Developmental Trajectories of Suicidal Thoughts and Behaviors From Adolescence Through Adulthood

Trajectories of suicidal risk among individuals with first-episode psychosis: Relationship to recovery and symptoms

This study examined trajectories of suicide-risk and their relationship to symptoms, recovery, and quality of life over time. Data was obtained from the Recovery after an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study. 404 individuals with first-episode psychosis (FEP) completed measures of suicide-risk, depression, positive symptoms, recovery, and quality of life at baseline, 6mo, 12mo, 18mo, and 24mo. Latent class analysis was used to identify temporal trajectories of suicide-risk. General linear mixed models for repeated measures were used to examine the relationship between the latent trajectories of suicide-risk and clinical variables. Results identified three latent trajectories of suicide-risk (low-risk, worsening, and improving). The low-risk and improving classes experienced improvements in depression, positive symptoms, quality of life, and recovery over time. The worsening class experienced improvements in positive symptoms and quality of life, but no change in depression or recovery. These results suggest that some individuals with FEP are at risk for persistent depression and worsening suicide-risk during treatment despite experiencing improvements in positive symptoms and quality of life. These findings have important clinical implications, as persistent depression and worsening suicide-risk might be masked by the primary focus on positive symptoms and quality of life in most FEP clinics.

Co-developmental trajectories of suicidal ideation and non-suicidal self-injury among Chinese adolescents: Transdiagnostic predictors and association with suicide attempts

INTRODUCTION

Adolescent suicidal ideation (SI) and non-suicidal self-injury (NSSI) are crucial public health issues, yet their co-developmental trajectories during early adolescence and their associations with predictors and outcomes are unclear. This study aimed to (a) identify heterogeneous co-developmental trajectories of SI and NSSI, (b) explore associations between transdiagnostic predictors and trajectories, and (c) assess suicide attempt risk across trajectories.

METHODS

Four hundred fifty-three adolescents (Mage = 12.35 years, 48.3% boys) completed surveys at 6-month intervals across 2 years. At Time 1 (Nov 2020), participants completed surveys encompassing SI, and NSSI, along with family, peer, and individual predictors. Subsequent surveys (Times 2-4) measured SI and NSSI, with suicide attempts queried at Time 4.

RESULTS

Parallel process latent class growth models revealed three co-developmental groups (i.e., Stable low NSSI and SI; Moderate-NSSI and high-SI, parallel decreasing; High-NSSI and moderate-SI, parallel increasing). Multivariate logistic regression indicated that group membership was predicted by parental rejection, parental warmth, bullying victimization, depressive and anxiety symptoms, thwarted belongingness, and perceived burdensomeness. Adolescents in the "High-NSSI and moderate-SI, parallel increasing" group reported the highest suicide attempt frequency.

CONCLUSION

These findings underscore subgroup distinctions and transdiagnostic predictors in comprehending SI and NSSI progression, emphasizing the necessity of dynamic monitoring and tailored interventions for distinct subgroup characteristics.

Emerging Risk of Adolescent Depression and Suicide Detected Through Pediatric Primary Care Screening

OBJECTIVE

The goal of the current study was to document patterns of stability and change in adolescent depression and suicide risk detected via universal depression screening in pediatric primary care and to determine who may go on to experience emerging risk.

METHODS

Retrospective electronic health record information (sociodemographic data and depression screening results for 2 timepoints) was extracted for adolescents aged 12-17 who attended well-visits between November 15, 2017, and February 1, 2020, in a large pediatric primary care network. A total of 27,335 adolescents with 2 completed depression screeners were included in the current study.

RESULTS

While most adolescents remained at low risk for depression and suicide across the 2 timepoints, others experienced emerging risk (i.e., low risk at time 1 but elevated risk at time 2), decreasing risk (i.e., high risk at time 1 but low risk at time 2) or stable high risk for depression or suicide. Odds of experiencing emerging depression and suicide risk were higher among adolescents who were female (compared to males), Black (compared to White), and had Medicaid insurance (compared to private insurance). Odds of experiencing emerging depression risk were also higher among older adolescents (compared to younger adolescents) as well as adolescents who identified as Hispanic/Latino (compared to non-Hispanic/Latino).

CONCLUSIONS

Findings can inform symptom monitoring and opportunities for prevention in primary care.

Associations between humiliation, shame, self-harm and suicidality among adolescents and young adults: A systematic review

BACKGROUND

Suicide is the second leading cause of death among young people worldwide. Research indicates that negative social contexts involving familial and peer relationships have far-reaching influences on levels of suicidality in later life. While previous systematic reviews have focused on evaluating associations between negative life events such as abuse and bullying in childhood and subsequent suicidality, this systematic review examines the prevalence of, and association between the processes of humiliation and shame in later self-harm, suicidal ideation, and suicide among adolescents and young adults.

METHODS

A systematic literature search of databases including MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, and Embase was conducted to identify potential studies. ProQuest was searched to identify relevant grey literature research. A combination of MESH terms and keywords was used. All original quantitative studies published in English that examined the prevalence, or association between humiliation or shame and suicidal behaviours and/or death by suicide were included. Studies were assessed for methodological quality using Joanna Briggs Institute critical appraisal tools. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022289843].

RESULTS

Narrative synthesis was performed. A total of 33 studies reporting the prevalence of, or association between humiliation (n = 10) or shame (n = 23) and suicidal thoughts/behaviours were included. The prevalence of humiliation among those with any suicidality ranged from 18% to 28.1%, excluding an outlier (67.1%), with two studies presenting a significant association between humiliation and self-harm in their fully adjusted analyses. The studies that outlined humiliation and suicidal thinking (intent/suicide plan) had no association after adjustment for confounders. For shame, half of the studies found an association in adjusted models (n = 10), and this was evident for both suicidal ideation and self-harm.

CONCLUSION

To our knowledge, this is the first study to attempt a systematic review on this topic. The dearth of research in this field of enquiry is reflective of unique challenges associated with assessments of humiliation and shame in various clinical settings amongst adolescent and young adult populations. Nonetheless, given the importance and relevance of the psychological imprint of humiliation in youth morbidity and mortality in the field of mental health, it is timely to attempt such a systematic review. In light of the associated role of humiliation and shame in self-harm and suicidality among young people, we recommend that these processes need to be explored further via prospective studies and assessed as part of a comprehensive bio-psycho-social assessment when focusing on life stressors for adolescent and young adults presenting with suicidality to emergency departments and mental health services.

Heterogeneous trajectories of suicidal ideation among homeless youth: predictors and suicide-related outcomes

The current study examined heterogeneous trajectories of suicidal ideation among homeless youth experiencing suicidal ideation over 9 months in a randomized controlled intervention study. Suicidal homeless youth (N = 150) were randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Treatment as Usual (TAU) or TAU alone. Youth reported their suicidal ideation four times during a 9-month period. We also assessed pretreatment mental health, demographic information and session attendance as predictors of the subgroups, as well as suicide-related factors as outcomes at the 9-month follow-up. Growth mixture models suggested three distinct trajectory groups among youth: Fast Declining (74.7%), Chronic (19.3%), and Steadily Declining (6.0%). Youth in the Chronic group used more substances at baseline than the Steadily Declining group, were more likely to be White, non-Hispanic than the Fast Declining group, and attended more CTSP sessions than other groups. Contrastingly, youth in the Steadily Declining group all experienced childhood abuse. Finally, youth in the Chronic group showed significant higher risk for future suicide compared to those in the Fast Declining group at 9 months. Findings support the heterogeneity of treatment responses in suicide intervention among homeless youth, with implications to improve treatment efforts in this very high-risk population.

Long-term trajectories of suicide ideation and its socioeconomic predictors: A longitudinal 8-year follow-up study

OBJECTIVE

Suicide ideation is the first stage of suicide behavior, and the long-term course of suicide ideation is highly variable. The aim of this study is to identify trajectories of suicide ideation over an 8-year period and explore the association of socioeconomic status (SES) with suicide ideation trajectories.

METHODS

We included 10,017 participants from Waves 7-15 of the Korea Welfare Panel Study; these have data on suicidal ideation (2012-2020). Trajectories analysis was conducted to identify distinct trajectories of suicidal ideation. Multinomial logistic regression was used to examine associations of SES with suicidal ideation trajectories. The interaction effects between current SES and prospective economic condition on trajectories were examined using a synergy index (SI).

RESULTS

We identified three suicide ideation trajectory groups: low-stable, moderate-decreasing, and high-persistent. Individuals in both moderate-decreasing and high-persistent trajectories had poorer current SES and prospective economic conditions than low-stable trajectories. Interestingly, those reporting poorer prospective economic conditions had a greater risk of being in a high-persistent trajectory than being in a moderate-decreasing trajectory. Further, individuals with poorer current SES and prospective economic conditions were more likely to be in the high-persistent trajectory.

CONCLUSIONS

Our findings demonstrated three distinct trajectories of suicide ideation which provide useful information for specific preventive interventions that could be developed. Moreover, poor prospective economic condition is a significant predictor of the high-persistent suicide ideation trajectory. Supporting economic difficulties and helping make goals and plans to strengthen positive thinking would help attenuate suicidal ideation and prevent suicidal behavior.

Trajectory of suicidal ideation among medical students during the COVID-19 pandemic: the role of childhood trauma

BACKGROUND

The aim of this study was to understand the longitudinal trajectory of suicidal ideation (SI) among Chinese medical students and the role of childhood trauma (CT).

METHODS

Using a whole-group sampling method, we assessed SI in 2192 (male = 834, female = 1358) medical students on three occasions over a period of one year. The Suicidal Ideation Self-Assessment Scale (SISAS) and the Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess SI and CT. The growth mixture modeling (GMM) was used to classify the developmental trajectory of SI.

RESULTS

A greater number of medical students were experiencing suicidal ideation during the COVID-19 pandemic. The trajectory of SI among medical students was divided into two groups: a low risk, slowly rising group and a high risk, continuous group. The low risk, slowly rising group had a significant time effect (B = 1.57, p < 0.001) and showed a slowly increasing trend. Emotional neglect (EN), physical neglect (PN), emotional abuse (EA) and physical abuse (PA) all had significant positive predictive effects for the high risk, continuous group (B = 0.18-0.65, P < 0.01).

CONCLUSION

The trajectory of SI among medical students can be divided into a low risk, slowly rising group and a high risk, continuous group; the more EN, PN, EA and PA experienced during childhood, the more likely medical students are to develop a high risk, continuous state of SI.

Brain grey and white matter structural associations with future suicidal ideation and behaviors in adolescent and young adult females with mood disorders

Background

To reduce suicide in females with mood disorders, it is critical to understand brain substrates underlying their vulnerability to future suicidal ideation and behaviors (SIBs) in adolescence and young adulthood. In an international collaboration, grey and white matter structure was investigated in adolescent and young adult females with future suicidal behaviors (fSB) and ideation (fSI), and without SIBs (fnonSIB).

Methods

Structural (n = 91) and diffusion-weighted (n = 88) magnetic resonance imaging scans at baseline and SIB measures at follow-up on average two years later (standard deviation, SD = 1 year) were assessed in 92 females [age(SD) = 16.1(2.6) years] with bipolar disorder (BD, 28.3%) or major depressive disorder (MDD, 71.7%). One-way analyses of covariance comparing baseline regional grey matter cortical surface area, thickness, subcortical grey volumes, or white matter tensor-based fractional anisotropy across fSB (n = 40, 43.5%), fSI (n = 33, 35.9%) and fnonSIB (n = 19, 20.6%) groups were followed by pairwise comparisons in significant regions (p < 0.05).

Results

Compared to fnonSIBs, fSIs and fSBs showed significant decreases in cortical thickness of right inferior frontal gyrus pars orbitalis and middle temporal gyrus, fSIs of left inferior frontal gyrus, pars orbitalis. FSIs and fSBs showed lower fractional anisotropy in left uncinate fasciculus and corona radiata, and fSBs in right uncinate and superior fronto-occipital fasciculi.

Conclusions

The study provides preliminary evidence of grey and white matter alterations in brain regions subserving emotional and behavioral regulation and perceptual processing in adolescent and young adult females with mood disorders with, versus without, future SIBs. Findings suggest potential targets to prevent SIBs in female adolescents and young adults.

Assessing Suicidal Ideation in Young People With Depression: Factor Structure of the Suicidal Ideation Questionnaire

Evaluating suicidal ideation in young people seeking mental health treatment is an important component of clinical assessment and treatment planning. To reduce the burden of youth suicide, we need to improve our understanding of suicidal ideation, its underlying constructs, and how ideation translates into suicidal behaviour. Using exploratory factor analysis, we investigated the dimensionality of the Suicidal Ideation Questionnaire (SIQ) among 273 participants aged 15-25 with Major Depressive Disorder. Area under the receiver operating characteristic curve (AUROC) analysis was used to explore associations between latent factors and actual suicidal behaviour. Findings suggested that the SIQ assesses multiple factors underlying suicidal ideation. AUROC analyses demonstrated that latent factors relating to both active and passive suicidal ideation predicted past-month suicidal behaviour and suicide attempt. These findings contribute to an improved understanding of the complexities of suicidal ideation and relationships with suicidal behaviour in young people with depression.

Factors Influencing Suicide Attempts of Adolescents with Suicidal Thoughts in South Korea: Using the 15th Korean Youth Risk Behavior Web-Based Survey (KYRBS)

Background

Adolescence is a period of physical and psychological change that causes adolescents to experience anxiety, stress, and loss of control. These experiences can lead to thoughts about suicide. However, not all adolescents with suicidal thoughts attempt suicide. This study aimed to identify the factors that influence suicide attempts among adolescents with suicidal thoughts, and to prepare a theoretical basis for a method to prevent suicide among adolescents.

Methods

In this descriptive cross-sectional study, the 15th Korean Youth Risk Behavior Web-Based Survey (2019) was used. The participants were 7,498 adolescents aged 12-18 yr with thoughts of suicide. Factors influencing suicide attempts among adolescents with suicidal thoughts were analyzed using a complex sample logistic analysis.

Results

Gender, age, academic performance, and economic level were the general factors associated with suicide attempts of adolescents with suicidal thoughts. Physical and psychological factors included smoking, alcohol use, drug use, sex-related experience, experiencing violence, efforts to reduce weight, level of physical activity, and depression.

Conclusion

Age and gender should be taken into consideration when designing suicide prevention activities. In addition, in order to lower the suicide rate of adolescents in Korea, an effective system of prevention and intervention strategies should be implemented, which attend to the issues of adolescents from low-income families, adolescent weight and body image concerns, and adolescent depression.

Temporal profiles of suicidal thoughts in daily life: Results from two mobile-based monitoring studies with high-risk adolescents

Advancements in mobile technology offer new possibilities to examine fine-grained processes underlying suicidal ideation in everyday, real-world conditions. Across two samples, this study examined temporal changes in near-term suicidal ideation in high-risk adolescents' daily life, and whether these dynamic experiences follow distinct longitudinal trajectories. Using latent process mixed modeling for multivariate outcomes, we investigated near-term changes in two parameters of suicidal thoughts (frequency and intensity) among adolescents who completed four-daily ecological momentary assessments (EMAs) during inpatient hospitalization (Sample 1: N = 61; 843 observations) or daily surveys for four weeks after discharge (Sample 2: N = 78; 1621 observations). Proximally assessed suicidal thoughts followed three trajectories characterized by low (Sample 1: 65.6%; Sample 2: 54%), declining (Sample 1: 4.9%; Sample 2: 15%), or persistently high (Sample 1: 29.5%; Sample 2: 31%) ideation in terms of frequency and urge severity. The persistent trajectory also showed consistently high within-person variability. The persistent group was differentiated by higher hopelessness and lower coping self-efficacy compared to the declining trajectory, and by an overall more severe clinical presentation relative to the low ideation trajectory. Suicidal thoughts in everyday life, across two contexts and regardless of data resolution (EMA and daily surveys), are not homogeneous and instead follow distinct longitudinal profiles. Findings point to the importance of closely monitoring suicidal ideation to identify patterns indicative of unrelenting suicidal thinking. Addressing high hopelessness and low self-efficacy may aid in reducing persistent ideation. Improving our understanding of how suicidal ideation unfolds in real-time may be critical to optimizing timely assessment and support.

Assessing Prevalence and Unique Risk Factors of Suicidal Ideation among First-Year University Students in China Using a Unique Multidimensional University Personality Inventor

BACKGROUND

University students with suicidal ideation are at high risk of suicide, which constitutes a significant social and public health problem in China. However, little is known about the prevalence and associated risk factors of suicidal ideation among first-year university students in China, especially during the COVID-19 pandemic.

OBJECTIVES

To investigate the prevalence of suicidal ideation and its factors in first-year Chinese university students from a vocational college in Zhejiang during the COVID-19 pandemic.

METHODS

Using a cluster sampling technique, a university-wide survey was conducted of 686 first-year university students from Hangzhou in March 2020 using University Personality Inventory (UPI). UPI includes an assessment for suicidal ideation and possible risk factors. Suicidal ideation prevalence was calculated for males and females. Univariate analysis and multivariable logistic regression models were conducted, adjusting for age and sex. Analyses were carried out using the SPSS version 22.0 software.

RESULTS

The prevalence of 12-month suicidal ideation among first-year university students during March 2020 was 5.2%, and there was no significant difference between males and females (4.8% vs. 6.0%, x2 = 0.28, p = 0.597). Multivariable logistic regression analysis identified social avoidance (B = 0.78, OR = 2.17, p < 0.001) and emotional vulnerability (B = 0.71, OR = 2.02, p < 0.001) as positively associated with suicidal ideation.

CONCLUSIONS

Social avoidance and emotional vulnerabilities are unique factors associated with greater suicidal ideation among first-year university students during the COVID-19 pandemic. UPI serves as a validated tool to screen suicide risks among Chinese university students. Encouraging social engagement and improving emotional regulation skills are promising targets to reduce suicidal ideation among first-year university students.

Future Well-Being Among U.S. Youth Who Attempted Suicide and Survived

To what extent does a suicide attempt impair a person's future well-being? We estimated the prevalence of future well-being (FWB) among suicide attempt survivors using a nationally representative sample of 15,170 youths. Suicide attempt survivors were classified as having high FWB if they reported (a) a suicide attempt at Wave I, (b) no suicidal ideation or attempts over the past year at Wave III (7 years after), and (c) a well-being profile at or above the top quartile of nonsuicidal peers. Seventy-five of 574 suicide attempt survivors (∼13%) met criteria for FWB at Wave III, compared to 26% of nonsuicidal peers. Wave I well-being levels, not depressive symptoms, predicted the likelihood of FWB at Wave III (OR = 1.23, 95% CI [1.05, 1.44], p < .05). In conclusion, a nonfatal suicide attempt reduced but did not preclude FWB in a large national sample. The observation that a segment of the population of suicide attempt survivors achieves FWB carries implications for the prognosis of suicidal behavior and the value of incorporating well-being into investigations of suicide-related phenomena.

Longitudinal predictors of suicidal ideation: Emerging to early adulthood

Few studies have examined the longitudinal trajectory of suicidal ideation (SI) in community samples, particularly during emerging adulthood. Additionally, there is scant data on predictors of longer-term course of SI across this period. We examined multiple domains of adolescent psychosocial and clinical functioning as predictors of SI trajectory and explored whether biological sex moderates those associations. The data came from the Oregon Adolescent Depression Project. Participants completed self-reports of psychosocial and clinical functioning and interviews assessing psychopathology in mid-late adolescence. SI was assessed using up to seven annual mailer assessments spanning ages 19-31. Multilevel growth models found that SI declined across emerging adulthood. Multiple indices of adolescent functioning were associated with higher levels of SI three years later. Few adolescent functioning constructs predicted faster reductions in SI, and no constructs predicted slower longitudinal reductions (or increases) in SI. Similar associations were found when controlling for adolescent SI. Lastly, we found little evidence for sex differences in these associations. This work shows that adolescent functioning is largely associated with initial and enduring levels of SI. Moreover, associations were similar between sexes. Given the modest associations found across long periods of time, future research should focus on proximal risk factors for SI.

Community-based participatory research: Suicide prevention for youth at highest risk in Guyana

Studied mostly in developed countries, the increased prevalence of suicide among youth, worldwide, is a preventable public health concern. Guyana, a developing country in South America, has the highest rate of youth death by suicide. Based on the diathesis-stress model, this community-based study aimed to identify both psychiatric and biological factors associated with repeated suicide attempts among high-risk youth.

OBJECTIVE

We measured psychiatric symptoms, childhood traumas, and cortisol to identify correlates with recurrent suicide attempts.

METHOD

Poisson regression tested the association between psychiatric symptoms, trauma, and cortisol levels on number of suicide attempts among 50 youths from three child welfare orphanages in Guyana. Sixty-six percent were female, and the average age was 14 years. DSM-5 symptom measure was administered and saliva samples collected.

RESULTS

Fifty percent of the youth endorsed suicide attempt. Within this subsample, a minimum of one and maximum of five suicide attempts were self-reported. Participants' number of suicide attempts was positively associated with number of past traumas, psychosis, and depression symptoms.

CONCLUSION

Suicide prevention screening among at-risk youth should target severity of psychosis and depression reports and number of traumatic life experiences.

Feasibility of an Integrated Treatment Approach for Youth with Depression, Suicide Attempts, and Substance Use Problems

Depression, suicidal behaviors and substance use problems frequently co-occur, and treatment for youth with these co-occurring problems is often fragmented and challenging. An integrated cognitive-behavioral treatment approach that builds upon a relapse prevention framework and applies common core skills, language, and approach for treating these related problems may be clinically beneficial. Following a description of the integrated approach, we present results of a pilot trial (n = 13) to examine the acceptability and feasibility of the Cognitive-Behavioral Therapy - Relapse Prevention (CBT-RP) intervention plus enhanced treatment as usual (TAU) compared to enhanced TAU alone. The feasibility of the CBT-RP + TAU intervention was reflected by high rates of retention (86%). The acceptability was reflected in positive evaluations regarding the helpfulness of the intervention by adolescents and families. The majority of youth in both CBT-RP + TAU and TAU alone groups evidenced reductions in depression and suicide ideation from study entry to Week 20. Patterns of reduction were more consistent, however, for youth receiving CBT-RP + TAU, and reductions were slower to emerge for some youth receiving TAU alone. Reductions in alcohol and marijuana problems were similar, but half of the youth in TAU alone (and none in the CBT-RP + TAU group) had emergency department visits related to psychiatric crises or substance related problems. These findings, although based on a small sample, underscore the feasibility and acceptability of an integrated cognitive-behavioral relapse prevention approach for youth with depression, suicide attempt histories, and substance use problems.

Incidence and Risk Factors for Suicide Attempts in Patients Diagnosed with Major Depressive Disorder

Objective

This study seeks to investigate the cumulative incidence and risk factors of suicide attempts in an outpatient sample of adults diagnosed with major depressive disorder (MDD).

Materials and Methods

This is a longitudinal study with 377 patients aged between 18 and 60 years. Those were diagnosed with MDD with no history of suicide attempts when they sought care at the Mental Health Outpatient Clinic of the Catholic University of Pelotas and evaluated again 3 years after. Participants were evaluated with the Mini International Neuropsychiatric Interview (MINI Plus) and answered instruments of clinical investigation and a sociodemographic questionnaire.

Results

The cumulative incidence of suicide attempts in the sample was 10.1%. Youths aged up to 29 years (OR 2.23; 95% CI 1.13 to 4.64), with low schooling (OR 2.35; 95% CI 1.15 to 4.80), who suffered intense physical abuse during childhood (OR 2.77; 95% CI 1.31 to 5.84) and were at prior suicide risk (OR 3.39; 95% CI 1.56 to 7.37) were more likely to attempt suicide.

Conclusion

The findings of this study may help health professionals identify depressed patients at greater risk for a first suicide attempt, supporting clinical decision and therapeutic planning.

Bayesian estimation and model selection in group-based trajectory models

We develop a Bayesian group-based trajectory model (GBTM) and extend it to incorporate dual trajectories and Bayesian model averaging for model selection. Our framework lends itself to many of the standard distributions used in GBTMs, including normal, censored normal, binary, and ordered outcomes. On the model selection front, GBTMs require the researcher to specify a functional relationship between time and the outcome within each latent group. These relationships are generally polynomials with varying degrees in each group, but can also include additional covariates or other functions of time. When the number of groups is large, the model space can grow prohibitively complex, requiring a time-consuming brute-force search over potentially thousands of models. The approach developed in this article requires just one model fit and has the additional advantage of accounting for uncertainty in model selection. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Characteristics of a First Suicide Attempt that Distinguish Between Adolescents Who Make Single Versus Multiple Attempts

Although a history of a suicide attempt is the strongest predictor of future suicide attempts, not all adolescents who make an attempt engage in repetitive suicidal behavior. The present study sought to determine whether certain characteristics of a first suicide attempt (e.g., age of first attempt, method of attempt used, intent seriousness, medical lethality, and receipt of treatment after attempt) can distinguish between adolescents who make single versus multiple suicide attempts. Adolescents (N = 95) who were psychiatrically hospitalized and their guardian completed a diagnostic interview to gather information on all lifetime suicide attempts. A multivariate hierarchical logistic regression was conducted, predicting single attempt versus multiple attempt status. Of the first-attempt characteristics examined, only age of first attempt, OR = 0.33, 95% CI [0.17-0.63], p = .001, and receipt of treatment following attempt, OR = 0.28, 95% CI [0.09-0.88], p = .028, significantly distinguished SA vs. MA status, even after controlling for current age and depression at the time of first attempt. Female and White participants were overrepresented in this sample, which limits generalization to more heterogenous and diverse samples. The cross-sectional nature of data introduces the potential for retrospective recall bias. Younger age of first attempt and lack of receipt of mental health treatment following a first attempt were associated with multiple attempt status. These findings highlight the importance of early mental health screening, parental psychoeducation, and linkage to mental health care after a suicide attempt.

Adolescent self-harm and suicidal behavior and young adult outcomes in indigenous and non-indigenous people

The aim of this study was to examine the associations between self-harm and suicidal behavior in indigenous Sami and non-Sami adolescents and mental health and social outcomes in young adulthood. Data were obtained by linking the Norwegian Patient Registry (2008-2012), the National Insurance Registry (2003-2013), and the Norwegian Arctic Adolescent Health Study, a school-based survey inviting all 10th grade students in North Norway (2003-2005). In total, 3987 (68%) of all 5877 invited participants consented to the registry linkage, of whom 9.2% were indigenous Sami. Multivariable logistic regression was used to explore the associations between self-harm only, suicidal ideation with and without self-harm, and suicide attempts in adolescence (≤16-year-old), and later mental health disorders, long-term medical, social welfare benefit receipt, or long-term unemployment in young adulthood. Self-harm and suicidal behavior in Sami and non-Sami adolescents were associated with increased risk of later mental health disorders, long-term welfare benefit receipt, and long-term unemployment. These associations were attenuated by adolescent psychosocial problems. No major differences between the indigenous Sami participants and their non-Sami peers were found. Young suicide attempters experienced the highest risk, with adolescent suicide attempts being significantly associated with all four adult outcomes after adjustment. Self-harm and suicidal behavior in adolescence are markers of mental health disorders and unfavorable social outcomes in young adulthood, mostly accounted for by adolescent psychosocial problems. In contrast to other indigenous peoples, no indigenous health disparities were found, indicating that the indigenous Sami adolescents were not worse off.

Association of Child Placement in Out-of-Home Care With Trajectories of Hospitalization Because of Suicide Attempts From Early to Late Adulthood

Importance

Children placed in out-of-home care (OHC) have higher rates of suicidal behaviors, including suicide attempts, compared with those who grow up in their family of origin. Several studies have shown that this elevated risk persists into young adulthood. Yet, our knowledge about any longer-term associations of OHC with suicide attempts is limited.

Objective

To examine how childhood experiences of placement in OHC are associated with trajectories of hospitalization because of suicide attempts (HSA) from early into late adulthood.

Design, Setting, and Participants

This prospective birth cohort study that was conducted in Stockholm, Sweden, and analyzed in March 2020 included 14 559 individuals born in 1953 who were living in the greater metropolitan of Stockholm in November 1963 and followed through registers up until December 2016.

Exposures

Childhood experiences of OHC based on information from the Social Register (age 0-19 years).

Main Outcomes and Measures

Hospitalization because of suicide attempts based on in-patient care data from the National Patient Register. Group-based trajectory modeling was used to cluster individuals according to their probabilities of HSA across adulthood (age 20-63 years).

Results

In this cohort of 14 559 individuals (7146 women [49.1%]), 1320 individuals (9.1%) had childhood experiences of OHC, whereas 525 individuals ( 3.6%) had HSA. A Cox regression analysis showed a substantially higher risk of HSA among those with childhood experiences of OHC (hazard ratio, 3.58; 95% CI, 2.93-4.36) and after adjusting for a range of adverse childhood living conditions (hazard ratio, 2.51; 95% CI, 2.00-3.15). Those with at least 1 HSA were grouped into 4 trajectories: (1) peak in middle adulthood (66 [12.6%]), (2) stable low across adulthood (167 [31.8%]), (3) peak in early adulthood (210 [40.0%]), and (4) peak in emerging adulthood (82 [15.6%]). A multinomial regression analysis suggested that those with experiences of OHC had higher risks of following any of these trajectories (trajectory 1: relative risk ratio [RRR], 2.91; 95% CI, 1.61-5.26; trajectory 2: RRR, 3.18; 95% CI, 2.21-4.59; trajectory 3: RRR, 4.32; 95% CI, 3.18-5.86; trajectory 4: RRR, 3.26; 95% CI, 1.94-5.46). The estimates were reduced after adjusting for adverse childhood living conditions.

Conclusions and Relevance

The findings suggest that the elevated risk of suicide attempts among former child welfare clients does not cease after young adulthood, indicating the necessity for clinical attention to childhood experiences of OHC as a risk marker for suicidal behavior across the life span.

Suicidal Behavior in Adolescents: A Latent Class Analysis

The main goal of the present study was to identify and validate latent classes of suicidal behavior in a representative sample of adolescents. The sample comprised a total of 1506 students, including 667 males (44.3%), selected through a sample stratified by clusters. The mean age was 16.15 years (SD = 1.36). The instruments used evaluated suicidal behavior, positive and negative affect, emotional and behavioral problems, prosocial behavior, and subjective well-being. Using the Paykel Suicide Scale, the latent class analysis identified four homogeneous subgroups: “low risk”, “suicidal act”, “suicidal ideation”, and “high risk for suicide”. These subgroups presented a differential pattern in terms of their social-emotional adjustment. The subgroups with the highest theoretical risk showed lower scores on subjective well-being and positive affect as well as higher scores on emotional and behavioral problems and negative affect compared to the non-risk subgroups. This study contributes to an understanding of the typologies of suicidal behavior among adolescents and the relationship with psychopathological adjustment. Ultimately, these findings may promote the development or improvement of early detection and prevention strategies in the suicidal behavior field in order to reduce the socio-economic burdens associated with suicide in young populations.

Are Suicidal Thoughts and Behaviors a Temporary Phenomenon in Early Adolescence?

Abstract.Background: The incidence of first suicidal thoughts and behaviors (STBs) peaks during early adolescence. After experiencing their first STBs, adolescents differ greatly in the extent to which they continue to have STBs. Aim: We determined the course of STBs in Dutch students at two ages: 13–14 years (t1) and 15–16 years (t2). Methods: Longitudinal data on STBs and sociodemographic factors were collected by self-report (n = 8,499). Associations between having STBs at t1 and t2 were determined with multinomial logistic regression analysis. Results: Students who reported suicidal thoughts at baseline (n = 1,077; 13%) reported suicidal thoughts (OR = 6.60; 95% CI [5.52, 7.88]) and suicidal attempts (OR = 6.97; 95% CI [4.20, 11.54]) at t2 more often than students with no STBs at t1. Students who reported a suicidal attempt at baseline (n = 144; 2%) also reported suicidal thoughts and suicidal attempts more often at t2 (OR = 5.98; 95% CI [3.89, 9.21]; OR = 30.00; 95% CI [15.84, 56.82], respectively). Limitations: The use of confidential self-reported data and the loss of cases after merging could have biased the results. Conclusion: For a subgroup of adolescents, STBs persisted and worsened over the 2 years. This demonstrates the importance of accurate identification of those at increased risk of suicide, in combination with personalized care.

Maladaptive mood repair predicts suicidal behaviors among young adults with depression histories

BACKGROUND

As the rates of suicidal behaviors continue to rise, research is needed that can facilitate prevention. The present study therefore examined whether a modifiable process, dysfunctional regulation of sadness (maladaptive mood repair), predicts a range of suicidal behaviors and if its impact is affected by risk and protective factors.

METHODS

Young adults with histories of childhood-onset mood disorder (COMD) (n = 173) or no histories of major psychiatric illness (controls, n = 96) were followed for approximately 3 years. Self-rated questionnaires and psychiatric evaluations were administered at study entry (T1) and across the follow-up (T2) and clinicians assessed the DSM-range of non-fatal suicidal behaviors. We hypothesized that the impact of depression on suicidal behaviors was mediated by dysfunctional regulation of sadness.

RESULTS

At T1, 90% of the COMD group had histories of various suicidal behaviors; 63% had past suicide attempts. During follow-up, 40% exhibited suicidal behaviors; 7% reported suicide attempts. Controlling for prior suicidal behaviors, T1 maladaptive mood repair predicted suicidal behavior during the follow-up and differentiated recurrent thoughts of death from other forms of suicidality. Protective and risk factors lost their predictive power in the presence of maladaptive mood repair.

LIMITATIONS

Few control cases exhibited suicidal behavior during the follow-up and the high inter-correlations among several key variables constrained the models that could be fitted.

CONCLUSIONS

Programs to prevent suicidal behavior among high-risk individuals should include maladaptive mood repair as an intervention target. Further research is needed on whether recurrent thoughts of death constitute a valid index of suicidality.

Longitudinal course of suicidal ideation and predictors of its persistence - A NESDA study

BACKGROUND

Prior research indicates that the factors that trigger suicidal ideation may differ from those that maintain it, but studies into the maintenance of suicidal ideation remain scarce. Our aim was to assess the longitudinal course of suicidal ideation, and to identify predictors of persistent suicidal ideation.

METHODS

We used data from the Netherlands Study of Depression and Anxiety (NESDA). We performed a linear mixed-effects growth model analysis (n = 230 with current suicidal ideation at baseline) to assess the course of suicidal ideation over time (baseline through 2-, 4-, 6- and 9-year follow-up). We used logistic regression analysis (n = 195) to test whether factors previously associated with the incidence of suicidal ideation in the literature (insomnia, hopelessness, loneliness, borderline personality traits, childhood trauma, negative life events) also predict persistence of suicidal ideation (i.e., reporting ideation at two consecutive assessment points, 6- and 9-years). We controlled for socio-demographics, clinical diagnosis and severity, medication use, and suicide attempt history.

RESULTS

Suicidal ideation decreased over time, and this decrease became slower with increasing time, with the majority of symptom reductions occurring in the first two years of follow-up. More severe insomnia and hopelessness were associated with increased odds of persistent suicidal ideation, and hopelessness was a significant mediator of the relationship between insomnia and persistent suicidal ideation.

LIMITATIONS

Findings may not generalize to those with more severe suicidal ideation due to dropout of those with the worst clinical profile.

CONCLUSIONS

Targeting insomnia and hopelessness in treatment may be particularly important to prevent the persistence of suicidal ideation.

Trajectories of Well-Being Among Latina Adolescents Who Attempt Suicide: A Longitudinal Qualitative Analysis

Significant research questions persist regarding the short- and long-term outcomes of Latina adolescents who attempt suicide. To address these limitations, we utilize an ecodevelopmental framework to identify potential factors that shape differential outcomes following a suicide attempt. Through an exploratory, longitudinal, qualitative research design, we investigate two research questions: How do trajectories of well-being vary among Latina teens after a suicide attempt? What risk and protective factors might contribute to different trajectories? We conducted qualitative interviews with 17 Latina participants living in predominantly low-income households in New York City. Interviews took place within the 6 months following their suicide attempts, and again, 12 months later. Analysis revealed three distinct trajectories after a suicide attempt: resilience, tenuous growth, and chronic stress. Our findings elucidate potential factors that contribute to resilience following a suicide attempt and underscore the importance of prevention and intervention programs that foster adolescents' connectivity across ecodevelopmental contexts.

Association between perinatal depressive symptoms and suicidal risk among low-income South African women: a longitudinal study

PURPOSE

The aim of this study was to assess the association between depressive symptoms and suicidal risk over time among perinatal women at risk for depression antenatally, and assess modifying effects of age, perinatal stage and depressive symptom trajectory.

METHODS

A total of 384 adult pregnant women were recruited from two antenatal clinics in an informal settlement near Cape Town, South Africa, and followed up at eight months gestation, and at 3- and 12-month postpartum. The MINI 6.0 Suicidality module and the Hamilton Depression Rating Scale (HDRS) were used to measure suicidal risk and depression, respectively. Generalised Estimating Equations were used to assess the association between change in depressive symptoms from one assessment to the next (predictor) and change in suicide score or change in suicidal risk (score ≥ 9) (outcomes).

RESULTS

HDRS scores were positively correlated with suicide score (95% CI 0.35, 0.78; p < 0.001), and with odds of being at moderate risk for suicide, after controlling for risk of suicide at the previous assessment (adjusted odds ratio = 1.15; 95% CI 1.09, 1.22; p < 0.001). Age was a significant effect modifier: change in HDRS scores was not associated with change in suicide scores among participants aged 35-45 years. Secondary analyses indicated that a decrease in HDRS score was associated with a decrease in suicide scores, but an increase in HDRS score was not associated with change in suicide score.

CONCLUSIONS

Depression and suicide are overlapping but relatively independent phenomena, especially among older or more chronically depressed perinatal women.

Trajectories of Suicidal Ideation from Middle Childhood to Early Adolescence: Risk and Protective Factors

Suicidal ideation is considered to be the first step on the pathway to suicide. Despite the fact that suicidal ideation is surprisingly prevalent among preadolescent children in China and elsewhere, and despite its possible increase during the transition into adolescence, its developmental patterns and predictors during this period are unclear, thus precluding a meaningful understanding of its determinants and possible trajectories. Thus, this study aimed to identify suicidal ideation trajectories and multisystemic predictors covering the transition from middle childhood to early adolescence. A total of 715 Chinese elementary school students (M_age = 8.95, SD = 0.71; 54.5% was male) participated in assessments at six time points, using six-month assessment intervals. Growth mixture modeling analyses extracted three distinct trajectories of suicidal ideation: "low-stable" (86.4%), "moderate-increasing" (7.1%) and "high-start" (6.5%). Multivariate logistic regression analyses revealed that social anxiety and academic anxiety served as risk factors for the adverse developmental trajectories of suicidal ideation; whereas self-esteem, life satisfaction, and academic achievement served as protective factors for the positive developmental trajectory of suicidal ideation. The identification of three subgroups with unique predictors highlights the importance of individual difference considerations in understanding the progression of suicidal ideation in childhood and adolescence and the need for specific programs tailored to the unique characteristics of the relevant trajectories. Furthermore, given that suicidal ideation may start in a proportion of middle childhood youths and continue into adolescence, the middle childhood period should provide an important window of opportunity for large-scale screening and prevention of the escalation of suicidality in adolescence.

Cognitive-Affective Correlates of Suicide Ideation and Attempt: Mindfulness is Negatively Associated with Suicide Attempt History but not State Suicidality

The objective of this study was to test whether 3 cognitive-affective correlates,--mindfulness, emotion reactivity, and depressive symptom severity-have different associations with current suicidal ideation (SI), a history of suicide attempt (SA) and SA + SI among emerging adults. Whether impulsive-aggression (IA) moderated associations between cognitive-affective correlates of suicidal behavior and suicidality was also tested. Survey data on current SI, SA history, mindfulness, emotion reactivity, depressive symptom severity, and IA were collected from 780 emerging adults. Results from multinomial logistic regression analysis showed greater depressive symptom severity among emerging adults with current SI, regardless of SA history. Those with a history of SA reported greater depressive symptom severity and less mindfulness than controls. IA did not moderate relationships of SI and/or SA and mindfulness, emotion reactivity, or depressive symptom severity. Mindfulness is a marker of SA, and depressive symptom severity is associated with current SI and SA history in emerging adults. IA does not moderate these associations. To the extent that a history of SA is indicative of elevated trait-like suicide risk and SI indicates state suicidality, our findings suggest that mindfulness protects against longer-term vulnerability to suicide while depressive symptom severity is associated with suicide state-trait risk.

Characteristics of Child Psychiatric Outpatients at Highest Risk for Suicidal Thoughts and Behaviors

On average, compared to non-referred youth, child psychiatric outpatients show elevated rates of suicidal thoughts and behaviors (STBs), which are predictors of completed suicide. Determining the psychopathology features that associate with highest risk for STBs among youth outpatients may yield opportunities for targeted prevention/intervention. Yet, outpatient studies are limited and have not systematically examined comorbidity and dimensional psychopathology. In 758 youth, aged 6-18, consecutively referred for neuropsychiatric evaluation, we examined the extent to which diagnostic groups, comorbid subgroups and dimensional symptoms associated with STBs. After controlling for comorbidity, mood, anxiety and conduct disorders associated with elevated STB risk. Regarding dimensions, symptoms of depression, aggression and psychosis all contributed to higher STB risk. Although ADHD (as a diagnosis or dimension) did not associate with elevated STB risk independently, ADHD that was comorbid with other conditions did. Suicide prevention/intervention efforts should be investigated in youth outpatients with the highest risk for STBs.

Trajectories of self-reported sleep disturbance across inpatient psychiatric treatment predict clinical outcome in comorbid major depressive disorder and generalized anxiety disorder

BACKGROUND

As there has been a demonstrated link between sleep disturbance and suicide, the present study investigated the relationship between self-reported sleep disturbance during inpatient psychiatric treatment and clinical outcomes at discharge and six months post-discharge.

METHODS

Participants were 2,970 adults receiving care in a long-term inpatient psychiatric hospital. Greater than 90% of inpatients reported at least mild sleep disturbance throughout treatment. Group-based trajectory modeling was used to determine patterns of sleep disturbance changes over time.

RESULTS

Participants fit into distinct categories based on their trajectories of sleep problems across treatment: No Sleep Problems (10.3% of participants, no sleep problems endorsed over the course of inpatient psychiatric treatment), Resolvers (sleep problems completely resolved over the course of inpatient psychiatric treatment; 10.6%), Non-Responders (did not respond to inpatient psychiatric treatment; 35.7%) and Responders (sleep problems decreased but did not fully resolve over the course of inpatient psychiatric treatment; 43.4%). Individuals with comorbid major depressive disorder and generalized anxiety disorder were significantly more likely to demonstrate higher rates of sleep disturbance throughout inpatient psychiatric treatment and their sleep problems did not respond to treatment as usual (Non-Responders). Further, patients in the Non-Responder group had significantly more suicidal ideation and worse clinical outcomes (higher anxiety, more disability, and lower well-being) at discharge and six months post-discharge, as well as were on more medication including hypnotics throughout treatment.

CONCLUSIONS

Findings indicate the urgent need to design and implement inpatient psychiatry sleep protocols to not only improve sleep and clinical outcomes, but also reduce the risk for suicide post-discharge.

Trajectories of Suicidal Ideation among Adolescents Following Psychiatric Hospitalization

Suicidal ideation (SI) is a common presenting problem for psychiatric hospitalizations in adolescents and often persists following discharge. This study examines whether distinct trajectories of SI could be delineated following hospitalization and the risk factors most strongly related to these trajectories. Adolescents (N = 104; 76 females; 28 males) were followed for 6 months after discharge from inpatient or partial hospitalization. Semi-parametric group modeling identified SI trajectory group membership. In all, 33.7% of adolescents fell in a Subclinical SI group, 43.3% in a Declining SI group, and 23.1% in a Chronic SI group. Multinomial logistic regression was utilized to examine baseline predictors of group membership. Emotion dysregulation differentiated Chronic SI from Declining SI. In multivariate analyses, adolescents endorsing greater non-acceptance of emotional responses (OR =1.18) and more limited access to emotion regulation strategies (OR =1.12) were more likely to belong to the Chronic SI than Declining SI trajectory. Those in the Chronic SI group also had the greatest number of suicide attempts and hospitalizations in the 6 months post-discharge. These results suggest that clinicians should closely monitor and address emotion dysregulation when assessing suicide risk. Greater dysregulation may require more intensive services in order to have an effect on chronic SI.

Perceived neighborhood social cohesion moderates the relationship between neighborhood structural disadvantage and adolescent depressive symptoms

There is a dearth of research exploring the moderating role of the social environment on neighborhood structural disadvantage and depressive symptoms, particularly among adolescents. Therefore, we examined if adolescent perceptions of neighborhood social cohesion and safety moderated the association between neighborhood structural disadvantage and adolescent depressive symptoms. This cross-sectional study used data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). The study sample consisted of 12,105 adolescents enrolled in 9th-12th grades during the 1994-1995 school year across the United States (U.S.). Mixed effects multilevel modeling was used to determine if adolescent perceptions of neighborhoods moderated the relationship between neighborhood structural disadvantage and adolescent depressive symptoms. Results showed that perceived neighborhood social cohesion moderated the relationship between neighborhood structural disadvantage and adolescent depressive symptoms (p ≤ 0.001). At higher levels of perceived neighborhood social cohesion, neighborhood structural disadvantage was associated with decreased depressive symptoms. Findings suggest that improving perceived neighborhood social cohesion may decrease adolescent depressive symptoms, particularly in neighborhoods with high disadvantage. This aspect of the neighborhood social environment may serve as a target for structural and other interventions to address the growing burden of depression among adolescents.

Subtypes of suicidal ideation in Korean adolescents: A multilevel latent profile analysis

OBJECTIVE

This study intended to classify subtypes of Korean adolescents with suicidal ideation based on mental health problems and to explore the relationship between such subtypes and individual-, school- and community-level factors.

METHOD

Data from high school freshmen who participated in the 2013 school-based mental health screening test and data about school and community variables obtained from public sources were combined and analyzed. A multilevel latent profile analysis using mental health issues as class indicators that included several predictors was conducted.

RESULTS

Three latent profiles were identified: Group 1 (6.5%) had high scores for both the internalizing and externalizing problems; Group 2 (40.2%) had high scores for internalizing problems, such as depression and mood related symptoms; and Group 3 (53.3%) had lower scores for all mental health problems compared to Groups 1 and 2. Gender, peer conflict, family conflict and academic problems were significant predictors at the individual level; school dropout rate was a significant school-level variable; and percent of youth in the total population, availability of mental health services, number of social welfare facilities and percentage of the total budget devoted to education/welfare were significant community-level variables.

CONCLUSION

The present findings suggest that adolescents with suicidal ideation can be classified into several distinct subtypes based on mental health problems. These profiles and their associated covariates will aid in the establishment of youth suicide prevention policies.

What distinguishes adolescents with suicidal thoughts from those who have attempted suicide? A population-based birth cohort study

BACKGROUND

Only one-third of young people who experience suicidal ideation attempt suicide. It is important to identify factors which differentiate those who attempt suicide from those who experience suicidal ideation but do not act on these thoughts.

METHODS

Participants were 4,772 members of the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort. Suicide ideation and attempts were assessed at age 16 years via self-report questionnaire. Multinomial regression was used to examine associations between factors that differentiated adolescents in three groups: no suicidal ideation or attempts, suicidal ideation only and suicide attempts. Analyses were conducted on an imputed data set based on those with complete outcome data (suicidal thoughts and attempts) at age 16 years (N = 4,772).

RESULTS

The lifetime prevalence of suicidal ideation and attempts in the sample was 9.6% and 6.8% respectively. Compared to adolescents who had experienced suicidal ideation, those who attempted suicide were more likely to report exposure to self-harm in others (adjusted OR for family member self-harm: 1.95, for friend self-harm: 2.61 and for both family and friend self-harm: 5.26). They were also more likely to have a psychiatric disorder (adjusted OR for depression: 3.63; adjusted OR for anxiety disorder: 2.20; adjusted OR for behavioural disorder: 2.90). Other risk factors included female gender, lower IQ, higher impulsivity, higher intensity seeking, lower conscientiousness, a greater number of life events, body dissatisfaction, hopelessness, smoking and illicit drug use (excluding cannabis).

CONCLUSIONS

The extent of exposure to self-harm in others and the presence of psychiatric disorder most clearly differentiate adolescents who attempt suicide from those who only experience suicidal ideation. Further longitudinal research is needed to explore whether these risk factors predict progression from suicidal ideation to attempts over time.

Prior suicide attempts predict worse clinical and functional outcomes in young people attending a mental health service

BACKGROUND

Mental disorders and suicidal thoughts and behaviours are common in help-seeking youth. Few studies report the longitudinal associations between these phenomena and clinical and functional outcomes. This study examined whether prior suicide attempts predict poorer outcomes in mental health service attendees.

METHODS

Clinical and functional data from 1143 individuals (aged 12-30) attending a primary care-based mental health service in Australia were collected over 3-60 months (median = 21 months). Odds ratios (OR) with 95% confidence intervals for the effect of a prior suicide attempt on follow-up outcomes were estimated (adjusted for confounders).

RESULTS

Prior suicide attempts were common (n = 164; 14%) and prospectively associated with suicidal thoughts (OR = 1.71), suicide attempts (OR = 2.59), self-harm (OR = 1.71), an increased likelihood of being diagnosed with bipolar disorder (OR = 2.99), and the onset of an alcohol/substance use disorder (OR = 2.87). Over the course of care, no suicide attempts were reported in 1052 (92%) individuals, but 25 (2%) had recurrent attempts, and 66 (6%) had new onset of an attempt. New onset was associated with being female and previous suicidal ideation or self-harm; recurrent attempts were associated with being older and comorbid alcohol/substance use disorder.

LIMITATIONS

The cohort includes only individuals who remained in clinical contact, and the consistency of their documentation varied (across clinicians and over time).

CONCLUSIONS

Young people with prior suicide attempts are vulnerable to ongoing suicidal behaviours, and poorer clinical and functional outcomes. More intensive management strategies may be needed to directly address these behaviours and the long-term risks they confer. These behaviours also emerge over the course of care among those with no previous history, which has important implications for active service-level strategies that target these behaviours for all of those who present to such services.

Impulsivity and Saliva Cortisol in Patients with Suicide Attempt and Controls

OBJECTIVES

The objective of this study was to prove concepts in the characterization of suicidal patients and the possible usefulness of those markers to potentially identify patients with a higher risk for suicidality.

METHODS

Patients with a recent suicide attempt were compared with patients suffering from depression, adjustment disorder, anxiety, or eating disorders without suicidality, healthy controls and remitted patients with a history of at least 1 suicide attempt (≥1 year). We analyzed impulsivity (Barratt Impulsivity Scale, BIS) and saliva cortisol concentrations.

RESULTS

Independently of suicidality and disease state patients display higher BIS scores than healthy controls. Saliva cortisol levels tend to be higher in patients in the acute disease state than in remitted patients and healthy controls.

CONCLUSIONS

Saliva cortisol may be a useful marker that reveals alterations in nonsuicidal patients suffering from depression, adjustment disorder, anxiety, or eating disorders who might be at risk.

Digital phenotyping of suicidal thoughts

BACKGROUND

To examine whether there are subtypes of suicidal thinking using real-time digital monitoring, which allows for the measurement of such thoughts with greater temporal granularity than ever before possible.

METHODS

We used smartphone-based real-time monitoring to assess suicidal thoughts four times per day in two samples: Adults who attempted suicide in the past year recruited from online forums (n = 51 participants with a total of 2,889 responses, surveyed over 28 days; ages ranged from 18 to 38 years) and psychiatric inpatients with recent suicidal ideation or attempts (n = 32 participants with a total of 640 responses, surveyed over the duration of inpatient treatment [mean stay = 8.79 days], ages ranged 23-68 years). Latent profile analyses were used to identify distinct phenotypes of suicidal thinking based on the frequency, intensity, and variability of such thoughts.

RESULTS

Across both samples, five distinct phenotypes of suicidal thinking emerged that differed primarily on the intensity and variability of suicidal thoughts. Participants whose profile was characterized by more severe, persistent suicidal thoughts (i.e., higher mean and lower variability around the mean) were most likely to have made a recent suicide attempt.

CONCLUSIONS

Suicidal thinking has historically been studied as a homogeneous construct, but using newly available monitoring technology we discovered five profiles of suicidal thinking. Key questions for future research include how these phenotypes prospectively relate to future suicidal behaviors, and whether they represent remain stable or trait-like over longer periods.

Mood Regulation Focused CBT Based on Memory Reconsolidation, Reduced Suicidal Ideation and Depression in Youth in a Randomised Controlled Study

Suicide attempts and suicidal ideation in adolescence are considered to be related to suicide and psychiatric adversity later in life. Secondary prevention by improving the treatment of suicidal youth is a distinct possibility. In this study, treatment with a systematised mood-regulation focused cognitive behavioural therapy (MR-CBT) (n = 15) was compared with treatment as usual (TAU) (n = 12) in a group of depressed adolescents in a clinical setting. MR-CBT focuses on mood regulation by means of counter conditioning with memory reconsolidation being the proposed mechanism of change. Subjects practice keeping emotionally positive memories to diminish the emotional impact of negative memories. Symptoms of depression were tested with a short version of the Mood and Feelings Questionnaire (SMFQ), and wellbeing with the World Health Organization 5 Wellbeing Index (WHO-5). Suicidal events were rated according to the clinical interview Columbia Suicide Severity Rating Scale (C-SSRS). Suicidal events at the end of treatment were significantly reduced in the MR-CBT group, but not in the TAU group. Depression and wellbeing improved significantly in both treatment groups. While far from conclusive, the results are encouraging enough to suggest that further studies should be undertaken to examine whether psychotherapy focusing on mood regulation for young individuals at risk might enhance secondary prevention of suicide.

Longitudinal Prediction of Suicide Attempts for a Diverse Adolescent Sample of Native Hawaiians, Pacific Peoples, and Asian Americans

The objective of this study was to determine the longitudinal predictors of past-6-month suicide attempts for a diverse adolescent sample of Native Hawaiians, Pacific peoples, and Asian Americans. The study used longitudinal data from the Hawaiian High Schools Health Survey (N = 2,083, 9th to 11th graders, 1992-1993 and 1993-1994 school years). A stepwise multiple logistic regression was conducted. The final model consisted of three statistically significant predictors: (1) Time 1 suicide attempt, odds ratio = 30.6; (2) state anxiety, odds ratio = 4.9; and (3) parent expectations, odds ratio = 1.9. Past suicide attempt was by far the strongest predictor of future suicide attempts. Implications are discussed, including the need for screening of prior suicide attempts and focused interventions after suicide attempts.

Adult Associations of Childhood Suicidal Thoughts and Behaviors: A Prospective, Longitudinal Analysis

OBJECTIVE

Suicidal thoughts and behavior (STBs) have their peak period of onset in adolescence, but little is known about how such behavior is associated with later functioning. The aim of this study is to test whether childhood STBs are related to adult psychiatric, suicidal, and functional outcomes.

METHOD

This is a prospective, population-based community study of 1,420 participants assessed with structured interviews up to 7 times in childhood/adolescence (ages 9-16 years; 6,674 observations) for STBs including passive and active ideation, plans, and attempts. Participants were then assessed 4 times in young adulthood (ages 19, 21, 24, and 30 years; 4,556 observations of 1,273 participants) for psychiatric diagnoses, STBs, and functional outcomes.

RESULTS

By age 16 years, 7.0% of participants had reported some type of STBs, with 3.9% reporting an attempt. Both ideation only and suicide attempts were associated with higher levels of anxiety disorders and STBs in adulthood, as well as poor functioning across financial, health, risky/illegal, and social domains. These observed effects generally were attenuated after adjusting for other psychiatric and psychosocial factors that predict childhood STBs (particularly maltreatment, depression, and disruptive behavior disorders). The exception was adult suicidal behavior, which was predicted by both childhood ideation and attempts, even in the fully adjusted model. Children and adolescents with STBs were more likely to have had a disrupted transition to adulthood.

CONCLUSION

Childhood STBs are a marker for a multitude of poor psychiatric and functional outcomes in adulthood, but these effects are largely accounted for by other factors. In contrast, childhood STBs are a robust risk factor for adult suicidal thoughts and behavior.

Prospective Study of Major Loss Life Events and Risk for Suicidal Thoughts and Behaviors Among Adolescents and Young Adults

This prospective, naturalistic study examined the association between major loss life experiences, other psychiatric risk factors (depression, hopelessness, and anxiety), and suicidal thoughts and behaviors (STBs) among adolescents followed through young adulthood for up to 14 years. Major loss life events were related to subsequent increases in STBs. Major loss life events were primarily related to increases in suicide ideation in the presence of lower levels of other risk factors. There was a bidirectional relationship between major losses and other risk factors. Implications for the association between loss experiences, other risk factors, and future STBs are discussed.

A within-person approach to risk for suicidal ideation and suicidal behavior: Examining the roles of depression, stress, and abuse exposure

OBJECTIVE

This study tests a novel, within-person model that reexamines depression and stress as risk factors for suicidal ideation and behavior among adolescent girls with and without sexual/physical abuse histories.

METHOD

This longitudinal study includes data from 220 adolescent girls between 12 and 16 years of age (M = 14.69 years, SD = 1.37; 61% White). At baseline, adolescents reported the presence or absence of prior abuse as part of a clinical interview. At baseline and every 3 months for 18 months, adolescents completed measures of suicidal ideation and behavior, depressive symptoms, and stress.

RESULTS

Multilevel models examined within-person mean, deviations from within-person mean, depression, and stress and their interactions with abuse as predictors of suicidal ideation and behavior. In addition to within-person mean depression, higher-than-usual depression (odds ratio [OR] = 1.99) and higher-than-usual stress (OR = 1.53) predicted greater risk of suicidal ideation at each follow-up assessment. Periods of higher-than-usual stress (1 SD increase) and periods of higher-than-usual depression (1 SD increase) were associated with an 82% and 57% increase in the odds of suicidal behavior, respectively, but only among those with abuse histories.

CONCLUSION

Depression, stress, and abuse are well-known risk factors for suicidal ideation and behavior; however, it has been unclear for whom, and when, these factors have their greatest impact. These results show that depression and stress are potent risk factors among those with a history of abuse and that within-person elevations in these risk factors signal increased short-term risk of suicidal ideation and behavior. (PsycINFO Database Record

Objectively Assessed Sleep Variability as an Acute Warning Sign of Suicidal Ideation in a Longitudinal Evaluation of Young Adults at High Suicide Risk

OBJECTIVE

Young adults attempt suicide at disproportionately high rates relative to other groups and demonstrate high rates of sleep disturbance. No study has yet prospectively evaluated disturbed sleep as an acute indicator of risk using an objective index of sleep. We investigated objective and subjective parameters of disturbed sleep as a warning sign of suicidal ideation among young adults over an acute period.

METHODS

A longitudinal study across a 21-day observation period and 3 time points. Fifty of 4,847 participants (aged 18-23 years) were prescreened from a university undergraduate research pool (February 2007-June 2008) on the basis of suicide attempt history and recent suicidal ideation. Actigraphic and subjective sleep parameters were evaluated as acute predictors of suicidal ideation (Beck Scale for Suicide Ideation), with adjustment for baseline symptoms. Hierarchical regression analyses were employed to predict residual change scores.

RESULTS

Ninety-six percent of participants (n = 48) endorsed a suicide attempt history. Mean actigraphy values revealed objectively disturbed sleep parameters; 78% (n = 39) and 36% (n = 18) endorsed clinically significant insomnia and nightmares, respectively. When results were controlled for baseline suicidal and depressive symptoms, actigraphic and subjective sleep parameters predicted suicidal ideation residual change scores at 7- and 21-day follow-ups (P < .001). Specifically, actigraphy-defined variability in sleep timing, insomnia, and nightmares predicted increases in suicidal ideation (P < .05). In a test of competing risk factors, sleep variability outperformed depressive symptoms in the longitudinal prediction of suicidal ideation across time points (P < .05).

CONCLUSIONS

Objectively and subjectively measured sleep disturbances predicted acute suicidal ideation increases in this population, independent of depressed mood. Self-reported insomnia and nightmares and actigraphically assessed sleep variability emerged as acute warning signs of suicidal ideation. These findings highlight the potential utility of sleep as a proposed biomarker of suicide risk and a therapeutic target.

Proximal Influences on the Trajectory of Suicidal Behaviors and Suicide during the Transition from Adolescence to Young Adulthood

Youth transitioning to adulthood have unique developmental tasks that make them vulnerable to suicide. Brain development, life stressors, and psychological adjustments during the transition contribute to a high rate of suicidal gestures. To reduce the incidence of self-harm in this age group, a public health approach that identifies and reduces risk factors and enhances protective factors should be used. Institutions and employment arenas should consider structural supports to facilitate this transition of youth into adulthood, with a particular focus on youth with self-harm thoughts, and should provide education about suicide, evidence-based resources, and intervention programs to encourage help seeking.

The Neurobiological Mechanisms of Generalized Anxiety Disorder and Chronic Stress

Two classification systems are now at the forefront of clinical psychiatric research: (1) Diagnostic and Statistical Manual, Fifth Edition and (2) the National Institutes of Mental Health Research Domain Criteria. Herein, we propose that these two classification systems are complementary rather than mutually exclusive, and when combined provide important information for understanding aspects of the pathophysiology related to Generalized Anxiety Disorder (GAD). The neurobiological literature for GAD and one relevant research domain criteria component, sustained threat, are reviewed from multiple units of analysis (genetic, neuroimaging, neuroendocrine, and psychophysiological). It is hypothesized that generating a comprehensive, biologically based understanding of the relationship between GAD, sustained threat, and the measureable units of analysis will provide information critical to design the most effective treatments.