The Treatment of Adolescent Suicide Attempters Study (TASA): Predictors of Suicidal Events in an Open Treatment Trial

ObjectiveTo identify the predictors of suicidal events and attempts in adolescent suicide attempters with depression treated in an open treatment trial.MethodAdolescents who had made a recent suicide attempt and had unipolar depression (n =124) were either randomized (n = 22) or given a choice (n = 102) among three conditions. Two participants withdrew before treatment assignment. The remaining 124 youths received a specialized psychotherapy for suicide attempting adolescents (n = 17), a medication algorithm (n = 14), or the combination (n = 93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute suicidal ideation necessitating emergency referral).ResultsThe morbid risks of suicidal events and attempts on 6-month follow-up were 0.19 and 0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence, and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the occurrence of a suicidal event.ConclusionsIn this open trial, the 6-month morbid risks for suicidal events and for reattempts were lower than those in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and increased therapeutic contact early in treatment may be warranted. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(10):987–996.     

Personality Characteristics of Adolescent Suicide Attempters

Objective: The purpose of this study was to explore both the personality characteristics and the symptoms of personality disorder of adolescent suicide attempters, as well as the relationship between personality variables and hopelessness in this population. Method: Two sample populations were used in this study. First, 102 adolescent suicide attempters between 13 and 18 years of age completed the Millon Adolescent Personality Inventory (MAPI) and the Hopelessness Scale for Children (HSC). A second group of 35 adolescent suicide attempters were administered the HSC and the revised Diagnostic Interview for Borderlines (DIB). Results: No distinctive personality characteristics or symptoms of personality disorders were found. However, affective distress seemed to be the most prominent feature in the presentation of these adolescents. Additionally, high scores on the HSC were associated with elevated scores on the Personality Style scales of the MAPI and higher (more dysfunctional) scores on Affect Regulation on the DIB. Conclusions: The results suggest that clinicians should focus most on the personality characteristic of sensitivity and on affect regulation when assessing adolescent suicide attempters. In addition, hopelessness is important to systematically assess because it appears to be related to a variety of dysfunctional personality characteristics that may affect follow-up outcome.     

The Role of Perfectionism and Depressive Cognitions in Understanding the Hopelessness Experienced by Adolescent Suicide Attempters

This study examined the relation of two cognitive variables, depressive cognitions and perfectionism, to the hopelessness experienced by adolescent suicide attempters. Adolescent suicide attempters (N = 68) were administered three measures assessing cognitive characteristics commonly associated with adolescent suicidal behavior: the Child and Adolescent Perfectionism Scale (CAPS), the Depressive Experiences Questionnaire for Adolescents (DEQ-A), and the Hopelessness Scale for Children (HSC). Socially prescribed perfectionism on the CAPS and self-criticism on the DEQ-A were both highly correlated with HSC. Regression analyses indicated that perfectionism was significantly related to hopelessness, but this relationship was attenuated after the effects of depressive cognitions on hopelessness were controlled. Self-criticism was the cognitive variable most strongly associated with hopelessness suggesting that it is a more important focus for cognitive interventions in adolescent suicide attempters than perfectionism.     

Clinical Characteristics and Precipitating Factors of Adolescent Suicide Attempters Admitted for Psychiatric Inpatient Care in South Korea

Objective

We aimed to examine the rates, correlates, methods, and precipitating factors of suicide attempts among adolescent patients admitted for psychiatric inpatient care from 1999 to 2010 in a university hospital in Korea.

Methods

The subjects consisted of 728 patients who were admitted for psychiatric inpatient care in a university hospital over a 12-year period and who were aged 10-19 years at the time of admission. We retrospectively investigated the information on suicidal behaviors and other clinical information by reviewing the subjects'' electronic medical records. Whether these patients had completed their suicide on 31 December 2010 was determined by a link to the database of the National Statistical Office.

Results

Among 728 subjects, 21.7% had suicidal ideation at admission, and 10.7% admitted for suicidal attempts. Female gender, divorced/widowed parents, and the presence of mood disorders were associated with a significantly increased likelihood of suicide attempts. Most common method of suicide attempts was cutting, and most common reason for suicide attempts was relationship problems within the primary support group. A diagnosis of schizophrenia was associated with increased risk of death by suicide after discharge.

Conclusion

These results highlight the role of specific psychosocial factor (e.g., relational problems) and psychiatric disorders (e.g., mood disorders) in the suicide attempts of Korean adolescents, and the need for effective prevention strategies for adolescents at risk for suicide.     

Suicidal Intent and the HPA-Axis Characteristics of Suicide Attempters with Major Depressive Disorder and Adjustment Disorders

The main purpose of the study was to investigate Hypothalamic-Pituitary-Adrenal (HPA) axis characteristics in relation to suicidal intent among suicide attempters with Major Depressive Disorder (MDD) and Adjustment Disorders (AD). The relationship between suicidal intent, assessed by means of the Suicidal Intent Scale (SIS), and serum cortisol after a Dexamethasone Suppression Test (DST) was investigated in 78 suicide attempters, divided into diagnostic subgroups. There was a significant negative correlation between suicidal intent and post DST cortisol in patients with MDD. Our findings may be attributed to pathophysiological processes, where a high suicidal intent is revealed during a potential chronic course of MDD, which in turnresults in a seemingly normal stress system.     

Parental Influences on Adolescent Major Depressive Symptoms and Marijuana Use

Adolescent depression is associated with many negative outcomes, including elevated marijuana use. Although parental influences on adolescent depressive symptoms and marijuana use have been examined independently, their interrelation remains understudied. The current research investigates the hypothesis that lower levels of parental monitoring and warmth are inversely associated with adolescent depressive symptoms and marijuana use. A path analytic approach (N = 12,115) on data from a representative US sample indicated depressive symptoms had an indirect effect on the relationship between parental warmth (p < .001), monitoring (p = .013), and adolescent marijuana use. Exploring relationships grouped by respondents’ age (12–14 and 15–17 years, respectively) revealed minor differences. Depressive symptoms had significant indirect effects on parental warmth and marijuana use (both p < .001) and on parental monitoring and marijuana use (both p < .05). Parental influences appear to play an important role in marijuana use among adolescents with depressive symptoms.

     

Depressive Symptoms Prospectively Predict Peer Victimization: A Longitudinal Study Among Adolescent Females

Child Psychiatry & Human Development - Research has consistently demonstrated a relationship between peer victimization, a major issue in early adolescence, and depression. However,...     

Characteristics of Recent Suicide Attempters with and without Borderline Personality Disorder

The present research compared recent suicide attempters with and without a diagnosis of Borderline Personality Disorder (BPD). One hundred and eighty recent suicide attempters, recruited in the Emergency Department, participated in extensive research interviews. Results showed that suicide attempters with BPD displayed greater severity of overall psychopathology, depression, hopelessness, suicidal ideation, past suicide attempts, and had poorer social problem solving skills than those without a BPD diagnosis. No differences were found between the groups regarding the intent to die or lethality associated with the index suicide attempt. These findings highlight the seriousness of BPD and the risk that individuals diagnosed with this disorder will attempt suicide.     

Degree of Suicide Intent and the Lethality of Means Employed: A Study of Chinese Attempters

This study was designed to determine if there is a relationship between the degree of suicide intent and the lethality of means employed by those who try to kill themselves. The study sample consists of 74 suicide attempters admitted to emergency rooms in a northeastern area of China. Structured interviews were performed with the patients and their companions to the hospital if necessary. It was found that the reason for the suicide attempt claimed by the highest percentage of attempters (35 of 74) was love/marriage issues, and there were significant gender differences in suicide reasons. It also was found that the choice of suicide means is generally independent of gender, and the lethality of means is positively correlated with the degree of suicide intent. One of the implications of the findings is a better understanding of the higher suicide rates for Chinese women than Chinese men. A hypothesis for future study on Chinese suicide may be that the high fatality rate of Chinese women who have swallowed poisonous pesticide is a function of the strong intent of death of the victim coupled with the well-known lethality of the pesticides.     

Child and Adolescent Clinical Features Preceding Adult Suicide Attempts

The objective of this study was to identify the predictive value of juvenile factors for adult suicidal behavior. We reviewed clinical records to compare factors identified in childhood and adolescence between adult suicidal versus nonsuicidal major affective disorder subjects. Suicide attempts occurred in 23.1% of subjects. Age-at-first-symptom was 14.2 vs. 20.2 years among suicidal versus nonsuicidal subjects (p < 0.0001). More prevalent in suicidal versus non-suicidal subjects by multivariate analysis were: depressive symptoms, hyper-emotionality, younger-at-first-affective-episode, family suicide history, childhood mood-swings, and adolescence low self-esteem. Presence of one factor yielded a Bayesian sensitivity of 64%, specificity of 50%, and negative predictive power of 86%. Several juvenile factors were associated with adult suicidal behavior; their absence was strongly associated with a lack of adult suicidal behavior.     

General Belonging is a Key Predictor of Adolescent Depressive Symptoms and Partially Mediates School Belonging

Rates of depression among adolescents are alarmingly high. School belonging is among the strongest predictors of adolescent depressive symptoms. Research in the adult literature indicates that context-specific belonging may contribute to an overarching sense of general belonging, which may be a stronger and more proximal predictor. This is the first study to explore the importance of general belonging among a community sample of adolescents to understand its interrelationship with school belonging in predicting depression. This multisite study includes 502 adolescents aged 13–17 from four geographically distinct Australian schools (rural, coastal, regional city, and capital city). Participants completed questionnaires measuring depressive symptoms, school, and general belonging. Confirmatory factor analysis demonstrated that school belonging, general belonging, and depressive symptoms are unique, separable constructs. Mediated regression revealed that school and general belonging accounted for 33.6% and 48.2% of the variance in depressive symptoms, respectively. General belonging partially mediated the association between school belonging and depressive symptoms, with school belonging expressing all but 7.8% of its influence on depression through general belonging. Results indicate that general belonging appears to have eclipsed school belonging as the largest known single independent correlate of adolescent depressive symptoms. Nevertheless, general belonging is strongly influenced by school belonging (accounting for approximately 35.0% of its variance). The strengths of the associations direct us to consider both context-specific and general belonging in the assessment, treatment, and prevention of adolescent depression.

     

Self-Injury Implicit Association Test: Comparison of Suicide Attempters and Non-attempters

Given the weaknesses of self-report measures, there has been an increased interest in alternative methods of suicide risk assessment, primarily the implicit measures of suicide risk. This study aimed to determine differences in implicit identification with self-injury and implicit attitude towards self-injury between attempters and non-attempters using the self-injury implicit association test (SI-IAT). The SI-IAT is a computer test designed to measure the implicit associations about self-injury. Participants were 100 forensic and civil inpatients at three psychiatric hospitals. A history of attempted suicide was very common in this sample. All participants completed the SI-IAT. Attempters and non-attempters did not significantly differ with respect to implicit identification with self-injury and implicit attitude towards self-injury. Implications are presented for assessment of suicide risk and future research.     

When the Pain Becomes Unbearable: Case-Control Study of Mental Pain Characteristics Among Medically Serious Suicide Attempters

The unbearable mental pain experience is recognized as a key antecedent of suicidal behavior. We aimed to examine the precise nature of the mental pain among medically serious suicide attempters (MSSAs), a population closely resembling those who died by suicide. We evaluated various factors of mental pain from the Orbach and Mikulincer Mental Pain Scale, as well as medical lethality and suicide intent. MSSAs were higher than non-MSSAs and psychiatric controls for Irreversibility of pain. Moreover, Emptiness predicted medical lethality, while Cognitive Confusion negatively predicted suicide intent level, controlling for hopelessness and depression. high sense of Irreversibility of pain as well as high Emptiness and low Cognitive Confusion are important risk factors for more severe suicidal behavior. Implications for identification of at-risk groups for suicide as well as for suicide prevention and treatment of suicidal individuals are discussed.     

Therapist Sensitivity Towards Emotional Life-career Issues and the Working Alliance with Suicide Attempters

This study investigated the usefulness of an action theoretical model of suicide in interviewing suicide attempters. Eighteen interviews were video-recorded and transcribed. The patients’ narratives were reconstructed and life-career issues relevant for the patient's suicidality formulated. Skin conductance response was used to determine narrative content associated with actualized emotions. Scores of the patients’ ratings of helping alliance experienced in the interview were positively associated with the therapists’ sensitivity towards emotionally relevant life-career issues. Furthermore, relationship satisfaction was related to a narrative interviewing style. We conclude that working alliance in clinical interviews with suicide attempters can be improved when the interviewer uses apatient-oriented approach aimed at understanding the patient's suicidality in the context of personal life-career, or identity issues.     

Bipolar Affective Disorders and Suicide During Psychiatric In-patient Treatment

ABSTRACT

On the basis of the known literature and our own results on patients' suicide, reflections are made with regard to the group of suicide cases with bipolar affective illnesses that commit suicide during inpatient psychiatric treatment. In our own studies, we diagnosed mania in as many as 8% of all suicide cases. Risk factors for suicidal behavior in bipolar affective disorder are discussed, especially in terms of psychopathology, and the social consequences of the disease are discussed.     

Gambling in Emerging Adulthood: the Role of Adolescent Depressive Symptoms,Antisocial Behaviors,and Alcohol Use

International Journal of Mental Health and Addiction - Emerging adults (ages 18–29) display higher prevalence of gambling participation and problem gambling as well as co-occurrence with...