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Levy T, Kil H, Schachar RJ, Itzhaky L, Andrade BF. Suicidality risk in children and adolescents with externalizing disorders: symptoms profiles at high risk and the moderating role of dysregulated family relationships. Eur Child Adolesc Psychiatry 2024; 33:811-820. [PMID: 37043094 DOI: 10.1007/s00787-023-02190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/08/2023] [Indexed: 04/13/2023]
Abstract
Children and adolescents with externalizing disorders are at risk for suicidal ideation or behavior. Factors that put them at risk could be symptoms related or facilitated by their environment. We evaluated the links of symptoms profiles with suicidality, and the effects of family relationship characteristics on these links. Latent profile analysis was used to subgroup participants referred for ADHD assessment (n = 1249, aged 6-17) based on their externalizing and internalizing symptoms. Self- and parent-reported child suicidal ideation (S-SI, P-SI), and parent-reported self-harm behavior (P-SHB) were compared across profiles. The moderating effects of parent-reported marital conflict and parenting practices were examined. A four-profile model showed optimal fit. Participants of the Low Symptoms profile followed by the Inattentive-Hyperactive/Impulsive profile showed lower P-SI compared to those of the Irritable-Defiant and the Conduct Problems profiles. Low Symptoms participants also reported lower S-SI compared to those of the Inattentive-Hyperactive/Impulsive and the Irritable-Defiant profiles. Participants of the Irritable-Defiant and the Conduct Problems profiles had higher P-SHB compared to the Low Symptoms and the Inattentive-Hyperactive/Impulsive participants. Dysregulated marital conflict practices were associated with greater increase in P-SI in all profiles compared to the Low Symptoms profile. Aggressive marital conflict practices were associated with increased P-SHB in the Conduct Problems profile compared to the Inattentive-Hyperactive/Impulsive profile. Children and adolescents with irritability and defiance symptoms with or without conduct problems show higher risk for suicidal ideation and behavior compared to those with ADHD symptoms alone. Dysregulated and aggressive marital conflict practices might pose additional suicidality risk in children and adolescents with disruptive behavior.
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Affiliation(s)
- Tomer Levy
- Behavior Regulation Service, Geha Mental Health Center, 1 Helsinki St., 49100, Petah-Tikva, Israel.
- Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel.
| | - Hali Kil
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Russell James Schachar
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Liat Itzhaky
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Brendan F Andrade
- McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Ehlers CL, Gilder DA, Karriker-Jaffe KJ, Bernert R. Comorbidity of anxiety/affective, conduct/antisocial, attention deficit, and alcohol use disorders with suicidal behaviors in an American Indian community sample of adults and adolescents. J Psychiatr Res 2023; 167:63-70. [PMID: 37837862 PMCID: PMC10997741 DOI: 10.1016/j.jpsychires.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
AIMS To study the associations of anxiety/affective disorders, conduct/antisocial disorders (ASPD/CD), attention deficit disorders (ADHD), and alcohol use disorders (AUD) with suicidal behaviors in an American Indian (AI) community sample of adolescents and adults. METHODS Participants were AI (360 adolescents, 925 adults) recruited from reservations who were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). RESULTS Among AI adults (mean age = 33 years), 17% percent reported lifetime experiences of suicidal thoughts (ideation and/or plans) and 14% reported suicidal acts (including either a suicide attempt history or verified death by suicide; n = 19 deaths). Among AI adolescents (mean age = 15 years), 20% experienced suicidal thoughts and 9% experienced suicidal acts (including 3 deaths). In logistic regression analyses, suicidal thoughts were significantly associated with lifetime diagnoses of affective disorder, CD and ADHD in adolescents, and with anxiety disorder, affective disorder, and ASPD/CD in adults. Suicidal acts were associated with affective disorder, ADHD, and alcohol drinking in adolescents and with anxiety disorder, ASPD/CD and AUD in adults. The number of comorbid disorders greatly increased the risk of both suicidal thoughts and acts among both adolescents and adults. CONCLUSIONS In addition to affective disorders, both ADHD and CD in adolescents, and ASPD in adults, demonstrated an association with suicidal thoughts. Alcohol use by adolescents and AUD among adults also were associated with suicidal attempts in this AI sample. These findings suggest need for additional research and potential integration of alcohol in screening and intervention programs focused on the prevention of suicide among AI.
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Affiliation(s)
- Cindy L Ehlers
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA.
| | - David A Gilder
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA, USA
| | | | - Rebecca Bernert
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Estévez-García JF, Cañas E, Estévez E. Non-Disclosure and Suicidal Ideation in Adolescent Victims of Bullying: An Analysis from the Family and School Context. PSYCHOSOCIAL INTERVENTION 2023; 32:191-201. [PMID: 37691712 PMCID: PMC10484023 DOI: 10.5093/pi2023a13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/22/2023] [Indexed: 09/12/2023]
Abstract
In recent years, suicide rates among bullying victims have raised much concern among educators and health professionals. Suicide is the fourth leading cause of preventable death among adolescents, data that warn about the need to monitor the signs before victims' suicidal behavior to prevent this fatal outcome. In the present study, the role of victims' silence about their victimization situation was analysed, as well as the particular impact of family and school environments. More specifically, we examined the mediating role of the victim's non-disclosure between the parental styles (observing the father's and mother's roles separately) and the school climate, concerning suicidal ideation in victims. The sample consisted of 2,977 adolescents (48.5% boys), aged 11-17 years (M = 14.1, SD = 1.42), of whom 635 (21.3%) reported having been victims of bullying in the past year. The results showed that parental styles of rejection and indifference were positively related to victims' non-disclosure of bullying and suicidal ideation. Conversely, a positive school climate showed a negative relationship with victims' disclosure of the bullying situation and suicidal ideation. The findings also indicated that non-disclosure mediates the relationship between the mother's parental style and suicidal ideation. These findings expand knowledge about the role of bullying victims' social context and the variable disclosure with regards to suicidal ideation in adolescents victimized by peers at school.
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Delaney SW, Hidalgo APC, White T, Haneuse S, Ressler KJ, Tiemeier H, Kubzansky LD. Behavioral and neurostructural correlates of childhood physical violence victimization: Interaction with family functioning. Dev Psychobiol 2023; 65:e22398. [PMID: 37338254 PMCID: PMC11012107 DOI: 10.1002/dev.22398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 03/15/2023] [Accepted: 04/06/2023] [Indexed: 06/21/2023]
Abstract
Violence victimization may cause child behavior problems and neurostructural differences associated with them. Healthy family environments may buffer these effects, but neural pathways explaining these associations remain inadequately understood. We used data from 3154 children (x̅age = 10.1) to test whether healthy family functioning moderated possible associations between violence victimization, behavior problems, and amygdala volume (a threat-responsive brain region). Researchers collected data on childhood violence victimization, family functioning (McMaster Family Assessment Device, range 0-3, higher scores indicate healthier functioning), and behavior problems (Achenbach Child Behavior Checklist [CBCL] total problem score, range 0-117), and they scanned children with magnetic resonance imaging. We standardized amygdala volumes and fit confounder-adjusted models with "victimization × family functioning" interaction terms. Family functioning moderated associations between victimization, behavior problems, and amygdala volume. Among lower functioning families (functioning score = 1.0), victimization was associated with a 26.1 (95% confidence interval [CI]: 9.9, 42.4) unit higher CBCL behavior problem score, yet victimized children from higher functioning families (score = 3.0) exhibited no such association. Unexpectedly, victimization was associated with higher standardized amygdala volume among lower functioning families (ŷ = 0.5; 95% CI: 0.1, 1.0) but lower volume among higher functioning families (ŷ = -0.4; 95% CI: -0.7, -0.2). Thus, healthy family environments may mitigate some neurobehavioral effects of childhood victimization.
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Affiliation(s)
- Scott W. Delaney
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrea P. Cortes Hidalgo
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kerry J. Ressler
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Xu YE, Barron DA, Sudol K, Zisook S, Oquendo MA. Suicidal behavior across a broad range of psychiatric disorders. Mol Psychiatry 2023; 28:2764-2810. [PMID: 36653675 PMCID: PMC10354222 DOI: 10.1038/s41380-022-01935-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023]
Abstract
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
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Affiliation(s)
- Yingcheng E Xu
- Department of Psychiatry and Behavioral Health, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, US
| | - Daniel A Barron
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Katherin Sudol
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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The mediating effects of personality traits on the relationship of youth conduct problems and mood disorders with adulthood suicidality. Sci Rep 2023; 13:4292. [PMID: 36922624 PMCID: PMC10017672 DOI: 10.1038/s41598-023-31338-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Identifying the relevant factors for suicidality in individuals with conduct problems is a public health concern, especially if they were under the influence of mood disorders later in life. This study investigates the relationship between youth conduct problems and mood disorders and adulthood suicidality, and to further explore the mediating effects of personality on this relationship. A retrospective cohort study was administered to 308 individuals aged 20-65 years, with or without mood disorders diagnosed by psychiatrists. The Composite International Diagnosis Interview was used to evaluate conduct problems in youth and suicidality (i.e., suicide plan and suicide attempt) in the past year. Personality traits were assessed using Eysenck Personality Questionnaire-Revised for extraversion and neuroticism. Multiple-mediator analysis was used to investigate the mediation effects of personality traits on the relationship between conduct problems and suicidality. The average age of enrolled participants was 31.6 years, and 42.5% of them were female. 39.2% reported suicidality and 43.2% reported conduct problems in youth. Participants who were diagnosed with mood disorders (p < 0.001) and reported having conduct problems (p = 0.004) were associated with high suicidality. Multiple-mediator analysis showed that conduct problems in youth increased the risk of adulthood suicidality through the indirect effects of higher neuroticism (suicide plan: OR = 1.30, BCA 95% CI = 1.04-1.83; suicide attempt: OR = 1.27, BCA 95% CI = 1.05-1.66). Neuroticism mediates the association between youth conduct problems and adulthood suicidality. This finding raises our attention to assess personality traits in individuals with youth conduct problems for designing proper intervention strategies to reduce the risk of suicide.
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Gracia-Liso R, Portella MJ, Puntí-Vidal J, Pujals-Altés E, Torralbas-Ortega J, Llorens M, Pamias M, Fradera-Jiménez M, Montalvo-Aguirrezabala I, Palao DJ. COVID-19 Pandemic Has Changed the Psychiatric Profile of Adolescents Attempting Suicide: A Cross-Sectional Comparison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2952. [PMID: 36833651 PMCID: PMC9956974 DOI: 10.3390/ijerph20042952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic is having a major impact on the mental health of adolescents, leading to suicidal behaviors. However, it remains to be clarified whether the COVID-19 pandemic has changed the psychiatric profile of adolescent suicide attempters. METHODS a retrospective observational analytical study was conducted to assess age, gender and clinical characteristics of adolescents attempting suicide during the year before and the year after the global lockdown. RESULTS ninety adolescents (12-17 y.o.) were recruited consecutively from February 2019 to March 2021 at the emergency ward for having attempted suicide. Fifty-two (57.8%) attended before the lockdown (pre-pandemic group) and thirty-eight (42.2%) the year after (pandemic group). There were significant differences in diagnostic categories between the periods (p = 0.003). Adjustment and conduct disorders were more frequent in the pre-pandemic group, while anxiety and depressive disorders were more prevalent during the pandemic. Although the severity of suicide attempts did not show significant differences between the two study periods (0.7), the generalized linear model showed that the suicide attempt severity was significantly associated with current diagnosis (p = 0.01). CONCLUSIONS the psychiatric profile of adolescents attempting suicide was different before and during the COVID-19 pandemic. During the pandemic, the proportion of adolescents with a prior psychiatric history was lower, and most of them were diagnosed with depressive and anxiety disorders. These diagnoses were also associated with a greater severity in the intentionality of suicide attempt, regardless of the study period.
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Affiliation(s)
- Rebeca Gracia-Liso
- Department of Mental Health, Parc Taulí-University Hospital of Sabadell, 08208 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Unitat de Neurociència Traslacional I3PT-Inc., Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
| | - Maria J. Portella
- Sant Pau Mental Health Research Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Joaquim Puntí-Vidal
- Department of Mental Health, Parc Taulí-University Hospital of Sabadell, 08208 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Unitat de Neurociència Traslacional I3PT-Inc., Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
| | - Elena Pujals-Altés
- Department of Mental Health, Parc Taulí-University Hospital of Sabadell, 08208 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Unitat de Neurociència Traslacional I3PT-Inc., Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
| | | | - Marta Llorens
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, 08950 Barcelona, Spain
| | - Montserrat Pamias
- Department of Mental Health, Parc Taulí-University Hospital of Sabadell, 08208 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Unitat de Neurociència Traslacional I3PT-Inc., Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Institut d’Investigació i Innovació Parc Taulí I3PT-CERCA, 08208 Sabadell, Spain
| | - Marc Fradera-Jiménez
- Department of Mental Health, Parc Taulí-University Hospital of Sabadell, 08208 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Unitat de Neurociència Traslacional I3PT-Inc., Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Institut d’Investigació i Innovació Parc Taulí I3PT-CERCA, 08208 Sabadell, Spain
| | - Itziar Montalvo-Aguirrezabala
- Department of Mental Health, Parc Taulí-University Hospital of Sabadell, 08208 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Unitat de Neurociència Traslacional I3PT-Inc., Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Institut d’Investigació i Innovació Parc Taulí I3PT-CERCA, 08208 Sabadell, Spain
| | - Diego J. Palao
- Department of Mental Health, Parc Taulí-University Hospital of Sabadell, 08208 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Unitat de Neurociència Traslacional I3PT-Inc., Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Institut d’Investigació i Innovació Parc Taulí I3PT-CERCA, 08208 Sabadell, Spain
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Lawrence TI, Mcfield AA. Does Conduct, Oppositional Defiant, and Panic Disorder Symptoms Associate with Suicidal Ideations Among African American Adolescents? JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:1179-1189. [PMID: 36439662 PMCID: PMC9684375 DOI: 10.1007/s40653-022-00452-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 05/25/2023]
Abstract
Previous studies suggest that mental illness symptoms among adolescents, such as conduct disorder, oppositional defiant disorder, and panic disorder symptoms often associate with suicidal ideations. Despite this, few studies have examined whether these mental illness symptoms associate with suicidal ideations among African American adolescents. To address these limitations, the current study examined whether conduct disorder, oppositional defiant disorder, and panic disorder symptoms associated with suicidal ideations (N = 261). Using binominal logistic regression, results suggest that conduct disorder symptoms were associated with a higher likelihood of endorsing suicidal ideations than oppositional defiant disorder symptoms. Finally, panic disorder symptoms and gender differences were not associated with suicidal ideations. Preventive efforts and psychotherapy implications are discussed.
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Affiliation(s)
- Timothy I. Lawrence
- Prairie View, A&M University, P. O Box 519 MS, 100 University Dr, Prairie View, Texas 77446 USA
| | - Ariel A. Mcfield
- Psychology Department , University of Texas Permian Basin, 4901 E University Blvd, Odessa, TX 79762 USA
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Kim KW, Lim JS, Yang CM, Jang SH, Lee SY. Classification of Adolescent Psychiatric Patients at High Risk of Suicide Using the Personality Assessment Inventory by Machine Learning. Psychiatry Investig 2021; 18:1137-1143. [PMID: 34732031 PMCID: PMC8600215 DOI: 10.30773/pi.2021.0191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/11/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE There are growing interests on suicide risk screening in clinical settings and classifying high-risk groups of suicide with suicidal ideation is crucial for a more effective suicide preventive intervention. Previous statistical techniques were limited because they tried to predict suicide risk using a simple algorithm. Machine learning differs from the traditional statistical techniques in that it generates the most optimal algorithm from various predictors. METHODS We aim to analyze the Personality Assessment Inventory (PAI) profiles of child and adolescent patients who received outpatient psychiatric care using machine learning techniques, such as logistic regression (LR), random forest (RF), artificial neural network (ANN), support vector machine (SVM), and extreme gradient boosting (XGB), to develop and validate a classification model for individuals with high suicide risk. RESULTS We developed prediction models using seven relevant features calculated by Boruta algorithm and subsequently tested all models using the testing dataset. The area under the ROC curve of these models were above 0.9 and the RF model exhibited the best performance. CONCLUSION Suicide must be assessed based on multiple aspects, and although Personality Assessment Inventory for Adolescent assess an array of domains, further research is needed for predicting high suicide risk groups.
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Affiliation(s)
- Kyung-Won Kim
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Jae Seok Lim
- Department of Oral and Maxillofacial Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Chan-Mo Yang
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Seung-Ho Jang
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Sang-Yeol Lee
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan, Republic of Korea
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Duko B, Pereira G, Tait RJ, Newnham J, Betts K, Alati R. Prenatal tobacco exposure and the risk of conduct disorder symptoms in offspring at the age of 14 years: Findings from the Raine Study. J Psychiatr Res 2021; 142:1-8. [PMID: 34304077 DOI: 10.1016/j.jpsychires.2021.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/30/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Emerging epidemiological evidence suggests that offspring born to mothers who smoked tobacco during pregnancy may have elevated risk of developing conduct disorder (CD) symptoms. We examined associations between maternal and paternal tobacco smoking during pregnancy and CD symptoms in offspring at the age of 14 years. METHODS We obtained data from the Raine Study, a multi-generational cohort study based in Western Australia. DSM-oriented scale of the Child Behavior Checklist (CBCL) was used to measure CD symptoms in offspring. Negative binomial regression was used to estimate the rate ratio (risks) (RR) of CD symptoms in offspring. We also produced the E-values to investigate the extent of unmeasured confounding. Paternal smoking during pregnancy was used as a proxy for environmental tobacco smoke exposure. RESULTS Complete data were available for 1747 mother-offspring and 1711 father-offspring pairs. After adjusting for potential confounders, we found elevated risks (rates) of CD symptoms in offspring born to mothers smoking tobacco during the first trimester [RR 1.52 (95 % CI: 1.24-1.87)], third trimester [RR 1.36 (95 % CI: 1.09-1.69)] and during both trimesters of pregnancy [RR 1.50 (95 % CI: 1.19-1.90)]. The rates of CD symptoms in offspring increased with the level of exposure to maternal smoking during pregnancy. However, we noted insufficient statistical evidence for an association between paternal smoking during pregnancy and CD symptoms in offspring. CONCLUSION The associations we found for maternal but not paternal smoking may suggest a biological mechanism for intrauterine tobacco exposure on the risk of CD symptoms in offspring. Early interventions assisting pregnant mothers to quit tobacco smoking, or avoid smoking initiation, have potential to contribute health benefits to both mothers and their offspring.
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Affiliation(s)
- Bereket Duko
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia.
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Robert J Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, 7 Parker Place Building 609, Level 2 Technology Park, Bentley, WA, 6102, Australia
| | - John Newnham
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, 17 Monash Ave, Nedlands, WA, 6009, Australia
| | - Kim Betts
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Rosa Alati
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia; Institute for Social Sciences Research, The University of Queensland, 80 Meier's Rd, Indooroopilly, Queensland, 4068, Australia
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11
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Szewczuk-Bogusławska M, Kaczmarek-Fojtar M, Adamska A, Frydecka D, Misiak B. Assessment of the association between non-suicidal self-injury disorder and suicidal behaviour disorder in females with conduct disorder. BMC Psychiatry 2021; 21:172. [PMID: 33771124 PMCID: PMC7995747 DOI: 10.1186/s12888-021-03168-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/15/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) and aggression have been demonstrated to serve as risk factors of suicidal behaviours (SB). Non-suicidal self-injury disorder (NSSID) and Suicidal Behaviour Disorder (SBD) are among new diagnostic categories for further studies in the DSM-5 classification. METHODS We recruited 196 girls (aged 15.5 ± 1.2 years) diagnosed with conduct disorder (CD). All of them were assessed with respect of non-suicidal self-injury acts, suicidal attempts, psychopathology, self-esteem and general functioning. RESULTS Age of NSSI onset was significantly lower compared to age of first suicidal attempt. SBD was present in 50.0% of patients with NSSID and the prevalence of NSSID in individuals with SBD was estimated at 52.2%. A diagnosis of NSSID, with at least 8 days of engagement in self-injuries during the preceding year, significantly predicted the risk of SBD. This effect appeared to be independent of depressive symptomatology. LIMITATIONS Our results cannot be generalized over the whole population of individuals diagnosed with CD because of a lack of male patients, as well as individuals with the most severe and mildest forms of CD. Causal inferences cannot be established due to a cross-sectional study design. CONCLUSIONS The NSSID with at least 8 days of engagement in self-injuries during the preceding year serves as a predictor of SBD independently of the effects of depressive symptoms. Longitudinal studies are required to confirm our findings.
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Affiliation(s)
- Monika Szewczuk-Bogusławska
- Department of Psychiatry, Wroclaw Medical University, Katedra i Klinika Psychiatrii UM, Wybrzeże L. Pasteura 10, 50-367, Wrocław, Poland.
| | | | - Agnieszka Adamska
- grid.4495.c0000 0001 1090 049XDepartment of Psychiatry, Wroclaw Medical University, Katedra i Klinika Psychiatrii UM, Wybrzeże L. Pasteura 10, 50-367 Wrocław, Poland
| | - Dorota Frydecka
- grid.4495.c0000 0001 1090 049XDepartment of Psychiatry, Wroclaw Medical University, Katedra i Klinika Psychiatrii UM, Wybrzeże L. Pasteura 10, 50-367 Wrocław, Poland
| | - Błażej Misiak
- grid.4495.c0000 0001 1090 049XDepartment of Psychiatry, Wroclaw Medical University, Katedra i Klinika Psychiatrii UM, Wybrzeże L. Pasteura 10, 50-367 Wrocław, Poland
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12
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Lee YJ, Ahn IY, Kim BJ, Lee CS, Cha B, Lee SJ, Seo J, Choi JW, Lee YJ, Lim E, Lee D. Association between Early Spermarche and Suicide Attempts in Boys: the Korea Youth Risk Behavior Web-based Survey. J Korean Med Sci 2021; 36:e73. [PMID: 33754506 PMCID: PMC7985288 DOI: 10.3346/jkms.2021.36.e73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Puberty is a biologically and psychologically unstable period, and pubertal changes differ by sex. However, most previous studies on pubertal timing and suicide have focused on girls. This study investigated the association between early spermarche and suicide attempts in boys. METHODS We analyzed a nationally representative sample of Korean adolescents (The Korea Youth Risk Behavior Web-Based Survey, KYRBS) that included approximately 35,000 boys annually from 2011 to 2015. Pubertal timing in boys was defined by spermarche. Complex sampling logistic regression analyses were performed to evaluate the odds ratios (ORs) for suicide attempts between the early and average spermarche groups. RESULTS The ORs for suicide attempts in boys with early spermarche were significantly higher than those in boys with average spermarche after adjustment for age, perceived stress, depressive symptoms, and suicidal ideation. The ORs from 2011 to 2015 were as follows: 1.782 (P < 0.001), 1.490 (P = 0.002), 1.693 (P < 0.001), 1.541 (P = 0.001), and 1.393 (1.024-1.895; P = 0.035), respectively. CONCLUSION These findings suggest that early pubertal timing is a risk factor for suicide attempts in Korean boys after adjustment for depressive symptoms, perceived stress, and suicidal ideation, which have been previously reported as risk factors for suicide attempts. Therefore, careful attention should be paid to the prevention of suicide in boys who experience early spermarche in Korea.
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Affiliation(s)
- Young Ji Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - In Young Ahn
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Bong Jo Kim
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Korea
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Korea
| | - Cheol Soon Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Korea
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Korea
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Korea
| | - So Jin Lee
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Korea
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Korea
| | - Jiyeong Seo
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jae Won Choi
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Korea
| | - Youn Jung Lee
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Korea
| | - Eunji Lim
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Dongyun Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Korea
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Korea.
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13
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Pan CH, Lee MB, Wu CY, Liao SC, Chan CT, Chen CY. Suicidal ideation, psychopathology, and help-seeking in 15 to 19-year-old adolescents in Taiwan: A population-based study 2015-2019. J Affect Disord 2021; 282:846-851. [PMID: 33601727 DOI: 10.1016/j.jad.2020.12.139] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/29/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Suicide in the young population has been an urgent issue worldwide. The study aimed to assess the overall prevalence of suicide ideation and the associations between adolescent suicide and psychiatric distress/ psychiatric morbidity, as well as the myths and help-seeking behavior of adolescents with suicide ideation. METHOD The nationwide community-based telephone interviews were conducted with adolescents aged between 15 to 19 for five consecutive years (2015-2019). The measurements included demographic variables, the five-item Brief Symptom Rating Scale (BSRS-5), and help-seeking experiences of formal medical services or psychological consultations. Stepwise multiple regression analysis was performed to examine which of the five symptoms and demographic variables had discriminative validity for suicidal ideation. RESULTS Among 727 participants, the prevalence of lifetime and one-week suicidal ideation was 11.4% and 2.8%, respectively. Adolescents with lifetime/ one-week suicidal ideation and with psychiatric morbidity (BSRS-5≥6) sought psychiatric service more than their counterparts (p<0.001). Female, depression, hostility, and anxiety were significantly associated with suicidal ideation in adolescents. LIMITATIONS Telephone interview and structured questionnaire. CONCLUSION Adolescents with psychiatric morbidity who have sought help should be carefully monitored for suicidal ideation by parents, teachers, mental health workers, and psychiatric specialists altogether.
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Affiliation(s)
- Chia-Ho Pan
- Department of Psychiatry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ming-Been Lee
- Department of Psychiatry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Taiwan Suicide Prevention Center, Department of Welfare and Health, Executive Yuan, Taipei, Taiwan
| | - Chia-Yi Wu
- Taiwan Suicide Prevention Center, Department of Welfare and Health, Executive Yuan, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan; School of Nursing, National Taiwan University College of Medicine, Taiwan.
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Taiwan Suicide Prevention Center, Department of Welfare and Health, Executive Yuan, Taipei, Taiwan
| | - Chia-Ta Chan
- Department of Psychiatry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Taiwan Suicide Prevention Center, Department of Welfare and Health, Executive Yuan, Taipei, Taiwan
| | - Chun-Yin Chen
- Taiwan Suicide Prevention Center, Department of Welfare and Health, Executive Yuan, Taipei, Taiwan
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14
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Lu YC, Wu MK, Zhang L, Zhang CL, Lu YY, Wu CH. Association between suicide risk and traumatic brain injury in adults: a population based cohort study. Postgrad Med J 2020; 96:747-752. [PMID: 32015186 PMCID: PMC7788485 DOI: 10.1136/postgradmedj-2019-136860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/01/2019] [Accepted: 12/31/2019] [Indexed: 12/16/2022]
Abstract
Background Traumatic brain injury (TBI) is a major cause of death and disability worldwide, and its treatment is potentially a heavy economic burden. Suicide is another global public health problem and the second leading cause of death in young adults. Patients with TBI are known to have higher than normal rates of non-fatal deliberate self-harm, suicide and all-cause mortality. The aim of this study was to explore the association between TBI and suicide risk in a Chinese cohort. Method This study analysed data contained in the Taiwan National Health Insurance Research Database for 17 504 subjects with TBI and for 70 016 subjects without TBI matched for age and gender at a ratio of 1 to 4. Cox proportional hazard regression analysis was used to estimate subsequent suicide attempts in the TBI group. Probability of attempted suicide was determined by Kaplan-Meier method. Results The overall risk of suicide attempts was 2.23 times higher in the TBI group compared with the non-TBI group (0.98 vs 0.29 per 1000 person-years, respectively) after adjustment for covariates. Regardless of gender, age or comorbidity, the TBI group tended to have more suicide attempts, and the risk attempted suicide increased with the severity of TBI. Depression and alcohol attributed disease also increased the risk of attempted suicide in the TBI group. Conclusion Suicide is preventable if risk factors are recognised. Hence, TBI patients require special attention to minimise their risk of attempted suicide.
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Affiliation(s)
- Yueh-Chien Lu
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Li Zhang
- Department of Neurosurgery, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, China
| | - Cong-Liang Zhang
- Department of Cardiology, Hebei Quyang Renji Hospital, Quyang, China
| | - Ying-Yi Lu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chieh-Hsin Wu
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan .,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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15
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Itzhaky L, Galfalvy H, Keilp JG, Gratch I, Brodsky BS, Stanley BH. Stress Response in Suicide Attempters with Borderline Personality Disorder: The Role of Behavioral Problems in Childhood. Psychiatry 2020; 83:221-230. [PMID: 32069167 PMCID: PMC8721090 DOI: 10.1080/00332747.2020.1716439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Suicidal individuals are a heterogeneous population and may differ in systematic ways in their responsiveness to stress. The primary aim of the present study was to identify whether a different pattern of physiological stress response exists among adult suicide attempters with a history of behavioral problems during childhood and adolescence, which earlier studies have related to both decreased activity of the HPA axis and to suicidal behaviors. Method: Seventy-eight participants with Borderline Personality Disorder were assessed using the SCID-II, and completed self-report measures assessing their history of suicide attempts, history of aggressive behaviors, depressive symptoms, history of lifetime abuse and demographics. Participants' cortisol reactivity was assessed using the Trier Social Stress Test. Results: Analyses indicated that suicide attempters with a history of behavioral problems in youth (n = 30) had a significantly lower response to stress than both suicide attempters without such a history (n = 26) and non-attempters (n = 22), when controlling for lifetime history of abuse. The groups did not differ in basal cortisol. Conclusions: These findings suggest a unique subtype of suicide attempter among those with Borderline Personality Disorder, characterized by a blunted physiological stress response.
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Affiliation(s)
- Liat Itzhaky
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Hanga Galfalvy
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - John G. Keilp
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ilana Gratch
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Beth S. Brodsky
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Barbara H. Stanley
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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16
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Clarke S, Allerhand LA, Berk MS. Recent advances in understanding and managing self-harm in adolescents. F1000Res 2019; 8:F1000 Faculty Rev-1794. [PMID: 31681470 PMCID: PMC6816451 DOI: 10.12688/f1000research.19868.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
Adolescent suicide is a serious public health problem, and non-suicidal self-injury (NSSI) is both highly comorbid with suicidality among adolescents and a significant predictor of suicide attempts (SAs) in adolescents. We will clarify extant definitions related to suicidality and NSSI and the important similarities and differences between these constructs. We will also review several significant risk factors for suicidality, evidence-based and evidence-informed safety management strategies, and evidence-based treatment for adolescent self-harming behaviors. Currently, dialectical behavior therapy (DBT) for adolescents is the first and only treatment meeting the threshold of a well-established treatment for self-harming adolescents at high risk for suicide. Areas in need of future study include processes underlying the association between NSSI and SAs, clarification of warning signs and risk factors that are both sensitive and specific enough to accurately predict who is at imminent risk for suicide, and further efforts to sustain the effects of DBT post-treatment. DBT is a time- and labor-intensive treatment that requires extensive training for therapists and a significant time commitment for families (generally 6 months). It will therefore be helpful to assess whether other less-intensive treatment options can be established as evidence-based treatment for suicidal adolescents.
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Affiliation(s)
- Stephanie Clarke
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA
| | - Lauren A. Allerhand
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA
| | - Michele S. Berk
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA
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17
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Suicidal behavior and aggression-related disorders. Curr Opin Psychol 2018; 22:54-58. [DOI: 10.1016/j.copsyc.2017.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 11/18/2022]
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