Soc Psychiatry Psychiatr Epidemiol 44:278–284. https://doi.org/10.1007/s00127-008-0434-x

    Article  PubMed  Google Scholar 

  11. 11.

    Chen CH, Chen YH, Chen CY, CShiu SS, Shao WC, Wang TN, Chen H, Tan HKL (2008) Factors associated with suicide ideations and attempts in adolescents. Taiwanese Journal of Psychiatry 22:57–66. https://doi.org/10.29478/TJP.200803.0007

  12. 12.

    Kang EH, Hyun MK, Choi SM, Kim JM, Kim GM, Woo JM (2015) Twelve-month prevalence and predictors of self-reported suicidal ideation and suicide attempt among Korean adolescents in a web-based nationwide survey. Aust N Z J Psychiatry 49:47–53. https://doi.org/10.1177/0004867414540752

    Article  PubMed  Google Scholar 

  13. 13.

    Kim HH-s (2016) The associations between parental involvement, peer network, and youth suicidality in China: evidence from the Global school-based student health survey (2003). Soc Sci J 53:77–87. https://doi.org/10.1016/j.soscij.2015.10.004

    Article  Google Scholar 

  14. 14.

    Lee CY, Lin MF, Tseng HF, Wang WL (2008) The prevalence of suicide risk behavior among high school students in southern Taiwan, and factors related thereto. J Evidence Based Nursing 4:71–81 (Chinese). https://doi.org/10.6225/jebn.4.1.71

    Article  Google Scholar 

  15. 15.

    Pan X, Zhang C, Shi Z (2011) Soft drink and sweet food consumption and suicidal behaviours among Chinese adolescents. Acta Paediatr 100:e215–e222. https://doi.org/10.1111/j.1651-2227.2011.02369.x

    Article  PubMed  Google Scholar 

  16. 16.

    Shek DTL, Yu L (2012) Self-harm and suicidal behaviors in Hong Kong adolescents: prevalence and psychosocial correlates. Sci World J. https://doi.org/10.1100/2012/932540

    Article  Google Scholar 

  17. 17.

    Abdollahi A, Talib MA, Yaacob SN, Ismail Z (2015) The role of hardiness in decreasing stress and suicidal ideation in a sample of undergraduate students. J Humanist Psychol 55:202–222. https://doi.org/10.1177/0022167814543952

    Article  Google Scholar 

  18. 18.

    Yeh ZT (2001) Negative mood regulation, anxiety, social support, life events and suicide ideations in adolescence: Chinese Annual report of guidance and counseling. https://doi.org/10.7082/CARGC.200109.0151

  19. 19.

    Wu CY, Yen CF, Yu LF (2007) A meta-analysis on risk factors in adolescent suicide. Taiwanese Journal of Psychiatry 21:271–281 (Chinese). https://doi.org/10.29478/TJP.200712.0005

  20. 20.

    Tu HT, Cheng JCC, Huang TM, Lin SR, See LC (2013) The epidemiology of suicide among adolescents and young adults in northern Taiwan. Cheng Ching Medical Journal 9:37–49 (Chinese).

    Google Scholar 

  21. 21.

    Tan L, Xia T, Reece C (2018) Social and individual risk factors for suicide ideation among Chinese children and adolescents: a multilevel analysis. Int J Psychol 53:117–125. https://doi.org/10.1002/ijop.12273

    Article  PubMed  Google Scholar 

  22. 22.

    Collishaw S (2015) Annual research review: Secular trends in child and adolescent mental health. J Child Psychol Psychiatry 56:370–393. https://doi.org/10.1111/jcpp.12372

    Article  PubMed  Google Scholar 

  23. 23.

    Bor W, Dean AJ, Najman J, Hayatbakhsh R (2014) Are child and adolescent mental health problems increasing in the 21st century? A systematic review. Aust N Z J Psychiatry 48:606–616. https://doi.org/10.1177/0004867414533834

    Article  PubMed  Google Scholar 

  24. 24.

    Wasserman D, Hoven CW, Wasserman C, Wall M, Eisenberg R, Hadlaczky G, Kelleher I, Sarchiapone M, Apter A, Balazs J, Bobes J, Brunner R, Corcoran P, Cosman D, Guillemin F, Haring C, Iosue M, Kaess M, Kahn J-P, Keeley H, Musa GJ, Nemes B, Postuvan V, Saiz P, Reiter-Theil S, Varnik A, Varnik P, Carli V (2015) School-based suicide prevention programmes: The SEYLE cluster-randomised, controlled trial. Lancet 385:1536–1544. https://doi.org/10.1016/S0140-6736(14)61213-7

    Article  PubMed  Google Scholar 

  25. 25.

    Hu T, Zhang D, Wang J (2015) A meta-analysis of the trait resilience and mental health. Pers Individ Dif 76:18–27. https://doi.org/10.1016/j.paid.2014.11.039

    Article  Google Scholar 

  26. 26.

    Chang HY, Song LY (2007) Adolescent resilience: The concept and related research analysis. Soochow J Soc Work 17:171–192. https://doi.org/10.29734/SJSW.200712.0006(Chinese)

    Article  Google Scholar 

  27. 27.

    Chan YC, Yeh YC, Peng YY, Yeh BL (2009) The development of the "Inventory of adolescent resilience". Psychological Testing 56:491–518. https://doi.org/10.7108/PT.200912.0491

    Article  Google Scholar 

  28. 28.

    Luthar SS, Cicchetti D, Becker B (2000) The construct of resilience: a critical evaluation and guidelines for future work. Child Dev 71:543–562. https://doi.org/10.1111/1467-8624.00164

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Breton JJ, Labelle R, Berthiaume C, Royer C, St-Georges M, Ricard D, Abadie P, Gérardin P, Cohen D, Guilé JM (2015) Protective factors against depression and suicidal behaviour in adolescence. Can J Psychiatry 60:S5–S15

    PubMed  PubMed Central  Google Scholar 

  30. 30.

    Wu PY, Tan TW, Tung YY (2012) The relationships among experiences of family violence, resilience and adolescent self-injurious. Journal of Research in Delinquency and Prevention 4:69–107. https://doi.org/10.29751/JRDP.201212.0003

  31. 31.

    Johnson J, Gooding PA, Wood AM, Tarrier N (2010) Resilience as positive coping appraisals: testing the schematic appraisals model of suicide (SAMS). Behav Res Ther 48:179–186. https://doi.org/10.1016/j.brat.2009.10.007

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Nagra GS, Lin A, Upthegrove R (2016) What bridges the gap between self-harm and suicidality? The role of forgiveness, resilience and attachment. Psychiatry Res 241:78–82. https://doi.org/10.1016/j.psychres.2016.04.103

    Article  PubMed  Google Scholar 

  33. 33.

    Stratta P, Capanna C, Carmassi C, Patriarca S, Di Emidio G, Riccardi I, Collazzoni A, Dell'Osso L, Rossi A (2014) The adolescent emotional coping after an earthquake: a risk factor for suicidal ideation. J Adolesc 37:605–611. https://doi.org/10.1016/j.adolescence.2014.03.015

    Article  PubMed  Google Scholar 

  34. 34.

    Burke TA, Connolly SL, Hamilton JL, Stange JP, Abramson LY, Alloy LB (2016) Cognitive risk and protective factors for suicidal ideation: a two year longitudinal study in adolescence. J Abnorm Child Psychol 44:1145–1160. https://doi.org/10.1007/s10802-015-0104-x

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Siegmann P, Teismann T, Fritsch N, Forkmann T, Glaesmer H, Zhang XC, Brailovskaia J, Margraf J (2018) Resilience to suicide ideation: a cross-cultural test of the buffering hypothesis. Clin Psychol Psychother 25:e1–e9. https://doi.org/10.1002/cpp.2118

    Article  PubMed  Google Scholar 

  36. 36.

    Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, Carli V, Höschl C, Barzilay R, Balazs J, Purebl G, Kahn JP, Sáiz PA, Lipsicas CB, Bobes J, Cozman D, Hegerl U, Zohar J (2016) Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry 3:646–659. https://doi.org/10.1016/S2215-0366(16)30030-X

    Article  PubMed  Google Scholar 

  37. 37.

    Chiu WH, Yang HJ, Kuo PH (2017) Chronotype preference matters for depression in youth. Chronobiol Int 34:933–941. https://doi.org/10.1080/07420528.2017.1327441

    Article  PubMed  Google Scholar 

  38. 38.

    Fu YZ, Zhang YH, Du SH, Liao PS (2014) Taiwan social change survey, round 4 of phase 6. Institute of Sociology Academia Sinica, Taipei

    Google Scholar 

  39. 39.

    Cohen S, Williamson GM (1988) Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S (eds) The social psychology of health: The claremont symposium on applied social psychology. Sage Publications, Thousand Oaks, CA, pp 31–67

    Google Scholar 

  40. 40.

    Lu W, Bian Q, Wang W, Wu X, Wang Z, Zhao M (2017) Chinese version of the perceived stress scale-10: a psychometric study in Chinese university students. PLoS ONE 12:e0189543. https://doi.org/10.1371/journal.pone.0189543

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Tsai YT, Li WL (2016) The study of the effect of team building for university students' resilience-a case in National Quemony University. J Phys Educ Fu Jen Catholic Univerity 15:41–55 (Chinese)

    Google Scholar 

  42. 42.

    Goldman-Mellor S, Gregory AM, Caspi A, Harrington H, Parsons M, Poulton R, Moffitt TE (2014) Mental health antecedents of early midlife insomnia: Evidence from a four-decade longitudinal study. Sleep 37:1767–1775. https://doi.org/10.5665/sleep.4168

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Kaneita Y, Yokoyama E, Harano S, Tamaki T, Suzuki H, Munezawa T, Nakajima H, Asai T, Ohida T (2009) Associations between sleep disturbance and mental health status: a longitudinal study of Japanese junior high school students. Sleep Med 10:780–786. https://doi.org/10.1016/j.sleep.2008.06.014

    Article  PubMed  Google Scholar 

  44. 44.

    Fraser SL, Geoffroy D, Chachamovich E, Kirmayer LJ (2015) Changing rates of suicide ideation and attempts among Inuit youth: a gender-based analysis of risk and protective factors. Suicide Life Threat Behav 45:141–156. https://doi.org/10.1111/sltb.12122

    Article  PubMed  Google Scholar 

  45. 45.

    Liu DWY, Fairweather-Schmidt AK, Roberts RM, Burns R, Anstey KJ (2014) Does resilience predict suicidality? A lifespan analysis. Arch Suicide Res 18:453–464. https://doi.org/10.1080/13811118.2013.833881

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Horwitz AG, Berona J, Czyz EK, Yeguez CE, King CA (2017) Positive and negative expectations of hopelessness as longitudinal predictors of depression, suicidal ideation, and suicidal behavior in high-risk adolescents. Suicide Life Threat Behav 47:168–176. https://doi.org/10.1111/sltb.12273

    Article  PubMed  Google Scholar 

  47. 47.

    Alavi A, Sharifi B, Ghanizadeh A, Dehbozorgi G (2013) Effectiveness of cognitive-behavioral therapy in decreasing suicidal ideation and hopelessness of the adolescents with previous suicidal attempts. Iran J Pediatr 23:467–472. https://doi.org/10.1016/j.neurenf.2012.04.266

    Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    McAuliffe C, Corcoran P, Keeley HS, Arensman E, Bille-Brahe U, De Leo D, Fekete S, Hawton K, Hjelmeland H, Kelleher M, Kerkhof AJ, Lonnqvist J, Michel K, Salander-Renberg E, Schmidtke A, Van Heeringen K, Wasserman D (2006) Problem-solving ability and repetition of deliberate self-harm: a multicentre study. Psychol Med 36:45–55. https://doi.org/10.1017/s0033291705005945

    Article  PubMed  Google Scholar 

  49. 49.

    Tyrer P, Thompson S, Schmidt U, Jones V, Knapp M, Davidson K, Catalan J, Airlie J, Baxter S, Byford S, Byrne G, Cameron S, Caplan R, Cooper S, Ferguson B, Freeman C, Frost S, Godley J, Greenshields J, Henderson J, Holden N, Keech P, Kim L, Logan K, Manley C, MacLeod A, Murphy R, Patience L, Ramsay L, De Munroz S, Scott J, Seivewright H, Sivakumar K, Tata P, Thornton S, Ukoumunne OC, Wessely S (2003) Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: The POPMACT study. Psychol Med 33:969–976. https://doi.org/10.1017/S0033291703008171

    CAS  Article  PubMed  Google Scholar 

  50. 50.

    Hetrick SE, Yuen HP, Bailey E, Cox GR, Templer K, Rice SM, Bendall S, Robinson J (2017) Internet-based cognitive behavioural therapy for young people with suicide-related behaviour (Reframe-IT): a randomised controlled trial. Evid Based Ment Health 20:76–82. https://doi.org/10.1136/eb-2017-102719

    Article  PubMed  Google Scholar 

  51. 51.

    Tang TC, Jou SH, Ko CH, Huang SY, Yen CF (2009) Randomized study of school-based intensive interpersonal psychotherapy for depressed adolescents with suicidal risk and parasuicide behaviors. Psychiatry Clin Neurosci 63:463–470. https://doi.org/10.1111/j.1440-1819.2009.01991.x

    Article  PubMed  Google Scholar 

  52. 52.

    Joshi SV, Hartley SN, Kessler M, Barstead M (2015) School-based suicide prevention: Content, process, and the role of trusted adults and peers. Child Adolesc Psychiatr Clin N Am 24:353–370. https://doi.org/10.1016/j.chc.2014.12.003

    Article  PubMed  Google Scholar 

  53. 53.

    Katz C, Bolton S-L, Katz LY, Isaak C, Tilston-Jones T, Sareen J (2013) A systematic review of school-based suicide prevention programs. Depress Anxiety 30:1030–1045. https://doi.org/10.1002/da.22114

    Article  PubMed  Google Scholar 

Download references


This work was supported by Ministry of Science of Technology grant (NSC101-2314-B-002–184-MY3; MOST 105–2628-B-002–028-MY3). We thank for all the participants in the study and Mei-Hsin Su, Pei-Chen Chu, Jen-Hsiu Shen, and Wen-Hsuan Chiu who assisted for data collection.


The funding has beeb received from Ministry of Science and Technology, Taiwan (TW) with Grant No. NSC101- 2314-B-002-184- MY3; Ministry of Science and Technology, Taiwan (TW) with Grant No. MST 105-2628-B-002-028-MY3.

Author information



Corresponding author

Correspondence to Po-Hsiu Kuo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was taken from all the students and their parents.


This study was approved by the ethical committee of National Taiwan University Hospital (No. 201202053RIC).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chen, YL., Kuo, PH. Effects of perceived stress and resilience on suicidal behaviors in early adolescents. Eur Child Adolesc Psychiatry 29, 861–870 (2020). https://doi.org/10.1007/s00787-019-01401-w

Download citation


  • Adolescent
  • Suicide
  • Stress
  • Resilience