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


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.

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Available from: Anthony Spirito, Sep 22, 2014
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    • "The profile of soldiers who died by suicide is different from those who made nonfatal suicide attempts (Apter et al., 2008; Maguen et al., 2015), according to previous studies it is estimated that for every suicide there are approximately 20–25 attempts that did not end in death (McIntosh, 2000; Simon and Shuman, 2008). Hence, and due to the fact that suicide attempts increase the risk for future nonfatal attempts and for death by suicide (Spirito and Esposito-Smythers, 2006; Cavanagh et al., 2003; Mann et al., 2005), it is of great importance to evaluate the risk factors for nonfatal suicide attempts. "
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    ABSTRACT: A major risk factor for suicide is suicide attempts. The aim of the present study was to assess risk factors for nonfatal suicide attempts. Methods The study's cohort consisted of 246,814 soldiers who were divided into two groups: soldiers who made a suicide attempt (n=2310; 0.9%) and a control group of soldiers who did not (n=244,504; 99.1%). Socio-demographic and personal characteristics as well as psychiatric diagnoses were compared. Results The strongest risk factors for suicide attempt were serving less than 12 months (RR=7.09) and a history of unauthorized absence from service (RR=5.68). Moderate risk factors were low socioeconomic status (RR=2.17), psychiatric diagnoses at induction (RR=1.94), non-Jewish religion (RR=1.92), low intellectual rating score (RR=1.84), serving in non-combat unit (RR=1.72) and being born in the former Soviet Union (RR=1.61). A weak association was found between male gender and suicide attempt (RR=1.36). Soldiers who met more frequently with a primary care physician (PCP) had a higher risk for suicide attempt, as opposed to a mental health professional (MHCP), where frequent meetings were found to be a protective factor (P<0.0001). The psychiatric diagnoses associated with a suicide attempt were a cluster B personality disorder (RR=3.00), eating disorders (RR=2.78), mood disorders (RR=2.71) and adjustment disorders (RR=2.26). Mild suicidal behavior constitutes a much larger proportion than among civilians and may have secondary gain thus distorting the suicidal behavior data. Training primary care physicians as gatekeepers and improved monitoring, may reduce the rate of suicide attempts. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 07/2015; 186:232-240. DOI:10.1016/j.jad.2015.07.016 · 3.38 Impact Factor
    • "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). "
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    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
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    • "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). "
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    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
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