Risk of future suicide attempts in adolescent psychiatric inpatients at 18-month follow-up

This study investigated potential predictors of suicidal behavior in adolescents during an 18-month follow-up period. Subjects included 60 adolescent psychiatric inpatients initially assessed in a private psychiatric hospital. Follow-up suicidality was most strongly predicted by high intake levels of hopelessness, and an increase in or persistent problems with depression during follow-up. Some family functioning variables measured at intake were predictive of suicidal behavior at the univariate level but did not add to the predictive ability of individual functioning variables. A mediational model was proposed in which the impact of family functioning on adolescent suicidality is mediated by its impact on individual functioning.     

The role of drugs in adolescent suicide attempts

Drug histories of 46 adolescent suicide attempters and their parents are described. In addition, these attempters and their parents are compared with a group of non-attempters and their parents on selected measures of drug use. Findings indicate that adolescent drug use is closely related to and perhaps symptomatic of suicidal behaviors and overall pathology. The relationship between adolescent suicidal behaviors and parental drug use is unclear because of the discrepancy between parent-adolescent responses.     

Sociological correlates of alienation among adolescent suicide attempts.

The purpose of this research is to assess the relationship between adolescent alienation and a number of sociological factors in a sample adolescent suicide attempts from a northern metropolitan area. First, Dean's alienation scale is employed and the distribution of responses of the adolescent suicide attempts are analyzed. Second a number of sociological variables are examined by means of multiple regression procedures. In the regression analysis, eight variables were found to be statistically significant-in descending order: social contact with peers in the neighborhood, conflict with parents, broken romance, economic status of parents, communication blockage with parents, school performance, stepparents, and broken romance, These variables have been salient in previous research and theorizing about adolescent suicidal behavior. The fact that adolescence, by itself, seems to be a good predictor of whether or not a person will attempt suicide strongly suggests that there is something about the condition of adolescence which underlies this type of behavior. One possibility is that biological maturation is itself the crucial variable. Alternatively, the argument which follows concentrates on a major sociological aspect of adolescence-the adolescent's relative alienation from institutionalized social life. Alienation may be endemic to the period of adolescence.     

The impact of a medical student's suicide

The suicide of a medical classmate can have a profound effect upon the survivors. After the violent death of a third-year medical student at the University of California-San Francisco, the level of concern expressed in discussion groups suggested a need to study the impact in more detail. Interviews and scale data from 20 volunteer medical students identified a pattern of posttraumatic symptoms persisting over several months. The interviewees' tendency to identify with the victim was related to the prevalent experience of medical student depression. Specific suggestions are made both for immediate crisis management and for preventive intervention strategies within a medical school.     

Comparison of non-suicidal self-injurious behavior and suicide attempts in patients admitted to a psychiatric crisis unit

The aim of the current study was to examine differences in personality, coping skills, and select psychopathology symptoms in psychiatric patients with and without non-suicidal self-injury and/or suicide attempts. We collected data in a sample of 128 psychiatric patients by means of self-report questionnaires measuring self-harm, psychological symptoms, personality and coping skills. Results support a continuum of self-harm such that patients with both non-suicidal self-injury and suicide attempts exhibit significantly greater levels of psychopathology and lower levels of adaptive personality traits and coping skills. The findings point to the clinical importance of making a distinction between non-suicidal self-injury and suicide attempts, and offers additional variables to consider outside of intent when appraising suicide risk.     

Examining a dimensional representation of depression and anxiety disorders' comorbidity in psychiatric outpatients with item response modeling

The current study replicated, in a sample of 2,300 outpatients seeking psychiatric treatment, a previous study (R. F. Krueger & M. S. Finger, 2001) that implemented an item response theory approach for modeling the comorbidity of common mood and anxiety disorders as indicators along the continuum of a shared latent factor (internalizing). The 5 disorders examined were major depressive disorder, social phobia, panic disorder/agoraphobia, specific phobia, and generalized anxiety disorder. The findings were consistent with the prior research. First, a confirmatory factor analysis yielded sufficient evidence for a nonspecific factor underlying the 5 diagnostic indicators. Second, a 2-parameter logistic item response model showed that the diagnoses were represented in the upper half of the internalizing continuum, and each was a strongly discriminating indicator of the factor. Third, the internalizing factor was significantly associated with 3 indexes of social burden: poorer social functioning, time missed from work, and lifetime hospitalizations. Rather than the categorical system of presumably discrete disorders presented in DSM-IV, these 5 mood and anxiety disorders may be alternatively viewed as higher end indicators of a common factor associated with social cost.     

Predictors of suicide attempts: state and trait components

The authors examined the state and trait components of 3 predictors of suicide attempts (depression, hopelessness, and anxiety), and their relationship to suicidal behavior. Self-report questionnaire and interview data from 180 adolescents enrolled in a prospective naturalistic study were analyzed. Between 23% and 30% of the variance in the predictors was attributable to subjects' trait levels of these variables; the trait, as well as the state, components of the predictor variables were interrelated; and trait levels of these variables were consistently related to suicide attempts. To reduce long-term risk of suicide attempts, clinicians should focus not only on reducing short-term distress but also on reducing individuals' more enduring patterns (trait levels) of negative affectivity.     

Social-psychological correlates of adolescent and youthful suicide

Recently it has been suggested that social-psychological profiles of suicide attempters are useful to identify high-risk persons. There also is evidence that the complexity of interpersonal and intrapersonal factors constrict the extent to which such identification can be made. Using data from a nonprobability sample of 455 adolescent and youthful committers to test the hypothesis that attempters and committers do not differ with respect to environmental and stress-producing factors, the results reveal some differences between committers and attempters. Social-psychological characteristics of committers and factors relating to their social support systems are also discussed in the context of these differences.     

The impact of comorbidity on the management of pathological gambling

A 30-year-old woman with severe pathological gambling and cyclothymia presented to our program with no previous history of pharmacologic or psychotherapeutic treatment. Pathological gambling is an impulse -control disorder not otherwise specified (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) in which comorbidity is common, particularly with substance abuse, obsessive-compulsive disorder and mood disorders. As described in this case, pathological gamblers with bipolar comorbidity may be effectively treated with mood stabilizers such as lithium. After receiving 10 weeks of lithium treatment, the patient showed improvement in both gambling behavior and affective instability. The identification of specific subtypes among patients with pathological gambling may be relevant to the choice of pharmacologic treatment.     

Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey

Definitions and classification schemes for suicide attempts vary widely among studies, introducing conceptual, methodological, and clinical problems. We tested the importance of the intent to die criterion by comparing self-injurers with intent to die, suicide attempters, and those who self-injured not to die but to communicate with others, suicide gesturers, using data from the National Comorbidity Survey (n = 5,877). Suicide attempters (prevalence = 2.7%) differed from suicide gesturers (prevalence = 1.9%) and were characterized by male gender, fewer years of education, residence in the southern and western United States; psychiatric diagnoses including depressive, impulsive, and aggressive symptoms; comorbidity; and history of multiple physical and sexual assaults. It is possible and useful to distinguish between self-injurers on the basis of intent to die.     

MMPI characteristics of drug abusers with and without histories of suicide attempts

Compared to drug addicts without histories of suicidal attempt (n = 50), drug addicts who have attempted suicide (n = 50) were characterized by higher levels of maladjustment--particularly in the areas of depression, feelings of alienation, and use of projection and externalization--and were more emotionally withdrawn. Certain Minnesota Multiphasic Personality Inventory (MMPI) codetypes appeared in the attempt group that were not present in the no history group. Drug addicts with suicidal ideation but no history of attempt (n = 13) were not significantly different from the other two groups, and their inclusion as a comparison group masked the real differences between the other two groups. The MMPI results suggest it may be possible to identify a suicide attempt group in substance abusers but not when contrasted with a suicidal ideation group. Treatment implications are considered.     

Evidence for an emotion-cognition interaction in the statistical prediction of suicide attempts

Suicidal behavior is a prevalent problem among adolescents and young adults. Although most theoretical models of suicide suggest that this behavior results from the interaction of different risk factors, most prior studies have tested only bivariate associations between individual risk factors and suicidal behaviors. The current study was designed to address this limitation by testing the effect of an emotion–cognition interaction on suicide attempts among youth. Specifically, we hypothesized that the interaction of emotion reactivity and problem-solving skills would statistically predict the probability of a recent suicide attempt among 87 adolescents and young adults. Results revealed a significant interaction, such that emotion reactivity was strongly associated with the probability of a suicide attempt among those with poor problem-solving skills, moderately associated among those with average problem-solving skills, and not significantly associated among those with good problem-solving skills. The next generation of studies on suicidal behavior should continue to examine how risk factors interact to predict this dangerous outcome.     

Examining the impact of administration medium on examine perceptions and attitudes

The present study explored the impact of administration medium on examinees' affective reactions. The research compared managers' reactions with 3 versions of the Conflict Resolution Skills Assessment (J. B. Olson-Buchanan et al., 1998) that were identical in content but varied in terms of the level of technology used: a paper-and-pencil form, a written form administered by computer (i.e., a computerized page-turner), and a multimedia form administered by computer. Managers completing the multimedia assessment perceived the assessment as more face valid and had more positive attitudes, relative to managers who completed the other 2 assessments. Computerization, however, was not enough to make a difference; instead, it was the multimedia nature of the computer presentation that resulted in the most positive affective reactions. Study limitations and implications for research and practice are discussed.     

Intensive follow-up does not decrease the risk of repeat suicide attempts.

We carried out a randomized controlled trial to determine whether an intensive intervention after a suicide attempt could decrease by half the risk of a repeat attempt in the following two years. After initial assessment and randomization, experimental subjects attended 18 therapy appointments over one year, including one home visit, and measures to improve attendance. Control subjects received the usual care. Of 63 experimental subjects, 35% made a repeat attempt, and so did 30% of 63 control subjects. The study had a 99% power to detect the desired decrease of risk (30% to 15%). Clearly, the intervention did not achieve its objective.     

Worst-point suicidal plans: a dimension of suicidality predictive of past suicide attempts and eventual death by suicide

Among 440 psychiatric outpatients with current suicidal ideation, we examined the empirical distinction between the “plans” vs. “desire” dimensions of suicidality, focusing for conceptual and empirical reasons on a worst-point assessment strategy. Factor analyses were consistent with the distinction, but more importantly, among the current ideators included in this study, the worst-point “plans” dimension was the only predictor significantly related to both of two important indices, history of past attempt and eventual suicide. These findings bear on the trajectory of suicidal behavior over time, as well as inform the clinical assessment of suicidal patients.     

Comparison of the WISC and WISC-R on a psychiatric adolescent inpatient sample

The present study compared the WISC and WISC-R on a group of psychiatric adolescent inpatients. The results indicated high intercorrelations between the two test versions but with the correlations linearly related to the changes in content and administration rules of the WISC-R. Analyses of variance indicated that, on the basis of the Full Scale IQ, the WISC is an easier test than the WISC-R.The authors gratefully acknowledge the assistance of Ms. Kathleen Lennox for her aid in data analysis and computer programming.