Suicide attempts in the "comprehensive community mental health services for children and their families" program

Factors associated with single and multiple suicide attempts in adolescents attending school in Argentina: national cross-sectional survey in 2018

BACKGROUND

Factors associated with single suicide attempts (SSA) and multiple suicide attempts (MSA) may differ.

AIMS

The study aimed to assess the factors associated with MSA in adolescents with a history of suicide attempts during the past 12 months in Argentina.

METHOD

National cross-sectional data from the Global School-based Student Health Survey in Argentina in 2018 were analysed. Students who reported having a history of suicide attempts in the past 12 months were included in the final sample (n = 8507). Students with MSA were compared with students with an SSA through multiple logistic regression.

RESULTS

In a subsample of adolescents attending school (mean age 14.8 years, s.d. = 1.3), 59.4% had an SSA and 40.6% had MSA in the past 12 months. In the final adjusted logistic regression model, compared with participants with SSA, both male and female students with MSA more frequently had no close friends, reported feeling more lonely and had more anxiety-induced sleep disturbances. Furthermore, among female participants, having been physically attacked, having participated in physical fights, low parental support, current tobacco use and lifetime amphetamine use were associated with MSA. Among male students, multiple sexual partners were associated with MSA. Furthermore, among both boys and girls, compared with participants without psychosocial distress, participants with one, two, three or more psychosocial distress factors had higher odds of MSA. Compared with students with one or two social or environmental risk factors, students with seven or eight social or environmental risk factors had higher odds of MSA; compared with students who had zero or one health risk behaviours, students with six or more health risk behaviours had higher odds of MSA.

CONCLUSIONS

Psychosocial distress (anxiety-induced sleep disturbance, having no close friends and loneliness) increased the odds of MSA among both sexes. The odds of MSA were increased by interpersonal violence, low parental support and substance use among girls, and by having multiple sexual partners among boys. This suggests the potential relevance of these variables in identifying multiple suicide attempters among adolescents attending school in Argentina.

Predicting the Risk of Future Multiple Suicide Attempt among First-Time Suicide Attempters: Implications for Suicide Prevention Policy

Suicide is listed in the top ten causes of death in Taiwan. Previous studies have pointed out that psychiatric patients having suicide attempts in their history are more likely to attempt suicide again than non-psychiatric patients. Therefore, how to predict the future multiple suicide attempts of psychiatric patients is an important issue of public health. Different from previous studies, we collect the psychiatric patients who have a suicide diagnosis in the National Health Insurance Research Database (NHIRD) as the study cohort. Study variables include psychiatric patients’ characteristics, medical behavior characteristics, physician characteristics, and hospital characteristics. Three machine learning techniques, including decision tree (DT), support vector machine (SVM), and artificial neural network (ANN), are used to develop models for predicting the risk of future multiple suicide attempts. The Adaboost technique is further used to improve prediction performance in model development. The experimental results show that Adaboost+DT performs the best in predicting the behavior of multiple suicide attempts among psychiatric patients. The findings of this study can help clinical staffs to early identify high-risk patients and improve the effectiveness of suicide prevention.

Assessment of suicidal youth in the emergency department

Accurate evaluation of suicidal adolescents in the emergency department (ED) is critical for safety and linkage to follow-up care. We examined self-reports of 181 adolescents who presented to an ED with suicidal ideation (SI) or a suicide attempt (SA). Parents also completed self-reports. Results showed fair agreement between parents and youth on the reason for the ED visit (e.g., SI vs. SA) and greater agreement between independent judges and youths than between judges and parents. In accordance with accepted definitions of suicide attempts (e.g., Crosby, Ortega, & Melanson, 2011; O'Carroll, Berman, Maris, Moscicki, Tanney, & Silverman, 1996, p. 237; Posner, Oquendo, Gould, Stanley, & Davies, 2007, p. 1035; Silverman, Berman, Sanddal, O'Carroll, & Joiner, 2007, p. 248), most youth with SA as the reason for the ED visit reported some intent to die associated with the attempt. Finally, youth presenting to the ED with SA did not differ clinically from youth presenting with SI, and almost half of youths with SI reported past suicide attempts. These results highlight the need to emphasize adolescents' reports in clinical decision making, suggest adolescents' defined suicide attempts similarly to published definitions, and show that assessment of past SAs, as well as present suicidal thoughts and behaviors, is critical in determining future risk.

The mediating roles of stress and maladaptive behaviors on self-harm and suicide attempts among runaway and homeless youth

Runaway and homeless youth often have a constellation of background behavioral, emotional, and familial problems that contribute to stress and maladaptive behaviors, which, in turn, can lead to self-harming and suicidal behaviors. The current study examined the roles of stress and maladaptive behaviors as mediators between demographic and psychosocial background characteristics and self-injurious outcomes through the lens of the stress process paradigm. The model was tested in a sample of runaway and homeless youth from Los Angeles County (N = 474, age 12-24, 41 % female, 17 % White, 32.5 % African American, 21.5 % Hispanic/Latino). Background variables (gender, age, sexual minority status, parental drug use history, and emotional distress) predicted hypothesized mediators of maladaptive behaviors and recent stress. In turn, it was hypothesized that the mediators would predict self-harming behaviors and suicide attempts in the last 3 months. Females and LGBT (lesbian, gay, bisexual, transgender) youth were more likely to have self-harmed and attempted suicide; younger participants reported more self-harming. The mediating constructs were associated more highly with self-harming than suicide attempts bivariately, although differences were modest. Maladaptive behaviors and recent stress were significant predictors of self-harm, whereas only recent stress was a significant predictor of suicide attempts. All background factors were significant predictors of recent stress. Older age, a history of parental drug use, and greater emotional distress predicted problem drug use. Males, younger participants, and participants with emotional distress reported more delinquent behaviors. Significant indirect effects on self-harming behaviors were mediated through stress and maladaptive behaviors. The hypothesized paradigm was useful in explaining the associations among background factors and self-injurious outcomes and the influence of mediating factors on these associations.

A comparison of two hospital districts with low and high figures in the compulsory care of minors: an ecological study

BACKGROUND

The last decade in Finland has seen a vast increase both in involuntary psychiatric treatment of adolescents and in the numbers of adolescents taken into care under the Child Welfare Act. Moreover, the variation in figures between different hospital districts is remarkable. The reasons for this are not known, but it cannot be due to variation in the epidemiology of mental disorders in minors.

AIM

The aim of the study was to explore features associated with compulsory care of adolescents at regional level by comparing two hospital districts clearly differing in this regard. The characteristics of involuntarily treated adolescents and adolescents taken into care, the resources and structures of adolescent psychiatric services and child welfare services, and the environmental factors associated with adolescent well-being and adaptation, such as indicators of social deprivation of families were all considered.

MATERIALS AND METHODS

For the present study, 2 out of the 22 hospital districts in Finland were selected, one using compulsory psychiatric care and taking into care of 13-17-year olds above and the other below the average in Finland. Register data on patient characteristics, services, and social deprivation were used. Absolute and population adjusted figures (95% confidence intervals) from the variables are given. The differences in incidences between health care districts were compared using Poisson regression analysis.

RESULTS

Proportions of divorces, single parent families, social exclusion and outpatient mental health service use, and detoxification treatment use of adults were higher in the health care district with above average coercion figures than in the area with below average coercion figures. The numbers of adolescent psychiatric outpatient visits were higher in the health care district with coercion figures below average despite the fact that the number of positions in adolescent outpatient services was lower than in the health care district with above average coercion figures.

CONCLUSION

Factors other than the characteristics of the adolescents themselves are associated with use of compulsory care on them, although an ecological study design cannot establish causality.

The impact of youth and family risk factors on service recommendations and delivery in a school-based system of care

The present study examines the impact of child and family risk factors on service access for youth and families in a school-based system of care. Regression analyses examined the relationships between risk factors and services recommended, services received, and dosage of services received. Logistic regression analyses examined the relationship between risk factors and whether or not youth received specific types of services within the system of care. Results revealed that youth with a personal or family history of substance use had more services recommended than youth without these risk factors, while youth with a family history of substance use received more services. Youth with a history of substance use received a significantly higher dosage of services overall. Finally, history of family mental illness was associated with receiving mental health and operational services (e.g., family advocacy, emergency funds). Implications and limitations are discussed.

Childhood predictors of deliberate self-harm behavior and suicide ideation in korean adolescents: a prospective population-based follow-up study

The aim of this study was to investigate predictors of adolescence suicidality in a longitudinal study. Additionally, the prevalence of deliberate self-harm behavior and suicide ideation at age 7 and during middle school were examined. Initial assessment data was obtained from 1998 to 2000, and a follow-up assessment was performed in 2006 when the original subjects became middle school students. The addresses and names of 1,857 subjects were located from the original data; they were 910 boys and 947 girls. The subjects were evaluated with the Korean version of the Child Behavior Checklist (K-CBCL), which was administered by the parents of the children, and by various demographic and psychosocial factors. They were reassessed using self reports on the Korea Youth Self Report (K-YSR); in particular, replies to items related to self-harm behavior and suicide ideation were recorded. A logistic regression analysis showed that the factors of gender, economic status, the overall amount of behavior problems, the tendency to internalizing and externalizing problems, somatic problems, thought problems, delinquent behavior, and aggressive behavior were independent predictors of adolescent suicide ideation and self-harm behavior. The importance of total behavior problems suggested that adolescent difficulty is a consequence of an accumulation of various risk factors. Accordingly, clinicians must consider a range of internalizing and externalizing issues, especially overall adaptation, for suicide intervention.

Factors associated with multiple versus single episode suicide attempts in the 1990-1992 and 2001-2003 United States national comorbidity surveys

This study sought to examine psychiatric and childhood traumatic event correlates of multiple suicide attempts (MSA) compared with single suicide attempts (SSA) in 2 nationally representative samples of the United States general population. Data came from the National Comorbidity Survey (n = 5,401; age 18-54; response rate = 82.4%) and the National Comorbidity Survey Replication (n = 4,083; age 18-54; response rate = 70.9%). Multiple logistic regressions were used to compare individuals with MSA to those with a SSA on the variables of interest after adjusting for sociodemographic variables. Individuals with a history of MSA had significantly higher odds of experiencing several traumatic events in childhood in the 2 surveys. Most notably, comorbidity of 3 or more mental disorders and the presence of at least 1 anxiety disorder distinguished individuals with MSA from those with a SSA in both surveys, suggesting the potential importance of these variables in association with multiple suicide attempts.

Adolescent Suicidal Behavior and Substance Use: Developmental Mechanisms

Adolescent suicidal behaviors and substance use are disturbingly common. Research suggests overlap of some of the etiological mechanisms for both adolescent suicidal behavior and substance use, yet clear understanding of the complex relations between these behaviors and their causal underpinnings is lacking. A growing body of evidence and a diathesis model (Mann et al. 1999; Mann, 2003) highlight the importance of impulse control as a proximal risk factor for adolescent suicidal and substance use behaviors. This literature review extends current theory on the relationships between adolescent suicidal behavior and substance use by: (1) examining how, when, and to what extent adolescent development is affected by poor impulse control, stressful life events, substance use behavior, and biological factors; (2) presenting proposed causal mechanisms by which these risk factors interact to increase risk for suicidal behaviors and substance use; and (3) proposing specific new hypotheses to extend the diathesis model to adolescents at risk for suicide and substance use. More specifically, new hypotheses are presented that predict bidirectional relationships between stressful life events and genetic markers of 5-HT dysregulation; substance use behavior and impulsivity; and substance use behavior and suicide attempts. The importance of distinguishing between different developmental trajectories of suicidal and substance use behaviors, and the effects of specific risk and protective mechanisms are discussed. Use of new statistical approaches that provide for the comparison of latent growth curves and latent class models is recommended to identify differences in developmental trajectories of suicidal behavior and substance use. Knowledge gained from these prospective longitudinal methods should lead to greater understanding on the timing, duration, and extent to which specific risk and protective factors influence the outcomes of suicidal behavior and substance use. In turn, findings from these studies should inform researchers who conduct future treatment and prevention studies.

Preventing youth suicide: issues for law enforcement personnel

Suicide is a leading cause of death for adolescents. A number of problem behaviors associated with youth suicide fall into the purview of law enforcement personnel, and they are therefore in a position to detect risk and prevent suicidal behaviors. Eight hundred one youth identified as having school difficulty, a group at increased risk for both suicide and legal problems, participated in a paper and pencil survey followed by an interview focusing on suicide risk and protective factors. Linear regression was used to examine the ability of factors within each risk and protective factor dimension to predict current suicide risk. The study goal was to determine the most relevant factors influencing suicide risk in each domain examined. Findings are discussed in terms of implications for assessment and policy for law enforcement personnel.

Pediatric emergency department suicidal patients: two-site evaluation of suicide ideators, single attempters, and repeat attempters

OBJECTIVE

Reducing youth suicide and suicide attempts are national priorities. Suicidal youth emergency department (ED) patients are at high risk for repeat and fatal attempts, yet information is lacking to guide service delivery. In one of the largest clinical studies of youth ED patients presenting with suicidality, we examine ideators, single attempters, and repeat attempters with the aim of clarifying optimal strategies for ED management and risk assessment.

METHOD

Consecutively admitted suicidal youths (10-18 years) from two EDs (N = 210) completed a questionnaire assessing sociodemographic, clinical, service use, and environmental stress variables.

RESULTS

Despite differences in background characteristics, high levels of depression, externalizing behavior, posttraumatic stress symptoms, substance use, and thought problems were observed across sites. Suicide attempt risk, defined along a continuum ranging from ideation to single attempts to repeat attempts, was predicted by higher levels of clinical symptoms, service use, and environmental stress. Specific stresses associated with increased suicide attempt risk were romantic breakups, exposure to suicide/suicide attempts, and pregnancy in self or partner. Significant predictors of attempt risk in the male-only subgroup were depression, thought problems, previous ED visits, and romantic breakups.

CONCLUSIONS

Pediatric ED patients presenting with suicidal ideation, single attempts, and repeat attempts fall along a continuum of increasing risk. Suicide attempt risk in males is associated with high levels of depression, but not with increased treatment rates, suggesting undertreatment in males, a group with particularly high risk for death by suicide. Treatment barriers must be addressed to achieve our national goal of reducing suicide/suicide attempts in youths.

Suicide risk and protective factors among youth experiencing school difficulties

Youth who experience difficulty in school are at risk for suicide, yet there is little published information specific to risk and protective factors among this group. The purpose of this study was to conduct an in-depth examination of risk and protective factors associated with suicidal behaviour among youth who were experiencing problems in school and to compare these factors between suicide risk and non-suicide risk subgroups. Participants were 730 high school students in the Northwest and Southwest regions of the United States, aged 14-21 years. All participants were known to be experiencing difficulty with grades and/or attendance. Students completed a paper-and-pencil questionnaire and a one-on-one interview, which assessed suicidal behaviours as well as risk factors (e.g. drug involvement, emotional distress, stress), and protective factors (e.g. self-esteem, coping, support). Analysis of covariance tests, controlling for age and sex, were conducted to examine differences between the suicide risk and non-suicide risk groups on each risk and protective factor. The suicide risk subgroup reported higher levels of all risk factors, except alcohol and marijuana use, and lower levels of protective factors. While the groups did not differ on frequency of alcohol or marijuana use, they did differ on other illicit drug use and consequences of alcohol and other illicit drug use. Recommendations for nurses practising in school settings are discussed.

Variation in functioning, psychosocial characteristics, and six-month outcomes among suicidal youth in comprehensive community mental health services

In this study we compared the psychosocial (n = 7,896) and clinical (n = 4,664) characteristics and 6-month functional outcomes (n = 2,594) of suicidal and nonsuicidal youth. Repeat and previous attempters were more likely than first-time and never attempters to experience psychosocial problems and to be functionally impaired in a variety of domains. Differences in functional impairment persisted at 6 months. Among those who were not severely functionally impaired at baseline, repeat attempters were more likely to be severely impaired at 6 months. Subgroups of suicide attempters may present to treatment differently, have a different expression of problems over time, and have different treatment needs.

Trapped in transition: The complex young adult patient

The transition from adolescence to adulthood is filled with new responsibilities, rights, and roles. As such, it can be a difficult period for the individual to navigate, and is only complicated by the presence of complex psychiatric illness. When these factors coincide, what can result is social and psychiatric disability. This article examines unique obstacles and considerations in the care of the complex young adult patient as illustrated by case vignettes from a specialty unit devoted to the care of this population. In the process, specific strategies useful in engaging, assessing, and treating this cohort are put forth.

Suicide attempts and life events 5-9 years after referral for emergency psychiatric outpatient treatment

The aim of this naturalistic and retrospective follow-up study was to identify putative predictors of suicide attempts among young adults at high risk with a particular view on adverse life events. One hundred young adults who had been given emergency treatment for mental health problems in child and adolescent outpatient clinics in Norway were assessed 5-9 years after referral. Suicide and suicide attempts in the follow-up period were registered as well as suicide attempts at referral and previous suicide attempts unrelated to the treatment referral. In addition, adverse life events during childhood and adolescence and social background factors were registered. Only one subject committed suicide during the follow-up period. However, suicide attempts were frequent (29/100) and equally distributed among those referred for suicidal or other reasons. Those who had attempted suicide experienced more adverse life events during adolescence, were more likely to be male, to have incomplete schooling and a record of psychiatric hospitalizations. Clinicians need to address the risk of future suicide attempts also among young emergency patients not referred for suicidal reasons.

Conceptual issues in understanding the relationship between suicidal behavior and substance use during adolescence

Alcohol and drug use are considered to be risk factors for suicidal behaviors in adolescence, but the precise nature of the relationship between suicidality and substance abuse, and the implications of this relationship for prevention and treatment interventions remain elusive. There are several conceptual issues that need to be addressed when considering the substance abuse-suicidality relationship. What are the most appropriate ways of defining suicidal behaviors? What are the best ways of assessing suicidal behavior and characterizing its course over time? Should adolescents who are suicidal be considered to be a single homogeneous population? What are the possible ways in which the course of substance abuse and suicidality over time are related? What factors potentially affect the trajectories of both substance abuse and suicidality? Does the relationship between substance abuse and suicidality change over time? And, to what extent can our knowledge of factors precipitating and maintaining the joint outcomes of suicidal and substance abuse behaviors be incorporated into interventions that target both? Careful consideration and exploration of these issues hopefully should improve our understanding the substance abuse-suicidality interrelationship, and ultimately the development of more effective prevention efforts and treatments for youths with both problems.

Gender differences in patterns of risk factors among children receiving mental health services: latent class analyses

Latent class analyses were used to analyze data from a sample of children participating in the national evaluation of the Comprehensive Communities Mental Health Services for Children and Their Families Program (N = 6786). Lifetime risk experiences of the child were analyzed to identify 4 classes of boys and girls with similar risk patterns. While low-risk, status-offense, abuse, and high-risk classes were identified for both boys and girls, there were nearly half the number of girls in the low-risk class, almost as many in the status-offense class, twice as many in the abuse class, and more than 3 three times as many in the high-risk class as there were boys. These findings suggest that there are specific groups of children entering services who differ as a function of their lifetime risk exposure. In addition, the relationship between class membership and child functioning, and class membership and family lifetime risk experiences. Understanding these differences provides critical information to the service planning process. In addition, it may result in immediate improvement in the triage of children into services and a better understanding of their behaviors during and after treatment.

Alcohol abuse and suicide attempts among youth

This study uses the Youth Risk Behavior Survey (YRBS) and the National Comorbidity Survey (NCS) to explore the causal relationship between alcohol abuse (binge drinking and clinically defined alcohol use disorders) and suicide attempts among youth. We use an empirical approach that allows one to assess the possible existence and strength of a causal relationship without relying on identifying assumptions. Our results suggest that a causal relationship between binge drinking and suicide attempts is very unlikely. The findings, however, support a causal relationship between clinically defined alcohol use disorders and suicide attempts among girls.

Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts

The purpose of this study was to examine affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Forty-seven adolescents with a history of multiple suicide attempts (MA) were compared to 74 single suicide attempters (SA) on psychiatric diagnosis, depressive symptoms, affect regulation, self-mutilation, alcohol use, and hopelessness. Results revealed that the MA group was more likely to be diagnosed with a mood disorder, and reported more severe depressive symptoms and anger, in comparison to the SA group. Behaviorally, the MA group had higher rates of disruptive behavior disorders and higher levels of affect dysregulation and serious self-mutilation than the SA group. Further, greater levels of hopelessness were reported by the MA than the SA group. After controlling for a mood disorder diagnosis, only differences in anger, affect dysregulation, and serious self-mutilation remained significant. Overall, results suggest that treatment with adolescent suicide attempters might specifically target anger and affect dysregulation to reduce risk for future suicidal behavior.

Child functioning in rural and nonrural areas: how does it compare when using the service program site as the level of analysis?

The current study uses data from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program to examine child functioning in rural (n = 8) as compared to nonrural (n = 18) system-of-care communities across the United States. In this study, the topic of rural versus nonrural differences is approached from a community-level perspective with aggregated functional impairment scores as the dependent variable of interest in weighted least squares regression. The demographic characteristics of children, particularly age, were more important predictors of functional impairment than geographic locale (i.e., rural vs nonrural). Specifically, while children served in nonrural communities were older than those served in rural communities, after controlling for this difference functional impairment levels were similar. It appears from these analyses that youth served in rural and nonrural communities with systems of care were more similar than they were different with regard to their level of functional impairment. This lack of aggregate functional difference between the rural and nonrural sites reminds policymakers and funding agents that youth in rural areas need equity in both access and resource for mental health services. As indicated by the findings in the current investigation youth in rural areas are not immune to the types of mental health challenges often publicized by researchers examining youth in nonrural areas.

Substance use disorder comorbidity among inpatient youths with psychiatric disorder

OBJECTIVE

Substance abuse/dependence has been reported to show significant association with psychopathology, and is likely to influence the course and outcome of psychiatric illness. The aim of this study was to determine the rate of substance use disorders (other than alcohol) comorbidity among inpatient adolescents with severe Axis 1 psychiatric disorder.

METHOD

A retrospective analysis of systematically collected data was carried out. The subjects were 16-18-year-old youths, admitted to an inpatient unit for severe psychiatric disorder. The data collection process utilized the DSM-IV criteria for diagnostic categorization of psychiatric disorder and substance use disorder. Demographic data, and data on suicide attempts were also collected.

RESULTS

Over a period of one year (March 2001-March 2002), 62 patients were admitted to the Christchurch Youth Inpatient Unit; 40 (64.5%) had a comorbid Substance Abuse Disorder (SAD) according to DSM-IV criteria and none had a Substance Dependence Disorder. The vast majority involved cannabis and stimulants. Sixty per cent of those with mood disorder, 63% of those with anxiety disorder and 80% of those with schizophrenia spectrum disorder had a comorbid SAD. Internalizing problems, especially mood disorders, pre-dominated among those with SAD reflecting the Unit's admission criteria. There were no differences in attempted suicide rates between those with SAD and those without SAD, but those with SAD were more likely to have unstable accommodation/living arrangements than those without SAD.

CONCLUSIONS

Our findings confirm previous reports suggestive of high rates of SAD comorbidity among youth with severe psychiatric illness. There are clinical and process implications for these findings particularly identification of substance use disorders and their treatment as well as resource availability and staff training.

Children with reported histories of sexual abuse: utilizing multiple perspectives to understand clinical and psychosocial profiles

OBJECTIVE

The current study examines multiple empirically based perspectives (i.e., child, caregiver, and clinician) of behavior and functioning as they contribute to the clinical and psychosocial profile of children (aged 5 to 17.5 years) with reported histories of sexual abuse.

METHOD

A large, multi-site data set of children referred into Comprehensive Community Mental Health Services both with and without reported histories of sexual abuse, was examined. Seven hundred and fifty-nine children with a reported history of sexual abuse were compared to 2722 without such a history on caregiver and child reported behavior, clinician rated functioning, diagnosis, demographic variables, and life challenges.

RESULTS

The multiple perspectives contributed unique and specific information to regression models: caregiver-reported behavior contributed information about externalizing behavior while child-reported behavior added information about internalizing behavior and clinician ratings about self-harmful behavior. Children with reported histories of sexual abuse were also more likely to be female, Caucasian, and have reported histories of life challenges (e.g., physical abuse, substance use, running away). Child sexual abuse was associated with higher rates of depression and anxiety diagnoses, and lower rates of substance abuse, conduct, and attention deficit disorder diagnoses.

CONCLUSIONS

The findings indicate that the profile of children entering into Comprehensive Community Mental Health Services with reported histories of sexual abuse, as compared to those without such histories, is complex and best understood via multiple perspectives. Caregiver, child and clinician rated information, when taken together, provide a comprehensive clinical and psychosocial profile around which to plan and implement individualized service plans.

Female offenders referred for community-based mental health service as compared to other service-referred youth: correlates of conviction

Data from a large federally supported national evaluation of system-of-care community mental health services were analysed to identify correlates of conviction. Female adolescents with a reported history of criminal conviction (n=88) were compared to three other service-referred youth groups: females without conviction histories (n=664), males with conviction histories (n=199), and males without conviction histories (n=1230) for possible differences in number and type of family, individual, and school-related life challenges. Multinomial regression analyses were first used to compare the quantity of child and family correlates in each conviction group, and then to test specific correlates in the individual, family, and school domains. The conditional odds of reporting a high vs. low number of child correlates was found to be significantly greater for females with a history of conviction compared to all other groups, over and above the number of family risk factors. Further, service-referred females with a conviction history, when compared to other service-referred youth groups, were much more likely to report having experienced a living instability (e.g. history of running away, multiple living arrangements) and personal adverse life events (e.g. history of drug and alcohol use, sexual abuse). Implications for community-based interventions and treatment are discussed.

Rates and predictors of aftercare services among formerly hospitalized adolescents: a prospective naturalistic study

OBJECTIVE

To examine rates and predictors of aftercare use, lengths of service use, and predictors of the duration of aftercare service use among 180 adolescents monitored for up to 8.1 years after discharge from an inpatient psychiatry unit.

METHOD

Drawing upon the Anderson-Newman model of service use, severity of illness, enabling, and predisposing factors assessed during the hospitalization were examined as potential predictors of service use. Information about outpatient mental health specialty services after hospitalization was assessed repeatedly and verified with treatment records.

RESULTS

Seventy-three percent of adolescents received aftercare within the first month after discharge, and 92% eventually received outpatient services. Fifty-seven percent of adolescents remained in treatment 6 months after initiation of services. Psychiatric comorbidity, prior service use, and presence of a biological parent or grandparent in the home were related to initial service use. Psychiatric comorbidity and history of repeated suicide attempts were related to longer duration, and older age and minority group status were related to shorter duration of aftercare service use.

CONCLUSIONS

Most adolescents receive aftercare services, but there are certain groups that are relatively less likely to access or remain in services. Interventions to decrease the barriers to care in such groups may be beneficial.

Suicidality in children and adolescents: a review

Suicide and suicide attempts by children and adolescents continue to be a major public health problem in the United States. Major risk factors include a previous suicide attempt, a mood disorder, a family history of suicide, a parental psychiatric disorder, and a history of sexual abuse. Genetic vulnerability appears to be a factor as well. Efforts to prevent subsequent attempts at suicide have not generally been successful, and many children and adolescents are not receiving treatment for the mood disorders and other psychiatric conditions that are risk factors. Evaluation of suicide risk should be carried out through multiple informants, not simply the adolescent or the parents, although a thorough clinical interview of the adolescent is essential.