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.
    Full-text · Article · Jul 2015 · Journal of Affective Disorders
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    • "To further focus on the risk of suicide, we also separated the question that asked about self-harm into two questions (Table 2). Furthermore, since it is well recognized that the most accurate predictor of actual suicide is a history of a previous suicide attempt[20],[21], we added an additional question that asked about a history of this (Table 2). In the present study, therefore, there were a maximum of 13 questions about depression, although the two additional questions were not asked of all the population and, therefore, they were not counted in the depression score (but were used to identify suicide risk—see below). "
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    ABSTRACT: We describe initial pilot findings froma novel school-based approach to reduce youth depression and suicidality, the Empowering a Multimodal Pathway Towards Healthy Youth (EMPATHY) program. Here we present the findings from the pilot cohort of 3,244 youth aged 11-18 (Grades 6-12). They were screened for depression, suicidality, anxiety, use of drugs, alcohol, or tobacco (DAT), quality-of-life, and self-esteem. Additionally, all students in Grades 7 and 8 (mean ages 12.3 and 13.3 respectively) also received an 8-session cognitive-behavioural therapy (CBT) based program designed to increase resiliency to depression. Following screening there were rapid interventions for the 125 students (3.9%) who were identified as being actively suicidal, as well as for another 378 students (11.7%) who were felt to be at higher-risk of self-harm based on a combination of scores from all the scales. The intervention consisted of an interview with the student and their family followed by offering a guided internet-based CBT program. Results from the 2,790 students who completed scales at both baseline and 12-week follow-up showed significant decreases in depression and suicidality. Importantly, there was a marked decrease in the number of students who were actively suicidal (from n = 125 at baseline to n = 30 at 12-weeks). Of the 503 students offered the CBT program 163 (32%) took part, and this group had significantly lower depression scores compared to those who didn't take part. There were no improvements in self-esteem, quality-of- life, or the number of students using DAT. Only 60 students (2% of total screened) required external referral during the 24-weeks following study initiation. These results suggest that a multimodal school-based program may provide an effective and pragmatic approach to help reduce youth depression and suicidality. Further research is required to determine longer-term efficacy, reproducibility, and key program elements.
    Full-text · Article · May 2015 · PLoS ONE
    • "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.
    No preview · Article · May 2015 · Perspectives on Psychological Science
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