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Williams R, Chiesa M, Moselli M, Frattini C, Casini M, Fonagy P. The relationship between mood disorders, personality disorder and suicidality in adolescence: does general personality disturbance play a significant role in predicting suicidal behavior? Borderline Personal Disord Emot Dysregul 2023; 10:32. [PMID: 37907967 PMCID: PMC10619325 DOI: 10.1186/s40479-023-00238-9] [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] [Received: 04/07/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Current research points to the importance personality pathology and Major Depression e as relevant psycopathological risk factors for understanding suicidal risk in adolescence. Literature has mainly focused on the role of BPD, however current orientations in personality pathological functioning suggest that BPD may be the representative of a general personality disturbance, a factor of vulnerability underlying diverse psychopathological variants and aspects of maladaptive functioning. However, recent studies seem to have neglected the contributions that other specific personality disorders and personality pathology as a general factor of vulnerability for suicidality; and only marginally investigated the interaction of personality disorder (PD) as an overall diagnosis and individual PDs and major depression (MDD). In this paper, the independent and cumulative effects of MDD and DSM-IV PDs on suicidal risk are investigated in a sample of adolescents observed in a longitudinal window of observation ranging from three months preceding the assessment to a six-month follow up period of clinical monitoring. METHODS A sample of 118 adolescents (mean age = 15.48 ± 1.14) referred for assessment and treatment on account of suicidal ideation or behavior were administered the CSSRS, SCID II, Kiddie-SADS at admission at inpatient and outpatient Units. All subjects included in the study had reported suicidal ideation or suicide attempts at the C-SSRS; The CSSRS was applied again to all patients who reported further suicidal episodes during the six-months follow-up period of clinical monitoring. Dimensional diagnoses of PDs was obtained by summing the number of criteria met by each subject at SCID-%-PD 5, In order, to test the significance of the associations between the variables chosen as predictors (categorical and dimensional PDs and MD diagnosis), and the suicidal outcomes variables suicide attempts, number of suicide attempts and potential lethality of suicide attempt, non-parametric bivariate correlations, logistic regression models and mixed-effects Poisson regression were performed PD. RESULTS The categorical and dimensional diagnosis of PD showed to be a significant risk factors for suicide attempt and their recurrence, independently of BPD, that anyway was confirmed to be a specific significant risk factor for suicidal behaviors. Furthermore, PD assessed at a categorical and dimensional level and Major Depression exert an influence on suicidal behaviors and their lethality both as independent and cumulative risk factors. LIMITATIONS Besides incorporating dimensional thinking into our approach to assessing psychopathology, our study still relied on traditionally defined assessment of PD. Future studies should include AMPD-defined personality pathology in adolescence to truly represent dimensional thinking. CONCLUSION These results point to the importance of early identification of the level of severity of personality pathology at large and its co-occurrence with Major Depression for the management of suicidal risk in adolescence.
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Affiliation(s)
- Riccardo Williams
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy.
| | - Marco Chiesa
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marta Moselli
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy
| | - Camillla Frattini
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy
| | - MariaPia Casini
- Section of Child and Adolescent Neuro-Psychiatry, "Sapienza" - University of Rome, Rome, Italy
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Moselli M, Casini MP, Frattini C, Williams R. Suicidality and Personality Pathology in Adolescence: A Systematic Review. Child Psychiatry Hum Dev 2023; 54:290-311. [PMID: 34524583 PMCID: PMC9977705 DOI: 10.1007/s10578-021-01239-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
This work presents a review of research papers examining the role of emerging personality pathology in suicidal ideation and behaviours in adolescence. Initially, 226 studies were selected in line with PRISMA guidelines, and 33 articles were finally included in this review. The data show percentages of any personality disorder diagnosis ranging from 19.5 to 22.8% in suicide attempters, while in autopsy studies, the rate of personality disorder diagnosis varied between 29.6 and 42.1%. The overwhelming majority of the studies focus on the role of borderline personality disorder (BPD) in suicidal behaviours, also highlighting its predictive role at a longitudinal level. Furthermore, the literature review shows that personality traits supposed to underlie BPD, such as affective instability, impulsivity and identity diffusion, have specific predictive links with suicidal conduct. Other personality pathology dimensions, such as aggressiveness, sadism and perfectionism that are associated with other personality disorders, namely, antisocial and narcissistic personality disorders, have also shown a significant mediating role for suicidal risk. Overall, these results seem to parallel the role of personality pathology in predicting suicide in adulthood and point to the relevance of assessing the presence of emerging patterns of personality disorders for the clinical management of suicidal risk in adolescence.
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Affiliation(s)
- Marta Moselli
- Department of Clinical and Dynamic Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Pia Casini
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Camilla Frattini
- Department of Clinical and Dynamic Psychology, Sapienza University of Rome, Rome, Italy
| | - Riccardo Williams
- Department of Clinical and Dynamic Psychology, Sapienza University of Rome, Rome, Italy.
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Alvarez-Subiela X, Castellano-Tejedor C, Verge-Muñoz M, Esnaola-Letemendia K, Palao-Vidal D, Villar-Cabeza F. Predictors of Suicide Re-Attempt in a Spanish Adolescent Population after 12 Months' Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137566. [PMID: 35805225 PMCID: PMC9265348 DOI: 10.3390/ijerph19137566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 01/27/2023]
Abstract
Background: This study aims to identify the main predictive factors that allow for the recognition of adolescents with a higher risk of re-attempting suicide. Method: A longitudinal 12-month follow-up design was carried out in a sample of 533 Spanish adolescents between 12 and 17 years old. The data collection period comprised September 2013 to November 2016, including a one-year follow-up after hospital discharge. Results: A statistically significant regression model was obtained to predict suicide re-attempt at 12-months’ follow-up (χ2 = 34.843; p < 0.001; Nagelkerke R2 = 0.105), including personal history of self-injury (OR = 2.721, p < 0.001, 95% CI [1.706, 4.340]) and age (OR = 0.541, p = 0.009, 95% CI [0.340, 0.860]), correctly classifying 82.6% of the sample. Our results show that having a personal history of self-injury and being younger than 14 years old were predictors of suicide re-attempt during the first year after an adolescent’s first admission to emergency services. Conclusions: Considering these factors could contribute to the design of more tailored and effective interventions to prevent suicidal behavior in adolescents at high risk of re-attempting suicide.
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Affiliation(s)
- Xavier Alvarez-Subiela
- Suicide Conduct Unit, Psychiatry and Psychology Department, Sant Joan de Déu Hospital, 08950 Esplugues del Llobregat, Spain; (X.A.-S.); (M.V.-M.); (K.E.-L.); (F.V.-C.)
- Doctoral Program in Psychiatry, Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, 08193 Bellaterra, Barcelona, Spain
| | - Carmina Castellano-Tejedor
- Research Group on Stress and Health (GIES), Department of Basic Psychology, Faculty of Psychology, Autonomous University of Barcelona, 08193 Bellaterra, Barcelona, Spain;
- RE-FIT Research Group, Parc Sanitari Pere Virgili & Vall d’Hebron Institute of Research, 08023 Barcelona, Spain
| | - Mireia Verge-Muñoz
- Suicide Conduct Unit, Psychiatry and Psychology Department, Sant Joan de Déu Hospital, 08950 Esplugues del Llobregat, Spain; (X.A.-S.); (M.V.-M.); (K.E.-L.); (F.V.-C.)
| | - Kike Esnaola-Letemendia
- Suicide Conduct Unit, Psychiatry and Psychology Department, Sant Joan de Déu Hospital, 08950 Esplugues del Llobregat, Spain; (X.A.-S.); (M.V.-M.); (K.E.-L.); (F.V.-C.)
| | - Diego Palao-Vidal
- Doctoral Program in Psychiatry, Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, 08193 Bellaterra, Barcelona, Spain
- Unitat de Neurociències Traslacional I3PT-INc, University Hospital Parc Taulí, 08208 Sabadell, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, 28029 Madrid, Spain
- Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Barcelona, Spain
- Department of Mental Health, University Hospital Parc Taulí, 08208 Sabadell, Barcelona, Spain
- Correspondence:
| | - Francisco Villar-Cabeza
- Suicide Conduct Unit, Psychiatry and Psychology Department, Sant Joan de Déu Hospital, 08950 Esplugues del Llobregat, Spain; (X.A.-S.); (M.V.-M.); (K.E.-L.); (F.V.-C.)
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Greenfield B, Jolicoeur-Martineau A, Brown M, Kandiyoti A, Henry M, Sasson T, Ahmadi S, Vivani T, Harnden B, de Castro F, Tran B, Boodaghians L, Weiss M, Atsaidis Z, Wazana A. Frequent follow-up of suicidal youth assessed in the emergency room: Long-term trajectory and predictors of suicidality. Prev Med 2021; 152:106737. [PMID: 34538378 DOI: 10.1016/j.ypmed.2021.106737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
UNLABELLED Suicide was the second‑leading cause of US deaths in 2018 among 15-24-year-olds. Suicide attempts, a risk factor for completions, and suicide ideation have doubled among pediatric emergency room (ER) patients during the past decade. Borderline Personality Disorder (BPD), a comorbid condition, has a 10% suicide rate. We examined the 4-year outcome of a cohort of suicidal adolescents, many also suffering from BPD and having undergone some form of treatment, to identify baseline factors which could inform intervention that would minimize suicidality 4 years post-discharge. METHODS We conducted a prospective longitudinal study of suicidality at twelve points (four assessment occasions) for 286 suicidal youth presenting to a pediatric ER, most suffering from BPD, with 36 suicide ratings from baseline to 2-, 6- and 48-month follow-up evaluations. We examined the trajectory and predictors of persisting suicidality. RESULTS Suicidality rapidly decreased within 2 months post-ER-discharge, subsequently remaining low throughout 48 months. Baseline functioning, female sex, stressful life events and BPD impulsiveness were most predictive of persisting suicidality at 48-month follow-up. CONCLUSION Most suicidal youth, many meeting BPD criteria, no longer feel suicidal 2 months after ER discharge. Management of participants' baseline poor functioning stressful life events and the impulsiveness component of BPD specifically in females could impact suicidality 4 years later, and guide treatment options. The absence of the BPD cognitive and affective subscales as predictors of suicidality at 4-year follow-up may reflect treatment received. Further investigation of treatment effects is warranted and under way.
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Affiliation(s)
- Brian Greenfield
- Department of Psychiatry, Faculty of Medicine, McGill University, Canada
| | - Alexia Jolicoeur-Martineau
- Mila, University of Montréal, Montréal, QC, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Maria Brown
- Department of Educational & Counselling Psychology, McGill University, Montréal, QC, Canada
| | - Alegra Kandiyoti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Melissa Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; Segal Cancer Centre, Jewish General Hospital, Canada
| | - Tania Sasson
- Department of Physical Medicine & Rehabilitation, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Tania Vivani
- Department of Psychology, Universite de Quebec a Montreal, Montréal, QC, Canada
| | - Bonnie Harnden
- Department of Creative Arts Therapies, Faculty of Fine Arts, Concordia University, Montréal, QC, Canada
| | - Filipa de Castro
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Brian Tran
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Levon Boodaghians
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Margaret Weiss
- Child Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
| | - Zoe Atsaidis
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Ashley Wazana
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; Centre for Child Development and Mental Health, Jewish General Hospital, Montréal, QC, Canada.
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