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


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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Available from: Ian M Goodyer, Dec 31, 2015
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    • "" A key reason for proposing a distinct disorder for NSSI was to distinguish the behavior from suicide attempts (i.e., self-harm with intent to die). Although NSSI is strongly correlated with suicide attempts (Klonsky et al. 2013, Wilkinson et al. 2011), the behaviors differ in terms of prevalence (NSSI is more prevalent), frequency (NSSI is often performed dozens or hundreds of times, whereas suicide attempts are typically performed once or a few times), methods (cutting and burning are more characteristic of NSSI, whereas self-poisoning is more characteristic of attempted suicide), severity (NSSI rarely causes medically severe or lethal injuries), and functions (NSSI is performed without intent to die, usually to temporarily relieve overwhelming negative emotion, and sometimes as an attempt to avoid suicidal urges) (CDC 2010a, Klonsky 2007, Klonsky & Muehlenkamp 2007, Muehlenkamp 2005, Muehlenkamp & Gutierrez 2004). We believe NSSI has a strong relationship with suicide attempts for two reasons: NSSI correlates with variables, such as depression, known to increase risk for suicidal ideation; and NSSI facilitates habituation to self-inflicted violence and pain, which in turn increases the capacity to attempt suicide (Klonsky et al. 2013). "
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    ABSTRACT: Suicidal behavior is a leading cause of death and disability worldwide. Fortunately, recent developments in suicide theory and research promise to meaningfully advance knowledge and prevention. One key development is the ideation-to-action framework, which stipulates that (a) the development of suicidal ideation and (b) the progression from ideation to suicide attempts are distinct phenomena with distinct explanations and predictors. A second key development is a growing body of research distinguishing factors that predict ideation from those that predict suicide attempts. For example, it is becoming clear that depression, hopelessness, most mental disorders, and even impulsivity predict ideation, but these factors struggle to distinguish those who have attempted suicide from those who have only considered suicide. Means restriction is also emerging as a highly effective way to block progression from ideation to attempt. A third key development is the proliferation of theories of suicide that are positioned within the ideation-toaction framework. These include the interpersonal theory, the integrated motivational-volitional model, and the three-step theory. These perspectives can and should inform the next generation of suicide research and prevention. Expected final online publication date for the Annual Review of Clinical Psychology Volume 12 is March 28, 2016. Please see for revised estimates.
    Full-text · Article · Apr 2016 · Annual Review of Clinical Psychology
    • "Non-suicidal self-injury (NSSI) is a related, but distinct, construct; NSSI is defined as the intentional self-injury of one's tissue without any associated intent to die (Klonsky and Muehlenkamp, 2007; Nock, 2009). Importantly, NSSI has been identified as a strong correlate of SAs (Andover and Gibb, 2010; Klonsky et al., 2013), and further, as a predictor of future suicidal ideation and SAs (Hamza et al., 2012; Whitlock et al., 2013; Wilkinson et al., 2011). Given this link, and the high-rate of NSSI presence among adolescents and young adults (e.g., 10–51%; Hilt et al., 2008; Ogle and Clements , 2008), it is important to identify the specific characteristics of NSSI that place individuals who engage in this behavior at highest risk for SA, thus better informing the direction of resources. "
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    ABSTRACT: Non-suicidal self-injury (NSSI) has been identified as a correlate and predictor of suicidal ideation and attempts. Given the high rates of NSSI presence among adolescents and young adults, it is important to identify specific characteristics of NSSI that might place individuals who engage in this behavior at highest risk for suicidal behaviors. NSSI is thought to increase the acquired capability for suicide via habituation to self-harm, though the NSSI characteristics most responsible for this relationship are unclear. The current study examined three characteristics of NSSI (frequency, number of methods, and subjective pain) that may help to elucidate this risk relationship. University students (N = 997) with a history of NSSI completed measures assessing lifetime NSSI frequency, number of NSSI methods employed, and subjective experience of pain during NSSI, as well as suicide attempt (SA) history. Results indicated that NSSI frequency, number of NSSI methods, and subjective pain experienced during NSSI were each positively associated with a SA history. Further, subjective pain experienced during NSSI moderated the relationship between NSSI frequency and SA history, such that the association between NSSI frequency and SA history was stronger for individuals who experienced lower levels of subjective pain.
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    • "Notwithstanding such limitations, it is interesting to note that both of these promising interventions draw on relationship focused treatment approaches and this may indicate that psychological therapies that target interpersonal dynamics within personally significant relationships are powerful interventions for both depression and suicidality. Parent–child conflict and impaired family functioning have been identified as risk factors for a suicidal event (Brent et al., 2009a;Wilkinson et al., 2011) and for depression (Lewis, 2014).[AQ: 6]Equally, family adaptability and cohesion are protective factors for adolescent suicidality (Brent et al., 2009b), so it may be expected that depression interventions, which address these critical family factors, would also demonstrate strong efficacy for suicidality. "
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    ABSTRACT: Abstract Objective: Given depression is a significant risk factor for suicidal behaviour, it is possible that interventions for depression may also reduce the risk of suicide in adolescents. The purpose of this literature review is to determine whether psychological interventions aimed to prevent and/or treat depression in adolescents can also reduce suicidality. Methods: We conducted a systematic review of psychological interventions aimed to prevent and/or treat depression in adolescents in which outcomes for suicidality were reported, using five databases: PsycINFO, Embase, Medline, CINAHL and Scopus. Study quality was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Results: A total of 35 articles pertaining to 12 treatment trials, two selective prevention trials and two universal prevention trials met inclusion criteria. No studies were identified that used a no-treatment control. In both intervention and active control groups, suicidality decreased over time; however, most structured psychological depression treatment interventions did not outperform pharmaceutical or treatment as usual control groups. Depression prevention studies demonstrated small but statistically significant reductions in suicidality. Limitations: Analysis of study quality suggested that at least 10 of the 16 studies have a high risk of bias. Conclusive comparisons across studies are problematic due to differences in measures, interventions, population differences and control groups used. Conclusions: It is unclear whether psychological treatments are more effective than no treatment since no study has used a no-treatment control group. There is evidence to suggest that Cognitive Behavioural Therapy interventions produce pre–post reductions in suicidality with moderate effect sizes and are at least as efficacious as pharmacotherapy in reducing suicidality; however, it is unclear whether these effects are sustained. There are several trials showing promising evidence for family-based and interpersonal therapies, with large pre–post effect sizes, and further evaluation with improved methodology is required. Depression prevention interventions show promising short-term effects. Keywords Suicide, adolescents, depression, systematic review, treatment
    Full-text · Article · Dec 2015 · Australian and New Zealand Journal of Psychiatry
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