Suicidality in adjustment disorder: Clinical characteristics of adolescent outpatients

Department of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland.
European Child & Adolescent Psychiatry (Impact Factor: 3.34). 06/2005; 14(3):174-80. DOI: 10.1007/s00787-005-0457-8
Source: PubMed


Although a remarkable proportion of adolescents suffering from adjustment disorder (AD) are suicidal, few studies have documented the characteristics of suicidal AD patients. We examined background, psychopathology and treatment-related factors among suicidal adolescent AD outpatients.
Data on 302 consecutively referred psychiatric outpatient adolescents, aged 12-22 years, were collected. DSM-III-R diagnoses were assigned at the end of treatment based on all available data. Of the patients 89 received a diagnosis of AD, 25% of whom showed suicide attempts, suicidal threats or ideation.
Compared with non-suicidal AD patients, suicidal AD patients were characterized by previous psychiatric treatment (OR = 6.1), poor psychosocial functioning at treatment entry (OR = 16.2), suicide as a stressor (OR = 33.3), dysphoric mood (OR = 6.9) and psychomotor restlessness (OR = 3.7).
Common risk factors for suicidality in major psychiatric disorders characterized suicidal AD patients. Psychiatric assessment of AD patients should include careful monitoring of both symptomatology and exposure to suicide of significant others.

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    • "In community samples comparing AD and DE the prevalence of suicidal ideation is similar (Nock et al., 2008; Casey et al., 2006a). Suicidal behaviour in AD (self-harm irrespective of motivation or intent) is common, varying between 25% and 60%, depending on age (Pelkonen et al., 2005; Kryzhananovskaya and Canterbury, 2001). "
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    ABSTRACT: Little is known about suicidal ideation and behaviours in adjustment disorder (AD). In this paper we sought to examine the variables independently associated with suicidal ideation and behaviour in patients diagnosed with AD or depressive (DE) episode among psychiatric outpatients and in liaison psychiatry. 370 patients who were referred to the liaison psychiatry services (including those seen in the Emergency Department) at 3 Dublin hospitals, and were clinically diagnosed with either DE or AD, based on the ICD 10 diagnostic criteria, were recruited to the study. We examined their demographic and clinical characteristics, and the associations between these and suicidal ideation and behaviour on multivariate analysis. Younger age, single marital status, and greater severity of depressive symptoms were significantly associated with suicidality across both diagnoses. On multivariate analysis, greater severity of depressive symptoms was associated with suicidality in those with AD (p=0.012) and DE (p=0.009). Those with AD exhibited suicidality at lower symptom scores than did those with DE but in both groups it still occurred at the highest level of severity. There were differences in the objective circumstances measure of suicide intent. We used clinical diagnosis rather as the main diagnostic classification. The generalisability of this paper may be limited to consultation-liaison psychiatry settings, where suicidal ideation and behaviours are common. Suicidality in AD and DE has broadly similar risk factors but differ in aspects of suicide intent. Different mechanisms may underpin suicidality in those with AD compared to DE. Copyright © 2014. Published by Elsevier B.V.
    Journal of Affective Disorders 12/2014; 174C:441-446. DOI:10.1016/j.jad.2014.12.003 · 3.38 Impact Factor
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    • "Consistent with our hypotheses, we found that adjustment disorder was associated with an increased rate of completed suicide, controlling for history of depression, income, marital status, and the matched factors. Possible mechanisms that could account for this observed association include subsyndromal psychiatric symptoms, particularly depressed mood, which are associated with suicidal ideation among adolescents and with adjustment disorder.16 In addition, stressful events that may result in an adjustment disorder diagnosis, which were not assessed in the current study, are associated with suicidal behavior among adolescents and young adults.17 "
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    ABSTRACT: Adjustment disorder is a diagnosis given following a significant psychosocial stressor from which an individual has difficulty recovering. The individual's reaction to this event must exceed what would be observed among similar people experiencing the same stressor. Adjustment disorder is associated with suicidal ideation and suicide attempt. However the association between adjustment disorder and completed suicide has yet to be examined. The current study is a population-based case control study examining this association in the population of Denmark aged 15 to 90 years. All suicides in Denmark from 1994 to 2006 were included, resulting in 9,612 cases. For each case, up to 30 controls were matched on gender, exact date of birth, and calendar time, yielding 199,306 controls. Adjustment disorder diagnosis was found in 7.6% of suicide cases and 0.52% of controls. Conditional logistic regression analyses revealed that those diagnosed with adjustment disorder had 12 times the rate of suicide as those without an adjustment disorder diagnosis, after controlling for history of depression diagnosis, marital status, income, and the matched factors.
    Clinical Epidemiology 08/2010; 2:23-8.
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    • "It was found that AD was the second most common psychiatric diagnosis among consequently referred non-psychotic outpatient adolescents [56], and 25% with AD had suicidal behaviour, of whome 9% had attempted suicide [57]. No difference was found in diagnostic co-morbidity between suicidal and non-suicidal AD patients. "
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    ABSTRACT: Adjustment Disorder is a condition strongly tied to acute and chronic stress. Despite clinical suggestion of a large prevalence in the general population and the high frequency of its diagnosis in the clinical settings, there has been relatively little research reported and, consequently, very few hints about its treatments. the authors gathered old and current information on the epidemiology, clinical features, comorbidity, treatment and outcome of adjustment disorder by a systematic review of essays published on PUBMED. After a first glance at its historical definition and its definition in the DSM and ICD systems, the problem of distinguishing AD from other mood and anxiety disorders, the difficulty in the definition of stress and the implied concept of 'vulnerability' are considered. Comorbidity of AD with other conditions, and outcome of AD are then analyzed. This review also highlights recent data about trends in the use of antidepressant drugs, evidence on their efficacy and the use of psychotherapies. AD is a very common diagnosis in clinical practice, but we still lack data about its rightful clinical entity. This may be caused by a difficulty in facing, with a purely descriptive methods, a "pathogenic label", based on a stressful event, for which a subjective impact has to be considered. We lack efficacy surveys concerning treatment. The use of psychotropic drugs such as antidepressants, in AD with anxious or depressed mood is not properly supported and should be avoided, while the usefulness of psychotherapies is more solidly supported by clinical evidence. To better determine the correct course of therapy, randomized-controlled trials, even for the combined use of drugs and psychotherapies, are needed vitally, especially for the resistant forms of AD.
    Clinical Practice and Epidemiology in Mental Health 07/2009; 5(1):15. DOI:10.1186/1745-0179-5-15
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