Attempted and Completed Suicide in Adolescence

Center for Alcohol and Addiction Studies and Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island 02912, USA.
Annual Review of Clinical Psychology (Impact Factor: 12.67). 02/2006; 2(1):237-66. DOI: 10.1146/annurev.clinpsy.2.022305.095323
Source: PubMed

ABSTRACT Suicide is the third leading cause of death in adolescence, and medically serious suicide attempts occur in approximately 3% of adolescents. This review examines a number of risk factors that contribute to suicidal behavior. A prior suicide attempt is one of the best predictors of both a repeat attempt and eventual completed suicide. Depression, disruptive behavior disorders, and substance-use disorders also place adolescents at high risk for suicidal behavior, with comorbidity further increasing risk. Research on families indicates that suicidal behavior is transmitted through families. Groups at high risk for suicidal behavior include gay, lesbian, and bisexual youths, incarcerated adolescents, and homeless/runaway teens. Although abnormalities in the serotonergic system have not been consistently linked to suicidal behavior, genetic and neurobiologic studies suggest that impulsive aggression may be the mechanism through which decreased serotonergic activity is related to suicidal behavior. Findings from prevention and intervention studies are modest and indicate the need for substantially more theory-driven treatment research.

Download full-text


Available from: Anthony Spirito, Sep 22, 2014
38 Reads
    • "Recent reviews have concluded that no replicated individual treatment has proven to be effective for suicidal youth (e.g., Corcoran, Dattalo, Crowley, Brown, & Grindle, 2011; Hawton, Saunders, & O'Connor, 2012; Ougrin, Tranah, Leigh, Taylor, & Asarnow, 2012; Spirito & Esposito-Smythers, 2006), but several treatments that incorporate families are showing success (Diamond et al., 2010; Huey et al., 2004; Pineda & Dadds, 2013; Wharff, Ginnis, & Ross, 2012). The potential effectiveness of family-oriented treatments could have been recognized much earlier if the correlational bias against corrective actions had been corrected for (Larzelere et al., 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although direct replications are ideal for randomized studies, areas of psychological science that lack randomized studies should incorporate Rosenbaum's (2001) distinction between trivial and nontrivial replications, relabeled herein as exact and critical replications. If exact replications merely repeat systematic biases, they cannot enhance cumulative progress in psychological science. In contrast, critical replications distinguish between competing explanations by using crucial tests to clarify the underlying causal influences. We illustrate this potential with examples from research on corrective actions by professionals (e.g., psychotherapy, Ritalin) and parents (e.g., spanking, homework assistance), where critical replications are needed to overcome the inherent selection bias due to corrective actions being triggered by children's symptoms. Purported causal effects must first prove to be replicable after plausible confounds such as selection bias are eliminated. Subsequent critical replications can then compare plausible alternative explanations of the average unbiased causal effect and of individual differences in those effects. We conclude that this type of systematic sequencing of critical replications has more potential for making the kinds of discriminations typical of cumulative progress in science than do exact replications alone, especially in areas where randomized studies are unavailable. © The Author(s) 2015.
    Perspectives on Psychological Science 05/2015; 10(3):380-9. DOI:10.1177/1745691614567904 · 4.89 Impact Factor
  • Source
    • "Suicide is the third leading cause of death among US adolescents , and there is some evidence that suicide rates in children and adolescents have increased in recent years (Spirito and Esposito- Smythers, 2006; Dervic et al., 2008). Several risk factors for suicidal thoughts and behaviors have been found in prior epidemiological studies, among the most consistently identified of which is substance use (Goldston, 2004; Nock et al., 2013; Spirito and Esposito-Smythers, 2006; also see Pompili et al., 2012 for a recent review). Indeed, in one recent cross-sectional epidemiological study, adolescent suicidal thoughts and behavior were strongly associated with substance abuse and dependence (Nock et al., 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Based on the interpersonal theory of suicide, pain habituation that occurs with injection substance use may raise risk for a suicide attempt. The current study tested whether injection substance use, relative to painless routes of substance administration, was related to greater risk for suicide attempts. We also assessed whether this risk was specific to suicide attempts and not suicidal ideation or suicide plans. Methods: Data on 2095 substance-using adolescents aged 12-17 who endorsed clinically significant depression symptoms and answered questions on suicidal thoughts and behavior were drawn from the 2004-2011 National Survey on Drug Use and Health, a nationally representative household survey. Logistic regression analyses were conducted to assess the associations between injection substance use and suicidal ideation, plans, and attempts. Results: Injection substance use was associated with suicide attempts (OR = 3.02, 95% CI = 1.75-5.23) but not ideation or plans. These findings were not accounted for by sex, age, race/ethnicity, family income, abuse and dependence symptoms, and depression symptoms. Among ideators, injection substance use was associated with suicide attempts (OR = 2.92, 95% CI = 1.58-5.06), but not plans. Among suicide planners, injection substance use was associated with suicide attempts (OR = 5.16, 95% CI = 1.88-14.17). Conclusion: Consistent with the interpersonal theory of suicide, adolescent injection drug use was associated with specific risk for suicide attempts but not ideation or planning. Hence, consideration of the manner in which adolescents use substances is important in evaluating suicide risk in this population.
    Journal of Psychiatric Research 05/2014; DOI:10.1016/j.jpsychires.2014.05.001 · 3.96 Impact Factor
  • Source
    • "Psychiatric disorder is present in 80–90% of adolescent suicides and nonfatal attempters from both community and clinical settings (Beghi and Rosenbaum, 2010). Comorbidity of psychiatric disorders, particularly mood, disruptive and substance use disorders increases the risk for youth suicide and suicidal behavior (Brent et al., 1999; Spirito and Esposito-Smythers, 2006). Other known major risk factors for suicide or nonfatal suicidal behavior include: previous suicide attempt, personality disorders (especially cluster B disorders ), impulsive aggressive traits, availability of lethal means, family history of depression or suicidal behavior, death of a parent or parental divorce, reported childhood physical and/or sexual abuse and feelings of social isolation (Beghi and Rosenbaum, 2010; Melhem et al., 2007)). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Suicide is the leading cause of death in most armies during peace-time. The recent dramatic rise in suicides in the US Army further focuses attention on the causes of suicidal behavior in the military. Methods: This study investigated demographic characteristics, psychological profile and stress-related risk factors associated with suicide attempts in Israelis aged 18-21 years, who served in the Army in 2009. Soldiers who attempted suicide (N=60) were compared to soldiers treated by a mental health professional, but reported no suicidal behavior (N=58), and to controls (N=50). Results: Suicide attempters had lower socioeconomic status and less cognitive ability compared with treated soldiers and untreated control soldiers. Only 25% of the suicide attempters had received mental healthcare prior to the attempt. The majority of the attempts were non-lethal (86.2%), and only 5.2% used firearms. Attempters had more previous suicide attempts (37.9%) and deliberate selfharm incidents (19.3%), compared to almost no such behaviors in the other two groups. Following the suicide attempt, 77% were diagnosed with moderate to severe mental disorders, 44.8% personality disorders and 8.6% mood disorders. Attempters reported higher levels of general stress compared to their peers in the other two groups. Being away from home and obeying authority were especially more stressful in attempters. Conclusions: Young soldiers are less prone to seek mental health assistance, despite suffering from higher levels of stress. Screening is required to detect soldiers at risk for suicidal behavior and preventive intervention will require active outreach.
    Journal of Affective Disorders 05/2013; 150(2). DOI:10.1016/j.jad.2013.04.009 · 3.38 Impact Factor
Show more