Mental disorders and the risk for the subsequent first suicide attempt: results of a community study on adolescents and young adults

Abstract

Adolescents and young adults represent the high-risk group for first onset of both DSM-IV mental disorders and lifetime suicide attempt (SA). Yet few studies have evaluated the temporal association of prior mental disorders and subsequent first SA in a young community sample. We examined (a) such associations using a broad range of specific DSM-IV mental disorders, (b) the risk of experiencing the outcome due to prior comorbidity, and (c) the proportion of SAs that could be attributed to prior disorders. During a 10-year prospective study, data were gathered from 3021 community subjects, 14–24 years of age at baseline. DSM-IV disorders and SA were assessed with the Munich-Composite International Diagnostic Interview. Cox models with time-dependent covariates were used to estimate the temporal associations of prior mental disorders with subsequent first SA. Most prior mental disorders showed elevated risk for subsequent first SA. Highest risks were associated with posttraumatic stress disorder (PTSD), dysthymia, and nicotine dependence. Comorbidity elevated the risk for subsequent first SA, and the more disorders a subject had, the higher the risk for first SA. More than 90% of SAs in the exposed group could be attributed to PTSD, and over 30% of SAs in the total sample could be attributed to specific phobia. Several DSM-IV disorders increase the risk for first SA in adolescents and young adults. Several promising early intervention targets were observed, e.g., specific phobia, nicotine dependence, dysthymia, and whether a young person is burdened with comorbid mental disorders.

Suicidality in Childhood and Adolescence

“…The "presuicidal syndrome" described by Ringel in 1953 (18) refers to a possible suicidal decision chain and defines various components, including inhibited aggression turned against the self. Many young people in suicidal crises are ambivalent to the (28,29) -Non-suicidal self-injury (NSSI) (24,25) -Mobbing (26,27) -Mental illness: in particular, depressive disorder and bipolar disorders, acute psychotic disorder (especially with imperative acoustic hallucinations), post-traumatic stress disorder (23), dependency diseases, bulimia nervosa, attention deficit/hyperactivity disorder, anxiety disorders, disordered social behavior with elevated impulsiveness, personality disorders with elevated impulsiveness, delinquency (22,31,32) -Suicidal behavior in the family (25) and among friends (33) -Conflict, separation, or divorce of parents, loss of a parent, or a history of sexual abuse/maltreatment (24, 34) -Performance problems at school (35) -Chronic organic illness and physical disability (22) -Low socioeconomic status (36) last (19). Although their actions are intended to end their life, they are actually striving for another life (5).…”

“…A German/Swiss study of adolescents and young adults showed that 93.4% of suicide attempts in this population were preceded by post-traumatic stress disorder. The authors concluded that these attempts at suicide might have been prevented by adequate treatment of the post-traumatic stress disorder (23). Young people with NSSI are more likely to have suicidal thoughts (OR = 2.95) (24) and to attempt to kill themselves (hazard ratio [HR] = 2.00) (25).…”

Comorbilidad en una Muestra de Pacientes con Agorafobia: La Presencia de la Ideación Suicida

“…Sin embargo, además de la comorbilidad con los trastornos afectivos, también ha podido observarse la presencia de la ideación suicida en personas con agorafobia con otro tipo de variables, como el estrés postraumático, abuso de alcohol/fármacos/drogas, trastorno de personalidad límite o ruptura de parejas (Bados, 2006). En este sentido, en el trabajo de Miché et al (2017), la relación más estrecha fue entre suicidio y estrés postraumático, pero esa relación era mayor en la medida en que se incrementaba la comorbilidad (como la presencia de depresión y abuso de sustancias). En la citada investigación de Sareen et al, (2005), también encontraron una relación significativa entre agorafobia, trastorno de pánico e intentos de suicidio.…”

Commentary: Paediatric post‐traumatic stress disorder from a neurodevelopmental network perspective: reflections on Weems et al. (2019)

“…PTSD imposes a tremendous degree of suffering for families, decreases academic achievement for the child, and often carries the burden of additional mental illness such as anxiety disorders, depression, ADHD and substance use disorders (Herringa, ). Furthermore PTSD carries the highest risk of all mental illnesses among youth for first suicide attempt (Miché et al., ). Given that suicide is a leading cause of death in teens and young adults, the stakes could hardly be greater.…”