Are Children and Adolescents Who Have Suicidal Thoughts Different from Those Who Attempt Suicide?

Kosky, Robert; Silburn, Sven; Zubrick, Stephen R.

doi:10.1097/00005053-199001000-00007

Cited by 149 publications

(68 citation statements)

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“…Rao and colleagues (14) found that adolescents with depression were more likely to develop substance abuse problems at an earlier age than nondepressed youths (1.5 years vs 3.3 years). Other research has demonstrated that substance abuse increased the risk of suicide attempts in outpatient youths with depressive disorders (8), and adolescent outpatient suicide attempters were significantly more likely to have abused alcohol, prescription drugs, or illicit drugs (7,15).…”

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confidence: 99%

“…In addition, substance abuse may play an important role in adolescent suicidal behaviours (2)(3)(4)(5)(6). Substance abuse is one factor that differentiates adolescent suicidal ideators from attempters (7) and that may also increase the risk of suicide attempts in adolescent outpatients (8). Further, substance abuse may be a risk factor for future attempts among adolescents who have already attempted suicide (9,10).…”

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Association of Substance Abuse and Depression among Adolescent Psychiatric Inpatients

2003

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D epression and substance abuse during adolescence frequently cooccur (1). In addition, substance abuse may play an important role in adolescent suicidal behaviours (2-6). Substance abuse is one factor that differentiates adolescent suicidal ideators from attempters (7) and that may also increase the risk of suicide attempts in adolescent outpatients (8). Further, substance abuse may be a risk factor for future attempts among adolescents who have already attempted suicide (9,10). Epidemiological samples of adolescents have focused on the relation between depression and substance abuse (for

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confidence: 99%

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confidence: 99%

Association of Substance Abuse and Depression among Adolescent Psychiatric Inpatients

2003

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“…Manifestations of family dysfunction (e.g., poor family problem solving, family conflict) are reported as precipitants to suicidal behavior by approximately 50% of suicidal adolescents (Berman & Schwartz, 1990;Hawton et al, 1996;Spirito et al, 1989;Tishler et al, 1981). In addition, prior work has revealed that adolescents' global family dysfunction is consistently correlated with suicidal ideation and behavior (Wagner, 1997) within normative samples (e.g., Rubenstein et al, 1989) and clinical samples (e.g., M. L. Miller, Chiles, & Barnes, 1982) and differentiates between suicidal and nonsuicidal clinical adolescents (Asarnow, 1992;King, Segal, Naylor & Evans, 1993;Morano, Cisler, & Lemerond, 1993) and between suicide-ideating and suicide-attempting adolescent inpatients (Kosky, Silburn, & Zubrick, 1990). For instance, Joffe, Offord, and Boyle (1988) found that adolescents' reports on the global dysfunction scale of the Family Assessment Device (FAD) significantly predicted suicidal behavior among 14-to 16-year-olds.…”

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Peer Functioning, Family Dysfunction, and Psychological Symptoms in a Risk Factor Model for Adolescent Inpatients' Suicidal Ideation Severity

Prinstein¹,

Boergers²,

Spirito³

et al. 2000

Journal of Clinical Child Psychology

214

176

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“…Although suicidal ideation is more frequent than suicidal behavior or completed suicide, 16-21 the relationships among ideation, suicide attempts, and completed suicide are uncertain. 5,6,8,[22][23][24][25][26][27] Patients rarely volunteer suicidal ideation, although many will acknowledge ideation if asked directly 13 Rather than increasing primary care physician vigilance to suicide potential in all patients, 31,34-39 a more targeted strategy would direct attention to patients with mental health problems among whom a large proportion of suicides occur. [40][41][42] Major depression, for example, accounts for 60% of suicides 42,44 and carries as much as a 20-fold increase in lifetime risk of suicide.…”

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confidence: 99%

“…Although suicidal ideation is more frequent than suicidal behavior or completed suicide, [16][17][18][19][20][21] the relationships among ideation, suicide attempts, and completed suicide are uncertain. 5,6,8,[22][23][24][25][26][27] Patients rarely volunteer suicidal ideation, although many will acknowledge ideation if asked directly 13 and may want their physician to inquire. 19 Although most primary care physicians believe in the value of detecting suicidal ideation, 28,29 recent reports suggest that…”

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Improving Detection of Suicidal Ideation Among Depressed Patients in Primary Care

Nutting

Dickinson²,

Rubenstein³

et al. 2005

The Annals of Family Medicine

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PURPOSE Primary care clinicians have diffi culty detecting suicidal patients. This report evaluates the effect of 2 primary care interventions on the detection and subsequent referral or treatment of patients with depression and recent suicidal ideation.METHODS Adult patients in 12 mixed-payer primary care practices and 9 not-forprofi t staff model health maintenance organization (HMO) practices were screened for depression. Matched practices were randomized within plan type to intervention or usual care. The intervention for mixed-payer practices entailed brief training of physicians and offi ce nurses to provide care management. The intervention for HMO practices consisted of guided development of quality improvement teams for depression care. A total of 880 enrolled patients met study criteria for depression, 232 of whom met criteria for recent suicidal ideation. Intervention effects on suicide detection and referral to mental health specialty care were evaluated with mixed-effects multilevel models in intent-to-treat analyses.RESULTS Depressed patients with recent suicidal ideation were detected on 40.7% of index visits in intervention practices, compared with 20.5% in usual care practices (odds ratio = 2.64, 95% confi dence interval, 1.45-5.07), with HMO plan type and male sex associated with detection. The interventions had no effect on referral of patients, starting an antidepressant, or suicidal ideation reported at a 6-month follow-up, although power was limited for all 3 analyses.CONCLUSIONS Primary care interventions to improve depression care can improve detection of recent suicidal ideation. Further work is needed to improve physician response to detection, including referral to specialty care and more aggressive treatment, and to observe the effect on outcomes. INTRODUCTION Suicide represents a major social 1 and economic 2,3 burden on the health of the American people and ranks among the top 10 causes of death for Americans aged 10 years and older. 4 Suicide attempts are even more common, 5-7 increase morbidity and health care costs, 3 and further elevate the risk of individuals for a subsequent completed suicide. 8 Suicide prevention has been identifi ed as a national priority 9,10 and is now the target of a comprehensive national strategy. 4 Primary care physicians have an important role in detecting patients at higher risk for suicide, and for prevention. Many [11][12][13][14] but not all 15 studies report that individuals make primary care visits before completing suicide. Improving primary care for suicidal patients poses several critical challenges. Completed suicide is relatively infrequent in primary care practice. Although suicidal ideation is more frequent than suicidal behavior or completed suicide, 16-21 the relationships among ideation, suicide attempts, and completed suicide are uncertain. 5,6,8,[22][23][24][25][26][27] Patients rarely volunteer suicidal ideation, although many will acknowledge ideation if asked directly 13 Rather than increasing primary care physician vigi...

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Are Children and Adolescents Who Have Suicidal Thoughts Different from Those Who Attempt Suicide?

Cited by 149 publications

References 0 publications

Association of Substance Abuse and Depression among Adolescent Psychiatric Inpatients

Association of Substance Abuse and Depression among Adolescent Psychiatric Inpatients

Peer Functioning, Family Dysfunction, and Psychological Symptoms in a Risk Factor Model for Adolescent Inpatients' Suicidal Ideation Severity

Improving Detection of Suicidal Ideation Among Depressed Patients in Primary Care

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