Clinical and Psychosocial Predictors of Suicide Attempts and Nonsuicidal Self-Injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT)

Developmental Psychiatry Section, Department of Psychiatry, Cambridge University, England, UK.
American Journal of Psychiatry (Impact Factor: 12.3). 02/2011; 168(5):495-501. DOI: 10.1176/appi.ajp.2010.10050718
Source: PubMed

ABSTRACT The authors assessed whether clinical and psychosocial factors in depressed adolescents at baseline predict suicide attempts and nonsuicidal self-injury over 28 weeks of follow-up.
Participants were 164 adolescents with major depressive disorder taking part in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT). Clinical symptoms, family function, quality of current personal friendships, and suicidal and nonsuicidal self-harm were assessed at baseline. Suicidal and nonsuicidal self-harm thoughts and behaviors were assessed during 28 weeks of follow-up.
High suicidality, nonsuicidal self-injury, and poor family function at entry were significant independent predictors of suicide attempts over the 28 weeks of follow-up. Nonsuicidal self-injury over the follow-up period was independently predicted by nonsuicidal self-injury, hopelessness, anxiety disorder, and being younger and female at entry.
Both suicidal and nonsuicidal self-harm persisted in depressed adolescents receiving treatment in the ADAPT study. A history of nonsuicidal self-injury prior to treatment is a clinical marker for subsequent suicide attempts and should be as carefully assessed in depressed youths as current suicidal intent and behavior.

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    • "ORIGINAL ARTICLE majority of these studies have shown that difficulties in the parent–child relationship predicts adolescent suicidal ideation independently of the adolescent's own psychopathology (Thompson et al. 2005; Connor & Rueter, 2006; Boeninger, 2013). Additionally, two cohort studies of depressed adolescents found that adolescent-rated poor family functioning was associated with later suicide attempt (Wilkinson et al. 2011; Asarnow et al. 2011). Previous literature has also shown that maternal depression can lead to disruptions in the parent–child relationship (Lovejoy et al. 2000; Keenan-Miller et al. 2010), and that these disruptions may be one pathway through which maternal depression increases risk for offspring psychiatric disorder (Goodman & Gotlib, 1999). "
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    ABSTRACT: It is well-established that offspring of depressed mothers are at increased risk for suicidal ideation. However, pathways involved in the transmission of risk for suicidal ideation from depressed mothers to offspring are poorly understood. The aim of this study was to examine the contribution of potential mediators of this association, including maternal suicide attempt, offspring psychiatric disorder and the parent-child relationship. Data were utilized from a population-based birth cohort (ALSPAC). Three distinct classes of maternal depression symptoms across the first 11 years of the child's life had already been identified (minimal, moderate, chronic-severe). Offspring suicidal ideation was assessed at age 16 years. Data were analysed using structural equation modelling. There was evidence for increased risk of suicidal ideation in offspring of mothers with chronic-severe depression symptoms compared to offspring of mothers with minimal symptoms (odds ratio 3.04, 95% confidence interval 2.19-4.21). The majority of this association was explained through maternal suicide attempt and offspring psychiatric disorder. There was also evidence for an independent indirect effect via the parent-child relationship in middle childhood. There was no longer evidence of a direct effect of maternal depression on offspring suicidal ideation after accounting for all three mediators. The pattern of results was similar when examining mechanisms for maternal moderate depression symptoms. Findings highlight that suicide prevention efforts in offspring of depressed mothers should be particularly targeted at both offspring with a psychiatric disorder and offspring whose mothers have made a suicide attempt. Interventions aimed at improving the parent-child relationship may also be beneficial.
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    • "Moreover, Asarnow et al. (2011) found baseline NSSI history to be not only a significant predictor of suicide attempts , but an even stronger predictor of suicide attempts than baseline history of suicide attempts. Similarly, prebaseline NSSI predicted suicide attempts better than prebaseline suicide attempts (Wilkinson et al. 2011). Approximately 12 % of college students engage in NSSI (e.g. "
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    ABSTRACT: Prior research has established a connection between non-suicidal self-injury (NSSI) and suicidal behavior. The interpersonal-psychological theory of suicidal behavior (IPTS) posits that an individual must possess both a desire and capability for suicide in order to engage in a lethal suicide attempt. The IPTS conceptualizes the role of NSSI in suicidal behavior as contributing to an individual’s acquired capability. The primary aim of this study was to investigate the relationship between frequency of engagement in NSSI and suicidal desire ( thwarted belongingness and perceived burdensomeness). In this study, undergraduate students (n = 999) completed various questionnaires online. Results revealed a significant, positive association between NSSI frequency and thwarted belongingness and a non-significant association between NSSI frequency and perceived burdensomeness. Additionally, results indicated a significant indirect effect of NSSI frequency on burdensomeness and belongingness through depression and borderline personality disorder symptoms. The direct effect of NSSI frequency on belongingness remained significant; however, the direct effect of NSSI frequency on burdensomeness did not. These findings suggest that the relationship between NSSI and suicide is not strictly limited to acquired capability, but rather includes a component of suicidal desire.
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    • "When we treated psychiatric diagnoses as a multi-categorical variable in the logistic regression analysis, only conduct disorder predicted higher likelihood of self-harm behavior (data not shown). It is important to note that: (a) 10 of the 20 adolescents without any diagnosis still had some form of selfharm/suicidality and (b) 20% of adolescents presenting with self-harming behavior did not have suicidal intent, in line with arguments in favor of the clinical significance of the category of NSSI (Wilkinson et al., 2011) and its inclusion in DSM-5 (American Psychiatric Association, 2013). "
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    ABSTRACT: Adolescents comprise a unique and often challenging group of patients with diverse presentations to the Mental Health Services; suicidal behavior being one of them. The main aim of this naturalistic project was to investigate demographic and clinical correlates of adolescent suicidal and self-harm events, which may be of value to decision-making in clinical practice. All adolescents (n = 149) registered and actively managed by a specialist community mental health service in South London were included in the study. Clinical information from their files was used to determine suicidality/self-harm events. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) was utilised for classification purposes. Logistic regression was used to explore the effects of age, sex, diagnosis, medication, substance use (alcohol and/or cannabis) and ethnicity on suicidality/self-harming behaviors. Age, sex and use of psychotropic medication were identified to play a significant role in determining the risk of engaging in self-harming behavior. The risk was higher with increasing age and female sex. Medication seemed to have a protective effect. Reporting a 20% prevalence of non-suicidal self-injury (NSSI) in our population, we highlight the importance of NSSI as a distinct diagnostic category. Our findings have implications for risk assessment and appropriate decision-making in clinical settings. Results are translatable and relevant to other metropolitan areas.
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